Judge Rejects Bid to Dismiss Fraudulent Billing Case

On Friday, the court issued an opinion in the case of Government Employees Insurance Co. et al v. AFO Imaging, Inc. et al. The case, filed in the Middle District of Florida, deals with a massive fraud complaint by Geico against Radiology Imaging Specialists, LLC d/b/a CareFirst Imaging.

The radiology practice is accused of two counts: First, fraudulently billing radiological procedures that were not medically necessary solely for the purpose of inflating the pip claims made to GEICO, and second, that the practice was not sufficiently licensed and overseen in contravention of Florida statute. The opinion represents the second motion to dismiss by a defendant in this case. In the original motion to dismiss, the court denied a motion to dismiss that included arguments that the claim was a shotgun complaint and that it didn’t plead the fraud counts with sufficient specificity.

With this new motion, the defendants sought to dismiss the claims, stating that the statute of limitations had expired, that the plaintiffs failed meet the certification requirements for malpractice related claims, and that the court should decline jurisdiction under various abstention doctrines. The court noted that while some of the actions involving the practice could be considered malpractice, the complaint was not being pursued under a theory of malpractice, nor was the plaintiff a victim of medical malpractice, so the complaint type controlled whether a certification was required. The court also noted while the Florida Agency for Health Care Administration and other entities might have later actions taken against the clinic, the decision of the court in regards to the fraud complaints did not rely upon those agency decisions and therefore the court’s actions were not precluded. Finally, the court noted that the statute of limitations claims had previously been determined by the prior motion to dismiss.

Plaintiffs are represented by Rivkin Radler and Smith, Gambrell & Russell. The defendants are represented by Lash & Goldberg and Latham & Watkins