Farmers Insurance Exchange, 21st Century Insurance Company, Coast National Insurance Company, Mid-Century Insurance Company and Truck Insurance Exchange have filed a lawsuit in the Superior Court of California against two radiological corporations and their owners. It’s claimed in the suit that the defendants prepared and submitted false and misleading documentation to receive payment for services never provided.
The complaint seeks restitution and additional remedies for alleged violations of California’s Unfair Business Practices and the Insurance Frauds Prevention Act. The Plaintiffs also requested an order directing Defendants to cease and desist from engaging in alleged improper billing practices. The lawsuit alleges that the radiological corporations and their owners billed Farmers for 3D Rendering of MRI and CT scans which were never performed. This involved more than two hundred bodily injury and workers’ compensation claims under policies of insurance issued to Farmers policyholders.
The complaint also alleges that one of the defendant radiological corporations was improperly owned and structured. That’s because a lay person, and not a licensed physician, was the majority owner. This, if true, is a violation of California law, which requires that corporations must practice medicine under the control of licensed medical doctors. Sean Zavala, director of Special Investigations, stated:
Farmers continues to take aggressive action to protect its policyholders and stop fraud. Our Special Investigative Unit is trained to detect this type of alleged fraud and prepared to protect the public by filing cases to stop it from continuing.
It’s essential that fraud and other wrongdoing in our health care system be eliminated to the extent possible. This is especially true when it comes to defending the government in federal programs. The regulatory system certainly needs to be more aggressive in this area of concern. The judicial system does it part and as a result remains under constant attack by powerful special interests.
Source: Claims Journal
