The popular Florida insurance company State Farm has filed a lawsuit against three healthcare clinics in Miami for allegedly defrauding the insurance carrier out of $4.7 million by billing them for unneeded or unprovided medical care for car accident injury victims.
The State Farm lawsuit centers around Florida’s no-fault insurance benefits which allow Florida drivers and other beneficiaries to receive up to $10,000 in automatic medical coverage after a car accident. Because Florida’s PIP law requires insurers to pay a driver’s medical bills, no matter who caused the accident, the law is often a target of fraud by shady medical providers.
The new lawsuit claims that the accused Florida healthcare clinics used a standardized treatment plan for all automobile accident victims instead of treating each patient individually based on their unique needs.
The Miami healthcare clinics accused in the lawsuit are:
- Health and Wellness Services Inc., its former and current owner, and its former and current medical director;
- Medical Wellness Services Inc., its owner its former medical director, and its current medical director;
- Naranja’s Pain Relief Clinic of Homestead Corp., and its former and current medical director.
All three clinics have some type of familial ties with each other.
The basis for most PIP fraud, and the allegations of the State Farm lawsuit, center around billing insurance companies for either unnecessary or unprovided medical treatment.
State Farm claims that some of the bills submitted to them by the named healthcare clinics were false, misleading, or fraudulent.
According to the lawsuit, the healthcare clinics would fail to fully examine their car accident patients, then diagnose them with a very general condition (i,e, non-specific pain, sprains, and/or strains) then order the same diagnostic imaging and treatment for every patient.
The lawsuit further accuses the clinics of depleting all of their patients’ benefits, so that if they needed other legitimate treatment later, they wouldn’t have any more coverage available.
As with most PIP fraud lawsuits, the insurance carrier also accused the clinics and their medical directors of failing to properly review the medical billing practices. One of the main roles of a medical director is to review the diagnosis, treatment, and billing by their clinic to prevent abuses and to catch misconduct.
State Farm claims the fraud occurred between 2007 and present.
Dolman Law Group is a personal injury firm representing clients throughout the State of Florida.
The information provided above are all allegations made by State Farm in a publicly filed complaint. None of the above information is the opinion of the Dolman Law Group and is simply a relaying of information from available news sources and public record.