The cases include three initially filed by Blue Hill Chiropractic Group Inc. against insurance companies for failing to pay claims it submitted for patients who supposedly received chiropractic treatment after car accidents. An insurance company initiated the fourth case against several clinics and chiropractors.
The cases are as follows: Blue Hill Chiropractic Group Inc. v. Commerce Insurance Co.; Blue Hill Chiropractic Group Inc. v. Encompass Insurance Co.; Blue Hill Chiropractic Group Inc. v. Premier Insurance Co.; and Norfolk & Dedham Mutual Ins. Co. v. Cohen Clinics.
Both the insurer-filed complaint and the insurance company counterclaims and third-party claims in the other three cases allege that the clinics, owners and their employees participated in a fraudulent billing scheme.
The insurance companies’ legal claims against the chiropractic parties included violations of the Racketeer Influenced and Corrupt Organizations (RICO) Act and the Massachusetts Consumer Protection Act, civil conspiracy, fraud and abuse of process.
They cases were consolidated for discovery but Suffolk County Superior Court maintained separate dockets for the four cases.
In separate May 10 judgments, Associate Justice John Cratsley awarded more than $3.8 million to Commerce, about $1.2 million to Encompass, $1.3 million to Premier and about $455,000 to Norfolk & Dedham Mutual.
In a combined April 22 order, Cratsley granted the insurance companies’ motion for summary judgment on damages and their motion for an assessment of damages and entry of final judgment.
In the order, Cratsley explained why he concluded that a jury trial on damages was unnecessary despite earlier orders bifurcating liability and damages. Cratsley relied on a 1994 ruling by the U.S. Court of Appeals for the 1st Circuit in Aetna Cas. & Sur. Co. v. P&B Autobody. That case upheld a District of Massachusetts ruling that there were “no genuine issues of material fact” about damages. According to Cratsley’s order, the Aetna case involved fraudulent car insurance claims as opposed to chiropractic claims from staged accidents. But as in the chiropractic insurance fraud cases, the case involved fraud, civil conspiracy and RICO claims.
The chiropractic entities’ main lawyer, Francis Gaimari, who heads the litigation group at Fireman & Associates in Needham, Mass., did not respond to request for comment.
David O. Brink, the litigation manager at Smith & Brink in Braintree, Mass., who represented the insurance companies, called the ruling a landmark decision. Brink said he believes the issue of culpability for paying so-called runners — people who refer patients who then get chiropractic services covered by insurance — is one of first impression.
“It’s the first time that a Massachusetts court has found expressly that the payment of runners represents fraud, unfair business practices under [the state's consumer protection law] and a violation of the federal RICO statute,” Brink said.
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