Case 0:22-cv-61648-AHS Document 1 Entered on FLSD Docket 09/02/2022 Page 1 of 101
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`UNITED STATES DISTRICT COURT
`SOUTHERN DISTRICT OF FLORIDA
`FORT LAUDERDALE DIVISION
`
`Case No.: _________________
`
`
`GOVERNMENT EMPLOYEES INSURANCE CO.,
`GEICO INDEMNITY CO., GEICO GENERAL
`INSURANCE COMPANY and GEICO CASUALTY CO.,
`
`
` Plaintiffs,
`
`vs.
`
`
`
`
`
`
`
`
`
`
`
`Jury Trial Demanded
`
`
`
`
`TITAN WELLNESS CENTER OF FORT MYERS, L.L.C.,
`HOA H. NGUYEN, D.C., ISO-DIAGNOSTICS TESTING,
`INC., DAVID BARUCH, JOEL D. STEIN, D.O., P.A., and
`JOEL D. STEIN, D.O.,
`
`
`
`Defendants.
`_____________________________________________________/
`
`
`COMPLAINT
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`Plaintiffs, Government Employees Insurance Co., GEICO Indemnity Co., GEICO General
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`
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`Insurance Company and GEICO Casualty Co. (collectively “GEICO” or “Plaintiffs”), sue
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`Defendants and allege as follows:
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`1.
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`This action seeks to recover more than $2,800,000.00 that Defendants wrongfully
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`obtained from GEICO by submitting thousands of fraudulent and unlawful no-fault (“no-fault”,
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`“personal injury protection”, or “PIP”) insurance charges through Defendants Titan Wellness
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`Center of Fort Myers, L.L.C. (“Titan Wellness”), ISO-Diagnostics Testing, Inc. (“ISO-
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`Diagnostics”), and Joel D. Stein, D.O., P.A. (“Stein P.A.”) relating to medically unnecessary,
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`illusory, unlawful, and otherwise non-reimbursable health care services and goods, including
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`purported examinations, physical therapy services, chiropractic services, range of motion testing,
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`muscle strength testing, ligament laxity testing, and home medical equipment (“HME”)
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`

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`Case 0:22-cv-61648-AHS Document 1 Entered on FLSD Docket 09/02/2022 Page 2 of 101
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`(collectively, the “Fraudulent Services”), that purportedly were provided to Florida automobile
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`accident victims (“Insureds”) who were eligible for coverage under GEICO no-fault insurance
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`policies.
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`2.
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`In addition, GEICO seeks a declaration that it is not legally obligated to pay
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`reimbursement of more than $75,000.00 in pending, fraudulent and unlawful PIP claims that
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`Defendants have submitted through Titan Wellness, ISO-Diagnostics, and Stein P.A., because:
`
`(i)
`
`(ii)
`
`
`(iii)
`
`
`(iv)
`
`
`3.
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`at all relevant times: (a) Titan Wellness, ISO-Diagnostics, and Stein P.A. operated
`in violation of the Florida Health Care Clinic Act, Fla. Stat. § 400.990 et seq. (the
`“Clinic Act”); (b) Titan Wellness, ISO-Diagnostics, and Stein P.A. operated in
`violation of Florida’s patient brokering act, Fla. Stat § 817.505 (the “Patient
`Brokering Act”); (c) Titan Wellness, ISO-Diagnostics, and Stein P.A. operated in
`violation of Florida’s anti-kickback statute, Fla. Stat. § 456.054 (the “Anti-
`Kickback Statute”); and (d) Titan Wellness operated in violation of Florida law
`governing home medical equipment provider licensure (the “HME Licensing
`Laws”), Fla. Stat. §§ 400.93 and 408.806;
`
`the underlying Fraudulent Services were not medically necessary, and were
`provided -- to the extent that they were provided at all -- pursuant to pre-determined
`fraudulent protocols designed to financially enrich Defendants, rather than to treat
`or otherwise benefit the Insureds who purportedly were subjected to them;
`
`in many cases, the Fraudulent Services never were provided in the first instance;
`and
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`the billing codes used for the Fraudulent Services misrepresented and exaggerated
`the level of services that purportedly were provided in order to fraudulently inflate
`the charges submitted to GEICO.
