Sibley Dolman Gipe Accident Injury Lawyers, PA

What are the allegations in the 411 PAIN Lawsuit?
Based on the Complaint filed with the Court, GEICO "seeks to recover more than $15,000,000.00 that the Defendants wrongfully obtained from GEICO by submitting, and causing to be submitted, thousands of fraudulent no-fault insurance charges".

GEICO claims that, beginning in 2014 and continuing to this day, Path Medical cheated them out of millions of dollars by submitting payments to them for medical procedures that "were medically unnecessary, illusory, unlawful, and otherwise unreimbursable…including initial examinations, follow-up examinations, diagnostic imaging, and physical therapy, and chiropractic services."

The lawsuit goes on to bring up 411 PAIN's muddy past by presenting the facts surrounding a 2012 lawsuit in which the Attorney General's Office sued the referral service for violating the Florida Deceptive and Unfair Trade Practices Act, as well as the Florida law against misleading advertising. 411 PAIN settled and agreed to paid over half a million dollars in penalties. After explaining this past case and its resolution, GEICO goes on to state: "Even so, 411-PAIN did not desist from its fraudulent and unconscionable conduct."

Additionally, GEICO wants the court to declare illegal $200,000 in current obligations the insurance company has to pay the named facilities, companies, and persons for PIP bills.

In 2015, the owner of 411-PAIN, Robert Lewin, sought to consolidate his huge network of chiropractic offices into one main company, which became Path Medical, LLC. This network relied on his advertising company called 411-PAIN to funnel clients into his medical facilities and to law firms that he took payment from to be part of his service.

Mostly it is this complicated web of questionable actions that led to this lawsuit.

How does PIP apply to the 411 PAIN Lawsuit?
The insurance payments in question stem from a Florida law known as Personal Injury Protection(Also known as PIP or No Fault laws), which affords each driver of a vehicle $10,000 in medical payments, paid by their own insurance company, regardless of fault. The system, when used correctly, is an efficient way to get injured victims swift medical attention without holding up the courts and patients with long lawsuits.

Florida PIP law allows an injured person to assign their PIP benefits to health care providers in exchange for medical services necessary to helping them recovery from their automobile accident injuries. Once the health care provider has the benfits assigned to them, they can then submit claims directly to an insurance company in order to receive payment for the services they provided.

Of course, in order for these reimbursement payments to be valid, they must be "legal", as one would expect. Florida law clearly defines this. Therefore, GEICO is alleging that 411 PAIN violated many different laws, which in turn makes null and void even legitimate medical payments since they were paid under illegal activities.

Which laws did 411 PAIN and other defendants violate?
GEICO's claim is that the medical centers, lawyer referral service, attorneys, doctors, and owners knowingly committed "fraudulent protocols designed solely to financially enrich the Defendants, rather than to treat or otherwise benefit the Insureds who purportedly were subjected to them."
In fact, the complaint accuses 411-PAIN and its companions of violating Florida's Patient Brokering Act, Anti-Kickback Statute, Self-Referral Act, Clinic Act, and chiropractor advertising laws.

Path Medical and the Clinic Act

One of the ways in which GEICO claims that 411 PAIN violated the law is by failing to follow the Clinic Act which, among other things, requires health care clinics to "appoint a medical director or clinic director who shall agree in writing to accept legal responsibility for [certain enumerated] activities on behalf of the clinic…[and] [c]onduct systematic reviews of clinic billings to ensure that the billings are not fraudulent or unlawful. Upon discovery of an unlawful charge, the medical director or clinic director shall take immediate corrective action." Additionally, a health care clinic medical director must ""[r]eview any patient referral contracts or agreements executed by the clinic."

