A major insurer is suing to recover more than $4.6 million, alleging a sweeping PIP fraud scheme by a Florida clinic and its operators.
GEICO and its affiliated companies have filed a complaint in the United States District Court for the Middle District of Florida, Tampa Division, against A J Therapy Center Inc., its owner Ramon Jimenez, and physician Jose Luis Cruz, M.D. The plaintiffs allege that the defendants wrongfully obtained more than $4,600,000.00 from GEICO by submitting thousands of fraudulent and unlawful no-fault (PIP) insurance charges through AJ Therapy. These charges, according to the complaint, related to medically unnecessary, illusory, unlawful, and non-reimbursable health care services and goods—including initial and follow-up examinations, physical therapy, home medical equipment, and related services—purportedly provided to Florida automobile accident victims eligible for coverage under GEICO PIP insurance policies.
GEICO is one of the top 10 car insurance companies in Florida. Get to know their coverage options, and more in this guide.
The complaint alleges that the scheme began no later than 2020 and has continued uninterrupted, resulting in damages to GEICO exceeding $4,600,000.00. The insurer claims that since at least 2019, each charge submitted by the defendants through AJ Therapy has been fraudulent and unlawful. The complaint details how the clinic submitted claims for services that were not medically necessary, not provided, or performed by unlicensed or unsupervised individuals.
Central to GEICO’s allegations is the assertion that AJ Therapy operated in pervasive violation of Florida law, including the Health Care Clinic Act, the False and Fraudulent Insurance Claims Statute, and the Physical Therapy Practice Act. The complaint states that these violations rendered the defendants ineligible to collect PIP insurance benefits, making all PIP charges noncompensable and unenforceable.
The insurer further alleges that the defendants used predetermined fraudulent protocols to maximize billing. These protocols, according to the complaint, included misrepresenting the severity of injuries, exaggerating the time spent on examinations, and misrepresenting the identities of supervising practitioners on insurance forms. The complaint also accuses the clinic of unlawfully billing for physical therapy services performed by massage therapists and unlicensed or unsupervised individuals, and of misrepresenting who actually performed or supervised these services in violation of Florida’s Motor Vehicle No-Fault Law.
The complaint references statutory language, noting that under Florida’s No-Fault Law, PIP benefits are only payable for “medically necessary” and “lawfully” provided services. The law defines “medically necessary” as a service or supply that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptom in a manner that is in accordance with generally accepted standards of medical practice, clinically appropriate, and not primarily for the convenience of the patient, physician, or other health care provider. The complaint alleges that the services billed by the defendants failed to meet these standards and were not lawfully provided due to licensing and operational violations.
GEICO seeks a declaration that it is not legally obligated to pay more than $75,000.00 in pending PIP claims submitted by the defendants and is seeking damages exceeding $4,600,000.00. The complaint includes causes of action for declaratory judgment, violation of the Racketeer Influenced and Corrupt Organizations (RICO) Act, violation of Florida’s Deceptive and Unfair Trade Practices Act, common law fraud, and unjust enrichment. The insurer is also seeking treble damages, attorneys’ fees, and punitive damages.
The complaint describes how Jimenez, who is not licensed to practice any health care profession in Florida, used AJ Therapy as a vehicle to submit fraudulent, unlawful, and non-reimbursable PIP billing to GEICO and other insurers. Dr. Cruz, though licensed, is alleged to have falsely posed as the medical director at AJ Therapy’s clinics, while ceding true authority to Jimenez and failing to perform the statutory duties required of a clinic medical director.
The complaint also alleges that the defendants engaged in the general business practice of waiving, or failing to make a good-faith effort to collect, PIP deductibles from patients, in violation of Florida law. According to GEICO, this further supports the claim that the charges were unlawful and noncompensable.
As of October 7, 2025, the case remains at the complaint stage. All allegations are unproven, and no final decision has been made by the court.
