Government Employees Insurance Company v. Zaitsev, 1:20-cv-03495

GEICO, as plaintiff, seeks summary judgment against Dr. Alexandr Zaitsev and Ridgewood Diagnostic Laboratory for allegedly unlawful insurance billing related to urine drug tests (UDT).
Plaintiffs allege Zaitsev covertly owned and controlled two referring medical practices (Tri-State and Riverside), and unlawfully directed patient referrals to his own lab, Ridgewood.
Plaintiffs further allege that Ridgewood billed GEICO for unauthorized or medically unnecessary UDT services, including for tests never ordered by a physician.
Defendants deny Zaitsev's ongoing ownership or control, claiming sales to other physicians; and argue factual disputes preclude summary judgment, relying especially on Zaitsev’s affidavit.
Plaintiffs challenge the credibility of Zaitsev’s affidavit as a sham, pointing to contradictory prior testimony and unsupported claims about practice ownership transfers.
The court’s consideration centers on whether material facts are genuinely disputed and the legal implications of self-referral, unauthorized testing, and the sufficiency of expert reports.

Issue	Plaintiff's Argument	Defendant's Argument	Held (Court's Ruling)
Is Zaitsev’s affidavit credible evidence?	Contradicts his prior sworn testimony; should be disregarded as a sham.	Zaitsev disputes continued ownership; factual disputes exist, precluding summary J.	Affidavit disregarded where contradicted; evidence favors GEICO.
Liability for self-referral scheme	Secret ownership/control violates self-referral prohibitions & makes billing illegal.	Even if proven, self-referral doesn't affect Ridgewood's reimbursement eligibility.	Self-referral renders defendants liable for disgorgement.
Billing for unauthorized or unnecessary UDT	Ridgewood billed and was paid for unauthorized and medically unnecessary UDT.	Knowledge and intent lacking; plaintiff can’t prove fraud, no liability.	Liability attaches regardless of intent for these claims.
Sufficiency of Dr. Murphy’s report	Unsworn & conclusory expert report is inadmissible and doesn't create issue of fact.	Report creates factual dispute; summary judgment improper.	Unsworn/conclusory report insufficient to preclude S.J.

Margo v. Weiss, 213 F.3d 55 (2d Cir. 2000) (self-serving affidavits contradicting prior deposition testimony disregarded)
State Farm Mut. Auto. Ins. Co. v. Mallela, 4 N.Y.3d 313 (N.Y. 2005) (civil liability for billing while not lawfully licensed)
Corsello v. Verizon N.Y., Inc., 967 N.E.2d 1177 (N.Y. 2012) (unjust enrichment claim is not duplicative if it provides relief unavailable under contract/tort)
Jeffreys v. City of New York, 426 F.3d 549 (2d Cir. 2005) (court may disregard unsupported, inconsistent testimony)
Scott v. Harris, 550 U.S. 372 (2007) (summary judgment appropriate if one version of facts is blatantly contradicted by the record)
Maryland Cas. Co. v. Rosen, 445 F.2d 1012 (2d Cir. 1971) (declaratory judgment must resolve a real controversy between parties)