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Proving Fraud by A Predetermined Treatment Protocol Articles in the March 15, 2021 

Issue include the following:  RICO Action Against Medical Providers Raises Discovery Difficulties  Insurance companies who claim to be the victims of health care providers  operating in a no fault auto insurance state like Florida. In  Government Employees Insurance Co., et al. v. Mark A. Cereceda, et al.,  CASE NO. 19-22206-CIV-ALTONAGA/GOODMAN, United States District Court  Southern District of Florida Miami Division (January 15, 2021) where  Plaintiffs filed a 406-page Complaint asserting 43 counts and attaching  more than 8,500 pages of spreadsheets as exhibits. Specifically,  Government Employees Insurance Co. (\\u201cGeico\\u201d) and related Geico entities  (\\u201cGeico,\\u201d collectively) sued chiropractor (Mark A. Cereceda), other  healthcare providers, and myriad LLCs which purportedly provided  fraudulent healthcare services. Geico alleges that Cereceda is the  managing member and owner of the LLCs.  An insurer alleging fraud based on a predetermined treatment protocol  should not have to prove that each claim, in a vacuum, is fraudulent. A  middle-ground accepted by courts allows insurers to rely on non-credible  patterns in providers\\u2019 bills and documentation to explain globally why  groups of claims are fraudulent, provided the insurer sufficiently  identifies the claims at issue. It can also use specific cases to prove  the pattern or fraud but then it must respond in detail to discovery  requests.  In that regard I have seen in my practice medical billing and  reporting that was identical to multiple patients except for the name  of the patient. If Geico can show that type of fraud it will have no  problem with the RICO action proof and will not need to answer  interrogatories about the thousands of fraudulent claims.  When You Do the Crime, You Must Do the Time Doctor Unsuccessfully Claimed He Was A \\u201cPatsy\\u201d Who Was Talked into  Helping A Criminal Insurance Fraud Should Not Be A Retirement Plan Insurance Fraud Gets You Three Squares and a Cot Good News From the Coalition Against Insurance Fraud  Taking Insurance Check & Cashing It Twice Is Fraud Insurance Fraudster & Thief Appeals Conviction Requiring A 35 Page  Opinion Affirming the Conviction Health Insurance Fraud Convictions Other Insurance Fraud Convictions