Plaintiffs State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company (together, "Plaintiffs" or "State Farm") bring this action seeking damages for benefits paid under no-fault automobile insurance policies for services rendered or purportedly rendered by Defendants. (ECF No. 5 ("Am. Compl.") ). State Farm also seeks a
Presently before the Court is State Farm's motion for a preliminary injunction of proceedings that have been commenced, and which may be commenced in the future, by Defendants to collect no-fault benefits from State Farm. (ECF No. 6). See Fed. R. Civ. P. 65. The temporary relief that State Farm requests may be divided into three branches:
1. an order staying lawsuits brought by Defendants against Plaintiffs to collect no-fault benefits and which are currently pending in New York state court;
2. an order staying pending American Arbitration Association ("AAA") proceedings brought by Defendants against Plaintiffs to collect no-fault benefits; and
3. an order enjoining Defendants from commencing any future lawsuits or arbitration proceedings in order to collect no-fault benefits.
(ECF No. 6).
It is the first branch that raises the most significant legal and policy questions, not only for New York's no-fault scheme, but for our ever-evolving jurisprudence on the scope of the Anti-Injunction Act ("AIA"),
BACKGROUND
I. New York's No-Fault Statute
The Comprehensive Motor Vehicle Insurance Reparations Act, see
Section 5106 create a "[f]air claims settlement" procedure for all no-fault claims. Nofault benefits are deemed overdue if they are not paid or denied within 30 calendar days after proof of claim is submitted. See
An insurer who pays no-fault benefits and subsequently discovers fraud may bring an action for damages. See State Farm Mut. Auto. Ins. Co. v. James M. Liguori, M.D., P.C. ,
II. Factual Background
Since August 2013, and "continu[ing] uninterrupted since that time," Defendants have allegedly subjected State Farm's insureds to a suite of medically unnecessary interventions, referred to in the complaint as the "Predetermined Treatment Protocol," to defraud State Farm and exploit those insureds' no-fault benefits. (Am. Compl. ¶¶ 2-3, 6). According to the complaint:
"[T]he Predetermined Treatment Protocol involves:
"(a) initial examinations that are not legitimately performed to determine the true nature and extent of patient injuries, but rather are performed, if at all, as a pretext to report substantially similar and in some instances nearly identical examination findings to justify a variety of unnecessary treatment services;
"(b) a treatment plan consisting of a combination of purported physical therapy modalities, chiropractic manipulations, and acupuncture, provided to almost every patient on almost every visit and often on the same dates of service, regardless of the unique circumstances and needs of each patient;
"(c) employing particular treatments, modalities, and services not because they are clinically beneficial to the patients, but to maximize charges and avoid limitations on the amounts that can be charged under the applicable fee schedule;
"(d) subjecting patients to medically unnecessary diagnostic tests, which include digital range of motion tests ('ROM Tests'), computerized muscle strength tests ('Muscle Tests'), Nerve Conduction Velocity Tests ('NCVs'), Electromyography Tests ('EMGs'), somatosensory evoked potential tests ('SSEPs'), brainstem auditory evoked potential tests ('BEPs'), Functional Capacity Evaluations, and pain fiber nerve conduction studies ('V-sNCT') (collectively, the 'Tests');
"(e) recommending and performing medically unnecessary trigger point injections and dry needling procedures;
"(f) recommending and providing virtually identical bundles of medically unnecessary durable medical equipment ('DME') and orthotic devices (collectively 'Supplies'); and
"(g) submitting documents to State Farm falsely representing that the examinations, treatment, Tests, injections, and Supplies purportedly rendered were medically necessary when, in fact, they either were not performed or were performed to exploit patients' No-Fault benefits and not because they were medically necessary."
(Am. Compl. ¶ 3).
According to the complaint, once patients arrive at 1786 Flatbush, the physician
Critically, Defendants' alleged fraud may not be apparent from any one individual claim or its supporting documentation. Rather, State Farm points to larger patterns in Defendants' conduct as evidence of fraud. These allegations include the following:
• The physical therapy and chiropractic treatments that patients purportedly receive at 1786 Flatbush are "almost identical" and do "not change regardless of whether the patients purportedly improve or get worse." (Am. Compl. ¶¶ 89, 106).
