Case 1:22-cv-03630 Document 1 Filed 06/20/22 Page 1 of 57 PageID #: 1
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`Michael A. Sirignano (MS 5263)
`Barry I. Levy (BL 2190)
`Joanna Rosenblatt (JR 3359)
`RIVKIN RADLER LLP
`926 RXR Plaza
`Uniondale, New York 11556
`(516) 357-3000
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`Counsel for Plaintiffs Government Employees
`Insurance Company, GEICO Indemnity Company,
`GEICO General Insurance Company and
`GEICO Casualty Company
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`UNITED STATES DISTRICT COURT
`EASTERN DISTRICT OF NEW YORK
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`GOVERNMENT EMPLOYEES INSURANCE
`COMPANY, GEICO
`INDEMNITY COMPANY,
`GEICO GENERAL INSURANCE COMPANY and
`GEICO CASUALTY COMPANY,
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`
`Plaintiffs,
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`
`
`-against-
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`
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`IDEAL CARE PHARMACY, INC., and
`LEONID NAISHULER,
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`Docket No.: _____( )
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`
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`Defendants.
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`COMPLAINT
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`Plaintiffs Government Employees Insurance Company, GEICO Indemnity Company,
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`GEICO General Insurance Company and GEICO Casualty Company (collectively, “GEICO” or
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`“Plaintiffs”), as and for their Complaint against Defendants, Ideal Care Pharmacy, Inc., and Leonid
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`Naishuler (collectively, “Defendants”), hereby allege as follows:
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`1.
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`This action seeks to terminate an on-going fraudulent scheme perpetrated by the
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`Defendants who have exploited the New York “No-Fault” insurance system by submitting more
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`than $2 million in fraudulent pharmaceutical billing to GEICO. Specifically, the Defendants
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`submitted, or caused to be submitted, thousands of fraudulent claims to GEICO seeking payment
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`for a set of specifically targeted medically unnecessary “pain relieving” topical prescription drug
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`products, primarily in the form of topical Diclofenac Sodium Gel 3% and Lidocaine 5% Ointment
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`(collectively, the “Fraudulent Topical Pain Products”), as well a limited number of other
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`medications including oral nonsteroidal anti-inflammatory drugs (“NSAIDs”) and muscle relaxers
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`(together with the Fraudulent Topical Pain Products, the “Fraudulent Pharmaceuticals”).
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`2.
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`Defendant Ideal Care Pharmacy, Inc. (“Ideal Care” or the “Pharmacy”) and
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`Defendant Leonid Naishuler (“Naishuler”) (collectively, the “Pharmacy Owner Defendants”)
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`dispensed the Fraudulent Pharmaceuticals to individuals involved in automobile accidents and
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`eligible for insurance coverage under policies of insurance issued by GEICO (the “Insureds”). To
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`exploit the Insureds for financial gain, the Defendants targeted the prescription and dispensing of
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`the Fraudulent Topical Pain Products in place of other effective, but much-less costly prescription
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`and non-prescription drug products because the Defendants were able to acquire the Fraudulent
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`Topical Pain Products at low cost and then dispense and bill for them at exorbitant prices.
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`3.
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`In furtherance of the fraudulent scheme, the Defendants entered into illegal,
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`collusive agreements with various prescribing healthcare providers (the “Prescribing Providers”)
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`and unlicensed laypersons (the “Clinic Controllers”) who work at or are associated with various
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`multidisciplinary medical clinics that almost exclusively treat No-Fault patients (the “No-Fault
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`Clinics”). Pursuant to these collusive agreements, in exchange for kickbacks or other financial
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`incentives, the Defendants steered the Prescribing Providers and Clinic Controllers to direct large
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`volumes of prescriptions for the targeted Fraudulent Topical Pain Products to Ideal Care. These
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`prescriptions were frequently generated using preprinted template prescription forms in violation
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`of law and at times contained stamped, or photocopied signatures.
