No-Fault RICO Defense

RICO, the federal Racketeer Influenced and Corrupt Organizations Act, makes it unlawful to conduct the affairs of an enterprise affecting interstate or foreign commerce through a pattern of racketeering activity, which includes mail and wire fraud. A person injured in business or property by reason of a violation can sue for three times its damages. No-fault insurers use that civil remedy to sue providers and the people they say control them, alleging that bills sent by mail or electronically were fraudulent.

If it proves its RICO claim, three times the damages it sustained, plus the cost of the suit including a reasonable attorney’s fee (18 U.S.C. 1964(c)). Insurers usually add state-law claims such as fraud and unjust enrichment, and ask the court to declare that they owe nothing on pending unpaid bills. What a court actually awards depends on what the insurer proves.

As soon as you are served, and earlier if you learn a complaint has been filed. The summons states the deadline to respond, and the complaint usually affects arbitrations and collection suits you already have pending against that insurer. A run of EUO requests or eligibility denials from one insurer can come before a lawsuit; that is a good time to review the practice’s records with counsel.

A civil RICO lawsuit is brought by a private party, here an insurer, seeking money damages and court orders; the defendant answers it like any federal civil case. A criminal RICO case is brought by federal prosecutors through an indictment and can lead to criminal penalties. The same statute defines the conduct, but the process, the stakes and the lawyers needed are different. This page covers civil suits.

A civil complaint does not suspend a licence; licensing consequences come from the licensing authorities. But the insurer will usually refuse to pay pending bills and may ask the court to pause your collection suits and arbitrations against it. New bills remain subject to the usual timing, verification and fee-schedule rules. Decide with counsel how to handle new bills to that insurer while the case is pending.

Under 1962(c): an enterprise affecting interstate or foreign commerce; that the defendant conducted or participated in its affairs; through a pattern of racketeering activity, such as mail or wire fraud. Two predicate acts within ten years are the minimum, not enough alone: they must be related and show continuity (H.J. Inc. v. Northwestern Bell, 1989). The insurer must also show injury to its business or property by reason of the violation. Conspiracy under 1962(d) requires an agreement.

There is no standard length. The stages are: the complaint and your response, often a motion to dismiss; motions about pending collection suits and arbitrations; discovery of records, testimony and claim data; summary judgment motions; then settlement or trial. Each stage has its own deadlines set by the rules and the court.

The statute reaches any person employed by or associated with the enterprise who conducts or participates in its affairs through the pattern, and anyone who conspires to do so. Complaints often name the professional corporations, the licensed owners, people the insurer says actually control them, and unnamed defendants. Being named is an allegation, not a finding.

It can ask, and federal courts have granted such requests on the records before them. In GEICO v. Patel, decided February 3, 2026, the Second Circuit affirmed a preliminary injunction that stayed a provider’s pending state collection suits and barred new ones until GEICO’s RICO claims were decided, following its 2024 Tri-Borough decision. Whether a stay is granted depends on the facts and the court’s findings.