Preview
FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 04/12/2024
EXHIBIT D
FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024
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UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF NEW YORK
Roosevelt Road Re, Ltd.,
Tradesman Program Managers, LLC,
Plaintiffs,
v.
John Hajjar, MD, Case No.
Surgicare, LLC,
Surgicare of Manhattan, LLC,
Surgicare of Westside, LLC,
Surgicare, PC, PLAINTIFFS DEMAND
Boro Ventures, LLC, TRIAL BY JURY
Sovereign Medical Group, LLC,
Sovereign Management, LLC,
Regent Medical Properties, LLC,
Anthony DeGradi,
Wayne Hatami,
Feliks Kogan,
Leonid Tylman,
Gregg Rock,
Siddhartha Sharma, MD,
Surgicore, LLC,
Surgicore Management, Inc.,
Surgicore Management, LLC,
Surgicore 5th Avenue, LLC,
KTHD Investment, LLC,
NY Ortho Sports Medicine & Trauma, PC,
Jeffrey Stone Kaplan, MD,
Matthew P. Grimm, MD,
Adrian Puia, RPT,
Joseph Weinstein DO, PC,
Joseph Weinstein, DO,
University Orthopedics of New York, PLLC,
Steven John Touliopoulos, MD,
Charles A. DeMarco, MD,
Andrew M. Cruz, RPA,
Andrew Merola, MD,
Kolb Radiology, PC,
Thomas M. Kolb, MD,
Lenox Hill Radiology and Medical Imaging Associates, PC,
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Fogelgaren Forman & Bergman, LLP,
Eric Fogelgaren,
Jonathan Forman,
Robert Bergman,
Gorayeb & Associates, PC,
Christopher J. Gorayeb,
Francisco Payano,
Sisa Pakari Cultural Center Inc.,
Sisa Pakari Centro Cultural & Laboral, Inc.,
Fanny Guadalupe,
Rolando Manzano Moreno,
Cidel del Carmen Tandoza Moreno,
Defendants.
PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND
TRADESMAN PROGRAM MANAGERS, LLC’S
ORIGINAL COMPLAINT
NOW COME PLAINTIFFS ROOSEVELT ROAD RE, LTD. (hereinafter referred to as
“Roosevelt”) and TRADESMAN PROGRAM MANAGERS, LLC (hereinafter referred to as
“Tradesman”) (hereinafter referred collectively to as “Plaintiffs”) by and through their attorneys
The Willis Law Group, LLC, allege as follows:
I.
NATURE OF THE ACTION
1. Roosevelt is a foreign Bermuda-based limited company which sues herein in its
capacity as reinsurer which underwrites policies and pertinently provides reinsurance that covers
the claims at issue sufficient to constitute a party directly and ultimately damaged by the
racketeering enterprises set forth herein.
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2. Tradesman is a limited liability company established in and resident of New York,
which sues herein as its own capacity and as managing general agent to Roosevelt, and tertiarily
in similar capacity with respect to Accredited Surety and Casualty Company, Inc. (hereinafter
referred to as “Accredited”), pursuant to its contractual authority and fiduciary obligation to bind,
issue and collect premiums on policies as well as manage all aspects of claims allegedly arising
under any such policy.
3. This action seeks to recover money fraudulently obtained and sought to be obtained
from Roosevelt and from costs incurred by Tradesman to identify and counteract Defendants’1
fraudulent enterprises, as well as significant damage to Tradesman’s business itself, through
systematic exploitation of the New York State Workers’ Compensation system, via submission of
bills and purported supporting documentation by physical or electronic mail pertaining to alleged
workplace accidents and purported medical treatment thereafter, patterns of alleged injury and
treatment that were ultimately designed to result in windfall tort claims alleging violations of
sections 240 and 241 of New York’s Labor Law. This pattern defines the overarching enterprise
scheme (hereinafter referred to as “Overarching Enterprise”) at issue herein, which ultimately
encompasses considerably more than the four specific claims identified and addressed herein.
1
Hereinafter the following are referred collectively to as “Defendants”: John Hajjar, MD, Surgicare, LLC,
Surgicare of Manhattan, LLC, Surgicare of Westside, LLC, Surgicare, PC, Boro Ventures, LLC, Sovereign Medical
Group, LLC, Sovereign Management, LLC, Regent Medical Properties, LLC, Anthony DeGradi, Wayne Hatami,
Feliks Kogan, Leonid Tylman, Gregg Rock, Siddhartha Sharma, MD, Surgicore, LLC, Surgicore Management, Inc.,
Surgicore Management, LLC, Surgicore 5th Avenue LLC, KTHD Investment, LLC, NY Ortho Sports Medicine &
Trauma, PC, Jeffrey Stone Kaplan, MD, Matthew P. Grimm, MD, Adrian Puia, RPT, Joseph Weinstein, DO, PC,
Joseph Weinstein, DO, University Orthopedics of New York, PLLC, Steven John Touliopoulos, MD, Charles A.
DeMarco, MD, Andrew M. Cruz, RPA, Andrew Merola, MD, Kolb Radiology, PC, Thomas M. Kolb, MD, Lenox Hill
Radiology and Medical Imaging Associates, PC, Fogelgaren Forman & Bergman, LLP, Eric Fogelgaren, Jonathan
Forman, Robert Bergman, Gorayeb & Associates, PC, Christopher J. Gorayeb, Francisco Payano, Sisa Pakari Cultural
Center Inc., Sisa Pakari Centro Cultural & Laboral, Inc., Fanny Guadalupe, Rolando Manzano Moreno, Cidel del
Carmen Tandoza Moreno
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4. As set forth by the Affidavits of Joyce deCastro, attached hereto as Exhibits A-1,
A-2, A-3, and A-4, and incorporated herein by reference, submission of said bills via electronic
means has further already resulted in payments being issued via the United States Postal Service
and/or electronically utilizing the Automated Clearing House (ACH) via Electronic Funds Transfer
(EFT) as set forth by Exhibits B-1, B-2, B-3, and B-4, attached hereto and incorporated herein by
reference.
5. The associations in fact are not entirely congruent across claims, and each claim set
forth herein constitutes its own distinct enterprise (hereinafter referred to as “Claimant Enterprise”)
for purposes of the Racketeer Influenced and Corrupt Organizations Act, maximized to benefit the
aforementioned Defendants individually and collectively by establishing the claim and
implementation of the fraudulent protocol for each claimant and thereafter receiving payments
irrespective of the claimant’s actual medical condition or lack thereof.
6. However, the claimants (hereinafter referred to as “Enterprise Claimants” or
“Claimants”) are not named as Defendants herein as – in marked contrast to the enterprises’
participants – there is no verifiable indication that any claimant has in fact exerted any control over
their putative claims, much less the requisite “some part in directing the enterprise’s affairs.” Reves
v. Ernst & Young, 507 U.S.170, 179 (1993).
7. Specifically, Plaintiffs possess the founded belief that the Claimants and others
similarly situated are targeted in part due to their lack of sufficient proficiency in the English
language and correlating reliance upon those who prey upon them, including but not limited to
Defendants identified herein and those not yet named.
8. The claims at issue arise from largely unwitnessed, and in many cases belatedly
reported, alleged incidents in which the Claimants either were treated and released from emergency
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care facilities with minor complaints or where they did not actually proceed to hospitals proximate
to the alleged date of incident.
9. The Claimants themselves are uniformly foreign-born individuals who may have
obtained fraudulent identification documents, and who typically utilize multiple names or
variations thereof and/or addresses in the course of their employment, claim filing, and alleged
treatment.