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`4.
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`The Defendants’ scheme to steer the Prescribing Providers and Clinic Controllers
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`to routinely prescribe and direct prescriptions to Ideal Care for large volumes of the Fraudulent
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`Topical Pain Products pursuant to their collusive arrangements egregiously inflated the charges
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`submitted to GEICO. For example, Ideal Care typically submitted claims to GEICO seeking
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`approximately $2,599.00 for a single tube of Diclofenac Sodium Gel 3% and between
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`approximately $1,681.00 and $2,100.00 for a single tube of Lidocaine 5% Ointment. The
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`Defendants’ scheme not only inflated the charges submitted to GEICO and other insurers, but also
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`posed serious risks to patients’ health, safety, and well-being.
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`5.
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`By this action, GEICO seeks to recover more than $527,000.00 that the Defendants
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`stole from it, along with a declaration that GEICO is not legally obligated to pay reimbursement
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`to Ideal Care of over $1.17 million in pending fraudulent No-Fault claims that the Defendants
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`submitted or caused to be submitted through Ideal Care because:
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`(i)
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`(ii)
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`The Defendants participated in illegal, collusive relationships in which the
`Defendants steered the Prescribing Providers and Clinic Controllers to
`direct illegal prescriptions for the Fraudulent Pharmaceuticals to Ideal Care
`in exchange for unlawful kickbacks and other financial incentives;
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`Ideal Care billed for pharmaceutical products that were prescribed and
`dispensed pursuant
`to
`illegal, collusive agreements, as well as
`predetermined fraudulent protocols designed to exploit the patients for
`financial gain, without regard for genuine patient care;
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`(iii) The Defendants intentionally targeted a specific set of pharmaceutical
`products (i.e., the Fraudulent Topical Pain Products) that they acquired at
`low cost and caused Ideal Care to dispense in large volumes to Insureds at
`egregious charges, in place of other effective, less costly pharmaceuticals;
`and
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`The Defendants made and continue to make false and fraudulent
`misrepresentations to GEICO by submitting or causing to be submitted
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`(iv)
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`6.
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`7.
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`8.
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`charges for the Fraudulent Pharmaceuticals under the name of Ideal Care
`pursuant to illegal and invalid prescriptions.
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`The Defendants fall into the following categories:
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`(i)
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`(ii)
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`Ideal Care is a New York corporation engaged in a fraudulent scheme in
`which it dispenses the Fraudulent Pharmaceuticals, pursuant to illegal,
`collusive agreements and predetermined protocols, without regard to
`genuine patient care, in order to submit to GEICO and other New York
`automobile insurers claims for reimbursement of No-Fault benefits to which
`it is not entitled; and
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`Naishuler is the record owner of Ideal Care since 2012.
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`The Defendants’ scheme began in 2020 and continues through the present day.
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`As discussed more fully below, the Defendants at all times have known that: (i) the
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`Defendants participated in illegal, collusive relationships in which they steered the Prescribing
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`Providers and Clinic Controllers to direct illegal prescriptions for the Fraudulent Pharmaceuticals
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`to Ideal Care in exchange for unlawful kickbacks and other financial incentives; (ii) the Fraudulent
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`Pharmaceuticals billed through Ideal Care were medically unnecessary, and prescribed and
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`dispensed pursuant to predetermined fraudulent protocols designed to exploit patients for financial
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`gain, without regard for genuine patient care; (iii) the Defendants intentionally targeted a specific
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`set of pharmaceutical products (i.e., the Fraudulent Topical Pain Products) that they acquired at
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`low cost and had Ideal Care dispense in large volumes to Insureds with exorbitant charges, in place
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`of other effective, less costly pharmaceuticals; and (iv) the Defendants made and continue to make
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`false and fraudulent misrepresentations to GEICO by submitting or causing to be submitted
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`charges for the Fraudulent Pharmaceuticals pursuant to illegal and invalid prescriptions.
