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South Florida Medical Provider Sues GEICO for Systematic Fraud; the Insurance Company is Bringing a Counterclaim for Billing Fraud


According to reporting from Insurance Business Magazine, the Florida Spine and Joint Institute (FSJI)—a Miami Lakes-based medical provider—has filed a fraud lawsuit against GEICO, the second largest motor vehicle insurance provider in the United States. In turn, GEICO contends that FSJI has submitted false bills for reimbursement. In this article, our Miami business and consumer fraud lawyers provide an overview of the allegations raised against the insurer and the counterclaim brought against the medical provider.

Allegations: Unjustified Denial of Personal Injury Protection (PIP) Claims in Florida 

In the Eleventh Judicial Circuit of Florida, the Florida Spine and Joint Institute has filed a complaint and demand for jury trial alleging that GEICO has engaged in systematic fraud in its handling of Personal Injury Protection (PIP) auto insurance claims. The medical provider is seeking $750,000 in damages, not including the additional costs for attorneys’ fees and legal fees.

Florida law requires motorists to carry PIP coverage and GEICO is one of the top PIP insurance providers in Miami-Dade County. In its health care business, FSJI is a provider that submits claims for reimbursement through GEICO’s PIP coverage. According to FSJI’s complaint, GEICO is improperly denying its patient’s claims in a systematic and fraudulent manner. 

Counterclaim: GEICO Alleges that FSJI Committed Insurance Fraud  

In documents submitted to the Eleventh Judicial Circuit court, GEICO argues that it is not obligated to pay the denied PIP claims submitted by the Florida Spine & Joint Institute. The insurance giant states that the specific reasons for denial of these claims need to be assessed on a case-by-case basis. Though, the insurer contends that FSJI has been submitting fraudulent bills. Specifically, GEICO lays out the following three arguments:

  1. FSJI is billing for massage therapy services that are simply not covered by Personal Injury Protection (PIP) coverage in Florida;
  2. The medical provider is “upcoding”—meaning it is charging for expensive and largely unneeded services, when other treatment would be sufficient; and
  3. The billing does not match the actual hours put in by the provider.

FSJI told reporters from the Insurance Business Journal that they are seeking a quick, efficient resolution. Their representatives state that they want to hold GEICO accountable for paying claims. For its part, representatives for GEICO indicated that the company does not comment on any pending litigation. 

Call Our South Florida Business Fraud Lawyers for Immediate Help With Your Claim

At Pike & Lustig, LLP, our experienced South Florida business fraud attorneys are committed to providing reliable and results-driven legal advocacy to clients. Our goal is to help our clients get justice and the maximum available financial support.

If your company suffered losses due to fraud, we are here to help. Call us now for a confidential, no obligation review of your case. With offices in Miami and West Palm Beach, we serve clients all over Southeastern Florida, including in Fort Lauderdale, Jupiter, Deerfield Beach, and Miami Beach.


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