10. This calculated pattern is intended to deprive Tradesman and the various entities
for which it provides essential services of the ability to timely locate and surveil the claimants
prior to the implementation of fraudulent treatment protocols that are designed to mimic legitimate
courses of treatment. When Tradesman has been able to do so, the surveillance video has stood in
sharp opposition to the claimed injuries and treatment.
11. The Fraudulent Treatment Protocol involves:
a. initial examinations that are not legitimately performed to determine the
true nature and extent of patient injuries, but rather are performed, if at all, as a pretext to
report substantially similar, and in some instances nearly identical, examination findings
to justify a variety of unnecessary treatment and services;
b. prematurely obtained radiographic imaging, whose reports are used to
retroactively justify the allegation that any and all listed positive findings resulted from
the alleged incident, after which the alleged treatment will facially relate to same;
c. a treatment plan of purported conservative care that consists entirely of
billing and treatment notes that vaguely assert that the treatment is more than passive
palliative care in nature, but which upon scrutiny fail to identify either any alleged
therapeutic exercises or set forth the specific body part(s) allegedly being so treated;
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d. alleged evaluations that use the pretextual alleged failure of conservative
treatment to justify medically unnecessary injections and surgeries, which are
overwhelmingly purportedly performed at certain ambulatory surgery centers which
thereby routinely collect immense amounts of money in the form of facility fees
authorized by the New York State Workers’ Compensation Medical Fee Schedule, which
was designed to reimburse facilities for necessary procedures;
e. submitting documents to Tradesman – and more importantly to the New
York State Workers’ Compensation Board – falsely representing that the examinations,
treatment, tests, injections, and surgeries purportedly rendered were medically necessary
when, in fact, they were either not performed or were performed to exploit the Claimants’
compensation claims and thereafter result in a windfall to their tort attorneys.
12. The Fraudulent Treatment Protocol was rendered by an immense network of
providers, including:
a. ambulatory surgery centers – John Hajjar, MD and his “Surgicare”
network, Anthony DeGradi, Wayne Hatami, Feliks Kogan, and Leonid Tylman, along with
Gregg Rock, in their “Surgicore” ring, as well as through complex series of limited
liability companies purporting to provide realty, management, anesthesia and other
services as set forth below;
b. medical doctors individually and as putative owners of their professional
corporations, who submit alleged evaluations and re-evaluations uniformly
recommending injections and surgeries to benefit other parties to the fraud rather than
being medically necessary – Jeffrey Stone Kaplan, MD, individually and as owner of NY
Ortho Sports Medicine &Trauma PC (“NY Ortho”), Matthew P. Grimm, MD of NY Ortho,
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Steven John Touliopoulos, MD individually and as owner of University Orthopedics of
New York, PLLC (“University Orthopedics”), Joseph Weinstein, DO, individually and as
owner of Joseph Weinstein, DO, PC, d/b/a Comprehensive Orthopedic & Spine Care
(“Weinstein”), Charles A. DeMarco, MD, and Andrew M. Cruz, RPA, of University
Orthopedics, and Andrew Merola, MD, along with the other physicians and healthcare
providers who purportedly performed services in furtherance of the scheme as employees
of the foregoing;
c. physical therapists working for the medical doctor defendants – most
notably Adrian Puia, RPT of NY Ortho;
d. diagnostic facilities who provided various services including purported
MRIs, EMG/NCV and/or laboratory testing – Thomas M. Kolb, individually and as owner
of Kolb Radiology, PC, and Lenox Hill Radiology and Medical Imaging Associates, PC.
13. Defendants’ scheme began at some point prior to 2018 and has continued
uninterrupted since that time.
14. Due to Defendants’ overarching scheme, Roosevelt has progressively incurred
general liability claim adjustment expenses rising from $14,020,890.00 in 2018 to $36,362,147.00
in 2019, to $58,694,694.00 in 2020, to $91,334,395.00 in 2021 and $142,127,559.00 in 2022.
15. Between 2021 and 2022 alone, Roosevelt’s net outstanding liability under general
liability reinsurance increased from $81,267,474.00 to $119,069,641.00, an increase of nearly 47%
notwithstanding the COVID-19 pandemic during 2020, which led to the single largest one-year
decline for the construction industry in New York City since 1990. See Office of the New York
State Comptroller, “The Construction Industry in New York City: Recent Trends and Impact of
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COVID-19,” March 3, 2022, at 3. See https://www.osc.ny.gov/files/reports/osdc/ pdf/report-3-
2021.pdf, incorporated herein by reference, last accessed February 15, 2024.
16. The drastically escalating cost of construction-related claims in both the Workers’
Compensation and general liability areas stands in marked contrast to the overall decreasing
number of workplace accidents, which in New York City reportedly decreased from 759 in 2018
to 554 in 2022. See e.g., “2022 New York City Construction Safety Report,” at
https://www.nyc.gov/assets/buildings/pdf/con_safe_2022.pdf, incorporated herein by reference,
last accessed February 15, 2024.
17. As a result of this scheme, Tradesman has incurred damages of more than $1 million
and the loss of substantial business when one of its significant general liability carrier clients,
Accredited, ceased to write insurance policies in the State of New York due to the cumulative toll
taken by this fraudulent pattern. Tradesman has therefore suffered significant injury to its property
in the form of moneys paid on as part of the fraudulent scheme, and further to its business, due to
the cessation of insurance carrier(s) writing Workers’ Compensation and/or general liability
policies in the State of New York, thereby rendering it impracticable for Tradesman to continue
providing the services to which it was contracted but for the fraudulent scheme at issue herein.
18. Tradesman was subsequently forced to stop binding Workers’ Compensation
policies, since when workers’ compensation claims exceed the amount of premium paid, the
insurer pays the excess amount. As the fraudulent enterprises are designed to maximize payments
to allegedly injured workers, the claims routinely exceed the amounts of premiums paid, and the
insurer with whom it worked elected to remove itself from the market rather than incurring costs
far above the amounts gained by writing the policies.
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19. Tradesman did not have any notice of the existence, much less the overarching
nature of the fraudulent pattern of claims and treatment until 2020, roughly 18 months after
Workers’ Compensation Board hearings began to be conducted virtually. Tradesman identified its
overall Workers’ Compensation payouts increasing exponentially, followed in turn by a significant
increase in tort claims alleging various workplace-related ‘violations’ as the cause of purported
injury, with attendant ramifications for exposure by reinsurers, including but not limited to
Roosevelt.
20. As a reinsurer, Roosevelt “is not responsible for providing a defense, for
investigating the claim or for attempting to get control of the claim in order to effect an early
settlement [which] are the sole responsibility of the primary insurer”. Unigard Sec. Ins. Co. v.
North River Ins. Co., 79 N.Y.2d 576, 583 (1992).
21. Accordingly, Roosevelt had no notice of fraudulent activity until Tradesman
identified the potential pattern and began its review and investigation in late 2020. However, due
to potential statistical anomalies stemming from the COVID-19 pandemic, necessary data could
not begin to be adequately compiled and analyzed until the third quarter of 2022.
22. In addition to the healthcare providers who are inextricably involved in the
enterprises herein, further Defendants consist of law firms and their attorneys who are materially
intertwined with the defendant healthcare providers’ alleged treatment and diagnoses, and
thereafter actively prosecute the fraudulent claims before the Workers’ Compensation Board and/or
through the filing of multimillion-dollar tort claims that effectively utilize the alleged care and
treatment obtained and paid for to construct facially viable tort claims with windfall recoveries.
23. Upon information and belief, for at least the past 10 years, Defendant law firm
Gorayeb & Associates, PC (hereinafter referred to as “Gorayeb PC”) has been specifically utilizing
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OSHA training courses to preemptively and unlawfully solicit new clients in violation of
applicable New York regulations, specifically 22 N.Y.C.R.R. § 1200 Rule 7.3.
