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GEICO sues three Miami clinics over alleged $1.35 million in false PIP claims

GEICO filed a federal lawsuit alleging that three Miami clinics submitted fraudulent no-fault insurance claims totaling over $1.35 million.

Opal Keller

August 19, 20262 min read

insurance fraud - illustration, Jake Team LLC

Government Employees Insurance Co. and three affiliated GEICO carriers filed a lawsuit in the U.S. District Court for the Southern District of Florida on August 17, 2026. The complaint accuses three Miami personal injury protection clinics of a multi-year billing fraud scheme.

The named defendants are A&Y Rehabilitation Medical Center, New World Health, and Rehab & Therapy Wellness of South Florida, along with their owners and a physician alleged to have served as medical director for all three facilities.

The insurer claims the clinics submitted thousands of no-fault charges for examinations, physical therapy, and nerve-stimulation treatments beginning no later than 2021. Central to the case is Florida’s Health Care Clinic Act, which mandates a qualified medical director to verify billing accuracy and staff licensing.

GEICO alleges the physician was paid to occupy this role without performing the required oversight, rendering the charges noncompensable under the law.

The filing includes specific examples of alleged inconsistencies. GEICO states it received bills crediting the physician with more than 30 hours of services at two clinics on November 24, 2023, a duration exceeding the hours in a single day. The complaint further alleges that hands-on physical therapy was performed by massage therapists, unsupervised assistants, or unlicensed staff, rather than the physician.

Since January 1, 2013, Florida’s no-fault law has excluded massage therapy from PIP coverage. The insurer claims the clinics omitted these workers from claim forms and listed the physician instead.

Additional allegations include the use of billing codes that indicate at least 45 minutes of work or moderate complexity, despite GEICO’s claim that no exam lasted 15 minutes or involved significant decision-making. The complaint also states that patients from minor crashes received identical soft-tissue diagnoses on the same day.

Furthermore, GEICO alleges the clinics routinely applied false emergency medical condition diagnoses to access the higher $10,000 PIP benefit cap, rather than the standard $2,500 limit.

The insurer also disputes the pricing of percutaneous electrical nerve stimulation, alleging sessions billed at $800 or $1,200 at one clinic and $630 at another were actually ordinary electrical stimulation. GEICO claims the clinics also waived patient deductibles, a practice Florida law treats as unlawful.

According to the filing, GEICO paid at least $650,000 to A&Y Rehab, $215,000 to New World Health, and $475,000 to Rehab & Therapy Wellness.

The 18-count complaint seeks treble damages under federal RICO and a ruling that GEICO owes nothing on more than $75,000 in pending claims. The allegations have not been tested in court, and no defendants have filed a response. The complaint reflects only GEICO’s account of the disputed billing.

Geico employs about 2,000 people in Richardson, according to local government records.

Source: Insurance Business.

Sources

https://www.insurancebusinessmag.com/us/news/risk-compliance-legal/geico-says-three-miami-clinics-billed-1-35-million-in-false-nofault-claims-586535.aspx

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Opal Keller

Opal Keller reports on local business, new openings, and economic development in Richardson.

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