State Farm Mutual Insurance Company’s insurance fraud claims against medical providers and their employees in Philadelphia were given the approval to proceed in federal court after a previous filing was dismissed, reported Pennsylvania Record
The initial fraud action filing of State Farm was dismissed in the District Court Feb. 17. An amended version was filed March 7, followed by the defendants’ motion to dismiss on March 16.
U.S. District Court Judge J. Curtis Joyner of the Eastern District of Pennsylvania ruled that the insurer’s complaint against defendants Eastern Approach Rehabilitation, Aquatic Therapy of Chinatown, Inc., as well as Leonard Stavropolskiy, P.T., D.C. and Joseph Wang, P.T., D.C. would move forward.
Wang and Stavropolskiy are owners and shareholders of Eastern Approach and Aquatic Therapy, respectively. Both medical providers offer chiropractic and medical examinations, treatment, testing, and other related services.
State Farm alleged the defendants “colluded together to engage in this alleged insurance fraud scheme, which consisted of billing for treatment and services not provided and that they fabricated medical records to exaggerate claims or include findings that were not actually observed.”
The insurer further alleged that the defendants submitted their false claims to plaintiffs in order to receive payments. State Farm purported that the defendants committed common law fraud, statutory insurance fraud and obtained unjust enrichment in excess of $850,000 through the aforementioned actions, from 2010 to the present.
State Farm seeks a declaratory judgment, on top of damages and restitution.
The defendants argued in their motion to dismiss that “the plaintiffs have not alleged that any of the medical records submitted were false, the plaintiffs have not shown that they justifiably relied, and the claims are barred by the statute of limitations.”
State Farm’s insurance fraud claims against local medical providers to proceed