HKP Physical Therapy, P.C. v. Gov't Emps. Ins. Co.
| Decision Date | 02 December 2019 |
| Docket Number | CV-702191/16 |
| Parties | HKP PHYSICAL THERAPY, P.C., a/a/o Natacha Hyppolite, Plaintiff, v. GOVERNMENT EMPLOYEES INSURANCE COMPANY, Defendant. Taira RX Corp. a/a/o Gengguan Chen, John Devito, Angie Flores, Damarys Fores, Michael Generoso, Jose Gomez, Deonarine Nauth, Armmeen Williams, Ke Xu, Hiba Zahmoul, Plaintiffs, v. Government Employees Insurance Company, Defendant. |
| Court | New York Civil Court |
Plaintiffs, David Forman, Portland, Esq., Law Offices of Leon Kucherovsky
Defendant, Angelica M. Barcsansky, Esq. (Taira a/a/o Chen, Flores, Fores, Nauth, Williams), Andrea C. Sacks, Esq. (Taira a/a/o Xu), Garin Scollan, Esq., Uniondale, (HKP a/a/o Hyppolite), Amy Weidmann, Esq. (Taira a/a/o Devito, Generoso, Gomez, Zahmoul)Rivkin Radler LLP
These actions, addressed together here solely for the purposes of this decision, relate to assigned, unpaid no-fault claims submitted by Plaintiffs Taira RX Corp ("Taira"), a pharmacy, and HKP Physical Therapy, P.C. ("HKP," collectively "Plaintiffs"), a medical clinic, to Defendant Geico. In every Taira action, Geico moves pursuant to CPLR 3212 for summary judgment, alleging that Plaintiffs filed these actions prematurely because verification requests remain outstanding, and that Geico had no obligation to deny the claims before receiving a complete verification response. In the HKP action, Geico argues that the denials were justified because HKP failed to respond to reasonable verification requests. Plaintiffs oppose each motion, arguing that the requests are inappropriate and/or unjustified, and that Plaintiffs have substantially complied. Plaintiffs also ask the Court to search the record and grant summary judgment in their favor. For the reasons below: (1) Geico's motions in the Chen (702201/17), Devito (702185/17), Generoso (700042/18), Nauth (702243/17), Williams (702247/17), Xu (703115/17), Zahmoul (700208/18) actions are GRANTED and those complaints are dismissed without prejudice as premature; (2) Geico's motion in the Hyppolite action (702191/16) is GRANTED, and the Complaint dismissed with prejudice; (3) Geico's motion in the Gomez action (CV-701984/17) is GRANTED in part and DENIED in part; and (4) the Flores (CV-702233/17) and Fores (702213/17) motions are DENIED and summary judgment is granted in favor of Plaintiffs.
In 2016, prior to any relevant claim submission, the owner of MSB Rx d/b/a "Forest Drugs" ("MSB"), Michael Bassanell, sold MSB to Taira, which continued to operate Forest Drugs.1 According to Geico, its investigation revealed "an alarming increase in the amount of prescription drug products prescribed to no-fault patients suffering from minor injuries sustained in fender-bender type automobile accidents" (Def/Sacks Affirm ¶ 11). Geico alleges that the prescriptions were "medically unnecessary," prescribed at "no-fault clinics" operating as "medical mills for the sole purpose of submitting inflated, fraudulent billing" (id. ).
In furtherance of Geico's investigation, in addition to document requests including financial and prescription records, Geico sought an examination under oath (EUO) of Bassanell. After Bassanell's EUO on April 27, 2017, Geico requested additional categories of documentation that it determined to be necessary and reasonable for its investigation (Def Reply Exh 2 ):2
gel, diclofenac /lidocaine compound cream, lidocaine patches, and flector patches from June 2016 onward; and
(8) the number of prescriptions that Taira dispensed from June 2016 onward pursuant to prescriptions from Mani Ushyarov, Solomon Halioua, Oleg Fuzaylov, Terry-Jan Blackett-Bonnett, and Danny Fuzaylov.3
On June 22, 2017, Geico received the first bill (Geico Exh A [Chen Action ] ).5 Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 1, 2017, then again on August 11, 2017 (id. ). Geico has not yet issued a denial.
