Docketed Ford Vs BC Bs

Case 2:23-cv-11286-LVP-EAS ECF No. 11, PageID.
59 Filed 06/16/23 Page 1 of 294
UNITED STATES DISTRICT COURT FOR THE

EASTERN DISTRICT OF MICHIGAN
Ford Motor Company, :

: CASE NO. 2:23-cv-11286 (LVP-EAS)
Plaintiff, :
Felix Brizuela :
Intervenor :
v. :
:
Blue Cross Blue Shield Association :
:
Defendant. :
:
Motion for Intervention of Right Pursuant to Federal Rules of Civil Procedure

Rule 24 (a)
Intervenor Felix Brizuela D.O. (“Intervenor”), is an American physician of Hispanic
origin (“Brown Skin Person of Color”), who moves Pro-Se, and requests this Honorable Court to
GRANT a Motion to Intervene based on Right pursuant to F.R.C.P. Rule 24. The Intervenor
seeks to provide a clear relation basis to Plaintiff Ford Motor Company. The issues are: 1)
suitable for judicial resolution, 2) the withholding judicial review would cause undue hardship,
and impair rights to the Intervenor, 3) Intervenor and the Plaintiff Ford Motor Company have a
common nucleus of operative facts resulting in damage and harm to Intervenor which can be
resolved through Judicial Relief by the Court, 4) Intervenor requests that the Honorable Judge
allow intervention by right and permission for purposes of judicial economy.
Brizuela intends to pursue damages if the Court allows intervention by filing a complaint
and numerous claims, against Defendant Blue Cross Blue Shield Association (“BCBSA” or
“Defendant”) as follows: (1) unjust enrichment, (2) fraudulent inducement, (3) breach of
fiduciary duty and duty of good faith and fair dealing, (4) misappropriation of confidential
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Case 2:23-cv-11286-LVP-EAS ECF No. 11, PageID.60 Filed 06/16/23 Page 2 of 294
information, (5) defamation, (6) unfair competition, (7) tortious interference with contract, (8)
tortious interference with prospective contract, (9) tortious interference with business relations,
(10) commercial disparagement, (11) prima facie tort, (12) intentional infliction of emotional
distress, (13) deceptive trade practices, (14) fraud, (15) trade libel, (16) tortious interference with
the business relationship between doctors and their patients, (17) liability for breach of fiduciary
duty by a co-fiduciary which is the parent company Blue Cross Blue Shield Association, (18)
Violation of the Racketeer Influenced and Corrupt Organizations Act, (19) Violation of
Conspiracy 18 U.S.C 241, (20) violation of Sherman Clayton Antitrust Act (21) Violation of
Federal Trade Commission Act and 15 U.S.C. § 2301 et seq Federal Trade Commission
Improvements Act (22) Violation of American Disability Act, (23) Violation of HIPAA Health
Insurance Portability and Accountability Act (portability and nondiscrimination provisions), (24)
Violation of the Patient Protection and Affordable Care Act (ACA), (25) Violation of the Mental
Health Parity Act of 1996 (MHPA) (Mental Health Parity Provisions), (26) Violation of the The
Mental Health Parity and Addiction Equity Act (MHPAEA), (27) Violation of 42 U.S.C § 1981;
seeking all available monetary damages, including punitive damages due to the outrageous
conduct, reckless indifference, and/or evil motives of Defendant Blue Cross Blue Shield
Association described herein which are intentional, reckless, and/or malicious.
Under Rule 24(a), a party may seek to intervene “of right” on a timely motion if that
party claims an interest in the pending litigation “and is so situated that disposing of the action
may as a practical matter impair or impede the movant’s ability to protect its interest, unless
existing parties adequately represent that interest.” Fed. R. Civ. P. 24(a)(2). Moreover, the
party’s interest must not be adequately represented by existing parties to the action. See
Defenders of Wildlife v. Perciasepe, 14 F.3d 1317, 1322–23 (D.C. Cir. 2013). Intervenor
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Brizuela makes the instant claim that he must intervene in the current litigation action to protect
his interest in pursuing justice against BCBSA in light of the recent legal rulings of the United
States District Court, Neil Anand et al. v. U.S. Department of Health and Human Services et
al. (Civil Action No. 21-1635), where Robin Brooks, Director, Freedom of Information Act
Division, Office of Inspector General (OIG), U.S. Department of Health and Human Services
(HHS or the Department), Freedom of Information Officer for OIG declared (ECF Docket# 91-3;
see in attached Appendix E) that: OIG maintains all records of investigations conducted by the
OIG Office of Investigations (“OI”), including complaints and documents related to civil and
criminal cases, in its law enforcement database (“LE database”)... A search by OIG of the LE
database by HHS revealed that there were at least a total of 32,728 Blue Cross Blue Shield cases
against American physicians (13,146 + 2,320 + 17,262 cases)…and where OIG released a
breakdown of the LE Database with “Blue Cross Blue Shield” – 17,262 case results, “BCBS” –
13,146 case results, “BC/BS” – 2,320 case results.
Analysis of the data accumulated by physician groups around the United States (see
attached Appendix E) reveal that BCBSA franchisees targeted predominantly physicians who
were non-white persons of color (Black Skin, Brown Skin), and/or predominantly Jewish
religion. Blue Cross Blue Shield Association also partnered with the public-private healthcare
cartel called Healthcare Fraud and Prevention Partnership (HFPP) and General Dynamics
Information Technology (GDIT) Trusted Third Party (TTP) to allow a present day, “Nazi
nightmare”, where these Blue Cross Blue Shield (BCBS) health insurance companies view their
human clients as “milk cows” on “their plantation”, branded with their “Blue Cross Blue Shield”
insurance logos and member identity cards, paying a contracted health care provider a modest
amount of money to keep their “members” healthy enough for a continuous milking stream of
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insurance premium payments until their human clients become too sick, old and costly, relegated
to become “beef cows” and consequently denied further expensive, innovative, and experimental
health care treatments, again, in a discriminatory manner.
Not only does BCBSA treat their patient Members as milk cows and beef cows; Blue
Cross Blue Shield partners and affiliates have a history of breaching the fiduciary duty owed to
others, especially to minority groups and economically disadvantaged groups in
American society, that Blue Cross Blue Shield classifies as being sub-human. See Saginaw
Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (where Blue Cross
Blue Shield defrauds Native American Indian Groups and denies care to sick Native Americans).
Blue Cross Blue Shield of Michigan also unlawfully targets anesthesia and pain management
companies for elimination in Michigan and nationwide. (See Anesthesia Associates of Ann
Arbor, PLLC, vs. Blue Cross Blue Shield of Michigan Mutual Insurance Company. Civil Action
No. 2:20-cv-12916. United States District Court for the Eastern District of Michigan).
The claims of unethical business practices against IBC and Blue Cross Blue Shield are
legion. Numerous physicians around the United States have claimed that the Franchisor Blue
Cross Blue Shield Association (informally known among doctors as the “Ku Klux Klan” of
health insurance companies for their race induced hate crimes against American physicians of
color), holds a dominant, monopoly, share of the U.S health insurance market, and has
coordinated utilization of the U.S. legal system against numerous physicians of color in a “Jim
Crow 2.0” process, through its franchisees and their subsidiaries (see Kaul v Horizon BCBS and
Robert Marino: 23-CV-00518; relevant filing attached in Appendix E). These physicians have
also claimed that Blue Cross Blue Shield Association (BCBSA) and its franchisees, provides
health insurance, powers back office and front office operations for Medicare and Medicaid,
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shares investigative methods of physicians involved in the treatment of pain and addiction,
targets physicians of color (including famous martyr, Dr. Reverend Ronald Myers, founder of
Juneteenth U.S. national holiday), coordinates investigations of health care fraud with law
enforcement, effectively raises health insurance premiums simultaneously via monopoly power,
and effectively fixes health entity and practitioner fee schedules via monopoly or monopsony
power. See (https://www.bcbssettlement.com/), (https://www.kff.org/interactive/premiums-and-
worker-
contributions-among-workers-covered-by-employer-sponsored-coverage-1999
2020/#),(https://energycommerce.house.gov/newsroom/press-releases/ec-launches-investigation-
into-health-and-dental-insurers) ; (https://www.documentcloud.org/documents/21116581-
20211105-bcbsnc-rate-reduction-notice_redacted?responsive=1&title=1),
(https://youarewithinthenorms.com/2021/12/08/crucified-on-the-blue-cross-the-story-of-dralves-
gene-edwards-do-practicing-medicine-while-black-and-the-racial-profiling-of-physicians-of-
color-in-america/).
Independence Blue Cross (IBC), Blue Cross Blue Shield of Michigan Mutual Insurance
Company (BCBSMMIC) and IBC’s and BCBSMMIC’s co-owned insurance company,
Amerihealth Caritas (AC), are franchises of the BCBSA who are publicly advertising their
actions in engineering medically racist policies to attack and incapacitate physicians of color
(often by submitting false evidence to law enforcement entities in a “Jim Crow 2.0” process see
United States v. Brizuela and United States v. Anand, and importantly United States v. Bothra
and United States v. Pompy of Eastern District Court of Michigan) and fueling a Black overdose
crisis as well as a worsening of the opioid epidemic and Covid pandemics, increasing overall
U.S. citizen deaths over a multi-year period for the purposes of increased profits for their
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companies and increased compensation for its executive class employees. See
(https://truthout.org/articles/medical-racism-is-fueling-the-black-overdose-
crisis-advocates
say/?fbclid=IwAR1L2Dyle8whs2PF_cHR8xIXYClqSPHdWVk0flSbT8kFsToCrHRc2_tnF8E),
(https://mibiz.com/sections/health-care/bcbs-takes-steps-to-respond-to-opioid-abuse),
(https://www.theguardian.com/us-news/2021/aug/06/us-healthcare-insurance-covid-19-
coronavirus).
Disposition by the District Court of the present civil litigation action in favor of the
Defendant Blue Cross Blue Shield Association (“BCBSA”) against Ford Motor Company would
impede any ability for Intervenor Brizuela to protect his interest in damages caused by
BCBSA. Intervenor Brizuela also obtained critical information Dr. Felix Brizuela (ECF 7)
against Blue Cross Blue Shield from Neil Anand et al. v. U.S. Department of Health and Human
Services et al. (Civil Action No. 21-1635) to prevent future incarceration of U.S. physicians and
reduce additional patient deaths nationwide.
In this legal action, Movant Brizuela intends to satisfy the requirements for permissive
intervention to this Court under Rule 24(b), pursuant to which the Court “may permit anyone to
intervene” who “(A) is given a conditional right to intervene by federal statute; or (B) has a
claim or defense that shares with the main action a common question of law or fact.” Fed. R.
Civ. P. 24(b). See EEOC v. Nat’l Children’s Ctr., Inc., 146 F.3d 1042, 1046 (D.C. Cir. 1998).
Movant Brizuela plainly satisfies this standard citing federal statutes supra and infra providing
Brizuela a conditional right to intervene in the instant case against BCBSA.
Movant Brizuela furthermore has a relevant “claim” related to the main action as relates
to Intervenor Brizuela’s overturned criminal case, United States v. Brizuela, fraudulently induced
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by Blue Cross Blue Shield as well as future plans to litigate his interests and argue the violation
of the human rights of U.S. physicians by BCBSA as a Class within the International Court of
Justice, which has its seat in The Hague, and is the principal judicial organ of the United
Nations.
LEGAL STANDARD OF REVIEW
Rule 24 allows intervention under two standards: intervention of right and permissive
intervention. Fed. R. Civ. P. 24(a),(b). Intervention of right is permitted for a party that files a
timely motion and claims an interest in the pending litigation “and is so situated that disposing of
the action may as a practical matter impair or impede the movant’s ability to protect its interest,
unless existing parties adequately represent that interest.” Fed. R. Civ. P. 24(a)(2). Under this
provision, putative intervenors must satisfy four criteria: 1) the application to intervene must be
timely, 2) the party must have an interest relating to the property or transaction which is the
subject of the action, 3) the party must be so situated that the disposition of the action may, as a
practical matter, impair or impede the party’s ability to protect that interest, and 4) the party’s
interest must not be adequately represented by existing parties to the action. Defenders of
Wildlife v. Perciasepe, 714 F.3d 1317, 1322–23 (D.C. Cir. 2013). Intervenor Brizuela meets the
four-factor test for intervention of right. He can establish: “1) timeliness of the application to
intervene; 2) a legally protected interest; 3) that the action, as a practical matter, impairs or
impedes that interest; and 4) that no party to the action can adequately represent [their] potential .
. . interest.” Crossroads Grassroots Pol’y Strategies v. FEC, 788 F.3d 312, 320 (D.C. Cir. 2015)
(citing Deutsche Bank Nat’l Trust Co. v. FDIC, 717 F.3d 189, 192 (D.C. Cir. 2013)).
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Blue Cross Blue Shield of Michigan
A. Restraint Of Trade
An express or implied contract existed between the franchisees of Blue Cross Blue Shield
Association (“BCBSA”), Blue Cross Blue Shield of Michigan Mutual Insurance Company
(“BCBSMMIC”), Independence Blue Cross (“IBC”), Highmark Blue Cross (“Highmark”),
among other franchisees of BCBSA and BCS Insurance Company. The parties above formed a
joint enterprise, named, HFPP (Health Care Fraud Partnership) that functions as a nationwide
cartel. HFPP is an instrumentality of interstate commerce. The contract excluded other health
insurers, in restraint of trade, such exclusion constitutes a criminal violation of the Sherman
Anti-Trust Act. High managerial employees at BCBSMMIC, Highmark, BCBSA, and BCS
Insurance Company aided, abetted, and ratified the restraint of trade.
Franchisor Blue Cross Blue Shield Association, through its franchisees and their
subsidiaries, hold a dominant share of the U.S health insurance market. Blue Cross Blue Shield
Association and its franchisees, such as Blue Cross Blue Shield of Michigan Mutual Insurance
Company, Highmark Blue Cross and Independence Blue Cross, provide health insurance, 1)
power back office and front office operations for Medicare and Medicaid, 2) share investigative
methods of physicians involved in the treatment of pain and addiction, 3) coordinate
investigations of health care fraud at a uniformly low price, and 4) effectively raises health
insurance premiums simultaneously. BCS Insurance Company provide insurance and
reinsurance services of the various Blue Cross Plans.
Qlarant (formerly Health Integrity NBI Medic), General Dynamics Information
Technology (GDIT), Medicare “Pill Mills” analysis, Blue Cross Blue Shield of Michigan
Mutual Insurance Company (BCBSMMIC) “Prescriber Block Analysis”, Blue Cross Blue
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Shield Association, Independence Blue Cross (“ IBC”), among other private companies, have
intertwined themselves and share equal control, as state actors, with the Drug Enforcement
Agency (DEA), OIG, CMS, Medicare, Medicaid, and the Federal Bureau of Investigation (FBI)
for an improper purpose. The above parties seek 1) prospective criminal investigations, 2)
mutually beneficial pecuniary gains via asset forfeitures of health care entities, 3) tax write- off
from speculative, but uncollectible restitution recoveries from health entities, where the dollar
amount in the restitutions bear no specific relation to actual damage, and the dollar amount
sought under restitution represents an unenforceable penalty under the Restatement (Second) of
Contracts § 352 (1981) and are a violation of the U.S. 13th U.S. Constitutional Amendment.
BSBSMMIC is a mutual insurance company, headquartered, domiciled, with its principle
place of business being the 83 counties of the state of Michigan. As a mutual insurance company,
the policyholders are the owners of the company. BCBSMMIC earns revenue by the payment of
health insurance premiums. Out of its revenues, BCBSMMIC pays physicians for patients in
whom BCBSMMIC has an insurable interest. The payments by BCBSMMIC on behalf of its
policy holders and owners represent an expense to BCBSMMIC.
The federal legislature did not intend for health insurer’s earning to exceed certain
threshold. Investigating the accounting on how BCBSMMIC earned profits that exceed the
limits placed on profits under the federal statutes; the total amount of income from all of the
premiums money earned, bring the Net Sales. The total amount of money paid by the health
insurer for services rendered to their intended beneficiary constitute the cost of sales. The Net
sales minus the cost of sales equals the Gross Profit. (Net Sales – Cost of Sales = Gross Profit.)
The Gross Profit minus Selling, general, and administrative expenses equal the Operating Profit.
(Gross Profit –Selling, general, and administrative expenses = Operating Profit.) Another name
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for the Operating Profit is the Earnings Before Interest and Taxes (EBIT). To the EBIT on the
accounting income statement, interest income earned by the insurer and “Other Income”, such as
restitution income from doctors, is added to the EBIT, to yield the Operating Income Before
Taxes. By statute, a health insurer Selling, General, and Administrative Expenses is limited to a
certain percentage of the Net Sales, typically about 20% to 30%. Thus, the profits to a health
insurer is limited.
BCBSMMIC has found ways to unlawfully circumvent the statutory limit. BCBSMMIC
has two ways of unlawfully maximizing its profits, either by: 1) increasing the premium through
fraudulent submissions of rate increases to insurance regulators, so that it would be allowed to
spend a greater of its Gross Profits to fuel greater executive salaries and perks from the increased
selling, general and administrative expenses, or 2) generate income classified under “other
income”, such that would not be classified in Operating Income Before Income Taxes, and not
the EBIT. BCBSMMIC can both raise health insurance premiums fraudulently while at the
same time, inducing false criminal proceedings against healthcare entities through the HFPP
cartel and BCBSA. The criminal proceedings generate lucrative “other income” under the
accounting scheme, via restitutions, civil and criminal forfeiture. The fraudulent scheme benefits
Daniel Loepp, the CEO of BCBSMMIC who out -earned executives of even, much bigger
companies. Senator Bernie Sanders criticized Blue Cross CEO for the exceptional $19 Million
salary pay.
BCBS intentional misrepresentation of federal statutes, induces false reliance by law
enforcement actions against physicians. Law enforcement justifiably, but unreasonably, relied
on the misrepresentation, in generating manufactured probable cause, in physicians selected for
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federal indictment, which constitutes Fraud. As a result of the misrepresentation, Intervenor
Brizuela suffered pecuniary and property loss.
As a mutual insurance company where the policyholders are the owners of the company,
the legal business structure of BCBSMMIC involves unregistered securities. BCS Insurance
Company (BCS) is the administrator of Plan Investment Fund, a mutual fund exclusively for the
Blue Cross Blue Shield System, and is involved with registered and unregistered securities.
Where registered and unregistered securities exist, § 10 (b) (Exchange Act) applies. § 10 (b)
(Exchange Act) prohibits any manipulative or deceptive devices that circumvent the rules. Rule
10b-5 (SEC) prohibits: “(c) To engage in any act, practice, or course of business which operated
or would operate as a fraud or deceit upon any person,”
Michigan physicians signed a “Blue Cross Provider Trust Agreement” with the CEO of
Blue Cross of Michigan, Richard Whitmer. Mr. Whitmer is the father of the current governor of
the state of Michigan, Governor Gretchen Whitmer. BCBSMMIC can exert undue influence,
corruption and coercion against Ford Motor Company in this litigation impacting Brizuela’s and
numerous other U.S. physicians’ rights across the country. This Honorable Court can redress the
issue and any other potential conflicts of interest, by the issuance of a Court order, demanding
the intervention of Dr. Felix Brizuela by right.
By the concerted action seeking a particular result, the private entities (BCBSMMIC,
IBC, BCBSA, BCS, Highmark) set of entities have advertised their entry into: 1) traditional
police of criminal investigations, 2) into governmental prosecutorial functions by coordinating
the criminal conviction of physicians, 3) depriving of medical care people considered disabled
and entitled at law to medical care under the American Disability Act and other various laws, 3)
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prevent the government from mitigating financial losses that arise from controlled substances
prescription drug diversion.
A public/private partnership named HFPP (Healthcare Fraud Prevention Partnership),
established a “pre-crime” industry –wide standard for the monitoring software product. The
partnership is composed of a small group of people. The industry-wide standard selects
physicians based on race, religion, and nation of origin as a suspect class for selective
prosecution. HFPP prevents those selected physicians from practicing medicine in a race –
neutral manner by coordinating selective enforcement of the Controlled Substance Act on the
suspect group of physicians. HFPP broke down the Chinese wall between the DEA and OIG
/CMS Medicare, while encouraging the performance of improper search and seizure of the
privileged medical records and personal identification data of patients treated by the suspect
class of physicians. The opioid monitoring software is defective on an industry-wide basis.
HFPP marketed, compiled, summarized, and disseminated the information to the
members of the “pre-crime” industry. HFPP excludes other health insurers from the data sharing.
In violation of §1 of the Sherman Act, HFPP provides a vehicle that deprives the marketplace of
independent decision making. Parties acting together in order to accomplish a particular result
are involved in a concert of action that makes anyone of them vicariously liable for the torts
committed by the others.
B . Potential Conflicts of Interest and Massive Corruption
Gretchen Whitmer, now Governor Gretchen Whitmer of the state of Michigan, first ran
for the state House in the 1990s when Loepp was a chief of staff to Democratic House Speaker
Curtis Hertel Sr. Fast-forward to 2015, the newspaper, Intercept released a 2015 interview of
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Daniel J. Loepp, Chairman, President and Chief Executive Officer of BCBSMMIC, and a
corporate board member of BCS Insurance Company. The Intercept has now unearthed an
interview from 2015 in which Whitmer revealed that her “friend Dan Loepp,” the current
president and CEO of Blue Cross Blue Shield of Michigan, was the first person to suggest she
run for office quoting:
“Q: What has made it possible for you to get where you are today?
A: Fortunately, I have been mentored by many great leaders throughout my life. I count both of
my parents among them. As a candidate for the House, I was extremely fortunate to have
someone like Frank J Kelley, our former Attorney General, support me and advise me along the
way. I know how a few words of encouragement can open up so much possibility. My friend
Dan Loepp was the first to suggest that I think about running for office, and both my parents
quickly voiced their support. Before that it had not really dawned on me and that is why I make
such an effort to encourage people to engage in this process and to run for office. ”
“Within hours of winning the Michigan governor’s race, Gretchen Whitmer appointed Dan
Loepp, CEO of Blue Cross Blue Shield Michigan (BCBS), to her transition team. This put many
socialists and health justice activists in the position of having voted for a candidate on Tuesday,
and by Wednesday evening being dialed into conference calls to oppose their governor elect’s
first move.”
Whitmer, a Democrat who took office Jan. 1, 2018 named Orlene Hawks director of the
Department of Licensing and Regulatory Affairs (LARA) — a $518-million agency with
responsibilities ranging from oversight of Michigan's lucrative new marijuana industry to liquor
licensing, regulation of utilities, and licensing of doctors, hospitals and physical therapy
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providers. Hawks, of Okemos, is married to Michael Hawks, an owner and principal of
Government Consultant Services, Inc. (GCSI). The firm's clients include marijuana interests
such as the Michigan Cannabis Development Association, CannArbor Inc., MedFarm of
Michigan LLC, and PSI Labs, state records show.
GCSI also represents many other clients affected by the policies and rulings of LARA
and its sub-agencies, such as the Liquor Control Commission, which handles liquor licensing,
and the Public Service Commission, which regulates utilities. While state records don't show
which GCSI accounts are specifically handled by Michael Hawks, those clients include the
Michigan Beer and Wine Wholesalers Association, Consumers Energy Co., the Michigan
Physical Therapy Association, and Blue Cross, Blue Shield of Michigan, to name a few.
Orlene Hawks, who will be paid $165,000 a year in her new role, formerly served as
director of the Office of Children’s Ombudsman, which deals with the state's child welfare
system, and before that worked for the state health department. She holds a bachelor's degree
from Michigan State University. BCBS took center stage during the Democratic primaries.
Democratic candidate Abdul El-Sayed, who backed Medicare for All, highlighted BCBS’s
significant contributions to the Whitmer campaign. The Whitmer campaign subsequently
promised objectivity and independence. Given the strong likelihood that Blue Cross Blue Shield
(BCBS) contributed dark money to Whitmer’s campaign, we may never know how much it paid
for a seat at the table.
The official who Gov. Gretchen Whitmer named to head one of the largest and most far-
reaching state government departments is married to an owner of one of Lansing's biggest
lobbying firms raising concerns about potential conflicts of interest related to industries such as
marijuana, where both spouses have responsibilities or client interests. Within a week of the Dan
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Loepp’s appointment, there were several protest actions. On the west side of the state, activists
from Our Revolution and DSA Grand Rapids planned and carried out a flash protest at BCBS’s
local office. And Detroit DSA circulated a petition in support of his removal from the transition
team, which has since gathered over a thousand signatures and national media attention.”
Gretchen Whitmer’s father, Richard Whitmer, was president and CEO of Blue Cross
Blue Shield of Michigan between 1988 and 2006. And in March 2018, lobbyists for the company
held a fundraiser for the Whitmer campaign. Blue Cross also donated more money to Whitmer
than any other gubernatorial candidate in the past decade. Unlike her 2018 Democratic
gubernatorial opponents, Whitmer refused to campaign on single-payer healthcare, telling Metro
Times she thought single-payer wasn't feasible. Blue Cross Blue Shield of Michigan operates as
an insurance company. The Company provides life, health, and disability insurance services.
Blue Cross Blue Shield of Michigan serves customers in the United States. Total compensation
for Daniel Loepp, CEO of Blue Cross since 2006, hit $19.2 million in 2018. That was up from
his $13.4 million payday in 2017 and $9 million in 2015. U.S. Senator Bernie Sanders tweeted in
2018 “The CEO of Michigan Anthem Blue Cross Blue Shield was paid $19M in 2018, a 43%
increase in pay from his $13 million in 2017, while 790,000 Michigan residents go without
health care and many more can't afford to use the insurance they have. We must pass a single-
payer health care system so ordinary Americans won't have to forgo getting the care they need
because they can't afford it.” Loepp's compensation, which included a base salary of $1.5 million
and a $16.2 million bonus, is exceptional nationwide. A study by healthcare information firm
AIS Health ranked Loepp as the seventh highest-paid health insurance exec in the country, and
ranked him first among all Blue Cross Blue Shield companies, The Detroit Free Press reports.
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U.S. automakers also pay a large portion of their executive compensation in stock
awards, an option that Blue Cross, as a nonprofit, cannot provide. The Michigan Department of
Insurance and Financial Services has the authority to challenge the salary size of any insurance
company in the state. Department spokeswoman Andrea Miller said state officials have
occasionally objected to salaries, although she would not provide examples.”
BCS Insurance Company actually powers the Blue Cross Plans. BCS Financial
Corporation delivers insurance and financial solutions for Blue Cross and Blue Shield
organizations nationwide, travel insurance, and medical malpractice insurance for physicians.
Products include stop loss, professional liability, pension trust, surety, and e-commerce coverage.
Through its subsidiaries, BCS Insurance Company and 4 Ever Life Insurance Company, BCS is
licensed in all 50 states. BCS Financial is a private finance company, subject to Gramm Leach
Bliley Act Privacy Notice, headquartered in Oakbrook Terrace, Ill. BCS is the administrator of
Plan Investment Fund, a mutual fund exclusively for the Blue Cross Blue Shield System.
BCS is one of four companies that falls under the BCS Insurance Group brand. The other
companies under this brand are:
• BCSI (BSC Insurance)
• BCS Life
• BCSI Holdings
• BCS Financial
BCSI has three divisions in their company that include:
• Insurance & Employee Benefits Products for Blue Cross & Blue Shield
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• Commercial Division Insurance
• Professional Liability Products for Blue Cross & Blue Shield
State Sen. Joe Hune, R-Fowlerville, who left the Senate at the end of 2018 because of
term limits, is married to Lansing lobbyist Marcia Hune. That relationship became an issue in a
federal lawsuit involving electric car manufacturer Tesla, because Joe Hune introduced
legislative language that Tesla alleges banned the insurgent company's sales model in Michigan,
while the firm Marcia Hune worked for counted the established Michigan auto dealers among its
clients.
In 2013 and under the authorization of the franchisor Blue Cross Blue Shield Association
(BCBSA), BCBSM was absorbed by a Mutual Insurance Company incorporated in the State of
Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company (BCBSMMIC).
Blue Cross Blue Shield of Michigan (BCBSM), a domestic nonprofit healthcare corporation,
merged with Blue Cross Blue Shield of Michigan Mutual Insurance Company (BCBSMMIC),
the surviving company, on December 31, 2013. Senator Hune provided the mechanism for
changing from the non-profit BCBSM to for profit BCBSMMIC. Under a legal duty to pay $1.56
billion over 18 years to a Michigan health endowment fund, BCBSMMIC is a state of Michigan
chartered, mutual insurance company, with statutory duty arising under insurance laws of the
State of Michigan. BCBSMMIC is sufficiently intertwined with The Michigan Health
Endowment Fund, and various state functions, to be considered as a state actor.
Introduced by Senators Hune and Smith, Senate Bill No.61, paved the way for the
inception of the “HEALTH ENDOWMENT FUND CORPORATIONS. “The Michigan Health
Endowment Fund, or the Health Fund for short, was created through Public Act 4 of 2013, which
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authorized certain changes on how Blue Cross Blue Shield of Michigan (BCBSM) operates. Blue
Cross Blue Shield of Michigan became Blue Cross Blue Shield of Michigan Mutual Insurance
Company (“BCBSMMIC”). The law requires BCBSMMIC to contribute up to $1.56 billion
over 18 years to a health endowment fund that benefits Michigan residents, and specified that the
fund should focus on children and seniors, with funding in eight areas, including behavioral
health.
Recipient of grants from the Michigan health Endowment funds has included:
x Comprehensive, Interprofessional Substance Use Disorder Treatment Initiative in a
Family Medicine Residency Program
x Great Lakes Recovery Centers, Inc.
x Recovery Centers of Michigan Planning Grant
x Opioid Epidemic: Prevention, Diagnosis, and Treatment in and Office-Based Integrated
Care Model
x Recovery Resources for Teens and Families
x Self-Help Addiction Rehabilitation (SHAR)
x Peer Recovery Support System for Addiction Treatment Project
x Michigan State Medical Society
x Connecting Treatment Courts and Health Professionals
x Michigan Public Health Institute
x Trauma Informed Substance Abuse & Treatment Services Program
x "Positive Steps Together" SUD Support Program
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C. Federal Advisory Committee Act (FACA) Violations
BCBSMMIC (Blue Cross Blue Shield of Michigan Mutual Insurance Company),
BCBSM (Blue Cross Blue Shield of Michigan), BCBSA (Blue Cross Blue Shield Association,
Independence Blue Cross (IBC), and Highmark Blue Cross as the members (also known as
“Champion Partners”) of the public-private joint enterprise created by the defendants: 1) intruded
into the corporate practice of medicine (the United States passed a statute that specifically
prohibits the Government from exercising any supervision or control over the practice of
medicine or the manner in which medical services are provided pursuant to 42 U.S.C. § 1395), 2)
codified their actions via the partnership in the HFPP (Health Care Fraud Partnership) without
substantial and procedural due process safeguards, 3) failed to monitor the continuation of
medical care of the petitioner that was once provided by the doctor, who faces criminal
proceedings induced by Blue Cross Blue Shield, and 4) failed to disclose the U.S. Federal
Deposit Insurance Corporation material facts related changed circumstances. Where a fiduciary
duty existed, the non-disclosure of fact amounts to a fraudulent assertion of fact under Gramm
Leach Bliley. The intrusion is disproportionately adversely prejudicial in the medical offices of
African American, Hispanic American and other doctors of ethnic minorities of nation of origin,
and much less prejudicial in the offices of white doctors.
The HFPP regularly issues reports that make recommendations to U.S. executive branch
government agencies including Department of Justice and Health and Human Services.
BCBSMMIC, IBC, GDIT and BCBSA formed a committee called Healthcare Fraud Prevention
Partnership (HFPP), which operates largely in the dark, in violation of the Federal Advisory
Committee Act (FACA). Statutory notice of the meetings to competitors of BCBSMMIC, IBC
and BCBSA did not occur, in violation of FACA. The violation creates a foreseeable risk of
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serious harm even when reasonable care is exercised by all actors. The FACA violations are not
in common usage by other health insurance companies. The activities leading up to the FACA
violations are abnormally dangerous activities.
Plaintiff Ford Motor Company’s patients fundamental right to medical treatment was
violated under conflict of laws, statutes and guidelines pursuant to: 1) CFR 42 § 2.61-2.67, 2)
the Americans with Disabilities Act, 42 U.S.C. §12101, et seq., the Rehabilitation Act of 1973,
29 U.S.C. §701, et seq., 3) the Affordable Care Act, 42 U.S.C. §18116, et seq, 4) the Nuremberg
Code §4 and §44 Code of the Geneva Convention, 5) Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) “pain as the 5th Vital Sign,” 6) EMTALA ( Emergency
Treatment and Labor Act) laws, 6) the Controlled Substance Act (CSA 802 (56)(c)), 7) the
Drug Addiction Treatment Act of 2000 (Data 2000) etc.
Arising out of the lack of transparency required under the Federal Advisory Act (FACA),
the FACA violations led to disastrous damages by failing to consider the conflict of laws. Many
U.S. physicians due to unlawful activities by the Defendants suffered a similar loss of medical
licensure. Facing the lack of medical care or alternative reliable efficacious treatment, the
affected class of patients have often died. Other patients have sought refuge in illegal drugs or
have suffered from worsening pain and suffering, depression, anxiety, disability. The data
analytic software intended to coordinate, strengthen and speed criminal convictions of doctors,
using a medical malpractice evidentiary standard of evidence as probable cause of criminal
intent, is not reasonable. The Defendants’ “pre- crime’’ software carries a high risk of death,
disability, and of inducing false criminal proceedings against physicians. As such, the
Defendants’ activity imposes an absolute duty to make safe. The dangerous aspects of the
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activity are the actual and proximate cause of injury in multiple patients. The Defendants’ were
involved in an abnormally dangerous activity, for which the Defendants are strictly liable.
Dr. Brizuela obtained BCBS documents through U.S. Federal Freedom of Information
Act and Pennsylvania Right to Know Law which explain that BCBS Corporate Financial
Investigations Department (“CFID”) employees who consist of former federal, state and local
law enforcement agents and lawyers improperly communicate with current State and Federal law
enforcement agents to initiate criminal proceedings against BCBS business competitors or
unfavored healthcare professionals, violating impartiality regulation, 28 C.F.R. § 45.2. Such
behavior also occurs in violation of 5 C.F.R. § 2635.501 – 503 (Subpart E – Impartiality in
Performing Official Duties). 28 C.F.R. § 45.2 and 5 C.F.R. § 2635.501 – 503 prohibits a BCBS
CFID employee, without written authorization, from participating in a criminal investigation or
prosecution if he or she has a personal or political relationship with any person or organization
substantially involved in the conduct that is the subject of the investigation or prosecution, or any
person or organization which he or she knows has a specific and substantial interest that would
be directly affected by the outcome of the investigation or prosecution.
BCBSA and Highmark Induced Criminal Proceeding Against Dr. Brizuela
Concise Biography
Dr. Brizuela, a Hispanic American physician of color, has spent the last 20+ years as a
Neurologist Specialist, treating those whose conditions were no longer manageable by general
practitioners and are often seen as a patient’s last resort. Dr. Brizuela was taken out of his
community of nearly 20 years in hand cuffs, escorted in a public spectacle in front of my
neighbors and family members. Dr. Brizuela and numerous other physicians throughout the
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United States were arrested in single day mass operations primarily orchestrated by Blue Cross
Blue Shield Association in Operation Pill Nation, Operation Snake Oil, Operation Oxy Alley,
Operation Juice Doctor, Operation Wasted Daze etc. in operations comparable to the Nazi,
Operation Kristallnacht, or the Night of Broken Glass against many Jewish physicians.
Highmark Blue Cross Blue Shield had been pursuing me since the 2000's. Originally for
prescribing intravenous gamma globulin (IVIG) for patients with chronic inflammatory
demyelinating polyneuropathy. Highmark Blue Cross Blue Shield accused me of getting
kickbacks. These allegations were based on speculation. I never collected a penny. Despite this
Highmark Blue Cross Blue Shield was relentless. In 2016, they went as far as having the FBI raid
my home and office, which terrified my only, who is autistic. They found nothing, but they took
and kept my sons iPad and my wife's kindle. Finally, they gave up after I was indicted for
something else in 2020. They gave up on the IVIG issue since they could not prove anything after
about 10 years of harassing me. Then I was falsely accused of prescribing opiates for no legitimate
medical purpose. I was convicted, spent 7 out of 48 months sentenced. The Fourth Circuit of the
Court of Appeals unanimously overturned my conviction, and I was assigned to a public defender
by the Court after my release. The Court told me that I could not pick my own public defender
which I now know was a lie. My public defender coerced me into a plea deal. My public defender
later admitted under a signed affidavit that he never reviewed discovery. My public defender is
under investigation for this by the Pennsylvania Attorney General's office and I have sued him for
ineffective counsel and fraud.
Since that day, Dr. Brizuela has not been allowed to work as a physician, his life’s
calling. Many of Dr. Brizuela’ patients have had to be hospitalized due to the abrupt withdrawal
of opioids and their inability to find a pain specialist that could treat them, especially during
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Covid. These patients remain in chronic pain and are still suffering to this day. Upon
information and belief the patients deaths were all related to them not receiving their monthly
pain medication. (I.e. withdrawal with cardiac consequences, buying fake pills on the street
spiked with fentanyl, and suicide)
There have been many false and derogatory things written about Dr. Brizuela in the
media. Since Dr. Brizuela arrest, he has had no income to support his family because while
practicing, many of his patients paid nothing. Since his incarceration and release following a
successful appeal, Dr. Brizuela has become actively involved in changing legislation to restore
the rights of patients to not live with the torture of uncontrolled pain and interfere with well-
intended physicians such as himself. Dr. Brizuela argues that the policies by Highmark, Blue
Cross Blue Shield of Michigan Mutual Insurance Company, and BCBSA are discriminatory and
interfere with the professional judgment of medical providers in ways that disparately impact the
disabled. See PGA Tour v. Martin, 532 U.S. 661, 683 n.38 (2001) and Beradelli v. Allied Serv.
Inst. of Rehab. Med., 900 F.3d 104, 115 (3d Cir.2018)) and 144 (1st Cir. 2014) Driscoll v. Bryant
University, 393 F.Supp.3d 153, 159. Blue Cross Blue Shield of Michigan Mutual Insurance
Company, Highmark’s and BCBSA’s policies have nationwide caused widespread refusal of
healthcare providers “to affirmatively accommodate [the disabled person’s] disability where such
accommodation was needed to provide ‘meaningful access to a public service.’” Nunes, 766
F.3d at 145 (citing Henrietta D. v. Bloomberg, 331 F.3d 261, 273-76 (2d Cir. 2003))
BCBSA’s policies cause disparate treatment, premised on proxy-discrimination; cause
disparate impact, under the meaningful access standard; and fail to allow trained healthcare
providers to make a reasonable accommodation by inducing a chilling effect. see Alexander v.
Choate ; Cf. CVS v. Doe, 982 F.3d at 1210. BCBSA’s conduct and policies constitutes unlawful
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discrimination against the disabled in violation of Title III 42 U.S.C. § 12182(b)(2)(A)(ii) of the
Americans with Disabilities Act (“ADA”), 42 U.S.C. § 12182(a); Section 504 of the
Rehabilitation Act, 29 U.S.C. § 794(a); and the anti-discrimination provisions of the Affordable
Care Act (“ACA”), 42 U.S.C. § 18116(a). see Nunes v. Massachusetts Dept. of Correction, 766
F.3d 136.
According to Blue Cross Blue Shield documents presented at the Economic Crime
Institute (see attached Appendix E), Corporate Financial Investigations Department (CFID)
utilizes STARS (Services: Tracking, Analysis & Reporting System) and STAR Sentinel
sophisticated software data-mining tools that analyze all categories of claims received. Blue
Cross Blue Shield CFID: 1) aims for recovery of payments, 2) engages in arbitrary and
capricious exclusion of professionals from networks, 3) schemes in changing provider behavior,
4) induces criminal prosecution for pecuniary gain through criminal restitution, 5) and engages in
referral of physician licenses to State Medical Boards for purposes of permanent incapacitation.
Blue Cross Blue Shield also publicizes entities convicted of fraud to create a sentinel effect in the
provider community.
It is a crime to knowingly and willfully hold another person to “involuntary servitude.
United States v. Kozminski 487 U.S. 931 (1988). Highmark in a conspiracy with regards to
BCBSA, BCBSMMIC, HFPP, and others, damaged Brizuela. Violation of conspiracy, 18 U.S.C
241, prohibits conspiracy to interfere with an individual’s Thirteenth Amendment right to be free
from “involuntary servitude.” Highmark and Blue Cross Blue Shield Association would
intentionally withhold payments of work performed by physicians, creating a situation where the
healthcare professionals including Dr. Brizuela essentially treated hundreds of
BCBSA/Highmark Members/patients for free. BCBSA/Highmark committed insurance fraud by
24
deliberately failing to pay insurance claims violating ERISA law and Highmark then invested
these unlawfully obtained proceeds into registered and unregistered securities, failing to disclose,
as required by law, to the Federal Deposit Insurance Corporation or Securities and Exchange
Commission, relevant material facts, violating the Gramm-Leach-Bliley Act of 1999.
After inducing Brizuela and other physicians by contractual and implied agreements to
provide medical services on behalf of BCBSA to their insured Members, Highmark would then
violate contractual law and constitutional law, by engineering abuse of the legal process and
referring the respective physicians for criminal prosecutions, to eliminate BCBSA/Highmark’s
accumulated debt owed to the physicians. BCBSA/Highmark seeks pecuniary gain under a
theory and practice of substantial restitution well beyond actual non-mitigated damages (also in
violation of 13th U.S. Constitutional Amendment and established Contract Law) well
documented in Pennsylvania State and Federal indictments against healthcare providers.
BCBSA/Highmark/BCBSMMIC also submits false information, about these payments/lack
of payments to physicians, to the Pennsylvania and Michigan Insurance Departments during their
yearly rate change requests. BCBSA/Highmark/ BCBSMMIC did not notify the Pennsylvania
and Michigan Insurance Departments of recouped or converted monies from Dr. Brizuela or
other healthcare professionals for accuracy of Highmark/ BCBSMMIC’s premium adjusted
ratings or in calculating Highmark/ BCBSMMIC’s requested yearly premium increases by the
Pennsylvania and Michigan Insurance Departments. These effective rate review requests are
rigorously reviewed by Pennsylvania/Michigan Insurance Department actuaries during a several
months long public review process. Highmark/ BCBSMMIC submits information and
calculations to Pennsylvania and Michigan Insurance Department for yearly requests to premium
changes for experience rated plans, community rated plans, adjusted community rated plans etc.
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Highmark/ BCBSMMIC submitted to Pennsylvania and Michigan Insurance Department
regulators incorrect or fraudulent calculations for rate bands, insurance plan ratings, Member
Safety Program, Population Health Management Strategy, Network adequacy, NCQA
accreditation, Access and availability standards, Appointment availability etc.
BCBSA/Highmark/ BCBSMMIC’s defrauded its experience rated premium payers, who
have not been reimbursed for monies obtained by BCBSA/Highmark/ BCBSMMIC from
criminal restitutions and asset forfeitures. Dr. Brizuela is in the process of obtaining extremely
detailed information from Pennsylvania Insurance Department and Pennsylvania Office of
Attorney General concerning the yearly requests for premium rate adjustments by
BCBSA/Highmark as well as obtained criminal asset forfeiture amounts. Dr. Brizuela has filed
an intent to sue the Pennsylvania Office of Attorney General if they do not release the requested
information.
Highmark Utilization Management (UM) department was discriminatory to Brizuela as
compared to other Pennsylvania and Michigan healthcare providers by denying expensive
intravenous immunoglobulin (IVIG) to patients. Highmark/ BCBSMMIC also seeks criminal
restitution for an already settled and subrogated litigated payout (where Highmark/ BCBSMMIC
already agreed to the payout) which creates several large legal issues that could destroy the entire
Pennsylvania and Michigan personal injury legal markets causing the wipeout of thousands of
attorney jobs for the sole benefit of BCBSA/Highmark/ BCBSMMIC. In most cases, an
individual’s health insurance company pays its client’s claim for losses directly, then seeks
reimbursement from the other party, or their auto insurance company. The insured client receives
payment promptly then the health insurance company may pursue a subrogation claim against
the party at fault for the loss. Insurance policies may contain language that entitles an insurer,
26
once losses are paid on claims, to seek recovery of funds from a third party if that third party
caused the loss. Subrogation is a term describing a right held by most insurance carriers to
legally pursue a third party that caused an insurance loss to the insured. This is done in order to
recover the amount of the claim paid by the insurance carrier to the insured for the loss.
Subrogation literally refers to the act of one person or party standing in the place of another
person or party. It effectively defines the rights of the insurance company both before and after it
has paid claims made against a policy. Also, it makes easier the process of obtaining a settlement
under an insurance policy. When an insurance company pursues a third party for damages, it is
said to "step into the shoes of the policyholder," and thus will have the same rights and legal
standing as the policyholder when seeking compensation for losses. Subrogation in the
insurance sector, especially among auto insurance policies, occurs when the insurance carrier
takes on the financial burden of the insured as the result of an injury or accident payment and
seeks repayment from the at-fault party.
BCBSA/Highmark/ BCBSMMIC by seeking double restitution has subverted the necessity of
filing petitions for interpleader claims in personal injury lawsuits in which medical providers and
letters of protection gave them priority to be paid in full. See Stuart M. Berger, RPT, P.A. v.
Silverstein, Silverstein & Silverstein, P.A. , 727 So. 2d 312 (Fla. 3d DCA 1999), for the
proposition that letters of protection grant medical providers priority over an attorney's claim to
settlement funds.
BCBSA/Highmark/ BCBSMMIC “double dipping” of seeking criminal restitution from
physicians for amounts already subject to the subrogation process and subject to law under
interpleaded fund statutes is massive fraud. Interpleader is such a desirable remedy that in 1831
the English Interpleader Act brought it into the law courts. A defendant was allowed to move for
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an interpleader rule, showing that the right was claimed by a third person, who, if a proper case
was established; would be brought into the suit, and the defendant would be discharged on
putting the res into court. The fundamental purpose of interpleader is simple and just. The
applicant has incurred one obligation, but is subjected to two or more claims. If one claim is
right, the rest must be wrong. An efficient and fair-minded system of justice ought not to subject
a citizen to double vexation on a single obligation, if this can be easily and satisfactorily avoided.
The purpose of an interpleader suit is not to protect a party against a double liability, but against
double vexation in respect of one liability or where there is a risk of double liability. Interpleader
actions are used in three-cornered litigation which abhors multiciplicity and is granted whenever
an applicant is vexed by two or more mutually exclusive claims. There must, in short, be only
one obligation due from the applicant, and in addition there must be genuine double vexation
with respect to this one obligation. For example, to avoid the need for further criminal litigation,
a trial court could first determine what each party is owed, then decide the priority of payment if
the funds are insufficient to pay each liquidated claim, and then order the distribution of the
funds. See Drummond Title Co. , 77 So. 2d at 610 ; Azelton , 390 So. 2d at 120–21 ("[A]fter the
court decides the preliminary [307 So.3d 782] question of whether interpleader is appropriate,
the court then proceeds to determine the issues made between the parties laying claim to the
funds held by the party seeking the order of interpleader."). A party "against whom double or
multiple claims are made," that "may give rise to double or multiple liability," may bring an
action against the claimants to compel them to interplead and litigate their claims. The complaint
must show that defendant makes conflicting claims to the subject matter, and that the Brizuela "
‘cannot safely determine which claim is valid and offers to deposit the money in court ....’"
(Westamerica , supra , 201 Cal.App.4th at pp. 607-608, 133 Cal.Rptr.3d 883.) But an
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interpleader action may not be maintained " ‘upon the mere pretext or suspicion of double
vexation.’ " (Id . at p. 608, 133 Cal.Rptr.3d 883).
A typical interpleader action occurs when two or more parties make a claim on an insurance
policy and the insurance company has no wish to become involved in the fight and interpleads
the policy with the court and asks the court to remove it from the matter. Normally, to be
released from the action, the interpleader res holder must deposit the sums with the court which
will hold them while the matter is litigated. In Federal interpleader actions, Federal Rules of
Civil Procedure 22 applies. Likewise at common law, the bill of interpleader required. The same
thing, debt, or duty must be the res claimed by all the claimants. All the adverse titles or claims
must be dependent or derived from a common source. The stakeholder must not have or claim
any interest in the res, the stakeholder must have incurred no independent liability to any
