Liberty Mutual Insurance Co. has served summons and complaints against New Jersey’s Spring Lake Psychological Group, and its owners Warren L. Goldberg and Carmela Gutierrez, for allegedly engaging in a fraudulent scheme to seek payment for illegally referred and rendered psychological services.
The lawsuit, filed Oct. 17 in the Superior Court of New Jersey, Morris County, accuses the defendants of violating the Insurance Fraud Prevention Act by, among other activities, accepting patient referrals in exchange for rent payments. According to the complaint, the defendants formed Spring Lake Psychological Group for the sole purpose of obtaining personal injury protection medical expense benefits by claiming to have rendered treatment to persons involved in automobile accidents.
All of the Group’s patients were referred to it by chiropractors throughout New Jersey who had lease agreements with Spring Lake. The complaint alleges the excessive rent payments for office space by Spring Lake to these chiropractors constitutes payment for referral, a violation of the New Jersey Administrative Code. Liberty Mutual claims investigations reveal all of the defendants’ patients had sustained minor soft-tissue injury or no injuries at all, with no medical or psychological basis for the chiropractors’ referral of the patients to Spring Lake for evaluation, testing or treatment. Spring Lake also allegedly submitted bills to Liberty Mutual for treatment or office visits that never took place.
The complaint also states Carmela Gutierrez was never licensed to practice psychology in New Jersey or any other state, thus prohibiting the defendant from having an ownership interest in a professional services corporation. The Group also allegedly hired and used personnel who are not properly licensed or trained to provide psychological evaluations and treatment.
Liberty Mutual seeks repayment of all prior PIP benefits paid to Spring Lake, and a punitive award tripling that amount, plus reimbursement of all of its costs and attorneys’ fees for this lawsuit under the New Jersey Insurance Fraud Prevention Act. Liberty Mutual also seeks judgment to declare that Spring Lake Psychological Group, P.C., is not a legitimate healthcare facility, assuring that in this case and in future cases, Liberty Mutual and its customers do not have to pay for improper services.
Was this article valuable?
Here are more articles you may enjoy.