The suit also claims the defendants’ patient population has become limited to automobile accident patients, and that Texas delegation requirements for its nurse practitioners were not followed. (Credit: Diego M. Radzinschi/ALM)
Allstate has filed a $5 million lawsuit against related Texas imaging centers and physicians for allegedly participating in an auto insurance scheme. The defendants in the case include Foundation Physician Group, a Dallas-based pain management firm, as well as affiliated entities Prime Imaging Partners and Memorial MRI & Diagnostic.
The suit, which was filed November 3, states that Allstate seeks to recover money it says was fraudulently procured by the defendants based on medical billings for services the insurer calls “unnecessary and unreasonable” in bodily injury claims. These services included examinations and injection procedures.
The alleged fraud occurred from mid-2019 to 2023.
The lawsuit claims that prior to 2019, Foundation Physicians Group included a number of orthopedic surgeons, pain management physicians and neurologists who saw an assortment of patients. However, by mid-2019, only a handful of part-time physicians saw patients at the Foundation, with nurse practitioners allegedly performing the majority of examinations and determinations. The suit also claims that at this time the Foundation’s patient population became more limited to automobile accident patients, and that Texas delegation requirements for the Foundation's nurse practitioners were not followed.
The suit states, in part: “Plaintiffs would show that in the period at issue particular law offices, directly or in coordination with chiropractic and multidisciplinary clinics associated with these law offices, referred automobile accident patients to Defendants’ Enterprise. Defendants converted otherwise soft-tissue bodily injury claims into major medical claims by conducting unnecessary injection procedures. Generally, patients were referred for MRIs, to a limited number of MRI facilities including ones of Prime Imaging Partners, LLC (“Prime”). Prime is a co-owned entity of Foundation, and their respective main offices are located in the same building along Loop 635 in north Dallas.”
Allstate claims that no physician evaluated the need for or otherwise approved the injection procedures ordered by the nurse practitioners. It argues that those working and associated with the Foundation inflated auto accident claims through a “build up” of the claims by unnecessary pain management services in violation of U.S. code.
“As a direct and proximate result of the Defendants’ conduct as set forth herein,” the suit states, “Plaintiffs were injured by paying sums in payment of fraudulently inflated bodily injury claims, arising from the pattern of racketeering activity.”
A full copy of the complaint can be found here.
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