BOSTON AREA MEDICAL PROVIDERS NAMED IN MULTIMILLION DOLLAR HEALTHCARE FRAUD SCHEME

BOSTON AREA MEDICAL PROVIDERS NAMED IN MULTIMILLION DOLLAR HEALTHCARE FRAUD SCHEME

Boston, MA, November 06, 2007

Owners and employees of Boston Regional Physical Therapy, Inc., and its sister corporation, Central Metropolitan Billing Services, Inc., have been named as defendants in a multi-million dollar lawsuit before the United States District Court for the District of Massachusetts; recoveries in the lawsuit could top $5 million.  This lawsuit is the culmination of an eighteen-month investigation spearheaded by the Special Investigations Unit of Metropolitan Property and Casualty Insurance Company (MetLife Auto & Home^®).  In recent years, MetLife Auto & Home has been one of the most active insurance companies in the Commonwealth in the fight against insurance fraud.

According to court documents, defendants Thomas J. Fiese, a physical therapist and owner of both Boston Regional Physical Therapy, Inc. (Boston Regional), and its sister corporation, Central Metropolitan Billing Services, Inc. (CMBS); Sapna Aggarwal, MD; Nicole Palma; and others are accused of engaging in a fraudulent scheme to obtain insurance benefits by billing for medical and physical therapy treatments allegedly provided to motor vehicle accident victims.  The documents also indicate that many of the treatments were never provided, or, if they were, they were either administered by unlicensed staff and/or were unwarranted and excessive.  The defendants allegedly then manipulated the Massachusetts Compulsory Motor Vehicle Liability Insurance Statute to coerce payment for these fraudulent treatments under threat of litigation, resulting in unwarranted payments made directly to the defendants and fraudulent and/or grossly inflated personal injury settlements.

Court documents indicate that MetLife Auto & Home has been awarded prejudgment attachments against the defendants in excess of $1.3 million – a ruling that required the court to initially find that the company was likely to succeed on the merits of its claims.  Should MetLife Auto & Home prevail on its claim that the defendants have violated the Massachusetts Consumer Protection Act, a judgment against all defendants, jointly and severally, could exceed $5 million.  To date, the Defendants have been unable to successfully refute the merits of MetLife Auto & Home’s claims and its prejudgment attachments.  MetLife Auto & Home is represented by McGovern & Ganem, P.C., in Boston.

“MetLife Auto & Home has an obligation to our customers to combat insurance fraud in all forms,” said John Sargent, director of MetLife’s Special Investigations Unit.  “Unfortunately, fraud within the automobile insurance industry has evolved beyond staged thefts and exaggerated property damage. We now face situations where unethical individuals and corporations within the healthcare industry are using sophisticated methods to engage in fraud, while hiding behind the veil of legitimacy provided by their professional licenses.  We’ve all seen the effects of fraudulent insurance schemes on auto insurance rates in the Commonwealth, and how increased fraud fighting has helped to stabilize insurance rates.  MetLife is proud to be part of that.”