claimant, i.e. he or she must be perfectly indifferent between them.
"The very purpose of a suit in interpleader is to prevent the prosecution of other suits against
the complainant in interpleader and to require those claiming the fund in the hands of the
interpleader to litigate their differences between themselves." Drummond Title Co. v. Weinroth ,
77 So. 2d 606, 610 (Fla. 1955)(quoting Miller v. Gulf Life Ins. Co. , 148 Fla. 1, 3 So. 2d 519, 520
(1941) ).
Pursuant to federal criminal indictments of Dr. Brizuela as well as other healthcare
providers nationwide, BCBSA/Highmark/ BCBSMMIC seeks substantial restitution, well above
any potential actual monetary harm. Michigan Blue Cross and it has combined investigative
prosecutorial functions and decision-making functions while also having financial stakes,
including proprietary gain, in the conviction of physicians, pharmacists, healthcare providers.
Highmark, Amerihealth Caritas (AC), BCBSMMIC and Blue Cross Blue Shield Association
29
(BCBSA), as agents of the government under Health Care Fraud Prevention Partnership (HFPP)
contract and by conduct during criminal investigations, have financial stakes and proprietary gain
in the conviction of physicians, pharmacists, healthcare providers, including Dr. Brizuela.
Highmark, BCBSA, BCBSMMIC, Amerihealth Caritas, and HFPP actively engage in the
exclusion of non-preferred healthcare providers in favor of preferred healthcare providers within
their “most favored” nation health networks (MFN). Thus, a structural bias exists between the
investigative, administrative, prosecutorial functions and decision making functions of the
Highmark, BCBSMMIC CFID, BCBSA, Amerihealth Caritas, and HFPP.
BCBSA, BCBSMMIC and Highmark’s Public-Private Partnership In HFPP Has
Established A Nationwide Cartel Monopsony
According to the U.S. Census Bureau, Health Insurance Coverage in the United States: 2020
published September 14, 202, Report Number P60-274 by Katherine Keisler-Starkey and Lisa N.
Bunch, in 2020, private health insurance coverage continued to be more prevalent than public
coverage at 66.5 percent and 34.8 percent, respectively. Of the subtypes of health insurance
coverage, employment-based insurance was the most common, covering 54.4 percent of the
population for some or all of the calendar year, followed by Medicare (18.4 percent), Medicaid
(17.8 percent), direct-purchase coverage (10.5 percent), TRICARE (2.8 percent), and
Department of Veterans Affairs (VA) or Civilian Health and Medical Program of the Department
of Veterans Affairs (CHAMPVA) coverage (0.9 percent).
Blue Cross Blue Shield controls the health insurance coverage of 106 million, or one out of
every 3 Americans. The U.S. Executive Branch through Health and Human Services
(HHS/CMS) controls the health care coverage of roughly 40% of all Americans. Together
30
HHS/CMS and the Blue Cross Blue Shield Companies control 73% of the entire U.S. healthcare
payor market. In economics, a monopsony (oligopsony or monopsonistic competition) is
a market structure in which a single buyer substantially controls the market as the major
purchaser of goods and services offered by many would-be sellers. The microeconomic theory of
monopsony assumes a single entity to have market power over all sellers as the only purchaser of
a good or service. This is a similar power to that of a monopolist, which can influence the price
for its buyers in a monopoly, where multiple buyers have only one seller of a good or service
available to purchase from.
Economists use the term "monopsony power" in a manner similar to "monopoly power", as a
shorthand reference for a scenario in which there is one dominant power in the buying
relationship, so that power is able to set prices to maximize profits not subject to competitive
constraints. Monopsony power exists when one buyer faces little competition from other buyers
for that labor or good, so they are able to set wages or prices for the labor or goods they are
buying at a level lower than would be the case in a competitive market. In economic literature
the term "monopsony" is predominantly used when referring to labor markets, however could be
applied to any industry, good or service where a buyer has market power over all sellers.
A classic theoretical example is a mining town, where the company that owns the mine is
able to set wages low since they face no competition from other employers in hiring workers,
because they are the only employer in the town, and geographic isolation or obstacles prevent
workers from seeking employment in other locations. The lower employment and wages caused
by monopsony power have two distinct effects on the economic welfare of the people involved.
Firstly, it redistributes welfare away from workers and to the monopsony. Secondly, it reduces
the aggregate (or social) welfare enjoyed by both groups taken together, as the monopsonists’ net
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gain is smaller than the loss inflicted on workers. This net social loss is called deadweight loss
and is a measure of the market failure caused by monopsony power, through a wasteful
misallocation of resources. The market failure can only be addressed in one of two ways: either
by breaking up the monopsony through anti-trust intervention, or by regulating the wage policy
of firms.
BCBSA/Highmark/ BCBSMMIC has publicly announced joint partnership with Health Care
Fraud Preventive Partnership (HFPP). Just like a monopolist, the monopsonistic public-private
“cartel”, maximizes profits through discriminatory fixed wages to healthcare professionals. In
this case the HFPP insurers pays different wages to different groups of workers (i.e. through
Blue Cross Blue Shield “most favored” Nation Health Networks), and lower wages paid to
disfavored healthcare providers. The simpler explanation of monopsony power in labor markets
is barriers to entry on the demand side. Such barriers to entry would result in a limited number of
private health insurance companies competing for labor (oligopsony). The BCBSA/HFPP
monopsony evidence is well described by Health and Human Services (HHS) Center for
Medicare Services (CMS) documents which has identified that physician and healthcare provider
inflation adjusted wages decreased as BCBSA/HFPP “cartel” industry concentration increased.
The BCBSA/HFPP controlled healthcare industry is very consolidated and successfully reduced
independent physicians and healthcare practitioners over many consecutive years.
BCBSA/HFPP targets highly skilled healthcare industries as it would be unable to drive down
wages via monopsonistic power if it were also competing against retail stores, construction, and
other jobs utilizing the same labor skill set. Low-skilled labor can move more fluidly through
different industries unlike highly skilled physicians and healthcare providers which is also
supported by studies of American labor markets which found monopsony effects were limited to
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professional sports, teaching, and nursing, and fields where skill sets limit moving to comparably
paid other industries. Monopsony power over physicians and healthcare providers by Highmark,
HFPP, BCBSMMIC and Blue Cross Blue Shield Association is also impacted due to
circumstances affecting entry of healthcare providers on the supply side directly reducing the
elasticity of labor supply to healthcare markets. Paramount among these are healthcare industry
accreditation or healthcare licensing fees, healthcare regulatory constraints, training or education
requirements, and the institutional factors that limit labor mobility between firms, including job
protection legislation.
Highly skilled healthcare industries have highly specialized labor conditions and physicians
are generally not substitutable. The HFPP and Blue Cross Blue Shield private insurers engage in
captive supply with Highmark and BCBSMMIC to maximize its own profits often at the
unknowing expense to the public due to the concealment of the collusion of Highmark,
BCBSMMIC, HFPP and the Blue Cross Blue Shield Companies. This is usually a characteristic
of a market that is dominated by one firm or a few firms and implicit collusion between those
firms. Often captive supply is called a beneficial market agreement by those controlling the
supply but the actions of those controlling that supply reveal otherwise. Captive supply is used to
subvert the natural forces of market price determination to accrue more economic benefits to
those who control it. It circumvents the typically price-moderating market force of supply and
demand by artificially restricting the supply.
The alleged monopolistic and price fixing activity of the Blue Cross Blue Shield
Companies is of common public awareness due to its recent antitrust settlement, arising from a
class action antitrust lawsuit called In re: Blue Cross Blue Shield Antitrust Litigation MDL 2406,
N.D. Ala. Master File No. 2:13-cv-20000-RDP, which was reached on behalf of individuals and
33
companies that purchased or received health insurance provided or administered by a Blue Cross
Blue Shield company. The Class Representatives reached a Settlement on October 16, 2020, with
the Blue Cross Blue Shield Association (BCBSA) and settling Individual Blue Plans that
knowingly violated antitrust laws by entering into an agreement not to compete with each other
and to limit competition among themselves in selling health insurance and administrative
services for health insurance. See https://www.bcbssettlement.com/.
Since the formation of the HFPP to the present, BCBSA/Highmark/ BCBSMMIC in the
HFPP, engaged in anticompetitive and deceptive conduct; willfully maintained monopoly and
monopsony power through such conduct; had a specific intent to monopolize; had a dangerous
probability of achieving monopoly and monopsony power; have not offered a non-pretextual
procompetitive justification that could not have been obtained through less restrictive means;
engineered anticompetitive effects of the public-private HFPP partnership so that the conduct
outweighs their proffered procompetitive benefits; and referred their business competitors to the
USDOJ, General Dynamics Information Technology (GDIT), or NBI Medic Qlarant for criminal
prosecution for purposes of eliminating respective business competitors and inducing fear in the
remaining physician, business, competitors.
HFPP private health insurers, BCBSA, BCBSMMIC, Highmark, Amerihealth Caritas,
PerformRx, and Perform Specialty Pharmacy actively engages in the exclusion of non-preferred
healthcare providers in favor of preferred healthcare providers within their “most favored nation”
Health Networks. Thus, a structural bias exists between the investigative, administrative,
prosecutorial functions and decision making functions of the HFPP, Blue Cross Blue Shield
Companies, BCBSMMIC and Highmark. In this manner with the Blue Cross Blue Shield
Companies expertise, Highmark and BCBSMMIC through the HFPP can formalize a physician
34
conviction process that is analogous to a commercial business process of eliminating the Blue
Cross Blue Shield Companies and the HFPP’s business competitors. The targeting of individual,
small, and upstart health entities by the Blue Cross Blue Shield Companies and HFPP allows it
to eliminate competition, restrain trade, and monopolize the U.S. healthcare market. The Blue
Cross Blue Shield Companies in concert with the Government and HFPP violates the per se rule,
“by a price restraint that tends to provide the same economic rewards to all practitioners
regardless of their skill, experience, training, or willingness to employ innovative and difficult
procedures in individual cases. Such a restraint may also discourage entry into the market and
may deter experimentation and new developments by individual entrepreneurs” quoting P.457 U.
S. 348 Arizona v. Maricopa County Med.Soc'y, 457 U.S. 332 (1982) ; and Group Life & Health
Ins. Co. v. Royal Drug Co., Inc., 440 U.S. 205 (1979).
Dr. Brizuela further argue that there is misuse of the HFPP public/private partnership, so
as to gain excessive market share in the health insurance market and exclude other market
participants in the restraint of trade. Pursuant to collateral estoppel, the restraint of trade by
Blue Cross Blue Shield Association (BCBSA) and its franchisees has been determined under In
re Blue Cross Blue Shield Antitrust Litig., FINAL ORDER, Master File No.: 2:13-CV-20000-
RDP (MDL NO.: 2406) (N.D. Ala. 2018). BCBSA/Highmark/BCBSMMIC violated Sections 1,
2, and 3 of the Sherman Antitrust Act, 15 U.S.C. §§ 1-3, by entering into an unlawful agreement
that restrained competition between them in the markets for selling health insurance and the
administration of Commercial Health Benefit Products in the United States and its territories.
BCBSA/Highmark/BCBSMMIC: (1) allocated geographic territories; (2) limited the Member
Plans from competing against each other, even when not using a Blue name, by mandating a
minimum percentage of business that each Member Plan must do under that name, both inside
35
and outside each Member Plan’s territory; (3) restricted the right of any Member Plan to be sold
to a company that is not a member of BCBSA; and (4) further agreed to other ancillary restraints
on competition. (Doc. # 1082).
BCBSA/Highmark/ BCBSMMIC CFID assists law enforcement by completion of a
“doctor targeting package”, commonly initiated in retaliation to higher medication expense and
less profits for BCBSA/Highmark/ BCBSMMIC. When a physician orders a medication, that a
private health care insurer perceives to be higher than average cost, without regard of the specific
disease state of the patient or the specific pharmacokinetic or pharmacodynamics of the costlier
medication, BCBSA/Highmark/ BCBSMMIC CFID induces criminal proceedings against the
doctor.
There is a preponderance of evidence that Blue Cross has retaliated against Dr. Brizuela
for advocating on behalf of his patients. Dr. Brizuela has been and is currently in extensive
communication with numerous U.S. physician associations and U.S. physicians like Dr. Joseph
Zolot (United States v. Zolot Criminal Action No. 11-10070-PBS) and Dr. Dralves Edwards
(Dralves Gene Edwards, M.D. v. Blue Cross Blue Shield of Texas 03-06872-B) who have
expressed similar retaliation, harassment and bullying by Blue Cross Blue Shield, including
Highmark Blue Cross, BCBSMMIC and other health insurance company affiliates of the Blue
Cross Blue Shield Association network. The intentional and unlawful actions of the Blue Cross
Blue Shield Association network against physicians nationwide have forced Dr. Brizuela and
other physicians to file complaints with the United Nations Human Rights Council. Currently
one of the Human Rights Committees at Council of Organizations is investigating all evidence
that has been collected by U.S. physician associations and U.S. patient groups regarding the
regulatory capture of the U.S. health insurance market, restraint of trade, and the organized
36
persecution of physicians and their patients, by the Blue Cross Blue Shield Association as well as
its member organizations including Highmark and BCBSMMIC.
Dr. Brizuela is in possession of evidence of discriminatory practices by Pennsylvania
Blue Cross (“IBC and Highmark”) and its parent organization, Blue Cross Blue Shield
Association (Appendix D), in violation of the 14th Constitutional Amendment Equal Protection
Clauses. Pennsylvania Blue Cross Blue Shield and its partners induced criminal proceedings
against Dr. Brizuela for using expensive medications to treat patients. U.S. Attorney Office
Prosecutors know or should have known of outcome uncertainty inherent in the Pennsylvania
and Michigan Blue Cross mathematical algorithms used in speeding, coordinating and
strengthening convictions of doctors. The computer algorithms and data analytic, targeting
packages of Pennsylvania and Michigan Blue Cross, as well as the validity and reliability testing
of Pennsylvania and Michigan Blue Cross criminal forensic, pre-crime criminal forensic tools
are withheld from criminal defense trial attorneys. This information at either pre-trial advocacy
or during a criminal trial would have impeached testimony based on novel ideas which were/are
essential to the government's case in chief.
According to Blue Cross Blue Shield Association documents (see Appendix E), the
“Corporate and Financial Investigations Department (CFID) is responsible for the prevention,
detection, and investigation of all potential areas of fraud, waste, and abuse against Independence
Blue Cross. The CFID is also responsible for conducting audits of Providers and pharmaceutical-
related services. It identifies, selects, and audits Providers for inaccurately paid claims. In
addition, the CFID seeks financial recoveries of overpaid claims and submits these claims for
correct adjudication. CFID Support uses data-mining software to proactively identify aberrant
claims, billing patterns, and trends across all Independence lines of business. CFID Support
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gathers and evaluates information from a variety of sources to support CFID including STARS
and STAR Sentinel sophisticated software data-mining tools that analyze all categories of claims
received, Provider demographics, and Member benefits are primary sources of audit and
investigation identification and selection. Financial Investigations evaluates all allegations of
fraud, waste, and abuse involving Providers, Members, vendors, associates, and others. They use
a wide array of investigative tools to: a) identify and investigate fraudulent and abusive
activities; b) make referrals to federal, State, and local law enforcement for criminal and/or civil
prosecution; c) make referrals to regulatory authorities for violations of professional licensure; d)
recover losses related to fraud and abuse; e) employ prevention techniques to decrease and
eliminate future losses; f) make recommendations to terminate Providers for cause from the
Independence network.”
BCBSA’s data analytics, controlled substances and healthcare fraud STARS and STAR
Sentinel computer programs, cause denial of treatment to patients. BCBSA’s computer
algorithms target “colored”, non-white physicians via a “physician conviction engine” which is a
violation of Human Rights Under Article 32 of the 1949 Geneva Convention IV. See United
States v. Karl Brandt. In United States v. Andrew M. Berkowitz, Case No. 19-356, in the Eastern
District of Pennsylvania Case 2:19-cv-02719-JD, Document 1, filed on, 06/24/2019, describes
how IBC induced criminal proceedings against Dr. Andrew Berkowitz, a Jewish physician.
A duty to treat patients afflicted with chronic pain and/or addiction, is established under
Federal Law including Affordable Care Act, Mental Health Parity and Addiction Equity Act,
The Rehabilitation Act, The American Disability Act, Drug Addiction Treatment Act of 2000
(Data 2000). Several medical, scientific, and ethical guidelines address the needs of palliative
and chronic pain and addiction care. Blue Cross Blue Shield artificial intelligence computer
38
programs are “medical or scientific experiments not necessitated by the medical treatment of a
protected person” and are thus prohibited. According to Article 147 of Geneva convention,
BCBSA, is conducting biological experiments on protected persons which is a grave breach of
the Convention. BCBSA data analytic physician conviction engine and controlled substance
algorithms are crimes against humanity violating: Nuremberg Code #1: Voluntary Consent;
Nuremberg Code #2: Yield Fruitful Results Unprocurable By Other Means; Nuremberg Code #3:
Base Experiments on Natural History of Disease; Nuremberg Code #4: Avoid All Unnecessary
Suffering and Injury; Nuremberg Code #5: No Experiment to be Conducted if There’s Reason to
Think Injury Will Occur; Nuremberg Code #6: Risk Should Never Exceed the Benefit;
Nuremberg Code #7: Preparation Made Against Remote Possibility of Injury, Disability or
Death; Nuremberg Code #8: Experiment Must Be Conducted by Scientifically Qualified
Persons; Nuremberg Code #9: The Freedom to Bring the Experiment to an End At Any Time;
Nuremberg Code #10: Bring the Experiment to an End At Any Time if There’s Probable Cause
of it Resulting in Injury or Death.
The Fourteenth Amendment provides that "no State shall . . . deprive any person of life,
liberty, or property, without due process of law. . . ." U.S. Const. amend. XIV, § 1. The Fourteenth
Amendment governs only state conduct, not that of private citizens. Rendell-Baker v. Kohn, 457
U.S. 830, 837-38, 102 S.Ct. 2764, 73 L.Ed.2d 418 (1982). The U.S. Department of Justice also,
through BCBSA/HFPP, converts or manipulates primary evidence to manufacture demonstrative
testimonial evidence in order to manufacture probable cause in supportive affidavits of search
warrants, as well as coordinate the criminal convictions of selective physicians, pharmacists and
other healthcare providers nationwide in a targeted and discriminatory fashion, as evidenced by
39
the extensive “Schindler’s type list” of prosecuted Black and Brown skin (Appendix C) as well as
Jewish physicians (Appendix A and B) that Dr. Brizuela has in his possession.
Blue Cross Blue Shield Association (BCBSA) and settling Individual Blue Plans (Appendix
D) knowingly violated antitrust laws by entering into an agreement not to compete with each
other and to limit competition among themselves in selling health insurance and administrative
services for health insurance. See https://www.bcbssettlement.com/. Blue Plan Special
Investigative Units, of the Blue Cross BlueShield Association (BCBSA), function as State Actors
in partnership with the HFPP as already admitted by Gary Cantrell, Deputy Inspector General for
Investigations Office of Investigations, Office of Inspector General Department of Health and
Human Services. The policies and goals of the Blue Plan Special Investigative Units are
coordinated by the Blue Cross Blue Shield Association’s Office of Policy and Representation.
Justine Handelman is senior vice president of the Office of Policy and Representation for the
Blue Cross BlueShield Association (BCBSA), a national federation of 34 independent,
community-based and locally operated Blue Cross and Blue Shield (BCBS) companies.
Today, roughly one in three Americans is covered by the Blue Cross Blue Shield System.
BCBSA negotiates with the U.S. Office of Personnel Management (OPM) to determine the
benefits and premiums for the Service Benefit Plan or Federal Employee Program. “In
overseeing BCBSA lobbying and policy development activities, Handelman represents BCBSA's
Washington office and BCBS companies with the Administration, Congress, government
agencies and other national associations. Handelman is involved in the development of
legislative and regulatory policy positions and legislative strategy on a wide range of issues,
including healthcare reform, government programs, healthcare financing, tax legislation and
health information technology”.
40
“During her tenure, Handelman developed key policy positions that were incorporated in
legislation enacted by Congress on key healthcare issues, including Medicare Modernization
Act, the Affordable Care Act, legislation to prevent opioid abuse and/or legislation to address
mental health parity.” Brizuela argues that the Blue Cross Blue Shield Association and Blue
Cross Blue Shield policies as overseen by Handelman continue to target colored, Black and
Brown dark skin, physicians of color, or Jewish physicians including Dr. Francene Gayle, Dr.
Mark Murphy, Dr. Orlando Leiva, and others who were arrested in nationwide opioid sweep
induced by Blue Cross Blue Shield.
Brizuela argues that Blue Cross Blue Shield Association has established racially disparate,
Most Favored Nation Health Networks (MFN), which are comprised mostly of physicians with
white skin. Blue Cross Blue Shield Association seeks to regulate and restrain trade in the
healthcare market by picking the winning physicians for invitation into the BCBSA’s MFN
while referring, unfavored, dark skin, colored practitioners who prescribe controlled substance
medications to Federal law enforcement and Michigan State law enforcement for criminal
indictment. In this manner, with BCBSA’s expertise, and in partnership with HFPP, the public-
private partnership can formalize a physician conviction process that is analogous to a
commercial business process of having Michigan State and Federal governments eliminate the
Michigan Blue Cross’ business competitors.
BCBSA has established in Michigan its “Most Favored Nation” Health Networks (MFN) that
are comprised mostly of White physicians as compared to “colored” Black and Brown skin
physicians. BCBSA seeks to regulate and restrain trade in the Michigan market by picking the
winning physicians for invitation into the BCBSA’s MFN, while referring to the Federal law
enforcement and Michigan State law for criminal indictment and prosecution, disfavored, dark
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skin, “colored” practitioners who prescribe Controlled Substance medications. BCBSA and their
subsidiary Amerihealth Caritas has a pattern of racial bias against Brown and Black, dark skin,
“colored” physicians including Philadelphia physicians, Dr. Neil Anand (Indian-Brown Skin),
Dr. Clarence Verdell (Black Skin), Dr. Walter Wrenn (Black Skin), Dr. Emmanuel Okolo (Black
Skin), and Dr. Mohanad Fallouh (Middle Eastern-Brown Skin), Dr. Ramesh Sarvaiya (Indian-
Brown Skin). Michigan Blue Cross Blue Shield and Amerihealth Caritas also racially targeted
and induced criminal proceedings against Michigan physicians of color, Dr. Lesly Pompy (Black
Skin), Dr. Ganiu Edu (Black Skin), Dr. David Lewis (Black Skin), and Dr. Rajendra Bothra
(Indian-Brown Skin).
Intervenor Brizuela seeks to litigate against BCBSA pertaining to the continuous dangerous
shift in the balance of power over medical decision making away from physicians to large risk
underwriting insurance companies, who have no significant comprehension or experience in
practicing medicine, have no vested interest in experimental medical advancement, and whose
primary measure of success is economic profits. Thus, it was foreseeable that Blue Cross Blue
Shield actions against physicians nationwide would give rise to mass tort litigation. The practice
of medicine hangs in the balance because prescribers who are experts in prescribing controlled
substances will be fearful of prescribing due to disagreements with BCBSA, pertaining to
medical decisions which constantly change over time and for which no definitive medical
standard exists, due to continuous scientific and technological advancement. Physicians are
contracted with BCBSA and their HFPP partners to treat a “risk adverse” population of chronic
pain or substance abuse disorder patients, as well as practice medicine in a race-neutral manner,
without facing intentional or reckless permanent foreclosure of Intervenor Brizuela’s ability to
practice medicine by BCBSA.
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Notice of Numerous Violations of Michigan Law By Michigan Blue Cross Blue Shield
Companies
Michigan Blue Cross Blue Shield Companies are engaging in illegal alternative risk
transfer upon health care providers, or involved in foisting and fronting illegal “captive insurance
agreements” upon unwitting healthcare providers. Sound insurance underwriting requires
accurately predicting the likelihood and cost of policy claims. Insurers also want to predict their
future investment and premium income. But even the best forecasts can err. Thus, large swings
in costs or income can affect profits industry wide or in particular industry segments.
Adverse selection typically refers to the theoretical tendency for high-risk people to be
more interested in insurance than low-risk people are. For example, all else equal, someone with
a history of medical problems (i.e., chronic disabling intractable pain) is more likely to be
concerned about losing health insurance than someone who has always been in good health.
Similarly, Insurers face particularly acute uncertainty when writing “long tail” coverage that may
extend for many years after premiums are received. The costs of paying out on claims for
chronic pain or addicted patients increased “underwriting risks” to the Michigan Blue Cross Blue
Shield Companies.
These “underwriting risks” to the Michigan Blue Cross Blue Shield Companies increased
dramatically and unexpectedly at the time someone become a chronic pain or addicted patient,
resulting in unanticipated losses for insurers that wrote the policies. Such unanticipated changes
can result in underwriting cycles in which profits for health insurers swing from well above the
historic average to well below historical averages. These cycles in “underwriting risk”, can in
turn, can have political consequences. Health insurers like Michigan Blue Cross Blue Shield
may face populist resentment when profits are high, and may seek government support and
43
favors when profits are low. In anticipation for the profit cycles, the Michigan Blue Cross Blue
Shield Companies purposefully intertwine their business with government actions.
Michigan Blue Cross Blue Shield Companies have been engaged in a pattern of criminal
activities for years inclusive of schemes calculated to deceive and defraud physicians and other
health care providers who are merely in possession of ordinary prudence and comprehension.
Health care providers and other members of the learned medical professions have error of
diagnosis risks, treatment risks, infectious risks, risks of contagion, criminal risks and
malpractice risks. Michigan Blue Cross Blue Shield Companies risk are limited to profits and
losses from actuarial underwriting, or risks of investment of insurance floats. Michigan Blue
Cross Blue Shield Companies have a notorious reputation for denying payments, retracting
payments, offsetting of payments, misleading doctors with respect to prior authorization, and
other forms of non-payments. Michigan Blue Cross Blue Shield Companies through its
intentional deceptive actions is transferring all claim payment risks to the health care provider
thereby making the unsuspecting health care provider the actual assumer of Michigan Blue Cross
Blue Shield Companies own Member’s disease underwriting risk.
Michigan Blue Cross Blue Shield Companies are engaging in illegal alternative insurance
risk transfers upon its contracted health care providers. Michigan Blue Cross Blue Shield
Companies behaviors suggest that it is involved in foisting and fronting illegal captive insurance
upon unwitting healthcare providers through the guise of a Provider Contract. Alternative risk
transfer (ART) is the use of techniques other than traditional insurance and reinsurance to
provide risk-bearing entities with coverage or protection. A fronting policy is a risk management
technique in which an insurer underwrites a policy to cover a specific risk, but then cedes the risk
to a reinsurer. Fronting policies, which are a type of alternative risk transfer (ART), is a risk
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management mechanism in which an insurer underwrites a policy to cover a specific risk or a set
of risks, which in Michigan Blue Cross Blue Shield Companies case is underwriting of risk of
disease and treatment of that disease. Michigan Blue Cross Blue Shield Companies can assume
the risk or cede the risk to a reinsurer, where the reinsurer is responsible for claims made against
the policy it now controls.
Michigan Blue Cross Blue Shield Companies sign contracts with its Members providing
underwriting of disease risk. It also signs Provider Contracts with health care providers that
receive “In Network” discounted fees for health care services. Michigan Blue Cross Blue Shield
Companies Provider Contracts are ploys. These Provider Contracts are actually an illegal form
of captive insurance ART, where Michigan Blue Cross Blue Shield Companies assume the role
of a Fronting health care insurer while the health care provider through the Provider Agreement
becomes an unwitting Captive “Re-Insurer” of Michigan Blue Cross Blue Shield Companies
Members. The health care provider then engages with an Michigan Blue Cross Blue Shield
Companies Member to diagnose and treat disease, assuming ALL traditional risks associated
with the learned medical profession but now also assuming disease payment claim risks, while
Michigan Blue Cross Blue Shield Companies as the fronting insurance company assumes
virtually zero risks or negligible risk.
Fronting has been defined as the use of a licensed, admitted insurer to issue an insurance
policy on behalf of a self-insured organization or captive insurer without the intention of
transferring any risk. The risk of loss is retained by the captive insurer through an indemnity
agreement. Traditionally the captive insurer is an unlicensed, non-admitted insurer. As a general
rule, it is illegal for an unlicensed insurer to issue policies. Health care providers cannot legally
engage in providing health care insurance coverage to patients.
45
Michigan Blue Cross Blue Shield Companies Provider Contracts do not use Captive or
Reinsurance vernacular in order to hoodwink “In Network” health care providers to assume the
entirety of the disease underwriting risks of Michigan Blue Cross Blue Shield Companies
Members. Michigan Blue Cross Blue Shield Companies through their duplicitous “Provider
Contracts”, has via the process of insurance fronting created an illegal “captive reinsurance”
alternative risk transfer vehicle upon unwitting health care providers. Michigan Blue Cross Blue
Shield Companies can then willfully under guise of “contract” subject these unfortunate “in
network” providers to Michigan Blue Cross Blue Shield Companies Byzantine fraudulent
schemes including non-payment of claims, retraction of claims, offsetting of claims etc.
This preference by Michigan Blue Cross Blue Shield Companies for the illegal captive
alternative risk transfer reinsurance “vehicle” is the prime reason why Michigan Blue Cross Blue
Shield Companies make unsolicited calls to Members utilizing their out of network benefits.
Michigan Blue Cross Blue Shield Companies actively discourages its Members to not use their
out of network benefits so as to assume virtually zero or negligible payments of submitted health
insurance claims.
Michigan Blue Cross Blue Shield Companies through its deceitful “Provider Contracts”
have figured out how to transfer this risk upon an involuntary In-Network provider. These
involuntary and unsuspecting health care providers are then assuming all underwriting risks as an
unwitting Captive “Re-Insurer”.
Furthermore, Michigan Blue Cross Blue Shield Companies are no longer protected by the
McCarran–Ferguson Act because on January 13, 2021, the President signed into law legislation
that eliminates some immunities for health insurers. The Competitive Health Insurance Reform
Act of 2020, passed unanimously by the Senate, repeals portions of the McCarran–Ferguson Act.
46
Michigan Blue Cross Blue Shield Companies engage in creating fictitious Provider Agreements
that are in actuality, illegal Alternative Risk Transfer Re-Insurance Captive contracts, that bind
ignorant health care providers into becoming unlicensed illegal agents of unauthorized insurer
activity.
Violation of Employment Retirement Income Security Act (ERISA) By The Michigan Blue
Cross Blue Shield Companies
Courts have generally found that assignment of benefits by the patient-beneficiary to a
healthcare provider can confer standing under ERISA section 502(a)(2). See Bloom v. Indep.
Blue Cross, 152 F. Supp. 3d 431, 439 (E.D. Pa. 2015) (citing CardioNet, Inc. v. Cigna Health
Corp., 751 F.3d 165, 176 n.10 (3d Cir. 2014)); see also New Jersey Brain & Spine Ctr. v. Aetna,
Inc., 801 F.3d 369 (3d Cir. 2015).
Michigan Blue Cross Blue Shield Companies often sign valid assignment of benefits,
doctor patient covenants, and contracts with Physicians and other healthcare providers. ERISA's
regulations set out the specifics of claims processing, including guidelines that health insurance
companies must follow when they establish internal rules for claims processing. The regulations
set time limits for deciding claims and appeals, govern the content of notices to participants of
claim denials and rights to appeal, and require consistent decisions on similar types of claims.
Under ERISA, those who exercise discretion over management of the plan or who are
named as fiduciaries in the plan are subject to fiduciary duties, and so is any person exercising
material discretion over plan assets or administration. This means that the individuals who make
healthcare benefit decisions are acting as fiduciaries and are bound by these duties; ERISA's
legislative history supports the imposition of fiduciary duties upon those who make claims
determinations and pay plan benefits. ERISA fiduciaries must discharge their duties with respect
47
to the plan "solely in the interest of the participants and beneficiaries. . .." also required to carry
out their duties "in accordance with the documents and instruments governing the plan.” The
traditional trustee, i.e., Michigan Blue Cross Blue Shield Companies, "is not permitted to place
himself in a position where it would be for his own benefit to violate his duty to the
beneficiaries."
In an ERISA healthcare claim, the denial notification to the patient triggers the due
process rights of the patient. The claim administrator has a fiduciary duty to the patient and basic
claim regulations are applicable to all benefit claims, including healthcare claims.
A healthcare claim denial notice must include:
(i) the specific reason or reasons for the adverse determination.
(ii) reference to the specific plan provisions on which the determination is based.
(iii) a description of any additional material or information necessary for the claimant to
perfect the claim and an explanation of why such material or information is necessary.
(iv) a description of the plan’s review procedures and the time limits applicable to such
procedures, including a statement of the claimant’s right to bring a civil action of the act
following an adverse benefit determination on review.
(v) a group healthcare plan must provide the guideline, the protocol, or other criteria
relied upon to the patient or state that a copy of it will be provided to the patient upon
request.
(vi) if the denial is based on lack of medical necessity or experimental treatment, there
must be an
48
explanation of the scientific or clinical judgment that applies the terms of the plan to the
patient’s medical circumstances or states that the explanation will be provided upon
request.
(vii) healthcare claims are subject to additional Affordable Care Act (ACA) regulations.
(viii) when the healthcare plan administrator fails to follow the regulatory claim
procedures, it will be deemed to have exhausted the appeal process.
(ix) ACA regulations mandate continued coverage and treatment during the appeal if the
adverse determination or denial involves the reduction or termination of treatment.
(x) the claim appeal must be timely processed, and one extension may be obtained by
written notice.
(xi) the claim administrator should have safeguards designed to ensure that plan
provisions are interpreted and applied consistently, in accord with the plan documents
Under the regulations, plan administrators like the Michigan Blue Cross Blue Shield
Companies, have an obligation to maintain reasonable claims procedures. Claims procedures are
defined as unreasonable if they contain any provision unduly inhibiting the processing of claims.
Michigan Blue Cross Blue Shield Companies failed in this regard. Procedures must contain
"administrative processes and safeguards" designed to ensure that plan provisions are interpreted
and applied consistently, and that decisions are made according to plan documents. Michigan
Blue Cross Blue Shield Companies failed in this regard. Claims for benefits must be processed
within thirty days after the plan's receipt of the claim, unless the plan administrator determines
that a fifteen-day extension is necessary and sends written notice of the extension. Michigan
Blue Cross Blue Shield Companies failed in this regard.
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If a claim is denied, a written denial must set out the basis for the denial, reference the
specific plan provision upon which the decision was based, and give a description of any
additional material or information needed to pursue the claim. Michigan Blue Cross Blue Shield
Companies failed in this regard.
If an internal rule, guideline, protocol, or similar criterion was relied upon in the denial,
that rule or criterion must be disclosed to the claimant upon request. In addition, the notice must
be written "in a manner calculated to be understood by the claimant." Michigan Blue Cross Blue
Shield Companies failed in this regard. The denial notice must also contain appropriate
information as to the steps required if the Participant wishes to submit the claim for review.
Michigan Blue Cross Blue Shield Companies failed in this regard. When benefits are denied, the
plan must afford the Participant the opportunity for a full and fair review. Michigan Blue Cross
Blue Shield Companies failed in this regard.
ERISA contains statutory penalty provisions related to healthcare claims. ERISA
provides for a $110 per day penalty for each day following the expiration of thirty days
following a Participant's request for a Summary Plan Description. Michigan Blue Cross Blue
Shield Companies failed in this regard. Michigan Blue Cross Blue Shield Companies violated
the procedures mandated by ERISA in a way that is "so flagrant as to alter the substantive
relationship between the employer and employee, thereby causing the beneficiary substantive
harm."
Michigan Blue Cross Blue Shield Companies have abused its discretion by failing to
provide a full and fair review. See, e.g., Blue Cross Blue Shield Settlement Information, AM.
MED. Ass'N, http://www.ama-assn.org/amalpub/advocacy/current-topics-advocacy/private-
sector-advocacy/ health-insurer-settlements/blue-cross-blue-shield.page (detailing business
50
practices such as automatic "downcoding" of certain billing codes that would no longer occur
under the settlement agreement's terms).
Each time the Michigan Blue Cross Blue Shield Companies failed to comply with the
regulations, it breaches its fiduciary duties. Parke v. First Reliance Standard Life Ins. Co., 368
F.3d 999, 1005-09, (8th Cir. 2004) ("[A]n award of interest on wrongfully delayed benefits
remains permissible ... as a remedy for a breach of fiduciary duty to a beneficiary."); Dunnigan v.
Metro. Life Ins. Co., 214 F.R.D. 125, 134-35 (S.D.N.Y. 2003) (noting that interest on wrongfully
withheld benefits is available under ERISA because it fits within the relief "typically available in
equity"). Insurance companies like Michigan Blue Cross Blue Shield Companies are subject to
state law in states that have established an external review process must meet the consumer
protection standards of the federal statute. Michigan Blue Cross Blue Shield Companies are in
breach of an implied duty of good faith and fair dealing with respect to ERISA health care
claims. The duty of an insurer to deal fairly and in good faith with its insured is governed by
decisions in Crisci v. Security Ins. Co (1967) and Communale v. Traders General Ins. Co (1958)
50 Cal. 2d 654 (328 P.2d 198, 68 A.L.R 2d 883). 549. A breach in contract and tort is imposed
upon Michigan Blue Cross Blue Shield Companies for unpaid health claims because there is an
implied covenant of good faith and dealing in every contract and insurance policies that neither
party will injure the right of the other to receive benefits of the agreement. (Comunale, supra at
page 658.)
Furthermore, New York State Conference of Blue Cross & Blue Shield v. Travelers
Insurance Co. Travelers was notable because the US Supreme Court curtailed ERISA’s
preemptory reach, concluding that the New York law was not preempted by the ERISA. The
Travelers Court noted that nothing about the ERISA or its legislative history “indicates that
51
Congress chose to displace general health care regulations, which historically has been a matter
of local concern.” Therefore, SCOTUS decision supports that ERISA violations by the Michigan
Blue Cross Blue Shield Companies are of Michigan citizen concern.
Violations of Gramm-Leach-Bliley Act by the Michigan Blue Cross Blue Shield Companies
Michigan Blue Cross Blue Shield Companies are knowingly and intentionally violating
the law with the intent to defraud the public and numerous health care providers. Insurance
companies exist in stock and mutual forms. Mutual insurers are owned by their policyholders.
Demutualization is the conversion of mutual firms to shareholder ownership which became the
dominant business model after the Gramm-Leach-Bliley Act. The Act nation demutualization by
making it easier for insurers to reincorporate in states receptive to demutualization. Moreover, to
affiliate with banks, insurers needed to have outside investors and to be part of holding
companies. Mutual ownership lends itself poorly to the holding company structure. Shareholder-
owned firms can also raise capital more easily than mutual firms.
Facing difficulty in the raising of capital, Michigan Blue Cross Blue Shield Companies
initially sought to change its status from a non-profit company to a for profit company.
Michigan Blue Cross Blue Shield Companies also sought to merge with Independence Blue
Cross. Michigan Blue Cross Blue Shield Companies and their affiliates and subsidiaries include
AmeriHealth Casualty Services, and NaviNet Inc, and AmeriHealth Caritas. NaviNet Inc. speeds
and simplifies payer-provider administration, financial, and clinical transactions. Michigan Blue
Cross Blue Shield Companies affiliates and subsidiaries, and partners include BCBS of
Michigan, Highmark Blue Cross, NaviNet, and Horizon Blue Cross.
52
Michigan Blue Cross Blue Shield Companies are insurer and financial holding companies
through insurance company floats. As such, they operate under the Gramm-Leach-Bliley Act.
Section 501 of The Federal Financial Institutions Examination Council (FFIEC) agencies
provide that every financial institution should develop and implement a response program
designed to address incidents of unauthorized access to sensitive customer information
maintained by the financial institution or its service provider. The FFIEC, under the authority of
section 501(b)(3) of the Gramm-Leach-Bliley Act (GLBA), provides that the information
security standards established by the agencies must include various safeguards to protect against
not only “unauthorized access to” but also the “use of” customer information in a manner that
could result in “substantial harm or inconvenience to any customer.”
Michigan Blue Cross Blue Shield Companies violated the Act when they granted
unauthorized access to and/or traded the confidential customer information of their Members. As
a result of the breach, patients who are suffering from substance abuse with a history
documented by the health care provider of utilizing controlled substances may be compelled by
law enforcement into becoming witnesses against themselves. Such behavior also constitutes a
violation of the 5th U.S. Constitutional Amendment.
The Gramm-Leach-Bliley Act (GLBA), Section 501, provides that “each financial
institution has an affirmative and continuing obligation to respect the privacy of its customers
and to protect the security and confidentiality of those customers nonpublic personal
information. In furtherance of this policy, federal banking regulators, state insurance authorities,
and the Federal Trade Commission are instructed to “establish appropriate standards for the
financial institutions subject to their jurisdiction relating to administrative, technical, and
physical standards: (1) to insure the security and confidentiality of customer records and
53
information; (2) to protect against any anticipated threats or hazards to the security or integrity of
such records; and (3) to protect against unauthorized access to or use of such records or
information which could result in substantial harm or inconvenience to any customer.”
Michigan Blue Cross Blue Shield Companies intentionally violated Section 502(e) of the
Gramm-Leach-Bliley Act. Health insurers like Michigan Blue Cross Blue Shield Companies
obtain personal information about their clients to determine insurable risks, and determine the
insurance premium rates. Michigan Blue Cross Blue Shield Companies is an “information
broker.” The Gramm-Leach-Bliley Act prevents the use of fraudulent techniques to obtain
customer information through the activities of “information brokers.”
Michigan Blue Cross Blue Shield Companies cannot use any means fair or foul to ferret
out facts about financial institution customers in order to trade the information to interested
parties. Section 521(a) forbids any person to “obtain or to attempt to obtain, or cause to be
disclosed or attempt to cause to be disclosed to any person, customer information of a financial
institution related to another person” by engaging in the practice of : making a false, fictitious,
or fraudulent statement or representation to an officer, employee, or agent of a financial
institution; making a false, fictitious, or fraudulent statement or representation to a customer of a
financial institution; or providing any document to an officer, employee, or agent of a financial
institution, knowing that the document is forged, counterfeit, lost, or stolen, was fraudulently
obtained, or contains a false, fictitious, or fraudulent statement or representation.
The Act makes it a violation to trade Member patient information of an insurer and
financial institution, either to Medicare, Medicaid or any other third party for the express purpose
of hoping to obtain improper restitution from deliberate ERISA violations. Michigan Blue Cross
Blue Shield Companies actions in trading such data mined information or attempting to obtain or
54
broker private information from Medicare or Medicaid in any manner is barred by the statute 15
U.S.C. §6821(a).
Violations of Sherman and Clayton Anti-Trust Laws Under: “Quick Look” Review of
Michigan Blue Cross Blue Shield Companies Most Favored Nation Model, The “Rule of
Reason” Monopsony Approach to Fixed Physician Fee Schedules, and Illegal Per Se
Restraints of Innovative Medical Treatments and Violations of Federal Trade Commission
Laws by the Michigan Blue Cross Blue Shield Companies
Michigan Blue Cross Blue Shield Companies restraint of trade and restraint of
interchangeable and cross-elastic medical treatments are causing a reduction of output and
deterioration in quality of goods and services with respect to chronic pain management and
substance use disorder diseases. Michigan Blue Cross Blue Shield Companies restraint of trade
is causing increased U.S. citizen and Michigan citizen deaths.
Michigan Blue Cross Blue Shield Companies and its “most favored” health providers
groups, are causing market injury to individual physicians and small physician groups. The
District Court could apply the quick look analysis of the Michigan Blue Cross Blue Shield
Companies “Most Favored” nation model to determine if its anticompetitive effects require full
analysis as the Rule of Reason, as a quick look can sometimes be applied in “the twinkling of an
eye.”. See National Collegiate Athletic Ass’n v. Board of Regents of University of Oklahoma,
468 U.S. 85 (1984); FTC v. Indiana Federation of Dentists, 476 U.S. 447, 459 (1986) ;
California Dental Ass’n v. FTC, 526 U.S. 756 (1999)
Michigan Blue Cross Blue Shield Companies are the largest health care insurers in
Michigan which is the relevant geographic market, and the anesthesia, chronic pain management,
and substance abuse treatment is the relevant product market and Michigan Blue Cross Blue
Shield Companies are exerting anticompetitive effects through its Most Favored Nation Health
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Networks. Tunis Bros. Co. , 952 F. 2d 715726 (3d Cir. 1991). A violation of Section 2 of the
Sherman Clayton Act, is when a service is procured not through providing a superior product,
business acumen, or historical accident but through illegal means, and it continues to violate the
law when it is used to suppress competition.
The Sherman Act reflects a legislative judgement that ultimately competition will
produce not only lower prices, but also better goods and services. “The heart of our national
economic policy long has been faith in the value of competition.” The assumption that
competition is the best method of allocating resources in a free market recognizes that all
elements of a bargain-quality, service, safety, and durability- and not just the immediate cost, are
favorably affected by the free opportunity to select among alternative offers. Even assuming
occasional exceptions to the presumed consequences of competition, the statutory policy
precludes inquiry into the question whether competition is good or bad.” Standard Oil Co. v.
FTC, 340 U.S. 231, 248.
Michigan Blue Cross Blue Shield Companies are utilizing their monopsony market
power by substantially controlling and reducing physician fee schedules as Michigan Blue Cross
Blue Shield Companies are the major purchaser of health services offered by Michigan
physicians. Michigan Blue Cross Blue Shield Companies are also utilizing its market power to
increase the premium prices and deductibles for its Members negatively. A perfectly
competitive market produces the maximum value for society (highest consumer surplus) while a
monopoly creates significant Dead Weight Loss (lowest consumer surplus).
Michigan Blue Cross Blue Shield Companies conduct is occurring openly and publicly,
and that these unreasonable restraint of trade conducts is causing negative competitive effects in
the relevant product and geographic markets of the Greater Detroit area. Section§ 2(b) of the
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McCarran-Ferguson Act exempts the "business of insurance," not the "business of insurers."
Pp.440 U. S. 210-211. Most Favored Nation and Fixed Physician Fee Agreements involve
contractual arrangements between Michigan Blue Cross Blue Shield Companies and other local
health providers [not its policyholders, which involves the underwriting of risk]. Pp. 440 U. S.
215-217. The per se rule is violated here, “by a price restraint that tends to provide the same
economic rewards to all practitioners regardless of their skill, experience, training, or willingness
to employ innovative and difficult procedures in individual cases. Such a restraint may also
discourage entry into the market and may deter experimentation and new developments by
individual entrepreneurs” quoting P.457 U. S. 348 Arizona v. Maricopa County Med.Soc'y, 457
U.S. 332 (1982) ; and Group Life & Health Ins. Co. v. Royal Drug Co., Inc., 440 U.S. 205 (1979)
Under the per se rule, Michigan Blue Cross Blue Shield Companies are not entitled to
justify their behavior based on any objective competitive justifications. Northern Pac. Ry. Co. v.
US 356 US (1940); Agnew v. National Collegiate Athletic Ass’n, 683 F.3d 328 (7th Circ. 2012);
