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Allstate Files $4.5 Million Insurance Fraud Claim in New York

Source: A.M. Best

Posted on 14 Oct 2011

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Allstate Insurance Co. is seeking to recover $4.5 million from five medical doctors, seven chiropractors and 10 professional medical corporations along with one nonprofessional in an alleged scheme to bilk insurance companies for medically unnecessary or inappropriate procedures.

Allstate has filed counterclaims and a third-party complaint alleging that two New York medical professional corporations — Cambridge Medical P.C. and Pine Hollow Medical P.C. — were fraudulently incorporated through a scheme using the names of licensed medical physicians, and that a layperson, who was not a physician, secretly owned and controlled the medical professional corporations. Allstate alleges these corporations fraudulently billed Allstate Insurance, the company said in a statement.

Attempts to reach the company for additional comment were not immediately successful.

Allstate's claims were filed following an investigation by Allstate's special investigative unit and seek reimbursement for personal injury protection benefits Allstate paid on behalf of its customers during time frames specified in the counterclaims and third-party complaint. Cambridge had filed an action seeking to recover billing from Allstate, which responded with its counterclaims and third-party complaint.

Since 2003, Allstate has filed 32 fraud lawsuits in New York State, seeking more than $175 million in damages.

In June, Allstate Insurance has filed a $1 million lawsuit against 10 New York-area defendants, alleging four professional service corporations were illegally operated by laypeople rather than professionals with the proper credentials (Best's News Service, June 24, 2011).

No-fault automobile insurance fraud is costing New Yorkers hundreds of millions of dollars a year, according to the Insurance Information Institute.

Allstate Insurance Group currently has a Best's Financial Strength Rating of A+ (Superior).