Allstate, State Farm Sue Medical Providers for Fraudulent Billing

Two insurance carriers filed separate lawsuits last week against medical doctors and their pain-management clinics, accusing them of submitting bills for unnecessary medical procedures performed on vehicle-accident victims.

State Farm Mutual Auto Insurance Co. filed suit in the U.S. District Court for Southern Texas against Dr. Nooruddin S. Punjwani as well as the clinic where he practiced, Pain Alleviation & Interventional Needs (PAIN), as well as the owners of the clinic. It is seeking $3 million in damages.

Allstate Insurance Co. filed a racketeering lawsuit in the U.S. District Court for the Eastern District of Michigan against The Pain Center USA, Interventional Pain Center and Dr.s Rajendra Bothra and Erick Backos, seeking $860,000 in damages. The carrier in February filed a similar lawsuit against several other clinics, seeking $3.5 million.

State Farm alleges that Punjwani performs epidural steroid injections for nearly all patients he sees at his Baytown, Texas practice without performing legitimate medical examinations. He reviewed magnetic resonance imaging scans and documented conditions that did not exist or exaggerated the severity of existing conditions, the suit says.

State Farm said PAIN charges $1,500 for the use of fluoroscopic guidance with the injections, but could not produce any fluoroscopic images when asked.Punjwani charged $8,000 for each epidural steroid injection and $500 for an examination in addition to the fluoroscopic charge, the carrier said.

The clinic billed State Farm for 810 epidural steroid injections out of 821 patients examined. All of them sere diagnosed with spondylosis and stenosis, according to the suit.

Defendants Barketali M. Roopani and his sons, Anil B. and Sohail B. Roopani, are laymen owners of the PAIN clinic, the suit says. State Farm alleges that they shared in the proceeds from the fraudulent scheme.

Allstate’s April 22 suit against The Pain Center USA and the other Detroit-area clinics is the latest of several racketeering lawsuits that it has filed against medical providers for allegedly taking advantage of the state’s no fault auto-insurance law.

The carrier says Bothra controlled and operated The Pain Center USA and Interventional Pain Center, both in Warren, Michigan. Backos “participated in the control” of both clinics, according to the suit.

While Bothra has claimed that the Pain Center treats only patients with chronic pain who have not been helped through conservative treatment, many patients started treatment there within days of their alleged motor vehicle accidents, the suit says.

Once the patients arrived, The Pain Center and Interventional Pain performed bilateral procedures that are normally performed on the say day into two separate dates “to multiply the amount of fees charged.”The carrier charges that the doctors prescribed patients opioids as an inducement for them to return to the practice, knowing full well that they were contributing the nation’s opioid addiction crisis. Those opioid prescriptions led to urine drug screening, which could also be billed to insurance carriers, the suit says.

Allstate says Bothra found a way to expand his billings in March 2016, when he opened the Interventional Pain Center’s ambulatory surgery center. The surgery center billed Allstate for facility fees for dates of service more than three months before it opened, according to the suit. The clinics billed for blood tests that were not performed, urine drug tests that weren’t performed, physical therapy that wasn’t performed and injections that were never given, the suit says.

Backos wrote out disability certificates for the “overwhelming majority” of patients who he treated at the clinics.

“The defendants’ goal in treating patients was to perform as much treatment as possible, regardless of whether such treatment was reasonably necessary to the patients’ care, recovery, or rehabilitation, and/or arose out of an alleged motor vehicle accident, in order to generate bills to Allstate,” the suit says.

Allstate in February filed a similar lawsuit against several other pain clinics. The defendants are Michigan Pain Management, Dearborn Pain Specialists, Southfield Pain Management, Sterling Heights Pain Management, Precision MRI of Michigan, Advanced Surgery Center, North Shore Injury Center, and Medi Transit. The lawsuit also names as defendants three chiropractors, four physicians and three other people. Allstate is seeking $3.5 million in damages.