Government Employees Insurance Company v. Binns

CourtDistrict Court, E.D. New York
DecidedApril 3, 2024
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. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK GOVERNMENT EMPLOYEES INSURANCE RAN COMPANY, GEICO INDEMNITY COMPANY, voc wes2 (Ni coy py GEICO GENERAL INSURANCE COMPANY, ~ ( ) @®) GEICO CASUALTY COMPANY, Plaintiffs, ~against- LIANA BINNS, N.P., et al., Defendants.

NICHOLAS G. GARAUFIS, United States District Judge. Pending before the court is a motion for default judgment filed by Government Employees Insurance Company, GEICO Indem- nity Company, GEICO General Insurance Company, and GEICO Casualty Company (collectively, “GEICO” or “Plaintiffs”), against Defendants Marie Lourdes Jean-Francois, N.P., Dorrett Bryan, N.P., Priscilla Rose Santana, N.P., Shernet Barrett, N.P., and Bar- bara Kerr, N.P. (collectively the “Defaulting Defendants”), brought pursuant to Rule 55(b)(2) of the Federal Rules of Civil Procedure. (See Not. of Mot. (Dkt. 161); Mem. in Supp. of Mot. (Dkt. 161-10).) The court referred this motion to Magistrate Judge Peggy Kuo for a report and recommendation (“R&R”). (See June 29, 2023 Order Referring Mot.) Judge Kuo issued the an- nexed R&R on March 14, 2024, recommending that the court grant Plaintiffs’ motion and award GEICO damages and prejudg- ment interest. (R&R (Dkt. 165) at 13.) No party has objected to Judge Kuo’s R&R, and the time to do so has passed. See Fed. R. of Civ. P. 72(b)(2). Therefore, the court reviews the R&R for clear error. See Velasquez v. Metro Fuel Oil Corp., 12 F. Supp. 3d 387, 397 (E.D.N.Y. 2014). Having found none, the court ADOPTS the R&R in full.

The court therefore GRANTS Plaintiffs motion for default judg- ment, finding that GEICO is not obligated to pay any outstanding claims submitted by the Defaulting Defendants. The court also awards GEICO damages in the amount of $112,258.59 and pre- judgment interest as specified in the annexed R&R. (See R&R at 11-13.)

SO ORDERED.

Dated: Brooklyn, New York April 4 , 2024 s/NICHOLAS G, GARAUVFIS NICHOLAS G. GARAUFIS nited States District Judge

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK en nennennecenennns & GOVERNMENT EMPLOYEES INSURANCE : COMPANY, GEICO INDEMNITY : COMPANY, GEICO GENERAL INSURANCE : COMPANY, and GEICO CASUALTY COMPANY, : REPORT AND : RECOMMENDATION Plaintiffs, : : 22-CV-01553 (NGG) PK) ~agains t- : LIANA BINNS, N_P., et al, Detendants. eee eee mnenene X Peggy Kuo, United States Magistrate Judge: Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, and GEICO Casualty Company (collectively, “GEICO” or “Plaintiffs” brought this action seeking to recover nearly $1 million for allegedly fraudulent no-fault insurance claims billed by Defendants to GEICO for medical services provided to victims of automobile accidents. (See Compl, Dkt. 1.) The Complaint alleges 139 causes of action for common law fraud, unjust enrichment, and civil RICO and civil RICO conspiracy to commit fraud. GEICO has moved for default judgment against Defendants Marie Lourdes Jean-Francois, N.P. (“Jean-Francois”), Dorrett Bryan, N.P. (“Bryan”), Priscilla Rose Santana, N.P. (“Santana”), Shernet Barrett, N.P. (“Barrett”), and Barbara Kerr, N.P. (“Kerr”) (collectively the “Defaulting Defendants”) pursuant to Rule 55(b)(2) of the Federal Rules of Civil Procedure. (“Motion,” Dkt. 161.) ‘The Honorable Nicholas G. Garaufis referred the Motion to me for a report and recommendation. For the reasons stated herein, I respectfully recommend that the Motion be granted.

