GOVERNMENT EMPLOYEES INSURANCE CO. v. ACTIVE MEDICAL CARE, P.C.

CourtDistrict Court, D. New Jersey
DecidedNovember 14, 2024
Docket2:24-cv-10909
StatusUnknown

This text of GOVERNMENT EMPLOYEES INSURANCE CO. v. ACTIVE MEDICAL CARE, P.C. (GOVERNMENT EMPLOYEES INSURANCE CO. v. ACTIVE MEDICAL CARE, P.C.) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
GOVERNMENT EMPLOYEES INSURANCE CO. v. ACTIVE MEDICAL CARE, P.C., (D.N.J. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK -------------------------------------------------------x GOVERNMENT EMPLOYEES : INSURANCE COMPANY; GEICO : INDEMNITY COMPANY; GEICO : GENERAL INSURANCE COMPANY; : MEMORANDUM & ORDER and GEICO CASUALTY COMPANY, : 24-cv-995 (DLI)(VMS) : Plaintiffs, : : -against- : : ACTIVE MEDICAL CARE, P.C., NJ PAIN : & SPINE, PC; and EDNAN SHEIKH, M.D., : : Defendants. : -------------------------------------------------------x

DORA L. IRIZARRY, United States District Judge:

On February 8, 2024, Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, and GEICO Casualty Company (“Plaintiffs”) filed the instant action against Active Medical Care, P.C. (“Active Medical”), NJ Pain & Spine, PC (“NJ Pain”); and Ednan Sheikh, M.D. (“Sheikh”) (collectively, “Defendants”) for claims arising out of allegedly fraudulent insurance reimbursement requests for car accident victims’ medical treatment. See, Complaint (“Compl.”), Dkt. Entry No. 1. Plaintiffs seek a declaratory judgment that Defendants have no right to reimbursement, assert civil RICO claims against Sheikh pursuant to 18 U.S.C. § 1962(c), and allege fraud and unjust enrichment claims against all defendants. Id. at ¶¶ 249–92. Defendants moved to dismiss the Complaint for improper venue pursuant to Fed. R. Civ. P. 12(b)(3), or, in the alternative, transfer the case to the United States District Court for the District of New Jersey (“District of New Jersey”). Defs.’ Mot. to Dismiss (“Defs.’ Mot.”), Dkt. Entry No. 17-5. Plaintiffs opposed the motion. Pls.’ Opp’n (“Opp’n”), Dkt. Entry No. 19. Defendants replied. Reply, Dkt. Entry No. 23. For the reasons set forth below, Defendants’ motion to transfer venue is granted, and this case hereby is transferred to the District of New Jersey. The Court finds that transfer, rather than dismissal, is the appropriate remedy in this instance. The parties currently are engaging in discovery, and Plaintiffs simply could refile their claims in the District of New Jersey if they are

dismissed. Such “extra expense and delay required if a case is dismissed only to be refiled in another district [] justif[ies] transfer over dismissal.” 5381 Partners LLC v. Shareasale.com, Inc., 2013 WL 5328324, at *10 (E.D.N.Y. Sept. 23, 2013). Accordingly, the Court need not address Defendants’ motion to dismiss the case. BACKGROUND Plaintiffs are Nebraska corporations with a principal place of business in Maryland. See, Compl. ¶ 6. Sheikh, a New Jersey physician, owns and controls NJ Pain, a New Jersey professional corporation, and Active Medical, a professional corporation based in Pearl River, New York. Id. at ¶¶ 3, 7–9; Declaration of Ednan Sheikh (“Defs.’ Decl.”) ¶¶ 7, 14, Dkt. Entry No. 17-1.1 Defendants operated their medical practice out of ten multidisciplinary healthcare clinics located

in New York and New Jersey (the “Clinics”). Compl. ¶ 70. Of those ten Clinics, seven are in New Jersey, one is in Manhattan, and two are in Queens. Id. However, Sheikh attests that NJ Pain and Active Medical rarely saw patients in this District. See, Defs.’ Decl. ¶¶ 19–23. Plaintiffs allege that, between 2017 and the present, Defendants submitted fraudulent no fault, or Personal Injury Protection (“PIP”), insurance reimbursements relating to medical treatment incurred by car accident victims. Compl. ¶ 58. Plaintiffs claim that such reimbursements