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`9.
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`Based on the foregoing, Ideal Care does not have – and never had – any right to be
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`compensated for the Fraudulent Pharmaceuticals allegedly dispensed to GEICO Insureds. The
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`chart attached hereto as Exhibit “1” sets forth the fraudulent claims that have been identified to-
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`date which the Defendants submitted, or caused to be submitted, to GEICO through the United
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`States mail. As a result of the Defendants’ scheme, GEICO has incurred damages of more than
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`$527,000.00.
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`I.
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`PLAINTIFFS
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`THE PARTIES
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`10.
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`Plaintiffs Government Employees Insurance Company, GEICO Indemnity
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`Company, GEICO General Insurance Company and GEICO Casualty Company are Nebraska
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`corporations with their principal places of business in Chevy Chase, Maryland. GEICO is authorized
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`to conduct business and to issue automobile insurance policies in New York.
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`II.
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`DEFENDANTS
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`11.
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`Defendant Ideal Care is a New York corporation, formed on or about August 14,
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`2012. Its current principal place of business is 811 Avenue U, Brooklyn, New York.
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`12.
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`Ideal Care knowingly submitted fraudulent claims to GEICO and continues to seek
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`reimbursement on unpaid fraudulent claims.
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`13.
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`Defendant Naishuler resides in and is a citizen of New York. Naishuler is the owner
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`of Ideal Care.
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`14.
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`Ideal Care received prescriptions from, among other locations, a No-Fault Clinic
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`that was identified in an ongoing criminal proceeding, captioned USA v. Rose, 19-cr-00789
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`(PGG). In that criminal proceeding, the US Government has credibly alleged that the laypersons
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`who own the various No-fault medical clinics (i) pay kickbacks to hospital workers, medical
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`service providers, and police officers in exchange for confidential information of motor vehicle
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`accident victims in New York; and (ii) accept kickbacks in exchange for allowing healthcare
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`providers access to patients so they can bill for medically unnecessary services for patients being
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`treated, or allegedly treated, at the No-Fault Clinics.
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`JURISDICTION AND VENUE
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`15.
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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 matter in controversy exceeds the sum or value of $75,000.00, exclusive
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`of interest and costs, and is between citizens of different states.
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`16.
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`This Court also has original jurisdiction pursuant to 28 U.S.C. § 1331, over the
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`claims brought under 18 U.S.C. §§ 1961 et seq., the Racketeer Influenced and Corrupt
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`Organizations (“RICO”) Act, because they arise under the laws of the United States.
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`17.
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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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`18.
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`Venue in this District is appropriate pursuant to 28 U.S.C. § 1391, as the Eastern
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`District of New York is the District where one or more of the Defendants reside and because this
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`is the District where a substantial amount of the activities forming the basis of the Complaint
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`occurred.
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`I.
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`19.
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`20.
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`ALLEGATIONS COMMON TO ALL CLAIMS
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`An Overview of New York’s No-Fault Laws
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`GEICO underwrites automobile insurance in the State of New York.
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`New York’s “No-Fault” laws are designed to ensure that injured victims of motor
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`vehicle accidents have an efficient mechanism to pay for and receive the healthcare services that
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`they need. Under New York’s Comprehensive Motor Vehicle Insurance Reparations Act (N.Y.
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`Ins. Law §§ 5101 et seq.) and the regulations promulgated pursuant thereto (11 N.Y.C.R.R. §§ 65
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`et seq.)(collectively, referred to herein as the “No-Fault Laws”), automobile insurers are required
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`to provide Personal Injury Protection Benefits (“No-Fault Benefits”) to the Insureds.
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`21.
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`No-Fault Benefits include up to $50,000.00 per Insured for necessary expenses that
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`are incurred for health care goods and services.
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`22.