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`Each and every charge submitted through Titan Wellness, ISO-Diagnostics, and
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`Stein, P.A. since at least 2017 has been fraudulent and unlawful for the reasons set forth herein.
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`The charts annexed hereto as Exhibits “1” - “3” set forth a large and representative sample of the
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`fraudulent and unlawful claims that have been identified to date that have been submitted to
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`GEICO by mail through Titan Wellness, ISO-Diagnostics, and Stein, P.A.
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`2
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`4.
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`The Defendants’ interrelated fraudulent schemes began no later than 2017, and
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`have continued uninterrupted since that time.
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`THE PARTIES
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`I.
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`Plaintiffs
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`5.
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`Plaintiffs Government Employees Insurance Co., GEICO Indemnity Co., GEICO
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`General Insurance Company and GEICO Casualty Co. (collectively, “GEICO”) are Nebraska
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`corporations with their principal places of business in Chevy Chase, Maryland. GEICO is
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`authorized to conduct business and to issue automobile insurance policies in Florida.
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`II.
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`Defendants
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`6.
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`7.
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`Defendant Hoa H. Nguyen, D.C. (“Nguyen”) resides in and is a citizen of Florida.
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`Nguyen was licensed to practice chiropractic in Florida on September 18, 2009, but
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`never has been licensed as a physician.
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`8.
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`Nguyen was the member and owner of Titan Wellness, purported to perform or
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`directly supervise virtually all of the Fraudulent Services at Titan Wellness, and used Titan
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`Wellness as a vehicle to submit fraudulent and unlawful PIP insurance billing to GEICO and other
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`insurers.
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`9.
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`Defendant Titan Wellness is a Florida limited liability company with its principal
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`place of business in Fort Myers, Florida.
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`10.
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`Titan Wellness was organized in Florida on or about July 7, 2015, had Nguyen as
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`its member and owner, and was used as a vehicle to submit fraudulent and unlawful PIP insurance
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`billing to GEICO and other insurers.
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`11.
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`At all relevant times, Titan Wellness falsely purported to be exempt from health
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`care clinic licensure requirements pursuant to Fla. Stat. § 400.9905(4)(g).
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`3
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`12.
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`13.
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`Defendant David Baruch (“Baruch”) resides in and is a citizen of Florida.
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`Upon information and belief based on a review of Florida Department of Health
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`records, Baruch is not a licensed physician or other licensed health care professional.
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`14.
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`Baruch owned and controlled ISO-Diagnostics, and used ISO-Diagnostics as a
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`vehicle to submit fraudulent and unlawful no-fault insurance billing to GEICO and other insurers.
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`15.
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`Defendant ISO-Diagnostics is a Florida corporation with its principal place of
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`business in Fort Lauderdale, Florida.
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`16.
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`ISO-Diagnostics was incorporated in Florida on or about April 10, 2005, was
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`owned by Baruch, and was used as a vehicle to submit fraudulent and unlawful PIP insurance
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`billing to GEICO and other insurers.
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`17.
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`At all times, ISO-Diagnostics falsely purported to a properly licensed health care
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`clinic that operated in compliance with the licensing and operating requirements set forth in the
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`Clinic Act.
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`18.
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`19.
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`20.
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`Defendant Joel D. Stein, D.O. (“Stein”) resides in and is a citizen of Florida.
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`Stein was licensed to practice medicine in Florida on June 30, 1984.
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`Stein owned and controlled Stein P.A., purported to perform or directly supervise
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`virtually all of the Fraudulent Services at Stein P.A., falsely purported to serve as medical director
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`at ISO-Diagnostics, and caused fraudulent and unlawful PIP insurance billing to be submitted
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`through Stein P.A. and ISO-Diagnostics to GEICO and other insurers.
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`21.
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`Defendant Stein P.A. is a Florida corporation with its principal place of business in
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`Fort Lauderdale, Florida.
