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Huntington Regional Chiropractic, P.C. v. Allstate Ins. Co.

New York District Court, Nassau County

June 18, 2013

HUNTINGTON REGIONAL CHIROPRACTIC, P.C. Assignee of Yeny Zelaya-Mendez, et al., Plaintiff,
v.
ALLSTATE INSURANCE COMPANY, Defendant.

[967 N.Y.S.2d 640] Israel, Israel & Purdy for Plaintiff.

Robert P. Macchia & Associates for Defendant.

FRED J. HIRSH, J.

Defendant moves to strike the Notice of Trial and Certificate of Readiness for Trial on the grounds discovery is not complete.

Page 979

BACKGROUND

Joseph Perez, M.D. is the owner of several medical facilities. While these facilities are located in different locations, the address for each of the medical facilities for which Dr. Perez is listed as the officer, shareholder or director with the Department of Education is 1890 New York Avenue, Huntington, New York 11746.

After receiving numerous no-fault claims from Dr. Perez facilities, Allstate Insurance Company (" Allstate" ) began to investigate the operation of these facilities.

At an examination under oath conducted by Allstate in 2005, Dr. Perez testified he used management companies to pick the location for his medical facilities, to hire and handle payroll for his support staff and to handle billing. The management companies used by Dr. Perez to provide these services are located at 1890 New York Avenue, Huntington, New York.

Allstate asserts it has repeatedly requested copies of the management agreements between Dr. Perez medical facilities and the management company. Allstate asserts it is entitled to discovery these documents in connection with a Mallela defense. See, State Farm Mutual Auto. Ins. Co. v. Mallela, 4 N.Y.3d 313, 794 N.Y.S.2d 700, 827 N.E.2d 758 (2005).

Allstate asserts the medical facilities owned by Dr. Perez also engage in a systematic pattern of overbilling. Testimony taken at Examinations Under Oath of patient's who receive treatment at Dr. Perez medical facilities indicate Dr. Perez and other doctors employed at those facilities submit bills for providing a complex examination that should take close to an hour when the examination took between 15 and 30 minutes.

Allstate further asserts Dr. Perez bills no-fault for services provided by independent contractors.

Allstate claims there is a pattern of providing similar if not identical treatment to patients who are examined by Dr. Perez or other doctors at Perez owned facilities. Allstate claims patients examined by Dr. Perez or at Perez owned facilities are regularly referred for chiropractic treatment at facilities owned by David Tubins, D.C. Allstate claims this raises issues regarding illegal fee-splitting with Dr. Tubins.

Allstate claims these circumstances lead it to believe Dr. Perez medical facilities are subject to a Mallela defense. Allstate seeks to obtain discovery in this regard and to take a deposition of ...


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