Government Employees Insurance Company et al. v. J Flexible Corp., LJR NY Inc., Yevgeniya Ivanova, and John Doe Defendants 1-10

CourtDistrict Court, E.D. New York
DecidedMarch 17, 2026
Docket1:25-cv-06700
StatusUnknown

This text of Government Employees Insurance Company et al. v. J Flexible Corp., LJR NY Inc., Yevgeniya Ivanova, and John Doe Defendants 1-10 (Government Employees Insurance Company et al. v. J Flexible Corp., LJR NY Inc., Yevgeniya Ivanova, and John Doe Defendants 1-10) 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 Company et al. v. J Flexible Corp., LJR NY Inc., Yevgeniya Ivanova, and John Doe Defendants 1-10, (E.D.N.Y. 2026).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ---------------------------------------------------------- X GOVERNMENT EMPLOYEES : INSURANCE COMPANY et al., : : Plaintiffs, : : MEMORANDUM DECISION AND -against- : ORDER : J FLEXIBLE CORP., LJR NY INC., : 25-cv-6700 (BMC) YEVGENIYA IVANOVA, and JOHN DOE : DEFENDANTS 1-10, : : Defendants. : ---------------------------------------------------------- X

COGAN, District Judge.

Plaintiffs bring this action under the Racketeer Influenced and Corrupt Organizations (“RICO”) Act and several common law theories of liability. Defendants have moved to dismiss plaintiffs’ claims under Fed. R. Civ. P. 9(b), 12(b)(1), and 12(b)(6). For the reasons that follow, the motion is granted in part and denied in part. SUMMARY OF COMPLAINT This case concerns New York’s “no-fault” car insurance system, which is designed to fast-track payment of insurance claims for personal injuries, regardless of who was at fault for causing the injury.1 No-fault benefits include up to $50,000 of medically necessary expenses per insured which, relevant here, include durable medical equipment (“DME”). DME generally refers to reusable medical equipment, such as wheelchairs, orthopedic mattresses, or lumbar cushions. DME can get expensive and, as with any reimbursable expense, DME prescriptions

1 See State Farm Mut. Auto. Ins. Co. v. Mallela, 372 F.3d 500, 503 (2d Cir. 2004) (“To guarantee that insureds are promptly compensated, the regulations also established strict, and brief, time periods for claim processing.”) (citing 11 N.Y.C.R.R. § 65-3.11); see also GEICO v. Mayzenberg, 121 F.4th 404, 409 (2d Cir. 2024) (“New York enacted these measures to displace most of the state’s common law tort regime for injuries arising from automobile accidents.”). must be medically necessary. At issue here are two items of DME: Powered Pressure-Reducing Air Mattresses (“PPRAMs”) and Pulsed Electro-Magnetic Field Therapy (“PEMF Devices”), each of which can be billed to plaintiffs for several thousand dollars. Defendants, two DME supply companies and their owner, abused the no-fault system by

seeking reimbursement from plaintiffs for hundreds of fraudulent prescriptions for PPRAMs and PEMF Devices. Defendants had no legitimate retail or office location and made no commercial efforts that one might expect from a DME supply company. Any “business” defendants obtained was through collusive agreements with various clinics that would prescribe medically unnecessary DME to inflate the bill later submitted to plaintiffs. Defendants concealed their fraud by routing the shipment of the DME back to themselves, so the patients never knew they were prescribed the DME in the first place. Defendants were enabled to commit this fraud scheme with the help of various unnamed persons, some of whom work for the medical clinics that issued the fraudulent DME prescriptions (“Clinic John Does”), and others who work for defendants, i.e., the DME suppliers

(“DME John Does”).2 The DME John Does procured the fraudulent prescriptions from the Clinic John Does so that defendants could submit them to plaintiffs for reimbursement. There are seven clinics that the Clinic John Does “illegally own and control.” The Clinic John Does issued the DME prescriptions even though they were not licensed healthcare professionals, but rather had conspired with defendants to further the fraudulent scheme. These clinics therefore prescribed and dispensed DME pursuant to predetermined protocols to