24. Gorayeb PC has done so under the guise of its sponsorship and partnership with
Defendant Fanny Guadalupe (“Guadalupe”) and her organizations, Defendant Sisa Pakari Cultural
Center, Inc. and Sisa Pakari Centro Cultural & Laboral, Inc. (hereinafter referred collectively to as
“Sisa Pakari”). These ostensibly non-profit entities, have conducted Gorayeb-sponsored Spanish-
language OSHA courses and thereby created the pipeline necessary for the overall enterprise and
each individual enterprise to exist and continue by effectively directing how the claims are reported
and the course of alleged care and treatment.
25. The courses of treatment directed by these entities are done not for the benefit of
the claimants, but to maximize recoveries by the Defendants herein, both individually and
collectively.
26. While all claims herein and others similarly undertaken reflect an overarching
scheme, each claim constitutes a separate and independent union of individuals and entities
associated in fact to improperly profit off of that specific alleged claim, sufficient to constitute an
independent enterprise.
27. Every individual enterprise is ongoing and has remained continuous over a
substantial period. The commonality of the predicate acts, the fraudulent treatment protocols, and
racketeering activity underscores the clear and present threat of repetition.
28. The remaining Defendants are limited liability companies and other incorporated
entities owned and/or controlled by Defendants who are actively furthering these enterprises and
the overarching scheme, and represent additional property obtained through the fraudulent activity
herein.
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29. Defendants herein have not only preyed upon the claimants in order to carry out
these enterprises but have specifically exploited favorable New York State laws to benefit
Defendants in New York and New Jersey.
30. As a matter of public knowledge, New York State’s Workers’ Compensation Law
“was designed to provide a swift and sure source of benefits to the injured employee or to the
dependents of the deceased employee” in return for “the loss of the common-law tort action in
which greater benefits might be obtained.” Liberty Mut. Ins. Co. v. Hurlbut, 585 F.3d 639, 641 (2d
Cir. 2009) (quoting O’Rourke v. Long, 41 N.Y.2d 219, 222 (1976)).
31. In order to ensure that workers would receive treatment, the New York State
legislature established the presumption that, in the context of any Workers’ Compensation claim,
unless a carrier could demonstrate substantial evidence to the contrary, inter alia “[t]he claim
comes within the provision of this chapter” and “[t]hat sufficient notice thereof was given”. New
York Workers’ Compensation Law § 21, subsections 1 and 2, respectively.
32. In turn, “[w]ith respect to a board determination that a particular injury was or was
not sustained in the course of employment, the judicial appellate function is limited.” O’Rourke,
supra, at 227.
33. Given the strong presumption in favor of claims, “[i]t has been estimated that more
than 90% of employee claims for benefits under the standards provided by the WCL are paid
without contest.” Hurlbut, supra, at 642 (citing Martin Minkowitz, New York Practice Series: New
York Workers’ Compensation § 15:1, at 594 (2003)).
34. As Defendant Gorayeb PC’s unlicensed investigator Francisco Payano (hereinafter
referred to as “Payano”) informed a Sisa Pakari class meant to receive OSHA training, on
December 4, 2022, following an alleged incident at the job site, “if you go in an ambulance, the
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boss cannot deny that the accident happened on the job ….[f]rom the moment that ambulance
arrives at compensation, right away that will get approved in a couple of months.” Exhibit D-1,
December 4, 2022 OHSA class, Transcription, English Translation, at p. 3, attached hereto and
incorporated herein by reference.
35. As noted, however, “an adjudication by the board that there was a relationship
between accident and employment, unless reversed on a direct appeal, would preclude any
recovery in a civil action against the employer.” O’Rourke, supra, at 227.
36. As set forth infra, the grooming phase of the enterprises relies heavily on the fact
that the Workers’ Compensation claim provides the means of facially establishing causality and
facially developing a treatment record, its barrier against tort claims has been fatally eroded with
respect to construction workers.
37. As Defendant Gorayeb PC’s unlicensed investigator Payano informed a Sisa Pakari
class meant to receive OSHA training, on December 4, 2022, “[c]onstruction workers are the only
workers, 99% of the time, they are the only ones that can, let’s say, have a lawsuit at the time of
the accident, okay? Why? Because construction workers can sue the owner of the building and the
general contractor, okay?” Exhibit D-1, December 4, 2022 OHSA class, Transcription, English
Translation, at p. 7, attached hereto and incorporated herein by reference.
38. In all four enterprises detailed herein and in the additional claims demonstrating the
same pattern, Gorayeb PC alleged violations of sections 200, 240(1) and 241(6) of New York
State’s Labor Law, amplified by Bills of Particulars that tied these statutory sections with alleged
violations of the Industrial Code as well as OSHA regulations. 29 C.F.R. § 1926 et seq.
39. More specifically, as Payano explained to students on December 4, 2022, “why do
construction workers have lawsuits? Because labor laws were violated when the accident
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happened.” Exhibit D-1, December 4, 2022 OHSA class, Transcription, English Translation, at 8,
attached hereto and incorporated herein by reference.
40. After detailing how to document alleged scaffolding and ladder claims –
distinguishing those from hallway or stair slip and falls where photographs are to be taken – Payano
explained the remaining category, namely that “[f]or a lawsuit there must be fall, some material
falling on the parson’s head or on another body part, that is a lawsuit.” Id. at 8-9.
41. The particularly useful legal principle to which Payano was referring was “Labor
Law § 240(1), often called the “scaffold law,” [which] governs “elevation-related safety
measures,” and imposes a statutory duty on owners, contractors, and their agents to make safety
devices that provide “proper protection” available to their workers.” Hernandez v. GPSDC (New
York) Inc., 2006 U.S. Dist. LEXIS 9172 at 26 (S.D.N.Y. March 9, 2006).
42. While the scaffold law was originally established to protect workers engaged in
activity rendered particularly dangerous due to significant height differential, New York courts
have “[t]here is no bright-line minimum height differential that determines whether an elevation
hazard exists.” Thompson v St. Charles Condominiums, 303 A.D.2d 152, 154 (1st Dept. 2003), lv.
dismissed, 100 N.Y.2d 556 (2003).
43. As importantly, “[t]he failure to provide a safety device is a per se violation of the
statute for which an owner/contractor is strictly liable.” Auriemma v. Biltmore Theatre, LLC, 82
A.D.3d 1, 4 (1st Dept. 2011) (citing Zimmer v. Chemung Co. Performing Arts, 65 N.Y.2d 513, 523-
524 (1985)).
44. Accordingly, each enterprise herein, further claims demonstrating the same pattern,
and countless others are most easily predicated on pre-identifying claimants whose Workers’
Compensation claims can be managed to maximize payments to providers and ambulatory surgery
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centers in the short term, even as the claims are crafted to fall into what amount to strict liability
‘violations’ to be asserted against general contractors and building owners in order to reap
windfalls for all attorneys involved in the ensuing tort actions.
45. Submission of the Workers’ Compensation claim documents – which is done
electronically per directive of the New York State Workers’ Compensation Board – are intended to
and do result in payments issued by mail and/or by EFT transfer utilizing the federal ACH, and
therefore constitute predicate acts of willful fraud from which each enterprise proximately derives.
46. By Congressional intent, “proximate cause “is generous enough to include the
unintended, though foreseeable, consequences of RICO predicate acts,” including, in some
instances, harms that flow from, or are derivative of, each other. Diaz, 420 F.3d at 901 (citing
Palsgraf v. Long Island R.R. Co., 248 N.Y. 339, 342-47 (1928) (Cardozo, C.J.).” Horn v. Med.
