Auto insurance provider GEICO has accused two New York physician groups and the physician who owned them of billing the insurer more than $2 million for auto-accident treatments the company says were medically unnecessary or, in many instances, never performed at all.
In a complaint, filed July 24, 2026, in the U.S. District Court for the Eastern District of New York, GEICO named Kings County Physicians Group and Kings Highway Physicians Group, both based in New York City, along with Ashraf Salem, MD, as the physician who purportedly owned and controlled both practices. The lawsuit also names unidentified “John Doe” defendants GEICO alleges directed the scheme from behind the scenes.
The case is built around New York’s no-fault insurance system, which requires auto insurers to cover up to $50,000 per person for necessary care after a crash — but only when that care is medically necessary, actually rendered and billed by a properly licensed, physician-controlled practice. GEICO alleges the two clinics ran patients through the same “pre-determined fraudulent protocols,” regardless of what their injuries actually required.
According to the complaint, initial exams were billed under CPT codes 99204 and 99205, which call for 45 to 60 minutes of face-to-face time with a patient presenting problems of moderate to high severity, generating charges of $200 to $275 per visit. GEICO alleges the exams actually ran 10 to 30 minutes and relied on boilerplate forms, regardless of how minor the reported injury was.
The complaint alleges similar inflation across other services. It says the clinics billed for extracorporeal shockwave therapy when the devices used delivered a lower-energy radial pressure wave treatment that didn’t meet the “high energy” standard the billing code requires, and that nerve conduction studies were run on far more nerves than any individual patient’s symptoms would justify — a practice the complaint said contradicts CPT Assistant guidance stating that “pre-set protocols automatically testing a large number of nerves are not appropriate.”
The complaint’s broadest allegation concerns who actually ran the clinics. Under New York state law, a medical practice forfeits its right to no-fault reimbursement if it’s owned or controlled by anyone other than a licensed physician. GEICO alleges the John Doe defendants — laypersons with no medical license — steered patients to the clinics, dictated their treatment protocols and shared in the profits, ceding control of the practices in violation of state licensing law. The complaint separately alleges many services were performed by independent contractors rather than clinic employees, which GEICO said is its own basis for denying payment.
GEICO ties the two practices to a wider network of pharmacies, durable medical equipment suppliers, and imaging and testing providers that billed off prescriptions written at the clinics. Several of those downstream providers, the complaint notes, are already facing separate fraud suits from GEICO or other insurers.
The complaint also details Dr. Salem’s regulatory history. He’s been licensed to practice in New York since 2002 and completed a five-year probation in 2017 after not contesting professional misconduct charges tied to self-prescribing controlled substances, including Oxycontin and Xanax. He was also previously sued by GEICO for allegedly aiding a separate no-fault fraud scheme involving a durable medical equipment supplier.
GEICO says its losses exceed $2 million and is asking the court to declare that it owes nothing on more than $1.1 million in the clinics’ pending claims — over $400,000 tied to Kings County and more than $700,000 to Kings Highway. Its claims include civil racketeering under the RICO Act, common-law fraud and unjust enrichment, with GEICO seeking treble damages on the racketeering counts.
GEICO alleges the scheme began no later than September 2020 and continues today, with the clinics still pursuing collection on unpaid bills. The allegations have not been tested in court, and no judge has ruled on any of the claims.
Becker’s has reached out to Kings County Physician’s Group and Kings Highway Physician Group and will update this article if more information becomes available.
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