However, GEICO alleges that since appointing a legitimate medical director to oversee Lewin's slew of chiropractic clinics would have "impeded" the Lewin's "ability to use the Path Medical clinics as vehicles to submit a large amount of fraudulent PIP billing to GEICO and other Florida automobile insurers." In order to circumvent this hindrance, GEICO alleges that Lewin and Path Medical appointed puppet medical directors that never even attempted to fulfill the requirements of the job. Lewin and his partners and company then appointed David A. Cheesman, D.O. as their medical director. GEICO claims he accepted the fraudulent position because "his advanced age, lack of professional qualifications, professional disciplinary history, and personal history made it extremely difficult for him to obtain legitimate, sufficiently-remunerative employment as a physician." Chessman was placed in charge, as medical director, of five (5) different chiropractic clinics in the Tampa area. Once can quickly see the difficulties posed for a 70+ year old doctor to over see all the referrals, medical billing, and records of five different busy clinics. GEICO claims that the five clinics Chessman was in charge of submitted thousands of bills and tens of thousands of charges to just GEICO alone (much less every other insurer) from 2015 to 2017.

GEICO goes on to detail similar allegations against Ralph G. Marino, M.D.; Tie Qian, M.D.; and Michael H. Wilensky, M.D.

Alleged Self-referral Act Violations
The Self-referral Act prohibits any health care or medical providers from referring patients to any entity or service that they own or have an investment interest in. Violation of this law would make any medical bills submitted to GEICO through Path Medical and its affiliates illegal, thus making GEICO not responsible for the payments. GEICO claims that since Lewin owns Path Medical LLC, Path Medical Holdings, and 411 PAIN referral service, he could not legally self-refer patients for medical services to his own clinics. Likewise, he could not refer clients to attorneys whom he knew would then refer the patients right back to his clinics.

GEICO claims that injured parties would call 411 PAIN and then be either self-referred right to a Path Medical clinic, or would be referred to an attorney (namely Kanner, Pintaluga, Kanner & Pintaluga, Landau, and Landau & Associates) who would then refer their new client to get treated at a Path Medical clinic.

GEICO provides the court with plenty of examples. One of which reads: "On March 10, 2017, an Insured named SS was involved in an automobile accident. SS then called 1-800-411-PAIN, and was referred - at Lewin and H. Lewin's direction - to Path Medical-St. Pete. Though the referral violated the Self-Referral Act, Path Holdings, Path Medical, Lewin, Permaul, and Manion nonetheless billed GEICO for services they purported to provide to SS at Path Medical-St. Pete, and then failed to refund the resulting payments - more than $5,000.00 - on a timely basis.".

The lawsuit goes on to claim that Path Medical not only provided clients to Landau & Associates-which was owned not only by Landau, but also by Kanner and Pintaluga-but also retained them to pursue PIP billing complaints which generated massive attorney's fees for the firm.




411 PAIN Lawsuit - Defendants
The defendants named in the complaint are comprised of the main holding company, its subsidiaries, and its owners, as well as a few doctors and law firms.

The complaint named Path Medical, 1-800-411-PAIN Referral Service, and Robert Cash Lewin and a few of his partners.

Additionally, law firms Landau & Associates, P.A., The Law Offices of Kanner & Pintaluga, P.A., Todd Landau, Howard Kanner, and Eric Pintaluga were also named. The complaint accuses them of participating, conspiring, aiding, and abetting their co-defendants.

Doctors Michael H. Wilensky, M.D.; David A. Cheesman, D.O.; Tie Qian, M.D.; and Ralph G. Marino, M.D. were also accused by GEICO of "falsely purport[ing] to serve as the medical directors of numerous Path Medical clinics, purport[ing] to perform many of the Fraudulent Services that were billed to GEICO through Path Medical, and participat[ing] in the submission of fraudulent billing for the Fraudulent Services through Path Medical to GEICO."

GEICO claims that they were billed for services that were never performed and for inflated medical coding that padded bills.

As for motive, GEICO specifically called out the lawyer and doctor defendants for having poor reputations that required them to participate in a fraudulent scam in order to secure new clients. GEICO cited public disciplinary records, sketchy personal and professional histories, past criminal charges, and Bar disciplinary actions, all that they claim can be found with a "quick internet search".

411 PAIN and Robert Lewin's Sketchy Past
This is not the first time that 411-PAIN or Robert Lewin have been brought into question. In 2010, Miami New Times wrote a scathing article on the referral service that basically amounted to calling them a scam. In 2012, 411-PAIN was forced to settle with Attorney General Pam Bondi's office over allegations of alleged misleading ads.

Dolman Law Group is a personal injury firm with offices in Clearwater, St Petersburg, New Port Richey, and Sarasota. For more information, visit our website at Dolman Law Group.