Fourteen insurers are suing a New York no-fault clinic operation, alleging a fraud scheme that has cost them more than $5.3 million.
The complaint, filed May 21 in the Eastern District of New York, names Dr. Jonathan Landow, Dr. Viviane Etienne, alleged layperson operator Kamrunnahar Kanny, two medical professional corporations - Macintosh Medical P.C. and Atlantic Medical & Diagnostic, P.C. - and 11 nurse practitioners and physician assistants who allegedly treated patients through the practices. Several plaintiffs carry the Farmers name, including Farmers Insurance Exchange, Farmers Casualty Insurance Company and Mid-Century Insurance Company.
The insurers say they have already paid more than $1.65 million on disputed claims and face another $3.7 million in pending bills they want declared unpayable. They want all of it back, and the rest off the books.
The case sits inside New York's no-fault system, which gives auto accident victims at least $50,000 in personal injury protection benefits and forces insurers to pay or deny claims within 30 days. Miss that window and the carrier owes the claim plus 24% interest and attorney's fees. The complaint says that pressure is exactly what makes the system a target.
On paper, Macintosh and Atlantic look like ordinary medical PCs. Landow is listed as sole owner of Macintosh and 95% owner of Atlantic, with Etienne holding 5% and serving as Atlantic's medical director. The complaint alleges the reality is different - that Kanny, who is not licensed to practice medicine, and unnamed John Doe defendants actually run both. Under no-fault regulation 11 NYCRR 65-3.16(a)(12), only licensed healthcare professionals can own or control a medical PC. The insurers allege Landow lives in Florida, does not practice medicine, and "is not ever physically in New York State to oversee operations."
What the insurers describe is a treatment line that does not flex for the patient. The complaint calls it a "pre-determined fraudulent protocol" - the same package applied to nearly everyone walking in, according to the filing: initial and follow-up exams, MRIs, durable medical equipment, transcranial doppler testing, shockwave therapy, videonystagmography, opioids, compounded creams, and a steady stream of trigger point injections.
The billing math is where the case sharpens. The complaint alleges Macintosh and Atlantic charged initial exams under CPT code 99204 - 45 minutes of face-to-face time, $203.76 a pop - while actual exams ran "about 10-15 minutes and, in some cases, were not provided at all." So-called outcome assessment tests, described in the filing as multiple-choice questionnaires patients filled out themselves, were billed under CPT code 99358 at $280.12 per round, a code that assumes at least an hour of physician work. Macintosh billed that test on "approximately 96% of its No-Fault claimants insured by Plaintiffs," the complaint states.
Trigger point injections are where the dollar figures stack. More than 80% of patients who got initial exams also got multiple trigger point injections under CPT code 20553, the complaint alleges, almost always with ultrasound guidance under CPT code 76942 at $289.20 a unit. Four to six units at a time meant $1,156.80 or $1,735.20 in ultrasound charges per session. Best practice, according to the filing, reserves trigger point injections for patients with three months of pain and a failed month of conservative care - but Macintosh and Atlantic allegedly billed for injections within a day of the accident in at least 50 cases.
A no-fault arbitrator quoted in the complaint described Atlantic's pay structure as one that "incentivizes performance of the injection…Additionally, the practitioner will not be paid the [fee-for-service] rate if they don't use guidance for the injection, even if they don't believe it is medically necessary."
The complaint also goes after how patients got there. Macintosh and Atlantic have no offices and do no marketing, the filing says - every patient came through referrals from more than 70 clinics across Brooklyn, the Bronx, Queens and Long Island. The "subleases" the practices paid those clinics were not real rent, the insurers allege, but disguised payments for access to patients. The arrangement was "Defendants sole business model" and "so extensive as to essentially cede control of Macintosh and Atlantic to the layperson John Does who referred patients," according to the complaint.
There is a second regulatory snag. 11 NYCRR 65-3.11(a) bars providers from billing for services performed by independent contractors they do not actually supervise. The complaint alleges Macintosh and Atlantic put the 11 NPs, PAs and Dr. Hiram Luigi Martinez on claim forms as employees while paying them as independent contractors on a fee-for-service basis. Each "has submitted over 400 claims to Plaintiffs and is aware of the falsity of the claims submitted," the filing states.
The complaint also surfaces history. It cites a 2011 U.S. Tax Court finding of tax deficiencies "over $1,730,000" against Landow, and a 2015 confession of judgment "exceeding $570,000 on a loan that was issued at an interest rate of 16.95%." It points to his appearance in a federal criminal case, United States v. Rose, where, the filing says, an FBI affidavit described a wiretap recording Landow coordinating treatment with a defendant the complaint calls "the reported illegal lay owner of several clinics" at which Macintosh held subleases. Several other insurers have sued Landow and Atlantic since 2018 on similar theories, the complaint notes.
The plaintiffs are bringing six counts: a declaratory judgment voiding the pending claims, three RICO counts under 18 U.S.C. §§ 1962(c) and (d), common law fraud and aiding and abetting fraud, and unjust enrichment. They are seeking compensatory and treble damages, attorney's fees, and a jury trial.
Exhibit 1 lists what the insurers say are 26,515 fraudulent billing submissions from Macintosh and Atlantic over six years. The complaint says the scheme is still running.
The allegations have not been tested in court. The defendants have not filed a response, and no court has ruled.
