New Jersey medical providers in hot water for abuse of PIP benefits
State Farm has filed suit against several chiropractors and medical providers claiming they have perpetuated fraud for the last 8 years, costing policyholders millions of dollars.
Insurance giant State Farm has filed suit against 12 medical providers across New Jersey for unjust enrichment and violations of the state’s Insurance Fraud Prevention Act. The 80-page complaint, filed in federal district court for the District of New Jersey, alleges that, for the past eight years, the defendants participated in an auto insurance fraud scheme abusing personal injury protection (PIP) benefits available in New Jersey. According to the complaint, State Farm named several individuals and businesses as defendants, including Tri-County Chiropractic and Rehabilitation Center, Robert Matturro, D.C., and Advanced Spine and Pain Management.
According to State Farm, the providers followed a troubling pattern of prescribing the same course of treatment for patients who gave similar responses to questions or tests after an auto accident. The doctors allegedly failed to perform an honest evaluation of injuries suffered by patients in auto accidents and recommended nearly identical treatments without regard for a patient’s particular circumstances. For example, a patient with a neck injury would receive hot and cold packs, chiropractic adjustments, physical medicine, massages, manual therapy, and even mechanical traction in a single visit, only to do the same thing over again in most subsequent visits. The doctors also took advantage of the availability of PIP benefits by referring patients for services that were either never performed or not medically necessary.
The defendants are also accused of making illegal referrals to diagnostic clinics owned by one of the defendants. The treatments at those clinics followed the same pattern, with substantially similar treatments followed for injuries of similar nature. The clinic treatments, however, sometimes went beyond “not medically necessary” to the point of unnecessary invasive procedures, such as injections, supported by false documentation.
State Farm is seeking $2.6 million for payment of fraudulent auto claims, as well as a declaratory judgment that they are no longer obligated to pay any claims coming from the named defendants.
Editor’s Note: Insurance fraud is, unfortunately, more common than people think. Insurers spend significant time and money investigating fraudulent claims, causing premiums to increase. Accident rings of doctors and lawyers are nothing new, but catching those committing fraud takes time and effort. If a case goes to court, these costs only multiply. A note to insurers; take insurance fraud seriously and work to catch those trying to take advantage of coverages.