Government Employees Insurance Company v. Surplus SG, Inc.

CourtDistrict Court, E.D. New York
DecidedOctober 9, 2024
Docket1:24-cv-01903
StatusUnknown

This text of Government Employees Insurance Company v. Surplus SG, Inc. (Government Employees Insurance Company v. Surplus SG, Inc.) 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. Surplus SG, Inc., (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 INSURANCE COMPANY, and GEICO CASUALTY COMPANY, REPORT & RECOMMENDATION

Plaintiffs, 24-CV-1903 (NCM) (LKE)

v.

SURPLUS SG, INC., SARIT GOSHINSKY A/K/A SARIT GOSHINSLY, and JOHN DOES 1-10,

Defendants. X

Lara K. Eshkenazi, United States Magistrate Judge:

Plaintiffs Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, and GEICO Casualty Company (collectively, “GEICO” or “Plaintiffs”) commenced this action for fraud and unjust enrichment, alleging that Defendants Surplus SG, Inc. (“Surplus”) and Sarit Goshinsky (“Goshinsky”) (collectively the “Defaulting Defendants” or “Defendants”) engaged in a scheme to submit fraudulent charges for medically unnecessary medical equipment and orthotic devices for covered individuals under New York’s no-fault insurance law. (See generally Complaint dated March 14, 2024 (“Compl.”), ECF No. 1.) Defaulting Defendants did not appear. The Clerk of Court entered defaults against Defaulting Defendants on May 10, 2024. (Clerk’s Entries of Default dated May 10, 2024, ECF Nos. 12-13.) Before the Court, on referral from the Honorable Natasha C. Merle, is Plaintiffs’ motion for default judgment pursuant to Federal Rule of Civil Procedure 55(b)(2). (See generally “Motion,” ECF No. 14.) For the reasons set forth below, the Court respectfully recommends that the Motion should be granted as to the common law fraud claim and request for a declaratory judgment, and denied as to the unjust enrichment claim. The Court further respectfully recommends that Plaintiffs be awarded damages as set forth below. I. BACKGROUND A. Factual Allegations

The following facts are taken from the Complaint (ECF No. 1), Plaintiffs’ Memorandum in Support of Plaintiffs’ Motion for Default Judgment (“Pl. Mem.,” ECF No. 14-7), and the Declarations of Sean Gorton (“Gorton Decl.,” ECF No. 14-1) and Kathleen Asmus (“Asmus Decl.,” ECF No. 14-2), and they are assumed to be true for the purposes of this motion. See Finkel v. Romanowicz, 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 allegations as true and draw all reasonable inferences in its favor). 1. New York’s No Fault Insurance Laws In New York, car insurers are required to provide personal injury benefits (i.e., “no-fault benefits”) to individuals who claim to have been involved in automobile accidents in New York

and are eligible for coverage under no-fault insurance policies issued by GEICO (“Insureds”). (Compl., ECF No. 1 ¶¶ 18-19.) Claims for no-fault benefits are governed by a specific fee schedule and can result in up to $50,000 per Insured for medically necessary expenses. (See id. ¶¶ 20-21 (citing N.Y. Ins. Law § 5102(a).) Healthcare service providers that do not comply with state or city licensing requirements are ineligible to collect no-fault benefits. (Compl., ECF No. 1 ¶ 26.) Further, the relevant laws prohibit licensed providers from paying or accepting kickbacks for referrals. (See id. ¶ 24 (citing N.Y. Educ. Law §§ 6509-a, 6530(18), 6531; 8 N.Y.C.R.R. § 29.1(b)(3).) No-fault benefits can be used to reimburse medically necessary durable medical equipment (“DME”) and orthotic devices (“OD”)1 provided pursuant to lawful prescriptions from licensed providers. (See Compl., ECF No. 1 ¶ 35 (citing N.Y. Ins. Law § 5102(a).) Payments for DME or OD are directly related to the fee schedule set forth by the New York State Medicaid Program. (Compl., ECF No. 1 ¶¶ 40–42.) If a specific DME or OD does not have a fee listed in the Medicaid fee schedule, then insurers must pay healthcare service providers a percentage of the