FACTUAL AND PROCEDURAL BACKGROUND I. Factual Background The following facts are taken from the Complaint (Dkt.-1), Plaintiffs Memorandum in Support of Application for Default Judgment (Pl. Mem.,” Dkt. 161-10), and the Declarations of Joshua D. Smith (“Smith Decl.” Dkt. 161-1; “Second Smith Decl.,” Dkt. 164) and Kathleen Asmus (“Asmus Decl.,” Dkt. 161-3), and are accepted as true for purposes of the Motion. See Finkel v. Romanowiex, 577 F.3d 79, 84 2d Cir. 2009) (in light of a defendant’s default, a court is required to accept all of plaintiff's factual allepations as true and draw all reasonable inferences in its favor). A, Nature of the Case New York’s Comprehenstve Automobile Insurance Reparations Act, N.Y. Ins. Law §§ 5101 ef seq. {the “No-Fault law”), requires no-fault insurers, like GEICO, to reimburse patients for up to $50,000 in personal injury benefits without proof of fault of the other driver. N.Y. Ins. Law §§ 5102, 5103. Insured patients may assign claims for benefits to theit healthcare provider to directly submit requests for payment to the insurance company. 11 N.Y.C.R.R. § 65-3.11(@). To qualify for reimbursement payments under the No-Fault law, a healthcare provider must comply with all applicable licensing requirements for performing covered services. Id. § 65-3.16(a)(12). New York law prohibits, zafer alia, the ownership or control of a medical practice by unlicensed individuals, fee- splitting arrangements among licensed and unlicensed individuals for the provision of professional services, and the payment or solicitation of kickbacks in exchange for patient referrals. See Gov't Hmps. Ins. Co. » Efmood Park Med. Grp., P.C., No. 21-CV-617 (FB)(RER), 2022 WL 772737, at *2 (E.D.N.Y. Feb. 23, 2022), Re*R adopted, 2022 WL 768360 (E.D.N.Y. Mar. 14, 2022) (citing N.Y. Educ. Law §§ 6509-a, 6512, 6530(11), 6530(18), 6530(19), 6531); Gov't Bumps. Ins. Co. ». Parkway Med. Care, P.C., No. 15-CV-3670 (FB)(VMS), 2017. WL.1133282, at *2 (E.D.N.Y. Feb. 21, 2017), R&*R adopted, 2017 WL 1131901 (E.D.N-Y. Mar. 24, 2017).

Beginning in 2019, Defendants engaged in a scheme in which they submitted thousands of fraudulent no-fault insurance clairms to GEICO relating to “medically unnecessary, illusory, and otherwise non-reimbursable healthcare services” allegedly provided to automobile accident victims in New York (the “Fraudulent Services”), (Compl. { 1; Pl Mem. 3-5; Smith Decl. 16.) Defendants are (1) unincorporated medical practices, (2) licensed healthcare professionals who falsely purported to own and control the medical practices, and (3) non-healthcare professionals who unlawfully owned and controlled the medical practices. (Compl. {/ 4.) GEICO alleges that the insurance claims submitted by Defendants were ineligible for reimbursement because they were based on setvices that were not medically necessary, were never provided in the first instance, ot were exaggerated for the purpose of inflating the charges submitted to GEICO for reimbursement, é¢., the Fraudulent Services. Ud J 3.) GEICO also alleges that the healthcare practices through which these insurance claims were billed wete not owned by licensed healthcate professionals but were instead owned of controlled by unlicensed individuals and entities. Ud. $f, 2-3.) Moreover, these healthcare practices were allegedly engaged in illegal fee-splitting with non-medical professionals and illegal referral arrangements in which kickbacks were paid for patient teferrals. (id 3.) Thus, GEICO allepes these healthcare practices were ineligible for no-fault reimbursement payments from GEICO under the No-Fault law. (Ud) See also N.Y. Ins. Law § 5102(a)(1); 11 NYCRR § 65-3.16(a) (12). B. The Defaulting Defendants Defaulting Defendants Jean-Francois, Bryan, Santana, Barrett, and Kerr are five licensed nurse practitioners who reside in and are citizens of New York. (Compl.

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Government Employees Insurance Company v. Binns, Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-company-v-binns-nyed-2024.