Government Employees Insurance Company v. Wilkins Williams Medical, P.C.

CourtDistrict Court, E.D. New York
DecidedSeptember 6, 2024
Docket1:22-cv-04608
StatusUnknown

This text of Government Employees Insurance Company v. Wilkins Williams Medical, P.C. (Government Employees Insurance Company v. Wilkins Williams Medical, P.C.) 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. Wilkins Williams Medical, P.C., (E.D.N.Y. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK

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GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO INDEMNITY COMPANY, GEICO GENERAL INSURANCE COMPANY and GEICO CASUALTY COMPANY,

Plaintiffs, MEMORANDUM & ORDER

- against - No. 22-CV-4608 (KAM)(JRC)

WILKINS WILLIAMS MEDICAL, P.C., ERIC ST. LOUIS, 1 BROOKLYN CONSULTING GROUP INC., KORSUNSKIY LEGAL GROUP, P.C., DENIS KORSUNSKIY, ESQ., BIG BRIDGE FUNDING, L.L.C., EMIL EFREM, and JOHN DOE DEFENDANTS “1” through “10”,

Defendants.

KIYO A. MATSUMOTO, United States District Judge:

On August 4, 2022, Plaintiffs Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, and GEICO Casualty Company (collectively, “Plaintiffs”) commenced this action for common law fraud, unjust enrichment, aiding and abetting fraud, negligent misrepresentation, Civil RICO violations, and a declaratory judgment, alleging that Defendants schemed to submit fraudulent no-fault insurance claims. (ECF No. 22, Am. Compl. (“AC”).) On March 9, 2023, Plaintiffs filed an Amended Complaint against Defendants Wilkins Williams Medical, P.C. (“Williams Medical”), Eric St. Louis (“St. Louis”), 1 Brooklyn Consulting Group Inc. (“1 Brooklyn”), Korsunskiy Legal Group, P.C. (“Korsunskiy Legal Group”), Big Bridge Funding, L.L.C. (“Big Bridge”), Denis Korsunskiy, Esq., Emil Efrem, and John Doe Defendants 1-10. All named Defendants except Mr. St. Louis and 1 Brooklyn answered, and Plaintiffs have dismissed all claims

against them without prejudice.1 Plaintiffs now move for default judgment only on the common law fraud claim against Mr. St. Louis and 1 Brooklyn (collectively, the “Defaulting Defendants”). For the reasons below, the Court grants the motion. Background I. Factual Background Unless otherwise indicated, the following facts are from Plaintiffs’ Amended Complaint. Because Mr. St. Louis and 1 Brooklyn are in default, the Court accepts as true all well-pleaded factual allegations in the Amended Complaint, except as to damages. See

City of New York v. Mickalis Pawn Shop, LLC, 645 F.3d 114, 137 (2d Cir. 2011) (“[A] defendant who defaults thereby admits all ‘well- pleaded’ factual allegations contained in the complaint.” (internal quotations omitted)). A. New York No-Fault Laws

1 Plaintiffs have not identified the John Doe Defendants by name and do not seek a judgment against them now. New York enacted the Comprehensive Motor Vehicle Insurance Reparations Act (the “Act”), New York Insurance Law §§ 5101–5109, for “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.” Gov't Emps. Ins. Co. v. Wellmart RX, Inc., 435 F. Supp.

3d 443, 446 (E.D.N.Y. 2020) (internal quotations omitted). Plaintiffs underwrite automobile insurance in New York. (AC ¶ 48.) The Act and corresponding regulations (11 N.Y.C.R.R. §§ 65, et seq.) (collectively, “No-Fault Laws”) require Plaintiffs, as automobile insurers, to provide Personal Injury Protection Benefits (“No-Fault Benefits”) to those they insure. (Id. ¶ 49.) Insured drivers can assign their rights to No-Fault Benefits, which include up to $50,000 for necessary expenses, to healthcare providers in exchange for healthcare services. (Id. ¶¶ 50-51.) Healthcare providers submit claims directly to insurance companies via “NF-3” or “HCFA-1500” forms, then receive payment for provided