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`An Insured can assign his or her right to No-Fault Benefits to the providers of
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`healthcare services in exchange for those services. Pursuant to a duly executed assignment, a
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`healthcare provider may submit claims directly to an insurance company and receive payment for
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`necessary goods and medical services provided, using the claim form required by the New York
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`State Department of Insurance (known as the “Verification of Treatment by Attending Physician
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`or Other Provider of Health Service,” or, more commonly, as an “NF-3”). In the alternative,
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`healthcare providers sometimes submit claims using the Health Care Financing Administration
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`insurance claim form (known as the “HCFA-1500 Form”).
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`23.
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`Pursuant to New York’s No-Fault Laws (11 N.Y.C.R.R. § 65-3.16(a)(12)), a
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`healthcare provider is not eligible to receive No-Fault Benefits if it fails to meet any applicable
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`New York state or local licensing requirement necessary to perform such services in New York.
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`24.
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`The implementing regulation adopted by the Superintendent of Insurance, 11
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`NYCRR § 65-3.16(a)(12), provides, in pertinent part, as follows:
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`A provider of health care services is not eligible for reimbursement under
`section 5102(a)(1) of the Insurance Law if the provider fails to meet any
`applicable New York State or local licensing requirement necessary to
`perform such service in New York … (emphasis supplied).
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`In State Farm Mut. Auto. Ins. Co. v. Mallela, 4 N.Y.3d 313, 320 (2005) and Andrew
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`25.
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`Carothers, M.D., P.C. v. Progressive Ins. Co., 33 N.Y.3d 389 (2019), the New York Court of
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`Appeals made clear that (i) healthcare providers that fail to comply with material licensing
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`requirements are ineligible to collect No-Fault Benefits, and (ii) only licensed providers may
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`practice a profession in New York because of the concern that unlicensed persons are “not bound
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`by ethical rules that govern the quality of care delivered by a physician to a patient.”
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`26.
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`Pursuant to New York Insurance Law § 403, the NF-3s and HCFA-1500 Forms
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`submitted by a healthcare provider to GEICO, and to all other automobile insurers, must be verified
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`by the health care provider subject to the following warning:
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`Any person who knowingly and with intent to defraud any insurance company or
`other person files an application for insurance or statement of claim containing any
`materially false information, or conceals for the purpose of misleading, information
`concerning any fact material thereto, commits a fraudulent insurance act, which is
`a crime.
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`An Overview of Applicable Licensing Laws
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`Pursuant to New York Education Law § 6808, no person, firm, corporation, or
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`II.
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`27.
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`association shall possess drugs, prescriptions, or poisons for the purpose of compounding,
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`dispensing, retailing, wholesaling, or manufacturing, or shall offer drugs, prescriptions, or poisons
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`for sale at retail or wholesale unless registered by the New York State Department of Education as
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`a pharmacy, wholesaler, manufacturer, or outsourcing facility.
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`28.
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`Pursuant to 8 N.Y.C.R.R. § 29.1 pharmacies in New York are prohibited from
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`“exercising undue influence on the patient or client, including the promotion of the sale of services,
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`goods, appliances or drugs in such manner as to exploit the patient or client for the financial gain
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`of the practitioner or of a third party.”
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`29.
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`Similarly, 8 N.Y.C.R.R. § 29.1 prohibits pharmacies from “directly or indirectly
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`offering, giving, soliciting, or receiving or agreeing to receive, any fee or other consideration to or
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`from a third party for the referral of a patient or client or in connection with the performance of
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`professional services.”
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`30.
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`Pursuant to 8 N.Y.C.R.R. § 63.1(7) pharmacists or pharmacy interns shall conduct
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`a prospective drug review before each prescription is dispensed, which review shall include
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`screening for potential drug therapy problems due to therapeutic duplication, drug-drug
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`interactions, including serious interactions with over-the-counter drugs, incorrect drug dosage or
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`duration of drug treatment, drug-allergy interactions, and clinical abuse or misuse.
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`31.
