Government Employees Insurance Company v. Patel

CourtDistrict Court, E.D. New York
DecidedJanuary 8, 2024
Docket1:23-cv-02835
StatusUnknown

This text of Government Employees Insurance Company v. Patel (Government Employees Insurance Company v. Patel) 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. Patel, (E.D.N.Y. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK

--------------------------------------X

GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO INDEMNITY COMPANY, GEICO GENERAL MEMORANDUM AND ORDER INSURANCE COMPANY and GEICO CASUALTY COMPANY; 23-CV-2835 (KAM)(PK)

Plaintiffs,

-against-

BHARGAV PATEL, M.D., PATEL MEDICAL CARE, P.C., and JOHN DOE DEFENDANTS “1”-“10”;

Defendants.

--------------------------------------X KIYO A. MATSUMOTO, United States District Judge: Plaintiffs Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, and GEICO Casualty Company (together, “Plaintiffs” or “GEICO”) commenced this action on April 17, 2023, against Dr. Bhargav Patel (“Patel”), Patel Medical Care, P.C. (“Patel Medical”), and John Doe Defendants Nos. 1-10 (collectively, “Defendants”), seeking declaratory relief and RICO and common law damages, alleging that Defendants submitted thousands of fraudulent No-Fault insurance charges relating to “medically unnecessary, experimental, excessive, illusory, and otherwise unreimbursable healthcare services.” (ECF No. 1, Complaint (“Compl.”).) On December 22, 2023, GEICO moved for injunctive relief, seeking: (1) a stay of all collection arbitrations arising under New York’s No-Fault insurance laws that are pending before the American Arbitration Association (“AAA”) and of all insurance collection lawsuits in state court brought by

Defendants against GEICO pending disposition of this federal action; and (2) a preliminary injunction prohibiting Patel Medical, and anyone acting or purporting to act on its behalf, from commencing any new No-Fault collection arbitrations or state collection lawsuits against GEICO pending disposition of this federal action. (ECF No. 24-1, Memorandum of Law in Support of Plaintiffs’ Motion (“Pl. Mem.”), at 1.) For the reasons set forth below, Plaintiffs’ motion for injunctive relief is granted, and bond is waived. BACKGROUND I. New York’s No-Fault Insurance Laws New York enacted the Comprehensive Automobile Insurance

Reparations Act, New York Insurance Law (“N.Y. Ins. Law”) §§ 5101– 5109, to “ensure prompt compensation for losses incurred by accident victims without regard to fault or negligence, to reduce the burden on the courts and to provide substantial premium savings to New York motorists.” Med. Soc’y of State of N.Y. v. Serio, 800 N.E.2d 728, 731 (N.Y. 2003) (citing Governor’s Mem. approving L. 1973, ch. 13, 1973 McKinney’s Session Laws of N.Y., at 2335). Under those No-Fault insurance laws, No-Fault insurers like GEICO may reimburse patients without requiring proof of the other driver’s fault in an amount up to $50,000, including for expenses incurred for necessary medical or other professional health services. See N.Y. Ins. Law § 5102(a)(1), (b).

Insurers must review, investigate, and verify an insured’s claim for benefits and then pay or deny the claim within 30 days after submission. See N.Y. Ins. Law § 5106(a); 11 N.Y. Comp. Codes R. & Regs. (“NYCRR”) § 65-3.8(a), (c). In certain circumstances, an insured may also assign his or her benefits “directly to providers of health care services” so that the provider may receive direct payment from the insurer. 11 NYCRR § 65-3.11(a). To be eligible to make a claim for benefits, a healthcare provider must be lawfully incorporated and, inter alia, “(1) must be owned by a physician who actually engages in the practice of medicine through that corporation, (2) may not bill for services provided by physicians who are not employees of the corporation, such as

independent contractors, and (3) may not pay kickbacks to third parties for the referral of insureds.” Gov’t Emps. Ins. Co. v. Mayzenberg, No. 17-CV-2802 (ILG), 2018 WL 6031156, at *2 (E.D.N.Y. Nov. 16, 2018) (internal citations omitted); see also Gov’t Emps. Ins. Co. v. Badia, No. 13-CV-1720 (CBA), 2015 WL 1258218, at *8–9 (E.D.N.Y. Mar. 18, 2015). Section 5106 of the New York Insurance Law creates a “[f]air claims settlement” procedure for all No-Fault claims. No-Fault insurance benefits are deemed overdue if they are not paid or denied within 30 calendar days after the insured submits a proof of claim. See N.Y. Ins. L. § 5106(a); 11 NYCRR § 65-3.8(c). If an insurer fails to comply with this timeframe, it is precluded

from asserting many (but not all) defenses to coverage, including most fraud-based defenses. See Fair Price Med. Supply Corp. v. Travelers Indem. Co., 890 N.E.2d 233, 236 (N.Y. 2008); Cent. Gen. Hosp. v. Chubb Grp. of Ins. Cos., 681 N.E.2d 413, 415 (N.Y. 1997). A claimant may bring a civil collection action in state court to recover overdue No-Fault benefits, and in that action the claimant need only show that the prescribed 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., 35 N.E.3d 451, 458 (N.Y. 2015). Insurers must also include a clause in their policies allowing the insured to seek arbitration of their claims for No-Fault benefits. See N.Y. Ins. L. § 5106(b); 11 NYCRR § 65-1.1(a), (d).

New York’s No-Fault insurance laws establish the procedures for arbitration of any disputed claims. See 11 NYCRR § 65–4.5. By statute, the New York Department of Financial Services Superintendent has designated AAA as the body responsible for administering the No-Fault arbitration process. Id. § 65- 4.2(a)(2). Insurers generally bear the costs associated with the arbitration process in direct proportion to the frequency with which they are named as respondents. Id. § 65-4.2(c)(1). The “arbitration process for No-Fault coverage is an expedited, simplified affair meant to work as quickly and efficiently as possible” where “[d]iscovery is limited or non-existent.” Allstate Ins. Co. v. Mun, 751 F.3d 94, 99 (2d Cir. 2014) (citing

11 NYCRR § 65-4.5). “Complex fraud and racketeering claims, maturing years after the initial claimants were fully reimbursed, cannot be shoehorned into this system.” Id. An insurer who pays No-Fault benefits and subsequently discovers fraud may bring an action for damages. See State Farm Mut. Auto. Ins. Co. v. James M. Liguori, M.D., P.C., 589 F. Supp. 2d 221, 229-35 (E.D.N.Y. 2008); State Farm Mut. Auto. Ins. Co. v. CPT Med. Servs., P.C., No. 04-CV-5045 (ILG), 2008 WL 4146190, at *6-7 (E.D.N.Y. Sept. 5, 2008). Where the insurer has not paid, the insurer may bring an action for a declaratory judgment that it is not liable for any unpaid claims because the provider has committed fraud or breached applicable No-Fault regulations. See 28 U.S.C. § 2201; Gov’t Emps. Ins. Co. v. Jacques, No. 14-CV-5299

(KAM) (VMS), 2017 WL 9487191, at *9-11 (E.D.N.Y. Feb. 13, 2017), report & recommendation adopted, 2017 WL 1214460 (E.D.N.Y. Mar. 31, 2017); State Farm Mut. Auto. Ins. Co. v. Cohan, No. 09-CV-2990 (JS) (WDW), 2009 WL 10449036, at *4 (E.D.N.Y. Dec. 30, 2009), report and recommendation adopted, 2010 WL 890975 (E.D.N.Y. Mar. 8, 2010), aff'd, 409 F.

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