Government Employees Insurance Company v. Binns

CourtDistrict Court, E.D. New York
DecidedSeptember 28, 2022
Docket1:22-cv-01553
StatusUnknown

This text of Government Employees Insurance Company v. Binns (Government Employees Insurance Company v. Binns) 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 v. Binns, (E.D.N.Y. 2022).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO INDEMNITY COMPANY, MEMORANDUM & ORDER. GEICO GENERAL INSURANCE COMPANY, 22-CV-1553 (NGG) (PK) GEICO CASUALTY COMPANY, Plaintiffs, -against- LIANA BINNS, N.P., KYUNGSOOK BU, N_P., WELLBEING NP IN FAMILY HEALTH PLLC, NICOLA BROWN, N.P., MINNIE CHOI, N.P., GEORGETTE T. DIXON, N.P., TINEA WHITE, N.P., LAILA COLLINS, N.P., DIMITRI BAZIN, P.A., JEANNIE ANNE, PARLAN, N.P., SANDRA AJIMAVO, N.P., JULIE JACOB, N.P., JONATHAN BILE, P.A., MIRAN AN, N.P., MICHELLE YOUNGER, N.P., FALLA POLYCARPE, N.P., CHRISTINE SHORTER, N.P., MARIE LOURDES JEAN-FRANCOIS, N.P., DARLENE SYLVAIN, P.A., GAYOUNG KIM, N.P., SEONHEE AN, N.P., DORRETT BRYAN, N.P., PRISCILLA ROSE SANTANA, N.P., BYOUNG IM LEE, N.P., ASHLEY SIM, P.A., JULIA KAY, N.P., EYRINEY AZER, P.A., HYUNG SOOK PAIK, N.P., IDY LIANG, N.P., SHERNET BARRETT, N.P., SASHA ARISTIDE, N.P., MOHAMMADREZA FEIZI LIGHVAN, N.P., BARBARA KERR, N.P., PRISCA JOHN-OGAM, P.A., TATIANA RYBAK, SUSAN TUANO, WILMA TANGLAO, and JOHN DOE DEFENDANTS 1-10, Defendants.

NICHOLAS G. GARAUFIS, United States District Judge. Pending before the court is Plaintiffs’ motion to (1) stay all pend- ing collection arbitrations; (2) enjoin Defendants from commencing any additional arbitration or state court collection

proceedings until the resolution of this federal action; and (3) relieve Plaintiffs from their obligation to post security for the in- junction. For the reasons stated below, Plaintiffs’ motion is GRANTED, as against Defendants Kyungsook Bu, N.P. and Well- being NP in Family Health PLLC, I. BACKGROUND! The Government Employees Insurance Company, together with certain related companies (collectively, “GEICO”), brought this action. GEICO alleges that it has been the target of a no-fault in- surance fraud scheme carried out by the thirty-eight individuals and entities named in the Complaint and certain unidentified others. A majority of the named Defendants are healthcare pro- fessionals and one professional limited liability company (the “Healthcare Defendants”), (Compl. (Dkt. 1) { 11-77.) The re- maining Defendants (the “Management Defendants”) are not healthcare professionals, but have “secretly and unlawfully owned, controlled, and derived economic benefit from” the ser- vices provided by the Healthcare Defendants “in contravention of New York law.” (id. {4 78-81.) A. New York’s No-Fault Insurance Scheme In New York, an insurer is required provide certain no-fault in- surance benefits (“Personal Injury Protection” or “PIP Benefits”) to the individuals that they insure, (“Insureds”). PIP Benefits cover up to $50,000 of necessary healthcare expenses that result from automobile accidents. See N.Y. Ins. Law §§ 5101, et seq.; N.Y. Comp. Godes R. & Regs. (“NYCRR”) tit. 11 §§ 65, ef seq.

1 The following background is taken from the allegations of the Complaint and declarations submitted by GEICO in connection with this motion. 2 GEICO notes that many of the Management Defendants have previously been involved in litigation with GEICO after allegedly operating similar schemes. (See Compl. □ 102-140.) The Healthcare Defendants operated out of the very same clinics that were used in prior actions. (Id. | 166.)