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`4
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`22.
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`Stein P.A. was incorporated in Florida on or about March 16, 1987, was owned by
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`Stein, and was used as a vehicle to submit fraudulent and unlawful PIP insurance billing to GEICO
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`and other insurers.
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`23.
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`At all relevant times, Stein P.A. falsely purported to be exempt from health care
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`clinic licensure requirements pursuant to Fla. Stat. § 400.9905(4)(g).
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`III. Other Relevant Individuals
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`24.
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`Although GEICO has not named them as Defendants in this Complaint, Rosemary
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`Sachs, A.P.R.N. (“Sachs”) and Kris Poncev (“Poncev”) are relevant to understanding Plaintiffs’
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`claims in this action.
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`25.
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`Sachs is licensed in Florida as an advanced practice registered nurse, and -- at Stein
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`and Stein P.A.’s direction -- purported to perform many of the Fraudulent Services that were billed
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`through Stein P.A. to GEICO.
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`26.
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`Upon information and belief based on a review of Florida Department of Health
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`records, Poncev is not licensed to practice any health care profession. Even so, Poncev -- at Baruch,
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`ISO-Diagnostics, and Stein’s direction -- purported to perform many of the Fraudulent Services
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`that were billed through ISO-Diagnostics to GEICO.
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`JURISDICTION AND VENUE
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`27.
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`This Court has jurisdiction over the subject matter of this action under 28 U.S.C. §
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`1332(a)(1) because the total matter in controversy, exclusive of interest and costs, exceeds the
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`jurisdictional threshold of $75,000.00, and is between citizens of different states.
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`28.
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`This Court also has original jurisdiction pursuant to 28 U.S.C. § 1331 over claims
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`brought under 18 U.S.C. §§ 1961 et seq. (the Racketeer Influenced and Corrupt Organizations
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`(“RICO”) Act).
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`5
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`29.
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`In addition, this Court has supplemental jurisdiction over the subject matter of the
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`claims asserted in this action pursuant to 28 U.S.C. § 1367.
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`30.
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`Venue in this District is appropriate pursuant to 28 U.S.C. § 1391, as the Southern
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`District of Florida is the District where one or more of Defendants reside and because this is the
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`District where a substantial amount of the activities forming the basis of the Complaint occurred.
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`I.
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`ALLEGATIONS
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`Brief Overview of Pertinent Law Governing No-Fault Insurance Reimbursement
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`31.
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`Florida requires automobile insurers such as GEICO to provide PIP insurance
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`benefits (“PIP Benefits”) to Insureds when they are injured in a motor vehicle accident. See Florida
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`Motor Vehicle No-Fault Law, Fla. Stat. §§ 627.730-627.7405 (the “No-Fault Law”).
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`32.
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`Under the No-Fault Law, a health care services provider that possesses a valid
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`assignment of PIP Benefits from an Insured and that provides medically necessary health care
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`services to an Insured may submit claims directly to an insurance company in order to receive
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`payment for medically necessary services, using the required claim forms, including the Health
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`Care Financing Administration insurance claim form (known as the “HCFA-1500 form” or “CMS-
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`1500” form).
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`33.
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`In order for a health care service to be eligible for PIP reimbursement, it must be
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`“lawfully” provided, medically necessary, and the bill for the service cannot misrepresent the
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`nature or extent of the service that was provided. Furthermore, insurers such as GEICO are not
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`required to pay anyone who knowingly submits a false or misleading statement relating to a PIP
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`claim or charges. See Fla. Stat. § 627.736.
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`34.
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`PIP reimbursement for health care services is limited to $2,500.00 per injured
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`person, unless a physician, physician assistant, or advanced practice registered nurse determines
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`6
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`that the injured person suffered from an “emergency medical condition”, in which case health care
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`providers can be reimbursed up to $10,000.00 for health care services. See Fla. Stat. § 627.736.
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`35.
