Allstate Insurance. v. Lyons

843 F. Supp. 2d 358, 2012 WL 517600, 2012 U.S. Dist. LEXIS 19866
CourtDistrict Court, E.D. New York
DecidedFebruary 16, 2012
DocketNo. 11-CV-2190
StatusPublished
Cited by29 cases

This text of 843 F. Supp. 2d 358 (Allstate Insurance. v. Lyons) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Insurance. v. Lyons, 843 F. Supp. 2d 358, 2012 WL 517600, 2012 U.S. Dist. LEXIS 19866 (E.D.N.Y. 2012).

Opinion

MEMORANDUM AND ORDER

JOHN GLEESON, District Judge:

This is a civil action brought by insurance companies who allege that defendants have engaged in sophisticated and related schemes to fraudulently obtain insurance proceeds that were supposed to pay for medical services for people injured in automobile accidents. Plaintiffs Allstate Insurance Company, Allstate Indemnity Company, Allstate Property and Casualty Insurance Company, Allstate Fire and Casualty Insurance Company, Allstate New Jersey Insurance Company, and Allstate New Jersey Property and Casualty Insurance Company (collectively, “Allstate”) bring multiple causes of action against John S. Lyons, M.D., Sanna Kalika, M.D., Ilya Burshteyn, M.D., Harvey Stern, M.D., Joseph McCarthy, M.D., Right Aid Diagnostic Medicine, P.C. (“Right Aid”), A Plus Medical P.C. (“A Plus”), Omega Medical Diagnostic, P.C. (“Omega”), Shore Medical Diagnostic, P.C. (“Shore”), Oracle Radiology of N.Y. P.C. (“Oracle”), Atlantic Radiology Imaging P.C. (“Atlantic Imaging”), Atlantic Radiology, P.C. (“Atlantic Radiology”), Aurora Radiology P.C. (“Aurora”), David Golub, Arthur Bogoraz, Simon Korenblit, Edward Atbayshan, Alexander Zharov, and Alma Building, LLC (“Alma”).1 Allstate asserts claims for violations of the Racketeer Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1962(c)-(d) (Counts I-XVI), common law fraud (Count XVII), violations of § 349 of the New York General Business Law (Count XVIII), and unjust enrichment (Count XIX). In addition to making demands for damages and injunctive relief, Allstate requests a declaration that defendants have no right to receive payment for any previously denied, pending, or future no-fault claims, and that Right Aid, A Plus, Omega, Shore, Oracle, Atlantic Imaging, Atlantic Radiology, and Aurora are operating in violation of law and have engaged in unlawful activities (Count XX). Kalika, Lyons, and Right Aid (collectively, the “Right Aid defendants”) and, separately, Stern, McCarthy, Atlantic Imaging, Atlantic Radiology, Korenblit, Atbayshan, and Zharov (collectively, the “Atlantic defendants”) move to dismiss. The Atlantic defendants also move, in the alternative, to compel arbitration. For the reasons set forth below, I deny the motions to dismiss in their entirety. I also deny the motion to compel arbitration with respect to all claims except those that Allstate has not yet paid. For this residual category of claims, the motion to compel arbitration is granted.

BACKGROUND2

New York’s no-fault insurance law was passed “to create a simple, efficient system that would provide prompt compensation to accident victims without regard to fault, and in that way reduce costs for both courts and insureds.” State Farm, Mut. Auto. Ins. Co. v. Mallela, 372 F.3d 500, 502 (2d Cir.2004). Under the law, automobile insurance providers are required to include in their policies coverage for injuries arising from car accidents, irrespective of who is to blame for the accident. The no-[366]*366fault scheme thus “supplant[s] the state’s common law tort remedies for most injuries associated with automobile accidents.” Id. The law requires car insurance providers to reimburse injured persons for “basic economic loss,” including medical expenses, and it sets forth a schedule of permissible charges for specific services. Id. (citing N.Y. Ins. Law §§ 5102, 5108). An injured person who seeks medical treatment may assign her right to no-fault benefits to her medical provider, and such assignment is typical.

According to the well-pleaded allegations in the Complaint,3 defendants were involved in a massive conspiracy to defraud Allstate for benefits under the no-fault law. The conspiracy consisted of several discrete clusters of actors linked together by Lyons. Id. ¶¶ 93-137, 505-516. The central entity within each cluster was a professional corporation (“PC”) that purported to provide health care services for individuals injured in car accidents. Id. ¶¶ 37-65. ■ All of the PCs involved were owned on paper by licensed medical doctors (“paper owners”), as required by New York law. Id. ¶¶ 6-9, 37-65. However, the PCs were in fact controlled by other individuals or entities that were not doctors (“actual owners”). Id. ¶¶ 394-504.

Lyons served as a radiologist for each of the PCs and purported to analyze Magnetic Resonance Imaging (“MRIs”) they performed for their injured patients. Id. ¶¶ 505-16. However, the reports he produced were fabricated. Id. ¶¶ 93-137. Some were based on MRIs of such poor quality that they could not serve any legitimate diagnostic purpose, id. ¶ 98; some were falsely duplicated' for multiple patients, id. ¶ 95; some identified conditions that did not appear on the corresponding MRIs, id. ¶ 96; some otherwise diagnosed conditions that did not exist, id. ¶ 97; and some ignored conditions that were apparent from the MRIs, id. ¶ 135.

The PCs provided these worthless MRIs and fake MRI reports, as well as other medically unnecessary services purportedly recommended or justified by the fake MRI reports, to individuals eligible for no-fault benefits. Id. ¶¶ 93-137, 126, 137. After receiving assignment of their patients’ no-fault benefits, the PCs then billed Allstate by mail for these medically unnecessary services under the no-fault law. Id. ¶¶ 517-524. In such billings, the PCs misrepresented that they were organized in accordance with New York law and that the medical treatment for which they sought payment was medically necessary and compensable under the no-fault law. Id. Allstate remitted payment as demanded to the PCs in sums totaling more than $4 million. Id. ¶ 16.

The clusters involved in this lawsuit include the following: (1) the PC Right Aid and its paper owner Kalika (the “Right Aid cluster”); (2) the PC Atlantic Imaging, its paper owner Stern, and its actual owners Korenblit, Atbayshan, and Zharov (the “Atlantic Imaging cluster”); (3) the PC Atlantic Radiology, its paper owner McCarthy, and its actual owners Korenblit, Atbayshan, and Zharov (the “Atlantic Radiology cluster”); (4) the PC A Plus and its paper owner Burshteyn; (5) the PC Omega and its paper owner Burshteyn; (6) the PC Shore and its paper owner Burshteyn; (7) the PC Oracle and its actual owner Alma, a management company owned and operated by Golub and Bogoraz; and (8) the PC Aurora and its paper owner Denise, who has been terminated [367]*367from this lawsuit. Allegations specific to any particular defendant or cluster are set forth where relevant in the discussion that follows.

DISCUSSION

A. Motion to Dismiss

1. Standard of Review

The Right Aid defendants and the Atlantic defendants (the “moving defendants” or “defendants”) move to dismiss under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim upon which relief may be granted.

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Cite This Page — Counsel Stack

Bluebook (online)
843 F. Supp. 2d 358, 2012 WL 517600, 2012 U.S. Dist. LEXIS 19866, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-v-lyons-nyed-2012.