Marijuana, 80 F.4th 130, 138 (2nd Cir. 2023), italicization in the original).
47. Some of the categories of damages are documented by Exhibits A-1, A-2, A-3, and
A-4, coupled with Exhibits B-1, B-2, B-3, and B-4 attached hereto and incorporated herein by
reference, being the respective Workers’ Compensation payments and costs incurred to identify
and respond to the fraudulent activities detailed herein. The remaining damage to which Roosevelt
is exposed in the general liability context is calculated by reference to application of New York
State Verdicts and Settlements data to the alleged claims herein, specifically the Labor Law and
Industrial Code sections allegedly violated, correlated with the injections and surgeries allegedly
underwent as putative result of the claims, the exact amount to be determined at trial.
48. With respect to damages in the general liability litigation settlement context, the
injections and surgeries performed are conservatively calculated to average $1.5 million on the
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low settlement side with the median settlement calculated to average $2 million per claim, the
exact amount to be determined at trial.
49. While Labor Law actions like these do not typically reach a jury verdict for reasons
set forth herein, the average such exposure for these claims and others facially similar in terms of
alleged treatment, injections and surgery has been calculated to average $5 million per claim, with
potential upward modifiers not presently calculable as they would necessarily be atypical in
reaching that stage in the normal course of litigation.
II.
JURISDICTION AND VENUE
50. Pursuant to 28 U.S.C. § 1331, this Court has jurisdiction over the claims brought
under 18 U.S.C. § 1961 et seq. (“RICO”) because they arise under the laws of the United States.
51. Pursuant to 28 U.S.C. § 1367, this Court also has supplemental jurisdiction over
the state law claims because they are so related to the RICO claims as to form part of the same
case and controversy, in this case each enterprise deriving from the predicate acts from which this
action is derived.
52. 18 U.S.C. § 1965(a), this Court has jurisdiction since more than one Defendant
“resides, is found, has an agent, or transacts business” in this district, and substantial events took
place within this district.
53. Pursuant to 28 U.S.C. § 1391(b)(2), venue is proper in this district since a
substantial part of the events giving rise to this action occurred within this district.
54. Pursuant to 28 U.S.C. § 1391(b)(3), venue is further proper in this district since a
plurality of Defendants are known to reside in this district, and specifically in that key Defendants
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in the form of Surgicore entities’ owners Anthony DeGradi and Wayne Hatami, as well as Regina
Moshe, titular owner of the CitiMed entities, maintain residences on Long Island proximately
located near this court. As set forth below, additional defendants own real property or maintain
places of business within the Counties of Nassau and/or Suffolk, New York.
55. The remainder of Defendants are located in multiple states, including New York,
New Jersey, and Florida. The ends of justice are therefore best met by maintaining this action
where a plurality of key defendants reside, which is further where a substantial part of the events at
issue have occurred and continue.
III.
PARTIES
A. Plaintiffs
56. Tradesman is a limited liability company organized and principally located in the
State of New York.
57. Tradesman’s primary business is to serve as a management general agency that
provides specialized management services that pertinently include general liability and workers’
compensation services from underwriting through claims handling and subsequent administrative
and legal actions.
58. Tradesman specifically focuses on safety management and effective claims
handling with respect to clients within the construction industry, encompassing in different
respects Workers’ Compensation claims and general liability claims.
59. As stated supra and expanded upon below with respect to the enterprises set forth
herein, Tradesman has been materially damaged in excess of $1,000,000 (one million dollars) as
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the result of Defendants’ pattern of racketeering, specifically the result of payments it has issued,
see, e.g. Exhibits A-1, A-2, A-3, and A-4, coupled with Exhibits B-1, B-2, B-3, and B-4hereto and
incorporated by reference, as a direct result of the tides of fraudulent billing submitted by
Defendants via mail and/or electronic means to the New York State Workers’ Compensation Board
as well as to Tradesman and its clients directly, and further by the fraud-prompted decision of its
long-time client Accredited, for whom it brings this suit as managing general agent, to cease
issuing general liability insurance policies in the State of New York, thereby causing direct and
irreparable harm to its business through the loss of income in an amount exceeding $1,000,000.00
to be determined at trial.
56. In its capacity as managing general agent, Tradesman is authorized and obligated
to bring this action pursuant to its contractual obligations following its discovery of a series of
fraudulent claims, including the four enterprises detailed herein, on behalf of Roosevelt, a foreign
limited company which is ultimately the damaged party in interest as the reinsuring entity liable
to remit payment on claims herein.
57. As set forth herein, Tradesman, individually and on behalf of Roosevelt,
demonstrates an injury in fact both actual and imminent, a causal connection between the injury
and conduct set forth, and the likelihood that a favorable decision will redress both actual and
imminent injuries.
58. Roosevelt is a foreign-based limited company which sues herein in its capacity as
reinsurer which underwrites policies and pertinently provides reinsurance that covers the claims at
issue sufficient to constitute a party directly and ultimately damaged by the racketeering
enterprises set forth herein as stated in the section designated Nature of Action supra.
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59. As New York State’s highest court has explained, “In a treaty reinsurance
relationship, there is “1) no individual risk scrutiny by the reinsurer, 2) obligatory acceptance by
the reinsurer of covered business, and 3) a long-term relationship in which the reinsurer’s
profitability is expected, but measured and adjusted over an extended period of time”. Mich. Nat’l
Bank-Oakland, 89 N.Y.2d 94, 106 (1996)(quoting Clark, Facultative Reinsurance: Reinsuring
Individual Policies, reprinted in Reinsurance, at 121 [Strain ed. 1980]).
60. Due to the ongoing and pervasive nature of Defendant’s enterprises set forth herein
and overall pattern of fraudulent activity, Roosevelt has been compelled to engage in overall risk
scrutiny in order to protect the profitability it reasonably expected but for Defendants’ activities.
B. Defendants
1. The Ambulatory Surgery Center Defendants
a. The Surgicare Enterprise.
61. John Hajjar, MD (hereinafter referred to as “Hajjar”) is a physician licensed to
practice in the State of New Jersey. Hajjar profited from fraudulent services allegedly performed
on patients at various Ambulatory Surgery Center facilities owned directly or indirectly by him,
including SCOB, LLC a/k/a “Surgicare Center of Brooklyn”, Surgicare of Westside, LLC a/k/a
“SOW”, and Surgicare of Manhattan, LLC a/k/a “SOM”.
62. Dr. Hajjar has utilized a series of limited liability companies through which to
control his various enterprises, including Boro Ventures LLC, which is the titular controlling owner
of SCOB, LLC, yet has been defunct since 2020.
