GEICO v. Mayzenberg

121 F.4th 404
Court of Appeals for the Second Circuit·Decided November 12, 2024·No. 22-2537·Published·Cited by 11 cases

Opinion

22-2537 GEICO v. Mayzenberg

In the

United States Court of Appeals For the Second Circuit

August Term, 2023

(Argued: February 15, 2024 Decided: November 12, 2024)

Docket No. 22-2537

GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO INDEMNITY COMPANY, GEICO GENERAL INSURANCE COMPANY, GEICO CASUALTY COMPANY,

Plaintiffs-Appellees,

–v.–

IGOR MAYZENBERG, MINGMEN ACUPUNCTURE, P.C., SANLI ACUPUNCTURE, P.C., LAOGONG ACUPUNCTURE, P.C.,

Defendants-Appellants,

TAMILLA DOVMAN, AKA TAMILLA KHANUKAYEV, IGOR DOVMAN, JOHN DOE Defendants. *

* The Clerk of Court is respectfully directed to amend the caption as set forth above. When Defendants-Appellants originally filed this appeal, their case was consolidated with an appeal filed by Defendants Igor Dovman and Tamilla Dovman. Since then, the Dovmans have settled with Plaintiffs-Appellees and voluntarily dismissed their appeals under Federal Rule of Appellate Procedure 42. The Dovmans’ appellate case is now closed.

Before: LIVINGSTON, Chief Judge, LYNCH, AND ROBINSON, Circuit Judges.

This appeal raises an important, but unsettled, question of state law concerning New York’s “no-fault” auto insurance system. Plaintiffs- Appellees—four insurance entities commonly known as GEICO— presented evidence that the Defendants-Appellants—whom we collectively call the “Mayzenberg Defendants”—paid third parties for referring patients who were eligible for medical benefits under their no-fault insurance coverage to Defendant Mingmen, P.C. Under 11 N.Y.C.R.R. § 65- 3.16(a)(12) (the “Eligibility Regulation”), an insurance company can deny reimbursement to a provider of health care services for no-fault benefits if the provider “fails to meet any applicable New York State or local licensing requirement necessary to perform such service in New York . . . .” Here, we must decide whether, by paying third parties for patient referrals in violation of New York’s rules of professional misconduct, Mingmen has “fail[ed] to meet” a “licensing requirement” within the meaning of the Eligibility Regulation.

GEICO says yes. GEICO characterizes the patient referrals as an illegal “kickback” scheme, arguing that when a provider breaches its ethical duties, it necessarily violates the underlying terms of its licensure. In turn, under the Eligibility Regulation, the provider would not be entitled to receive no-fault payments.

The Mayzenberg Defendants disagree. They argue that paying for patient referrals may constitute professional misconduct, thereby subjecting the provider to licensure-related consequences, but does not constitute violation of a “licensing requirement” under the Eligibility Regulation. The Mayzenberg Defendants suggest that a “licensing requirement” refers to registration paperwork filed with the state to secure or maintain a license.

The United States District Court for the Eastern District of New York (Glasser, J.), agreed with GEICO. On cross motions for summary judgment, it awarded GEICO declaratory judgment on the question. The district court also granted GEICO summary judgment on its common law claim of fraud and statutory claims under the Racketeer Influenced and

Corrupt Organizations Act, 18 U.S.C. § 1962, largely based on the same conclusions about Mingmen’s ineligibility to receive assigned no-fault insurance benefits. The Mayzenberg Defendants appealed.

Because we cannot confidently predict how the New York Court of Appeals would interpret the Eligibility Regulation in this context, we hereby CERTIFY a question to that Court.

BARRY I. LEVY (Michael A. Sirignano, Henry M.

Mascia, Steven T. Henesey, on the brief), Rivkin Radler LLP, Uniondale, NY for Plaintiffs-Appellees.

MATTHEW J. CONROY, Schwartz, Conroy & Hack, PC, Garden City, NY, for Defendants-Appellants.

ROBINSON, Circuit Judge:

This appeal raises an important, but unsettled, question of state law concerning New York’s “no-fault” auto insurance system. Plaintiffs-Appellees Government Employees Insurance Company and three affiliated entities (collectively, “GEICO”) presented evidence that Defendants-Appellants Igor Mayzenberg and two of his businesses—Laogong Acupuncture, P.C., (“Laogong”) and Sanli Acupuncture, P.C. (“Sanli”)—paid third parties “kickbacks” for referring patients who were eligible for medical benefits under their no-fault insurance coverage to another Mayzenberg-owned business, Mingmen Acupuncture, P.C., (“Mingmen”). Mingmen then provided medical services and

billed GEICO. In this opinion, we collectively refer to all four Defendants- Appellants as “the Mayzenberg Defendants.”

The first question presented by the parties’ cross-motions for summary judgment is whether the summary judgment record viewed in the light most favorable to the Mayzenberg Defendants establishes as a matter of law that the Mayzenberg Defendants paid third parties for patient referrals to Mingmen. If so, the second question—the unsettled question of New York law—is whether those facts render Mingmen ineligible to receive no-fault medical benefits from GEICO.

Under 11 N.Y.C.R.R. § 65-3.16(a)(12) (the “Eligibility Regulation”), an insurance company can deny reimbursement to a provider of health care services for no-fault benefits if the provider “fails to meet any applicable New York State or local licensing requirement necessary to perform such service in New York . . . .” If GEICO has established that Mingmen—through Mayzenberg, Laogong, and Sanli—paid third parties for patient referrals, in violation of New York’s rules of professional misconduct, the legal question is whether Mingmen “fail[ed] to meet” a “licensing requirement” within the meaning of the Eligibility Regulation.

GEICO says yes. According to GEICO, complying with the state’s standards of professional conduct is necessary to maintaining a license. Thus, if

a provider pays “kickbacks” for patient referrals in breach of its ethical duties, Appellee’s Br. at 26, the provider necessarily violates the underlying terms of its licensure and cannot receive no-fault reimbursements. 1 The Mayzenberg Defendants disagree. They suggest that when the Eligibility Regulation talks about a “licensing requirement,” it refers to registration paperwork filed with the state to obtain or maintain a license. They also argue that GEICO’s reading would allow insurance companies to engage in all sorts of delay tactics to avoid paying no-fault claims.

The United States District Court for the Eastern District of New York (Glasser, J.), agreed with GEICO as to both the facts and the law. It granted GEICO’s motion for summary judgment and entered a declaratory judgment absolving GEICO of any obligation to pay Mingmen’s pending claims. See Government Employees Insurance Company v. Mayzenberg, 2022 WL 5173745, at *13 (E.D.N.Y. Aug. 24, 2022) (declaring that “Mingmen is ineligible for reimbursement on its pending no-fault claims . . . .”). The district court also granted GEICO summary judgment on its common law claim of fraud and its statutory claims

1 Unless otherwise noted, when we quote the parties’ briefs, the summary judgment evidence, and caselaw, we omit all internal quotation marks, alterations, footnotes, ellipses, and citations.

under the Racketeer Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1962, both of which flowed from the same legal analysis. Id. at *13–14.

The Mayzenberg Defendants appealed, challenging the district court’s rulings on the declaratory judgment and fraud claims. They argue that GEICO failed to demonstrate that any kickbacks for referrals actually occurred here. They also contend that even if they had paid referral fees, or “kickbacks” for patient referrals, that would not be a basis to deny payment for Mingmen’s medical services or to recoup payments already made.

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GEICO v. Mayzenberg, 121 F.4th 404 (2d Cir. 2024).

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