Allstate v. 22791
In Allstate v. 22791 filed in 2008, Allstate claimed that they discovered a fraud ring of staged collisions that involved vehicles that were already heavily damaged from a prior car accident being “recycled” in a second accident. The scheme involved using a car that was already heavily damaged from a prior car accident and making it seem like all the damage happened in the new accident. Allstate was able to match the VIN numbers and confirm that the damage was from the original car accident. The cars were usually from out-of-state; purchased by a straw owner who was a friend of the body shop; and the body shops would keep the money for the repair job without performing the repairs. Multiple body shops got sued in this lawsuit.
Several PIP clinics and doctors got sued in this case and the only allegation against them was that they were upcoding all exams as a 99205 or a 99204. If they billed a lower level/appropriate exam code like 99203 or 99202 then they might not have been dragged into this staged collision lawsuit targeting the body shops.
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company; therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.