Oxford Health Plans (N.Y.), Inc. v. Bettercare Health Care Pain Mgmt. & Rehabilitation,
2003 WL 21101092 (N.Y. App. Div. May 15, 2003) (Fraud and Abuse)

An HMO sued, alleging a provider submitted claims constituting fraudulent billing. The HMO alleged the provider billed for services rendered by a physician that actually were rendered by a chiropractor or acupuncture practitioner (or substitute in allied health practitioners), billed for medically unnecessary services, and submitted bills showing services rendered by a physician simultaneously at different locations. The provider moved to dismiss the action arguing the HMO insufficiently pled the fraudulent allegations. The provider further argued the action was preempted by ERISA. An appellate court in New York affirmed a lower court's denial of the provider's motion to dismiss. The court held the HMO sufficiently pled the elements of fraud and held the action was not preempted by ERISA.