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`New York Education Law § 6810 prohibits pharmacies from dispensing when a
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`prescription form for a drug includes any other drug. Separate prescriptions are required for each
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`drug prescribed and dispensed.
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`32.
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`New York Education Law § 6810 prohibits persons and corporations, not licensed
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`to issue a prescription, to willfully cause prescription forms, blanks, or facsimiles thereof to be
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`disseminated to any person other than a person who is licensed to issue a prescription.
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`33.
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`New York Education Law § 6530(17) prohibits a physician from “exercising undue
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`influence” on the patient by promoting the sale of drugs so as to exploit the patient for the financial
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`gain of the licensee or of a third party.
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`34.
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`New York Education Law § 6530(18) prohibits a physician from “directly or
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`indirectly” offering, giving, soliciting, receiving or agreeing to receive any fee or other
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`consideration to or from a third party in connection with the performance of professional services.
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`35.
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`New York Education Law § 6509-a, prohibits a professional licensee from “directly
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`or indirectly” requesting, receiving, or participating in the division, transference, assignment,
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`rebate, splitting, or refunding of a fee in connection with professional care or services including
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`services related to drugs and/or medications.
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`36.
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`Pursuant to New York Education Law § 6808(2)(c), “[t]he names of the owner or
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`owners of a pharmacy shall be conspicuously displayed upon the exterior of such establishment.
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`The names so displayed shall be presumptive evidence of ownership of such pharmacy by such
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`person or persons.”
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`37.
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`Pursuant to New York Education Law § 6808(e), pharmacy owners and supervising
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`pharmacists shall be responsible for the proper conduct of a pharmacy.
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`38.
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`Pursuant to New York Education Law § 6808(e), pharmacy owners are responsible
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`“for the strength, quality, purity and the labeling thereof of all drugs, toxic substances, devices and
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`cosmetics, dispensed or sold, subject to the guaranty provisions of this article and the public health
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`law.”
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`39.
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`Pursuant to New York Education Law § 6808(h), “an application for registration as
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`a pharmacy shall be over good moral character.”
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`III. The Defendants Scheme Involving the Fraudulent Pharmaceuticals
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`A. Overview of the Scheme
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`40.
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`Beginning in 2020 and continuing uninterrupted through the present day, the
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`Defendants masterminded and implemented a fraudulent scheme in which they used Ideal Care to
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`exploit patients for financial gain by billing the New York automobile insurance industry for
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`millions of dollars in exorbitant charges relating to the Fraudulent Pharmaceuticals purportedly
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`provided to the Insureds.
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`41.
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`Ideal Care purports to be a storefront neighborhood pharmacy operating in
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`Brooklyn, New York but instead operates as part of a large-scale fraud scheme that exploited
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`GEICO’s Insureds as well as insureds of other New York automobile insurers, through the
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`prescribing and dispensing of the Fraudulent Pharmaceuticals, while intentionally ignoring a vast
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`array of prescription and over-the-counter (“OTC”) medications readily available at a fraction of
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`the cost.
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`42.
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`Ideal Care has been submitting billing to GEICO since 2014 but in 2020 began to
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`participate in the fraud scheme described herein, focusing its business on a limited set of
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`pharmaceutical products (i.e., the Fraudulent Topical Pain Products), rather than dispensing a wide
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`variety of pharmaceutical products like legitimate pharmacies.
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`43.
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`Indeed, approximately 88% of the billing the Defendants submitted to GEICO
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`through Ideal Care since 2020 is for Fraudulent Topical Pain Products – primarily consisting of
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`Lidocaine 5% Ointment (“Topical Lidocaine”) and Diclofenac Sodium Gel 3% (“Topical
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`Diclofenac”) and resulting in claims for reimbursement of at least $2 million.
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`44.