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`Pursuant to the No-Fault Law, an “emergency medical condition” means a “medical
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`condition manifesting itself by acute symptoms of sufficient severity, which may include severe
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`pain, such that the absence of immediate medical attention could reasonably be expected to result
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`in any of the following: (a) serious jeopardy to patient health. (b) serious impairment to bodily
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`functions. (c) serious dysfunction of any bodily organ or part.” Fla. Stat. § 627.732.
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`36.
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`Additionally, in order for a health care service to be eligible for PIP reimbursement,
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`the applicable claim form must set forth the professional license number of the provider who
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`personally performed or directly supervised the underlying health care service, in the line or space
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`provided for “Signature of Physician or Supplier, Including Degrees or Credentials.” See Fla. Stat.
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`§ 627.736.
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`37. Moreover, under Florida law, subject to limited exceptions not applicable here,
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`entities providing home use durable medical equipment (“HME”) must be licensed by the Florida
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`Agency for Health Care Administration. See Fla. Stat. § 400.93(1). Insurers such as GEICO are
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`not required to pay PIP reimbursement to HME providers that unlawfully operate in violation of
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`Florida HME licensure requirements.
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`38.
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`Furthermore, Florida’s Patient Brokering Act, Fla. Stat. § 817.505, broadly
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`prohibits any person from offering, paying soliciting, or receiving any commission, bonus, rebate,
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`kickback, or bribe -- directly or indirectly, in cash or in kind -- or from engaging in any fee-splitting
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`arrangement of any type whatsoever, to either induce a patient referral or in exchange for a patient
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`referral.
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`7
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`39.
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`Likewise, Florida’s Anti-Kickback Statute, Fla. Stat. § 456.054, prohibits any
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`health care provider from offering, paying, soliciting, or receiving a kickback, directly or
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`indirectly, overtly or covertly, in cash or in kind, for referring or soliciting patients. Violations of
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`the Anti-Kickback Statute also constitute violations of the Patient Brokering Act.
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`40.
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`Insurers such as GEICO are not required to make any payments of PIP Benefits to
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`clinics and other health care providers that operate in violation of the Patient Brokering Act or
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`Anti-Kickback Statute, whether or not the underlying health care services were medically
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`necessary or actually provided.
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`41.
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`Subject to certain limited exceptions, a license issued by the Florida Agency for
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`Health Care Administration is required in order to operate a health care clinic in Florida. See Fla.
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`Stat. § 400.991(1)(a).
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`42.
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`However, the Clinic Act provides an exemption from the clinic licensing
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`requirements for:
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`A sole proprietorship, group practice, partnership, or corporation that provides health care
`services by licensed health care practitioners . . . that is wholly owned by one or more
`licensed health care practitioners, or the licensed health care practitioners set forth in this
`paragraph and the spouse, parent, child, or sibling of a licensed health care practitioner if
`one of the owners who is a licensed health care practitioner is supervising the business
`activities and is legally responsible for the entity's compliance with all federal and state
`laws. However, a health care practitioner may not supervise services beyond the scope of
`the practitioner's license … .
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`Fla. Stat. § 400.9905(4)(g)(emphasis added).
`
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`In order to qualify for the “wholly owned” exemption under the Clinic Act, the
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`43.
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`licensed health care practitioner has a continuing obligation to supervise the business activities of
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`the clinic and remain legally responsible for the entity’s compliance with all federal and state laws.
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`44.
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`Pursuant to the Clinic Act, clinics operating in Florida without a valid exemption
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`from the licensing requirements must -- among other things -- appoint a medical director who must
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`Case 0:22-cv-61648-AHS Document 1 Entered on FLSD Docket 09/02/2022 Page 9 of 101
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`“[c]onduct systematic reviews of clinic billings to ensure that the billings are not fraudulent or
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`unlawful”, and take immediate corrective action upon discovery of a fraudulent or unlawful
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`charge. See Fla. Stat. § 400.9935(1). In addition, a clinic medical director must “[e]nsure that all
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`health care practitioners at the clinic have active appropriate certification or licensure for the level
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`of care being provided.” See Fla. Stat. § 400.9935(1).
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`45.