or In re Flat Glass Antitrust Litigation 385 F.3d 350 (3rd Cir. 2004)). Michigan Blue Cross Blue
Shield Companies actions distinguishes between “restraints with an anticompetitive effect (or
resulting in conduct likely to cause such injury) that are harmful to the consumer, as well as
restraints stimulating competition that are in the consumer’s best interest”. quoting Continental
T.V., Inc. v. GTE Sylvania Inc., 433 U.S. 26, 49 (1977); State Oil v. Kahn, 522 U.S. 3, 10
(1997)).
Michigan Blue Cross Blue Shield Companies are the largest health insurer in Detroit and
adjacent surrounding counties. Michigan Blue Cross Blue Shield Companies controls such a
large percentage of the Michigan health insurance market that it is an established monopoly.
Michigan Blue Cross Blue Shield Companies control of the market can be calculated by the
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Herfindahl-Hirschman Index (HHI). The U.S. Department of Justice uses the HHI for evaluating
potential merger issues.
Michigan Blue Cross Blue Shield Companies are unlawfully simultaneously regulating a
market while being an active participant in that market through its Most Favored Nation Health
Networks. North Carolina State Board of Dental Examiners v FTC, S. Ct 13-534 (2015). The
question answered in this case pertains to whether state actors/agencies were liable to anti-trust
claims if they simultaneously regulated a market and were active participants in that market. The
Supreme Court concluded that the state actors/agencies were liable to anti-trust claims quoting:
“Limits on state-action immunity are most essential when the State seeks to delegate its
regulatory power to active market participants, for established ethical standards may blend with
private anticompetitive motives in a way difficult even for market participants to discern. Dual
allegiances are not always apparent to an actor. In consequence, active market participants
cannot be allowed to regulate their own markets free from antitrust accountability.” Midcal.
Supra At 106, 100 S. Ct. 937, Allied Tube & Conduit Corp v. Indian Head Inc, 486 US 492, 501,
108 S. Ct 1931, 100 L. Ed. 2d 497 (1988); Hoover, supra. At 584, 104 S. Ct 1989. At 1111.
The monopolization of the health insurance market by Michigan Blue Cross Blue Shield
Companies has resulted in a decrease of competition in the market for healthcare insurance at a
detriment to patient care. Although Michigan Blue Cross Blue Shield Companies argue that the
McCarran-Ferguson Act exempts from application of antitrust law activities that are in the
“business of insurance,” so long as such activities do not constitute “boycott, coercion, or
intimidation.” Id. § 1013. However, on January 13, 2021, the President signed into law
legislation that eliminates some immunities for health insurers. The Competitive Health
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Insurance Reform Act of 2020, passed unanimously by the Senate, repeals portions of the
McCarran–Ferguson Act
Federal antitrust laws provide for both private enforcement and government enforcement.
Stratienko v. Chattanooga-Hamilton County Hospital Authority No. 1:07-CV-258, 2009 WL
736007 at 22(E.D. Tenn. Mar 17, 2009. A private plaintiff can recover on an antitrust claim only
where the loss stems from a competition reducing aspect or effect of the defendant’s behavior.
“In the context of health care antitrust litigation, courts have observed that physicians may not be
the most efficient enforcer of the antitrust laws. Nevertheless, where a physician’s interest
coincides with the patient’s interest, a physician may be a proper enforcer of the antitrust laws.
N.Y. Medscan LLC v. N.Y. Univ. Sch. Of Med., 430 F. Supp. 2d 140, 146-47.
There is strong evidence by Member complaints against the Michigan Blue Cross Blue
Shield Companies that physicians are experiencing retaliation and antitrust activities merely
because physicians are pursuing “expensive” and/or “experimental treatments”; medical
treatments that coincides with the patient’s interest, allowing a physician to become a proper
enforcer of the antitrust laws against the Michigan Blue Cross Blue Shield Companies. N.Y.
Medscan LLC v. N.Y. Univ. Sch. Of Med., 430 F. Supp. 2d 140, 146-47.
Rule 201 (See Appendix E)
Rule 201 (a) Scope. This rule governs judicial notice of an adjudicative fact only, not a
legislative fact. (b) Kinds of Facts That May Be Judicially Noticed. The court may judicially
notice a fact that is not subject to reasonable dispute because it: (1) is generally known within the
trial court’s territorial jurisdiction; or (2) can be accurately and readily determined from sources
whose accuracy cannot reasonably be questioned. (c) Taking Notice. The court: (1) may take
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judicial notice on its own; or (2) must take judicial notice if a party requests it and the court is
supplied with the necessary information; (d) Timing. The court may take judicial notice at any
stage of the proceeding; (e) Opportunity to Be Heard. On timely request, a party is entitled to be
heard on the propriety of taking judicial notice and the nature of the fact to be noticed. If the
court takes judicial notice before notifying a party, the party, on request, is still entitled to be
heard.
Intervenor Brizuela hereby provides the Court under Rule 201, information and evidence of
Blue Cross Blue Shield Association (BCBSA) Corporate and Financial Investigations
Department (CFID). The evidence is proof of BCBSA’s actions against Intervenor Brizuela as
well as other physicians nationwide. See Appendix E for Rule 201 Statement of Facts.
1. According to Blue Cross Blue Shield Association (BCBSA) documents, the “Corporate and
Financial Investigations Department (CFID) is responsible for the prevention, detection, and
investigation of all potential areas of fraud, waste, and abuse against Independence Blue
Cross.
2. The CFID is also responsible for conducting audits of Providers and pharmaceutical-related
services. It identifies, selects, and audits Providers for inaccurately paid claims.
3. In addition, the CFID seeks financial recoveries of overpaid claims and submits these claims
for correct adjudication.
4. According to BCBSA Corporate and Financial Investigation Department (CFID) documents,
claims payments in general undergo a 4-step process: a) claims submission, b) claims
processing, c) document generation, d) financial processing.
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5. Claims processing by BCBSA involves eligibility review, provider contract pricing, claims
adjudication, and claims adjustment.
6. Document Generation by BCBSA involves check creation, member explanation of benefit
creation, and provider statement of remittance creation.
7. Financial Processing by BCBSA involves 835 Electronic Remit Transmission, Electronic
Funds Transfer Creation, Bank Reconciliation, General Ledger Updates, and 1099 reporting.
8. CFID Support uses data-mining software to proactively identify aberrant claims, billing
patterns, and trends across all Independence lines of business.
9. CFID Support gathers and evaluates information from a variety of sources to support CFID
including STARS (Services: Tracking, Analysis & Reporting System) and STAR Sentinel
sophisticated software data-mining tools that analyze all categories of claims received,
Provider demographics, and Member benefits are primary sources of audit and investigation
identification and selection.
10. Financial Investigations evaluates all allegations of fraud, waste, and abuse involving
Providers, Members, vendors, associates, and others.
11. CFID uses a wide array of investigative tools to: a) identify and investigate fraudulent and
abusive activities; b) make referrals to federal, State, and local law enforcement for criminal
and/or civil prosecution; c) make referrals to regulatory authorities for violations of
professional licensure; d) recover losses related to fraud and abuse; e) employ prevention
techniques to decrease and eliminate future losses; f) make recommendations to terminate
Providers for cause from the Independence network.”
12. CFID have publicly stated that their Department Objectives includes Early proactive
detection of fraud/abuse, Proactive Use of Data Mining Tools for Analysis, Denial or
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suspension of inappropriate claims processing/payment, Recovery of payments, Exclusion of
professionals from networks, Change provider behavior, Civil litigation, Criminal
prosecution, Refer licenses to appropriate state boards, Publicize entities convicted of fraud
and Create Sentinel Effect in Provider Community.
13. According to CFID documents, CFID measures results of success by: a) Recovered Savings,
b) Claims Denied, c) Claim Recoveries, d) Claim Offsets, e) Voluntary Restitution, f)
Pharmacy Audits, g) Court Ordered Restitution.
14. According to CFID documents, CFID employees consist of former federal, state and local
law enforcement agents, lawyers, claims pharmacy technicians, registered nurse, certified
coding specialists.
15. According to CFID documents, CFID engages in Healthcare Professionals Surveillance
Undercover investigation, and Data (excel spreadsheets) analysis.
16. BCBSA in criminal cases against physicians, commonly testify without providing hard
factual evidence of CFID employees qualifications, education, training and experience as
pertaining to: 1) billing procedures, 2) how prescription drugs diverted into illegal channels
are bought and sold, 3) current and historical street prices of illegally diverted prescription
drugs within federal districts, 4) prescription drugs that are most in-demand on the illegal
street market, 5) the dosages of each, 6) the common street names for such drugs, 7) and the
street market value.
17. BCBSA and CFID has an illegitimate incentive to investigate health care claims and report
claims deemed “fraudulent” to their law enforcement partners for the purposes of improper
and unlawful criminal restitutions via asset forfeitures.
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18. Criminal asset forfeiture via an illicit and unlawful profit motive aids and abets the
aggressive behaviors of BCBSA and provides for excessive bonus to the members of
BCBSA’s executive and managerial class of employees.
19. BCBSA’s software and CFID protocols were designed with a selection process of identifying
criminal intent in physicians.
20. BCBSA’s software fails to consider events beyond the control of the physician (i.e., the
patient decides to sell their pain medications), and medical necessity (pain intensity, medical
status of the patients, dependent and independent intervening causes, responsible versus
irresponsible drug use).
21. BCBSA’s CFID and employees also categorize age, race and nation of origin as the “suspect
class” which violates the 14th Amendment Equal Protection Clause of the US Constitution.
22. CFID selection process generates probable cause, to induce criminal proceedings, against the
“suspect class,” via the wrong standard of evidence.
23. CFID STARS (Services: Tracking, Analysis & Reporting System) or STAR Sentinel
software uses plausibility evidentiary standard that misrepresents the statutory, beyond a
reasonable doubt, criminal evidence standard.
24. The pattern of CFID amounts to a custom or practice amounting to a policy of deliberate
indifference to constitutional rights of physicians who were classified as members of the
suspect class.
25. BCBSA’s and CFID’s pattern of action, amounts to cause violations of international law and
human rights for sick, infirm, and disabled human patients.
26. CFID documents admit that CFID’s objective is to change provider behavior.
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27. BCBSA’s CFID computerized, data analytics programs can erroneously identify and classify
thousands of “colored”, Black and Brown skin, and/or Jewish doctors as drug dealers in
white coats for civil and criminal asset forfeiture purposes to increase its market share at the
expense of the criminally indicted physicians.
28. Essentially through BCBSA’s use of deliberate rewards/punishment and/or “carrots and
sticks” claim reimbursement policy and threats of investigation by the CFID, BCBSA can
interfere with the delivery of health care by its in-network and out of network providers to its
insured Members.
29. BCBSA’s artificial intelligence computers and CFID in a conspiracy with other members of
the Healthcare Fraud Preventive Partnership (HFPP) joint partnership are forcing ideological
conformity by U.S. physicians in the practice medicine with respect to controlled substance
medications in the treatment of pain or substance abuse disorders to according to BCBSA’s
own perverted medical standards, under threats of marking unwilling physicians with false
and contrived negative “Scarlet Letter” National Practitioner Data Bank Reports, OIG
Exclusion Lists and/or felony convictions.
30. Blue Cross Blue Shield Association and its for-profit subsidiary Amerihealth Caritas, also
induces criminal proceedings through its CFID which has an established pattern of racial bias
against Brown skin and Black skin, “colored” physicians including Philadelphia physicians,
Dr. Neil Anand (Indian-Brown Skin), Dr. Clarence Verdell (Black Skin), Dr. Walter Wrenn
(Black Skin), Dr. Emmanuel Okolo (Black Skin), and Dr. Mohanad Fallouh (Middle Eastern-
Brown Skin).
31. This behavior by BCBSA is not common in the field of health care.
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32. The conduct of BCBSA’s behavior through its untested and unvalidated computer software
and mathematical algorithms will increase health care costs and destroy the inherent
empathic compassionate nature of physicians. Thus, the behavior of BCBSA, CFID and the
creation, inputs, and outputs of BCBSA’s software is abnormally dangerous.
33. Please see attached Appendix E of BCBSA’s CFID department.
The BCBSA Target Healthcare Providers Based On Skin Color and Religion
Recently, Dr. Brizuela has become aware that BCBSA has been targeting groups of
physicians in a very nefarious manor, similar to the way the Nazi’s did. Dr. Brizuela has seen
preliminary data that indicate out of approximately 6000 pain management physicians more than
1500 of them have been arrested and a high percentage of them have been forced to take
fraudulent plea deals as they were facing very long prison sentences. Dr. Brizuela has read a
federal memo suggesting the targeting of physicians over 60 years old because they exhibited the
4 D’s (dated, easily duped, dishonest, disabled from decision making). Of the arrested doctors
approximately 50% were Black, Asians, Hispanic, minority nation of origin (Appendix C) and
foreign medical graduates. Between 20%-50% of targeted white physicians are Jewish
(Appendix A and B). Dr. Brizuela practice consisted of a high percentage of minority patients
and patients that couldn’t find another doctor to treat their pain because they were indigent and
often had no insurance.
YOU ARE WITHIN THE NORMS Blog has documented seven physicians that have
represented to a Court of the United States that physicians (especially of colored skin) are being
targeted in a pattern of racial discrimination by Blue Cross Blue Shield insurance companies for
the purposes of criminal asset forfeiture and incapacitation. Doctors communicated with or
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reported on include: 1) Dr. Neil Anand, 2) Dr. Lesly Pompy, 3) Dr. Walter Wrenn, 4) Dr.
Richard Kaul (who has argued to the U.S. Supreme Court and several Federal U.S. District
Courts that insurance companies like Horizon Blue Cross racially targeted him to deprive him of
liberty and happiness) 5) Dr. Clarence Verdell, 6) Dr. Evangelos Megariotis, and 7) Dr. Andrew
Berkowitz (Jewish physician). The common pattern of behavior by the Blue Cross Blue Shield
companies exceeds the plausibility standards for the obtaining of legal redress and judicial relief
from a U.S. Federal District Court.
BCBSA franchisees have publicly documented its successful retaliation against other
physicians whom were “colored”, non-white and dark skinned. Physicians targeted for criminal
indictments by BCBSA franchisees include Dr. Jorge A. Martinez (Hispanic), Dr. Richard Kaul
(Indian), Dr. Arun Gupta (Indian), Dr. Dralves Edwards (Black), Dr. Sreekrishna Cheruvu
(Indian), Dr. Xiulu Ruan (Chinese), Dr. Kamal Tiwari (Indian), Dr. Vilasini Ganesh (Indian), Dr.
Gregory Belcher (Black) and Dr. Sanjay Kumar (Indian).
Upon information or belief Blue Cross Blue Shield Association and their franchises
targeted the now deceased, Rev. Ronald V. Myers, Sr., M.D the founder of one of eleven of the
United States National Holidays, Juneteenth. Upon information or belief BCBSA and their
franchises were opposed to another Doctor who was also a Reverend obtaining another national
holiday for celebrating African-American culture. BCBSA targeted Reverend Dr. Ronald Myers
because they opposed the Juneteenth National Holiday as there was already a national holiday
for Reverend Dr. Martin Luther King (also a doctor and reverend). The general consensus of the
common public is that Reverend Dr. Ronald Myers was martyred by Blue Cross Blue Shield for
his beliefs and ideologies regarding the Juneteenth Holiday. See
https://youarewithinthenorms.com/2021/10/12/exposing-healthcare- apartheid-in-the-united-
66
states-of-america-targeting-convictions-imprisonments-of- doctors-of-color-and-its-disparity-
covid-mortality-rates/
In 1988, Dr. Myers and his wife opened a family health center in Tchula, Mississippi,
located in an area with scarce medical resources and a high infant mortality rate. In 1990, he was
ordained by Pilgrim Rest Missionary Baptist Church in Milwaukee, and commissioned by the
Wisconsin Baptist Pastors Conference as a medical missionary to the Mississippi Delta. Myers
was also elected as Chairman of the National Juneteenth Holiday Campaign, National Juneteenth
Christian Leadership Council, National Juneteenth Observance Foundation, and the National
Association of Juneteenth Jazz Presenters.
On April 15, 2016, Rev. Ronald Vincent Myers, Sr., MD was indicted in association with
3 other health professionals in Oklahoma City, OK. He was charged with one count of
racketeering and two counts of unlawfully distributing controlled substances on accusations he
prescribed painkillers and antidepressants to multiple people who had no medical reason for
receiving the drugs. See “Murder, racketeering indictments come down from ‘pill mill’ operation
in Sequoyah County.” https://tulsaworld.com/news/local/crime-and-courts/murder-racketeering-
indictments-come-down-from-pill-mill-operation-in-sequoyah-county/ article_901bad7a-ef73-
50ed-afd6- ff77a84cfabc.html#:~:text=OKLAHOMA%20CITY%20%E2%80%94%20A%20m
ulticounty%20grand,79%2C%20of%20Wichita%3B%20Dr
There are currently eleven national public holidays in the United States designated in
Title V of the United States Code (5 U.S.C. § 6103). These federal holidays apply to all federal
government entities. State and city holidays may be observed concurrently with federal holidays.
Federal Holidays are among the United States of America’s most treasured ultra-precious
American cultural commodities. Federal law also provides for the declaration of other public
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holidays by the President of the United States. Generally, the president will provide a reasoning
behind the elevation of the day, and call on the people of the United States to observe the day
"with appropriate ceremonies and activities." Examples of presidentially declared holidays were
the days of the funerals for former Presidents Ronald Reagan, George H. W. Bush, and Gerald
Ford; federal government offices were closed and employees given a paid holiday. The eleven
national holidays are: National New Year's Day, Birthday of Martin Luther King, Jr.,
Washington's Birthday, Memorial Day, Juneteenth National Independence Day, Independence
Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, Christmas Day.
Intervenor Brizuela has standing as a medical professional and human being damaged by
these violations of the Geneva Convention by BCBSA. In 1948, the Convention on the
Prevention and Punishment of the Crime of Genocide defined genocide as “acts committed with
the intent to destroy, in whole or in part, a national, ethnical, racial or religious group, as such.”
It also specified that these acts include not just killing but also attempted group destruction
through “bodily or mental harm,” impeding reproduction, harsh living conditions and child
removal. The U.N. remediation guidelines for mass human rights violations like genocide have
some clear goals. These include safeguarding basic human rights of the offended group,
investigating abuses and providing redress. Intervenor Brizuela’s primary focus is on validating
the millions of Americans subjected to serial violations of their federal rights under color of law.
In describing violations of their rights via the Motion to Intervene, Brizuela attests to a
persistent, national pattern of persecution which for innumerable Americans is torture as
proscribed by the International Covenant on Civil and Political Rights (ICCPR); Convention
against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment; and The
Universal Declaration of Human Rights.
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Intervenor Brizuela argues that the apparent goals of persecution by BCBSA (which for
some clearly amounts to mental torture) overlaying persistent, extreme U.S. legal system abuse
are as follows: 1. Disparage and discredit targets through legal process; 2. Intimidate and perhaps
terminate witnesses and/or targets; 3. Neutralize and eventually preempt the target's access to
courts; 4. Impoverish the targets; and, 5. Incarcerate the targets. Intervenor Brizuela argues that
the BCBSA violates Article 14, paragraph 1. of the ICCPR: All persons shall be equal before the
courts and tribunals. In the determination of any criminal charge against him, or of his rights and
obligations in a suit at law, everyone shall be entitled to a fair and public hearing by a competent,
independent and impartial tribunal established by law. ICCPR, Art. 14, ¶1. Article 17 of the
ICCPR provides: 1. No one shall be subjected to arbitrary or unlawful interference with his
privacy, family, home or correspondence, nor to unlawful attacks on his honor and reputation. 2.
Everyone has the right to the protection of the law against such interference or attacks. ICCPR,
Art. 17 “Everyone shall have the right to hold opinions without interference.” ICCPR, Art. 19,
¶1. This right is subject to restrictions, “but these shall only be such as are provided by law and
are necessary: (a) For respect of the rights or reputations of others; (b) For the protection of
national security or of public order (order public), or of public health or morals.” ICCPR, Art.
19, ¶3 (a)-(b). “All persons are equal before the law and are entitled without any discrimination
to the equal protection of the law. In this respect, the law shall prohibit any discrimination and
guarantee to all persons equal and effective protection against discrimination on any ground such
as race, color, sex, language, religion, political or other opinion, national or social origin,
property, birth or other status.” ICCPR, Art. 26
Articles of the Covenant or Convention alleged to have been violated by BCBSA include
the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or
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Punishment: Article 16, ¶1.: 1. Each State Party shall undertake to prevent in any territory under
its jurisdiction other acts of cruel, inhuman or degrading treatment or punishment which do not
amount to torture as defined in article I, when such acts are committed by or at the instigation of
or with the consent or acquiescence of a public official or other person acting in an official
capacity. In particular, the obligations contained in articles 10, 11, 12 and 13 shall apply with the
substitution for references to torture of references to other forms of cruel, inhuman or degrading
treatment or punishment.
BCBSA data analytics and controlled substances, physician conviction algorithms,
induce the deliberate denial of diagnosis and treatment of patients who suffer from chronic pain
or substance use disorders. The algorithms target older physicians or Black and Brown skin
physicians (Appendix C). These BCBSA untested and unverified criminal forensic tools to create
a “physician conviction engine” to cause the mass abandonment of sick patients are violations of
Human Rights Under Article 32 of the 1949 Geneva Convention IV. See United States v. Karl
Brandt. The algorithms violate international law including, U.N. General Assembly Resolution
60/147 (Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of
Gross Violations of International Human Rights Law and Serious Violations). Pursuant to
Article 15 of the Rome Statute of the International Criminal Court, Intervenor Brizuela has
discovered publicly available evidence probative of “Crimes against humanity” within the
meaning of Article 7 in terms of “facilitating the commission of such a crime” and/or
“contributing to the commission or attempted commission of such a crime by a group of persons
acting with a common purpose” respectively within the meaning of Article 25, subparagraphs
3.(c) and (d). of said statute by BCBSA.
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Intervenor Brizuela is seeking additional evidence pursuant to this civil litigation against
BCBSA to help sick patients receive medical treatment in compliance with Article 2, paragraph
3(a) and (b) of the International Covenant on Civil and Political Rights (ICCPR) which mandates
effective domestic remedies for ICCPR violations under color of law and seek judicial relief of
organized persecution and psychological torture attendant to organized legal system abuse by
alleged violators through the literal weaponization of America’s legal system against physicians
and pharmacists. “Crimes against humanity” which itself is a crime within jurisdiction of the
International World Court, apparently “(f)or the purpose of facilitating the commission of such”
crimes and/or “contributing to the commission or attempted commission of such (crimes) by a
group of persons acting with a common purpose”, both offenses within the respective meaning of
Article 25, subparagraphs 3.(c) and (d). of the Rome Statute. Public documents reveal that
Pennsylvania Blue Cross, HFPP, and Blue Cross Blue Shield Association (BCBSA) may have
committed “Crimes against humanity” within the meaning of Article 7 in terms of “facilitating
the commission of patient abandonment” and/or “contributing to the commission or attempted
commission of such a crime by a group of persons acting with a common purpose” respectively
within the meaning of Article 25, subparagraphs 3.(c) and (d).
Intervenor Brizuela is part of the group of U.S. physicians and pharmacists who treat
patients suffering from chronic diseases whom are at imminent risk of losing life, liberty, and/or
property as a direct and proximate result of mutual international treaty and U.S. federal law
violations which may stem from one or more acts of treason as defined by the U.S. Constitution
and expounded upon by the U.S. Supreme Court. Alternatively, there may be further violations
that stem from one or more torts cognizable under the U.S. Federal Tort Claims Act. Persecution
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of physicians and pharmacists through untested, predictive criminal forensic tools is causing
increased overdose deaths of U.S. citizens which are crimes against humanity.
Defective or untested criminal forensic tools may be intentionally corrupting the process
by which one or more agents of U.S. government imply that our national government or one of
its states has verified the veracity of evidence produced by these defective or untested HFPP or
BCBSA criminal forensic tools. See, U.S. v. Rudberg, 122 F.3d 1199. The reckless actions of
Pennsylvania Blue Cross, HFPP insurers and BCBSA are inducing via peaceful protest, national
pain rallies where sick patients, the “People” being duly empowered to resist “any Form of
Government . . . destructive” in the indicated manner of their lives, liberty, and/or
property. Sickly, U.S. citizen patients via peaceful protest are hereby wielding the right for
themselves and as envoys for “the People to alter . . .” U.S. government such that they “seem
most likely to effect Safety and Happiness” and that of our fellow countrymen and
countrywomen as well as America’s children. Intervenor Brizuela seeks the identification of
past, present and future, physicians and pharmacists that are at imminent risk of losing life,
liberty, and/or property as a direct and proximate result of Michigan Blue Cross and BCBSA
confirmed violation of its ICCPR – specifically the treaty’s Article 2, paragraph 3(a) and (b)
which mandate effective domestic remedies for ICCPR violations under color of law – and what
may be the country’s de facto policy of extending impunity to HFPP, Michigan Blue Cross, or
Blue Cross Blue Shield Association (Appendix D) for their role in persistent, organized U.S.
legal system abuse.
America’s International Covenant on Civil and Political Rights (ICCPR) requires good
faith execution of all corresponding administrative, investigative, adjudicatory, and legislative
processes anticipated by U.N. General Assembly Resolution 60/147 (Basic Principles and
72
Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of
International Human Rights Law and Serious Violations) on behalf of any and all American
physicians, pharmacists or patients alleging to have endured organized U.S. legal system abuse
nation by unchecked judicial misconduct as of 1990 A.D. or later, plus U.S. ratification of the
First Optional Protocol to its ICCPR. Sick patients who cannot achieve legal redress may be able
to approach the U.N. Human Rights Council (UNHRCouncil) as a “class of Americans . . . who
as of 1990 A.D. or later, exhausted all ostensible avenues of relief before the three (3) branches
of U.S. federal government and appropriate state governments in seeking a fair and impartial
redress of actual or reasonably perceived U.S. legal system abuse nation by unchecked
regulatory capture by BCBSA, and whose legal claims were respectively thwarted primarily due
to America’s de facto policy of judicial impunity with regard to such allegations.
BCBSA Seeks Unlawful Return On Investment Via Criminal Asset Forfeiture
Private businesses that are willing to put moral and human rights concerns aside, are able to
profit from the repression of fascist regimes. Many German companies have reckoned with
histories of collaboration with the Nazi regime, among them: Hugo Boss, Mercedes-
Benz, BMW and others. Nazism through contracts, slave labor, the appropriation of stolen goods
or other means. Nazi businesses didn’t profit only from forced labor. “Contracts with the Nazis
were not uncommon for an exclusive circle of entrepreneurs who were in the friendship circle of
SS leaders or had other connections,” says Christopher Kopper, a German professor of
economics and business history. Another way businesses profited from the war was by using the
free labor of people captured by Nazis—inmates in concentration camps and prisoners of war.
73
BCBSA acquire market share either by eliminating Jewish (Appendix A and B) or Black and
Brown skin physicians (Appendix C) or acquire (without paying) market share of a number of
eliminated Black and Brown skin (Appendix C) owned healthcare businesses, a practice of
appropriation copied from the Nazis. In Nazi Germany, the industrialists who led the way were
two huge German firms, I.G. Farben and Krupp, which are similar to Blue Cross Blue Shield
Association (Appendix D) and General Dynamics Information Technology. Leaders of both of
companies were among the few civilians who were later charged with war crimes at the Nurem-
berg Tribunals after World War II. These trials placed the story of their financial and moral
support of the Nazis into the historical record. Krupp was a huge arms manufacturer and I.G.
Farben was a vast chemical company which made everything from Bayer aspirin to Zyklon B,
the poison used in the gas chambers.
https://www.forbes.com/sites/maddieberg/2019/04/02/more-than-a-dozen-of-europes-wealthiest-
billionaires-and-their-families-had-nazi-ties/?sh=581684706015
As the book Hell’s Cartel explains, the history of the German industrialists’ support of Hitler
shows “what can go wrong when political objectives and the pursuit of profit become danger-
ously entwined.” https://www.brennancenter.org/our-work/analysis-opinion/how-big-business-
bailed-out-nazis Hitler stated that “private enterprise cannot be maintained in a demo-
cracy.” Hitler also told the men that he would eliminate trade unions and communists. Hitler
asked for their financial support and to back his vision for Germany. Likewise, the Michigan
Blue Cross, BCBSA, and HFPP attempt to eliminate and discriminate against physicians and
healthcare providers for the benefit of their own nation health networks. According to the
opening of the tribunal against the directors of I.G. Farben, prosecutor U.S. Gen. Telford Taylor
stated: “The indictment accuses these men of major responsibility for visiting upon mankind the
74
most searing and catastrophic war in human history. It accuses them of wholesale enslavement,
plunder, and murder.”
https://en.wikipedia.org/wiki/List_of_companies_involved_in_the_Holocaust
In the book by Edwin Black (2001). IBM and the Holocaust: The Strategic Alliance
Between Nazi Germany and America's Most Powerful Corporation. Thomas Watson, the
founder of IBM, directed his German subsidiary, Dehomag, to bid for the job of tabulating the
results of a census the Nazi government wants to conduct. Thomas Watson knew that the census
and other work that his German branch has performed for the Nazis has been used not just to
count cars and cows but to identify Jews. On the 18 January 1943 Heinrich Himmler
the Reichsfuhrer SS ordered Richard (Reinhard) Korherr who was “Inspekteur fur Statiskik” (The
Inspector of Statistics for the Reichsfuhrer SS) to produce a report on the Final Solution of the
“Jewish Question in Europe.” up to the period of the 31 December 1942. Reinhard Koherr, a
statistician working for the Nazi Government, sinisterly announced that: “…in using statistics
the government now has the road map to switch from knowledge to deeds.”
https://www.theatlantic.com/magazine/archive/2001/04/hitlers-willing-business-partners/303146/
The Holocaust was worsened by the Hollerith tabulating machines and punch cards
IBM/Dehomag leased to the Nazis which are the mathematical algorithmic precursors to the
Michigan Blue Cross, HFPP, and BCBSA own data analytic, pre-crime, criminal forensic,
computer programs. The Nazi’s computer algorithms allowed Hitler's destruction of the Jews to
occur rapidly and claimed many victims because of the harvest of deadly information recorded
by the Hollerith machines, on IBM punch cards, by IBM/Dehomag employees working for the
Nazi death bureaucracy. On the efficiency of the use of Nazi data analytic computers, Black
provocatively contrasts Holland and France. The Nazis ordered censuses in both countries soon
75
after they were occupied. In Holland, a country with "a well-entrenched Hollerith infrastructure,"
out of "an estimated 140,000 Dutch Jews, more than 107,000 were deported, and of those
102,000 were murdered—a death ratio of approximately 73 percent." In France, where the
"punch card infrastructure was in complete disarray," of the estimated 300,000 to 350,000 Jews
in both German-occupied and Vichy zones, 85,000 were deported, of whom around 3,000
survived. "The death ratio for France was approximately 25 percent."
Prior to the market is the corporation, led by human beings who cannot escape
responsibility for its actions. A capitalist free market " is an efficient system for investment and
production but cannot achieve moral aims itself. In this it resembles its physical technology. A
hypodermic syringe can be used to inject cyanide or penicillin. It is not an independent moral
agent." Prior to technology are the "independent moral agents" who made it—syringes and
tabulating machines don't drop from heaven. And prior to the corporation—to continue our
movement away from the market to the persons seeking to enter it—are the owners, the
stockholders. "Holleriths could not function without IBM's unique paper. Watson controlled the
paper.... Holleriths could not function without cards. Watson controlled the cards.... Hollerith
systems could not function without machines and spare parts. Watson controlled the machines
and spare parts." The HFPP private insurers, Pennsylvania Blue Cross, and Blue Cross Blue
Shield Association (Appendix D) provide information to the U.S. Department of Justice to
criminally prosecute physicians and healthcare providers. The capitalist free market is indeed
amoral, as the HFPP through the BCBSA seek to “concentrate” Jewish (Appendix A and B)
physicians, Black and Brown skin (Appendix C), Black, Hispanic, and Asian physicians into
American camps and prisons for the purposes of criminal asset forfeiture.
76
BCBSA data analytics, controlled substance medication algorithms, and healthcare fraud
computer programs induce the denial of treatment to patients and target “colored”, non-white,
and Jewish (Appendix A and B) physicians via a BCBSA “physician conviction engine” which
are violations of Human Rights Under Article 32 of the 1949 Geneva Convention IV. See United
States v. Karl Brandt
Mass classification of human beings in a society was previously attempted by the German
Third Reich with disastrous consequences for the entire World. Blue Cross Blue Shield data
analytics, mass classification of patients through the HFPP- Blue Cross Blue Shield database is
ideologically similar to the Nazi, Deutsche Hollerith Maschinen Gesellsehaft, mass classification
“final solution” computer program.
Michigan Blue Cross’ algorithms are now deliberately being used in the specific
occupational targeting of U.S. physicians, whom are engaged in the treatment of patients
afflicted with diseases that are costly to HFPP and other Blue Cross Blue Shield Association
(BCBSA) Franchisees. Michigan Blue Cross’ encouragement of the persecution of physicians
who chose to treat all human beings, including humans classified by Michigan Blue Cross’ as
“superutilizers” or “useless eaters”, is inducing a chilling effect of compassionate treatment by
U.S. physicians, similar to that experienced in the German Third Reich via a Nazi government
eugenics program that encouraged physicians to abandon and forcibly sterilize German citizens
deemed to be “useless eaters” or “superutilizers”.
Michigan Blue Cross in concert with BCBSA, HFPP, and USDOJ has invented a data
analytics, computer program which intentionally misclassifies Black and Brown skin (Appendix
C) physicians among other providers who are engaged in the treatment of addiction and/or
chronic pain as drug dealers. The purpose of this private-public partnership is to steal and
77
appropriate Black and Brown skin (Appendix C) physician’s property via criminal asset
forfeiture by falsely labeling them and convicting them under current U.S. law as drug dealers.
The methods and manners utilized by Michigan Blue Cross are similar and analogous to the
methods that the Nazi Party of the German Third Reich used via German Courts of Justice to
appropriate Jewish and Gypsy property and the targeting of minority races through the passage
of the Nuremberg Race Laws, because these small minority groups lacked political support
within Germany. The Nuremberg Laws allowed one group of German people to discriminate
against another group of people for isolation in concentration camps whereupon their property
would be taken from them.
A system of private-public cooperation between Michigan Blue Cross, HFPP, and BCBSA,
for the sole purpose of appropriating Black and Brown skin physicians’ property by purposely
mislabeling them and classifying them as “drug dealers” whereupon the Black and Brown skin
physicians’ property can be taken via criminal asset forfeiture is an unconstitutional process that
was not intended by the Founding Father’s of the United States. The Pennsylvania Blue Cross,
HFPP, and Blue Cross Blue Shield Association (Appendix D), “physician conviction engine”,
classifies Black and Brown skin physicians (Appendix C) as drug dealers for appropriation of
Black and Brown skin physician property under U.S. criminal asset forfeiture law. Michigan
Blue Cross’ data analytics, pre-crime, computer programs and criminal asset forfeiture schemes
are a significant and severe violation of the Constitutional rights of US citizens. Michigan Blue
Cross use of analogous Nazi Hollerith computer algorithms in the classification of human beings
for the sole purpose of appropriating their property violates United States Constitutional Law.
These intentional Constitutional violations by Michigan Blue Cross in a private-public
partnership through HFPP is analogous to the Nazi appropriation scheme. BCBSA is subverting
78
the U.S. legal system to intentionally enrich HFPP and Blue Cross Blue Shield through the
stealing of the property of Black and Brown skin physicians (Appendix C). Michigan Blue
Cross’ artificial intelligence computer is forcing U.S. physicians to practice medicine according
to Michigan Blue Cross, BCBSA, and HFPP own perverted standards, under threats of marking
unwilling physicians with false and contrived negative “Scarlet Letter” National Practitioner
Data Bank Reports and/or felony convictions. Michigan Blue Cross scheme of negative National
Practitioner Data Bank Reports to permanently mark American physicians are similar and
analogous to the Star of David system that was used by the Nazi German Third Reich to
permanently mark and incapacitate Jewish people.
Michigan Blue Cross has purposely used this scheme as in a partnership with USDOJ
through the HFPP and BCBSA which are organizations that act as a shield for all BCBSA own
illegal actions, thus allowing HFPP to intentionally violate Intervenor Brizuela’s Constitutional
Rights in his interactions and treatments of patients including: 1st U.S. Constitutional
Amendment; Freedom of Association, 4th U.S. Constitutional Amendment, 5th U.S.
Constitutional Amendment, 14th U.S. Constitutional Amendment; Equal Protection Clause;
Article I, Section 10, Clause 1 U.S. Constitution; Contract Clause; Article 1, Section 8, Clause 3
of the U.S. Constitution; Due Process Rights of 14th Constitutional Amendment.
Statistical analysis by Dr. Brizuela and his colleagues of the selection process by analyzing
indicted physicians reveals a classification selection process that has produced a disproportionate
number of physicians of Jewish faith (Appendix A and B), minority racial origin (i.e. Hispanic
American origin), independent medical practitioners, and elderly physicians (old age) for
criminal investigation and prosecution. Michigan Blue Cross and the HFPP public-private joint
enterprise’s, algorithms is a Titanic repeat of the Tuskegee Experiment, and is used to almost
79
exclusively target older physicians, wealthy physicians, Jewish physicians (Appendix A and B),
dark skinned “colored” physicians, or independent physicians (as compared to large physician
groups), and this is readily evident by a list of nearly 1500 indicted healthcare providers in my
possession.
See https://www.washingtonpost.com/history/2022/07/26/tuskegee-syphilis-experiment-
50-
years/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl
_most&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-
tr%2F377ad92%2F62e00ce7cfe8a2160107ae0f%2F608ab442ade4e210587ea861%2F32%2F72
%2F62e00ce7cfe8a2160107ae0f&wp_cu=66f4fb3afebb7d837126376f3e964a43%7CC11D5C2C
5BBD5C65E0530100007FBECA
A potential reason for this discriminatory practice is that Michigan Blue Cross considers
Jewish (Appendix A and B), “colored” or older physicians to be disposable and because there is
less worry that there will be a public outcry by the general population for the targeting of Jewish
(Appendix A and B), Black and Brown skin (Appendix C), minority physicians and/or elderly
physicians. A potential reason that Michigan Blue Cross targets wealthy physicians is to
maximize return on investment (ROI). A potential reason that Michigan Blue Cross targets
individual physicians or small medical entities is that these smaller entities lack the financial
resources for proper legal defense, allowing the USDOJ to achieve “easy” convictions regardless
of the innocence or guilt of its victims. The targeting of individual, small, and upstart health
entities by the Michigan Blue Cross allows their larger healthcare partners (i.e. private members
of HFPP and the BCBSA joint enterprise and nation health networks) to eliminate competition,
restrain trade, and monopolize the U.S. healthcare market. The Michigan Blue Cross “physician
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selection process” discriminates based on religion, age, race, gender and nation of origin and has
no basis in truth, a basic necessity in the court of law.
Likewise, the HFPP, BCBSA and Michigan Blue Cross computer algorithms categorize
religion, age, race and nation of origin as the “suspect class” which violates the 14th Amendment
Equal Protection Clause of the US Constitution. The selection process generates probable cause,
to induce criminal proceedings, against the “suspect class,” via the wrong standard of evidence.
The computer software uses plausibility evidentiary standard that misrepresents the statutory,
beyond a reasonable doubt, criminal evidence standard. The pattern amounts to a custom or
practice amounting to a policy of deliberate indifference to the Constitutional rights of
physicians who were classified as members of the suspect class. The Michigan Blue Cross’
discriminatory pattern amounts to cause violations of international law and human rights for sick,
infirm, and disabled human patients. The members of the suspect class experience a common
nucleus of operative facts, namely, an improper style of an investigation that violated the Equal
Protection of the 14th U.S Constitutional Amendment, and the 5th U.S. Constitutional
Amendment Due Process. These constitutional injuries among others are the actual and
proximate cause of commercial or tort injury to suffering patients and their physicians.
Dr. Brizuela’ list of nearly 1500 healthcare providers has documented hundreds of
physicians that have represented to a Court of the United States, that physicians (especially
Black and Brown skin Appendix C) are being targeted in a pattern of racial discrimination by
HFPP private insurance companies for the purposes of criminal asset forfeiture and
incapacitation. Michigan Blue Cross data analytics and Controlled Substance medication
“conviction algorithms”, induce the deliberate denial of diagnosis and treatment of patients who
suffer from chronic pain or substance use disorders. Judicial relief in allowing Intervenor
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Brizuela to obtain civil restitution through monetary damages and more information through
discovery will allow the common public to evaluate the Red Flags used by Blue Cross Blue
Shield Association that identified Dr. Xiulu Ruan, America’s most educated physician, and
hundreds of other competent, compassionate and educated physicians, as criminal drug
traffickers, while avoiding the incrimination of any members of the Illicit Drug Cartels.
Conclusion
The health and safety of millions of Americans compels the need for Intervenor Brizuela to
seek an Order by the District Court for Intervention. Dr. Felix Brizuela’ Motion for Intervention
request is made in good faith and through discovery will provide additional vital information to
the public, to potentially save the 1.2 million human lives as risk of dying as recently identified
by Stanford–Lancet Commission. The monetary damages obtained from BCBSA for their
reckless destruction of my career and family, will help me rebuild my life as a physician which is
my life’s calling.
Intervenor Brizuela is also requesting from discovery, vital documents produced by the
BCBSA that also involves the loss of substantial due process rights or matters of widespread and
exceptional media interest in which there exists possible questions about the government's
integrity that affect public confidence. Ultimately, Intervenor Brizuela intends to obtain
information from BCBSA that will potentially save millions of lives and help instruct U.S.
physicians of the proscribed behavior to prevent future U.S. physician drug trafficking as well as
identify the “most likely drug seeking patients” in whom prescribing controlled substance
treatments should be avoided, should BCBSA computerized “pre-crime” mathematical
algorithms currently in use, prove to be valid.
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Furthermore, Intervenor Brizuela also believes that one or more of the parties to this
HFPP agreement in concert with Michigan Blue Cross and BCBSA, committed acts that are
themselves torts against physicians nationwide in pursuance of the agreement amongst the
partnership. The HFPP Insurers are private companies that are pervasively entwined with
Michigan Blue Cross and Blue Cross Blue Shield Association . Intervenor Brizuela desires to
litigate for damages on the unlawful formal and informal business arrangements of BCBSA with
federal, Michigan and Pennsylvania, government agencies, to protect his own interests in pursuit
of life, liberty and happiness. Intervenor Brizuela additionally requires from discovery all
information pertaining to developed computer algorithms as criminal forensic tools by BCBSA
including all studies pertaining to the authentication and validation of the efficacy of these
unique criminal forensic tools that were used in a criminal case against himself, United States v.
Brizuela.
BCBSA criminal forensic tools that intentionally produce false results produce false legal
proceedings via the legal doctrine of FALSUS IN UNO, FALSUS IN OMNIBUS, and are a
threat to fair and impartial criminal tribunals. Intervenor Brizuela is a health care physician
whose civil rights and ability to work were deliberately violated by BCBSA and therefore
Brizuela has standing to intervene by right and permission in Plaintiff Ford Motor Company’s
lawsuit. Chronic pain patients nationwide have been protesting wholesale abandonment causing
them to widely complain especially on social media of a persistent, national pattern of
persecution and psychological torture imposed through U.S. legal system abuse, where
physicians and their patients are: disparaged and discredited through legal process; intimidated
for their passive grassroots activism through violence and/or threats of violence; denied the equal
protection of law and corresponding access to courts; causing physician impoverishment through
83
questionable job losses, unwarranted black listings, and/or the questionable imposition of fines,
sanctions, and/or damages; incarceration of physicians under questionable circumstances.
Intervenor Brizuela, with the help of other colleagues, has documented and identified that
nationwide, previously incarcerated physicians, have uniformly expressed: procedural legal
irregularities (particularly hearing request denials, untimely notice, and/or evidence
tampering/destruction); one or more questionable departures from well-established legal
precedent; undisclosed grounds for adverse credibility determinations; personal character
disparagement; and total or substantial denial of relief through judicial activism, i.e., an arguable
usurpation of legislative powers; judicial proscriptions that are the functional, civil equivalent of
ex post facto law; and/or total or substantial denial of relief pursuant to some form of Judicial
Engineering.
Intervenor Brizuela as a physician, who was damaged by BCBSA has the right or
obligation to: (a) Take appropriate legislative and administrative and other appropriate measures
to prevent these gross human rights violations (b) Investigate the alleged violations effectively,
promptly, thoroughly and impartially and, where appropriate, take action against those allegedly
responsible in accordance with domestic and international law; (c) Provide those who claim to be
victims of these violations with equal and effective access to justice irrespective of who may
ultimately be the bearer of responsibility for the violation; and (d) assist with providing effective
remedies to victims, including reparation. Recurrences of discriminatory violations should be
prevented, and responsible parties should be brought to justice. Thus, Dr. Brizuela’ intervention
in this civil litigation will help Dr. Brizuela obtain his goals. Dr. Brizuela emphasizes to this
Court that judicial relief should not be contingent on the wealth, celebrity, and/or political clout
of targeted offenders or their victims. The BCBSA is unlawfully using discriminatory data
84
analytic, pre-crime, criminal forensic, computer programs to “concentrate” Black and Brown
skin physicians (Appendix C) into American camps and prisons for criminal asset forfeiture
purposes.
Unwanted or disfavored physicians and healthcare providers that are identified and
categorized by Michigan Blue Cross’ computer algorithms, can seek reasonable alternatives like
political asylum. Other foreign governments could also airlift and evacuate identified and
categorized Black and Brown skin physicians and healthcare providers, persecuted by the
Michigan Blue Cross’ data analytic, mathematical algorithm, discriminatory, computer
programs, for the purposes of peace and tranquility. Israel could also airlift and evacuate
identified and categorized Jewish physicians and healthcare providers, persecuted by the
Michigan Blue Cross’ data analytic, mathematical algorithm, discriminatory, computer
programs, for the purposes of peace and tranquility.
For this, as well as the aforementioned reasons, Intervenor Brizuela respectfully requests
that the Court GRANT, Motion for Intervention of Right Pursuant to Federal Rules of Civil
Procedure Rule 24 (a).
Respectfully submitted,
/s/ Felix Brizuela D.O.
Felix Brizuela D.O.
Pro Se Plaintiff Intervenor
1103 Redoak Drive, Harrison City, PA, 15636
[email protected]; 724-205-4308
Date: 6/16/2023
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Appendix A (“Schindler’s List” of Targeted and Prosecuted Jews)
Full Name Degree Year of Birth
Aaron Borengasser PA 1981
Addie Gratz NP 1975
Alan Arnold Godofsky MD 1957
Alan Barnett MD 1948
Alan Craig Schold MD 1942
Alan Martin Bostom Owner of Angel’s Recovery 1943
Alan Summers MD 1938
Albert Daher Pharmacy Owner 1959
Albert Kofsky DO 1932
Alexander Alperovich MD 1960
Alexander Theodore MD 1943
Alina M. Resnick Owner 1966
Amy Schneider Office Manager 1985
Clinic’s business manager and
Andrea Grossman bookkeeper 1959
Andrew M. Berkowitz MD 1959
Andrew Rudin MD 1970
Ann C. Kammeyer MD 1949
Anthony Greenberg MD 1960
Anush Davtyan Clinic Owner 1960

