GEICO takes aim at a Florida physician and five clinics in a $2.89 million alleged PIP fraud scheme.
Government Employees Insurance Co., GEICO Indemnity Co., GEICO General Insurance Company, and GEICO Casualty Co. have filed a 26-count complaint in the United States District Court for the Middle District of Florida, Tampa Division, targeting physician Albert Matos, M.D., five rehabilitation clinics, and their respective owners and operators - 14 defendants in all.
At the heart of the complaint is the allegation that Matos acted as a sham medical director across all five clinics: Primera Health Center Inc., Health Clinic Rehabilitation Center, Inc., Tampa Healthcare Therapy Center LLC, Allure Med & Wellness Services LLC, and Blue Sea Rehabilitation Center Inc. According to GEICO, Matos allegedly entered into secret agreements with each clinic's owner, accepting compensation to falsely pose as the clinics' legitimate medical director while never actually fulfilling the statutory duties required under Florida's Health Care Clinic Act. GEICO alleges that real decision-making authority over patient care and billing was handed off to the non-physician clinic owners instead.
The alleged scheme, which GEICO says began no later than 2020, revolved around Florida's No-Fault Law. Under that law, insurers are only required to pay PIP benefits for services that are "medically necessary." The complaint alleges that clinics operating in violation of the Clinic Act's licensing and medical director requirements are ineligible to collect PIP benefits - and that the defendants' charges were therefore noncompensable and unenforceable. GEICO further alleges that the defendants violated the False and Fraudulent Insurance Claims Statute and the Physical Therapy Practice Act.
The complaint describes what GEICO characterizes as pre-determined fraudulent treatment protocols. According to the filing, the defendants allegedly funneled patients - including those whose contemporaneous police reports indicated they were not injured and who did not require significant treatment — into courses of medically unnecessary physical therapy. Matos is alleged to have issued false lists of unverifiable soft tissue injury diagnoses and fraudulent "emergency medical condition" determinations. The complaint also alleges that the clinics billed GEICO under CPT codes that misrepresented the nature and complexity of services purportedly rendered, and that in many cases, the billed services were never actually performed.
The 26 causes of action span federal RICO claims, Florida's Deceptive and Unfair Trade Practices Act, common law fraud, and unjust enrichment. GEICO is seeking compensatory damages, treble damages under RICO, punitive damages, attorneys' fees, and a court declaration that the clinic defendants have no right to payment on any pending bills. The total alleged damages exceed $2,891,000.00, broken down as $1,048,000.00 tied to Primera Health, $719,000.00 to Health Clinic Rehabilitation Center, $391,000.00 to Tampa Healthcare, $124,000.00 to Allure Med, and $609,000.00 to Blue Sea Rehabilitation Center.
The case is at the complaint stage and a jury trial has been demanded. No ruling has been issued.
