GOVERNMENT EMPLOYEES INSURANCE COMPANY, INC. v. ELKHOLY, M.D.

CourtDistrict Court, D. New Jersey
DecidedDecember 23, 2024
Docket3:21-cv-16255
StatusUnknown

This text of GOVERNMENT EMPLOYEES INSURANCE COMPANY, INC. v. ELKHOLY, M.D. (GOVERNMENT EMPLOYEES INSURANCE COMPANY, INC. v. ELKHOLY, 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.

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GOVERNMENT EMPLOYEES INSURANCE COMPANY, INC. v. ELKHOLY, M.D., (D.N.J. 2024).

Opinion

NOT FOR PUBLICATION

UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY

GOVERNMENT EMPLOYEES INSURANCE CO.,, et al., Plaintiffs, Civil Action No. 21-16255 (MAS) (JTQ) Vv. MEMORANDUM OPINION WAEL ELKHOLY, M._D., et al., Defendants.

SHIPP, District Judge This matter comes before the Court on a Motion to Stay Pending Arbitration by Defendants Precision Pain & Spine Institute, LLC (“Precision Pain’), Precision Spine & Sports Medicine of New Jersey, LLC (“Precision Spine”), Precision Anesthesia Associates, PC (“Precision Anesthesia”), Wael Elkholy, M.D. (“Elkholy”), Ashraf Sakr, M.D. (“Sakr’), Fouad Karam, D.C. (“Karam”), Luis Ramirez-Pacheco, M.D. (“Ramirez-Pacheco”), Lydia Shajenko, M.D. (“Shajenko”), Stuart Atkin, M.D. (“Atkin”), Mehrdad Langroudi, M.D. (“Langroudt’’), Chang Lee, M.D. (“Lee”), Khaled Morsi, M.D. (“Morsi”), and Monica Johnson, N.P. (“Johnson”) (collectively, “Defendants”), (ECF No. 106.) Plaintiffs Government Employees Insurance Co., GEICO Indemnity Co., GEICO General Insurance Company, and GEICO Casualty Co. (collectively “Plaintiffs” or the “Geico Entities”) opposed (ECF No. 107), and Defendants replied (ECF No. 108). The Court has carefully considered the parties’ submissions and decides the matter without oral argument under Local Civil Rule 78.1(b). For the reasons below, the Court grants Defendants’ Motion.

1. BACKGROUND A. Factual Background This case is about the relationship between healthcare providers and the insurance companies that pay those providers for treating patients for injuries arising from automobile accidents. (See generally Am. Compl., ECF No. 72.) Plaintiffs allege against Defendants a series of fraudulent schemes, including unlawful compensation in exchange for patient referrals; misrepresentation of the nature, extent, and results of patient examinations; and false representations regarding compliance with pertinent healthcare laws. (See id.) In 2016, Precision Pain, Precision Anesthesia, and Precision Spine (collectively, the “Precision Facilities”) were founded. Ud. 9] 17, 19-22.) Elkholy, Sakr, and Karam were the primary owners and members of those facilities, and the other characters involved are straightforward: several New Jersey medical doctors, nurse practitioners, and other healthcare providers—-Ramirez-Pacheco, Shajenko, Atkin, Langroudi, Lee, Morsi, and Johnson—who performed various medical procedures at the Precision Facilities over the years. Ud. 9] 12-29.) These medical procedures included patient examinations, pain management injections, X-ray testing, chiropractic treatment, physical therapy treatment, and anesthesia services. (Ud. 4] 1.) After the Precision Facilities opened, they began treating patients, some of whom were involved in automobile accidents. (/d. 4 2.) And among that subgroup of patients, several of them were insured by the Geico Entities. 7d.) So, under New Jersey and New York’s PIP Benefits programs, Defendants submitted bills to the Geico Entities and other insurance companies directly for the medical services they provided the insured patients. (L.g., id. § 30.) That is, prospective patients insured through the Geico Entities would visit Defendants’ facilities, provide insurance paperwork to Defendants assigning their rights to PIP Benefits, and in return Defendants would treat the patients. (See generally id.)