63. Dr. Hajjar is also owner of Sovereign Medical Services, Inc. (hereinafter referred
to as “Sovereign” a/k/a Sovereign Health System) and Regent Medical Properties (hereinafter
referred to as “Regent”), as well as a myriad of specialized limited liability companies that were
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FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 04/12/2024 EXHIBIT D FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 1 ofRECEIVED 99 PageID #: 234304/12/2024 NYSCEF: UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF NEW YORK Roosevelt Road Re, Ltd., Tradesman Program Managers, LLC, Plaintiffs, v. John Hajjar, MD, Case No. Surgicare, LLC, Surgicare of Manhattan, LLC, Surgicare of Westside, LLC, Surgicare, PC, PLAINTIFFS DEMAND Boro Ventures, LLC, TRIAL BY JURY Sovereign Medical Group, LLC, Sovereign Management, LLC, Regent Medical Properties, LLC, Anthony DeGradi, Wayne Hatami, Feliks Kogan, Leonid Tylman, Gregg Rock, Siddhartha Sharma, MD, Surgicore, LLC, Surgicore Management, Inc., Surgicore Management, LLC, Surgicore 5th Avenue, LLC, KTHD Investment, LLC, NY Ortho Sports Medicine & Trauma, PC, Jeffrey Stone Kaplan, MD, Matthew P. Grimm, MD, Adrian Puia, RPT, Joseph Weinstein DO, PC, Joseph Weinstein, DO, University Orthopedics of New York, PLLC, Steven John Touliopoulos, MD, Charles A. DeMarco, MD, Andrew M. Cruz, RPA, Andrew Merola, MD, Kolb Radiology, PC, Thomas M. Kolb, MD, Lenox Hill Radiology and Medical Imaging Associates, PC, PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 1 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 2 ofRECEIVED 99 PageID #: 234404/12/2024 NYSCEF: Fogelgaren Forman & Bergman, LLP, Eric Fogelgaren, Jonathan Forman, Robert Bergman, Gorayeb & Associates, PC, Christopher J. Gorayeb, Francisco Payano, Sisa Pakari Cultural Center Inc., Sisa Pakari Centro Cultural & Laboral, Inc., Fanny Guadalupe, Rolando Manzano Moreno, Cidel del Carmen Tandoza Moreno, Defendants. PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT NOW COME PLAINTIFFS ROOSEVELT ROAD RE, LTD. (hereinafter referred to as “Roosevelt”) and TRADESMAN PROGRAM MANAGERS, LLC (hereinafter referred to as “Tradesman”) (hereinafter referred collectively to as “Plaintiffs”) by and through their attorneys The Willis Law Group, LLC, allege as follows: I. NATURE OF THE ACTION 1. Roosevelt is a foreign Bermuda-based limited company which sues herein in its capacity as reinsurer which underwrites policies and pertinently provides reinsurance that covers the claims at issue sufficient to constitute a party directly and ultimately damaged by the racketeering enterprises set forth herein. PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 2 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 3 ofRECEIVED 99 PageID #: 234504/12/2024 NYSCEF: 2. Tradesman is a limited liability company established in and resident of New York, which sues herein as its own capacity and as managing general agent to Roosevelt, and tertiarily in similar capacity with respect to Accredited Surety and Casualty Company, Inc. (hereinafter referred to as “Accredited”), pursuant to its contractual authority and fiduciary obligation to bind, issue and collect premiums on policies as well as manage all aspects of claims allegedly arising under any such policy. 3. This action seeks to recover money fraudulently obtained and sought to be obtained from Roosevelt and from costs incurred by Tradesman to identify and counteract Defendants’1 fraudulent enterprises, as well as significant damage to Tradesman’s business itself, through systematic exploitation of the New York State Workers’ Compensation system, via submission of bills and purported supporting documentation by physical or electronic mail pertaining to alleged workplace accidents and purported medical treatment thereafter, patterns of alleged injury and treatment that were ultimately designed to result in windfall tort claims alleging violations of sections 240 and 241 of New York’s Labor Law. This pattern defines the overarching enterprise scheme (hereinafter referred to as “Overarching Enterprise”) at issue herein, which ultimately encompasses considerably more than the four specific claims identified and addressed herein. 1 Hereinafter the following are referred collectively to as “Defendants”: John Hajjar, MD, Surgicare, LLC, Surgicare of Manhattan, LLC, Surgicare of Westside, LLC, Surgicare, PC, Boro Ventures, LLC, Sovereign Medical Group, LLC, Sovereign Management, LLC, Regent Medical Properties, LLC, Anthony DeGradi, Wayne Hatami, Feliks Kogan, Leonid Tylman, Gregg Rock, Siddhartha Sharma, MD, Surgicore, LLC, Surgicore Management, Inc., Surgicore Management, LLC, Surgicore 5th Avenue LLC, KTHD Investment, LLC, NY Ortho Sports Medicine & Trauma, PC, Jeffrey Stone Kaplan, MD, Matthew P. Grimm, MD, Adrian Puia, RPT, Joseph Weinstein, DO, PC, Joseph Weinstein, DO, University Orthopedics of New York, PLLC, Steven John Touliopoulos, MD, Charles A. DeMarco, MD, Andrew M. Cruz, RPA, Andrew Merola, MD, Kolb Radiology, PC, Thomas M. Kolb, MD, Lenox Hill Radiology and Medical Imaging Associates, PC, Fogelgaren Forman & Bergman, LLP, Eric Fogelgaren, Jonathan Forman, Robert Bergman, Gorayeb & Associates, PC, Christopher J. Gorayeb, Francisco Payano, Sisa Pakari Cultural Center Inc., Sisa Pakari Centro Cultural & Laboral, Inc., Fanny Guadalupe, Rolando Manzano Moreno, Cidel del Carmen Tandoza Moreno PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 3 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 4 ofRECEIVED 99 PageID #: 234604/12/2024 NYSCEF: 4. As set forth by the Affidavits of Joyce deCastro, attached hereto as Exhibits A-1, A-2, A-3, and A-4, and incorporated herein by reference, submission of said bills via electronic means has further already resulted in payments being issued via the United States Postal Service and/or electronically utilizing the Automated Clearing House (ACH) via Electronic Funds Transfer (EFT) as set forth by Exhibits B-1, B-2, B-3, and B-4, attached hereto and incorporated herein by reference. 5. The associations in fact are not entirely congruent across claims, and each claim set forth herein constitutes its own distinct enterprise (hereinafter referred to as “Claimant Enterprise”) for purposes of the Racketeer Influenced and Corrupt Organizations Act, maximized to benefit the aforementioned Defendants individually and collectively by establishing the claim and implementation of the fraudulent protocol for each claimant and thereafter receiving payments irrespective of the claimant’s actual medical condition or lack thereof. 6. However, the claimants (hereinafter referred to as “Enterprise Claimants” or “Claimants”) are not named as Defendants herein as – in marked contrast to the enterprises’ participants – there is no verifiable indication that any claimant has in fact exerted any control over their putative claims, much less the requisite “some part in directing the enterprise’s affairs.” Reves v. Ernst & Young, 507 U.S.170, 179 (1993). 7. Specifically, Plaintiffs possess the founded belief that the Claimants and others similarly situated are targeted in part due to their lack of sufficient proficiency in the English language and correlating reliance upon those who prey upon them, including but not limited to Defendants identified herein and those not yet named. 8. The claims at issue arise from largely unwitnessed, and in many cases belatedly reported, alleged incidents in which the Claimants either were treated and released from emergency PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 4 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 5 ofRECEIVED 99 PageID #: 234704/12/2024 NYSCEF: care facilities with minor complaints or where they did not actually proceed to hospitals proximate to the alleged date of incident. 9. The Claimants themselves are uniformly foreign-born individuals who may have obtained fraudulent identification documents, and who typically utilize multiple names or variations thereof and/or addresses in the course of their employment, claim filing, and alleged treatment. 10. This calculated pattern is intended to deprive Tradesman and the various entities for which it provides essential services of the ability to timely locate and surveil the claimants prior to the implementation of fraudulent treatment protocols that are designed to mimic legitimate courses of treatment. When Tradesman has been able to do so, the surveillance video has stood in sharp opposition to the claimed injuries and treatment. 