The Worst Health Insurance in the World?

     BATON ROUGE (CN) – A Baton Rouge company says it was bilked for thousands of dollars in a fraudulent health insurance racket by a slew of defendants who stiffed its workers for claims and, in an odd twist, charged them an extra $20 a month to make doggy diapers.

     The plaintiffs say many of the defendants are the same people or successor entities that were ordered in 2009 to stop running their insurance game in Florida.
     “Defendants have clearly continued their scheme and brought it to Louisiana,” according to the federal RICO complaint.
     Pat’s Garage Doors & Repairs and four of its employees say they were duped into paying for heath insurance they never received, and that their bogus insurance contracts described them as “employees” of the insurers – a ruse by which the defendants tried to duck insurance regulations.
     There are six corporate and five individual defendants.
     Pat’s Garage says the defendants snookered it as it sought affordable insurance for its workers.
     The defendants “devised a scheme whereby they would market group and individual plans to small businesses and individuals through licensed and unlicensed insurance agents, such as defendants Strategic Benefit Alliance and [John] Micalizio, under the guise of an employment agreement with defendants Datagen, Smart Services, or Coconut,” the complaint states.
     “These defendants’ employees were dually employed by their regular employer and defendants. After becoming ’employees,’ the employees were eligible for health insurance. Essentially, each employees’ job was to go to the doctor if they got sick or injured, to call Datagen when he or she did so, and to fill out health care providers’ paperwork and provide copies thereof to defendants, all as part of a purported ‘health study’ by Defendant Gallagher. If the employee did not comply with all job requirements, claims were not paid.
     “Defendants apparently perpetrated this scheme so they could engage in the business of insurance without being subject to state regulation. This scheme also allowed defendants to deny claims based upon Datagen’s, Smart Services’, and Coconuts’ employees’ failure to comply with their employment agreements.
     “Defendants marketed these schemes as opportunities to obtain health insurance. Upon information and belief, defendants promoted this plan throughout the southeastern United States. Upon information and belief, the result has been unpaid healthcare claims of numerous individuals.
     “A May 24, 2011 Immediate Final Order issued by the Florida Office of Insurance Regulation (FOIR) found defendants Datagen, Gallagher, Smart, Services, Coconut, [Marlin] Dixon, [Micheal] Purr, [Grant] Lockhart, and [John V.] Head had engaged in the unauthorized and illegal transaction of insurance in the State of Florida. The FOIR order was apparently based upon the very same scheme as perpetrated against petitioners herein and as set forth below. Remarkably, the FOIR investigation found that Smart Services, Datagen, Gallagher, and Coconut were successor entities to parties named in the August 26, 2009 FOIR Immediate Final Order which found that those entities were engaged in the unauthorized marketing, selling and distribution of health insurance and prohibiting them from doing so.
     “Defendants have clearly continued their scheme and brought it to Louisiana,” the complaint states.
     As for the doggy diapers: “The employee agreement also stated as ‘other considerations’ that each employee agreed to, inter alia donate $20 of their monthly pay to ‘Green Gables Artisan’s Co-op which will create two bellybands for dogs and donate them to kennels around the country.'”
     A footnote explains: “Notably, defendant Purr is a director of Green Gables Artisan’s Cooperative, Inc., a Florida corporation. ‘Belly Bands’ are essentially diapers for male dogs.”
     Pat’s says that when its workers sought medical treatment, the defendants refused to pay, under the pretext that they had not fulfilled their employment obligations.
     Pat’s says it alone paid more than $15,000 to defendants Datagen and Smart Services.
     Due to hospitalizations and other medical expenses never reimbursed by the defendants, some of the employees owe thousands of dollars in medical bills, according to the complaint.
     Here are the defendants: Datagen Inc., Gallagher Health Studies Inc., Inspired by Coconut Inc., Sentinel Administrators Inc., Smart Services Inc., Micheal Purr, Marlin Dixon, Grant Lockhart, John V. Head, John Micalizio, and Strategic Benefit Alliance Inc.
     The plaintiffs seek treble damages for breach of contract, fraud, negligence, detrimental reliance, unfair trade and RICO conspiracy.
     They are represented by Tim Hartdegen with Hymel Davis of Baton Rouge.
     According to the complaint:
     Defendant Datagen is based in Tucker, Ga.; Gallagher Health Studies and Inspired by Coconut in Jacksonville, Fla.; Smart Services in Atlanta, “However, Smart Services, Inc. is not registered in Georgia, and upon information and belief it has no registered agent and no officers of whom to speak;” Strategic Benefit Alliance in Boynton Beach, Fla.; Sentinel Administrators in Las Vegas, Nev.
     Defendant Michael Purr, of Atlanta, is administrator of Datagen; Marlin Brett Dixon, of Georgia, is CEO and CFO of Datagen; Grant Lockhart, of Jacksonville, Fla., “is Gallagher’s registered agent and sole officer;” John V. Head, of Orlando, Fla., “is the incorporator of Gallagher;” and John Micalizio, of Florida, “is the sole officer of Strategic Benefit Alliance.”

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