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`Pursuant to the Clinic Act, “[a] charge or reimbursement claim made by or on behalf
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`of a clinic that is required to be licensed . . . but that is not so licensed, or that is otherwise operating
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`in violation of this part . . . is an unlawful charge.” See Fla. Stat. § 400.9935(3).
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`II.
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`Defendants’ Interrelated Fraudulent Schemes
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`46.
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`Since at least 2017, and continuing through the present day, the Defendants
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`masterminded and implemented interrelated fraudulent schemes in which they billed GEICO
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`millions of dollars, or caused GEICO to be billed millions of dollars, for unlawful, medically
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`unnecessary, illusory, and otherwise non-reimbursable services.
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`A.
`
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`The Unlawful Operation of Titan Wellness Without Supervision by Nguyen
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`47.
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`Although Titan Wellness purported to be exempt from the Clinic Act’s health care
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`clinic licensure requirements, Titan Wellness operated without a valid exemption and, as a result,
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`operated as an unlicensed health care clinic in violation of the Clinic Act.
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`48.
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`In particular, Nguyen failed to supervise Titan Wellness’s business activities -- as
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`required by the Clinic Act -- and, as a result, Titan Wellness did not qualify for the “wholly owned”
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`exemption from the Clinic Act’s health care clinic licensure requirements.
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`49.
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`Nguyen did not legitimately supervise the business activities of Titan Wellness,
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`inasmuch as Nguyen never conducted reviews of the billing or treatment records from Titan
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`Wellness to ensure that the billing was not fraudulent or unlawful, and -- to the contrary -- directed
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`9
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`the submission of the fraudulent and unlawful charges through Titan Wellness to GEICO and other
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`insurers.
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`50.
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`Indeed, given the fraudulent treatment and billing protocol described below --
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`which was pervasive across all of the billing submitted to GEICO through Titan Wellness -- there
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`is simply no way that Nguyen could have legitimately supervised the business activities of Titan
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`Wellness to ensure that the billing was not fraudulent or ensure compliance with all applicable
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`federal and state laws as required by the Clinic Act.
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`51.
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`Had Nguyen legitimately supervised the business activities of Titan Wellness, he
`
`would have noted, among other things, that:
`
`(i)
`
`(ii)
`
`
`(iii)
`
`
`(iv)
`
`Titan Wellness was -- as set forth herein -- operated in pervasive violation of,
`variously, the Clinic Act, the Patient Brokering Act, the Anti-Kickback Statute, and
`HME licensing laws;
`
`the Fraudulent Services purportedly provided by and billed through Titan Wellness
`were not medically necessary, and were provided -- to the extent that they were
`provided at all -- pursuant to a pre-determined fraudulent protocol;
`
`in many cases, the Fraudulent Services purportedly provided by and billed through
`Titan Wellness were never provided in the first instance; and
`
`the billing codes used for the Fraudulent Services purportedly provided by and
`billed through Titan Wellness misrepresented and exaggerated the level of services
`that were provided in order to fraudulently inflate the charges submitted to GEICO.
`
`52.
`
`Accordingly, Titan Wellness never qualified for the “wholly owned” exemption
`
`
`
`
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`from licensure as a “health care clinic” set forth in Section 400.9905(4)(g). Nor did Titan Wellness
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`qualify for any other exemption to the Clinic Act, or have a medical director as required for a
`
`health care clinic without an exemption. As a result, Titan Wellness operated -- at all relevant times
`
`-- in violation of the Clinic Act.
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`B.
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`The Unlawful Operation of Stein P.A. Without Supervision by Stein
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`53.
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`Furthermore, Stein P.A. purported to be exempt from the Clinic Act’s health care
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`clinic licensure requirements, but operated without a valid exemption and, as a result, operated as
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`an unlicensed health care clinic in violation of the Clinic Act.
`
`54.
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`In particular, Stein failed to supervise Stein P.A.’s business activities -- as required
`
`by the Clinic Act -- and, as a result, Stein P.A. did not qualify for the “wholly owned” exemption
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`from the Clinic Act’s health care clinic licensure requirements.
`
`55.