11. The Fraudulent Treatment Protocol involves: a. initial examinations that are not legitimately performed to determine the true nature and extent of patient injuries, but rather are performed, if at all, as a pretext to report substantially similar, and in some instances nearly identical, examination findings to justify a variety of unnecessary treatment and services; b. prematurely obtained radiographic imaging, whose reports are used to retroactively justify the allegation that any and all listed positive findings resulted from the alleged incident, after which the alleged treatment will facially relate to same; c. a treatment plan of purported conservative care that consists entirely of billing and treatment notes that vaguely assert that the treatment is more than passive palliative care in nature, but which upon scrutiny fail to identify either any alleged therapeutic exercises or set forth the specific body part(s) allegedly being so treated; PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 5 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 6 ofRECEIVED 99 PageID #: 234804/12/2024 NYSCEF: d. alleged evaluations that use the pretextual alleged failure of conservative treatment to justify medically unnecessary injections and surgeries, which are overwhelmingly purportedly performed at certain ambulatory surgery centers which thereby routinely collect immense amounts of money in the form of facility fees authorized by the New York State Workers’ Compensation Medical Fee Schedule, which was designed to reimburse facilities for necessary procedures; e. submitting documents to Tradesman – and more importantly to the New York State Workers’ Compensation Board – falsely representing that the examinations, treatment, tests, injections, and surgeries purportedly rendered were medically necessary when, in fact, they were either not performed or were performed to exploit the Claimants’ compensation claims and thereafter result in a windfall to their tort attorneys. 12. The Fraudulent Treatment Protocol was rendered by an immense network of providers, including: a. ambulatory surgery centers – John Hajjar, MD and his “Surgicare” network, Anthony DeGradi, Wayne Hatami, Feliks Kogan, and Leonid Tylman, along with Gregg Rock, in their “Surgicore” ring, as well as through complex series of limited liability companies purporting to provide realty, management, anesthesia and other services as set forth below; b. medical doctors individually and as putative owners of their professional corporations, who submit alleged evaluations and re-evaluations uniformly recommending injections and surgeries to benefit other parties to the fraud rather than being medically necessary – Jeffrey Stone Kaplan, MD, individually and as owner of NY Ortho Sports Medicine &Trauma PC (“NY Ortho”), Matthew P. Grimm, MD of NY Ortho, PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 6 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 7 ofRECEIVED 99 PageID #: 234904/12/2024 NYSCEF: Steven John Touliopoulos, MD individually and as owner of University Orthopedics of New York, PLLC (“University Orthopedics”), Joseph Weinstein, DO, individually and as owner of Joseph Weinstein, DO, PC, d/b/a Comprehensive Orthopedic & Spine Care (“Weinstein”), Charles A. DeMarco, MD, and Andrew M. Cruz, RPA, of University Orthopedics, and Andrew Merola, MD, along with the other physicians and healthcare providers who purportedly performed services in furtherance of the scheme as employees of the foregoing; c. physical therapists working for the medical doctor defendants – most notably Adrian Puia, RPT of NY Ortho; d. diagnostic facilities who provided various services including purported MRIs, EMG/NCV and/or laboratory testing – Thomas M. Kolb, individually and as owner of Kolb Radiology, PC, and Lenox Hill Radiology and Medical Imaging Associates, PC. 13. Defendants’ scheme began at some point prior to 2018 and has continued uninterrupted since that time. 14. Due to Defendants’ overarching scheme, Roosevelt has progressively incurred general liability claim adjustment expenses rising from $14,020,890.00 in 2018 to $36,362,147.00 in 2019, to $58,694,694.00 in 2020, to $91,334,395.00 in 2021 and $142,127,559.00 in 2022. 15. Between 2021 and 2022 alone, Roosevelt’s net outstanding liability under general liability reinsurance increased from $81,267,474.00 to $119,069,641.00, an increase of nearly 47% notwithstanding the COVID-19 pandemic during 2020, which led to the single largest one-year decline for the construction industry in New York City since 1990. See Office of the New York State Comptroller, “The Construction Industry in New York City: Recent Trends and Impact of PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 7 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 8 ofRECEIVED 99 PageID #: 235004/12/2024 NYSCEF: COVID-19,” March 3, 2022, at 3. See https://www.osc.ny.gov/files/reports/osdc/ pdf/report-3- 2021.pdf, incorporated herein by reference, last accessed February 15, 2024. 16. The drastically escalating cost of construction-related claims in both the Workers’ Compensation and general liability areas stands in marked contrast to the overall decreasing number of workplace accidents, which in New York City reportedly decreased from 759 in 2018 to 554 in 2022. See e.g., “2022 New York City Construction Safety Report,” at https://www.nyc.gov/assets/buildings/pdf/con_safe_2022.pdf, incorporated herein by reference, last accessed February 15, 2024. 17. As a result of this scheme, Tradesman has incurred damages of more than $1 million and the loss of substantial business when one of its significant general liability carrier clients, Accredited, ceased to write insurance policies in the State of New York due to the cumulative toll taken by this fraudulent pattern. Tradesman has therefore suffered significant injury to its property in the form of moneys paid on as part of the fraudulent scheme, and further to its business, due to the cessation of insurance carrier(s) writing Workers’ Compensation and/or general liability policies in the State of New York, thereby rendering it impracticable for Tradesman to continue providing the services to which it was contracted but for the fraudulent scheme at issue herein. 18. Tradesman was subsequently forced to stop binding Workers’ Compensation policies, since when workers’ compensation claims exceed the amount of premium paid, the insurer pays the excess amount. As the fraudulent enterprises are designed to maximize payments to allegedly injured workers, the claims routinely exceed the amounts of premiums paid, and the insurer with whom it worked elected to remove itself from the market rather than incurring costs far above the amounts gained by writing the policies. PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 8 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 9 ofRECEIVED 99 PageID #: 235104/12/2024 NYSCEF: 19. Tradesman did not have any notice of the existence, much less the overarching nature of the fraudulent pattern of claims and treatment until 2020, roughly 18 months after Workers’ Compensation Board hearings began to be conducted virtually. Tradesman identified its overall Workers’ Compensation payouts increasing exponentially, followed in turn by a significant increase in tort claims alleging various workplace-related ‘violations’ as the cause of purported injury, with attendant ramifications for exposure by reinsurers, including but not limited to Roosevelt. 20. As a reinsurer, Roosevelt “is not responsible for providing a defense, for investigating the claim or for attempting to get control of the claim in order to effect an early settlement [which] are the sole responsibility of the primary insurer”. Unigard Sec. Ins. Co. v. North River Ins. Co., 79 N.Y.2d 576, 583 (1992). 21. Accordingly, Roosevelt had no notice of fraudulent activity until Tradesman identified the potential pattern and began its review and investigation in late 2020. However, due to potential statistical anomalies stemming from the COVID-19 pandemic, necessary data could not begin to be adequately compiled and analyzed until the third quarter of 2022. 22. In addition to the healthcare providers who are inextricably involved in the enterprises herein, further Defendants consist of law firms and their attorneys who are materially intertwined with the defendant healthcare providers’ alleged treatment and diagnoses, and thereafter actively prosecute the fraudulent claims before the Workers’ Compensation Board and/or through the filing of multimillion-dollar tort claims that effectively utilize the alleged care and treatment obtained and paid for to construct facially viable tort claims with windfall recoveries. 23. Upon information and belief, for at least the past 10 years, Defendant law firm Gorayeb & Associates, PC (hereinafter referred to as “Gorayeb PC”) has been specifically utilizing PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 9 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 10 ofRECEIVED 99 PageID #: 2352 NYSCEF: 04/12/2024 OSHA training courses to preemptively and unlawfully solicit new clients in violation of applicable New York regulations, specifically 22 N.Y.C.R.R. § 1200 Rule 7.3. 