Allstate Slammed With RICO Charge Over Sham Medical Exams

Allstate Insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams. The rigged exams were done to deny payments for future treatment, according to a civil complaint filed in the United States District Court for the Eastern District of New York. McGee-v-Allstate.pdf

This racketeering allegations were filed by a physician, John McGee, just one month after he filed a similar racketeering complaint against State Farm. The doctor charges that Allstate conspired with medical evaluation companies and physicians to contest the necessity for care and treatment rendered by McGee to his patients. Allstate, through these companies and physicians, conducted “independent” exams to see if treatment was still needed, but which exams McGee says were rigged. Those companies and doctors are co-defendants in the suit. He alleges a scam to “defraud over a million dollars through the creation and submissions of thousands of fraudulent documents created for the sole purpose of denying [McGee] his constitutional rights to practice medicine in the state of New York.”

According to McGee, the defendants were producing boilerplate medical evaluation reports and falsely represented that the tests were independent under New York’s No-Fault law. The medical evaluators profited, it is alleged, due to the increase in business from Allstate while Allstate profited by not having to pay for medically necessary future treatments.

McGee also alleges that kickbacks are involved, with Allstate paying an amount in excess of the No Fault fee schedule, with a portion getting kicked back to the evaluation company.

The defendant evaluation companies include D&D Evaluations, Medimax and Allegiance Healthcare. These companies had merged to become another defendant, Hooper Evaluations, in 2006, and are owned by Hooper Holmes, Inc. (AMEX-HH). The company has seen its stock tank from $4.30 last April to $0.65 cents at its close on Friday.

[A related story on allegedly "independent" medical exams is here: How to Fool a Jury (Is It Insurance Fraud?)]

Plaintiff’s counsel is Bruce Rosenberg of Bellmore, New York, who also filed the suit against State Farm.

Full Disclosure: I have pending personal injury litigation where Allstate and State Farm are the insurance carriers and where one or more defendants may be involved with medical exams.

Update: 3/3/08 A Doctor Sued, In Insurance Company RICO Suit, Responds To The Charge

Comments:

Eric – [A related story on allegedly "independent" medical exams is here: How to Fool a Jury (Is It Insurance Fraud?)]???? As the comments to that story indicated, it really is not a “related story”. It really is a totally different matter. Nothing in the lawsuit as reported speaks of leaving things out. It appears to allege that the reports set forth untruths, for if not, then what is the big fuss.
# posted by Blogger Louis Schepp : March 02, 2008 11:05 PM

 

It’s related in that it deals also with “independent” exams, a company that provides those services, and the allegation of dishonesty in creating them.
# posted by Blogger Eric Turkewitz : March 03, 2008 6:48 AM

 

Something doesn’t make sense. If McGee is being “investigated” by State Farm et al then why would they choose him to be on an IME panel?

Also what doctor in NY that treats PI patients has not been “investigated” by State Farm et al?

# posted by Anonymous Anonymous : March 04, 2008 12:16 AM

 

State Farm is commencing a RICO suit against McGee, he wanted to beat them to the punch.
# posted by Anonymous Anonymous : March 07, 2008 5:03 PM

 

State farm was bring the same suit that was brought again Rozenberg et al.
He knew it was coming…..
# posted by Anonymous Anonymous : March 08, 2008 6:18 AM

 

By what law or right could SF or Allstate bring a claim. Maybe either you or the Insurance company or their lawyers should read the contract that was sold to the citizens of the state of New York and by which are receiving hundreds of millions of dollars.
# posted by Anonymous Anonymous : March 08, 2008 11:28 PM

 

several fundemental issues are here. The first is that several of the “named cases” in the McGee V Allstate were never seen at all. The second, is that MCGEE, has been known for YEARS to treat without necessity and has failed to document physical findings that would be consistent with the treatments rendered. Moreover, McGee, will create evaluations to appear like radiculopathy at almost EVERY claimant he treats. Months later, it would appear the claimant really has a rotator cuff tear or a tear in the knee, requiring surgery because McGee’s false physical findings while benefitting his own pocket as he provides unnecessary tests and treatments NEVER actually gets a patient the treatment they do need. McGee and his attorney, like Rozenberg and his attorney, were under suspicion because they have been fraudulently rendering testing and treatments. This was a pre-emptive strike to avoid the suspension of his license and possible jail time. IF he were to prove something as outlandish as this, then Allstate could not press on with their charges. HE IS ALSO suing STate Farm and all of their IME vendors.
# posted by Anonymous Anonymous : April 24, 2008 4:27 PM

 

I was injured in an auto accident Dec 2003.I’ve been receiving physical therapy since, and eventually surgery for right scapula winging Oct 2007..As far as IME doctors & Allstate. It is bad enough injured parties loose time & pay @ work for PT, then we have to take time off for IME’s..This is insane, the only purpose is to DENIE, DENIE, DENIE our injury & treatment.