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`Stein did not legitimately supervise the business activities of Stein P.A., inasmuch
`
`as Stein never conducted reviews of the billing or treatment records from Stein P.A. to ensure that
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`the billing was not fraudulent or unlawful, and -- to the contrary -- directed the submission of the
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`fraudulent and unlawful charges through Stein P.A. to GEICO and other insurers.
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`56.
`
`Indeed, given the fraudulent treatment and billing protocol described below --
`
`which was pervasive across all of the billing submitted to GEICO through Stein P.A. -- there is
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`simply no way that Stein could have legitimately supervised the business activities of Stein P.A.
`
`to ensure that the billing was not fraudulent or ensure compliance with all applicable federal and
`
`state laws as required by the Clinic Act.
`
`57.
`
`Had Stein legitimately supervised the business activities of Stein P.A., he would
`
`have noted, among other things, that:
`
`
`
`(i)
`
`(ii)
`
`
`(iii)
`
`
`
`Stein PA. was -- as set forth herein -- operated in pervasive violation of, variously,
`the Clinic Act, the Patient Brokering Act, and the Anti-Kickback Statute;
`
`the Fraudulent Services purportedly provided by and billed through Stein P.A. were
`not medically necessary, and were provided -- to the extent that they were provided
`at all -- pursuant to a pre-determined fraudulent protocol;
`
`in many cases, the Fraudulent Services purportedly provided by and billed through
`Stein P.A. were never provided in the first instance; and
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`(iv)
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`the billing codes used for the Fraudulent Services purportedly provided by and
`billed through Stein P.A. misrepresented and exaggerated the level of services that
`were provided in order to fraudulently inflate the charges submitted to GEICO.
`
`58.
`
`Accordingly, Stein P.A. never qualified for the “wholly owned” exemption from
`
`
`
`licensure as a “health care clinic” set forth in Section 400.9905(4)(g). Nor did Stein P.A. qualify
`
`for any other exemption to the Clinic Act, or have a medical director as required for a health care
`
`clinic without an exemption. As a result, Stein P.A. operated -- at all relevant times -- in violation
`
`of the Clinic Act.
`
`C.
`
`The Unlawful Operation of ISO-Diagnostics Without a Legitimate Medical Director
`
`59.
`
`Because Baruch was not a licensed health care professional, Baruch could not
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`obtain a health care clinic license for ISO-Diagnostics, lawfully operate ISO-Diagnostics, or use
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`ISO-Diagnostics as a vehicle to submit PIP billing to GEICO and other insurers, unless he retained
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`a licensed physician to serve as ISO-Diagnostics’ medical director. See Fla. Stat. §§ 400.9905,
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`440.9935.
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`60.
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`However, if Baruch recruited a legitimate physician to serve as a legitimate medical
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`director at ISO-Diagnostics, the physician actually would be obligated to fulfill the statutory
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`requirements applicable to a clinic medical director. See, e.g., Fla. Stat. § 400.9935(1). By
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`extension, any such legitimate medical director would impede Baruch’s ability to use ISO-
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`Diagnostics as a vehicle to submit a large amount of fraudulent and unlawful PIP billing to GEICO
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`and other Florida automobile insurers.
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`61.
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`Accordingly, Baruch required a physician willing to falsely pose as the “medical
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`director” at ISO-Diagnostics, but who -- in actuality -- would not even attempt to fulfill the
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`statutory requirements applicable to a clinic medical director, and thereby permit Baruch to use
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`12
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`ISO-Diagnostics as a vehicle to submit a large amount of fraudulent and unlawful PIP billing to
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`GEICO and other insurers.
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`62.
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`Therefore, Baruch retained Stein, a licensed physician who in exchange for
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`compensation was willing to falsely pose as the legitimate medical director of ISO-Diagnostics.
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`63.
