Gov’t Emps. Ins. Co. v. Koppel, No. 2:21-cv-03413-MEF-JRA, 2023 U.S. Dist. LEXIS 151531, (D.N.J. Aug. 28, 2023)

The insurance carrier brought a civil action against various medical providers, asserting an illegal kickback scheme in connection to New Jersey Personal Injury Protection (PIP) benefits.

The insurance carrier sought copies of the defendants’ criminal and investigative records from the New Jersey Office of the Insurance Fraud Prosecutor (OIFP). The defendants filed a motion to quash the subpoena, asserting the evidence was irrelevant and privileged.

The court rejected the defendants’ arguments that the records were privileged because N.J.A.C. 13:88-2.10 only prohibits disclosure of Medicaid fraud records sought pursuant to the Open Records Act. Additionally, the court found that the insurance carrier was allowed the records pursuant to the New Jersey Insurance Fraud Prevention Act (IFPA), holding that this privilege is only held by the insurance commissioner and not a medical provider. Since the Insurance Commissioner did not seek to quash the motion, the court ordered the records disclosed.

This case highlights one of the underutilized tools under the IFPA for insurance carriers, the ability to seek investigatory records complied by the OIFP to help assist an insurance carrier’s fraud claims in New Jersey.