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\\nArbitrator Must Decide No Fault Fraud Claims\\nThis case is about the relationship between New Jersey healthcare \\nproviders and the insurance companies that pay those providers for \\ntreating patients for injuries arising from automobile accidents.\\n\\nIn GEICO In v. Caring Pain Management PC a/k/A Careon Pain Management, \\nJinghui Xie, M.D., First Care Chiropractice Center, L.L.C., and \\nKonstantine Fotiou, D.C., No. 2:22-cv-05017(BRM)(JSA), United States \\nDistrict Court, D. New Jersey (May 31, 2023) the insurer attempted to \\ndefeat fraudulent claims under the New Jersey no-fault law.\\n\\nBACKGROUND\\n\\nMultiple GEICO insurers (the "Plaintiffs) alleged a series of fraudulent\\n schemes, including unlawful compensation in exchange for patient \\nreferrals, misrepresentation of the nature, extent, and results of \\npatient examinations, and false representation regarding compliance with\\n pertinent healthcare laws.\\n\\nMOTION TO DISMISS\\n\\nIn deciding a motion to dismiss pursuant to Federal Rule of Civil \\nProcedure 12(b)(6), a district court is required to accept as true all \\nfactual allegations in the complaint and draw all inferences from the \\nfacts alleged in the light most favorable to the non-moving party.\\n\\nDECISION\\n\\nThe Insurance Fraud Prevention Act (\\u201cIFPA\\u201d), which was enacted roughly a\\n decade after the No-Fault Law, provides that an \\u201cinsurance company \\ndamaged as the result of a violation of any provision of this act may \\nsue therefor in any court of competent jurisdiction.\\u201d In part, the New \\nJersey Legislature enacted the IFPA to address rising insurance rates \\nresulting from widespread fraud with the clear objective to confront \\naggressively the problem of insurance fraud in New Jersey by \\nfacilitating the detection of insurance fraud and eliminating the \\noccurrence of such fraud through the development of fraud prevention \\nprograms.\\n\\nA person or practitioner violates the IFPA by presenting or preparing \\nfalse or misleading statements in connection with an insurance claim, or\\n by failing to disclose the occurrence of an event that affects an \\nindividual\'s entitlement to insurance benefits or the amount of benefits\\n\\nTHE COMMON LAW FRAUD, UNJUST ENRICHMENT, AND RICO CLAIMS\\n\\nThe No-Fault Law\'s language, legislative intent and application cover \\nPlaintiffs\' claims for common law fraud, unjust enrichment and RICO. The\\n plain language of the No-Fault statute provides that \\u201c[a]ny dispute \\nregarding the recovery of . . . benefits provided under personal injury \\nprotection coverage . . . arising out of the operation, ownership, \\nmaintenance or use of an automobile may be submitted to dispute \\nresolution on the initiative of any party to the dispute.\\u201d (emphasis \\nadded)\\n\\nPlaintiffs\' claims involve:\\n\\na dispute by [Plaintiffs]\\ninvolving Defendants\' recovery of PIP Benefits that\\none party wishes to send to arbitration.\\n\\nConsequently, Plaintiffs\' common law fraud, unjust enrichment, and RICO \\nclaims fall within the statute\'s arbitration provision. \\n\\nNew Jersey IFPA Claim\\n\\nThe plain meaning of the New Jersey Insurance Fraud Prevention Act \\n(IFPA) requires insurers\' claims for damages under the IFPA be \\njudicially resolved.\\nTo the extent Plaintiffs seek a declaration \\nthat Defendants violated RICO, committed common law fraud, or are liable\\n for unjust enrichment, an arbitrator shall decide that issue.\\n\\nZALMA OPINION\\n\\nClearly, the health care providers who were accused by GEICO of fraud \\nfelt that they had a better chance of success with an arbitrator rather \\nthan a federal judge. The judge found the statutes allowed for \\narbitration and sent the fraud to an arbitrator. I would like to be that\\n arbitrator and hope the parties get an arbitrator who dislikes \\ninsurance fraud as much as I do, and find they would have done better \\nwith a federal judge. GEICO should be honored for working to defeat \\nfraud by attempting to take the profit out of the fraud.\\n\\nc) 2023 Barry Zalma & ClaimSchool, Inc.\\n\\n