BRM 5/19/2008 Albany NY

# posted by Anonymous Anonymous : May 18, 2008 5:38 PM

 

5/20/2008–IME’s are for one reason only..DENIE, DENIE, DENIE, so our insurance companies do not have to pay for our medical expenses and treatment. It’s bad enough we loose time & pay from work for treatment. Then we have to see an IME that only skims through our medical records & has no idea what we have been or going through. I HOPE ALLSTATE GETS WHAT THEY DESERVE AS WELL AS ALL INSURANCE COMPANIES.. SOMEONE SHOULD CHANGE THE LAW…WHAT GIVES IME DOCTORS THE RIGHT TO DENIE US TREATMENT????
# posted by Anonymous Anonymous : May 18, 2008 5:44 PM

 

Hey has everyone lost interest? Why isn’t there any new comments? Personally, I hope everyone involved keeps involved and teach all the insurance companies that “WE” don’t have to take their abuse, and their IME doctors insults, claiming we don’t need treatment.
# posted by Anonymous Anonymous : July 24, 2008 8:24 PM

 

Feb 20,2009–Has everyone given up going after these insurance companies that keep sending us to IME doctors to denie our claims? How can they refuse us treatment for injuries they have medical proof for. Whats the update on this case?
# posted by Anonymous Anonymous : February 20, 2009 8:40 PM

 

DOES ANYONE HAVE AN UPDATE AS TO ALLSTATE RICO CHARGE AND THE CASE? I’M STILL FIGHTING WITH ALLSTATE TO APPROVE MY SURGERY..PLEASE RESPOND..
# posted by Anonymous Anonymous : March 27, 2009 12:49 PM

 

Yeah,there is an update: Apparently Bruce Rosenberg filed a similar lawsuit on behalf of two patients where there were similar allegations. the case is Sundahl vs State Farm, et al.. The case was tossed out by a Federal judge on 3/31/09. The Allstate case will likely be tossed next since it is essentially the same. Sorry, Bruce you cannot go into court as a mickey mouse attorney and make up lies about people with not a single shred of evidence. LOL, LOL
# posted by Anonymous Anonymous : April 14, 2009 12:27 AM

 

To the anonymous person who commetted on april 14, 2009. How do you know the case was thrown out & what makes you think Mr.Rosenberg will also loose the Allstate case? Where did you get the info from. I give Mr. Rosenberg alot of credit for standing up to these insurance companies, tell me another attorney who would do this.
# posted by Anonymous Anonymous : May 26, 2009 7:10 PM

 

How do I know? Lets, see (scratching head)…I can READ. I have the order of the judge in front of me, which indicates the case is to be dismissed with prejudice dated 3/31/09 in Central Islip by judge Joanna Sybert….it is public record. The case with Allstate will be thrown out eventually because it is all lies and just things Rosenberg made up. I am 100% sure of that.

You applaud Rosenberg for smearing doctors and just making up lies about people…well, thats interesting…Don’t worry, what comes around goes around :-)

# posted by Anonymous Anonymous : June 05, 2009 8:17 PM

 

The State Farm Case involving the IME docs and IME vendors was dismissed today with prejudice by the Federal judge. Interestingly, most Federal RICO claims, if dismissed are done so, without prejudice. However, the cases brought by the so called attorney, BR, were so preposterous, that the judge dismissed them with prejudice. And, please to all bloggers, do not ask me how do I know it was thrown out since I am looking at a copy of it now.

Interestingly, because the Federal judge does not have “jurisdiction” over State matters, the court dismisses the State claims without prejudice. Anyway, how ya’ feeling now Brucey? :-)

# posted by Anonymous Anonymous : July 14, 2009 7:48 PM

 

Some have commented that the initiation of the law suit way back when was due to McGee and others being pursued by State Farm….apparently that is true…below is a copy of an order of a federal judge affirming a prior judge’s decision.