In essence, Plaintiffs allege that Defendants hatched a plot to scheme the Geico Entities and other insurance companies out of millions of dollars in PIP Benefits. Ud. 1-2.) According to the Geico Entities, Defendants engaged in the following illegal conduct: (1) performed medical procedures that were not medically necessary; (2) billed for medical services that were never provided; (3) misrepresented and exaggerated the types of medical services rendered; (4) received unlawful kickbacks in exchange for patient referrals; (5) engaged in unlawful self-referrals; and (6) engaged in the unlawful practice of medicine based on the healthcare providers’ corporate structure. (/d. J 1-2; see id. {J 88-446 (referencing Am. Compl. Exs. 1, 2, 3, ECF Nos. 72-1, 72-2, 72-3).) B. Procedural History On August 30, 2021, after the Geico Entities discovered the illegal conduct (see id. 4 403), they filed suit. (See generally id.) Through seventeen counts, they raise essentially four types of claims: (1) violation of the Insurance Fraud Protection Act (“IFPA”) (id. {9 408-11); (2) common law fraud (id. Jf 426-40, 461-75, 496-510); (3) violation of the Racketeering Influenced and Corrupt Organizations Act (“RICO”) (id. J§] 412-25, 447-60, 482-95); and (4) unjust enrichment (id. {§ 441-46, 476-81, 511-16). Ultimately, the Geico Entities seek $7.1 million in recovery for payments made on more than 20,000 of Defendants’ allegedly fraudulent PIP claims, punitive damages, treble damages, costs, and attorney’s fees. Ud. 4 517.) Additionally, the Geico Entities seek a declaratory judgment that Defendants have no right to receive reimbursement for the outstanding charges that they have submitted to Geico under New York automobile insurance policies, seeking reimbursement under the New York no-fault insurance law, because of the alleged fraudulent and unlawful activities. Ud. { 4.) On June 30, 2022, the Court granted in part and denied in part Defendants’ motion to compel arbitration of all claims of the complaint. (Mem. Op., ECF No. 46.) The Court granted

Defendants’ motion to compel arbitration of Plaintiffs’ RICO, fraud, and unjust enrichment causes of action but denied it as to the IFPA cause of action. (See generally Mem. Op.) Shortly after, Defendants answered the complaint (ECF No. 51), and Plaintiffs subsequently filed a motion for leave to file an amended complaint (ECF No. 53). Then, on November 17, 2022, Defendants moved to compel arbitration of the IFPA claim and for judgment on the pleadings. (ECF No. 63.) While Defendants’ motion was pending, the Court granted Plaintiffs’ motion for leave to file an amended complaint on April 25, 2023. (ECF No. 71.) Plaintiffs filed their Amended Complaint the next day. (Am. Compl.) The Amended Complaint largely sets forth the same substantive allegations as the original complaint. (/d.) The Amended Complaint, however, makes changes to the PIP claims. (See generally id.) In the original complaint, Plaintiffs’ allegations for the IFPA claim were based only on New Jersey PIP claims (see generally Compl., ECF No. 1), but the Amended Complaint now predicates the IFPA claim on both New Jersey PIP claims and New York PIP claims (Am. Compl. 6-7, 409). More specifically, the IFPA claim is based on 19,774 New Jersey PIP claims and 2,498 New York PIP claims. (See Am. Compl. (referencing Am. Compl. Exs. 1, 2, 3).) Like the original complaint, the Amended Complaint asserts RICO, fraud, unjust enrichment, and declaratory judgment claims but is now based on only the 2,498 New York PIP claims.! (/d. 404-407, 412-516.) After Plaintiffs filed their Amended Complaint, the Court sua sponte dismissed Defendants’ motion to compel arbitration of the IFPA claim and for judgment on the pleadings because the motion was based on an inoperative complaint—the original complaint. (Text Order, ECF No. 76.) In turn, Defendants filed an interlocutory appeal of the text order dismissing its

' The Amended Complaint was the first time Plaintiffs asserted New York PIP-based claims. (Compare Compl. with Am. Compl.)

motion. (Notice of Appeal, ECF No. 79.) On April 26, 2024, the Third Circuit Court of Appeals issued a written decision “remand[ing] with instructions to compel arbitration of [Plaintiffs’ | IFPA claim[] against... [Defendants].” Gov ’t Emps. Ins. Co. v. Mount Prospect Chiropractic Ctr., P.A., 98 F.4th 463, 473 Gd Cir. 2024).

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GOVERNMENT EMPLOYEES INSURANCE COMPANY, INC. v. ELKHOLY, M.D., Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-company-inc-v-elkholy-md-njd-2024.