GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO INDEMNITY COMPANY, GEICO GENERAL INSURANCE COMPANY, GEICO CASUALTY COMPANY, Plaintiffs, -against- LIANA BINNS, N.P., et al., Defendants.
Case 1:22-cv-01553-NGG-PK
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK
September 28, 2022
NICHOLAS G. GARAUFIS, United States District Judge
MEMORANDUM & ORDER
MEMORANDUM & ORDER
NICHOLAS G. GARAUFIS, United States District Judge.
Pending before the court is Plaintiffs’ motion to (1) stay all pending collection arbitrations; (2) enjoin Defendants from commencing any additional arbitration or state court collection
I. BACKGROUND1
The Government Employees Insurance Company, together with certain related companies (collectively, “GEICO“), brought this action. GEICO alleges that it has been the target of a no-fault insurance fraud scheme carried out by the thirty-eight individuals and entities named in the Complaint and certain unidentified others. A majority of the named Defendants are healthcare professionals and one professional limited liability company (the “Healthcare Defendants“). (Compl. (Dkt. 1) ¶¶ 11-77.) The remaining Defendants (the “Management Defendants“) are not healthcare professionals, but have “secretly and unlawfully owned, controlled, and derived economic benefit from” the services provided by the Healthcare Defendants “in contravention of New York law.” (Id. ¶¶ 78-81.)2
A. New York‘s No-Fault Insurance Scheme
In New York, an insurer is required provide certain no-fault insurance benefits (“Personal Injury Protection” or “PIP Benefits“) to the individuals that they insure (“Insureds“). PIP Benefits cover up to $50,000 of necessary healthcare expenses that result from automobile accidents. See
Providers are prohibited from receiving PIP Benefits if they fail to meet any applicable New York licensing requirement. Id. § 65-3.16(a)(12); see also State Farm Mut. Ins. Co. v. Mallela, 4 N.Y.3d 313, 321 (2005). This includes, inter alia, that unlicensed professionals may not own or control a professional healthcare practice, employ or supervise other healthcare professionals, or derive economic benefit from professional healthcare services. See
Under the no-fault insurance scheme, insurers must pay PIP Benefits within 30 days of the claimant‘s provision of proof of the claim. See
B. Operation of the Alleged Scheme
According to GEICO, around June 2019, the Management Defendants recruited the Healthcare Defendants to “serve as the nominal or ‘paper’ owners of the professional healthcare practices operated in their names” in exchange for compensation. (Compl. ¶¶ 143-44.) The Healthcare Defendants then worked in various clinics (the “Clinics“) throughout the New York area. (Id. ¶ 164.) The Healthcare Defendants treated patients who were referred to the Clinics by personal injury attorneys or “through a network of individuals . . . who were paid by the Management Defendants for each Insured that they delivered.” (Id. ¶¶ 157, 162.)3 Once Insureds arrived at the Clinics, they would be further
The Healthcare Defendants treated the Insureds as if they had significant injuries and health problems in order to maximize reimbursements from insurance companies, despite the fact that most were involved in “relatively minor accidents, to the extent that they were involved in any actual accidents at all.” (Id. ¶ 172.) One of the Healthcare Defendants would conduct an initial examination in which the Insured would be given a diagnosis that would allow for extensive no-fault insurance billing. (Id. ¶ 180.) The Healthcare Defendants used a billing code for this initial examination that misrepresented the severity of injuries, the amount of time spent on examinations, the extent of the physical examination and medical decision-making, and the existence of consultation reports. (See id. ¶¶ 186-240.) Then, the Insureds would come back for a series of follow-up examinations, during which the Healthcare Defendants would perform medically unnecessary, high-billing value procedures, primarily dry-needling. (Id. ¶¶ 241, 243-45, 269, 273.) Dry-needling therapy should typically not be administered until more conservative therapies, such as rest, physical therapy, and massage, have been used, and symptoms have nonetheless persisted for more than three months. (Id. ¶¶ 275-76.) These types of injections should not be administered more frequently than every other month. (Id. ¶ 278.) However, the Healthcare Defendants regularly submitted reimbursement claims for dry-needling within a month of an automobile accident—frequently within days of the accident—and subjected the Insureds to an extreme amount of dry-needling. (Id. ¶¶ 280-81.)
