State Farm Mutual Automobile Insurance Company v. Lewin, D.C.

CourtDistrict Court, M.D. Florida
DecidedApril 20, 2021
Docket8:20-cv-02428
StatusUnknown

This text of State Farm Mutual Automobile Insurance Company v. Lewin, D.C. (State Farm Mutual Automobile Insurance Company v. Lewin, D.C.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Mutual Automobile Insurance Company v. Lewin, D.C., (M.D. Fla. 2021).

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION

STATE FARM MUTUAL AUTOMOBILE INSURANCY COMPANY, and STATE FARM FIRE AND CASUALTY COMPANY,

Plaintiffs, v. Case No. 8:20-cv-2428-VMC-TGW

ROBERT LEWIN, D.C., et al.,

Defendants. /

ORDER This matter comes before the Court upon consideration of Defendants Robert Lewin, D.C., 1-800-411-PAIN Referral Service, LLC, Path Medical, LLC, and Path Medical Center Holdings, Inc.’s Motion to Dismiss (Doc. # 32), and Defendants David Cheesman, D.O., Chintan Desai, M.D., Ralph Marino, M.D., Tie Qian, M.D., Roger Ramos, M.D., Donald Thomas III, M.D., Nelson Vazquez, M.D., Michael Wilensky, M.D., Brittany Chong, D.C., Ronald Golden, D.C., William Kurzbuch, D.C., Frank Lassiter, D.C., Adam Lewis, D.C., Dheeraj Manocha, D.C., Lisa Nerbonne, D.C., Kieron Parchment, D.C., Joseph Sefick, D.C., and Sarah Vleko, D.C.’s Motion to Dismiss and to Join and Adopt Motion to Dismiss (Doc. # 33), both filed on January 8, 2021. Plaintiffs State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company responded to both Motions on February 5, 2021. (Doc. # 54). With leave of Court, Defendants replied on February 24, 2021. (Doc. # 57). For the reasons set forth below, the Motions are granted in part and denied in part. I. Background This case arose out of Defendants’ alleged scheme of fraudulently collecting personal injury protection insurance (“PIP” insurance) benefits from Plaintiffs. (Doc. # 1 at ¶

1). Plaintiffs are insurers and Defendants are legal and medical referral services, health care clinics, and health care clinic owners, medical directors, and chiropractors. (Id. at ¶¶ 1-2, 15-16). Specifically, Dr. Lewin is a chiropractor who, at the relevant times, owned 1-800-411- PAIN, a now dissolved legal and medical referral service for individuals in automobile accidents, and Path Medical Center Holdings, which owns Path Medical. (Id. at ¶¶ 2, 17-18). Path Medical “consists of twenty-eight licensed health care clinics located in [the] Orlando, Tampa, and South Florida areas.” (Id. at ¶¶ 2, 19). Dr. Cheesman, Dr. Desai, Dr. Marino, Dr. Qian, Dr. Ramos, Dr. Thomas, Dr. Vazquez, and Dr.

Wilensky are physicians who served as medical directors of the various Path Medical clinics. (Id. at ¶¶ 2, 20-28). Dr. Chong, Dr. Golden, Dr. Kurzbuch, Dr. Lassiter, Dr. Lewis, Dr. Manocha, Dr. Nerbonne, Dr. Parchment, Dr. Sefick, and Dr. Vleko are chiropractors who worked at the Path Medical clinics. (Id. at ¶¶ 2, 29-38). Plaintiffs aver that Defendants entered into a complex, multifaceted scheme to exploit patients’ PIP benefits by submitting or causing to be submitted fraudulent bills for medically unnecessary and unlawfully rendered services. (Id. at ¶¶ 1, 3). The scheme involved Dr. Lewin and 1-800-411-PAIN