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`By contrast, between 2014 and 2019, prior to Ideal Care’s involvement in the
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`fraudulent scheme described herein, billing for the Fraudulent Topical Pain Products comprised
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`significantly less of Ideal Care’s total billing submitted to GEICO- approximately 10%.
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`45.
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`Not only did Ideal Care experience an unprecipitated increase in billing for the
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`Fraudulent Topical Pain Products, but between 2019 and 2020 when the Pharmacy began
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`participating in the fraudulent scheme described herein Ideal Care’s overall billing to GEICO
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`increased by over 2,700%, from approximately $13,000.00 to over $371,000.00.
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`46. What is more, due to Ideal Care’s continued involvement in the fraudulent scheme
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`described herein, between 2020 and 2021 during the COVID-19 pandemic and without engaging
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`in virtually any marketing or advertising, the Pharmacy’s billing to GEICO increased again by
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`over 347% from approximately $371,000.00 to over $1.65 million.
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`47.
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`In keeping with the fact that Ideal Care began participating in the fraudulent scheme
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`in 2020, over 96% of Ideal Care’s total billing to GEICO was submitted between 2020 and 2022.
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`48.
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`In addition to the substantial and otherwise inexplicable change in the volume and
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`nature of the billing submitted by Ideal Care to GEICO, the prescriptions for the Fraudulent
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`Topical Pain Products directed to Ideal Care were typically based on generic, preprinted, and
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`boilerplate examination reports that are meant to justify continuous, voluminous, excessive
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`healthcare services, including prescriptions for pharmaceuticals.
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`49.
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`Further, the prescriptions for the Fraudulent Topical Pain Products dispensed by
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`Ideal Care were (i) directed to Ideal Care from prescribing practitioners and No-Fault Clinics that
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`have been the subject of criminal actions, investigations and lawsuits commenced by various New
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`York insurers with regard to their fraudulent billing and treatment practices; (ii) consisted of
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`prescription products (diclofenac gel and lidocaine ointment) as to which the U.S. Department of
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`Health & Human Services, Office of Inspector General (“OIG”) has raised concern about
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`“potential fraud and abuse related to both diclofenac and lidocaine.” See Questionable Billing For
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`Compounded Topical Drugs in Medicare Part D, OEI-02-16-00440 (August 2018); and (iii) were
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`at times duplicative of other medications contemporaneously prescribed and dispensed to the
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`Insureds.
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`50.
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`In furtherance of the fraudulent scheme, the Defendants entered into illegal,
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`collusive agreements with the Prescribing Providers and the Clinic Controllers where, in exchange
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`for the payment of kickbacks of other financial incentives, they steered the Prescribing Providers
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`and the Clinic Controllers to prescribe large volumes of medically unnecessary Fraudulent Topical
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`Pain Products to Insureds treating at various No-Fault Clinics and to direct those prescriptions to
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`Ideal Care.
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`51.
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`Specifically, the Defendants paid unlawful kickbacks or provided other incentives
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`to the Prescribing Providers and Clinic Controllers and, in exchange, the Prescribing Providers and
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`Clinic Controllers prescribed or caused to be prescribed to Insureds specific prescription drugs
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`with exorbitant profit margins (i.e., the Fraudulent Topical Pain Products) and routed those
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`prescriptions to the Defendants. This permitted the Defendants to submit egregious claims for
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`reimbursement for the Fraudulent Topical Pain Products to GEICO through Ideal Care.
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`52.
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`In keeping with the payment of kickbacks by Defendants, Ideal Care issued at least
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`one check to an entity that appears to have no legitimate business operations, which check was
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`illegally exchanged for cash at a check-cashing facility in New Jersey by an individual named Alla
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`Kuratova. Kuratova has exchanged more than $35 million in checks, payable to hundreds of
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`persons/healthcare entities besides Ideal Care, for cash. See Gov’t Empl. Ins. Co., et al. v.
