Schatzberg v. State Farm Mutual Automobile Insurance

877 F. Supp. 2d 232, 2012 U.S. Dist. LEXIS 96567, 2012 WL 2864475
CourtDistrict Court, E.D. Pennsylvania
DecidedJuly 12, 2012
DocketCivil Action. No. 10-2900
StatusPublished
Cited by6 cases

This text of 877 F. Supp. 2d 232 (Schatzberg v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schatzberg v. State Farm Mutual Automobile Insurance, 877 F. Supp. 2d 232, 2012 U.S. Dist. LEXIS 96567, 2012 WL 2864475 (E.D. Pa. 2012).

Opinion

MEMORANDUM

GENE E.K. PRATTER, District Judge.

I. INTRODUCTION

Peter Schatzberg, D.C., and his medical practice, Philadelphia Pain Management, Inc., bring a six count Amended Complaint against State Farm Mutual Automobile Insurance Company and State Farm Fire & Casualty Company (collectively “State Farm”) alleging that State Farm is attempting to eliminate his medical practice by (1) falsely accusing him of having engaged in fraudulent business activity, (2) creating the false perception in the community that he has engaged in professional impropriety, and (3) engaging in a pattern of racketeering activity with others in order to systematically pay significantly less than is legally owed on treatment provided by Plaintiffs to State Farm insureds.

State Farm filed the present Motion to Dismiss the Amended Complaint (Doc. No. 14). State Farm seeks to have five counts of the Amended Complaint dismissed for failure to state a claim under Rule 12(b)(6), and to have Count III, a state law claim, dismissed for lack of independent jurisdiction, or alternatively to dismiss the Plaintiffs’ demand for attorney’s fees as to that Count. For the reasons that follow, the Court grants in part and denies in the part the Motion to Dismiss.

II. FACTUAL BACKGROUND

Dr. Schatzberg is a licensed chiropractor and owner of a large chiropractic and pain management practice with four locations in the greater Philadelphia area, including Philadelphia Pain Management, Inc. Am. Compl. ¶ 7. Many of Dr. Schatzberg’s patients have suffered injuries as a result of automobile accidents, and his treatment is sometimes billed to insurance companies like State Farm pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law (75 Pa. Cons.Stat. § 1701, et seq.) (“MVFRL”). Id. ¶ 8. Dr. Schatzberg alleges that because of his large practice, which is “a significant source of auto claim expense to State Farm ... [his] practice has been targeted for destruction by State Farm pursuant to a revenue strategy implemented by State Farm beginning in the 1990’s called ACE.” Response at 15 (citing Am. Compl. ¶¶ 10-41).

According to Dr. Schatzberg, State Farm began implementing the “Advancing [239]*239Glaims Excellence” (“ACE”) program in an effort to reduce claim payouts by approximately one billion dollars per year. Id. ¶¶ 16-23. One element. of this cost reduction program is to characterize all claims for soft tissue injuries in motor vehicle accidents as potentially fraudulent, and to pursue the doctors who treat such injuries for perpetuating such fraud. Id. ¶¶ 28-31. State Farm allegedly executes the ACE program by enlisting State Farm’s fraud unit, the Special Investigations Unit (“SIU”), and outside counsel to investigate and litigate against any and all claimants who have sustained, and doctors who have treated, soft tissue injuries in motor vehicle accidents regardless of whether cause for suspicion exists. Id. ¶¶ 30-31. These fraud investigations are designed to create a public perception that the claimants and the doctors are suspected of fraud or other wrongdoing. Id. ¶¶ 51-52, 64. Accordingly, once the legal and medical communities learn of a State Farm investigation, word spreads, and the stigma of a fraud investigation quickly serves to isolate and destroy the business of the targeted provider or facility irrespective of wrongdoing. Id. Dr. Schatzberg claims that the ACE program allegedly achieves success when it can eliminate the business of a provider that represents a significant source of claim expense for State Farm. Id. ¶¶ 40-53.