These benefits are provided “to ensure that injured victims . . . have an efficient mechanism to pay for and receive the healthcare services that they need.” (Compl. { 87.) Insureds commonly as- sign their PIP Benefits to healthcare providers in exchange for services, and in those instances, the provider, rather than the In- sured, files no-fault claims with the insurance company. See NYCRR tit. 11 § 65-3.11(a) (providing that the benefits may be paid only “directly to the applicant” or “upon assignment by the applicant ... directly to providers of healthcare services”). Providers are prohibited from receiving PIP Benefits if they fail to meet any applicable New York licensing requirement. Id. § 65- 3.16(a) (12); see also State Farm Mut. Ins. Co. v. Mallela, 4N.Y.3d 313, 321 (2005). This includes, inter alia, that unlicensed profes- sionals may not own or control a professional healthcare practice, employ or supervise other healthcare professionals, or derive ecoriomic benefit from professional healthcare services. See N.Y. Bus. Corp. Law § 1507. Under the no-fault insurance scheme, insurers must pay PIP Benefits within 30 days of the claimant’s provision of proof of the claim. See N.Y. Ins. Law § 5106(a); NYCRR tit. 11 § 65-3.8(a), (c). After 30 days, interest begins to accrue at a rate of two percent per month. See N.Y. Ins. Law § 5106(a). Claimants may dispute unpaid no- fault claims either in a state civil action or arbitration proceeding. See NYCRR tit. 11 § 65-3.9(c)-(d). Insurers are preciuded from asserting many defenses to coverage in these proceedings, in- cluding most fraud-based defenses. See Fair Price Med. Supply Corp. v. Travelers Indem. Co., 10 N.Y.3d 556, 564 (2008). In a civil action to recover no-fault benefits, the Insured merely needs to show that the required statutory billing forms were mailed and received and that the claimed benefits are overdue. See Viviane Etienne Med. Care, P.C. v. Country-Wide Ins. Co., 25 N.Y.3d 498, 506 (2015).

In arbitration proceedings to recover no-fault benefits—which in- surers must provide for in their contracts, see N.Y. Ins. Law § 5106(b); 11 NYCRR § 65-1.1(a), (d)—the process is “an expe- dited, simplified affair meant to work as quickly and efficiently as possible,” and “[dJiscovery is limited or non-existent.” Allstate Ins. Co. v. Mun, 751 F.3d 94, 99 (2d Cir. 2014) (citing 11 NYCRR § 65-4.5). The Second Circuit has found that “[c]omplex fraud , and [racketeering] claims, maturing years after the initial claim- ants were fully reimbursed, cannot be shoehorned into this system.” Id. The proceedings “typically are heard and resolved in minutes, with arbitrators conducting one hearing after another, generally in 15-minute intervals,” which makes it difficult for an arbitrator to “consider a pattern of fraudulent treatment.” (As- mus Decl. (Dkt. 124-3) § 16.) In arbitration proceedings for unpaid no-fault claims, the claimant pays a nominal filing fee, but the defendant insurance company is required to pay a man- datory non-refundable fee of several hundred dollars in each case in which it is named as a respondent. Ud. { 14.) B. Operation of the Alleged Scheme . According to GEICO, around June 2019, the Management De- fendants recruited the Healthcare Defendants to “serve as the nominal or ‘paper’ owners of the professional healthcare prac- tices operated in their names” in exchange for compensation. (Compl. 4 143-44.) The Healthcare Defendants then worked in various clinics (the “Clinics”) throughout the New York area. (Id. " 164.) The Healthcare Defendants treated patients who were referred to the Clinics by personal injury attorneys or “through a network of individuals... who were paid by the Management Defendants for each Insured that they delivered.” Gd. (| 157, 162.}? Once Insureds arrived at the Clinics, they would be further

3 The personal injury attorneys also benefitted from the referrals since the extensive treatment that would be billed to the insurance company sup- ported higher damages for their clients. (See id. | 160.)

referred by receptionists or other non-medical personnel to the Healthcare Defendants for treatment, “regardless of individual symptoms or presentation.” (Id.

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