Ardella Fisher NP 1980
Arlene Gerson Pharmacist 1967
Arnold Roth MD 1952
Barry M. Schultz MD 1956
Barry Sloan MD 1958
Bernard Bass Dr. 1947
Berry Kabov PharmD 1971
Boris Zigmond DC 1966
Bradford Roberg MD 1955
Brenda Banks MD 1953
Brett Ryabik MD 1959
Brian C. Weiler Pharmacist 1959
Brian Heim MD 1959
Bruce I Tetalman MD 1946
Bruce Kammerman MD 1957
Bruce M. Coplin MD 1957
Calvin Bynum Clinic Owner 1991
Charles Esham MD 1959
Charles Neuringer MD 1938
Charles R. Szyman MD 1951
Clifford Jacobson MD 1949
Daniel C. Gillick MD 1950
Daniel Garner DDS 1972

Daniel John Wise Co-defendant 1979
Daniel Podell Pharmacist 1926
Daniel Schwarz Dr. 1963
Darrel R. Rinehart MD 1955
David Alan Ruben MD 1948
David Betat MD 1961
David Litwin PA 1958
David V. Fischer MD 1966
Davis Bregman MD 1967
Douglas Moss MD 1961
Edward Neil Feldman MD 1940
Edward T. Schwab DO 1934
Egisto Salerno MD 1944
Elena Lev Polukhin MD 1957
Elizabeth Reimers MD 1970
Emmanuel Lambrakis MD 1948
Eric Jacobson MD 1962
Eric L Ressner MD 1965
Eric Snyder Owner 1987
Eugene Gosy MD 1960
Frank Fisher MD 1954
Frederick Weintraub DPM 1951
Gary Ridenour MD 1948