In the Philadelphia region, SIU adjuster Mr. Doug Babin, and the law firm of attorney Cy Goldberg are allegedly most often involved in implementing the ACE program and performing investigations. Id. ¶¶ 44, 59. Mr. Goldberg is alleged to have a reputation for using aggressive tactics to target medical providers for fraud in civil litigation on behalf of State Farm. Id. ¶¶ 58-69. In particular, Dr. Schatzberg claims that Mr. Goldberg “uses the civil process to collect information about providers and provide[s] an opinion as to whether State Farm might be able to use said information to bring a civil lawsuit alleging fraud against the targeted provider.” Id. ¶ 62. Indeed, since 2001, State Farm has retained Mr. Goldberg to investigate and bring at least eight (8) different lawsuits against various medical providers that were flagged by the SIU.1 Id. ¶ 67. It is further alleged that because of Mr. Goldberg’s reputation for aggressively pursuing fraud claims on behalf of State Farm, “his involvement alone sends State Farm’s desired message that a facility is being targeted.” Id. ¶ 69.

In addition to supposedly aggressive investigative and litigious practices, State Farm also allegedly reduces claims payouts pursuant to the ACE program by manipulating the peer review process of the MVFRL.2 Id. ¶ 117. State Farm contracts with specific peer review organizations, such as Rehabilitation Planning, Inc., according to Dr. Schatzberg, to obtain favorable peer review reports in exchange for giving the peer review organization a steady source of business. Id. ¶¶ 129, 131-32. In particular, Rehabilitation Planning, Inc. purportedly assigns a great many of these alleged “sham” peer reviews of chiropractic treatments to Jane McBride, D.C. Id. ¶¶ 138-39.

[240]*240Dr. Sehatzberg alleges that State Farm has singled him and his chiropractic practice out for destruction in accordance with its ACE program. Id. ¶ 74. State Farm has allegedly targeted Dr. Sehatzberg in a number of ways. First, Mr. Babin allegedly called Ms. Arlene O’Brien and other current and former employees of Dr. Sehatzberg to (1) inform them that he is a “fraud investigator,” (2) explain that State Farm was investigating Dr. Schatzberg’s billing practices, and (3) give these individuals the impression that State Farm possesses facts that establish Dr. Sehatzberg is engaged in fraud. Id. ¶¶ 75-82.

Second, at State Farm’s direction, Mr. Goldberg allegedly began investigating and pursuing civil litigation against Dr. Sehatzberg in various third and first party cases. Id. ¶ 83-85. Dr. Sehatzberg alleges that these cases were brought for the dual purposes of conducting a fishing expedition into his billing practices and to send a message that State Farm has information suggesting Dr. Sehatzberg is engaged in fraud. Id. Specifically, in one case, Mr. Goldberg, on behalf of the defendant against the plaintiff, Mr. Terry Martin, a patient of Dr. Sehatzberg, allegedly (1) compelled the deposition of a billing clerk to inquire about the administration and mechanics of Dr. Schatzberg’s practice, and (2) refused to take the trial testimony of a chiropractor via videotape to accommodate his work schedule. Id. ¶¶ 90-91.

Third, in the case of Mr. Anthony Full-wood, another patient of Dr. Sehatzberg, an SIU adjuster from State Farm named Nova Crespo sent a letter to the offices of Dr. Sehatzberg and Mr. Fullwood’s attorney on March 11, 2010 stating that Mr. Fullwood’s claim for payment of Dr. Schatzberg’s medical bills was “under investigation.” Id. ¶ 102. Ms. Crespo sent the same letter to the offices of both Dr. Sehatzberg and Mr.

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Cite This Page — Counsel Stack

Bluebook (online)
877 F. Supp. 2d 232, 2012 U.S. Dist. LEXIS 96567, 2012 WL 2864475, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schatzberg-v-state-farm-mutual-automobile-insurance-paed-2012.