New Jersey medical providers charged with abuse of PIP benefits

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According to State Farm, providers have followed a troubling trend of prescribing the same treatment to patients who gave similar responses to questions or tests after a car accident. (Credit: sasirin pamai/Shutterstock.com)

Insurance giant State Farm has filed a lawsuit against 12 New Jersey medical providers for unjust enrichment and violation of the state’s insurance fraud prevention law. The 80-page complaint, filed in the United States District Court for the District of New Jersey, alleges that over the past eight years, the defendants participated in an auto insurance fraud scheme abusing accident protection benefits. injuries (PIP) available in New Jersey. According to the complaint, State Farm named several people and companies as defendants, including the Tri-County Chiropractic and Rehabilitation Center, Robert Matturro, DC, and Advanced Spine and Pain Management.

According to State Farm, providers have followed a troubling trend of prescribing the same treatment to patients who gave similar responses to questions or tests after a car accident. Doctors allegedly failed to make honest assessments of injuries sustained by patients in car crashes and recommended nearly identical treatments without considering a patient’s particular circumstances. For example, a patient with a neck injury would receive hot and cold compresses, chiropractic adjustments, physical medicine, massage, manual therapy, and even mechanical traction all in one visit, only to do the same again on most subsequent visits. Physicians have also taken advantage of the availability of PIP benefits by referring patients for services that were never performed or were not medically necessary.

The defendants are also accused of making unlawful referrals to diagnostic clinics owned by one of the defendants. Treatments at these clinics followed the same pattern, with substantially similar treatments being followed for injuries of a similar nature. In-clinic treatments, however, sometimes went beyond “not medically necessary” to the point of resorting to unnecessary invasive procedures, such as injections, supported by false documentation.

State Farm is seeking $2.6 million for payment of fraudulent automobile claims, as well as a declaratory judgment that they are no longer obligated to pay claims from named defendants.

Editor’s note: Insurance fraud is unfortunately more common than you might think. Insurers spend a lot of time and money investigating fraudulent claims, which leads to higher premiums. Accident networks of doctors and lawyers are nothing new, but catching those who commit 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 who try to take advantage of coverage.

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