`
`In order to circumvent Florida law and induce the Florida Agency for Health Care
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`Administration to maintain ISO-Diagnostics’ licensure and to permit ISO-Diagnostics to operate
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`as a clinic, Baruch entered into a secret scheme with Stein. In exchange for compensation from
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`Baruch and ISO-Diagnostics, Stein agreed to falsely represent, to the Florida Agency for Health
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`Care Administration, to the Insureds who sought treatment at ISO-Diagnostics, and to the insurers
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`including GEICO that received PIP claims from ISO-Diagnostics, that he was the true medical
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`director at ISO-Diagnostics, and that he truly fulfilled the statutory requirements applicable to
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`clinic medical directors at ISO-Diagnostics.
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`64.
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`However, Stein never genuinely served as medical director at ISO-Diagnostics.
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`Instead, from the beginning of his association with ISO-Diagnostics as its phony “medical
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`director”, Stein ceded decision-making and oversight regarding health care services at ISO-
`
`Diagnostics, and the resulting billing, to Baruch.
`
`65.
`
`Stein never legitimately served as medical director at ISO-Diagnostics, inasmuch
`
`as he never conducted systematic reviews of ISO-Diagnostics’ billings to ensure that the billings
`
`were not fraudulent or unlawful, and never even made any attempt to discover the unlawful charges
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`submitted through ISO-Diagnostics, much less take any immediate corrective action. See Fla. Stat.
`
`§ 400.9935(1).
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`Case 0:22-cv-61648-AHS Document 1 Entered on FLSD Docket 09/02/2022 Page 14 of 101
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`66.
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`Had Stein legitimately served as ISO-Diagnostics’ medical director, Stein would
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`have noted, among other things, that ISO-Diagnostics was operating in pervasive violation of the
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`Clinic Act, the Patient Brokering Act, and the Anti-Kickback Statute.
`
`67.
`
`In fact, true authority over the provision of health care services through ISO-
`
`Diagnostics, and the resulting billing -- including the authority that would, at a legitimate clinic,
`
`be vested in the medical director -- was held at all times by Baruch.
`
`68.
`
`Stein unlawfully permitted Baruch to dictate the manner in which Insureds would
`
`be treated at ISO-Diagnostics, and to dictate the manner in which health care services at ISO-
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`Diagnostics would be billed to GEICO and other insurers, because he wanted to continue profiting
`
`through ISO-Diagnostics’ fraudulent and unlawful PIP billing.
`
`69.
`
`Baruch used the façade of Stein’s “appointment” as ISO-Diagnostics’ phony
`
`“medical director” to do indirectly what he was forbidden from doing directly -- namely: (i) to
`
`operate a clinic without a legitimate medical director; (ii) to engage in unlicensed medical decision-
`
`making with respect to the Insureds who sought treatment at ISO-Diagnostics; and (iii) to use ISO-
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`Diagnostics as a vehicle to submit a large amount of fraudulent and unlawful PIP billing to GEICO
`
`and other insurers.
`
`D.
`
`The Violations of the HME Licensing Law
`
`
`
`70.
`
`At all relevant times, Titan Wellness purported to provide Insureds with HME as
`
`part of the Defendants’ fraudulent, pre-determined treatment protocol.
`
`71.
`
`72.
`
`However, Titan Wellness never obtained an HME license to provide HME.
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`Accordingly, Titan Wellness operated -- at all relevant times -- in violation of the
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`HME Licensing Laws.
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`Case 0:22-cv-61648-AHS Document 1 Entered on FLSD Docket 09/02/2022 Page 15 of 101
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`73.
`
`In the claims for HME identified in Exhibit “1”, Titan Wellness and Nguyen falsely
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`represented that Titan Wellness was in compliance with the HME Licensing Laws and was entitled
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`to be reimbursed on their HME charges, when in fact Titan Wellness was not in compliance with
`
`the HME Licensing Laws, and was not entitled to collect PIP Benefits, because Titan Wellness
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`purported to provide HME without proper licensure to do so.
`
`E.
`
`The Violations of the Patient Brokering Act and the Anti-Kickback Statute
`
`74.
`
`To the extent that the Insureds in the claims set forth in Exhibits “1” - “3” suffered
`
`any injuries at all in their automobile accidents, they virtually always were minor soft tissue
`
`injuries such as sprains or strains. These minor soft tissue injuries did not constitute legitimate
`
`“emergency medical conditions”.
