State Farm Charges Chiro Clinics with Fraud in Gaming Florida’s PIP Law

February 3, 2022

In a federal lawsuit filed this week, State Farm Insurance accuses a chiropractor and his string of Florida clinics of widespread fraud by regularly and falsely claiming that car accident victims needed emergency care, so that the clinics could take advantage of the maximum reimbursement allowed under Florida’s no-fault insurance laws.

“When the bills and supporting documentation across all claims at issue are viewed together do the patterns emerge, revealing the fraudulent nature of all the bills and supporting documentation,” reads the complaint against Ronald Utter, a Daytona Beach chiropractor who had his license revoked in 2020.

The license revocation also means that Utter cannot legally continue to operate his 13 clinics, and many of the pending bills sent to the insurer are not reimburseable, the lawsuit said. Utter continues to hold himself out as a licensed doctor, according to the complaint.

Altogether, State Farm was defrauded of more than $3 million, said the lawsuit.

Florida’s statute governing no-fault accident insurance, also known as personal injury protection, allows victims of automobile accidents to have quick access to medical care for their injuries, without determining who may be at fault in the crash. Auto insurers are required to reimburse health care providers 80% of reasonable expenses, up to $2,500 in most cases.

If the provider determines that the patient needs emergency care, the reimbursement limit rises to $10,000.

The suit, filed by attorneys with the Holland and Knight law firm in West Palm Beach, argues that Utter’s chiropractic clinics followed a protocol designed to fraudulently upcode the treatment needed. Most patients were given strikingly similar evaluation procedures, treatments and diagnoses, despite wide variations in injuries, ages and circumstances. The clinics almost never ordered X-rays, but usually prescribed the more expensive magnetic resonance imaging (MRI), the complaint alleges.

The clinics, in the Orlando, Daytona Beach and Tampa areas, advertised Utter as the “auto injury doctor.” Utter started one clinic under the name of No Utter Way, but some now operate under the name Preferred Injury Physicians.

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The clinics paid selected physicians to certify patients as needing emergency care, the complaint notes. But many of these evaluations appear to be simply rubber stamps for the chiropractor’s initial exam. In many cases, it’s unclear that physicians actually checked the accident victims. Some reports from the initial chiropractor and the emergency evaluating physician are nearly identical, the suit said.

Utter also cultivated injury lawyers to refer accident victims to his clinics, State Farm contends.

“Defendants’ scheme is centered on cultivating, building, and maintaining a network of personal injury attorneys and other medical providers throughout central Florida to ensure a constant stream of patient referrals to the Defendant clinics,” the suit argues.

Utter could not be reached for comment Wednesday. He does not have an attorney listed in the case file in the U.S. District Court for the Middle District of Florida, and his company has not yet filed an answer to the complaint.

Topics Florida Fraud

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