GEICO's $3.7 Million PIP Fraud Lawsuit Against Florida Clinics

GEICO has launched a lawsuit against three Florida clinics, accusing them of being involved in a Personal Injury Protection (PIP) fraud scheme exceeding $3.7 million. The case was filed on March 13 in the U.S. District Court for the Middle District of Florida. It names ten defendants associated with three clinics located in the Tampa area: Relief and Rehab, Inc., Renew Health Center LLC, and Tampa Bay Therapy Care, Inc., collectively referred to as the "Fossi Clinics" in court filings.

Carlos E. Fossi, M.D., emerges as a pivotal figure in this case. GEICO alleges that he misrepresented himself as the medical director for all three clinics, neglecting the responsibilities mandated by Florida's Health Care Clinic Act. This law requires medical directors to frequently review clinic billings to deter fraud. Instead, GEICO claims that Fossi failed to conduct these evaluations, entrusting the clinic owners with these tasks while seldom being present at the clinics.

This alleged non-compliance is critical, rendering the clinics ineligible for PIP reimbursement under the Clinic Act. GEICO also claims that services billed as physical therapy were illicitly performed by massage therapists or individuals without licenses. Florida's No-Fault Law, amended in 2013, prohibits PIP reimbursement for massage therapy and payment for services by therapists lacking appropriate licensing or supervision. Despite this, defendants allegedly falsified supervising provider information on billing documents.

Moreover, GEICO accuses the clinics of infringing upon Florida's False and Fraudulent Insurance Claims Statute by habitually waiving patient deductibles and co-payments. Allegedly, nearly all billing submissions from these clinics showed no collections from patients. Additionally, GEICO highlights the inflated number of therapy sessions claimed to have been performed by certain providers across multiple locations in a single day, asserting it is implausible.

The lawsuit includes 18 counts, encompassing federal RICO violations, common law fraud, unjust enrichment, and breaches of the Florida Deceptive and Unfair Trade Practices Act. GEICO seeks both compensatory and punitive damages, including treble damages under RICO. The company also requests declaratory relief on claims over $75,000, alleging fraud. The case is set to proceed to a jury trial. As it stands, no ruling has been made, and the defendants have not yet formally responded.