medical services. (Id. ¶ 52.) These forms contain warnings that filing claims with false information or concealing information is a crime. (Id. ¶ 65). Plaintiffs are under statutory and contractual obligations to process claims within 30 days. (Id. ¶ 215.) Further, the No-Fault Laws state that a health care provider is ineligible to receive No-Fault Benefits if fraudulently licensed, if paying or receiving unlawful kickbacks for patient referrals, if permitting unlicensed laypersons to control or dictate treatments, or if allowing unlicensed laypersons to share fees for professional services. (Id. ¶ 59.) Billing entities are ineligible to bill for or receive payment for goods or services that independent contractors provide; instead, healthcare services must be provided by the billing provider itself, or by its

employees. (Id. ¶ 196.) B. The Alleged Scheme Plaintiffs allege that Mr. St. Louis “holds himself out as a healthcare industry practice manager and operator of various healthcare offices, despite not having a medical license”; that he “owns, operates and manages [] multidisciplinary clinics in the New York metropolitan area that purport to provide treatment to patients covered by No-Fault insurance, but are, in actuality, organized to supply convenient, one-stop shops for no-fault insurance fraud”; and that he uses 1 Brooklyn “to secure and funnel money relating to the fraudulent scheme[.]” (Id. ¶¶ 8-9.)

Overall, Plaintiffs allege that the Defaulting Defendants ran a scheme that systematically submitted fraudulent no-fault claims to Plaintiffs for unnecessary medical services by illegally using the medical license, signature, and other relevant information from a Dr. Wilkins B. Williams (“Dr. Williams”) and by illegally controlling Williams Medical. (Id. ¶¶ 1-2, 5.) The Defaulting Defendants allegedly colluded with Mr. Efrem and Big Bridge (collectively, the “Funding Defendants”), the John Doe Defendants, and Mr. Korsunskiy and Korsunskiy Legal Group (collectively, the “Lawyer Defendants”). The Defaulting Defendants also engaged a no- fault collection firm (the “Clearing Law Firm”) as an escrow agent for the purported benefit of Williams Medical. (Id. ¶ 29.) In 2016, Dr. Williams incorporated Williams Medical, though

he never practiced medicine in any capacity through Williams Medical. (Id. ¶ 67.) In 2021, Mr. St. Louis approached Dr. Williams, his friend, to open a new medical practice with him. (Id. ¶ 70.) In order to secure a loan, Mr. St. Louis presented Dr. Williams with illegitimate loan documents and deceived him into providing, inter alia, his signature, medical license, the Williams Medical name, and its tax identification number (“TIN”). (Id. ¶¶ 16, 74-76.) The information enabled Mr. St. Louis to unlawfully operate and control Williams Medical; to use the professional corporation to bill Plaintiffs for fraudulent services; and to benefit the scheme participants. (Id. ¶ 80.)

Plaintiffs allege that, through an unlawful referral arrangement, the Defaulting Defendants accessed patients from clinics largely in Brooklyn and Nassau County. (Id. ¶ 84.) When visiting a clinic, an insured person was automatically referred for a fraudulent service, regardless of the circumstances. (Id. ¶ 88.) However, there was no physician involved with performing the fraudulent services; rather, unlicensed technicians saw the insured person to facilitate capturing their signatures and generating and submitting bills to Plaintiffs. (Id. ¶ 136.) Where any fraudulent services were performed, independent contractors not employed or supervised by Dr. Williams or Williams Medical performed them. (Id. ¶ 199.) The Defaulting Defendants, in coordination with the John Doe

Defendants, created the claim paperwork to bill for fraudulent services. (Id. ¶ 91.) The Defaulting Defendants and the John Doe Defendants created a stamp with the name of Williams Medical, Dr. Williams’s National Provider Identifier number, and medical license number, then placed the stamp on, inter alia, Assignment of Benefit (“AOB”) and medical record forms, with Dr. Williams’s forged signature, to misrepresent that Dr. Williams performed the services. (Id. ¶¶ 91-94.) Hundreds of NF-3 forms, AOBs, and medical reports or records with Dr.

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Government Employees Insurance Company v. Wilkins Williams Medical, P.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-employees-insurance-company-v-wilkins-williams-medical-pc-nyed-2024.