Government Employees Insurance Co. v. Gerling

CourtDistrict Court, E.D. New York
DecidedFebruary 26, 2024
Docket1:23-cv-07693
StatusUnknown

This text of Government Employees Insurance Co. v. Gerling (Government Employees Insurance Co. v. Gerling) 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
Government Employees Insurance Co. v. Gerling, (E.D.N.Y. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK -------------------------------------------------------x GOVERNMENT EMPLOYEES INSURANCE CO., GEICO INDEMNITY CO., GEICO GENERAL INSURANCE COMPANY, and GEICO CASUALTY CO., MEMORANDUM & ORDER 23-CV-7693 (PKC) (MMH) Plaintiffs,

- against -

MICHAEL GERLING, M.D., NY ORTHOPEDICS, P.C., GERLING INSTITUTE NJ, P.C., SPINE HEALTH ORTHOPEDIC, P.C., SPINE CONSULT NJ, P.C., JOSEPH PYUN, M.D., IGOR DOVMAN, VLADIMIR GRANOVSKIY a/k/a WALTER GRAN, and CAMPIRO, INC.,

Defendants. -------------------------------------------------------x PAMELA K. CHEN, United States District Judge: On October 16, 2023, Plaintiffs Government Employees Insurance Co., GEICO Indemnity Co., GEICO General Insurance Co., and GEICO Casualty Co. (collectively, “GEICO”) commenced this action alleging RICO violations, 18 U.S.C. §§ 1962(c), 1962(d); common law fraud; aiding and abetting fraud; unjust enrichment; violations of the New Jersey Insurance Fraud Prevention Act, N.J. Stat. Ann. 17:33A-1 et seq.; and seeking a declaratory judgment, 28 U.S.C. §§ 2201, 2202, based on an alleged scheme to collect reimbursement on thousands of fraudulent no-fault insurance claims. (Complaint, Dkt. 1 (“Compl.”) ¶¶ 1–3, 250–405.) On January 18, 2024, GEICO moved against Defendants Michael Gerling, M.D. (“Gerling”); NY Orthopedics, P.C. (“NY Orthopedics”); Gerling Institute NJ, P.C. (“Gerling Institute”); Spine Consult NJ, P.C. (“Spine Consult”); and Spine Health Orthopedic, P.C. (“Spine Health”) (collectively, the “Gerling Defendants”), seeking an order, pending disposition of GEICO’s claims in this action, (1) staying all pending no-fault insurance collection arbitrations and state court collections lawsuits that have been commenced against GEICO by or on behalf of the Gerling Defendants; and (2) enjoining the Gerling Defendants, and anyone acting or purporting to act on their behalf, from commencing any further no-fault insurance collection arbitrations or collections litigation against GEICO. (See

generally Pls.’ Mem. of Law, Dkt. 43-1 (“Pls.’ Mem.”).) For the reasons set forth below, the motion is granted in full. BACKGROUND I. New Jersey’s No-Fault Insurance Laws The New Jersey Insurance Fraud Prevention Act (“IFPA”) allows insurance companies to bring an action relating to fraudulent insurance claims in any court of competent jurisdiction. See N.J. Stat. Ann. § 17:33A-7(a). A person violates the IFPA if he or she “[p]resents or causes to be presented any written or oral statement as part of, or in support of or opposition to, a claim for payment or other benefit pursuant to an insurance policy . . . knowing that the statement contains any false or misleading information concerning any fact or thing material to the claim.” N.J. Stat Ann. § 17:33A-4(a)(1). Although New Jersey generally requires arbitration for no-fault insurance