24. Gorayeb PC has done so under the guise of its sponsorship and partnership with Defendant Fanny Guadalupe (“Guadalupe”) and her organizations, Defendant Sisa Pakari Cultural Center, Inc. and Sisa Pakari Centro Cultural & Laboral, Inc. (hereinafter referred collectively to as “Sisa Pakari”). These ostensibly non-profit entities, have conducted Gorayeb-sponsored Spanish- language OSHA courses and thereby created the pipeline necessary for the overall enterprise and each individual enterprise to exist and continue by effectively directing how the claims are reported and the course of alleged care and treatment. 25. The courses of treatment directed by these entities are done not for the benefit of the claimants, but to maximize recoveries by the Defendants herein, both individually and collectively. 26. While all claims herein and others similarly undertaken reflect an overarching scheme, each claim constitutes a separate and independent union of individuals and entities associated in fact to improperly profit off of that specific alleged claim, sufficient to constitute an independent enterprise. 27. Every individual enterprise is ongoing and has remained continuous over a substantial period. The commonality of the predicate acts, the fraudulent treatment protocols, and racketeering activity underscores the clear and present threat of repetition. 28. The remaining Defendants are limited liability companies and other incorporated entities owned and/or controlled by Defendants who are actively furthering these enterprises and the overarching scheme, and represent additional property obtained through the fraudulent activity herein. PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 10 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 11 ofRECEIVED 99 PageID #: 2353 NYSCEF: 04/12/2024 29. Defendants herein have not only preyed upon the claimants in order to carry out these enterprises but have specifically exploited favorable New York State laws to benefit Defendants in New York and New Jersey. 30. As a matter of public knowledge, New York State’s Workers’ Compensation Law “was designed to provide a swift and sure source of benefits to the injured employee or to the dependents of the deceased employee” in return for “the loss of the common-law tort action in which greater benefits might be obtained.” Liberty Mut. Ins. Co. v. Hurlbut, 585 F.3d 639, 641 (2d Cir. 2009) (quoting O’Rourke v. Long, 41 N.Y.2d 219, 222 (1976)). 31. In order to ensure that workers would receive treatment, the New York State legislature established the presumption that, in the context of any Workers’ Compensation claim, unless a carrier could demonstrate substantial evidence to the contrary, inter alia “[t]he claim comes within the provision of this chapter” and “[t]hat sufficient notice thereof was given”. New York Workers’ Compensation Law § 21, subsections 1 and 2, respectively. 32. In turn, “[w]ith respect to a board determination that a particular injury was or was not sustained in the course of employment, the judicial appellate function is limited.” O’Rourke, supra, at 227. 33. Given the strong presumption in favor of claims, “[i]t has been estimated that more than 90% of employee claims for benefits under the standards provided by the WCL are paid without contest.” Hurlbut, supra, at 642 (citing Martin Minkowitz, New York Practice Series: New York Workers’ Compensation § 15:1, at 594 (2003)). 34. As Defendant Gorayeb PC’s unlicensed investigator Francisco Payano (hereinafter referred to as “Payano”) informed a Sisa Pakari class meant to receive OSHA training, on December 4, 2022, following an alleged incident at the job site, “if you go in an ambulance, the PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 11 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 12 ofRECEIVED 99 PageID #: 2354 NYSCEF: 04/12/2024 boss cannot deny that the accident happened on the job ….[f]rom the moment that ambulance arrives at compensation, right away that will get approved in a couple of months.” Exhibit D-1, December 4, 2022 OHSA class, Transcription, English Translation, at p. 3, attached hereto and incorporated herein by reference. 35. As noted, however, “an adjudication by the board that there was a relationship between accident and employment, unless reversed on a direct appeal, would preclude any recovery in a civil action against the employer.” O’Rourke, supra, at 227. 36. As set forth infra, the grooming phase of the enterprises relies heavily on the fact that the Workers’ Compensation claim provides the means of facially establishing causality and facially developing a treatment record, its barrier against tort claims has been fatally eroded with respect to construction workers. 37. As Defendant Gorayeb PC’s unlicensed investigator Payano informed a Sisa Pakari class meant to receive OSHA training, on December 4, 2022, “[c]onstruction workers are the only workers, 99% of the time, they are the only ones that can, let’s say, have a lawsuit at the time of the accident, okay? Why? Because construction workers can sue the owner of the building and the general contractor, okay?” Exhibit D-1, December 4, 2022 OHSA class, Transcription, English Translation, at p. 7, attached hereto and incorporated herein by reference. 38. In all four enterprises detailed herein and in the additional claims demonstrating the same pattern, Gorayeb PC alleged violations of sections 200, 240(1) and 241(6) of New York State’s Labor Law, amplified by Bills of Particulars that tied these statutory sections with alleged violations of the Industrial Code as well as OSHA regulations. 29 C.F.R. § 1926 et seq. 39. More specifically, as Payano explained to students on December 4, 2022, “why do construction workers have lawsuits? Because labor laws were violated when the accident PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 12 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 13 ofRECEIVED 99 PageID #: 2355 NYSCEF: 04/12/2024 happened.” Exhibit D-1, December 4, 2022 OHSA class, Transcription, English Translation, at 8, attached hereto and incorporated herein by reference. 40. After detailing how to document alleged scaffolding and ladder claims – distinguishing those from hallway or stair slip and falls where photographs are to be taken – Payano explained the remaining category, namely that “[f]or a lawsuit there must be fall, some material falling on the parson’s head or on another body part, that is a lawsuit.” Id. at 8-9. 41. The particularly useful legal principle to which Payano was referring was “Labor Law § 240(1), often called the “scaffold law,” [which] governs “elevation-related safety measures,” and imposes a statutory duty on owners, contractors, and their agents to make safety devices that provide “proper protection” available to their workers.” Hernandez v. GPSDC (New York) Inc., 2006 U.S. Dist. LEXIS 9172 at 26 (S.D.N.Y. March 9, 2006). 42. While the scaffold law was originally established to protect workers engaged in activity rendered particularly dangerous due to significant height differential, New York courts have “[t]here is no bright-line minimum height differential that determines whether an elevation hazard exists.” Thompson v St. Charles Condominiums, 303 A.D.2d 152, 154 (1st Dept. 2003), lv. dismissed, 100 N.Y.2d 556 (2003). 43. As importantly, “[t]he failure to provide a safety device is a per se violation of the statute for which an owner/contractor is strictly liable.” Auriemma v. Biltmore Theatre, LLC, 82 A.D.3d 1, 4 (1st Dept. 2011) (citing Zimmer v. Chemung Co. Performing Arts, 65 N.Y.2d 513, 523- 524 (1985)). 44. Accordingly, each enterprise herein, further claims demonstrating the same pattern, and countless others are most easily predicated on pre-identifying claimants whose Workers’ Compensation claims can be managed to maximize payments to providers and ambulatory surgery PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 13 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 14 ofRECEIVED 99 PageID #: 2356 NYSCEF: 04/12/2024 centers in the short term, even as the claims are crafted to fall into what amount to strict liability ‘violations’ to be asserted against general contractors and building owners in order to reap windfalls for all attorneys involved in the ensuing tort actions. 45. Submission of the Workers’ Compensation claim documents – which is done electronically per directive of the New York State Workers’ Compensation Board – are intended to and do result in payments issued by mail and/or by EFT transfer utilizing the federal ACH, and therefore constitute predicate acts of willful fraud from which each enterprise proximately derives. 46. By Congressional intent, “proximate cause “is generous enough to include the unintended, though foreseeable, consequences of RICO predicate acts,” including, in some instances, harms that flow from, or are derivative of, each other. Diaz, 420 F.3d at 901 (citing Palsgraf v. Long Island R.R. Co., 248 N.Y. 339, 342-47 (1928) (Cardozo, C.J.).” Horn v. Med. Marijuana, 80 F.4th 130, 138 (2nd Cir. 2023), italicization in the original). 