Allstate Insurance Co., Country Insurance & Financial Services (formerly MSI Insurance Cos.), Encompass Insurance (through underwriting company Continental Insurance Co.), and Progressive Casualty Insurance and other affiliate companies have filed a $1.5 million suit against the owners and operators of 16 medical clinics, alleging that they schemed to defraud the insurers.
The suit accuses Robert Wohfeld, Jeanette C. Couf, Craig Waltzer, and others of conspiring to falsely bill insurance companies for $770,000, although the suit also seeks legal and investigative fees. The complaint alleges that the defendants committed fraud by, among other things, illegally soliciting accident victims to receive treatment in chiropractic clinics and other clinics that they owned or operated, charging for medical services never performed, and administering and billing for unnecessary and excessive treatments. According to the suit, the defendants worked with runners who contacted people involved in accidents and then transported them to the defendants' clinics for chiropractic, physical therapy, and other treatments that were unnecessary or excessive. In addition, the treatments were prescribed according to a standardized plan that was not based on the needs of the patients but designed to maximize the clinics' billings, the plaintiffs charged.
Recently, in New Jersey, Allstate won a $6.65 million judgement in a case that Allstate New Jersey Insurance Co. and Encompass Insurance had brought against a former local chiropractor. Mathew E. Lister's undisclosed ownership in multiple medical facilities and his self-referral of patients among those facilities constituted a pattern and practice of fraud under the New Jersey Insurance Fraud Prevention Statute, according to the judge who heard the case.
Last month, Allstate filed a half-million-dollar lawsuit against a Philadelphia chiropractic clinic, All-Care, Chiropractic, alleging fraudulent billing practices for insurance claims involving patients with personal injury lawsuits. The suit alleges that All-Care owners and operators, Richard Walinsky and Eileen Nelson Means, fraudulently billed the insurer for treatments that never were performed, over-billed for services that were performed, and used improperly licensed and unsupervised personnel for in-home patient visits.
"Allstate is serious about fighting insurance fraud," said Edward J. Moran assistant vice president in charge of Allstate's special investigation unit. "We have no tolerance for this crime. Our policyholders and consumers in general benefit from our aggressive fight against insurance fraud."
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