GOVERNMENT EMPLOYEES INSURANCE CO. v. MENKIN, M.D.

CourtDistrict Court, D. New Jersey
DecidedDecember 30, 2023
Docket3:23-cv-02184
StatusUnknown

This text of GOVERNMENT EMPLOYEES INSURANCE CO. v. MENKIN, M.D. (GOVERNMENT EMPLOYEES INSURANCE CO. v. MENKIN, M.D.) 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. MENKIN, M.D., (D.N.J. 2023).

Opinion

NOT FOR PUBLICATION

UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY

GOV. EMPLOYEES INS. CO., et al.,

Plaintiffs, Civil Action No. 23-2184 (ZNQ) (JBD)

v. OPINION

SERGE MENKIN, MD, et al.,

Defendants.

QURAISHI, District Judge

This matter comes before the Court upon the Motion to Dismiss (the “Motion,” ECF No. 6) filed by Defendants Serge Menkin, MD (“Menkin”), the Center for Joint & Spine Relief, PA (the “Center for Joint & Spine” or “CJS”), Lawrence Petracco, DC (“Petracco”), United Care Medical, PLLC (“United Medical”), and Advanced Pain Solutions, PC (“Advanced Pain”) (collectively, “Defendants”). In support of their Motion, Defendants filed a brief. (“Moving Br.,” ECF No. 6-2.) Plaintiffs Government Employees General Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, and GEICO Casualty Company (collectively, “GEICO” or “Plaintiffs”) filed an opposition (“Opp’n Br.,” ECF No. 8), to which Defendants did not reply. After careful consideration of the parties’ submissions, the Court decides the Motion without oral argument pursuant to Federal Rule of Civil Procedure 78 and Local Civil Rule 78.1.1 For the reasons outlined below, the Court will GRANT IN PART and DENY IN PART Defendants’ Motion to Dismiss.

1 Hereinafter, all references to “Rule” or “Rules” refer to the Federal Rules of Civil Procedure. I. BACKGROUND A. Procedural Background On April 19, 2023, GEICO filed a Complaint stemming from various no-fault insurance charges that Defendants submitted to GEICO for reimbursement under the New Jersey and New York no-fault insurance statutes (“Compl.,” ECF No. 1). The Complaint asserts claims against CJS, United Medical, and Advanced Pain for declaratory judgment under 28 U.S.C. §§ 2201 and 2202 (Count One), against CJS, Menkin, and Petracco for violation of the New Jersey Insurance Fraud Prevention Act (“NJIFPA”) (Count Two), against Menkin and Petracco for violations of the Racketeer Influenced and Corrupt Organizations Act (“RICO”) (Counts Three and Four), against CJS, Menkin, and Petracco for common law fraud and unjust enrichment (Counts Five and Six, respectively), against Menkin for further RICO violations (Counts Seven and Eight), against

United Medical and Menkin for common law fraud and unjust enrichment (Counts Nine and Ten, respectively), against Advanced Pain and Menkin for NJIFPA violations (Count Eleven), against Menkin for further RICO violations (Count Twelve), and against Advanced Pain for common law fraud and unjust enrichment (Counts Thirteen and Fourteen, respectively). On May 22, 2023, Defendants filed the current Motion to Dismiss for lack of jurisdiction under Rule 12(b)(1) and for failure to state a claim under Rule 12(b)(6). B. Factual Background2 From 2018 to the present (the “Relevant Period”), Menkin and Petracco3 performed medical and chiropractic services for people injured in automobile accidents (“Insureds”) who were eligible for no-fault insurance coverage (“Personal Injury Protection” or “PIP” benefits) in

New York and New Jersey under state no-fault insurance laws. (Compl. ¶¶ 1–2.) The Complaint

2 For the purpose of considering the instant Motion, the Court accepts all factual allegations in the Complaint as true. See Phillips v. County of Allegheny, 515 F.3d 224, 233 (3d Cir. 2008). 3 The Complaint additionally mentions some providers who performed services at Petracco and/or Menkin’s direction. alleges that these medical and chiropractic services (the “Fraudulent Services”), to the extent provided at all, were not medically necessary and often were not “legitimately provided in the first instance”—rather, they were provided “pursuant to pre-determined fraudulent protocols designed to financially enrich the Defendants.” (Id. ¶ 6.) Defendants’ billing for the Fraudulent Services exaggerated and misrepresented the treatments, fraudulently inflating the charges that Defendants ultimately submitted to GEICO. (Id.) The Fraudulent Services were provided primarily at CJS, United Medical, and Advanced Pain, in which Menkin and Petracco held “significant beneficial interest[s],”4 through self-referrals that the Complaint alleges were made unlawfully. (Id. ¶¶ 86– 89.) Defendants submitted thousands of allegedly unlawful no-fault insurance charges to GEICO during the Relevant Period,5 totaling over $2.3 million that Plaintiffs now seek to recover. (Id. ¶

1.) II. JURISDICTION The Court has federal question jurisdiction pursuant to 28 U.S.C. § 1331 over the federal claims alleged in the Complaint, and supplemental jurisdiction over the other claims pursuant to 28 U.S.C. § 1367. III. LEGAL STANDARDS A. Rule 12(b)(1) If a court determines that it lacks subject matter jurisdiction over a suit, it must be dismissed. See Fed. R. Civ. P. 12(h)(3). A Rule 12(b)(1) motion can raise a facial attack or a factual attack, which determines the standard of review. Constitution Party of Pa. v. Aichele, 757 F.3d 347, 357 (3d Cir. 2014). A facial attack “is an argument that considers a claim on its face and

asserts that it is insufficient to invoke the subject matter jurisdiction of the court because, for

4 Petracco is a chiropractor who owns and treats patients at CJS. Menkin is a physician who owns United Medical and Advanced Pain, and who treats patients at both locations as well as at CJS. (Compl. ¶ 5.) 5 Defendants submitted the charges on behalf of their patients pursuant to assignments of those patients’ PIP benefits to Defendants under GEICO’s Decision Point Review Plan. (Compl. ¶¶ 26–29.) example, it does not present a question of federal law . . . or because some other jurisdictional defect is present.” Id. at 358. In reviewing a facial attack, the court must only consider the allegations of the complaint and documents referenced therein and attached thereto in the light most favorable to the plaintiff. Id. On the other hand, a factual attack “concerns the actual failure of [a plaintiff’s] claims to comport with the jurisdictional prerequisites.” CNA v. United States, 535 F.3d 132, 139 (3d Cir. 2008) (internal quotation marks omitted). When considering a factual challenge, “the plaintiff [has] the burden of proof that jurisdiction does in fact exist,” the court “is free to weigh the evidence and satisfy itself as to the existence of its power to hear the case,” and “no presumptive truthfulness attaches to [the] plaintiff’s allegations . . . .” Mortensen v. First Fed.

Sav. & Loan Ass’n, 549 F.2d 884, 891 (3d Cir. 1977). B. Rules 12(b)(6) and 9(b) Under Rule 12(b)(6), a complaint may be dismissed for “failure to state a claim upon which relief can be granted.” Fed. R. Civ. P. 12(b)(6).

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