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`Zilberman, et al. Docket No. 1:20-cv-00209(FB)(RML), Docket No. 71. Kuratova was previously
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`indicted for recruiting individuals to act as phony patients in connection with an illegal prescription
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`drug trafficking ring.
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`53. What is more, certain of the Prescribing Providers and the No-Fault Clinics that
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`were the source of prescriptions steered to Ideal Care have been the subject of criminal actions,
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`investigations and lawsuits commenced by various New York insurers with regard to their
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`fraudulent billing and treatment practices, and/or professional disciplinary actions, and have been
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`the source of excessive, fraudulent treatment and billing schemes aimed at generating profits
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`without regard to patient care.
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`54.
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`The Prescribing Providers’ history of professional misconduct, insurance fraud, or
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`criminal activity limited their opportunity to find employment at legitimate medical offices or to
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`develop their own legitimate practices, leaving them to work for unlicensed laypersons at the No-
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`Fault Clinics with their fraudulent treatment and billing protocols.
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`55.
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`For example, Alexander Baldonado, M.D. (“Dr. Baldonado”) was recently indicted
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`on six counts of health care fraud in the District of New Jersey. The United States Government has
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`alleged Dr. Baldonado ordered expensive and unnecessary cancer genetic testing for Medicare
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`Case 1:22-cv-03630 Document 1 Filed 06/20/22 Page 14 of 57 PageID #: 14
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`beneficiaries, and billed Medicare for services, including office visits, that were never provided.
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`U.S. v. Baldonado, 2:21-cr-00430(SDW)(1).
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`56. Michael Alleyne, M.D. (“Dr. Alleyne”) purportedly treated automobile accident
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`victims through Metro Pain Specialists, P.C. (“Metro Pain”) and steered prescriptions to Ideal
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`Care. Metro Pain has been named as a defendant in multiple no-fault insurance fraud cases
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`involving fraudulent services billed to No-fault insurers based on allegations that it was controlled
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`by laypersons and engaged in illegal kickback and referral arrangements. See State Farm Mut. Ins.
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`Co., et al. v. Metro Pain Specialists, P.C., et al, 21-cv-05523 (E.D.N.Y.); Allstate Ins. Co., et al. v.
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`Metro Pain Specialists P.C., et al., 21-cv-05586 (E.D.N.Y.) (collectively, the “Metro Pain Cases”).
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`Dr. Alleyne also admitted guilt in 1991 in response to a series of charges file by the New York
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`State Department of Health, Office of Professional Medical Conduct which resulted in seven-year
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`license revocation that was converted to probation.
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`57.
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`Hong Sik Pak, M.D. (“Dr. Pak”) has a history of professional misconduct which
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`resulted in discipline from the New Jersey State Board of Medical Examiners, including assessing
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`Dr. Pak a $5,000.00 penalty and a public reprimand in 2009. In December 2009, the Pennsylvania
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`Department of State reprimanded Dr. Pak and assessed a $2,000.00 civil penalty for Dr. Pak’s
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`failure to timely report the New Jersey disciplinary action to the Pennsylvania Board of Medicine.
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`58.
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`Furthermore, the No-Fault Clinics from which prescriptions were steered to Ideal
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`Care present themselves to be legitimate healthcare practices when, in fact, they are known No-
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`Fault medical mills that house a “revolving door” of numerous healthcare providers who subject
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`Insureds to as many healthcare goods and services as possible in order to exploit the Insureds’ No-
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`Fault Benefits by submitting large volumes of fraudulent claims to No-Fault insurers such as
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`GEICO.
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`59.
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`For example, GEICO has received billing from 788 Southern Boulevard, Bronx,
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`New York (the “788 Southern Boulevard Clinic”) and 1975 Linden Boulevard, Elmont, New York
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`(the “Linden Boulevard Clinic”) from over 100 purportedly different healthcare providers each.
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`60.
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`GEICO has received billing from 146 Empire Boulevard, Brooklyn, New York (the
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`“Empire Boulevard Clinic”) from approximately 90 purportedly different healthcare providers.
