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Geico Seeks $2.3M From Med Center In Insurance Fraud Suit
JERSEY CITY, NJ - Geico is seeking to recover more than $2.3 million from a group of pain management providers, telling a New Jersey federal court that the providers charged no-fault insurance patients for services that were not necessary or never provided. In a 142-page complaint Wednesday, Geico accused doctor Serge Menkin, chiropractor Lawrence Petracco, both based in New Jersey, and several entities that Menkin and Petracco either own or serve as director, of billing no-fault insurance patients for fraudulent services. "The defendants do not now have — and never had — any right to be compensated for the fraudulent services that they billed or caused to be billed to Geico," the insurer said and added that the defendants "masterminded and implemented" the scheme since 2018.
According to the complaint, the Center for Joint and Spine Relief is a purported multidisciplinary medical-chiropractic practice that provides services such as medical exams, pain management injections and more. Geico said Petracco has been a majority owner of the center, at least since 2018. The insurer added that Petracco cannot lawfully own a majority interest in a multidisciplinary medical-chiropractic practice because he is a chiropractor rather than a physician. Menkin served as the center's medical director, Geico said, and owned United Care Medical PLLC and Advanced Pain Solutions PC. Geico asserted that thousands of fraudulent no-fault insurance charges were submitted through the center, United Care and Advanced Pain Solutions. The defendants were not eligible to receive no-fault insurance reimbursement because they were not in compliance with all New Jersey and New York laws relating to health care practice and/or licensing, Geico argued, among other reasons.
The insurer accused the defendants of providing "as many chiropractic and physical therapy services as possible to the insureds, without regard for medical necessity," as well as misrepresenting things such as how much time was spent on follow-up exams and the severity of the insureds' presenting problems. The defendants hired law firms to pursue collection of the fraudulent charges from it and other insurers, Geico said, and the firms would "routinely" file "expensive and time-consuming arbitration" against insurers if the charges weren't promptly paid in full.
"Based upon the defendants' material misrepresentations, omissions, and other affirmative acts to conceal their fraud from Geico,
Geico did not discover and could not reasonably have discovered that its damages were attributable to fraud until shortly before it filed this complaint," the insurer said. Counsel for Geico declined to comment Thursday. Menkin, Petracco and a representative for the Center for Joint and Spine Relief did not immediately respond to requests for comment. Geico is represented by Gene Y. Kang of Rivkin Radler LLP. The case is Government Employees Insurance Co. et al. v. Menkin M.D. et al., case number 3:23-cv-02184. in the U.S. District Court for the District of New Jersey.
Source: law’360. com
D.A. Gascon Seeks Additional Victims in Case of Man Accused of Impersonating a Doctor
LOS ANGELES, CA - Los Angeles County District Attorney George Gascon announced today that a man has been charged for falsely claiming to be a licensed doctor and practicing medicine on thousands of individuals, offering treatment for serious medical conditions including cancer for several years.
“Practicing medicine without a license is not only a criminal activity in California, it can cause irreparable harm to the health of unsuspecting people, some with serious illnesses, who believe they are under the care of a licensed physician,” District Attorney Gascon said. Gevorkian’s preliminary hearing was scheduled for May 24 in Department 36 of Foltz Criminal Justice Center. The case was filed for warrant on April 19.
On November 17, 2022, an undercover investigator received consulting from Gevorkian, who owns and operates Pathways Medical in North Hollywood. The business conducts blood tests on patients, advises them on treatments and offers treatment for serious conditions including cancer and viral infections. In the consultation, Gevorkian allegedly failed to accurately address abnomial levels of a hormone that could indicate a serious medical condition. The case is being investigated by the California Department of Consumer Affairs, Division of Investigation and prosecuted by the District Attorney’s Consumer Protection Division.
Anyone who believes they may have been a victim in this case should call the Consumer Protection hotline at (213) 257-2465.
Source: Los Angeles District Attorney’s Office
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