2 Defendants make arguments in support of dismissal of the Counts brought against the John Doe defendants. Presumably, those arguments apply only to the DME John Does because defendants’ counsel does not represent the clinics or their employees. Thus, there is no motion to dismiss the claims against the Clinic John Does. Nonetheless, because the Clinic John Does are integral to the scheme, the Court will consider whether to “dismiss [plaintiffs’] claims against the [Clinic] John Doe[s] sua sponte.” See Rivera v. Fed. Bureau of Prisons, 368 F. Supp. 3d 741, 744 n.2 (S.D.N.Y. 2019). maximize profits, rather than medical necessity. This is evidenced by examples of identical DME being issued to persons involved in the same accident,3 and the testimony of former healthcare providers at these clinics, who have testified that the employees forged their signatures on prescriptions.

To date, defendants have wrongfully obtained $455,000 from plaintiffs and have made around another $2 million worth of claims that plaintiffs have not yet paid. Plaintiffs seek a judgment declaring that they need not pay the outstanding claims and awarding damages for the paid claims, based on theories under RICO and common law fraud and unjust enrichment. DISCUSSION I. Legal Standards To survive a motion to dismiss under Rule 12(b)(6), a complaint must plead “enough facts to state a claim to relief that is plausible on its face,” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007), and to “allow[] the court to draw the reasonable inference that the defendant is liable for the misconduct alleged[.]” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). When

deciding a motion to dismiss, the Court must “constru[e] the complaint liberally, accept[] all factual allegations in the complaint as true, and draw[] all reasonable inferences in the plaintiff’s favor.” Elias v. Rolling Stone LLC, 872 F.3d 97, 104 (2d Cir. 2017) (quoting Chase Grp. All. LLC v. City of N.Y. Dep’t of Fin., 620 F.3d 146, 150 (2d Cir. 2010)).

3 In a hypothetical car accident involving three passengers who vary in age, physical characteristic, health, etc., one can reasonably expect each passenger to suffer different injuries requiring different treatment. So, if all three passengers sought medical help at the same clinic, it would be odd if each passenger’s records showed that they suffered identical injuries and received identically worded prescriptions. One or two instances might be negligible, but hundreds of times, resulting in millions of dollars’ worth of claims, as plaintiffs allege here, sounds in fraud. II. Declaratory Judgment Defendants first argue that the Court should decline to hear plaintiffs’ claim for declaratory judgment because there “are procedures available [in] state court proceedings that allow for the global determination of coverage issues in no-fault cases, [which] duplicates what a

federal declaratory judgment can offer.” Even if such procedures exist, defendants offer no reason why the Court should require plaintiffs to use those procedures. And the Court sees none. “Rather than adjudicating hundreds of individual claims in a piecemeal fashion, all claims can be efficiently and effectively dealt with in a single declaratory judgment action.” See GEICO v. Cean, No. 19-cv-2363, 2019 WL 6253804, at *5 (E.D.N.Y. Nov. 22, 2019) (citing Allstate v. Elzanaty, 929 F. Supp. 2d 199, 222 (E.D.N.Y. 2013)). The Court therefore declines to discretionarily dismiss Count 1. In the alternative, defendants argue that the Court should compel arbitration of the unpaid claims. Plaintiffs counter that compulsory arbitration does not apply to these claims under the “‘effective vindication’ exception.” See State Farm v. Tri-Borough, 120 F.4th 59, 90 (2d Cir.

2024) (“Developed by the Supreme Court, the ‘effective vindication’ doctrine . . . invalidates, ‘on public policy grounds, arbitration agreements that operate as a prospective waiver of a party’s right to pursue statutory remedies.’” (quoting Am. Express Co. v.

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Bluebook (online)
Government Employees Insurance Company et al. v. J Flexible Corp., LJR NY Inc., Yevgeniya Ivanova, and John Doe Defendants 1-10, Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-company-et-al-v-j-flexible-corp-ljr-ny-nyed-2026.