State Farm Mutual Automobile Insurance v. Philly Family Practice, Inc.

525 F. Supp. 2d 718, 2007 U.S. Dist. LEXIS 87433
CourtDistrict Court, E.D. Pennsylvania
DecidedNovember 27, 2007
DocketCivil Action 05-2081
StatusPublished
Cited by4 cases

This text of 525 F. Supp. 2d 718 (State Farm Mutual Automobile Insurance v. Philly Family Practice, Inc.) 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
State Farm Mutual Automobile Insurance v. Philly Family Practice, Inc., 525 F. Supp. 2d 718, 2007 U.S. Dist. LEXIS 87433 (E.D. Pa. 2007).

Opinion

MEMORANDUM

EDUARDO C. ROBRENO, District Judge.

An insurance company sued several health-care providers for fraud and racketeering based on their alleged participation in a scheme to submit false bills for treatment of injuries purportedly sustained in certain staged accidents. The parties settled the case and executed a release. The insurance company and a related entity subsequently brought the instant suit against several health-care providers, some of whom are affiliated with the defendants in the prior action, for fraud and racketeering, also based on alleged participation in a scheme to submit false bills.

Certain defendants now move for summary judgment on the basis that the release executed in the prior case bars all of the plaintiffs’ claims against them in this case. Plaintiffs argue that the scope of the *720 release is limited to only certain acts of insurance fraud and does not cover the fraud alleged in this case, that the release applies to only one of the plaintiffs, and that the release applies to only certain defendants.

For the reasons that follow, the motions for summary judgment will be denied.

I. BACKGROUND

A. The Makñs Case: Parties

On October 19, 2001, State Farm Mutual Automobile Insurance Co. (“State Farm Mutual”) brought suit against certain health-care providers and related persons in this Court. See State Farm Mut. Auto. Ins. Co. v. Makris, No. Civ. A. 01-5351 (E.D.Pa.2001). One of the defendants in the Makris case, Rennard Health Care, Inc. (“Rennard Inc.”), is also a defendant in the instant case. On March 10, 2003, the parties settled the Makris case, and State Farm Mutual voluntarily dismissed its claims and executed a settlement agreement and release in favor of Rennard Inc.

B. The Instant Case: Parties

On May 3, 2005, State Farm Mutual and State Farm Fire and Casualty Co. (“State Farm Fire”) sued certain health-care providers. This is the case sub judice. Defendants in this case are Rennard Inc.; Rennard Health Care, P.C. (“Rennard P.C.”); Philly Family Practice, Inc.; Advanced Family Medicine, P.C.; Management Services of PA, Inc.; Hav Moeung; Alexander Tarnopolsky; Bernard Snyder; Joseph Mandale; and Lana Mandale.

Before the Court are the motions for summary judgment filed by Alexander Tarnopolsky and Rennard P.C. (doc. no. 156), and Joseph Mandale, Lana Mandale, and Management Services of PA, Inc. (doc. no. 158). 1

C.The Makris Case: The Complaint

The second amended complaint filed in the Makris case was the operative complaint at the time the release was executed. It was filed on June 11, 2003, and it alleged in relevant part:

Defendants were active participants in a scheme to defraud State Farm and other insurers by staging automobile accidents, alleging phony injuries as a result of the staged accidents, preparing, and assisting in the preparation of, false and fraudulent medical reports and bills alleging injuries never sustained and treatment never provided, and filing of false and fraudulent insurance claims with State Farm and other insurers under various policies for first party benefits, uninsured and underinsured motorist benefits, property damage payments and payments for bodily injury claims.
Defendants were active participants in a scheme to defraud State Farm by making, and assisting in making, false and fraudulent insurance claims under State Farm automobile insurance policies and initiating third-party claims against State Farm insureds seeking *721 payment for pain and suffering allegedly suffered in the staged accidents.
It was further part of the scheme to defraud State Farm that defendants created and submitted documents including bills, medical reports, treatment records and other documents that:
a. reported false examination findings and provided unnecessary physical therapy and chiropractic treatment to “support” billing for certain examinations and to justify the need for ongoing treatment;
b. documented examinations, modalities and treatments not rendered;
c. reported and billed for treatment that was excessive and/or unnecessary and/or redundant;
d. prescribed durable medical equipment that was medically unnecessary.
The relief sought by State Farm against defendants includes claims for compensatory damage to recover payments made by State Farm to defendants in third-party and uninsured and underinsured motorist claims, property damage claims and payments made on behalf of defendants by State Farm under medical payment coverage for treatment allegedly provided to defendants for the injuries they falsely claimed to have suffered as a result of the staged accidents.
The scheme to defraud is based upon a series of alleged motor vehicle accidents, including but not limited to those described below ....
It was part of the conspiracy and scheme to defraud State Farm that passengers in the vehicles that were involved in staged accidents were referred to medical facilities, in most cases Ren-nard and Philmont, for phony medical treatment. In the furtherance of the scheme to defraud, fraudulent medical reports, bills and other records were prepared by defendant doctors Fayn-berg and Berdichevsky on behalf of Rennard and Philmont and sent to State Farm to obtain payment on behalf of defendant doctors and facilities. These reports, bills or other records were false and fraudulent in that they concerned physical examinations and physical therapy treatments at defendants facilities which were never provided or were unnecessary.

Second Am. Compl., Makris, ¶¶ 2-5, 38, 45 (doc. no. 158, ex. E).

State Farm Mutual then listed five allegedly staged accidents — those occurring on December 19, 1996; November 18, 1997; April 20, 1998; April 30, 1998; and June 24,1999 — and alleged that the motorists purportedly injured in the accidents went to Rennard Inc., and other medical facilities, to receive treatment even though they were not in fact injured. Id. ¶¶ 48-81. The “relevant times to this action” were alleged to be from 1996 to the “present,” i.e., the filing date of the second amended complaint, June 11, 2003. Id. ¶ 7.

D. The Instant Case: The Complaint

The first amended complaint is the relevant complaint in this case. It was filed on May 16, 2006, and it alleges:

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Cite This Page — Counsel Stack

Bluebook (online)
525 F. Supp. 2d 718, 2007 U.S. Dist. LEXIS 87433, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-v-philly-family-practice-inc-paed-2007.