What is interesting is that apparently McGee did not want to be deposed because he felt that the information provided in a deposition would result in disciplinary action by a licensing board against him…hmmm…now why would he NOT want to be deposed? What is McGee afraid of? I know, but I will leave that open to interpretation…here is the document:

http://royamura.googlepages.com/StateFarmv.CPTMedicalServs..pdf

# posted by Anonymous Anonymous : September 21, 2009 7:27 PM

 

I had an IME in Jan 2009. The IME doctor recommended surgery for two tears in my right shoulder that was the result of a serious auto accident. Forward another month and the same IME changed the report and never recommended surgery. Again, one month later I see the same IME. I walk into the office and he tells me that my shoulder is healed before he turns around. The IME doctor spends a total of 10 seconds examining my arms. I get a letter from Allstate stating that they will no longer cover my injuries.

With all the documentation I have I know the doctor gave Allstate the information they wanted. If the IME doctor had not given Allstate the report they wanted I would have been at an IME exam every month. The nurse at one of these IME’s told me that she has seen people at the IME more than a dozen times.

# posted by Anonymous Anonymous : February 28, 2010 11:32 AM

 

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ghost of the flea: litigants never learn  
there’s something about eric turkewitz at new york personal injury law, that makes people want to spill their guts to him. we all remember the flea, the great anonymous medical blogger who happened to be a pediatrician in a med mal case
posted by SHG @ March 10, 2008 2:28 AM
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UPDATE This piece from today’s Wall Street Journal Law Blog post by Dan Slater about the 60 Minutes story on legal ethics broke after the Blawg Review went up, but I think it’s important enough that it deserves a place in the review,
posted by cgreen@trustedadvisor.com (Charles H. Green (posted by Administrator)) @ March 10, 2008 1:12 AM
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posted by cgreen@trustedadvisor.com (Charles H. Green (posted by Administrator)) @ March 10, 2008 1:12 AM
allstate slammed with rico charge over sham medical exams  
the physician also alleges that kickbacks are involved, with allstate paying an amount in excess of the no fault fee schedule, with kickbacks to the evaluation company…bd. allstate insurance was hit late last week with a 78 page
posted by Ducknet Services @ March 03, 2008 9:13 PM
allstate slammed with rico charge over sham medical exams  
posted on new york personal injury law blog. allstate insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams. the rigged exams were done to deny payments
posted by Eric Turkewitz @ March 03, 2008 10:18 AM
Good Hands, Meet Your Neighbors…  
Our friend Eric “The Lawblogger” Turkewitz has another hot scoop: “Allstate Insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams.”
posted by Henry Stern, LUTCF, CBC @ March 02, 2008 10:37 PM

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3 Responses Leave a comment

  • Anonymous 2010.2.28 at 10:32 | Quote

    I had an IME in Jan 2009. The IME doctor recommended surgery for two tears in my right shoulder that was the result of a serious auto accident. Forward another month and the same IME changed the report and never recommended surgery. Again, one month later I see the same IME. I walk into the office and he tells me that my shoulder is healed before he turns around. The IME doctor spends a total of 10 seconds examining my arms. I get a letter from Allstate stating that they will no longer cover my injuries.

    With all the documentation I have I know the doctor gave Allstate the information they wanted. If the IME doctor had not given Allstate the report they wanted I would have been at an IME exam every month. The nurse at one of these IME's told me that she has seen people at the IME more than a dozen times.

  • anonymous 2011.2.9 at 00:39 | Quote

    Allstate is using a firm called “Exam Works” as a stable for some of their IME “doctors”. The results the doctor reported following my exam were considerably different than what I had recorded on my tape recorder during the visit. On the report the doctor even claims that it was true “under penalty of perjury”. Wouldn’t this be considered fraud? How do I go about reporting the doctor to his licensing organization?

  • Eric Turkewitz 2011.2.9 at 12:05 | Quote

    Allstate is using a firm called “Exam Works” as a stable for some of their IME “doctors”. The results the doctor reported following my exam were considerably different than what I had recorded on my tape recorder during the visit. On the report the doctor even claims that it was true “under penalty of perjury”. Wouldn’t this be considered fraud? How do I go about reporting the doctor to his licensing organization?

    It depends on where you live. If it was New York, the place to go might be the Department of Health.

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