Gavin Awerbuch MD 1959
Gerald J. Klein MD 1934
Gerald S. Kane MD 1932
Gerald Wiseberg Owner 1933
Gordon Freedman MD 1960
Gregory Parker NP 1960
Harold Marshall MD 1962
Harry Meyer Katz MD 1941
Howard Gregg Diamond MD 1961
Howard Hirsh Pharmacists 1952
Howard Hoffberg MD 1955
Indira Martell Pharm Owner 1967
Isaac George MD 1960
James Ferris MD 1974
James Lassiter MD 1955
James Stanley Ross MD 1953
James William Eisenberg MD 1941
Janet E. Akremi MD 1957
Janet S. Arnold MD 1958
Jeffrey Abraham MD 1966
Jeffrey Bado DO 1956
Jeffrey Friedlander MD 1959
Jeffrey Goldstein DO 1970

Jeffrey J Reiter 1958
Jeffrey Pearlman Drug Rep 1967
Jeffrey R. Green Pharmacy Owner 1965
Jerrold Rosenberg MD 1955
Jerry Reifeiss MD 1955
Joel C. Jacobson 1970
Joel C Jacobson MD 1959
Joseph Baumstarck MD 1958
Joseph Baumstarck, Jr. MD 1967
Joseph G. Pastorek II MD 1951
Joseph Rybicki DO 1959
Joseph Zolot MD 1950
Joyce Vercauteren Owner 1974
Kay Speir Employee 1965
Keith A. Schwartz MD 1968
Keith Leroy Hindman DO 1940
Keith Neil Levitt MD 1967
Keith Petnel Employee 1985
Keith Sokoloff DO 1972
Kelly W Tucker MD 1960
Larry Webman Owner 1948
Lawrence Zaslwo Pharmacist 1954
Leonard I. Stambler MD 1951

Lester Sadler Owner 1956
Lewis Gabriel Stouffer Firefighter 1980
Lilian Jakacki Pharm 1965
Linda Schneider LPN 1958
Lonnie Keith Sipsy DO 1966
Louis Adamo MD 1958
Marc Klein Pharmicist 1971
Mark Greenbain MD 1944
Martin Tesher MD 1936
Matthew R. Perry Pharmacist 1970
Michael Anthony Spector MD 1957
Michael B Rosen MD 1961
Michael Belfiore DO 1963
Michael Fronstin MD 1937
Michael Hellman MD 1946
Michael Reinstein MD 1944
Michael Resnick Owner 1961
Michael Shook MD 1959
Michael Weiss DO 1953
Michael Schuster MD 1960
Mitchell Fagin MD 1952
Monica Ann Berlin Office Staff 1978
Morris “Moishe” Starkman MD 1959

Nancy Sadler Owner 1963
Paul Weinstein MD 1952
Peter Katz MD 1945
Rachel Smolitsky Office Manager 1952
Randy Barnett MD 1963
Randy Binder PHARMACIST 1953
Randy Weiss DO 1954
Raymond Fankell Owner of Prime Pharmacy 1955
Richard Albert MD 1947
Richard Ira Mintz DO 1950
Richard Koff MD 1956
Richard R. Ruth DO 1937
Richard S. Schlesinger MD 1949
Richard Sofinowski MD 1967
Robert Rand MD 1963
Robert Snyder DO 1970
Roger Pellmann MD 1955
Ronald M Mansolo MD 1969
Rosalind Sugarmann Clinic Director 1955
Russell Sachs MD 1959
Scott Alan Eskanos Pharmacist 1955
Sherry Ann Fetzer NP 1973
Sherry L. Barnett NP 1969

Stephen Chalker Pharmacist 1976
Stephen Schneider DO 1953
Steven Forman DPM 1957
Steven Goodman Pharmacist 1942
Steven Pearlstein MD 1955
Stuart Fox MD 1951
Stuart Gitlow MD 1962
Ted A. Glass MD 1957
Thomas Kline MD 1944
Todd Koppel MD 1967
Todd Schlifstein DO 1969
Tovah Jasperson Owners of Angel’s Recovery 1970
Vladimir Kleyman PharmD 1961
William Bauer MD 1937
William E. Hurwitz MD 1945
William R. Wolfe Dr. 1964
Zeljko Stjepanovic MD 1960
Zhanna Kanevsky MD 1963

Appendix B (List of Prosecuted
Health Professionals with
Potential Jewish Origin)
Full Name Degree Year of Birth
Andrew Stoveken Owner 1950
Andrzej Zielke MD 1955
Artak Ovsepian Co-owner 1982
Austin Haskew Pharmacy technician 1989
Howard Temeck MD 1951
Barry N. Odegaard MD 1952
Bernard Rottschaefer MD 1944
Bernard Tougas PA, Owner 1973
Cecil Walter Gaby MD 1955
Chad H. Poage DO 1984
Charles Fred Gott MD 1952
Charles T. Tenhet Owner 1951
Corinne Basch MD 1964
Courtland Burr
Twyman Homeowner 1974
Craig Bammer DO 1951
Craig D. Gialanella MD 1964
Craig Henry MD 1957

Curtis Edens MD 1959
Dale Andrew Gatlin Clinic manager 1953
Dalibor Kabov PharmD 1983
Daniel Maynard DO 1961
Daniel Palmer MD 1957
Dara Webman Office Manager 1985
David Eric
Brickhouse Staff 1973
David Flick MD 1955
David J. Muyres Owner 1962
David Rath MD 1956
David Ringel DO 1959
David Taylor MD 1944
David Thurman MD 1942
David Vincent
Gierlus DO 1953
David W. Webb MD 1942
Diana Philipoff Employee 1983
Donald Raymond
Kiser DO 1966
Donald Russell Owner 1965
Dusan Bosotov Office Staff 1983
Edward Mila Prats MD 1948

Elena Perry-Thornton MD 1951
Elizabeth Cronier NP 1948
Elizabeth Korcz MD 1972
Enna I. Amedome NP 1986
Eric Backos MD 1953
Eric D. Jorgensen MD 1961
Eric Math MD 1969
Eric Peper MD 1962
Erin Pealor Counselor 1984
Ernest Bade MD 1939
Ernest W. Singleton Owner 1968
Esther Wadley DO 1969
Ethan E. Bickelhaupt MD 1952
Eugene Evans Jr. MD 1959
Evelyn Parrado Owner 1987
Evelyne Ennis Nurse 1967
Forest Tennant MD 1941
Frank Bregar MD 1953
Frank Craig Purpera MD 1976
Frank Gilman MD 1958
Frank Telang MD 1955
Fred Gilliard MD 1941
Frederick Battle MD 1932

Frederick Reichle MD 1937
Gary Frantz MD 1952
Gay Gundersen-
Watson NP 1959
George Beecher MD 1940
George David Psychiatrist (MD) 1940
George David
Gowder MD 1957
George Howell MD 1937
George Norkus Pharmacist 1948
George Pueblitz MD 1946
George Richard
Bolling Pharmacist 1961
Gerald Jay Schaar Pharm Sales Rep 1971
Gerald Petrash PA 1948
Gilbert Ghearing MD 1954
Glen R. Bonifield Pharmacist 1940
Glenn Bryan Davis MD 1953
Glenn Gary
Robertson MD 1969
Gregory Salko MD 1958
Henri Wetselaar MD 1924
Horace W. Bledsoe MD 1951

Ilya Smuglin MD 1969
James Banner Owned of Oracle Diagnostic Laboratories 1968
James Brett Krablin MD 1972
James Graves MD 1951
James H. Blume DO, Owner 1956
James M Shortt MD 1946
James M Stanch MD 1952
James R. Webb Dr. 1959
Janelle Hibson NP 1956
Jasna Mrdjen MD 1943
Jason Cole Votrobek Owner 1984
Jason Hunt OB/GYN 1968
Jason May Pharmacist 1979
Jay Milton Beams MD 1941
Jeff Ferryman PA 1963
Jeffery F. Addison MD 1955
Jeffrey C. Leathersich PA 1965
Jeffrey Gundel MD 1965
Jeffrey Kent Bates MD 1963
Jeffrey M Pont MD 1968
Jennifer Farrell MD 1982
Jennifer Franklin Employee 1977
Jennifer Hess Clinic Owner 1969

Jennifer Zampogna 1973
Jeri Lynn Ellis MD 1961
Jerome Sherard MD 1955
Jesse B. Henry MD 1935
Jesse Violante Employee 1987
Jessica Joyce Spayd NP 1971
Jill Hunt MD 1954
Jody Robinson Owner 1974
Joel E. Miller DO 1958
Joel S. Dreyer MD 1937
Joel Shumrak Owner 1948
Joel Smithers DO 1983
Joseph Borkson MD 1943
Joseph Oesterling MD 1956
Joseph Talley MD 1937
Julie Ann DeMille NP 1959
Karen Climer Administrative Employee 1957
Karen Hebble Pharmacy Manager 1971
Katherine Dossey Pharmacist 1969
Kelvin L. Douglas MD 1953
Kenneth Cherry MD 1959
Kenneth D Richards DO 1972
Kenneth Hines MD 1944

Kenneth M. Stanko MD 1949
Kenneth Rivera-Kolb MD 1953
Kevin Denny MD 1954
Kevin E. Gorin MD 1960
Kevin Huff Pharm 1976
Kevin R. Clemmer DO 1954
Keyhosrow Parsia MD 1937
Kofi Shaw-Taylor MD 1950
Konstantinos
Afthinos NOT A DOCTOR 1980
Kristen Holland Pharmacist 1982
Kristen Raines NP 1977
Kurt Paul Moran MD 1952
Lafayette J. Twyner MD 1949
Larren Wade MD 1958
Larry Curtis White DO 1941
Larry Egan
Boatwright Licensed Pharmacist 1963
Laurence T
McKinney MD 1956
Lavern Davidhizar DO 1945
Lawrence (Larry) M.
Friedes MD 1969
Lawrence Adams MD 1960
Lawrence J.
Gogenola MD 1950
Lawrence J. Valdez MD 1969
Lawrence M Simons MD 1956
Lawrence Miller DO 1971
Lawrence Wean MD 1954
Lawrence Womack MD 1961
Lazar Feygin MD 1947
Leslie Wayne Benson MD 1953
Lianna “Lili”
Ovsepian Owner 1981
Linda Richards Nurse 1948
Mary Jane Eicher DO 1935
Matthew R.
Crouthamel MD 1978
Matthew S. Miller DO 1979
Megaly S.
Bethencourt MD 1949
Melisa Million Employee 1970
Melissa Tenhet Office Manager 1964
Melvin Lee Robison DO 1954
Michael Cash DO 1968

Michael Chait MD 1961
Michael Dawes MD 1955
Michael E Metzger MD
Michael F. Myers MD 1955
Michael Frey MD 1973
Michael K Johnson DO 1963
Michael Kostenko DO 1956
Michael L Williams MD 1968
Michael Lapaglia MD 1972
Michael Lee
Cummings MD 1955
Michael Milchin Office Manager 1982
Michael Millette MD 1961
Michael Minas MD 1965
Michael Morgan
Dietch MD 1957
Michael Pendleton MD 1967
Michael Randall DO 1967
Michael Roger
Chiarottino MD 1949
Michael S. Basch MD 1959
Michael Shramowiat MD 1953
Michael Taba MD 1965