In the course of this scheme, Defendants submitted bills seeking more than $6.4 million in no-fault benefits. (See Asmus Decl. ¶ 6.) GEICO has already paid the Defendants more than $2.6 million in no-fault claims. (See id. ¶ 7.) At the time this motion was filed, Defendants were prosecuting over 950 arbitrations against GEICO, seeking to collect a total of more than $1.6 million in no-fault damages, with an average ad damnum of under $1,600 per arbitration proceeding, in addition to 470 civil court suits. (See id. ¶¶ 7-8; Mot. at 10.) There is more than $4.3 million in pending no-fault insurance claims that have been submitted to GEICO by Defendants. (Compl. ¶ 3.)
C. Evidence of the Alleged Scheme
In support of its fraud claim, GEICO has submitted affidavits from two of the Healthcare Defendants, Julia Kay and Eyriney Azer, who have settled with the company, and a chart, totaling over 750 pages, of allegedly fraudulent no-fault claims submitted by Defendants, which are merely a “representative sample.” (Compl. ¶ 7.) The affidavits tell very similar stories of being hired by a woman named “Wilma,” presumably Wilma Tanglao, one of the Management Defendants. (See Kay Aff. (Dkt. 124-4) ¶¶ 7-8; Azer Aff. (Dkt. 124-5) ¶ 9.) In their interviews, Wilma informed Kay and Azer that they would be providing dry-needling to motor
When Insureds arrived at the Clinics, the front desk personnel would send them to Kay or Azer‘s examination room. (See Kay Aff. ¶ 13; Azer Aff. ¶ 14.) Kay typically used only one needle, and Azer typically used approximately ten needles, as each was taught. (See Kay Aff. ¶ 14; Azer Aff. ¶ 15.) Neither affiant ever performed an examination or consultation of any patient nor filled out any examination reports. (See Kay Aff. ¶ 15; Azer Aff. ¶ 16.) At one point, Kay was contacted by an individual who identified himself as Dr. Parisien, who told Kay to indicate on the forms that each patient required sixteen to twenty needles, even though the actual amount was never more than two or three. (See Kay Aff. ¶ 16.)
D. Procedural History
On March 21, 2022, GEICO initiated this action. (See Compl.) In its 139-count Complaint, GEICO alleges violations of the Racketeering Influenced Corrupt Organizations Act,
On July 22, 2022, Defendants Kyungsook Bu, N.P. (“Bu“) and Wellbeing NP in Family Health PLLC (“Wellbeing NP,” and together, the “Bu Defendants“), two of the Healthcare Defendants, filed a motion in opposition, arguing that GEICO‘s motion should be denied as against them. (See Opp. (Dkt. 124-7).) GEICO filed its Reply on July 29, 2022. (See Reply (Dkt. 124-8).) At the time that the fully briefed motion was filed, most of the named Defendants had not appeared, so GEICO had started to seek certificates of default. Subsequently, on August 18, 2022, an attorney entered a notice of appearance for all remaining
E. Involvement of the Bu Defendants
Because the court must now consider only whether it should stay and enjoin collection proceedings involving the Bu Defendants, the court provides a brief overview of their involvement. Bu is a licensed nurse practitioner, who “falsely purported to own and control Bu Medical and Wellbeing NP.” (Compl. ¶ 13.) Bu is purportedly the sole member of Wellbeing NP, which “is a New York professional limited liability company,” but GEICO alleges that it has actually “been owned and controlled by unlicensed non-professionals since at least 2021.” (Id. ¶ 15.) Bu Medical, which has not been named as a Defendant in this action and has not opposed GEICO‘s motion, “is an unincorporated healthcare practice that is purportedly owned by Bu, but in actuality has been owned and controlled by unlicensed non-professionals since at least 2019.” (Id. ¶ 14.)