• The examination reports for acupuncture services reveal "patterns which are not credible across a large sample of individuals," including similar or identical symptoms. (Am. Compl. ¶ 123).
• Defendants "routinely provided particular physical therapy modalities" in combinations that would allow them to bill for the maximum allowable number of 'relative units' per day. (Am. Compl. ¶ 76).
• "Almost none of the patients at 1786 Flatbush are discharged from care based on their purported clinical conditions. To the extent the medical records of patients at 1786 Flatbush contain references to discharges, they routinely show (a) the patient made the decision to stop treating; (b) the patient claimed to undergo treatment after the date of the purported discharge; or (c) the discharge came shortly after [State Farm] requested one of the defendant providers appear for an EUO...." (Am. Compl. ¶ 75).
• Defendants submitted multiple bills for services rendered by the same providers on the same date of service. (Am. Compl. ¶ 237).
• Defendants created various controlled entities with separate tax identification numbers to conceal that they are submitting claims from the same individuals for the same fraudulent services. (Am. Compl. ¶¶ 60-61).
As of the date State Farm filed this motion, Defendants had submitted bills totaling more than $9.5 million, of which $3.3 million were paid, leaving an unpaid balance
State Farm brought this action for damages under the Racketeer Influenced and Corrupt Organizations ("RICO") statute,
DISCUSSION
III. Statutory Authority to Enjoin Pending State Court Proceedings
1. The in-aid-of-jurisdiction exception generally
The source of this Court's authority to enjoin the pending actions is the All-Writs Act,
The Court's authority to enjoin pending state proceedings is limited by the AIA,
At a minimum, the law is clear that the mere pendency of a parallel proceeding in state court, in and of itself, is insufficient grounds to invoke the exception. This is so even where the state proceeding threatens to preclude the federal court from reaching the same issue through res judicata or collateral estoppel. See Atlantic Coast Line,
State Farm does not quarrel with this rule as a general matter but argues that this case presents special considerations: "the very nature of Defendants' [alleged] fraud scheme renders it uniquely unjust to be litigated on a claim-by-claim basis." (ECF No. 58, at 5-6) (emphasis added). To wit, State Farm will be forced to defend over 2,300 separate actions and demonstrate the fraudulent nature of each claim seriatim , without a meaningful opportunity demonstrate the pattern of fraud common to all. The Court is aware of no relevant Supreme Court or Second Circuit precedent addressing the unique challenges posed by such a colossal number of individual actions, particularly where the plaintiff has alleged that the defendants acted pursuant to a single fraudulent scheme, and where the federal court has asserted jurisdiction over proceedings with the potential to resolve all claims globally.
2. Applicability of the in-aid-of-jurisdiction exception to "in personam " proceedings
The Second Circuit has held that, "generally," the in-aid-of-jurisdiction exception
The source of the in rem exception to the AIA is the Supreme Court's holding in Kline,
It was not until Toucey,
In any event, the in rem doctrine, whatever its justifications, "does not seem an accommodation relevant to the interests of federalism." William T. Mayton, Ersatz Federalism Under the Anti-Injunction Statute ,
In recent times, courts have liberalized their interpretation of the in-aid-of-jurisdiction exception. See 17A C. Wright & A. Miller, Federal Practice & Procedure § 4225 (3d ed.) ("Commentators have urged that the 'necessary in aid of its jurisdiction' exception be read more broadly, so that it would encompass more than the in rem situation.... There have been some signs of such flexibility in the recent cases"). A paradigmatic example of this shift has been in the realm of class action practice and consolidated multidistrict litigation (MDL) proceedings. In these cases, courts have held that the in-aid-of-jurisdiction exception may be invoked where parallel state actions might trigger a breakdown in settlement negotiations. See In re Diet Drugs,
More broadly, courts have held that, at least where important constitutional rights are at stake, in personam state court proceedings may be enjoined where a litigant's "right, if any, to litigate the issues in a state court appears more theoretical than real," Caulder v. Durham Housing Authority ,
In sum, while it is clear that the court may not enjoin a state in personam for the sole purpose of being the first court to reach judgment, see Atlantic Coast Line,
Returning to the facts in this case, the question that must be asked is whether the pendency of 2,300 individual no-fault actions would render "trial in the [state] forum ... so gravely difficult and inconvenient that [plaintiff] will for all practical purposes be deprived of [its] day in court." Bremen ,
