GEICO v. Mount Prospect Chiropractic Center PA

98 F.4th 463
CourtCourt of Appeals for the Third Circuit
DecidedApril 15, 2024
Docket23-1378
StatusPublished
Cited by20 cases

This text of 98 F.4th 463 (GEICO v. Mount Prospect Chiropractic Center PA) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
GEICO v. Mount Prospect Chiropractic Center PA, 98 F.4th 463 (3d Cir. 2024).

Opinion

PRECEDENTIAL

UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT

Nos. 23-1378, 23-2019 & 23-2053

GOVERNMENT EMPLOYEES INSURANCE CO.; GEICO INDEMNITY CO.; GEICO GENERAL INSURANCE COMPANY; GEICO CASUALTY CO.

v.

MOUNT PROSPECT CHIROPRACTIC CENTER, P.A., d/b/a Mount Prospect Health Center; TERRY MCSWEENEY, D.C.; HASSAN MEDICAL PAIN RELIEF AND WELLNESS CENTER LLC, d/b/a Hassan Spine and Sports Medicine; SHADY HASSAN, M.D.

HASSAN MEDICAL PAIN RELIEF AND WELLNESS CENTER LLC, d/b/a Hassan Spine and Sports Medicine; SHADY HASSAN, M.D.,

Appellants in No. 23-1378 GOVERNMENT EMPLOYEES INSURANCE CO; GEICO INDEMNITY CO; GEICO GENERAL INSURANCE CO; GEICO CASUALTY CO

v. CARING PAIN MANAGEMENT PC, AKA Caring Pain Management; JINGHUI XIE, MD; FIRST CARE CHIROPRACTIC CENTER LLC; KONSTANTINE FOTIOU, D.C.

CARING PAIN MANAGEMENT PC, AKA Caring Pain Management; JINGHUI XIE, MD,

Appellants in No. 23-2019

GOVERNMENT EMPLOYEES INSURANCE CO; GEICO INDEMNITY CO; GEICO GENERAL INSURANCE CO; GEICO CASUALTY CO

WAEL ELKHOLY, MD; PRECISION PAIN & SPINE INSTITUTE LLC; PRECISION SPINE & SPORTS MEDICINE OF NEW JERSEY LLC; PRECISION ANESTHESIA ASSOCIATES PC; ASHRAF SAKR, MD; FOUAD KARAM, D.C.; LUIS RAMIREZ-PACHECO, MD; LYDIA SHAJENKO, MD; STUART ATKIN, MD; MEHRDAD LANGROUDI, MD; CHANG LEE, MD; KHALED MORSI, MD; MONICA JOHNSON, N.P.,

Appellants in No. 23-2053

2 Appeal from the United States District Court for the District of New Jersey (D.C. Civil Action Nos. 2-22-cv-00737, 2-22-cv-05017, and 3-21-cv-16255) District Judges: Honorable John M. Vazquez, Honorable Brian R. Martinotti, and Honorable Michael A. Shipp

Argued on January 18, 2024 Before: JORDAN, BIBAS, and AMBRO, Circuit Judges (Opinion filed: April 15, 2024)

Brian Block Andrew Gimigliano [Argued] Mandelbaum Barrett 3 Becker Farm Road Suite 105 Roseland, NJ 07068

Counsel for Appellants in Case Nos. 23-1378, 23-2019 & 23-2053

Mohamed Nabulsi Mandelbaum Barrett 3 Becker Farm Road Suite 105 Roseland, NJ 07068

Counsel for Appellants in Case Nos. 23-2019 & 23-1378

3 Damian P. Conforti Mandelbaum Barrett 3 Becker Farm Road Suite 105 Roseland, NJ 07068

Counsel for Appellants in Case No. 23-1378

Max S. Gershenoff [Argued] Rivkin Radler 926 RXR Plaza West Tower Uniondale, NY 11556

Gene Y. Kang Rivkin Radler 25 Main Street, Court Plaza North Suite 501 Hackensack, NJ 07601

Counsel for Appellees in Case Nos. 23-1378, 23-2019 & 23-2053

Yonatan Bernstein Rivkin Radler 926 RXR Plaza West Tower Uniondale, NY 11556

Counsel for Appellees in Case No. 23-1378

4 OPINION OF THE COURT

AMBRO, Circuit Judge

These consolidated appeals ask if claims under New Jersey’s Insurance Fraud Prevention Act (“IFPA”), N.J. Stat. Ann. §§ 17:33A-1 to 30, are arbitrable. They are, so we reverse and compel arbitration.

