Legal Action Against Fraudulent No-Fault Medical Clinic in New York
A consortium of fourteen insurance companies has initiated legal proceedings against a New York-based no-fault medical clinic, accusing it of engaging in a fraudulent scheme that purportedly resulted in losses exceeding $5.3 million. The lawsuit, filed on May 21 in the Eastern District of New York, identifies several defendants, including Dr. Jonathan Landow, Dr. Viviane Etienne, Kamrunnahar Kanny, and the entities Macintosh Medical P.C. and Atlantic Medical & Diagnostic, P.C. Additionally, eleven nurse practitioners and physician assistants associated with these practices are named. Among the plaintiffs are Farmers Insurance Exchange, Farmers Casualty Insurance Company, and Mid-Century Insurance Company.
The insurers claim to have already disbursed over $1.65 million on contested claims and are demanding that an additional $3.7 million in pending claims be deemed non-payable. They seek to recover all disbursed amounts and cessation of further liabilities related to the alleged scheme.
Operating under New York's no-fault insurance system, the complaints arise from the mandate to provide $50,000 in personal injury protection benefits to auto accident victims and require insurers to process claims within 30 days. Failure to comply with this timeframe could result in owing the claims amount along with 24% interest and legal fees—a vulnerability the insurers argue has been exploited.
The complaint describes Macintosh and Atlantic as ostensibly standard medical entities. However, it alleges that, contrary to regulatory requirements under 11 NYCRR 65-3.16(a)(12), which stipulate only licensed medical professionals can own or control such entities, the actual operations are managed by Kanny and undisclosed individuals rather than the listed medical professionals. The complaint further asserts that Landow, allegedly residing in Florida and not practicing medicine, lacks physical presence in New York to supervise the operations.
The lawsuit contends a uniform treatment protocol was applied irrespective of patient needs, incorporating standardized regimens of examinations, MRIs, and medical equipment. It scrutinizes billing practices, alleging initial exams were charged under CPT code 99204 for 45-minute sessions, whereas the actual exams lasted about 10-15 minutes or were not conducted. Another questionable billing practice involved assessments billed under CPT code 99358, presumed to represent extensive physician work, when they comprised self-completed questionnaires by patients.
Furthermore, the lawsuit highlights that a majority of patients underwent trigger point injections, citing improper adherence to best practice guidelines, which recommend such procedures only after sustained conservative care efforts. Referral practices are under scrutiny as well, with claims that defendants relied solely on patient referrals from over 70 external clinics across New York's boroughs, masked as subleases to circumvent direct marketing costs.
Another legal concern arises from listing medical employees as independent contractors, potentially infringing upon 11 NYCRR 65-3.11(a), which prohibits billing for unsupervised services by non-employees. The complaint implicates consistent misrepresentations on claims submitted. References to Dr. Landow's prior financial and legal controversies add weight to charges of racketeering under the Racketeer Influenced and Corrupt Organizations Act (RICO), common law fraud, and unjust enrichment. Plaintiffs seek compensatory damages, treble damages, attorneys' fees, and a jury trial. Exhibit 1 details 26,515 allegedly fraudulent billing instances from Macintosh and Atlantic over six years. As the proceedings unfold, the allegations remain unproven pending judicial review, with the defendants yet to submit a formal response.