GEICO submitted charts with 3,792 entries of allegedly false claims made by Bu and 3,373 made by Wellbeing NP. (See Bu Chart (Dkt. 1-4); Wellbeing NP Chart (Dkt. 1-5).) And these are merely “a representative sample of the fraudulent claims that have been identified to-date.” (Compl. ¶ 7.) Two examples drawn from the charts that are described in the Complaint illustrate the fraudulent nature of the claims:
On June 19, 2021, an Insured named LB was involved in an automobile accident. Though LB could not have experienced persistent pain symptoms or failed conservative treatments less than a week after the accident, Bu and Wellbeing NP—at the direction of the Management Defendants—purported to administer more than a dozen dry needling injections to LB on June 22, 2021, three days after the accident. (Id. ¶ 282(xi).)
Though GEICO alleges that it has paid $977,000 to Defendants for fraudulent no-fault claims, only $40,000 is attributable to Defendant Bu and $57,000 to Defendant Wellbeing NP, for a total of $97,000. (See id. ¶ 1, (F)-(M).) The parties have not apprised the court of what percentage of the outstanding $4.3 million in pending no-fault insurance claims involve the Bu Defendants.
II. DISCUSSION
In determining whether to enjoin a proceeding or issue a stay, courts in this Circuit have employed the preliminary injunction standard. See Allstate Ins. Co. v. Elzanaty, 929 F. Supp. 2d 199, 217 (E.D.N.Y. 2013); see also Moore v. Consol. Edison Co. of N.Y., 409 F.3d 506, 510 (2d Cir. 2005).4 “[A] movant must demonstrate (1) irreparable harm absent injunctive relief; and (2) either a likelihood of success on the merits, or a serious question going to the merits to make them a fair ground for trial, with a balance of hardships tipping decidedly in the plaintiff‘s favor.” Elzanaty, 929 F. Supp. 2d at 217.5 Plaintiffs must establish these elements by a preponderance of the evidence. See AFA Dispensing Grp. B.V. v. Anheuser-Busch, Inc., 740 F. Supp. 2d 465, 471 (S.D.N.Y. 2010). Courts in this Circuit—including this court—have consistently stayed and enjoined proceedings in the context of similar no-fault insurance fraud schemes. See, e.g., Gov‘t Emps. Ins. Co. v. Landow, No. 21-CV-1440 (NGG) (RER), 2022 WL 939717, at *14 (E.D.N.Y. Mar. 29, 2022); Gov‘t Emps. Ins. Co. v. Relief Med., P.C., 554 F. Supp. 3d 482, 506 (E.D.N.Y. 2021); Gov‘t Emps. Ins. Co. v. Wallegood, Inc., No. 21-CV-1986 (PKC) (RLM) (Dkt. 36), at 21 (E.D.N.Y. July 16, 2021); Gov‘t Emps. Ins. Co. v. Beynin, No. 19-CV-06118 (DG) (PK), 2021 WL 1146051, at *10 (E.D.N.Y. Mar. 25, 2021); Gov‘t Emps. Ins. Co. v. Big Apple Med. Equip., Inc., No. 20-CV-5786 (PKC) (JRC) (Dkt. 52), at 22 (E.D.N.Y. Mar. 25, 2021); Gov‘t Emps. Ins. Co. v. Wellmart RX, Inc., 435 F. Supp. 3d 443, 456 (E.D.N.Y. 2020); State Farm Mut. Auto. Ins. Co. v. Parisien, 352 F. Supp. 3d 215, 235 (E.D.N.Y. 2018).