1 Defendants assert that Active Medical is registered in Pearl River, New York with the Department of State, but did not include any documentation supporting this assertion. See, Defs.’ Mot. at 6. However, the Court takes judicial notice of Department of State records confirming that Active Medical is based in Pearl River, New York. See, J & J Sports Prods., Inc. v. La Parranda Mexicana Bar & Restaurante Co., 2018 WL 4378166, at *1 n.3 (E.D.N.Y. Apr. 9, 2018) (“The Court can and does take judicial notice of information from the New York Secretary of State’s website.”). were fraudulent because Defendants: (1) were not entitled to PIP benefits to begin with; and (2) sought reimbursement for medically unnecessary procedures. Id. Specifically, pursuant to New York and New Jersey law, insurers only are required to reimburse entities that comply with state licensing laws and regulations. 11 N.Y.C.R.R. § 65-

3.16(a)(12); Varano, Damian & Finkel, L.L.C. v. Allstate Ins. Co., 366 N.J. Super. 1, 6 (App. Div. 2004). Accordingly, Plaintiffs assert that Defendants were not entitled to PIP benefits because: (1) NJ Pain and Sheikh operated a medical practice in New York without authority to do so; (2) all Defendants unlawfully referred patients to entities in which Sheikh had a financial interest, known as “self referrals”; and (3) Sheikh and NJ Pain engaged in an unlawful “kickback” scheme in which they received patient referrals from the Clinics in exchange for: (a) referral fees disguised as “rent” payments; and (b) return referrals to the Clinics. See, Compl. ¶¶ 59–74, 178–219; N.J.S.A. 45:9-22.5; N.J.A.C. 13:35-6.17(c)(1); NY. Educ. Law §§ 6509-a, 6530, 6531; 8 N.Y.C.R.R. § 29.1. Plaintiffs further allege that, as a result of this unlawful scheme, Defendants submitted

charges for medically unnecessary examinations, tests, and procedures. Specifically, Sheikh and NJ Pain purportedly examined patients referred by the Clinics, misrepresented the nature, extent, and results of such examinations, and exaggerated the severity of the patients’ injuries to get reimbursed at a higher rate. Compl. ¶¶ 66–162. Based on these fraudulent examinations, NJ Pain and Sheikh subjected patients to extensive electrodiagnostic (“EDX”) testing, which they submitted to Plaintiffs for reimbursement. Id. at ¶¶ 220–39. NJ Pain and Sheikh then used the fraudulent examinations and tests to justify referrals for medically unnecessary pain management injections at Global Surgery Center LLC (“Global Surgery”), a New Jersey ambulatory care facility in which Sheikh had a financial interest. Id. at ¶¶ 163–204. Plaintiffs also allege that, as part of this scheme, Sheikh self referred patients to Active Medical and sought reimbursement for medically unnecessary drug screenings. Id. at ¶¶ 205–19. The screenings were conducted in Pearl River, New York, where Active Medical’s lab is located. Defs.’ Decl. ¶ 27. As a result of this scheme, Plaintiffs allege they paid out approximately $400,000 in claims

to NJ Pain, and $500,000 in claims to Active Medical, totaling more than $900,000 in damages. Id. at ¶¶ 258, 278. However, since 2016, Plaintiffs only paid out $48,000, or about 5% of the damages, to NJ Pain for services rendered in this District. Declaration of Kathleen Asmus (“Pls.’ Decl.”) ¶ 5, Dkt. Entry No. 19-1. Plaintiffs did not disclose the amount paid out to Active Medical for services rendered in this District. Instead, they assert that, since 2014, Active Medical submitted over $815,000 in reimbursement requests pursuant to New York insurance policies. Pls.’ Decl. ¶ 5. Of that amount, Active Medical submitted $105,000 in claims for services rendered in this District, and Plaintiffs paid out $372,000 to Active Medical for all New York insureds, not just those in this District. Id. By totaling the $48,000 in claims paid to NJ Pain and $372,000 paid to Active Medical, Plaintiffs assert that approximately $420,000, or half of their damages, are

based on claims submitted pursuant to New York policies. Opp’n at 11; Pls.’ Decl. ¶ 5. Plaintiffs processed and paid out claims for New York policies from their office in this District. Compl. ¶ 14; Pls.’ Decl. ¶ 5.

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GOVERNMENT EMPLOYEES INSURANCE CO. v. ACTIVE MEDICAL CARE, P.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-co-v-active-medical-care-pc-njd-2024.