The gravamen of State Farm's allegations is that Defendants have systematically and concertedly administered treatments in a rote fashion, independent of the clinical needs of the patient, in such a combination as to maximize reimbursements while minimizing the possibility of detection through the use of various controlled entities. Yet these alleged violations may not be apparent if the claims and their supporting documentation are examined in isolation on a case-by-case basis. Facially legitimate treatments may be provided with little variance across multiple patients, but it is only by analyzing the claims as a whole that the irresistible inference arises that the treatments are not being provided on the basis of medical necessity. See State Farm Automobile Insurance Company v. Physicians Injury Care Center, Inc. ,
Any judgment in the state no-fault proceedings will be res judicata for purposes of this action. See Government Employees Ins. Co. v. Five Boro Psychological Services, P.C. ,
In theory, State Farm could move to consolidate cases within the same court if they "involv[e] a common question of law or fact." N.Y. Civil Practice Law and Rules 602(a) ; see Metroscan Imaging, P.C. v. Geico Ins. Co. ,
Failure to enjoin the state actions would "destroy the utility of the [declaratory judgment procedure] otherwise ideally suited to resolving such broad claims." Baldwin-United Corp.,
Although not cited by State Farm, American Ins. Co. v. Lester ,
... [W]e think it advisable to express the view that [the District Court] has the power, to be exercised in its discretion, to enjoin the Lesters from proceeding further in the civil actions they have filed in the West Virginia State Court. Without such a power, the granting of a declaratory judgment may well, in many cases as in the instant case, fall short of attaining the objectives which are sought in proceedings looking to a declaratory judgment. The power of the court to grant injunctive relief in such cases is not forbidden by28 U.S.C. § 2283 , since the exercise of the injunctive power is not only 'in aid' of the court's jurisdiction but is essential to its effective exercise.
Earlier cases, some of which are referenced in the Lester decision, may be cited
... the metaphysical protection of state sovereignty [should] yield to an efficient administration of justice in a country that after all is one.... The advantages of an early determination of the fundamental question of coverage and company liability may in many cases be deemed to outweigh the alleged necessities for an immediate trial ..., which in any event would not be long delayed and which might never be prosecuted were the legal immunity of the company promptly established.
Edwin Borchard, Declaratory Judgments 665 (2d ed. 1941). As explored above, however, it is now open to significant doubt whether Toucey may continue to be relied on for the proposition that parallel in personam proceedings may not be enjoined in aid of a court's jurisdiction. The Second Circuit has already departed from this framework in at least one respect. See Baldwin-United,
Although the district court cast doubt on Lester in Maryland Cas. Co. v. W.R. Grace & Co. ,
Finally, enjoining the state actions in this case is consistent with the purpose of the AIA, which is rooted in respect for the sovereignty of state governments over matters within their jurisdiction. Far from creating "friction between the state and federal courts," Vendo ,
To be clear, the Court is not invoking the exception to § 2283 solely on the grounds that its judgment may be precluded by an inconsistent judgment in state court. In a typical case with parallel state proceedings, the effect of issue or claim preclusion, "far from requiring the federal court to stay proceedings in the state court, is a result which should [usually] be welcomed to avoid the task of reconsidering issues which have already been settled by another competent tribunal." Ret. Sys. of Ala. ,
Therefore, the Court finds that it has statutory authority to enjoin the pending state court actions.
IV. Authority to Enjoin Arbitration Proceedings
Although Defendants oppose State Farm's request to enjoin pending and future arbitration proceedings, they do not advance any substantial legal basis for this branch of the motion to be denied. To the
V. Whether Preliminary Injunction Pursuant to Fed. R. Civ. P. 65 Is Warranted
The Court now turns to whether the injunction is warranted under traditional principles of equity. To obtain a preliminary injunction pursuant to Fed.R.Civ.P. 65, the moving party must demonstrate "(1) irreparable harm absent the injunctive relief and (2) either (a) a likelihood of success on the merits or (b) sufficiently serious questions going to the merits to make them a fair ground for litigation and a balance of hardships tipping decidedly toward the party requesting the preliminary relief." Jackson Dairy, Inc. v. H. P. Hood & Sons, Inc. ,
1. Irreparable harm
A showing of irreparable harm is the "single most important prerequisite for the issuance of a preliminary injunction." Faiveley Transp. Malmo AB v. Wabtec Corp. ,
Courts have readily held that irreparable harm occurs where, as here, 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. See Government Employees Insurance Company v. Strutsovskiy ,
Defendants cite Jayaraj v. Scappini ,
Therefore, the Court finds that State Farm has established that it would suffer irreparable injury if a preliminary injunction does not issue.