Michael Troyan PA 1979
Mitchell White PA 1986
Myra Sue Miller Office Manager 1963
Natalie A. Anderson Office manager 1979
Nathaniel Brown MD 1955
Neil Cutler MD 1941
Nestor Merces Employee 1978
Nicholas J. Capos Jr. MD 1951
Nicholas Kaloudis MD 1972
Nicholas Sasson MD 1968
Nolan Denny Crisp MD 1937
Norman Werther MD 1940
Nurista Grigoryan Operators of Manor Medical Imaging 1955
Okechukwu Dimkpa MD 1969
Oliver W. Herndon MD 1972
Omar Lorden 1964
Oscar A. Linares MD 1957
Patabendige S.
Deundara MD 1954
Paul Bellofiore MD 1960
Paul Caviness MD 1958
Paul Howard
Emerson DO 1959
Paul Maglinger MD 1976
PETER ALAN
LODEWICK MD 1941
Peter Grigg MD 1960
Peter Scott Dietrich MD 1957
Phil Astin III MD 1957
Philip B. Eatough DO 1947
Philip G. Wagman MD 1958
Philip Mach MD 1957
Philipp Leo Bannwart MD 1965
Ramil Mansourov MD 1970
Randall D. Halley DO 1956
Randy J. Lamartiniere MD 1959
Randy Webman Owner 1954
Rassan Tarabein MD 1960
Raymond Kraynak DO 1958
Raymond Paul Freitas MD 1952
Reynat Glaz Physical therapist 1974
Rezik A. Sager MD 1954
Richard A. Mazur MD 1953
Richard Arthur Evans MD 1944
Richard Farmer MD 1937
Richard Larson MD 1936

Richard Philipoff Employee 1981
Richard Rydze MD 1950
Richard Stehl MD 1960
Ricky L.
Houdersheldt DO 1952
Robert Agresti DO 1957
Robert Allara MD 1956
Robert Ritchea MD 1963
Robert Terdiman MD 1946
Robert Z. Braun MD 1949
Robert A. Wiemer MD 1947
Rodney Crock DO 1975
Roger Gordon MD 1947
Sarah Harding-
Huffine Employeee 1984
Sarah Shoopman Employee 1981
Scott Becker MD 1959
Scott D. Tingler Pharmacist 1979
Scott W. Houghton MD 1967
Sharon Naylor NP 1966
Sherry Isbell 1970
Sidney S. Loxley MD 1942
Simmon Lee Wilcox Dr. 1956

Sohrab Shafinia DO 1962
Stanley Elmer
Heatwole MD 1944
Stanley Reeves Pharmacist 1959
Stephen C. Arny MD 1947
Stephen S. Jewett MD 1940
Stephen K Shaner Owner 1950
Stephen Pierce MD 1949
Stephen S. Jewet MD 1949
Founder and co-owner of Comprehensive Pain
Steve Dickerson Specialists (MD) 1964
Steve Fanto MD 1962
Steven A. Holper MD 1951
Steven B. DeWilde DO 1957
Steven Bruce Hefter MD 1958
Steven Bryce Inbody MD 1956
Steven Cox NP 1955
Steven Edson Clinic owner 1972
Steven Kotsonis MD 1981
Steven Owens DO 1954
Steven Ringel MD 1987
Stuart W. Bilyeu DO 1971
Susan H Yandle MD 1964

Susan Perry NP 1960
Suzette Cullins MD 1961
Sylvia Hofstetter Pain Clinic Owner 1964
Tandy McElwee MD 1948
Tania Sanchez Owner 1971
Tara Atkins Office manager 1978
Thomas Hewitt PA 1954
Thomas Rodenberg MD 1959
Thomas Sachy MD 1964
Thomas Strick MD 1959
Timothy Dennis
Gowder MD 1947
Timothy Spencer PA 1949
Tina Marie Stapleton Co-Owner 1982
Tina Sheldon Staff Assistant 1970
Tod Hagins MD 1966
Tonia Snook Employee 1977
Tracy Bias Owner of clinic 1965
Van Coleman MD 1958
Victor Georgescu MD 1960
Victor Hanson MD 1933
Victor Manuel Ron Owner 1985
Viktoriya Makarova FNP 1986

Vyacheslav
Maksakov Office Managers 1959
Wallace Stogner Employee 1955
Walter Broadnax MD 1957
Walter David
Blankenship PA 1977
Warren H Williams MD 1951
Warren R Stack MD 1947
Wayne
W. Williamson DO 1943
Wendi Henry Owner of Pain Therapy Center 1969
William Beals MD 1951
William F. Ryckman MD 1948
William Hedrick MD 1963
William Husel Dr 1976
William J Scheyer MD 1928
William Joseph
Watson DO 1955
William Lee Matzner MD 1959
William Mangino II MD 1948
William Martin
Valuck DO 1942
William McCutchen
III MD 1970
William Pierce DME Owner 1968
William R. Lockridge MD 1954
William Richardson MD 1954
William S. Belfar MD 1964
William Sokoll MD 1956
William Soyke PA 1953
Appendix C
List of Targeted and Prosecuted Black and Brown Skin Healthcare Professionals
Full Name Year of Birth Race/ Ethnicity Age (end of 2020)
Venkat Aachi 1967 Asian 53
Moustafa Moataz Ibrahim
Aboshady 1983 Asian 37
Arman Abovyan 1975 Middle Eastern 45
Vanja Abreu 1963 Asian 57
Emmanuel G. Acosta 1953 Hispanic 67
George Agapios 1967 Asian 53
Krishan Kumar Aggarwal 1958 Asian 62
Madhu Aggarwal 1950 Asian 70

Shelinder Aggarwal 1968 Asian 52
Pankaj Agrawal 1947 Asian 73
Kofi Ohene Agyekum 1978 Black 42
Ishtiaq Ahmad 1963 Asian 57
Salahuddin Ahmad 1954 Asian 66
Muhammad K. Ahmed 1947 Middle Eastern 73
Sheikh Ahmed 1963 Middle Eastern 57
Sheikh Irfan Ahmed 1963 Middle Eastern 57
Ajay Ahuja 1954 Asian 66
Paramjit Singh Ajrawat 1955 Asian 65
Sukhveen Kaur Ajrawat 1958 Asian 62
Ezekiel Akande 1959 Black 61
Syed Jawed Akhtar–Zaidi 1955 Asian 65
Abbey AkinWumi 1960 Black 60
Lillian Akwuba 1979 Black 41
Oslay Borrego Alarcon 1971 Hispanic 49
Ricardo Alerre 1929 Hispanic 91
Anthony Alexander 1961 Black 59
Harry Alexanderian 1926 Middle Eastern 94
Ashmead Ali 1958 Middle Eastern 62
Muhammad Ali 1964 Middle Eastern 56
Hussamaddin Al-Khadour 1970 Middle Eastern 50
Eklis Almanza 1968 Hispanic 52

Emilio Almuina 1969 Hispanic 51
Omar Almusa 1973 Middle Eastern 47
Charles Alston 1947 Black 73
William Alvear 1955 Asian 65
Tameshwar Ammar 1968 Asian 52
Khaled L. Amr 1963 Middle Eastern 57
Neil K. Anand 1977 Asian 43
Marcus Anderson 1986 Black 34
Adrian Armas 1988 Hispanic 32
Hussam Armashi 1956 Asian 64
Gautam Arora 1977 Asian 43
Vasu D. Arora 1934 Asian 86
Annamalai Ashokan 1953 Asian 67
Sardar Ashrafkhan 1958 Asian 62
Nevorn Askari 1956 Asian 64
Michael Assevero 1957 Black 63
Arnita Avery-Kelly 1962 Black 58
Hussein Awada 1970 Middle Eastern 50
Chowdhury Azam 1954 Asian 66
Najam Azmat 1957 Asian 63
Hasan Babaturk 1957 Middle Eastern 63
Alaaeldin Babiker 1959 Middle Eastern 61
Satish Narayanappa Babu 1967 Asian 53

Gurpreet Singh Bajwa 1971 Asian 49
Jatinder Bajwa 1950 Asian 70
Yvette K Baker 1959 Black 61
Masoud Bamdad 1953 Middle Eastern 67
Sanjoy Banerjee 1976 Asian 44
Luella Bangura 1962 Black 58
Vinay Bararia 1970 Asian 50
Francis J. Barbuscia 1977 Hispanic 43
Manuel Barit 1948 Middle Eastern 72
Shanta Barnes 1956 Black 64
Carlos M. Barrera 1949 Hispanic 71
Ihab Steve Barsoum 1970 Middle Eastern 50
Javaid M. Bashir 1954 Asian 66
Harriston Bass 1954 Black 66
Edward Benjamin Alister Beckles 1954 Black 66
Sukhdarshan Bedi 1954 Asian 66
Afzal Beemath 1976 Black 44
Jong H. Bek 1942 Asian 78
Ruben Taguiam Benito 1941 Hispanic 79
Johnny Clyde Benjamin 1966 Black 54
Matthew A. Bennett 1965 Middle Eastern 55
Amar Nath Bhandary 1960 Asian 60
Parth Bharill 1959 Asian 61

Nikhil Bhasin 1987 Asian 33
Carol Neema Biggs 1985 Black 35
Nilaja C. Biggs 1982 Black 38
Emad Mikhail Tewfik Bishai 1972 Middle Eastern 48
Noel Blackman 1948 Black 72
Faith Blake 1975 Black 45
Rano Bofill 1942 Asian 78
Olivia Bolles 1980 Hispanic 40
Ibem Borges 1962 Hispanic 58
Odalys del Carmen Borrego 1968 Hispanic 52
Rajendra Bothra 1942 Asian 78
Domenick Braccia 1962 Hispanic 58
Shavonta Devon Bright 1986 Black 34
Milton Lee Brindley 1976 Asian 44
Felix Brizuela, Jr. 1961 Hispanic 59
Charles Brooks Jr. 1958 Black 62
Avrom Brown 1948 Asian 72
Charles Brown Jr. 1960 Asian 60
Loretta Brown 1953 Asian 67
Michael R. Brown 1953 Asian 67
Tayjha Brown 1985 Black 35
Victor Bruce 1965 Black 55
Hector Bruno 1978 Hispanic 42

Lauran Bryan 1959 Hispanic 61
Washington Bryan II 1969 Black 51
Harold Budhram 1948 Asian 72
Alexandru Burducea 1976 Hispanic 44
Belafonte Byard 1967 Black 53
Chetan Byhadgi 1964 Asian 56
Frank H. Bynes, Jr. 1950 Black 70
Juan Cabezas 1958 Hispanic 62
Cynthia Cadet 1970 Black 50
Yolanda Camara 1969 Hispanic 51
Rosetta Valerie Cannata 1957 Hispanic 63
Francisco R. Carbone 1958 Hispanic 62
Candace A. Carreras 1987 Hispanic 33
Gilberto A. Carrero 1961 Hispanic 59
Agustin M. Castellanos 1955 Hispanic 65
Roland Rafael Castellanos 1980 Hispanic 40
Hector Castro 1961 Hispanic 59
Joseph Castronuovo 1939 Hispanic 81
Shannon Christopher Ceasar 1973 Hispanic 47
Wayne Jerome Celestine 1961 Black 59
Jose Rosendo Cesena 1965 Hispanic 55
Christina Chai 1984 Asian 36
Daniel Cham 1959 Asian 61

Zongli Chang 1966 Asian 54
Kenny Chatman 1971 Black 49
Aziz Chaudhry 1949 Asian 71
Mona Alicia Chavarin 1972 Hispanic 48
Bonnie Chen 1964 Asian 56
Paul P. Cheng 1978 Asian 42
Willie Chester 1953 Black 67
Janaki Chettiar 1975 Asian 45
Russell Chlysta 1949 Black 71
Jay J. Cho 1945 Asian 75
Joon H. Chong 1943 Asian 77
Harish Chowdary 1949 Asian 71
Vijay Chowdary 1944 Asian 76
Lawrence Choy 1952 Asian 68
Noel Chua 1962 Asian 58
Charles Randall Chube 1959 Black 61
David Chube 1963 Black 57
Brent Clark 1962 Black 58
Cordell Clark 1944 Black 76
Anthony Clavo 1964 Black 56
Jacqueline Cleggett 1962 Black 58
Ona M. Colasante, 1956 Hispanic 64
Jorge Collazo 1985 Hispanic 35

Luis Collazo 1960 Hispanic 60
Odeane H. Connor 1951 Black 69
Alexis Corazon 1964 Hispanic 56
Debra Cortez 1963 Hispanic 57
Pablo Cortina 1964 Hispanic 56
Karl K. Covington 1955 Black 65
Gazelle Craig 1976 Black 44
William Crittenden III 1964 Black 56
Pablo Cruz-Lopez 1960 Hispanic 60
Kevin Custis 1965 Black 55
Mamoun Dabbagh 1955 Asian 65
Rajat Daniel 1966 Asian 54
Horace Junior Davis 1951 Black 69
Dewundara P. Dayananda 1948 Asian 72
Gail E. Dehart 1952 Asian 68
Robert Delagente 1974 Hispanic 46
Cesar Deleon 1946 Hispanic 74
Julio Delgado 1962 Hispanic 58
Denis Deonarine 1945 Black 75
Iraj Derakhshan 1948 Asian 72
Schiller Desgrottes 1948 Black 72
Rools Deslouches 1971 Black 49
Stacy Delvalle 1989 Hispanic 31

David Devido 1939 Hispanic 81
Johnny Di Blasi 1973 Hispanic 47
Albert Diaz 1940 Hispanic 80
Julio Gabriel Diaz 1950 Hispanic 70
Mario Alberto Diaz 1951 Hispanic 69
Dominic Dileo 1953 Hispanic 67
Gerard M. DiLeo 1952 Hispanic 68
Paul DiLorenzo 1954 Hispanic 66
John Dimowo 1959 Black 61
Jean C. Dominique 1948 Black 72
Khanh Van Kim Duong 1979 Asian 41
Janardhanna Durgappa 1966 Asian 54
Maria Echarri 1974 Hispanic 46
Ganiu Edu 1968 Black 52
Sanyani Edwards 1976 Asian 44
Azuka Egbuniwe 1969 Black 51
Reza Ray Ehsan 1958 Middle Eastern 62
Uzma Ehtesham 1968 Asian 52
Mamdouh El-Attrache 1944 Middle Eastern 76
Ahab Elmadhoun 1972 Middle Eastern 48
Cleveland James Enmon 1978 Black 42
Anthony J. Enrico 1957 Hispanic 63
Ereida Arlett Escobar 1991 Hispanic 29

Martin Escobar 1963 Hispanic 57
John Christopher Esparza 1987 Hispanic 33
Tamara Esponda 1967 Hispanic 53
Adeline Essian 1962 Black 58
Jessica Evans 1984 Black 36
Mohanad Fallouh 1969 Middle Eastern 51
Muhammad Faridi 1976 Middle Eastern 44
Munir Hussain Faswala 1955 Middle Eastern 65
Kim Xuan Feldman 1950 Asian 70
Asley Del Sol Fernandez 1981 Hispanic 39
Samuel Cube Fernando 1945 Hispanic 75
Sameer Andoni Fino 1967 Asian 53
Miguel Flores 1951 Hispanic 69
Lee Lee “Audrey” Foong 1959 Asian 61
John Friedl 1958 Black 62
Amir Friedman 1955 Middle Eastern 65
Kumi Frimpong 1961 Black 59
Gladys Fuertes 1974 Hispanic 46
Mario Fuertes 1974 Hispanic 46
Liz Gaitan 1987 Hispanic 33
Guarang Gandhi 1974 Asian 46
Jayshriben Gandhi 1970 Asian 50
Carlos Garcia 1967 Hispanic 53

Madhu Garg 1951 Asian 69
Jeanne Germeil 1964 Black 56
Pasquale Gervasio 1976 Hispanic 44
Fadi Ghanem 1962 Middle Eastern 58
Jacinta Irene Gillis 1970 Black 50
William C. Go 1940 Asian 80
Carlos Godoy 1937 Hispanic 83
Fernando Gonzales-Ramos 1966 Hispanic 54
Angelina Gonzalez 1977 Hispanic 43
Jeffrey Gonzalez 1966 Hispanic 54
Juan E. Diaz Gonzalez 1968 Hispanic 52
Juan Oscar Gonzalez 1957 Hispanic 63
Magaly Gonzalez 1955 Hispanic 65
Jose Jorge Abbud Gordinho 1949 Hispanic 71
Spurgeon Green, Jr 1938 Black 82
Narinder S. Grewal 1951 Asian 69
Rene Guerra 1973 Hispanic 47
Jaime Guerrero 1967 Hispanic 53
Suresh Gupta 1954 Asian 66
Sai Gutti 1959 Asian 61
Tamral Tammy Guzman 1971 Middle Eastern 49
Yong Soo Ha 1940 Asian 80
Imad Haddad 1970 Middle Eastern 50

Moheb Hallaba 1929 Middle Eastern 91
Ehteshamul Haque 1966 Middle Eastern 54
Adolph Harper, Jr. 1951 Black 69
Althea Harris 1952 Black 68
Tormarco Harris 1986 Black 34
Shaikh Monirul Hasan 1963 Asian 57
Khaled Hassan 1967 Middle Eastern 53
Zia Hassan 1967 Middle Eastern 53
Jeri Hassman 1956 Middle Eastern 64
Clella Louise Hayes 1975 Black 45
Adolfo Pliego Hernandez 1940 Hispanic 80
Gabriel Hernandez 1961 Hispanic 59
Callie Herpin 1971 Black 49
Pascual Herrera, Jr. 1955 Hispanic 65
Roger Hershline 1956 Hispanic 64
Amgad Hessein 1960 Middle Eastern 60
Mehran Heydarpour 1962 Asian 58
Andrew M. Ho 1965 Asian 55
Kyin S. Ho 1942 Asian 78
Larry B. Howard 1964 Hispanic 56
Abul Hussain 1963 Middle Eastern 57
Osasuyi K. Idumwonyi 1962 Black 58
Patrick Emeka Ifediba 1959 Black 61

Priscilla Ilem 1926 Asian 94
Umawa Oke Imo 1954 Black 66
Zahid Imran 1956 Asian 64
Raif Wadie Iskander 1966 Middle Eastern 54
Emmanuel C. Iwuoha 1963 Black 57
Jayam Krishna Iyer 1952 Asian 68
Mohamed Kawam-Jabakji 1959 Middle Eastern 61
Anthony Jackson 1967 Black 53
James Don Jackson Jr 1960 Black 60
Sam Jahani 1962 Middle Eastern 58
Pawankumar Jain 1953 Asian 67
Gandam Jayakar 1935 Asian 85
Harvey Jenkins 1964 Black 56
Fernando Jimenez 1945 Hispanic 75
Nilesh Jobalia 1965 Asian 55
Cherian John 1953 Asian 67
Teresa Johnson 1967 Black 53
Jay K. Joshi 1975 Asian 45
Nasreen Kader 1966 Middle Eastern 54
Alex Kafi 1948 Asian 72
Ronald Kahn 1955 Middle Eastern 65
Shakeel Kahn 1965 Asian 55
Byung Kang 1939 Asian 81

Sandeep Kapoor 1967 Asian 53
Spiro Y. Kassis 1953 Middle Eastern 67
Gurbachan S. Kathpal 1954 Asian 66
Sriramloo Kesari 1943 Asian 77
Azad Khan 1954 Asian 66
Fahim Ahmed Khan 1958 Middle Eastern 62
Subramaniam Khanthan 1942 Asian 78
Mukesh Khunt 1979 Asian 41
Ndufola Kigham 1971 Black 49
Naeem Mahmood Kohli 1953 Asian 67
Walter Krajewski 1950 Hispanic 70
Ruvim Krupkin 1952 Middle Eastern 68
Sanjay Kumar 1967 Asian 53
Asif Kundi 1987 Asian 33
Mahesh Kuthuru 1970 Asian 50
Hassan Lahham 1958 Middle Eastern 62
Felix Lanting 1926 Asian 94
Abel Lau 1972 Asian 48
Juan Carol Lazaro-Paulina 1957 Hispanic 63
Hieu Tu Le 1973 Asian 47
Vu Le 1963 Asian 57
Chia Jean Lee 1957 Asian 63
Ji Yun Lee 1969 Asian 51

HI JONG LEE 1942 Asian 78
Jose Leyson 1946 Asian 74
Shouping Li 1962 Asian 58
Stan Xuhui Li 1948 Asian 72
Celia Lloyd-Turney 1954 Black 66
Ernesto Lopez 1943 Hispanic 77
Kevin Lowe 1962 Black 58
Alfonso Luevano 1968 Hispanic 52
Hung Thien Ly 1958 Asian 62
Ihsanullah Maaf 1978 Middle Eastern 42
Paul C. Madison 1953 Black 67
Atif Babar Malik 1969 Asian 51
Atif Mahmood Malik 1980 Middle Eastern 40
Steve Mangar 1970 Asian 50
Estrella Martinez 1958 Hispanic 62
Jorge A. Martinez 1952 Hispanic 68
Jose L. Martinez 1960 Hispanic 60
Fathalla Mashali 1955 Middle Eastern 65
Presmil Masson 1971 Black 49
Danielle C. Mata 1978 Hispanic 42
Rakesh Mathur 1954 Asian 66
Mohammed A.H. Mazumder 1970 Asian 50
Donatus Mbanefo 1953 Black 67

Paul McClung 1960 Black 60
Wayland McKenzie 1947 Black 73
Apryl Mamzette Mcneil 1965 Black 55
Hemal Mehta 1970 Asian 50
Pravin Mehta 1939 Asian 81
Emmanuel I. Mekowulu 1957 Black 63
Andres Julio Mencia 1954 Hispanic 66
Eugenio Menez 1951 Hispanic 69
Jean-Luc Michel 1956 Black 64
Moshe Mirilashvili 1949 Middle Eastern 71
Anwar Mithavayani 1963 Asian 57
Avijit Mitra 1964 Asian 56
Abdelrahman Mohamed 1954 Middle Eastern 66
Irfan Mohammed 1979 Middle Eastern 41
Nibedita Mohanty 1959 Asian 61
Benjamin Moore 1957 Black 63
Marco Moran 1976 Black 44
Steven Anthony Morris 1960 Black 60
Christopher V. Moses 1953 Middle Eastern 67
Mukunda D. Mukherjee 1941 Asian 79
Sukhwinder S Multani 1974 Black 46
Mark A. Murphy 1957 Black 63
Conrad Murray 1953 Black 67

Ronald Myers 1956 Black 64
Nadeem Iqbal 1960 Middle Eastern 60
Narendra Nagareddy 1959 Asian 61
Demian Ibrahim Naguib 1965 Middle Eastern 55
Muhammed S. Nasher-Alneam 1972 Middle Eastern 48
Abdul Naushad 1964 Middle Eastern 56
Wajiha Naushad 1975 Middle Eastern 45
Imo F. Ndem 1960 Black 60
Joseph Ngui Mwau Ndolo 1954 Black 66
Rajaa Nebbari 1972 Asian 48
Christopher Nelson 1972 Black 48
Richard Ng 1952 Asian 68
Kaitlyn Phuong Nguyen 1986 Asian 34
Habiboola Niamatali 1942 Asian 78
Nikhil Nihalani 1974 Asian 46
Mehdi Nikparvar-Fard 1970 Middle Eastern 50
Nkanga Nkanga 1953 Black 67
Manasseh Nwaigwe 1944 Black 76
Absylom Kwabena Nyamekye 1967 Black 53
Vedat Obuz 1965 Middle Eastern 55
Rosemary Ofume 1958 Black 62
Theodore Okechuku 1957 Black 63
Emmanuel Okolo 1967 Black 53

Valentine Okonkwo 1962 Black 58
Sonny Oparah 1941 Black 79
Samson Orusa 1961 Black 59
Agnes Osire 1966 Black 54
Elechi N. Oti 1966 Black 54
Ebube Otuonye 1972 Black 48
Guy Owens 1926 Black 94
Stephen Owusu 1955 Black 65
Cheryl Ozoh 1954 Black 66
Ngozi Justina Ozuligbo 1970 Black 50
Bharani Padmanabhan 1970 Asian 50
Nicolas Alfonso Padron 1959 Hispanic 61
Pradeep Pandya 1964 Asian 56
Bruce Parsa 1963 Middle Eastern 57
Babubhai Patel 1954 Asian 66
Bharat Patel 1947 Asian 73
Devendra I Patel 1959 Asian 61
Krina Patel 1978 Asian 42
Mehul Patel 1979 Asian 41
Sanjay Patel 1974 Asian 46
Sharadchandra Patel 1945 Asian 75
Manoj Dinkar Patharkar 1971 Asian 49
Evelio Fernandez Penaranda 1968 Hispanic 52

Constantino Perales 1951 Hispanic 69
Anand Persaud 1969 Asian 51
Donald Alvin Petties 1964 Black 56
Dzung Ahn Pham 1961 Asian 59
Can D. Phung 1949 Asian 71
James Eliot Pickens 1948 Black 72
Venkata Pinnamaraju 1977 Asian 43
Loren Piquant 1981 Asian 39
Nisar Piracha 1954 Asian 66
Shriharsh L. Pole 1953 Asian 67
Lesly Pompy 1961 Black 59
Anil Prasad 1957 Asian 63
Venkata Pulivarthi 1960 Asian 60
Rana Purvi 1992 Asian 28
Basil Qandil 1978 Middle Eastern 42
Saloumeh Rahbarvafaei 1979 Middle Eastern 41
Ronald Rahman 1950 Middle Eastern 70
Ashis Rakhit 1953 Asian 67
Jayati Gupta Rakhit 1962 Asian 58
Alfred Ramirez 1938 Hispanic 82
Mashiyat Rashid 1981 Middle Eastern 39
Silas Richmond II 1985 Black 35
Edward Ridgill 1953 Black 67

Andres Rojas 1959 Hispanic 61
Alexis Roman-Torres 1963 Hispanic 57
Asok Roy 1939 Asian 81
Manjula Roy 1941 Asian 79
Xiulu Ruan 1963 Asian 57
Joel Sabean 1948 Middle Eastern 72
Evelyn Frances Sabugo 1939 Black 81
Maureen Sachy 1939 Asian 81
Anil Sahijwani 1974 Asian 46
Osama Salouha 1973 Middle Eastern 47
Samah Salouha 1978 Middle Eastern 42
Daysi Sanchez 1964 Hispanic 56
Luca Sartini 1960 Asian 60
Abdus Sattar 1957 Middle Eastern 63
Nadem Sayegh 1954 Middle Eastern 66
Sbeih Sbeih 1969 Middle Eastern 51
Clarence Scranage Jr. 1956 Black 64
Ramon Scruggs 1948 Black 72
Daniel Seeley 1961 Hispanic 59
Vinod Shah 1950 Asian 70
Yunus Shah 1968 Middle Eastern 52
Milad Shaker 1971 Asian 49
Ghulam Shakir 1972 Middle Eastern 48

Mudassar Sharif 1975 Middle Eastern 45
Mohammed Shariff 1951 Middle Eastern 69
Arun Sharma 1955 Asian 65
Kiran Sharma 1955 Asian 65
Rakesh Sharma 1971 Asian 49
Vikas Sharma 1979 Asian 41
Timothy Shawl 1960 Asian 60
Ali Shaygan 1973 Middle Eastern 47
Sandeep Sherlekar 1965 Asian 55
Marc Shinderman 1942 Hispanic 78
Jay Shires 1984 Asian 36
Victor Boon Huat Siew 1952 Asian 68
Michael A. Simental 1972 Hispanic 48
Sanjay Sinha 1964 Asian 56
Armando Solis 1951 Hispanic 69
Murray Soss 1941 Asian 79
Harold C. Spear III 1954 Black 66
Kim Spina 1964 Asian 56
Oscar Stokes 1975 Black 45
Daniel Suarez 1991 Hispanic 29
Andrew Sun 1936 Asian 84
Kenneth Sun 1962 Asian 58
Michael Taitt 1960 Black 60

Nicola Tauraso 1935 Hispanic 85
Naga Raja Thota 1954 Asian 66
Suwarna Tilak 1967 Asian 53
Patrick Allen Titus 1963 Hispanic 57
Kamal Tiwari 1952 Asian 68
Enemisis Torres 1967 Hispanic 53
Erik Raul Torres 1983 Hispanic 37
Tomas Garcia Torres 1971 Hispanic 49
Anmy Tran 1971 Asian 49
Thomas Trieu 1967 Asian 53
Sanjay Trivedi 1963 Asian 57
Hong Truong 1966 Asian 54
Hsiu-Ying Tseng 1970 Asian 50
Pete Anthony Tyndale 1972 Black 48
Michael Umansky 1931 Hispanic 89
Richard Utarnachitt 1942 Asian 78
Brij R. Vaid 1962 Asian 58
Fernando Valle 1954 Asian 66
Thu-Hoa Van 1966 Asian 54
John Van Wu 1969 Asian 51
Pravin Vasoya 1967 Asian 53
Carlos Luis Venegas 1957 Hispanic 63
Clarence R Verdell 1950 Black 70

Tomasito Virey 1955 Asian 65
Agustin Vitualla 1949 Asian 71
David Wang 1954 Asian 66
David M. Wasanyi 1969 Black 51
Rohan Wijetilaka 1949 Asian 71
Freddy J. Williams 1949 Black 71
John K. Yacoub 1956 Middle Eastern 64
Waleed Yaghmour 1967 Middle Eastern 53
Rajendra D. Yande 1965 Asian 55
Han M. Yang 1943 Asian 77
Harrison Yang 1944 Asian 76
Paul Yang 1967 Asian 53
Bassam Yassine 1969 Middle Eastern 51
Alvin Mingczech Yee 1969 Asian 51
Jerry Ning Yee 1933 Asian 87
Albert Yeh 1965 Asian 55
Alphonse Yezbick 1929 Middle Eastern 91
In Whan Yun 1938 Asian 82
Muhammad Zafar 1972 Asian 48
Jorge Zamora-Quezada 1957 Hispanic 63
Konstantin Zeva 1952 Middle Eastern 68
Mengjia Zhao 1954 Asian 66

