State Farm Alleges $2.6M Auto Insurance Fraud By New Jersey Chiropractors, Doctors
State Farm Alleges $2.6M Auto Insurance Fraud By New Jersey Chiropractors, Doctors
$2.6M Auto Insurance Fraud By New Jersey Chiropractors, Doctors – State Farm
State Farm Insurance claims that since 2014, a fraudulent medical scheme has been taking advantage of New Jersey’s personal injury protection (PIP) benefits law. State Farm is fighting this claim.
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The insurer is requesting a declaratory ruling that it is not required to pay any additional claims made by the accused scheme’s providers in addition to recovering $2.6 million in what it believes are fraudulent motor injury claims.
12 chiropractic and spinal clinics and doctors are accused of fraud, unjust enrichment, and violations of the New Jersey Insurance Fraud Prevention Act in the lawsuit filed by State Farm. According to the insurer, these providers employed a “predetermined protocol” for all patients and a patient referral system for services that were either not rendered or were not medically required for the specific patients. According to the lawsuit, the services were actually provided to enrich the defendants by taking advantage of the patients’ eligibility for PIP benefits.
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The suit accuses the providers of failing to legitimately evaluate patients to determine the true nature of their injuries and of reporting the same or similar findings for all patients to justify a predetermined course of treatment that was substantially the same for all patients.
State Farm Alleges $2.6M Auto Insurance Fraud By New Jersey Chiropractors, Doctors
Part of the “predetermined protocol” for patients with soft-tissue injuries of the neck and back consisted of hot and cold packs, chiropractic manipulations, massage, mechanical traction, physical medicine and rehabilitation, and manual therapy, administered to almost every patient on almost every visit, regardless of each patient’s unique circumstances and needs, according to the complaint.
Also, according to the insurer, the chiropractors would refer patients to diagnostic clinics, some allegedly illegally owned by the chiropractors, for an “unnecessary and predetermined course of pain management and invasive treatments” including injections. State Farm says the doctors would submit false documentation for each case representing that the treatments were legitimately performed and medically necessary.
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The 80-page complaint details case after case where the patient’s responses to questions and tests were the same or similar, allegedly serving as a “pretext to justify” the chiropractors’ wide range of treatments.
State Farm Guaranty and State Farm Indemnity claim they are entitled to compensatory damages, together with interest and costs.
State Farm Alleges $2.6M Auto Insurance Fraud By New Jersey Chiropractors, Doctors
New jersey’s Automobile Insurance Cost Reduction Act (AICRA) requires automobile insurers to provide PIP benefits to pay for medically reasonable, necessary and appropriate treatment. An insured is permitted to assign his or her right to PIP benefits to healthcare providers for payment of their treatment. Providers can submit claims directly to insurers.
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The defendants in the complaint filed in U.S. District Court for New Jersey are Tri-County Chiropractic and Rehabilitation Center, Robert Matturro, D.C., Advanced Spine and Pain Management, Varinder Dhillon, M.D., Nicholas Rosania, D.C., Bloomfield UAI, Dov Rand, M.D., Primary Medical Services, Louis J. Citarelli, M.D., Chiro Health Center P.C., Marc Matturro, D.C. and Marco Tartaglia, M.D.
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