Allstate accuses Texas provider network of operating $1.7M auto injury fraud scheme

Insurer Allstate is accusing a network of provider clinics in Texas of extensive medical fraud, alleging they embellished the injuries patients suffered in auto accidents, inflated medical claims and ordered unnecessary procedures as part of a $1.7 million conspiracy.

According to Insurance Business, the lawsuit names Foundation Physicians Group as the defendant, along with Prime Imaging Partners, Complete Pain Solutions and Memorial MRI & Diagnostic. Various providers and clinicians working for the organizations are also implicated in the alleged fraud.

Allstate contends the group profited from the scheme, involving multiple incidents that occurred between 2019 and 2023. The specifics include ordering excessive imaging tests and upcoded diagnoses, with referrals happening within the network.

No patients are being sued. Instead, it is alleged they were swept up by the supposedly coordinated scheme, which frequently involved repeated trigger point injections—a dubious medical treatment used to relieve pain by loosening tight muscles.

In many cases, Allstate said these injections cost $6,000 apiece, despite allegedly taking only a few minutes to administer. Further, it’s alleged that nurse practitioners ordered these injections despite a Texas law that requires a doctor to make the decision.

At the heart of the case are personal injury attorneys who would make referrals to the network as part of the overbilling conspiracy, Allstate alleges. In total, the company says it paid $1.7 million in settlements, but it’s suing for interest plus attorney fees. Under federal law, it could be awarded as much as $5.2 million.

Insurance Business said no financial determinations have been made. The lawsuit was filed in October and has yet to proceed. All allegations remain unproven.

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