Appendix D
List of All Blue Cross Blue Shield Association Companies
Blue Cross and Blue Shield of Alabama, Premera, Premera Blue Cross, PremeraFirst, Inc.,
LifeWise Health Plan of Washington, LifeWise Health Plan of Oregon, LifeWise Health Plan of
Arizona, Inc., Premera Blue Cross Blue Shield of Alaska, Corp., Medical Services Corporation
of Eastern Washington, NorthStar Administrators, Inc., CareFirst, Inc., Group Hospitalization
and Medical Services, Inc., Access America, Inc., The GHMSI Companies, Inc., CareFirst
BlueChoice, Inc., Capital Care, Inc., CareFirst of Maryland, Inc., CFS Health Group, Inc., Blue
Cross and Blue Shield of Florida, Inc., Health Options, Inc., Hawaii Medical Service
Association, The Regence Group, Regence BlueShield of Idaho, Inc., Regence BlueCross
BlueShield of Utah, Regence BlueCross BlueShield of Oregon, Regence BlueShield, Regence
Life and Health Insurance Company, RegenceCare, Regence HMO Oregon, Regence Health
Maintenance of Oregon, Inc., Healthwise, Asuris Northwest Health, Wellmark, Inc. d/b/a
Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., Wellmark
Community Insurance, Inc., Wellmark of South Dakota, Inc. dba Wellmark Blue Cross and Blue
Shield of South Dakota, Louisiana Health Service & Indemnity Company dba Blue Cross and
Blue Shield of Louisiana, HMO Louisiana, Inc., Blue Cross and Blue Shield of Massachusetts,
Inc., Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc., Blue Cross Blue Shield of
Michigan, BCBSM, Inc. dba BlueCross BlueShield of Minnesota, HMO Minnesota dba Blue
Plus, Comprehensive Care Services, Inc., Blue Cross & Blue Shield of Mississippi, HMO of
Mississippi, Inc., Blue Cross and Blue Shield of Montana, Inc., Horizon Healthcare Services,
Inc. d/b/a Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare Plan Holding
Company, Inc., Horizon Healthcare Insurance Company of New York, Horizon Healthcare of
New Jersey, Inc., Horizon Healthcare of New York, Inc., Enterprise Holding Company, Inc.,
AtlantiCare Administrators, Inc., Horizon Healthcare Administrators, Inc., Horizon AtlantiCare
LLC, Horizon Healthcare of Delaware, Inc., NASCO of New Jersey, Inc., Empire HealthChoice
Assurance, Inc., d/b/a Empire Blue Cross Blue Shield, Empire HealthChoice HMO, Inc.,
WellChoice Insurance of New Jersey, Inc., WellChoice Holdings of New York, Inc., WellPoint
Holding Corp., Blue Cross and Blue Shield of North Carolina, Hospital Service Association of
Northeastern Pennsylvania, HMO of Northeastern Pennsylvania, Independence Blue Cross,
AmeriHealth HMO, Inc., La Cruz Azul de Puerto Rico, Keystone Health Plan East, Inc., Triple-
S, Inc.; Triple-S, Inc., of Puerto Rico, Triple-C, Inc., Blue Cross Blue Shield of Rhode Island,
Blue Cross and Blue Shield of South Carolina, BlueChoice HealthPlan of South Carolina, Inc.
f/k/a Companion HealthCare Corporation, Planned
Administrators, Inc., Thomas H. Cooper & Co., Inc., BlueCross BlueShield of Tennessee, Inc.,
Tennessee Health Care Network, Inc., Health Care Service Corporation, Group Health
Maintenance Organization, Inc. d/b/a Bluelincs HMO, Group Health Service of Oklahoma, Inc.
d/b/a Blue Cross Blue Shield of Oklahoma, HMO New Mexico, Inc., New Mexico Blue Cross
and Blue Shield, Inc. d/b/a Blue Cross and Blue Shield of New Mexico, New Mexico Blue Cross
and Blue Shield, Inc., Hallmark Services Corporation, BCI HMO, Inc., HCSC Insurance
Services Corporation.
Certificate of Service
I, Felix Brizuela, hereby certify that on the date set forth below a copy of the foregoing was filed with clerk of
courts. Notice of this filing will be sent to all parties by email or by regular mail.
Plaintiff Ford Motor Company- J. Travis Mihelick, 900 Wilshire Drive, Suite 300, Troy MI 48084
(248) 203-1655 /(248) 647-5210 fax
[email protected]
Defendant, BLUE CROSS BLUE SHIELD OF MICHIGAN MUTUAL INSURANCE COMPANY
600 EAST LAFAYETTE BOULEVARD DETROIT, MI 48226 USA
Defendant, Blue Cross Blue Shield Association
225 North Michigan Ave. Chicago, IL 60601
/s/ Felix Brizuela
Name
06/16/2023
Appendix E For
Rule 201
Case 2:23-cv-00337-CCW-PLD
Case 2:23-cv-11286-LVP-EAS ECF No. Document 6 FiledFiled
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IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF PENNSYLVANIA
FELIX BRIZUELA, )
)
Plaintiff, )
)
v. ) Civil Action No. 23-337
)
HIGHMARK BLUE CROSS BLUE )
SHIELD OF PENNSYLVANIA, )
)
Defendants. )
REPORT AND RECOMMENDATION
I. RECOMMENDATION
It is respectfully recommended that the Court dismiss Plaintiff’s Complaint under the
screening provisions of 28 U.S.C. § 1915. 1
II. REPORT
A. Relevant Procedural History
Plaintiff Felix Brizuela commenced this pro se in forma pauperis (“IFP”) lawsuit alleging
federal question jurisdiction under 28 U.S.C § 1331. 2 (ECF No. 4 at 3). Brizuela bring suits
against Defendant Highmark Blue Cross Blue Shield of Pennsylvania for violation of his
constitutional rights. (Id.) He also appears to allege a breach of contract claim. (Id. at 7.)
Brizuela was granted IFP status on March 13, 2023, (ECF No. 3), and his Complaint was
docketed the same day. (ECF No. 4.)
1
See 28 U.S.C. § 1915(e)(2)(B) (“[T]he court shall dismiss the case at any time if the court determines that . . . the
action . . . (i) is frivolous or malicious; (ii) fails to state a claim on which relief may be granted; or (iii) seeks
monetary relief against a defendant who is immune from such relief.”).
2
Because Brizuela alleges that both he and Defendant are citizens of Pennsylvania, no diversity jurisdiction
pursuant to 28 U.S.C § 1332 exists. (See ECF No. 4 at 4.)
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B. Relevant Factual Background
The Complaint alleges that in October 2016, Brizuela’s house was raided by the FBI
pursuant to an illegal search warrant that lacked probable cause. (See generally, ECF No. 4
at 6.) An agent stated that the raid was due to an ongoing investigation for insurance fraud
(or “kickbacks”) that had been allegedly initiated by Defendant arising out of Brizuela’s use
of intravenous gamma globulin (“IVIg”). (Id.) Brizuela alleges that he followed the proper
process for such prescriptions, that only patients who were approved by the insurance
companies had infusions of IVIg, and that those infusions were performed by a service
provider approved by the insurance provider. (Id.) Brizuela alleges that he did not receive
any compensation and that Defendant “‘speculated’ that [he] was getting kick backs” and
had “zero proof of this.” (Id.) Thus, Brizuela alleges that Defendant violated his Fourth
Amendment rights due to the “unlawful and illegal raid” that took place at his house. (Id.)
Brizuela also alleges that the FBI “unlawfully and without due process” contacted the
CEO of Highland Hospital and lied to her that he was doing IVIg infusions in a hospital
office. (Id.) The CEO then evicted Brizuela from his office and revoked his hospital
privileges “without due process.” (Id.) Brizuela alleges that his Fifth Amendment right to
due process has been violated and he has been deprived of his right to liberty, due to not
being credentialed and not being able to make a living. (Id.)
Additionally, Brizuela alleges that a law firm in West Virginia illegally 3 learned of
the investigation, gathered the names of his patients receiving IVIg infusion, and started
asking them if they wanted to sue Brizuela for their “misdiagnosis.” (Id.) Brizuela asserts
that all patients were properly diagnosed and had documented improvements. (Id.) He then
3
Brizuela alleges that the FBI, under the orders of Defendant, disclosed this information. (ECF No. 4 at 6.)
2
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alleges that he only settled with these individuals because his own defense attorney did not
have an expert witness and would not let Brizuela serve as his own expert witness. (Id.) As
a result, Brizuela argues that he was “coerced” into settling with seven patients for $1.2
million (paid by his insurance carrier) and has had difficulty finding working, tending to his
family, and getting credentialed. (Id.)
In conclusion, Brizuela argues that neither “Blue Cross Blue Shield nor the FBI ever
proved that [he] was getting kick backs for infusing IVIg and [he] was never charged with
insurance fraud as a result of the false accusations….” (Id. at 7.)
C. Legal Standard
Section 1915 requires courts to screen an IFP complaint and dismiss the action before the
complaint is served if the complaint fails to state a claim or is frivolous or malicious. See 28
U.S.C. § 1915(e)(2)(B)(i)-(iii); Ball v. Famiglio, 726 F.3d 448, 452 (3d Cir. 2013)). In screening
complaints under § 1915, courts utilize the same standard that is applied to motions to dismiss
under Federal Rule of Civil Procedure 12(b)(6). D’Agostino v. CECOM RDEC, 436 F. App’x
70, 72 (3d Cir. 2011) (citing Tourscher v. McCullough, 184 F.3d 236, 240 (3d Cir. 1999)).
A complaint is susceptible to dismissal if it fails to state a claim upon which relief can be
granted. Fed. R. Civ. P. 12(b)(6). A complaint must be dismissed under Rule 12(b)(6) if it does
not allege “enough facts to state a claim to relief that is plausible on its face.” Bell Atlantic
Corp. v. Twombly, 550 U.S. 544, 556 (2007). The court must “accept all factual allegations as
true, construe the complaint in the light most favorable to the plaintiff, and determine whether,
under any reasonable reading of the complaint, the plaintiff may be entitled to relief.” Fowler v.
UPMC Shadyside, 578 F.3d 203, 210 (3d Cir. 2009) (quoting Phillips v. Cnty. of Allegheny, 515
F.3d 224, 233 (3d Cir. 2008)).
3
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Additionally, “[i]f the court determines at any time that it lacks subject-matter
jurisdiction, the court must dismiss the action.” Fed. R. Civ. P. 12(h)(3). Therefore, when
screening a complaint, a court must determine whether it has subject matter jurisdiction over the
case. Mowery v. Wetzel, No. 1:19-cv-44, 2019 WL 2931672, at *1 (W.D. Pa. June 11, 2019),
report and recommendation adopted by, 2019 WL 2929002 (W.D. Pa. July 8, 2019).
Federal courts are courts of limited jurisdiction “defined (within constitutional bounds)
by federal statute.” Badgerow v. Walters, 142 S.Ct. 1310, 1315 (2022) (citing Kokkonen v.
Guardian Life Ins. Co. of Am., 511 U.S. 375, 377 (1994)). District courts have jurisdiction over
“two main kinds of cases,” diversity cases and cases involving a federal question. Id. at 1315–
16. Diversity cases are “suits between citizens of different States as to any matter valued at more
than $75,000.” Id. at 1316 (citing 28 U.S.C. § 1332(a)). Federal question cases are those that
arise under federal law. Id. (citing 28 U.S.C. § 1331). “Typically, an action arises under federal
law if that law ‘creates the cause of action asserted.’” Id. (quoting Gunn v. Minton, 568 U.S.
251, 257 (2013)).
As Brizuela is proceeding pro se, the Court construes his factual allegations liberally. See
Higgs v. Att’y Gen., 655 F.3d 333, 339 (3d Cir. 2011) (“The obligation to liberally construe a pro
se litigant’s pleadings is well-established.”).
D. Discussion
1. Defendant Highmark Blue Cross Blue Shield of Pennsylvania Is Not

Sufficiently Alleged to Be a State Actor
a. Brizuela’s Arguments for Federal Jurisdiction
Brizuela recognizes that, in general, private companies cannot be held liable for
violations of constitutional rights and argues that “sometimes private companies are doing
4
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government work” and “when a private company is under contract to the government, they can
be sued.” (ECF No. 4 at 3). In support of federal jurisdiction, Brizuela continues:
Insurance companies are regulated by the states. Each state has a regulatory body
that oversees insurance matters. This body is often called the Department of
Insurance, but some states use other names. Examples are the office of the
Insurance Commissioner (Washington) and the Division of Financial Regulation
(Oregon). The insurance department is headed by a commissioner. Depending on
the state, the insurance commission may be appointed or elected.
(Id.).
Thus, Brizuela concludes “[i]nsurers are therefore subject to civil litigation due to
constitution violations.” (Id.)
b. Section 1983’s State Actor Requirement
Section 1983 does not create substantive rights but instead “provides only remedies for
deprivations of rights established elsewhere in the Constitution or federal laws.” Kneipp v.
Tedder, 95 F.3d 1199, 1204 (3d Cir. 1996). To state a viable § 1983 claim, a plaintiff must plead
“that []he was deprived of a federal constitutional or statutory right by a state actor.” Kach v.
Hose, 589 F.3d 626, 646 (3d Cir. 2009) (emphasis added).
Generally, “[a]nyone whose conduct is ‘fairly attributed to the State’ can be sued as a
state actor under § 1983.” Filarsky v. Delia, 566 U.S. 377, 383 (2012) (citing Lugar v.
Edmondson Oil Co., 457 U.S. 922, 937 (1982)). Conversely, “private actors do not act under
color of state law [and] thus are not liable under Section 1983.” Gerhart v. Energy Transfer
Partners, L.P., No. 1:17-cv-017262018, WL 6589586, at *9 (M.D. Pa. Dec. 14, 2018) (quoting
Luck v. Mount Airy No. 1, LLC, 901 F. Supp. 2d 547, 560 (M.D. Pa. 2012)).
Whether a private defendant is acting under color of state law depends on “whether there
is ‘such a close nexus between the State and the challenged action that seemingly private
behavior may be fairly treated as that of the State itself.’” Kach v. Hose, 589 F.3d 626, 646 (3d
5
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Cir. 2009) (citing Leshko v. Servis, 423 F.3d 337, 339 (3d Cir. 2005) (internal quotations
omitted). To answer that question, the United States Court of Appeals for the Third Circuit has
“outlined three broad tests generated by Supreme Court jurisprudence to determine whether state
action exists: (1) whether the private entity has exercised powers that are traditionally the
exclusive prerogative of the state; (2) whether the private party has acted with the help of or in
concert with state officials; and (3) whether the state has so far insinuated itself into a position of
interdependence with the acting party that it must be recognized as a joint participant in the
challenged activity.” Id. (internal quotations and alteration omitted).
c. Brizuela Fails to Allege Sufficient Facts to Show that Defendant

Highmark Blue Cross Blue Shield of Pennsylvania Is a State Actor
Brizuela brings claims against Highmark Blue Cross Blue Shield of Pennsylvania—
which, he admits, is a private health insurance company. (ECF No. 4 at 3.)
In support of jurisdiction, Brizuela argues that regulatory oversight of health insurance
companies permits suits against insurance companies as “state actors” under § 1983. (Id.) These
broad allegations are insufficient as the United States Supreme Court has “consistently held that
‘the mere fact that a business is subject to state regulation does not by itself convert its action
into that of the State for purposes of the Fourteenth Amendment.’” Am. Mfrs. Mut. Ins. Co. v.
Sullivan, 526 U.S. 40, 53 (1999) (citing Jackson v. Metropolitan Edison Co., 419 U.S. 345, 350
(1974)).
Brizuela has offered no specific factual allegations as to why Highmark Blue Cross Blue
Shield of Pennsylvania is a state actor under any of the applicable three tests. See Anand v.
Indep. Blue Cross, No. 20-6246, 2021 WL 3128690 (E.D. Pa. July 23, 2021), aff’d in relevant
part by, No. 21-2679, 2022 WL 2339476, at *3 (3d Cir. June 29, 2022) (finding that a private
health insurance company that allegedly “‘data mined analytics in partnership with Medicare,
6
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about physicians and patients’ and work[ed] with ‘USDOJ and Medicare [to induce] criminal[]
proceedings” was not a state actor, 4 because (1) “providing medical insurance is not a traditional
public function reserved exclusively for the state,” defendant’s “work with the government
funded and regulated Medicare program is insufficient to identify it as a state actor” and there
were no allegations “that the government delegated any of its prosecutorial or investigative
responsibility to [defendant]”; (2) “[g]overnment contractors do not automatically become state
actors by performing contractual obligations” and allegations that a defendant “willfully
participated” by accessing its insurance data analytics program to share with the government
“failed to allege any agreement between the private actor and a state entity to violate the
plaintiff’s federal constitutional or statutory rights”; and (3) plaintiff failed to allege a
“conspiracy between a state actor and the defendant-insurance company” as there were no facts
“from which it could be inferred that the state actors substituted [the defendant’s] judgement for
their own” and “[s]upplying information to the government does not automatically make a
private party a state actor.”).
Finally, even a liberal reading of Brizuela’s complaint that Defendant was somehow
involved 5 in the FBI investigation into his alleged insurance fraud scheme is insufficient,
because “[m]erely calling the police [or] furnishing information to the police . . . does not . . .
transform a private entity into a state actor.” Cooper v. Muldoon, No. 05-4780, 2006 U.S. Dist.
4
Brizuela sought unsuccessfully to intervene in Anand v. Indep. Blue Cross, in part, to discover information related
to that defendant’s use of certain data algorithms to analyze claim and provide information to law enforcement. (See
Anand v. Indep. Blue Cross (E.D. Pa.) No. 20-6246, ECF Nos. 54, 59, 64).
5
Defendant’s alleged “involvement” in the FBI raid and investigation varies within the complaint. See ECF No. 4 at
6 (alleging the investigation was “initiated by Blue Cross Blue Shield”); id. (alleging that “Blue Cross Blue Shield
‘speculated’ that I was getting kick backs just because [IVIg] was an expensive therapy, which ultimately lead to the
unlawful and illegal raid…They thus violated my fourth amendment rights.”); id. (alleging that the FBI was “under
the orders of Blue Cross Blue Shield” to disclose the investigation to a private law firm.); id. at 7 (alleging that
neither “Blue Cross Blue Shield nor the FBI ever proved that I was getting kick backs.”)
7
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LEXIS 23388 (E.D. Pa. Apr. 26, 2006) (finding that a police tip from a bank employee is
“woefully insufficient to establish the necessary joint action”).
Thus, Brizuela has failed to state a claim for which relief can be granted. Thus, it is
respectfully recommended that Brizuela’s § 1983 claim against Defendant Highmark Blue Cross
Blue Shield of Pennsylvania be dismissed.
When dismissing a civil rights case for failure to state a claim, a court must give a
plaintiff the opportunity to amend a deficient complaint, regardless of whether the plaintiff
requests to do so, unless doing so would be inequitable or futile. Fletcher-Harlee Corp. v. Pote
Concrete Contractors, Inc., 482 F.3d 247, 251 (3d Cir. 2007). “An amendment is futile if the
amended complaint would not survive a motion to dismiss for failure to state a claim upon which
relief could be granted.” Alvin v. Suzuki, 227 F.3d 107, 121 (3d Cir. 2000) (citation omitted).
This Court cannot foresee any additional facts that could convert Defendant Highmark
Blue Cross Blue Shield of Pennsylvania, a private health insurance company, into a state
actor. See Moody v. Lawson, No. 22-CV-4073, 2022 WL 17487735, at *2 (E.D. Pa. Dec. 7,
2022) (‘Courts have routinely found that insurance companies are not state actors for
purposes of § 1983.”); see also, Clissuras v. Teachers’ Ret. Sys., Nos. 02-CV-8130, 02-CV-
8138, 2003 WL 1701992, at *3 (S.D.N.Y. Mar. 28, 2003) (“Private companies frequently
administer health benefits and insurance plans. Providing health insurance (even if funded
by the government) does not transform the Fund into a state actor.”)
Thus, it is respectfully recommended that Brizuela’s § 1983 claim be dismissed with
prejudice because any attempt to amend the complaint would be futile.
8
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2. No Extraordinary Circumstances Justify the Exercise of

Supplemental Jurisdiction
Brizuela’s Complaint also (briefly) appears to assert a breach of contract claim. (See
ECF No. 8 at 3, 6.)
“A district court may decline to exercise supplemental jurisdiction over state law claims
if it has dismissed all claims over which it has original jurisdiction unless considerations of
judicial economy, convenience, or fairness to the parties provide an affirmative justification for
exercising supplemental jurisdiction.” Patel v. Meridian Health Sys., 666 F. App’x 133 (3d Cir.
2016) (internal citations and quotations omitted); see 28 U.S.C. § 1367(c)(3) (“The district courts
may decline to exercise supplemental jurisdiction . . . [if] the district court has dismissed all
claims over which it has original jurisdiction.”); Byrd v. Shannon, 715 F.3d 117, 128 (3d Cir.
2014) (affirming dismissal of state law claims where district court dismissed all of the plaintiff’s
federal claims).
Because there are no extraordinary circumstances in this case which would warrant the
exercise of supplemental jurisdiction, it is recommended that Brizuela’s pendent state law claim
be dismissed without prejudice.
E. Conclusion
Based on the foregoing, it is respectfully recommended that the Court dismiss Brizuela’s
Complaint under the screening provisions of 28 U.S.C. § 1915.
F. Notice
In accordance with the Federal Magistrates Act, 28 U.S.C. § 636(b)(1), and Fed. R. Civ.
P. 72(b)(2), the parties are allowed fourteen (14) days from the date of service of this Report and
Recommendation to file written objections thereto. Any party opposing the objections shall have
fourteen (14) days from the date of service of objections to respond thereto. Failure to file
9
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objections will waive the right to appeal. Brightwell v. Lehman, 637 F. 3d 187, 193 n.7 (3d Cir.
2011).
Dated: March 22, 2023 s/ Patricia L Dodge

PATRICIA L. DODGE
United States Magistrate Judge
10
Investigations Department
Corporate & Financial
Independence Blue Cross
2009
• 3.3 million members
• $10.5 billion in Premiums
• $93.9 million paid in nonpayroll taxes
• $9.4 billion paid to Physicians, Hospitals and
other health care providers for Members’
care
• 5,590 people employed
• 25,840,222 members’ claims processed
(91% electronic) (45 day prompt pay)

2009
• 51,914 employer groups served, 96.8% with

less than 100 employees
• 16,820 inquiries received each business day
• 159 hospitals and 38,053 physicians in our
network
Plans
Individual
– Serves families and individuals under 65
Senior
Provides Medicare-eligible members with Medicare
Advantage, a managed care alternative for Medicare
and the Medicare supplement programs
Local group
– Locally owned businesses 2-20,000 employees
Plans
National
Serves employer groups primarily
headquartered in the five-county southeast
Pennsylvania region with employees working
in other states
Government-Sponsored
AdultBasic, Children’s Health Insurance
Program (CHIP)
Federal Employee Program

Prescription Drug
Products
Traditional
Use any professional and hospital
Preferred Provider Organization(PPO)

Network of professional providers and hospitals
Health Maintenance Organization (HMO)

Primary care physician (PCP) who acts as a
gatekeeper
Types of Claims
Professional Providers (CMS 1500)
Facility/Hospital (UB 04)
Pharmacy
Claims Payment Process

MISSION
The Corporate and Financial Investigations
Department (CFID) is responsible for the
prevention, detection and investigation of all
potential areas of fraud, waste and abuse
against the IBC family of companies, and to
secure financial recoveries.
CFID
Provider Audit – Facility
Provider Audit – Professional
Provider Audit – Ancillary
Pharmacy Audit
Fraud Support
Financial Investigators
CFID Staff
Former Federal, State and Pharmacy Technicians
Local Law Enforcement
Registered Nurses
Agents
Certified Coding
Lawyers
Specialists
Healthcare Professionals
What to Expect from Us
Continuing Co-operation
Investigative report
Surveillance
Undercover investigation
Data (excel spreadsheets)
Claims
Department Objectives
• Early proactive detection of fraud/abuse
• Denial or suspension of inappropriate claims

processing/payment
• Recovery of payments
• Exclusion of professionals from networks
• Change provider behavior

Department Objectives
• Civil litigation
• Criminal prosecution
• Refer licenses to appropriate state boards
• Publicize entities convicted of fraud
Data Mining
• STARS (Services: Tracking, Analysis &Reporting System)
– Data mining tool
• Identifies what
• STARS Sentinel
– Early detection tool
• Identifies who
Initiatives
• Create Sentinel Effect in Provider Community
• Proactive Use of Data Mining Tools for Analysis
• Case Management Information Tracking System
• 1-866-282-2707 Fraud Hot Line - anonymous
• Communication Strategy
Associate Independence Ink
IBX.com
Member Magazine Update
Provider Newsletter
Source: HCI, Inc. February 2009

Source: HCI Inc, March 2010
CFID Financial Results
Fraud, Waste & Abuse (FWA)
2004 – 2009 $ 260.0 Million
Recovered Savings
Claims Denied
Claim Recoveries
Claim Offsets
Voluntary Restitution
Pharmacy Audits
Court Ordered Restitution

Professional Provider FWA
Billing for services/supplies not provided
Alterations appear on claim and/or patient record;
e.g., dates of service inserted, charges altered
Physician/Supplier manipulates billing codes –
Misreporting codes
Changing procedure codes when first code submitted
denied
Billing non-covered services as covered services
Unbundling
Billing a code that pays higher than the service rendered
Professional Provider FWA
• Practicing without a license or outside the
scope of their license
• Name and/or address of the subscriber is the

same as the provider
Member FWA
• Allowing someone else to use your insurance
card or your spouse’s card
• Using an insurance card that has been
canceled
• Ineligible dependents
• False prescriptions
• Identity theft
Prescription Drug FWA
Who commits Prescription Drug Fraud?
Members & Medicare Part D
Beneficiaries
Prescribers
Pharmacies
Pharmacy Benefit Management

Companies (PBMs)
Prescription Drug FWA: Members
• Pharmacy Shopping - Using Multiple
Pharmacies
• Doctor Shopping – Using Different Prescribing
Physicians
• Large Number of Prescriptions for Controlled
Substances - i.e. Oxycontin, Vicodin,
Percocet, Actiq, Xanax
Prescription Drug FWA: Members
• Prescription forging, diversion, or
inappropriate use
• Identity theft
• Resale of drugs on black market
• Altered Pharmacy Receipts
Prescription Drug FWA: Prescribers
• Drug switching
• Script mills
• Provision of false information
• Theft of prescriber’s DEA number
• Illegal remuneration schemes
Group FWA
• Subscribers that are NOT Employees
– Some with high health needs shift from self-
insured to managed care program
• Part-time Employees
• Ineligible Dependents
– boyfriends/girlfriends
– overage children - not full-time students
Facility FWA
• Take-home drugs, patient does not receive
• Up coding DRGs (Diagnostic Related Groups
approx. 500) to get higher reimbursement
• Billing for services not rendered - Lab series
• Misreporting services provided
• Credit balances with failure to refund
• Outpatient services rendered in connection
with inpatient stays
Referrals to CFID
• Hotline
– 866-282-2707 or 215-640-2407
• Websites
– www.ibx.com/anti-fraud
– iway
• Departments - Corporate Compliance/Internal Audit
• Resources – Fraud and Abuse Tip Referral Form
Contact
Rod Sullivan
Director Financial Investigations &
Support
1901 Market St 15th Floor
Philadelphia, PA 19103
(215) 241-0414
Fax (215)567-6901
[email protected]
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UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF COLUMBIA
NEIL ANAND, et al.,
Plaintiffs,
v. Civil Action No. 21-1635 (CKK)
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES, et al.,
Defendants.
SUPPLEMENTAL DECLARATION OF ROBIN BROOKS
I, Robin Brooks, declare as follows:
1. I am the Director, Freedom of Information Act Division, Office of Inspector
General (“OIG”), U.S. Department of Health and Human Services (“HHS” or “the Department”).
In this capacity, I am the Freedom of Information Officer for OIG. I have held this position with
the Department since February 2006.
2. The Department’s administration of its obligations under the Freedom of
Information Act, 5 U.S.C. § 522 (“FOIA”), is decentralized and consists of eleven Operating
Divisions, the Office of the Secretary, and OIG, all of which receive and respond to FOIA
requests.
3. The FOIA Division of OIG, which handles all FOIA requests for OIG records, is
currently comprised of only three people and will temporarily be down to two people following
my retirement later this spring. Our team is responsible for processing between 1,800 and 2,300
FOIA requests directed to OIG each year.
1
4. My duties include responding to FOIA requests for OIG records, managing
searches for OIG records in response to requests under the FOIA, and determining whether to
release or withhold records or portions of Department records in accordance with the FOIA and
the HHS regulations implementing the FOIA. See 45 C.F.R. Part 5.
5. I make this declaration based upon my personal knowledge and information
available to me in my official capacity.
6. I am familiar with OIG’s handling of the FOIA request at issue in this case.
7. On April 17, 2021, Plaintiff Anand submitted a FOIA request to OIG seeking
“[a]ll information concerning data analytics algorithms used in the Pill Mill Doctor Project, all
reports and work product generated by contractor Qlarant corporation concerning the Pill Mill
Doctor Project, statement of work and official contract of Qlarant corporation, all reports from
Blue Cross Blue Shield corporation to OIG concerning improper prescribing of opiates by
specific physicians, all reports of OIG concerning Neil Anand or Institute of Advanced Medicine
and Surgery.” A true and correct copy of the request is attached to my first declaration in this
case as Exhibit 1.
8. The purpose of this declaration is to explain why a search for “all reports from
Blue Cross Blue Shield corporation to OIG concerning improper prescribing of opiates by
specific physicians” would be unduly burdensome.
System Limitations of the OIG Law Enforcement Database
9. OIG maintains all records of investigations conducted by the OIG Office of
Investigations (“OI”), including complaints and documents related to civil and criminal cases, in
its law enforcement database (“LE database”). OIG has indexed the database by subject and
does not have the ability to sort information by submitter unless an OIG investigative analyst
2
determines it is a complaint. Searches for complaints submitted by “Blue Cross Blue Shield,”
“BCBS,” and “BC/BS” did not return any results. OIG does not use the term “report” to
categorize information it receives, but I interpreted that term as simply information. To locate
information not rising to the level of a complaint submitted by Blue Cross Blue Shield, OIG
must search all Electronic Case Files (“ECF”) in the database.
10. The LE database is a legacy system created in or around 2004, and the search
features of the LE database are limited. OIG cannot narrow an ECF search by date or conduct
Boolean searches. To select a particular date range, OIG must still search by name/entity and
then sort by date. Even that approach is unreliable, however, as most cases stay open for
multiple years. For example, OIG may open a case in 2005 but not close it until 2012.
11. A further complication in reviewing search results for responsive records is that
case files contain documents embedded within other documents. OIG must open each document
to ensure there are no embedded documents. Moreover, some of the documents within a case
file are not searchable electronically because they have not been converted into a machine-
readable text format via Optical Character Recognition (“OCR”).
Search Procedure and Results
12. To conduct a search, OIG must open the LE database and search the ECF with
specified search terms. When OIG conducts a search, the database caps the results to 10,000
search hits. To obtain the true number of hits, OIG must enlist the aid of its IT director.
13. I ran seven searches using terms related to Plaintiff Anand’s request, which
yielded the following results:
a. “Blue Cross Blue Shield Corporation” – 0 results
b. “Blue Cross Blue Shield” – 17,262 case results
3
c. “Blue Cross Blue Shield Opioids” – 0 results
d. “Blue Cross Blue Shield Opiates” – 0 results
e. “Blue Cross Blue Shield Reports” – 0 results
f. “BCBS” – 13,146 case results
g. “BC/BS” – 2,320 case results
14. OIG searched for Blue Cross Blue Shield records involving both “opioids” and “opiates,”
though Plaintiff Anand’s request referenced the narrower category of “opiates.” The terms are
often used interchangeably, though “opiates” technically refers to natural opioids such as heroin,
morphine and codeine. “Opioids” refers to natural, semisynthetic, and synthetic opioids.
15. OIG does not have the ability to deduplicate results across the searches.
Extrapolated Length of Review
16. To determine the length of time it would take to review all search results for responsive
records, I selected a random sample of five case files from each of the sets of search results,
ensuring that each sample contained unique cases. Each case file contains “line items,” which
are documents uploaded into the ECF in sequential order, similar to a litigation docket. The first
document is usually the opening investigative memo or complaint. All subsequent documents
are listed in chronological order until the final closing document.
17. The search for “BCBS” returned 13,146 hits. My random sampling of five cases revealed
the following:
a. The first case file contained 296 line items and took me two hours and twelve
minutes to review. This file only contained Blue Cross Blue Shield (“BCBS”)
claims information and did not contain any discussion of opioids or
reports/complaints from BCBS.
4
b. The second case file contained 86 line items and took me 41 minutes to review.
This case, which is still open, involved a qui tam claim and did not contain any
reports/complaints from BCBS. The search returned this case file because it
contained a subpoena for BCBS claims information.
c. The third case file contained 443 line items and took me three hours and four
minutes to review. This case contained BCBS claims information related to the
inappropriate billing of cardiac procedures and did not contain any discussion of
opioids.
d. The fourth case file contained 150 line items and took me one hour and six
minutes to review. This case included a report from Horizon BCBS regarding the
misrepresentation of physical therapy services as surgical procedures. There was
no discussion of opioids.
e. Finally, the fifth case file contained eleven line items and took me nine minutes to
review. This case related to diabetes drugs and did not contain any discussion of
opioids or any reports/complaints from BCBS.
18. Based on the sampling above for the “BCBS” search, reviewing five case files took me
approximately seven hours and twelve minutes to review.
19. The search for “BC/BS” returned 2,320 hits. My random sampling of five cases revealed
the following:
a. The first case file contained 200 line items and took me one hour and 31 minutes
to review. I opened each line item and determined that there were no
reports/complaints related to opioids.
5
b. The second case file contained 18 line items and took me 24 minutes to review.
This case contained no reports/complaints related to opioids.
c. The third case file contained 285 line items and took me two hours and two
minutes to review. This file contained one COVID-19 test from BCBS of Idaho
but no opioid cases.
d. The fourth case file contained 45 line items and took me 43 minutes to review.
This case involved the inappropriate billing of BCBS for mental health
treatments, but there were no reports/complaints from BCBS and no opioids.
e. The fifth case file contained 828 line items and took me three hours and seven
minutes to review. This case involved a qui tam claim related to physician
kickbacks but did not involve opioids.
20. Based on the sampling above for the “BC/BS” search, reviewing five case files took me
approximately seven hours and 47 minutes.
21. The search for “Blue Cross Blue Shield” returned 17,262 hits. My random sampling of
five cases revealed the following:
a. The first case file contained 363 line items and took me two hours and 38 minutes
to review. The file contained claims information from BCBS but no reports. The
case concerned prescriptions issued in one state while the provider was located in
another but did not concern opioids.
b. The second case file contained 125 line items and took me one hour and six
minutes to review. BCBS had been subpoenaed for claims information, and the
file contained a spreadsheet with 1,700 claims. The case file did not contain any
reports/complaints from BCBS.
6
c. The third case file contained 102 line items and took me two hours and eleven
minutes to review. The first line item consisted of information from BCBS of
Michigan but did not regard opioids. The file also contained a lot of embedded
files, which increased the review time significantly.
d. The fourth case file contained 534 line items and took me four hours and nine
minutes to review. The file did not contain any reports/complaints from BCBS.
Several items had embedded files or consisted of portfolios of multiple pdfs, and
there were over 40,000 pages in the case file in total.
e. The fifth case file contained 262 line items and took me one hour and 54 minutes
to review. This case did not contain any reports from BCBS or complaints
involving opioids.
22. Based on the sampling above for the “Blue Cross Blue Shield” search, reviewing five
case files took me approximately eleven hours and 58 minutes to review.
23. Combined, reviewing these fifteen case files took approximately 26 hours and 57
minutes. Assuming this was a representative sample, it would take approximately 58,801 hours
of continuous time to review the 13,146 “BCBS” search results, 2,320 “BC/BS” search results,
and 17,262 “Blue Cross Blue Shield” search results, which cannot be deduplicated—i.e., 26.95
hours / 15 sample case files * (13,146 + 2,320 + 17,262 records)). At a rate of 52 weeks per
year, 40 work hours per week, it would take someone more than 28 years to finish reviewing
these records (i.e., 58,801.31 continuous hours / (52 weeks * 40 hours)). Even if my office,
when it resumes being fully staffed at three people, were to assign each individual to work
fulltime on this specific request and neglect all other FOIA requests or other work duties, this
7
would still take them more than nine years to finish (i.e., 28.26 work years / 3 people), and every
other FOIA request would need to be ignored during this time.
24. The consistency in the time required to review five “BCBS” search results
(approximately seven hours and twelve minutes) and five “BC/BS” search results (approximately
seven hours and 47 minutes) lends further credence to this random sampling. Even if the greater
time required to review the five sampled “Blue Cross Blue Shield” search results were not
considered in the calculation, it would still take someone more than 23.5 years to finish
reviewing the records for these three search terms (i.e., [(7.2 hours + 7.78 hours) / 10 sample
case files * (13,146 + 2,320 + 17,262 records)] / (52 weeks * 40 hours)).
25. The above estimates do not account for annual and sick leave and the demands of other
cases. Attempting to sift through all search results for responsive records would consume all
resources of the OIG FOIA office for decades, making the search for responsive records unduly
burdensome. Additionally, these estimates only estimate the length of time needed to review
records for responsiveness. Making release determinations and applying applicable FOIA
exemptions would take additional time.
26. The individuals who would process FOIA records in my office range from GS-14 to
GS-15. If HHS would employ a GS-14, Step 1 employee full-time to work on Plaintiff Anand’s
FOIA request for 28 years, it would cost HHS more than $3,534,524 in salary alone, which does
not even account for the significant costs of benefits, nor does it account for the fact that the
employee would generally receive yearly pay increases, as the employee climbs the GS scale.
27. My office currently has a backload of 57 cases, and we are currently processing three
cases of great public interest regarding COVID-19, the Wuhan Institute of Virology, and the NIH
8
grant to EcoHealth Alliance. Those three cases alone have more than 450,000 responsive
records. As a result, my office cannot devote all its resources to Plaintiff Anand’s request.
I declare under penalty of perjury that the foregoing to true and correct, to the best of my
information and belief. 28 U.S.C. § 1746. Executed this 24th day of April, 2023.
____________________________
Robin Brooks
Director
Freedom of Information Act Division
Office of Inspector General
U.S. Department of Health and Human Services
9
Case 2:19-cv-10334-DML-APP ECF
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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION
LESLY POMPY, and No. 2:19-cv-10334