provider’s cost to acquire the DME or OD or the usual and customary cost of the DME or OD charged to the public. (Id. ¶ 45.) 2. The Alleged Fraudulent Scheme In this action, Plaintiffs are Nebraska corporations with their principal places of business in Maryland and are authorized to conduct business and underwrite automobile insurance in New York. (Id. ¶¶ 10, 17.) Surplus is a New York corporation (incorporated in 2017) based in Brooklyn that sells DME and OD. (Id. ¶¶ 3,11.) Goshinsky is a New York resident who owns and operates Surplus, but he is not—and has never been—a licensed healthcare provider. (Id. ¶¶ 12-13.) Beginning in 2021, Goshinsky used Surplus to submit and cause to be submitted to GEICO

hundreds of fraudulent no-fault insurance claims for medically unnecessary, illusory, and otherwise non-reimbursable DME and OD. (See id. ¶¶ 1-3, 55.) Defendants maintained illegal financial arrangements with unidentified third parties to which Defendants paid kickbacks to obtain prescriptions for DME and/or OD issued by referring providers. (Id. ¶¶ 69-90.) Pursuant to a prearranged protocol, providers prescribed medically unnecessary DME and/or OD to Insureds, then gave the prescriptions directly to Defendants to fill to ensure that Insureds did not

1 DME includes items that individuals use for medical purposes in their homes, such as bed boards, cervical pillows, orthopedic mattresses, electronic muscle stimulator units (“EMS units”), hot/cold packs, infrared heat lamps, lumbar cushions, orthopedic car seats, transcutaneous electrical nerve stimulators (“TENS units”), electrical moist heating pads (known as thermophores), and whirlpool baths. (Compl., ECF No. 1 ¶ 36.) OD includes cervical collars, lumbar supports, knee supports, ankle supports, and other instruments that are applied to the body to align, support, or correct deformities or to improve the movement of the spine, joints, or limbs. (Id. ¶ 37.) fill the prescriptions with legitimate DME and OD retailers. (Id. ¶¶ 58-62.) Additionally, Defendants improperly fulfilled vague or generic prescriptions by choosing specific DME and/or OD for Insureds that had high reimbursement rates according to the Medicaid fee schedule. (Id. ¶¶ 61-62.) Defendants also submitted bills to GEICO for DME and/or OD that was never actually provided to Insureds or bills that misrepresented the equipment that was provided. (Id. ¶¶ 65-67.)

GEICO, in turn, relied on this false information to process Defendants’ claims promptly pursuant to statutory and contractual obligations, resulting in payments of over $126,000. (Id. ¶ 56, 198.) Defendants not only submitted claims to GEICO knowing that they included materially false information, but also hired law firms to pursue collection of the fraudulent claims from GEICO, which resulted in expensive and time-consuming litigation against GEICO if the charges were not promptly paid in full. (Id. ¶ 197.) B. Procedural History GEICO initiated this action in March 2024. (Compl., ECF No. 1.) Subsequently, GEICO served Goshinsky with process on March 20, 2024, and Surplus with process on April 5, 2024.

(See ECF Nos. 8-9.) After Defendants failed to appear or otherwise respond to the Complaint, the Clerk of Court entered certificates of default against them. (ECF Nos. 12-13.) GEICO moved for default judgment in June 2024, seeking compensatory damages, prejudgment interest, and a declaratory judgment. (ECF No. 14.) Judge Merle referred the motion for a report and recommendation. (June 13, 2024 Order.) To date, Defendants still have not appeared in this case or responded to Plaintiffs’ motion. II.

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Government Employees Insurance Company v. Surplus SG, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-company-v-surplus-sg-inc-nyed-2024.