GEICO is taking aim at two more Florida medical clinics and their owners, accusing them of orchestrating a years-long scheme to defraud the insurer out of more than $3.5 million through bogus personal injury protection (PIP) claims.
Filed in the US District Court for the Middle District of Florida, the lawsuit alleges that Preziosi West/East Orlando Chiropractic Clinic, Integrity Medical Group, and their principals, Dr. Vincent A. Preziosi, Jr. and Dr. Donald L. Behrmann, systematically billed GEICO for thousands of “medically unnecessary, illusory, unlawful, and otherwise non-reimbursable” healthcare services. The complaint describes a pattern of alleged fraudulent activity stretching back to at least 2019, targeting Florida auto accident victims eligible for coverage under GEICO PIP insurance policies.
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According to the lawsuit, the clinics submitted claims for a wide range of services, including initial and follow-up examinations, physical therapy, chiropractic treatments, and extracorporeal shockwave therapy. GEICO alleges that many of these services were either not performed, not medically necessary, or provided by unlicensed or unsupervised individuals - violating Florida’s requirements for health care providers and insurance billing.
The complaint lays out a detailed web of alleged misconduct. GEICO claims the clinics falsely asserted exemptions from state licensing and medical director requirements, using those exemptions as cover to submit fraudulent bills. The lawsuit also accuses the defendants of engaging in unlawful referral and kickback schemes, in which patients were referred between clinics and subjected to pre-determined treatment protocols designed to maximize billing rather than provide genuine care.
In one example cited in the complaint, GEICO alleges that the clinics routinely billed for initial examinations under CPT code 99203, representing moderate-severity injuries, even when police reports indicated only minor accidents and no injuries. The complaint details that, in many instances, the same diagnoses and treatment plans were given to multiple patients involved in the same accident, regardless of their individual circumstances.
The complaint further alleges that the clinics’ billing forms misrepresented who actually provided or supervised the services, often listing licensed professionals when the work was performed by massage therapists or other unqualified staff. GEICO claims that, on certain days, Dr. Preziosi was listed as having performed or directly supervised more than 25 hours of therapy in a single day - an “impossible” amount, according to the complaint.
GEICO seeks to recover more than $3,540,000 it claims was paid out on fraudulent claims, as well as a declaration that it is not legally obligated to pay more than $75,000 in pending PIP claims submitted by the defendants. The insurer is also pursuing damages under the federal Racketeer Influenced and Corrupt Organizations (RICO) Act, as well as under Florida law and common law fraud.
While the lawsuit does not cite specific insurance policy clauses, it centers on Florida’s No-Fault Law, which requires that PIP benefits be paid only for services that are both medically necessary and lawfully provided.
The case, filed on Oct. 8, is still in its early stages, with no final decision issued.