A. Irreparable Harm
“The showing of irreparable harm is perhaps the single most important prerequisite for the issuance of a preliminary injunction, and the moving party must show that injury is likely before the
Courts in this district have consistently found irreparable harm where there is concern “with wasting time and resources in an arbitration with awards that might eventually be, at best, inconsistent with this Court‘s ruling, and at worst, essentially ineffective.” Elzanaty, 929 F. Supp. 2d at 222. Thus, when “an insurer is required to waste time defending numerous no-fault actions when those same proceedings could be resolved globally in a single, pending declaratory judgment action,” courts regularly find irreparable harm. Parisien, 352 F. Supp. 3d at 233; see also Gov‘t Emps. Ins. Co. v. Tolmasov, No. 21-CV-7058 (KAM), 2022 WL 1438602, at *5 (E.D.N.Y. May 3, 2022) (finding that allowing the arbitrations and lawsuits to proceed would “nullify [GEICO‘s] efforts to prove fraud at a systematic level, impair a federal declaratory judgment action over which the Court has taken jurisdiction precisely to eliminate such fragmentation, and deprive [GEICO] of an avenue towards complete relief in any court“).
GEICO asserts that there are over 950 pending arbitration proceedings filed by Defendants, in addition to potentially “hundreds more collection arbitrations and civil court collection suits.” (Asmus Decl. ¶ 9.) As a result, GEICO faces potentially hundreds of inconsistent awards. However, now that the majority of Defendants have stipulated to a stay of both arbitration and state court proceedings as well as an injunction against future
Many courts in this district have also been persuaded by “the risk that money damages would not be available if plaintiff ultimately obtained a declaratory judgment.” Gov‘t Emps. Ins. Co. v. Advanced Comprehensive Lab., No. 20-CV-2391 (KAM), 2020 WL 7042648, at *9 (E.D.N.Y. Dec. 1, 2020); see also WPIX, Inc. v. ivi, Inc., 691 F.3d 275, 286 (2d Cir. 2012) (“The unlikelihood that defendants would, in any event, be able to satisfy a substantial damage award further supports a finding of irreparable harm.“). Courts have found that a plaintiff-insurance company would be irreparably harmed where “future monetary compensation would be insufficient,” specifically because the defendants “no longer conduct business, and are essentially judgment-
If Defendants are no longer in operation and permitted to prosecute ongoing collection proceedings, GEICO‘s harm may not be limited to inconsistent judgments or the unnecessary expenditure of time and resources . . . [A]ny dollar awarded to Defendants in a AAA or state court collection proceeding may be permanently unrecoverable, even if GEICO ultimately prevails in this case.
Id. at *6. GEICO argues that because all Defendants have closed down medical operations and ceased billing GEICO, GEICO may be unable to recover any monetary award even if it were to prevail in this case. (See Asmus Decl. ¶ 9; Mot. at 13 (collecting cases).)7 Thus, GEICO also faces irreparable harm stemming from the risk that it may be unable to collect monetary damages.
