Allstate Effectively Alleges RICO Conspiracy
Post 4818
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In Allstate Insurance Co. et al. v. Lint Chiropractic PC et al., No. 2:23-cv-10904, United States District Court, E.D. Michigan, Southern Division (May 30, 2024) Allstate brought a RICO case against chiropractors and conspiracies to defraud Allstate.
BACKGROUND
Robert Super, exercises “dominion and control” over all units of a medical device called the Nervomatrix. Super proliferated the fraudulent use of Nervomatrix machines at numerous medical clinics in Michigan. Super implemented a “predetermined protocol” mandating the use of Nervomatrix machines-regardless of medical necessity.
ANALYSIS
Plaintiffs allege violations of two provisions of the RICO statute. Plaintiffs have plausibly alleged claims under both provisions.
THE RICO ENTERPRISE
A RICO “enterprise” may include any legal entity and any group of individuals associated in fact although not a legal entity. [18 U.S.C. § 1961(4)].
THE PARTICIPANTS
1. Lint Chiropractic Enterprise. Super owned and managed Lint Chiropractic and directed its staff’s conduct. He installed Nervomatrix machines there and developed a predetermined protocol to direct patients toward unnecessary treatments, resulting in fraudulent billing.
2. MI Medical Enterprise. Super also owned and managed MI Medical, implementing the same fraudulent protocol.
3. Supplies Plus Enterprise. Super managed Supplies Plus, deciding to write prescriptions for unnecessary DME.
Pattern of Racketeering Activity
To establish a pattern of racketeering activity, Plaintiffs demonstrated that Defendants committed at least two predicate acts of racketeering. Plaintiffs allege that all the predicate acts of mail and wire fraud served the common purpose of inducing Plaintiffs to pay large sums for bogus medical bills. These allegations sufficiently demonstrate the necessary relationship among the acts.
Predicate Acts and Civil Rule 9(b)
The Allstate plaintiffs adequately alleged the fraudulent scheme.
Plaintiffs’ Motion to Dismiss, was GRANTED.
ZALMA OPINION
The type of Fraud that Allstate used to base its RICO action is rampant as detailed in hundreds of health insurance fraud convictions reported in Zalma’s Insurance Fraud Letter twice a month. The Allstate entities, as the victim of the fraud, is proactively fighting the frauds perpetrated against it by this RICO case that, when tried successfully, will take the profit out of the crime.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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