47. Some of the categories of damages are documented by Exhibits A-1, A-2, A-3, and A-4, coupled with Exhibits B-1, B-2, B-3, and B-4 attached hereto and incorporated herein by reference, being the respective Workers’ Compensation payments and costs incurred to identify and respond to the fraudulent activities detailed herein. The remaining damage to which Roosevelt is exposed in the general liability context is calculated by reference to application of New York State Verdicts and Settlements data to the alleged claims herein, specifically the Labor Law and Industrial Code sections allegedly violated, correlated with the injections and surgeries allegedly underwent as putative result of the claims, the exact amount to be determined at trial. 48. With respect to damages in the general liability litigation settlement context, the injections and surgeries performed are conservatively calculated to average $1.5 million on the PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 14 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 15 ofRECEIVED 99 PageID #: 2357 NYSCEF: 04/12/2024 low settlement side with the median settlement calculated to average $2 million per claim, the exact amount to be determined at trial. 49. While Labor Law actions like these do not typically reach a jury verdict for reasons set forth herein, the average such exposure for these claims and others facially similar in terms of alleged treatment, injections and surgery has been calculated to average $5 million per claim, with potential upward modifiers not presently calculable as they would necessarily be atypical in reaching that stage in the normal course of litigation. II. JURISDICTION AND VENUE 50. Pursuant to 28 U.S.C. § 1331, this Court has jurisdiction over the claims brought under 18 U.S.C. § 1961 et seq. (“RICO”) because they arise under the laws of the United States. 51. Pursuant to 28 U.S.C. § 1367, this Court also has supplemental jurisdiction over the state law claims because they are so related to the RICO claims as to form part of the same case and controversy, in this case each enterprise deriving from the predicate acts from which this action is derived. 52. 18 U.S.C. § 1965(a), this Court has jurisdiction since more than one Defendant “resides, is found, has an agent, or transacts business” in this district, and substantial events took place within this district. 53. Pursuant to 28 U.S.C. § 1391(b)(2), venue is proper in this district since a substantial part of the events giving rise to this action occurred within this district. 54. Pursuant to 28 U.S.C. § 1391(b)(3), venue is further proper in this district since a plurality of Defendants are known to reside in this district, and specifically in that key Defendants PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 15 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 16 ofRECEIVED 99 PageID #: 2358 NYSCEF: 04/12/2024 in the form of Surgicore entities’ owners Anthony DeGradi and Wayne Hatami, as well as Regina Moshe, titular owner of the CitiMed entities, maintain residences on Long Island proximately located near this court. As set forth below, additional defendants own real property or maintain places of business within the Counties of Nassau and/or Suffolk, New York. 55. The remainder of Defendants are located in multiple states, including New York, New Jersey, and Florida. The ends of justice are therefore best met by maintaining this action where a plurality of key defendants reside, which is further where a substantial part of the events at issue have occurred and continue. III. PARTIES A. Plaintiffs 56. Tradesman is a limited liability company organized and principally located in the State of New York. 57. Tradesman’s primary business is to serve as a management general agency that provides specialized management services that pertinently include general liability and workers’ compensation services from underwriting through claims handling and subsequent administrative and legal actions. 58. Tradesman specifically focuses on safety management and effective claims handling with respect to clients within the construction industry, encompassing in different respects Workers’ Compensation claims and general liability claims. 59. As stated supra and expanded upon below with respect to the enterprises set forth herein, Tradesman has been materially damaged in excess of $1,000,000 (one million dollars) as PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 16 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 17 ofRECEIVED 99 PageID #: 2359 NYSCEF: 04/12/2024 the result of Defendants’ pattern of racketeering, specifically the result of payments it has issued, see, e.g. Exhibits A-1, A-2, A-3, and A-4, coupled with Exhibits B-1, B-2, B-3, and B-4hereto and incorporated by reference, as a direct result of the tides of fraudulent billing submitted by Defendants via mail and/or electronic means to the New York State Workers’ Compensation Board as well as to Tradesman and its clients directly, and further by the fraud-prompted decision of its long-time client Accredited, for whom it brings this suit as managing general agent, to cease issuing general liability insurance policies in the State of New York, thereby causing direct and irreparable harm to its business through the loss of income in an amount exceeding $1,000,000.00 to be determined at trial. 56. In its capacity as managing general agent, Tradesman is authorized and obligated to bring this action pursuant to its contractual obligations following its discovery of a series of fraudulent claims, including the four enterprises detailed herein, on behalf of Roosevelt, a foreign limited company which is ultimately the damaged party in interest as the reinsuring entity liable to remit payment on claims herein. 57. As set forth herein, Tradesman, individually and on behalf of Roosevelt, demonstrates an injury in fact both actual and imminent, a causal connection between the injury and conduct set forth, and the likelihood that a favorable decision will redress both actual and imminent injuries. 58. Roosevelt is a foreign-based limited company which sues herein in its capacity as reinsurer which underwrites policies and pertinently provides reinsurance that covers the claims at issue sufficient to constitute a party directly and ultimately damaged by the racketeering enterprises set forth herein as stated in the section designated Nature of Action supra. PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 17 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-NG-LB 7 Document 1 Filed 03/01/24 Page 18 ofRECEIVED 99 PageID #: 2360 NYSCEF: 04/12/2024 59. As New York State’s highest court has explained, “In a treaty reinsurance relationship, there is “1) no individual risk scrutiny by the reinsurer, 2) obligatory acceptance by the reinsurer of covered business, and 3) a long-term relationship in which the reinsurer’s profitability is expected, but measured and adjusted over an extended period of time”. Mich. Nat’l Bank-Oakland, 89 N.Y.2d 94, 106 (1996)(quoting Clark, Facultative Reinsurance: Reinsuring Individual Policies, reprinted in Reinsurance, at 121 [Strain ed. 1980]). 60. Due to the ongoing and pervasive nature of Defendant’s enterprises set forth herein and overall pattern of fraudulent activity, Roosevelt has been compelled to engage in overall risk scrutiny in order to protect the profitability it reasonably expected but for Defendants’ activities. B. Defendants 1. The Ambulatory Surgery Center Defendants a. The Surgicare Enterprise. 61. John Hajjar, MD (hereinafter referred to as “Hajjar”) is a physician licensed to practice in the State of New Jersey. Hajjar profited from fraudulent services allegedly performed on patients at various Ambulatory Surgery Center facilities owned directly or indirectly by him, including SCOB, LLC a/k/a “Surgicare Center of Brooklyn”, Surgicare of Westside, LLC a/k/a “SOW”, and Surgicare of Manhattan, LLC a/k/a “SOM”. 62. Dr. Hajjar has utilized a series of limited liability companies through which to control his various enterprises, including Boro Ventures LLC, which is the titular controlling owner of SCOB, LLC, yet has been defunct since 2020. 63. Dr. Hajjar is also owner of Sovereign Medical Services, Inc. (hereinafter referred to as “Sovereign” a/k/a Sovereign Health System) and Regent Medical Properties (hereinafter referred to as “Regent”), as well as a myriad of specialized limited liability companies that were PLAINTIFFS ROOSEVELT ROAD RE, LTD. AND TRADESMAN PROGRAM MANAGERS, LLC’S ORIGINAL COMPLAINT PAGE 18 OF 99 FILED: QUEENS COUNTY CLERK 04/12/2024 11:39 AM INDEX NO. 707865/2024 Case NYSCEF DOC. NO.1:24-cv-01549-