On July 14, 2017, Geico received the subject bills (Geico Exh B [Chen Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 31, 2017, then again on August 31, 2017 (id. ). Geico has not yet issued a denial.
a. Bills 1-2 ($2,364.00, $232.19 for June 1, 2017 prescriptions)
On July 6, 2017, Geico received the subject bills (Geico Exh A [Devito Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 26, 2017, then again on August 28, 2017 (id. ). After a January 3, 2018 exam by Dr. Russ, on January 10, 2018, Geico issued a denial of all future benefits, but this claim remains pending (Taira Exh G [Devito Action] ).
a. Bills 1-3 ($399.00, $2,364.00, $125.02 for May 15, 2017 prescriptions)
On June 7 and 8, 2017, Geico received the subject bills (Geico Exh A [Flores Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on June 26, 2017, then again on August 10, 2017 (id. ).6 After a January 3, 2018 exam by Dr. Yang, on October 27, 2017, Geico issued a denial of all future benefits, but this claim remains pending (Taira Exh G [Flores Action] ).
a. Bill 1 ($1,432.05 for May 15, 2017 prescription)
On June 8, 2017, Geico received the subject bill (Geico Exh A [Fores Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on June 26, 2017, then again on August 10, 2017 (id. ).7 After receiving some of the requested items, Geico sent a subsequent letter on October 31, 2017 outlining which items Geico considered to be outstanding (id. ). Geico has not yet issued a denial.
a. Bill 1 ($1528.80 for June 26, 2017 prescription)
On August 7, 2017, Geico received the subject bill (Geico Exh A [Generoso Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on August 18, 2017, then again on September 19, 2017 (id. ). After receiving some of the requested items, Geico sent a subsequent letter on November 1, 2017 outlining which items Geico considered to be outstanding (id. ). After a July 17, 2017 exam by Drs. Silverman and Lyons, Geico issued a denial of all future benefits on October 27, 2017, but this claim remains pending (Taira Exh G [Flores Action] ).
On June 21, 2017, Geico received the subject bill (Geico Exh A [Gomez Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 10, 2017, then again on August 11, 2017 (id. ). Geico has not yet issued a denial.
On June 21, 2017, Geico received the subject bill (Geico Exh A [Gomez Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 10, 2017, then again on August 11, 2017 (id. ). On July 12, 2017, Geico denied the claim for lack of medical necessity based on a November 8, 2016 exam by Dr. Hershon (Geico Exh B [Gomez Action] ).
a. Bill 1 ($313.28 for May 16, 2017 prescriptions)
On June 22, 2017, Geico received the subject bill (Geico Exh A [Nauth Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 11, 2017, then again on August 14, 2017 (id. ).8 After receiving some of the requested items, Geico sent a subsequent letter on November 1, 2017 outlining which items Geico considered to be outstanding (id. ). After a September 12, 2017 exam by Dr. Krishnan, Geico issued a denial of all future benefits on September 21, 2017, but this claim remains pending (Taira Exh G [Flores Action] ).
On June 22, 2017, Geico received the subject bill (Geico Exh A [Williams Action ] ). Due to the concerns raised in its investigation, including those raised by the Bassanell EUO, Geico sought verification on July 12, 2017, then again on August 15, 2017 (id. ). After receiving some of the requested items, Geico sent a subsequent letter on November 1, 2017 outlining which items Geico considered to be outstanding (id. ). After a July 25, 2017 exam by Dr. Littman, Geico issued a denial of all future benefits on July 31, 2017, but this claim remains pending (Taira Exh G ...
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