`
`75.
`
`For instance, and in keeping with the fact that the Insureds in the claims identified
`
`in Exhibits “1” - “3” did not legitimately suffer from any “emergency medical conditions”, in the
`
`substantial majority of the claims identified in Exhibits “1” - “3” the Insureds did not seek
`
`treatment at any hospital as the result of their accidents.
`
`76.
`
`To the limited extent that the Insureds did report to a hospital after their accidents,
`
`they virtually always were briefly observed on an outpatient basis and then sent on their way after
`
`a few hours with, at most, a minor sprain, strain, or similar soft-tissue injury diagnosis.
`
`77.
`
`Furthermore, in most cases, contemporaneous police reports indicated that the
`
`underlying accidents involved low-speed, low-impact collisions, that the Insureds’ vehicles were
`
`drivable following the accidents, and that no one was seriously injured in the underlying accidents,
`
`or injured at all.
`
`78.
`
`Even so, Titan Wellness and Nguyen wanted to bill GEICO and other insurers for
`
`a large amount of expensive and medically unnecessary examinations, chiropractic, physical
`
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`Case 0:22-cv-61648-AHS Document 1 Entered on FLSD Docket 09/02/2022 Page 16 of 101
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`therapy, testing, and HME, without regard for the fact that the Insureds had not suffered any
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`injuries that would warrant these Fraudulent Services.
`
`79.
`
`However, Titan Wellness and Nguyen know that -- unless they could get a
`
`physician, physician assistant, or advanced practice registered nurse to falsely report that their
`
`patients suffered from “emergency medical conditions” -- they would be limited to recovering
`
`$2,500.00 in PIP Benefits per patient, as opposed to the $10,000.00 per patient they could
`
`potentially recover if the patient had an “emergency medical condition” diagnosis.
`
`80.
`
`At the same time, Stein, Stein P.A., Baruch, and ISO-Diagnostics wanted to submit
`
`as much PIP billing as possible for expensive and medically unnecessary examinations and testing,
`
`without regard for the fact that the Insureds had not suffered any injuries that would warrant these
`
`examinations or tests.
`
`81.
`
`However, in order to bill GEICO and other insurers for medically unnecessary and
`
`illusory examinations and testing, Stein, Stein P.A., Baruch, and ISO-Diagnostics needed to obtain
`
`patient referrals from other health care providers, such as Titan Wellness and Nguyen.
`
`82.
`
`Accordingly, Titan Wellness, Nguyen, Stein, Stein P.A., Baruch, and ISO-
`
`Diagnostics entered into a secret and unlawful patient brokering agreement, whereby:
`
`(i)
`
`(ii)
`
`In exchange for patient referrals from Titan Wellness and Nguyen for expensive
`and medically unnecessary examinations and muscle strength testing, Stein and
`Stein P.A. provided the Insureds with phony “emergency medical condition”
`diagnoses, which enabled Titan Wellness and Nguyen to submit substantial
`additional PIP billing per Insured for medically unnecessary chiropractic, physical
`therapy, testing, and HME.
`
`Then, after receiving these patient referrals from Titan Wellness and Nguyen in
`exchange for their phony “emergency medical condition” diagnoses, Stein and
`Stein P.A. referred the Insureds on to Baruch and ISO-Diagnostics for expensive
`and medically useless range of motion and muscle strength testing, in exchange for
`monetary compensation from Baruch and ISO-Diagnostics.
`
`
`
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`83.
`
`In reality, these were “pay-to-play” arrangements that caused Nguyen, Titan
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`Wellness, Stein, and Stein P.A. to provide medically unnecessary patient referrals in violation of
`
`the Patient Brokering Act and Anti-Kickback Statute.
`
`84.
`
`(i)
`
`(ii)
`
`For example:
`
`On or about April 10, 2019, Titan Wellness and Nguyen referred an Insured named
`JF to Stein P.A. and Stein for a medically unnecessary examination and muscle
`strength tests, which then were billed through S