claims, New Jersey courts have repeatedly found that claims under the IFPA may be heard in state or federal courts. See Gov’t Emps. Ins. Co. v. Elkholy, No. 21-16255 (MAS) (DEA), 2022 WL 2373917, at *9–10 (D.N.J. June 30, 2022) (citing Allstate N.J. Ins. Co. v. Lajara, 117 A.3d 1221, 1232 (N.J. 2015)) (“[C]ourts routinely uphold the IFPA’s absolute mandate for judicial resolution notwithstanding contractual clauses that would otherwise require arbitration of IFPA claims.”); see also Citizens United Reciprocal Exch. v. Meer, 321 F. Supp. 3d 479, 492 (D.N.J. 2018) (“The [IFPA] is not preempted by [no-fault] arbitration rules.”). II. Factual Background GEICO is an authorized automobile insurer in New York and New Jersey. (Compl. ¶ 8.) GEICO alleges that the Gerling Defendants participated in an unlawful patient brokering and referral scheme wherein the Gerling Defendants provided fraudulent, medically unnecessary services (the “Fraudulent Services”) to individuals who claimed that they were involved in

automobile accidents and covered by no-fault insurance policies issued by GEICO (the “Insureds”). (Id. ¶¶ 5–6.) In turn, the Gerling Defendants submitted or caused to be submitted thousands of fraudulent no-fault insurance charges for reimbursement by GEICO. (Id. ¶ 1.) According to GEICO, Gerling entered into a patient brokering and referral scheme with Defendants Igor Dovman (“Dovman”), Vladimir Granovskiy a/k/a Walter Gran (“Gran”), and Campiro, Inc. (“Campiro”) (collectively, the “Campiro Defendants”).1 The Campiro Defendants and various personal injury attorneys “would cause patients to be referred to Gerling and NY Orthopedics for surgical procedures,” and the Campiro Defendants would pay Gerling “to perform invasive, expensive, and medically unnecessary surgeries.” (Id. ¶ 98.) GEICO alleges that “the

surgical procedures performed by Gerling as part of his agreement” were not designed “to treat or otherwise benefit the surgical patients,” but to “create billing opportunities for Gerling and his practices, including NY Orthopedics,” and to “artificially drive up the supposed value of the patients’ prospective personal injury settlements.” (Id. ¶ 100.) GEICO further alleges that NY Orthopedics (a New York medical professional corporation) and Gerling Institute (a New Jersey medical professional corporation) operated in New Jersey and New York, respectively, in violation

1 Beyond the Gerling Defendants and Campiro Defendants, GEICO brings suit against Defendant Joseph Pyun, M.D. (“Pyun”) (collectively, “Defendants”). The allegations against Pyun do not materially bear on GEICO’s instant motion. of each state’s law, (id. ¶¶ 10–11, 73–87), and that Dovman has previously been found liable for engaging in no-fault insurance fraud and patient brokering schemes, (id. ¶¶ 18–22). To support its separate but related claim that the Gerling Defendants billed GEICO for treatments provided “pursuant to pre-determined fraudulent protocols,” GEICO alleges that its

four exhibits attached to the Complaint—spreadsheets detailing more than 5,200 claims billed to GEICO for Fraudulent Services provided by the Gerling Defendants to Insureds—“set forth a large representative sample of the fraudulent claims.” (Id. ¶ 6; see Dkts. 1-3, 1-4, 1-5, 1-6.) GEICO references these exhibits throughout its Complaint. (See, e.g., Compl. ¶ 182 (“virtually all” of the claims in the exhibits “involved [Insureds] in relatively minor accidents”); id. ¶ 176 (“[I]n the vast majority of claims identified in Exhibits ‘1’ – ‘3’, during the initial examinations the Insureds did not present with any significant continuing medical problems that legitimately could be traced to an underlying automobile accident.”); id. ¶ 204 (for “virtually all” of the Exhibit 1 through 3 claims, the Gerling Defendants “falsely represented that the Insureds presented with problems of moderate to high severity, when in fact the Insureds either did not have any genuine presenting

problems at all” at the time of examination “or else their presenting problems were minimal”).) In further support, the Complaint provides 20 examples of billing by the Gerling Defendants for initial examinations purportedly presenting moderate-to-high severity medical problems, yet where the Insureds were involved only in low-speed, low-impact collisions. (Id. ¶¶ 142–43.) GEICO further provides five examples of billing by the Gerling Defendants where the Insureds underwent spinal surgical procedures regardless of whether those procedures were warranted in the first instance (id.

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Government Employees Insurance Co. v. Gerling, Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-co-v-gerling-nyed-2024.