Allstate accuses Florida clinic of billing fraud, unnecessary spine surgeries

Spine

Allstate Insurance Company has filed a lawsuit against Florida Anesthesiology and Pain Clinic, alleging it fraudulently performed unnecessary, life-threatening spinal surgeries and billed for surgeries that were not performed using falsified medical records, according to a Dec. 30 report from the Sun Sentinel.

The Florida clinic has six locations across the state in Pompano Beach, Palm Beach Gardens, Miami Gardens, Tampa, Orlando and Pensacola

Allstate has accused the clinic's owner, Ravi Xavier, MD, of running an insurance fraud scheme designed to elicit false payments.

Allstate claims that it has paid millions for insurance claims "that were based on the false, fabricated, unlawful, and improper medical services," according to the lawsuit. 

All of the submitted claims listed Dr. Xavier as the physician providing the alleged services. The lawsuit also alleges that Dr. Xavier could not have safely performed all of the billed services. 

"If the defendants actually performed all the procedures they billed in the manner they claimed, the lives of the patients at issue herein were placed at risk," the lawsuit reads. "Florida Anesthesiology regularly billed for alleged injections into patients' spines using body positioning, approaches and medications that were contraindicated, physiologically impossible, and extremely and unnecessarily dangerous."

The procedures were billed on behalf of car crash victims who were not seeking medical treatment, but were allegedly steered to the clinic by several law firms. 

The lawsuit claims that the clinic sent patient bills and records to attorneys, who in turn sent them to Allstate, and that the clinic's advertising targeted plaintiffs' attorneys rather than patients. 

Allstate claims that the clinic billed an "incredible number" of spinal injections at a rate of $65,000 each. Allstate also accused the clinic of over-performing radiofrequency ablations, routinely billing for up five RFAs on the same day and up to 10 per patient. 

Before filing the lawsuit, Allstate reached out to Dr. Xavier and negotiated a settlement agreement in December to try and stop the fraud as soon as possible, according to the report. 

On Dec. 8, the clinic's lawyer agreed to pay $2.5 million to Allstate and waive all outstanding bills to the company, but on Dec. 19, told the insurer that "he was instructed by the defendants to convey that the defendants will not honor their Settlement Agreement obligations."

Dr. Xavier did not respond to the Sentinel's request for comment. Dr. Xavier has been a practicing physician specializing in anesthesiology, pain management and critical care medicine for more than 30 years.



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