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`61.
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`GEICO has also received billing from 3027 Avenue V, Brooklyn, New York (the
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`“Avenue V Clinic”) and 3041 Avenue U, Brooklyn, New York (the “Avenue U Clinic”) from over
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`70 purportedly different healthcare providers each.
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`62. What is more, Ideal Care received prescriptions from a No-Fault Clinic located at
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`717 Southern Boulevard Bronx, New York (the “717 Southern Boulevard Clinic”) that was
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`identified in an on-going criminal proceeding, USA v. Rose, 19-cr-00789 (PGG). In that criminal
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`action, the United States of America credibly alleged that the laypersons who own the clinics (i)
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`pay kickbacks to hospital workers, medical service providers, and police officers in exchange for
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`confidential information of motor vehicle accident victims in New York; and (ii) accept kickbacks
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`in exchange for allowing healthcare providers access to patients so they can bill for medically
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`unnecessary services for patients being treated, or allegedly treated, at the No-Fault Clinics.
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`63.
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`These No-Fault Clinics were the primary source of prescriptions that were routed to
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`Ideal Care by the Prescribing Providers and Clinic Controllers operating therefrom and submitted by
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`the Defendants in support of their fraudulent charges.
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`64.
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`In keeping with the fact that the Defendants illegally steered the Prescribing
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`Providers and the Clinic Controllers at the No Fault Clinics to provide Ideal Care with prescriptions
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`for the Fraudulent Pharmaceuticals pursuant to predetermined fraudulent protocols, Insureds were
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`rarely given the option to use a pharmacy of their choosing.
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`Case 1:22-cv-03630 Document 1 Filed 06/20/22 Page 16 of 57 PageID #: 16
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`65.
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`Instead, the Defendants colluded with the Prescribing Providers and Clinic
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`Controllers to ensure that they directed the prescriptions for the Fraudulent Pharmaceuticals to
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`Ideal Care, regardless of the distance of this pharmacy from the Insureds or the No-Fault Clinics
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`where they were treating.
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`66.
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`In many cases, Ideal Care either purported
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`to deliver
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`the Fraudulent
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`Pharmaceuticals directly to the Insureds’ homes or the Fraudulent Pharmaceuticals were given to
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`Insureds directly by the front desk staff at the various No-Fault Clinics.
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`67.
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`At times, the Insureds were not even aware that a Fraudulent Pharmaceutical
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`dispensed by Ideal Care was prescribed to them until the medication was delivered to them or
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`distributed to them by the front desk staff.
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`68. What is more, at times, Ideal Care submitted billing to GEICO for Fraudulent
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`Pharmaceuticals that were never dispensed to an Insured.
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`69.
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`In furtherance of the scheme, the Defendants used what is essentially a product list
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`– disguised as a “prescription order form” – of the various Fraudulent Pharmaceuticals that Ideal
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`Care dispensed.
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`70.
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`The pre-printed “checklist-type” prescription order forms (the “Fraudulent
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`Prescription Forms”) list the names of the Fraudulent Pharmaceuticals the Defendants dispense
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`and bill for, and the quantity in which they were to be prescribed and dispensed to Insureds.
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`71.
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`The Fraudulent Prescription Forms ensured that the Prescribing Providers would
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`prescribe, or the Clinic Controllers would cause to be prescribed, specifically targeted
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`predetermined Fraudulent Topical Pain Products (i.e., “Lidocaine 5% Ointment,” “Diclofenac
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`Sodium 3% Gel,” and “Lidocaine Patch 5%”) so that the Pharmacy Defendants could submit those
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`prescriptions to GEICO in support of the claims for reimbursement at egregiously inflated rates.
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`Additionally, the Fraudulent Prescription Forms allowed the Prescribing Providers to prescribe
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`other Fraudulent Pharmaceuticals, including predetermined oral NSAIDs and muscle re