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.
Also what doctor in NY that treats PI patients has not been “investigated” by State Farm et al?
BRM 5/19/2008 Albany NY
You applaud Rosenberg for smearing doctors and just making up lies about people…well, thats interesting…Don’t worry, what comes around goes around 🙂
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? 🙂
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:
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.
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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 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 …
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.” …