2. Serious question going to the merits
For a preliminary injunction to issue, there must be either "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. Jackson Dairy ,
The Court need not run through the individual elements of each of State Farm's causes of action, as the parties have wisely focused their arguments on the core factual dispute: whether the services rendered at 1786 Flatbush were, in fact, medically necessary. State Farm has submitted detailed grids purporting to show the initial evaluations made of patients at 1786 Flatbush, the services and supplies rendered, and how those services and supplies were billed. (ECF Nos. 5-1 to 5-8). State Farm has also provided copies of documents allegedly containing false statements by some of the Defendants. For instance, State Farm provides documentation submitted by Defendant Ksenia Pavlova, representing her as an M.D., which State Farm alleges is false. (Am. Compl. ¶ 20; ECF No. 5-9). State Farm also presents a sworn affidavit from Maiga Borisevica ("Borisevica") on behalf of Defendant Maiga Products Corporation, which had failed to appear for a scheduled EUO. (ECF No. 5-26). Borisevica claims that unsuccessful attempts were made to respond to the request, but State Farm avers that they have no record of any such communications. (Am. Compl. ¶ 233; ECF No. 5-26 ¶ 6).
The Court finds that State Farm has "adequately detailed a complicated scheme of alleged fraud activity," Elzanaty ,
3. Balance of hardships tipping decidedly in the plaintiffs' favor
Because the Court finds that there are "serious questions going to the merits" in lieu of a "likelihood of success on the merits," it must further inquire as to whether that there is a "balance of hardships tipping decidedly" in State Farm's favor. Jackson Dairy ,
CONCLUSION
For the reasons set forth above, State Farm's motion is GRANTED in its entirety. Because the Court is temporarily staying Defendants' right to further commence and prosecute any no-fault arbitrations and state court actions, all discovery, potential dispositive motions, and a potential trial should proceed on an expedited basis.
SO ORDERED.
Notes
Defendants are Jules Parisien, M.D.; Luqman Dabiri, M.D.; Ksenia Pavlova, D.O.; Noel Blackman, M.D.; Frances Lacina, D.O.; Allay Medical Services, P.C.; FJL Medical Services P.C.; JFL Medical Care P.C.; JPF Medical Services, P.C.; KP Medical Care P.C.; PFJ Medical Care P.C.; RA Medical Services P.C.; Darren Mollo, D.C.; Darren Mollo D.C., P.C.; ACH Chiropractic, P.C.; Energy Chiropractic, P.C.; Island Life Chiropractic Pain Care, PLLC; Charles Deng, L.A.c.; Charles Deng Acupuncture, P.C.; David Mariano, P.T.; MSB Physical Therapy P.C.; Maiga Products Corporation; Madison Products of USA, Inc.; Quality Custom Medical Supply, Inc.; Quality Health Supply Corp.; Personal Home Care Products Corp.; and AB Quality Health Supply Corp. (Am. Compl. ¶¶ 12-43).
Defendants do not contend that the AIA prohibits the Court from enjoining the commencement of future proceedings in state court. See Dombrowski v. Pfister,
In Atlantic Coast Line , the Court declined to reaffirm Toucey 's distinction between in rem and in personam actions, holding more broadly that the exception "impl[ied] that some federal injunctive relief may be necessary to prevent a state court from so interfering with a federal court's consideration or disposition of a case as to seriously impair the federal court's flexibility to decide that case."
Less than a year before Toucey , the Supreme Court held in Maryland Cas. Co. v. Pacific Coal & Oil Co. that a court presiding over an insurer declaratory judgment action had no authority to enjoin a state court action against the insured.
