NY insurer files suit over $28M in 'fraudulent and abusive' claims from ASC, physicians & pain companies: 7 things to know

Written by Angie Stewart | February 12, 2019 | Print  |

American Transit Insurance Corp. filed a lawsuit alleging Hackensack, N.J.-based Dynamic Surgery Center, physicians and other related parties submitted over $28 million in "fraudulent and abusive" claims under New York's no-fault coverage system.

What you should know:

1. The lawsuit alleges Ronald A. Hayek, Ramkumar Panhani, MD, Reuven Alon, Mark Heyligers, Regina Moshe, MD, Leonid Shapiro, MD, Todd Koppel, MD, and their companies conspired with Yan and Margarita Moshe, Dynamic Surgery Center (formerly known as Excel Surgery Center) and other defendants to illegally bill American Transit.

The New York State Workers' Compensation Board has temporarily suspended Dr. Koppel and Dr. Panhani from treating injured workers.

2. The ASCs named in the lawsuit allegedly "used and submitted falsified operative reports" and enlisted Fort Lee, N.J.-based Metro Pain Specialists Professional Corp. and Hackensack-based Citimed to provide additional medically unnecessary services.

3. American Transit alleges the defendants submitted claims for unnecessary services and services that weren't provided as outlined. The defendants named in the lawsuit allegedly participated in an "illegal referral scheme" to inflate billing.

4. American Transit also alleges several patients were transferred out of New York. On several occasions, the New Jersey providers allegedly offered patients free transportation to New Jersey facilities "a significant distance from their homes."

5. New York's automobile no-fault coverage provides reimbursement of healthcare expenses, lost wages and other benefits to people injured in automobile accidents.

6. American Transit is seeking a decision that it has no obligation to pay the claims it has received from the defendants, and hopes to recover the more than $5 million in payments it has already made.

7. Becker's ASC Review was unable to reach a spokesperson for Dynamic Surgery Center at the time of publication. However, a spokesperson told northjersey.com, part of the USA Today network, that Dynamic and Saddle Brook, N.J.-based HealthPlus Surgery Center — both owned by defendant Yan Moshe — "are popular with New York doctors because they are better managed, less crowded, cleaner and provide superior staff than facilities available in New York." HealthPlus was not named in the American Transit lawsuit.

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