Background

Before us are three strikingly similar cases. Plaintiff- appellee Government Employees Insurance Company and certain affiliates (collectively, “GEICO”) sued defendants- appellants (collectively, the “Practices”1) in separate actions in the District of New Jersey, alleging they defrauded GEICO of more than $10 million by abusing the personal injury protection (“PIP”) benefits offered by its auto policies. It alleges the Practices filed exaggerated claims for medical services (sometimes for treatments that were never provided), billed medically unnecessary care, and engaged in illegal kickback schemes. GEICO’s suits against the Practices each included a claim under the IFPA, which gives insurers a fraud-

1 For simplicity, we refer to each case by a medical practice defendant – Precision Pain and Spine Institute, L.L.C. (“Precision Spine”), Mount Prospect Chiropractic Center, P.A. (“Mount Prospect”), and Caring Pain Management P.C. (“Caring Pain”).

5 like action with fewer elements than common-law fraud. Allstate N.J. Ins. Co. v. Lajara, 117 A.3d 1221, 1231-32 (N.J. 2015). The Practices sought arbitration of GEICO’s IFPA claim, arguing both that a valid arbitration agreement covered the claim and that a different New Jersey insurance law allowed them to compel arbitration. But each District Court disagreed, ruling instead that IFPA claims cannot be arbitrated. The Practices appeal to us.

Jurisdiction and Standard of Review

The Federal Arbitration Act (“FAA”), 9 U.S.C. § 1 et seq., provides us jurisdiction over interlocutory appeals of orders declining to compel arbitration. FAA § 16(a)(1)(B); In re Rotavirus Vaccines Antitrust Litig., 30 F.4th 148, 153 (3d Cir. 2022).

We review de novo rulings on motions to compel arbitration. Flinktote Co. v. Aviva PLC, 769 F.3d 215, 219 (3d Cir. 2014). Our role is to apply the test district courts are to use in deciding those motions. Singh v. Uber Techs., Inc., 939 F.3d 210, 217 (3d Cir. 2019).

When federal courts answer questions of state law, they rule as they predict the state supreme court would. New Castle Cnty. v. Nat’l Union Fire Ins. Co. of Pittsburgh, 174 F.3d 338, 342 (3d Cir. 1999). If that court has not issued a determinative decision, we may consider decisions from state appellate courts, though we are not bound by them if they are not well reasoned or otherwise unpersuasive. In re Makowka, 754 F.3d 143, 148-52 (3d Cir. 2014) (disagreeing with precedential state appellate decision because we are “not, in fact, bound by [such] a decision[,]” and “the decision’s sparse reasoning and internal

6 inconsistency” would not persuade the state supreme court); Roma v. United States, 344 F.3d 352, 359-62 (3d Cir. 2003) (disregarding state intermediate appellate decision because it “is inconsistent with the plain language of [the statute] . . . and, therefore, cannot be used as an accurate predictor of how the Supreme Court of New Jersey would [rule]”). If the state supreme court would not defer to those opinions, then – given that our goal is predicting that court’s decision – neither will we.2

A. IFPA Claims Can Be Arbitrated.

GEICO’s primary argument to us is that the IFPA implicitly prohibits arbitration. This might defeat the

2 This is not to say that we disregard intermediate state appellate decisions merely because we disagree with them. We are not writing on an empty slate, and state appellate courts are more expert at deciding state law questions than we are. We owe that expertise significant respect when state courts use it. Budget Rent-A-Car Sys., Inc. v. Chappell, 407 F.3d 166, 174 (3d Cir. 2005) (we afford the “considered judgment[s]” of “intermediate appellate state court[s]” meaningful deference. (quoting West v. Am. Tel. & Tel. Co., 311 U.S. 233, 237 (1940))). But the deference we should give has limits, and if we believe an opinion is unsupported, we should not reflexively follow it. Circuit courts are competent to interpret state law, too. Cf. United States v. Defreitas, 29 F.4th 135, 141 (3d Cir. 2022) (“[I]t is inappropriate to certify any state-law question solely because its outcome may control a case; federal courts are often required to make faithful predictions of how a state supreme court will rule.”)

7 Practices’ effort to compel arbitration under a different New Jersey law and could do the same for the Practices’ FAA-based request. While the FAA typically preempts state laws that prohibit arbitration, another federal statute, the McCarran- Ferguson Act, 15 U.S.C.

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98 F.4th 463, Counsel Stack Legal Research, https://law.counselstack.com/opinion/geico-v-mount-prospect-chiropractic-center-pa-ca3-2024.