In opposition, the Bu Defendants argue that GEICO‘s monetary injuries “can be estimated and compensated” and thus there will be no irreparable harm. See Brenntag Int‘l Chems., Inc. v. Bank of India, 175 F.3d 245, 249 (2d Cir. 1999). Further, they argue that, under Allstate Insurance Co. v. Harvey Family Chiropractic, a factually similar case, “mere injuries . . . in terms of money, time, and energy necessarily expended are not enough” to establish irreparable harm. 677 F. App‘x 716, 718 (2d Cir. 2017) (summary order).8 However, the Bu Defendants’ reliance on Harvey is misplaced. They are not the first defendants in an alleged no-fault
Finally, the Bu Defendants have directed this court to similar cases in which preliminary injunctive relief was denied. (See Opp. at 11-12.) These cases are distinguishable. In Allstate Insurance Company v. Avetisyan, No. 17-CV-4275 (LDH) (RML), 2018 WL 6344249, at *3-4 (E.D.N.Y. Oct. 30, 2018), Judge DeArcy Hall addressed a case “premised upon an alleged pattern comprising discrete claims of fraudulent activity,” while the insurer asserted a defense of “medical necessity” in the parallel arbitrations. In contrast with Elzanaty, which Judge DeArcy Hall characterized as involving “proceedings present[ing] actual risks of inconsistent rulings on the same issue,” none of the parallel arbitrations in Avetisyan would “result in any determination on the issue of fraud . . . [and] there is simply no danger of inconsistent determinations.” Id. Other courts have similarly found
The other two cases cited by the Bu Defendants were decided orally by Judge Bianco. (See Oral Arg. Tr., Allstate Ins. Co. v. Zelefsky (“Zelefsky Tr.“), No. 13-CV-5830 (JFB) (AKT) (Dkt. 66) (E.D.N.Y. Apr. 2, 2014); Oral Ruling Tr., Allstate v. E. Island Med. Care (“Eastern Island Tr.“), No. 16-CV-2802 (JFB) (AKT) (Dkt. 106) (E.D.N.Y. June 5, 2017).) Eastern Island is distinguishable because the plaintiffs had conceded that if Judge Bianco were to reject their preclusion arguments, there would be no irreparable harm, and Judge Bianco did ultimately reject these arguments. (See Eastern Island Tr. at 23:17-18, 24:4-14.) In both Eastern Island and Zelefsky, Judge Bianco found that monetary damages would be adequate compensation and that potential inconsistencies in judgments did not constitute irreparable harm. (See id.; Zelefsky Tr. at 54:6-15.) Because Judge Bianco was ruling from the bench, this court cannot discern the specifics of those cases and is not in a position to analyze the rulings. Other courts in this district have declined to allow Eastern Island and Zelefsky to “color the[i]r . . . analysis” on this basis. Wellmart, 435 F. Supp. 3d at 452 (“The court is unable to discern the specific basis for Judge Bianco‘s conclusion that Allstate was not at risk of irreparable harm.“); see also Gov‘t Emps. Ins. Co. v. SMK Pharmacy Corp., No. 21-CV-3247 (AMD) (RLM), 2022 WL 541647, at *6 (E.D.N.Y. Feb. 23, 2022) (“[N]either decision explains the basis for finding that there was no irreparable harm.“).
Because GEICO has shown the irreparable harm of inconsistent judgments and of being potentially unable to collect damages, GEICO has shown irreparable harm.
B. Serious Question Going to the Merits
For a court to issue a preliminary injunction, the moving party must show either a “a likelihood of success on the merits,” or “sufficiently serious questions going to the merits to make them a fair ground for litigation and a balance of hardships tipping decidedly” in the movant‘s favor. Parisien, 352 F. Supp. 3d at 234 (citing Jackson Dairy, Inc. v. H. P. Hood & Sons, Inc., 596 F.2d 70, 72 (2d Cir. 1979)). However, a “[l]ikelihood of success is not the focus at the early stages of a case such as this, because any likelihood of success inquiry would be premature.” Elzanaty, 929 F. Supp. 2d at 217. At this early juncture, this court will instead consider “whether there is a serious question going to the merits to make them a fair ground for trial.” Id.; see also Parisien, 352 F. Supp. 3d at 234. “Because the moving party must not only show that there are ‘serious questions’ going to the merits, but must additionally establish that ‘the balance of hardships tips decidedly’ in its favor, its overall burden is no lighter than the one it bears under the ‘likelihood of success’ standard.” Citigroup Glob. Mkts., Inc. v. VCG Special Opportunities Master Fund Ltd., 598 F.3d 30, 35 (2d Cir. 2010) (emphasis in original).