“soliciting and steering individuals involved in auto accidents to Path Medical through a multi-million dollar marketing campaign that urges them to call [1-800-411-PAIN] purportedly for legitimate legal and medical referrals.” (Id. at ¶¶ 4, 39, 61-80). At least some of those callers were then referred to Path Medical clinics. (Id. at ¶¶ 4, 70, 77). Despite these referrals, Defendants allegedly caused these patients to sign forms falsely representing that they were not solicited by any person to seek medical services from Path Medical. (Id. at ¶¶ 4, 78-80). Once the individuals became Path Medical patients, Defendants allegedly performed services on those patients

pursuant to a “predetermined protocol,” designed to provide patients with medically unnecessary services so as to exploit their PIP insurance benefits. (Id. at ¶ 5). The predetermined protocol allegedly included: (1) “failing to legitimately examine patients to determine the true nature and extent of their injuries;” (2) “documenting a litany of diagnoses for each patient, most often exceeding ten or more diagnoses per patient, including predetermined findings of sprains and/or strains, to justify a predetermined course of medically unnecessary treatment;” (3) “falsely documenting [that] patients had sustained an emergency medical condition . . .

as a result of their auto accident to maximize Defendants’ collection of [PIP insurance benefits];” (4) routinely providing medically unnecessary durable medical equipment . . . to patients;” (5) “providing the predetermined course of treatment to patients, [consisting] of five or more modalities on virtually every visit;” (6) “ordering medically unnecessary x-rays and [magnetic resonance imaging (“MRIs”);]” and (7) “performing final examinations falsely documenting [that] nearly every discharged patient . . . suffers from a permanent impairment, despite receiving the extensive battery of services in the [p]redetermined [p]rotocol.” (Id.). Path Medical would then submit bills for

these services to Plaintiffs. (Id.). In support of this alleged predetermined protocol, Plaintiffs provide examples of individuals who were treated following the same accident and were subject to “the same or nearly identical treatment” and “discharged with impairments on or about the same date.” (Id. at ¶¶ 105-06). For example: [P]atient E.B.A., a thirty-one-year-old female, and patient J.G.O., a forty-two year old male, were involved in the same auto accident on February 21, 2017. Both patients began treatment at Path Medical-Kissimmee on the same day – February 22, 2017. On that date, Cameron Banks, D.C. prepared Initial Exam Reports for patients E.B.A. and J.G.O., diagnosed them with sprains/strains in multiple regions of the spine, recommended a predetermined course of treatment, and referred each patient for MRIs to “rule out internal derangement[.]” On March 1, 2017, Path Medical-Apex performed cervical and lumbar MRIs on patients E.B.A. and J.G.O. Desai prepared reports purporting to document his interpretation of each patient’s MRIs, all of which reflected “herniations” and “bulges” of the cervical and lumbar spine. On March 29, 2017, Marino purportedly examined patients E.B.A. and J.G.O., diagnosed them with cervical and lumbar sprains/strains, recommended continued treatments, and documented they had both sustained an [emergency medical condition]. Pursuant to the predetermined course of treatment, patients E.B.A. and J.G.O. received the same litany of medically unnecessary treatment modalities, which consisted of at least five modalities across [twenty-one] dates of service. On May 3, 2017, Marino purportedly performed a final examination of patients E.B.A. and J.G.O. Although neither patient reported any pain, Marino diagnosed patients E.B.A. and J.G.O with a cervical sprain/strain, lumbar sprain/strain, and various “herniations” and “bulges” of the cervical and lumbar spine, and discharged both patients with a permanent impairment.

(Id. (citations omitted)). Plaintiffs aver that such uniformity of treatment is not “credible given the unique circumstances presented by each patient, including each patient’s physical characteristics, symptoms, history, ability to participate in treatment, and his or her response thereto.” (Id. at ¶ 107). Plaintiffs also provide an exhibit with examples of patients who were provided with MRIs, despite the fact that they suffered only soft tissue injuries, for which “MRIs are rarely indicated, and almost never indicated in multiple

regions of the spine and body simultaneously, especially on a patient’s first date of treatment.” (Id. at ¶ 109; Doc. # 1-21). The complaint further provides examples of patients for whom MRIs were medically unnecessary, as exemplified by the fact that the MRI results were not utilized to alter the patients’ treatment plans. (Doc. # 1 at ¶¶ 112, 114). For instance, M.M.B. initiated treatment at Path Medical on February 9, 2017.

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State Farm Mutual Automobile Insurance Company v. Lewin, D.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-company-v-lewin-dc-flmd-2021.