GEICO is taking aim at three Florida clinics it says operated a coordinated PIP fraud scheme worth more than $3.7 million.
The insurer filed suit on March 13 in the US District Court for the Middle District of Florida, naming ten defendants across three Tampa-area clinics - Relief and Rehab, Inc. f/k/a Del Sol Care & Rehab Center, Inc., Renew Health Center LLC f/k/a Baycare Health Center, LLC, and Tampa Bay Therapy Care, Inc. - referred to collectively in court papers as the "Fossi Clinics."
At the heart of the case is Carlos E. Fossi, M.D., approximately 81 years old, who GEICO says falsely purported to serve as medical director at all three locations. According to the filing, Fossi was never genuinely the medical director at any of the clinics and only occasionally showed up - if at all. Licensing applications submitted to the state's Agency for Health Care Administration allegedly indicated he was present at certain clinics just once a month.
That detail matters. Under Florida's Health Care Clinic Act, a medical director is required to conduct systematic reviews of clinic billings to ensure they are not fraudulent or unlawful, and to take immediate corrective action when problems are discovered. GEICO alleges Fossi never carried out those duties and instead handed all day-to-day decision-making to the clinic owners.
The insurer says none of the three clinics were operating in compliance with the Clinic Act — making them ineligible to collect PIP reimbursement in the first place. It also alleges that purported physical therapy services were actually performed by massage therapists and unlicensed or unsupervised individuals, in violation of Florida law. Since 2013, the state's No-Fault Law has barred PIP reimbursement for massage or any services delivered by massage therapists. Despite this, the defendants allegedly listed other providers on HCFA-1500 billing forms as the supposed supervisors of those very services.
GEICO also accuses the defendants of routinely waiving patient deductibles and co-payments - a practice prohibited under Florida's False and Fraudulent Insurance Claims Statute. In nearly all of the thousands of billing forms submitted through the clinics, the defendants reportedly indicated they collected no money whatsoever from patients.
Then there is the question of volume. GEICO alleges that certain providers claimed to have personally performed or supervised an impossible number of therapy sessions - sometimes at multiple locations on the same day. The insurer says its own losses are only a fraction of the total fraudulent billing pushed across the broader Florida auto insurance market.
The suit brings 18 causes of action, including federal RICO claims, common law fraud, unjust enrichment, and violations of the Florida Deceptive and Unfair Trade Practices Act. GEICO is pursuing compensatory and punitive damages, treble damages under RICO, and declaratory relief on more than $75,000 in outstanding claims it says are fraudulent. A jury trial has been demanded.
No determination has been made on any of these claims, and the defendants have not yet responded.