GEICO has shown a serious question going to the merits. GEICO is seeking a declaratory judgment that the Defendants have no right to receive payment for any pending bills submitted to GEICO, an estimated $4.3 million in pending no-fault insurance claims. (See Compl. ¶¶ 3, 309.) In its 288-page Complaint, GEICO “detail[s] a complicated scheme of alleged fraudulent activity,” Elzanaty, 929 F. Supp. 2d at 222, intended to exploit New York‘s
The Bu Defendants’ primary argument in opposition is that they were not sufficiently involved in the scheme, and many of the allegations do not signal their involvement. (See Opp. at 13-14.) The court has already discussed the extensive allegations of the Bu Defendants’ conduct, including the detailed examples discussed in the Complaint and the charts of fraudulent no-fault claims submitted on their behalf. The court notes that the Bu Defendants have not denied submitting these claims nor asserted that the claims were actually for legitimate services. In the face of a “representative sample” of 7,165 allegedly fraudulent no-fault claims, the Bu Defendants do not attempt to argue that GEICO has somehow misunderstood that these services were medically necessary. (See Bu Chart; Wellbeing NP Chart.) They do not explain why less than a week after two different accidents, they injected two different patients with over a dozen dry needles. (See Compl. ¶ 282(v), (xii).)
Finally, the Bu Defendants focus on the fact that they represent only $97,000 out of the $977,000 that GEICO seeks repayment of, ignoring the fact that this stay will also impact their share of the $4.3 million in pending claims. (See Opp. at 2.)9 However, the fact that the Bu Defendants are responsible for only some portion of the fraud does not mean there is any less of a serious question going to the merits.
Given the extensive evidence of the overall scheme and of the Bu Defendant‘s involvement, the court finds that there are serious questions going to the merits.
C. Balance of Hardships
Since the court found that there are “serious questions going to the merits,” in lieu of a “likelihood of success on the merits,” the court must further determine if the “balance of hardships tip[s] decidedly” in GEICO‘s favor. Parisien, 352 F. Supp. 3d at 234. If
The Bu Defendants argue that this injunction will inflict a financial toll and create hardship. (Opp. at 3.) Though the court acknowledges that delaying the receipt of funds could cause financial hardship, the Bu Defendants will conserve time and resources by litigating all of the claims in one forum and will be paid interest as a result of the delay. The Bu Defendants seek to have it both ways, on one hand minimizing their financial stake as compared to the other Defendants, but also stressing significant economic harm. The court does not find that a potential delay in receiving reimbursements from GEICO—if it is even appropriate for the Bu Defendants to be receiving these reimbursements at all—tips the balance of hardships in their favor.
Thus, the court finds that the balance of hardships tips decidedly in favor of issuing a preliminary injunction.
D. Security
GEICO asks the court to waive the security requirement of
While this case was not brought under a federal health and welfare statute, the New York no-fault insurance scheme is “designed to protect accident victims regardless of fault by enabling them to obtain necessary medical attention without concern of the ability to pay.” Mayzenberg, 2018 WL 6031156, at *10. Consequently, courts in this district have consistently found these types of fraudulent no-fault insurance schemes to implicate the enforcement of “public interests.” See, e.g., Wallegood, No. 21-CV-01986 (PKC) (RLM), at 19-20; Landow, 2022 WL 949717, at *14. The Bu Defendants have not made any arguments in opposition to dispensing with the security requirement. Nor have they sufficiently demonstrated a likelihood of harm as a result of a preliminary injunction because, even if they are rightfully owed these claim reimbursements, the reimbursements will merely be delayed, and they will be paid later with interest. Thus, the court will dispense with the bond requirement since the case implicates the enforcement of public interests, and the Bu Defendants have not established a likelihood of harm.
III. CONCLUSION
For the reasons stated above, GEICO‘s motion to (1) stay all pending collection arbitrations; (2) enjoin Defendants from commencing any additional arbitration or state court collection proceeding until the resolution of this federal action; and (3) relieve GEICO from its obligation to post security for the injunction, is GRANTED, as against the Bu Defendants.
SO ORDERED.
Dated: Brooklyn, New York
September 28, 2022
s/Nicholas G. Garaufis
NICHOLAS G. GARAUFIS
United States District Judge