INTERVENTIONAL PAIN
LAWSON, J.
MANAGEMENT ASSOCIATES, P.C.,
PATTI, M.J.
Plaintiff,
v.
JURY DEMAND
BLUE CROSS
BLUE SHIELD OF MICHIGAN,
MARC MOORE, and
BRIAN BISHOP,
Defendants.
SECOND AMENDED COMPLAINT
Plaintiffs complain as follows:
INTRODUCTION
1. Under the prevailing fee-for-service model of healthcare
insurance, insurance companies pay doctors for medical services rendered to
patients. Like any insurance business, healthcare insurers have a financial
incentive to maximize the receipt of insurance premiums from patients and to
minimize payment to doctors and other healthcare providers.
2. It is too expensive and time consuming for healthcare insurers to
challenge fee-for-service claims and prescriptions on a patient-by-patient,

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visit-by-visit, service-by-service basis. So, under the guise of combating
waste, fraud, and abuse, Blue Cross Blue Shield of Michigan (“BCBSM”) has
devised a scheme to target for criminal prosecution doctors who bill “too
much” for seeing “too many” patients, who write “too many” expensive
prescriptions to patients, or both.
3. The object of this scheme is to (a) unlawfully recover medical
expenses rightly paid to doctors for services rendered; and (b) wrongfully
deter other doctors from serving patients or prescribing medications that are
too expensive.
4. The method by which BCBSM implements its scheme is to
conspire with law enforcement officers looking to make a name for themselves
and their agency to “investigate” and falsely accuse doctors of running “pills
mills” and/or billing for services not rendered or not medically necessary.
Doctors targeted for “investigation” are publicly raided, have their financial
assets seized, and have their medical licenses and registrations to prescribe
controlled substances suspended when criminally charged. With their assets
seized, unable to work, and facing charges that can carry many decades in
prison, doctors are routinely pressured into accepting plea agreements that,
among other things, require them to give up their seized assets. Those assets
are then split between BCBSM and the law enforcement officer’s agency:
“restitution” to BCBSM and “asset forfeiture” to the agency. BCBSM
recoups money to which it is not entitled, the officer is promoted or receives
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accolades from the agency for sizeable forfeiture “haul,” and the agency gets
to tout itself to the public as being tough on crime.
5. This case is about one doctor who fought back and succeeded.
BCBSM conspired with Lt. Marc Moore and other law enforcement officers
detailed to the Monroe Area Narcotics Team and Investigative Services
(“MANTIS”), a drug task force team under the direction of the Michigan
State Police, comprised of investigators from the Michigan State Police,
Monroe County Sheriff’s Office, and the Monroe City Police Department.
They targeted Dr. Lesly Pompy—a triple board-certified doctor in
anesthesiology, pain management, and addiction treatment—who long
provided health care to the medically underserved community of Monroe
County, Michigan.
6. Dr. Pompy was one of only a small number of physicians in Monroe
County qualified to provide pain management to patients with chronic pain
from real conditions—e.g., patients with cancer pain, patients who had been
in catastrophic highway accidents, patients who had degenerative disc
disease in their spines, and more—and who were referred by other doctors.
Because of the small number of specialists in this field in Monroe County, Dr.
Pompy saw more than the average number of patients—“too many” in Blue
Cross’s eyes. And because the overwhelming majority of the patients needed
expensive medications to alleviate and control their pain, Dr. Pompy also
wrote “too many” expensive prescriptions for Blue Cross’s liking. See PX 1,
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Affidavit of Det. Robert Blair ¶4.S.4 (Sept. 27, 2016) (averring that BCBSM
determined Dr. Pompy to rank first in 2015 for the average number of
BCBSM beneficiaries receiving “high cost medications”); PX 12, BCBSM
2014 Specialists Rank Paid Prescriber Block Analysis.
7. Monroe County, like many communities, experienced a rise in
addiction and overdose deaths due to street drugs like heroin, a type of opioid
that cannot be lawfully prescribed. Most controlled substances used in pain
management are also opioids, but they are opioids that can be lawfully
prescribed. Doctors became easy scapegoats for law enforcement’s failure to
interdict heroin.
8. These two circumstances—BCBSM looking for ways to
disincentivize doctors from writing expensive medications and claw back
payments made to doctors, and law enforcement officers looking to facilitate
career advancement by boosting departmental coffers with forfeiture dollars
through easier collars and high-profile arrests of doctors—gave birth to a
conspiracy between BCBSM and MANTIS officers. BCBSM would provide
data mining and undercover support, and the officers, acting under color of
authority, would provide the muscle—“shock and awe” raids of doctors’
offices, the seizure of doctors’ assets, and cherry-picking evidence to persuade
prosecutors to indict, to scare doctors into pleading guilty, or to convince
juries to convict. The fruits of the conviction—restitution dollars to BCBSM
and forfeiture dollars to MANTIS (or the agencies that staffed it)—would
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serve both their purposes. BCBSM would succeed in clawing back funds and
sending a message to doctors to cut back on expensive services and
medicines, while the officers would parlay the conviction and forfeiture funds
into accolades and promotions.
9. In furtherance of the conspiracy, Moore opened an “investigation”
of Dr. Pompy and used James Howell, a BCBSM employee, as an undercover
patient, who had a fake Michigan driver’s license issued under the alias James
Stewart, who obtained a fake referral from a cooperating BCBSM doctor, and
who claimed to be a truck driver suffering from back pain—a common
problem for truckers—to obtain prescription medication to control his pain.
10. After Howell successfully lied to get prescriptions, BCBSM and
Moore caused members of MANTIS to misrepresent facts, omit facts, and
mispresent the law to a nonlawyer magistrate for the purpose of obtaining
search warrants for Dr. Pompy’s office, his home, and bank accounts belonging
to Dr. Pompy and his medical practice, Interventional Pain Management
Associates, P.C. (“IPMA”). Moore then organized a very public raid on Dr.
Pompy’s practice, complete with a news helicopter and a statement to the
press denigrating Dr. Pompy as a pill pusher responsible for opioid addiction
in the community.
11. BCBSM and Moore first shopped the case to county prosecutors.
Dr. Pompy refused a plea offer that required him, among other things, to
surrender a substantial portion of the seized funds. The case was then taken
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to federal prosecutors, with BCBSM and Moore hoping that exposure to a
substantial prison term under federal law would coax Dr. Pompy into
capitulating.
12. Dr. Pompy steadfastly maintained his innocence and went to trial.
A jury of his peers acquitted him on all counts. By this lawsuit, Plaintiffs
seek to expose this corrupt scheme and the real harm it causes patients, as
well as to secure compensation for the damages they have sustained.
PARTIES
13. Plaintiff Lesly Pompy is a citizen of the United States and a
citizen of the State of Michigan. He is domiciled at 533 North Monroe Street
in Monroe, Michigan 48162.
14. Plaintiff Interventional Pain Management Associates, P.C., is a
professional corporation organized under the laws of the State of Michigan
with a registered office at 400 Galleria Officenter, Suite 500, in Southfield,
Michigan 48034.
15. Defendant Blue Cross Blue Shield of Michigan is a mutual insurance
company organized under the laws of the State of Michigan with headquarters at
600 East Lafayette Boulevard in Detroit, Michigan 48226. It is an independent
corporation operating under a license from the Blue Cross and Blue Shield
Association, an association of independent Blue Cross and Blue Shield Plans,
allowing BCBSM to use the Blue Cross and Blue Shield service marks in the state
of Michigan. BCBSM is the largest health insurer in Michigan and the ninth
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largest insurer in the country. It provides private health insurance to over 4.5
million insureds in Michigan—nearly half of the state’s population. In about 2013,
BCBSM converted from a nonprofit to a for-profit corporation. Despite reporting
a loss of annual revenue, BCBSM’s chief executive officer received $16.9
million in compensation in 2022. Reindl, Michigan Blue Cross CEO Daniel
Loepp earned $17M in cash in 2022, Detroit Free Press (Mar. 1, 2023),
https://perma.cc/UYV3-ASYF. This, however, was a pay cut from the $19.2
million made by the same BCBSM CEO in 2018. Noble, $19.2M paid to
CEO of Blue Cross Blue Shield of Michigan, Detroit News (Mar. 1, 2019),
https://perma.cc/PG27-EUPZ. See also Herman, Big raises for CEOs of the
big Blues plans, Axios (Oct. 14, 2021), https://perma.cc/7ERJ-5F9G.
16. Defendant Marc Moore is, on information and belief, a detective
first lieutenant employed by the Michigan Department of State Police (“MSP”)
at the state police post located at 300 Jones Avenue in Monroe, Michigan
48161. He is sued in his personal capacity only.
17. Defendant Brian Bishop is, on information and belief, an
investigator for the United States Department of Homeland Security and
was, during all or most of the time relevant to this complaint, a diversion
investigator for the United States Drug Enforcement Administration (“DEA”).
JURISDICTION
18. This action presents federal questions that arise under 18 U. S. C.
§ 1964, 42 U. S. C. § 1983, and Bivens v. Six Unknown Named Agents of the
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Federal Bureau of Narcotics, 403 U. S. 388 (1971). The Court therefore has
original subject-matter jurisdiction under Article III of the Constitution of
the United States and 28 U. S. C. § 1331.
19. The Court has supplemental subject-matter jurisdiction over
pendent state law claims under 28 U. S. C. § 1367(a).
VENUE
20. A substantial part of the events and omissions giving rise to the
claims in this Complaint occurred in the City of Monroe, a municipality
located in Monroe County, Michigan. Monroe County is within the territorial
jurisdiction of the Eastern District of Michigan. 28 U. S. C. § 102(a)(1). This
Court is therefore a proper venue for this action under 28 U. S. C. § 1391(b)(2).
GENERAL ALLEGATIONS
A. Dr. Pompy and IPMA

21. Dr. Pompy was born in Haiti and came to the United States with
his family when he was 12 years old. The Pompys settled in Bedford–
Stuyvesant, a small community in Brooklyn, New York, where he lived out
his childhood.
22. The two greatest influences in Dr. Pompy’s life were his great-
uncle, who was a Catholic priest, and the physician who made house calls to
care for his great-grandmother. Dr. Pompy was drawn to the priesthood and
medicine. After watching many neighborhood kids fall into drugs and gang
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violence, Dr. Pompy decided to pursue a vocation in medicine.
23. After graduating from City College of New York, Dr. Pompy
received a scholarship to medical school and was admitted to an accelerated
program. While he was attending medical school, he was mugged and shot on
the streets of Brooklyn while visiting his parents; two men entered the
elevator with him, one put a gun to his head, and the other pointed one at his
ribs. In a struggle with the gunmen, one of them shot Dr. Pompy in the arm
before fleeing. The bullet shattered the bone right about the elbow, causing
radial nerve damage in his arm. He was in the hospital for a week and
couldn’t lift his wrist for several months because of the nerve damage.
24. Dr. Pompy underwent intensive physical therapy and was
prescribed pain medication—hydrocodone—just like many of his patients,
including “James Stewart.” This traumatic event forced him to deal with
extreme pain. Although the bone and nerve healed, he developed Reflex
Sympathetic Dystrophy or “RSD”—just like some of his patients. Dr.
Pompy knew from personal experience what they were going through because
he had gone through a similar experience in his own life and could empathize
with them at a personal level; he knew what it was like to a patient himself.
25. It took almost a year to fully heal from that bullet wound. Yet he
persevered, keeping up with his accelerated studies throughout that year. He
graduated on time from New York Medical School in 1986.
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26. After medical school, Dr. Pompy pursued anesthesia training as a
resident at SUNY Brooklyn. He then performed a two-year fellowship in
cardiac anesthesia at the prestigious Cleveland Clinic.
27. Dr. Pompy passed his anesthesia boards and became a board-
certified anesthesiologist by the American Board of Anesthesiology. Board
certification is the highest level of accreditation within a given specialty.
The anesthesiology certification is widely considered to be one of the most
difficult to obtain in all of medicine. The overall pass rate is only about 60%.
Dr. Pompy passed it on his first attempt. This certification lasts only for 10
years; anesthesiologist must continue to prove to their peers that they are
still at the top of the profession. Dr. Pompy has passed his anesthesiology
boards three times.
28. In 1991, Dr. Pompy moved to Monroe, Michigan, to become the
chief of anesthesia at Mercy Memorial Hospital.
29. By the mid-1990s, Dr. Pompy had been encountering more
patients suffering from long term, chronic pain. As a gunshot victim, who
knew firsthand what it is like to experience pain for an extended period of
time, Dr. Pompy wanted to help those patients better manage their pain. So,
he obtained his second board certification, this time in pain management,
from the American Board of Pain Medicine in 1996.
30. By 2002, Dr. Pompy decided to step down as chief of
anesthesiology at Mercy Memorial Hospital to open IPMA. He bought an
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office suite in the hospital’s office building and opened his doors to the people
of Monroe County, which the federal government recognizes as a “medically
underserved community.”
31. Dr. Pompy built a referral-only specialty practice at IPMA, where
mostly family doctors or primary care physicians would send their hardest
cases to him. On top of seeing patients daily and often late into the evening
in his hospital office, Dr. Pompy additionally worked two mornings each
week at IPMA’s off-campus interventional center, where he offered patients
nonsurgical procedures to treat the root causes of their pain. He also worked
a Saturday each month at a surgical outpatient center owned by other doctors.
32. Over many years of serving as a pain management doctor, Dr.
Pompy came to learn that people turn to the streets to self-medicate and
become addicted to illegal drugs when they can’t obtain legitimate medical
treatment for their pain. This is especially true for poorer people who have
difficulty affording quality care. Folks in that condition need two kinds of
help—help getting off street drugs and help getting legitimate treatment for
the pain. Having witnessed too many neighborhood kids falling into drugs
while growing up, Dr. Pompy saw the destruction that addiction causes and
wanted to do something to help break the cycle of addiction and help these
people live their best lives. So, in 2014, Dr. Pompy obtained his third board
certification, this time in addiction medicine the American Society of
Addiction Medicine.
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33. That’s who Dr. Pompy was—a triple board-certified doctor with
over 25 years of experience in anesthesiology, interventional pain
management, and addiction medicine—when he became the target of
racketeering conspiracy alleged in this complaint.
COUNT 1
CONSPIRACY
18 U.S.C. §1962(D)
(BCBSM and Moore)
34. IPMA incorporates each of the prior paragraphs by reference.
35. A private right of action exists under 18 U. S. C. § 1962(d) against
a person who conspired to violate 18 U. S. C. § 1962(c) and injured a plaintiff’s
business or property by reason of an overt act of racketeering activity under
18 U. S. C. § 1961(1).
36. From about November 2015, through January 4, 2023, BCBSM
and Moore conspired to injure IPMA’s business and property by violating
18 U. S. C. § 1962(c).
37. The object of BCBSM and Moore’s conspiracy was to abuse the
criminal justice system to obtain Plaintiffs’ assets under the guise of
“restitution” to BCBSM and “asset forfeiture” that Moore could tout for
career advancement.
38. In furtherance of the conspiracy, BCBSM and Moore committed
numerous overt acts.
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A. Overt Acts
39. BCBSM and Moore began a joint “investigation” into Dr. Pompy’s
prescription of controlled substances, treatment and testing methods, and
billing practices.
40. BCBSM infiltrated IPMA by sending in BCBSM Investigator
James Howell as an undercover patient using the pseudonym “James Stewart.”
41. Howell surreptitiously recorded each of his visits to IPMA as
“James Stewart.”
January 5, 2016
42. On January 5, 2016, Howell visited IPMA as “James Stewart”
and sought acceptance as a new patient. IPMA declined to accept him as a
patient without a referral for pain management from another physician and
completion of a new patient packet of several documents, including a
comprehensive medical questionnaire of about 20 pages in length through
which a prospective patient was required to provide detailed information
about the history of the pain(s) that brought them to IPMA for treatment.
IPMA provided “James Stewart” with the new patient packet and instructed
him to return with it fully completed once he obtained the required referral.
Obtaining and preparing false information to secure acceptance

as a new patient
43. After IPMA declined to accept “James Stewart” as a new patient
without a referral for pain management from another physician, BCBSM
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procured for Howell a fabricated referral for pain management for “James
Stewart” from Dr. J. Alan Robertson, a cooperating BCBSM physician. The
referral was backdated.
44. Howell also completed the new patient packet, including the
questionnaire. He fraudulently completed the forms in the new patient packet
with the intent to fool Dr. Pompy that “James Stewart” was a real patient
with real pain seeking real care for pain management.
45. For example, Howell: (1) circled “joint pain – stiffness” and “back
problems” on the review of systems; (2) represented that he had diagnosed
with “back” and “nerves” problems; (3) answered the question “[w]here is
your pain located” by circling “other” and writing “stiff back”; (4) described
his pain as a stiff back; (5) represented that his pain was “always present,
always same intensity”; (6) answered the question “[w]hat time of day is your
pain worst” by checking the box “morning on arising” with the notation
“stiffness”; (7) circled the lower back on the depiction of the human form
where asked to indicate where his pain occurs; (8) answered the question
“[w]hat makes your pain feel worse?” by checking the “other” box and writing
in “driving,” and noting on the form that he is a driver by occupation, ibid.;
(9) represented that he did not use recreational drugs; (10) represented that
he first saw a doctor for his pain a year earlier in 2015, ibid.; (11) answered
the question “if you take medicines for pain, [when] do you take it” by checking
the box “when needed for pain,”; and (12) represented that his pain had
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increased since it began. PX 2, Howell New Patient Packet Forms (emphases
added).
January 9, 2016
46. On January 26, 2016, Howell returned to IPMA and submitted
the fabricated referral for pain management and the fraudulently completed
new patient packet for “James Stewart,” along with a fake Michigan driver’s
license and a BCBSM insurance card. Both the fake license and the
insurance card bore the name “James Stewart.”
47. On or after January 9, 2016, in reliance on the fabricated referral
for pain management and the fraudulently completed new patient packet that
Howell provided, but without knowing of their falsity, Dr. Pompy authorized
IPMA staff to schedule “James Stewart” for an initial patient visit.
February 18, 2016

48. On February 18, 2016, Howell arrived for his first visit as a new
patient. He again provided the fake license, BCBSM insurance card, or both,
in connection with the visit.
49. Howell provided a urine sample before his first visit with Dr.
Pompy. He lied to the urine collector, falsely telling her that he took Norco
and Xanax under prescription.
50. After providing a urine sample, Howell was taken to an exam
room where a medical assistant, K.G., collected additional information. Howell
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informed K.G. that he was there for a refill of medication. K.G. recognized
that this was his first visit and that Dr. Pompy had not yet prescribed
medications to “James Howell” (such that there could be no “refills”), so
she asked him why he wanted medications and whether he was a new addiction
patient or a new pain patient. Howell told her that he was a pain patient.
51. K.G. asked “James Stewart” what the most difficult thing was
for him to do because of his pain, and he replied “move.” When she asked
him where his pain was at, he said his low back. K.G. asked if the pain
travelled down his legs, and he said “no.” She performed a preliminary
physical exam to isolate the area of pain. During the exam, Howell
repeatedly represented that certain areas of his body being tested were
“stiff,” “stiffer than s—t,” and “sore.” These representations followed his
initial representations that he was a pain patient and was having pain in
those same areas later described as “stiff,” giving the impression that “pain”
and “stiffness” were synonymous to him—an impression consistent with his
description of his pain as stiffness in the new patient questionnaire.
52. After the medical assistant’s preliminary examination, Dr.
Pompy met with “James Stewart.” Dr. Pompy reviewed Howell’s paperwork
and performed a physical exam of his own. After the exam, Dr. Pompy did
not detect any immediate problems, but ordered tests based on Howell’s
complaints, which Howell associated with his occupation as a driver,
because of the possibility of a degenerative disc disease. Dr. Pompy also
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referred him for physical therapy. Howell asked for Norco, stating that he
has no pain when he takes that medication. Dr. Pompy refused to issue a
prescription without diagnostic testing and a drug screen.
March 9, 2021
53. On March 9, 2016, Howell arrived for his second appointment as
an IPMA patient. It is believed he again provided the fake license, BCBSM
insurance card, or both, in connection with the visit.
54. Howell lied to a medical assistant that the purpose of his visit
was to obtain refills. After Howell volunteered that Dr. Pompy had not
written him a prescription at the last visit, the medical assistant observed
that Dr. Pompy had, in fact, not yet prescribed “James Stewart” any
medications. She informed him that Dr. Pompy was not going to write him a
prescription at this visit because Dr. Pompy was going to be closing the office
for two weeks and would be unavailable should any problems arise while he
was away. It was his practice only to renew existing prescriptions; Dr.
Pompy would not prescribe new medications or change existing medications
if he was planning on being away for an extended period.
55. Howell did not meet with Dr. Pompy on this visit. The medical
assistant rescheduled his appointment to a date after Dr. Pompy returned to
the office. Howell informed the medical assistant that he would use the
intervening time to go to physical therapy.
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Physical therapy
56. Howell went to physical therapy multiple times as “James
Stewart” to give the impression that he was trying to follow Dr. Pompy’s
treatment advice.
57. On about March 7, 2016, two days before the appointment at
IPMA on March 9, 2016, Howell went unannounced to Fitness Rehab Services,
Inc., in Newport, MI, to schedule an appointment as “James Stewart.” PX 3,
Howell Reports on Physical Therapy.
58. Plaintiffs believe Howell selected this location because it was in
Monroe County, MI. During his first visit with Dr. Pompy on February 18,
2016, Dr. Pompy asked “James Stewart” how he had found IPMA since the
referring physician was located in St. Clair Shores, MI. Howell responded
that he had friends in Monroe and that one of them had referred him to IPMA.
Obtaining physical therapy services in Monroe County would support
“James Stewart’s” ties to the local community.
59. On about March 15, 2016, Howell went to his first physical
therapy appointment at Fitness Rehab Services. Ibid.
60. On about March 22, 2016, Howell went to his second physical
61. On about March 23, 2016, Howell went to his third physical
62. On about March 30, 2016, Howell went to his fourth physical
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March 22, 2016

63. On March 22, 2016, Howell arrived for his third appointment as
64. Howell completed a follow-up questionnaire, a shorter version of
the more comprehensive new patient questionnaire. On the follow-up
questionnaire, Howell: (a) represented that his pain began 20 years ago,
characterizing it as “stiff”; (b) circled “5” on a scale of 1–10 to describe the
intensity of his pain; (c) represented that his pain had stayed the same since
the last appointment; (d) represented that he had pain in his lower back, with
the note “stiff”; and (e) circled the box labeled “other” and wrote “stiff,” in
response to the question “describe your pain,” thereby representing once
again that the word “stiff” meant a quality or type of pain. PX 4, 2016-03-
22 “James Stewart” Follow-up Questionnaire.
65. Howell provided a urine sample.
66. Howell informed a medical assistant that he had gone to physical
therapy. The medical assistant later relayed this information to Dr. Pompy in
Howell’s presence.
67. After Dr. Pompy left the room, Howell asked for Norco and
Xanax and specified the dosages he needed. After leaving the room to share
this request with Dr. Pompy, the medical assistant returned and informed
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“James Stewart” that Dr. Pompy will not prescribe him any medication until
he received an MRI report. Howell falsely stated that his insurance would
not pay for an MRI. The medical assistant offered to help with a “prior
authorization” request to his insurance company to obtain coverage, but
Howell refused. The medical assistant explained that Dr. Pompy needed
some documentation showing a need for the medicine.
April 26, 2016

68. On April 26, 2016, Howell arrived for his fourth appointment as
69. Howell completed another follow-up questionnaire, in which he:
(a) represented that his pain originally began 20 years ago; (b) circled “5” on
a scale of 1–10 when asked to describe the intensity of his pain; (c) represented
that his pain had “stayed the same” and was “continuous”; (d) represented
that his pain was located in his lower back, with the note “stiff back”; (e)
circled the box labeled “other” and wrote “stiff,” in response to the question
“describe your pain,” thereby representing to Dr. Pompy that the word “stiff”
meant a quality or type of pain; and (f) represented that he tried physical
therapy in March 2016 and April 2016. PX 5, 2016-04-26 “James Stewart”
Follow-up Questionnaire.
70. Howell once again tells a medical assistant that he was visiting
for refills, despite not having been prescribed any medication by Dr. Pompy.
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He also falsely told her that Dr. Pompy had prescribed him Norco. The
medical assistant checked the patient file and saw no dispense date. When
she challenged him whether Dr. Pompy had actually prescribed Norco to
“James Stewart” before, he admitted that he had not.
71. The medical assistant informed “James Stewart” that he had
tested positive for a barbiturate. Howell claimed that was “impossible.” He
provided another urine sample to convince everyone that he had not consumed
a barbiturate as part of his effort to fraudulently obtain a prescription for a
controlled substance.
72. Faced with an apparently indigent and underinsured patient who
could not obtain the MRI test necessary to explore a non-narcotic interventional
approach, Dr. Pompy turned to the primary tool left to pain management
doctors: prescription medication. Based on Howell’s false statements that
“James Stewart” had a subjective pain score of 5/10, had low back pain, and
nerve problems, Dr. Pompy prescribed “James Stewart” Norco, Lyrica, and
Zanaflex for a two-week trial period. Norco is a Schedule II controlled
substance commonly prescribed by pain management physicians to alleviate
pain. The strength of the prescription was 5-325mg, the lowest available
strength. It was both an appropriate medication and strength to treat a pain
score of 5/10. Lyrica is a low-risk Schedule V controlled substance commonly
prescribed to treat nerve and muscle pain. Howell had complained of nerve
problems in connection with his back pain in his new patient questionnaire.
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Zanaflex is a non-narcotic muscle relaxer commonly prescribed for stiff
muscles; it is not a controlled substance.
73. Thereafter, Howell filled the prescriptions at a pharmacy and
gave the medication to Moore, who was present at the pharmacy.
May 9, 2016
74. On May 9, 2016, Howell arrived for his fifth appointment as an
IPMA patient. It is believed he again provided the fake license, BCBSM
(a) circled “5” on a scale of 1–10 when asked to describe the intensity of his
pain; (b) represented that his pain had “stayed the same” and he experienced
the pain “daily”; (c) represented that his pain was located in his lower back,
with the note “stiff”; and (d) circled the box labeled “other” and wrote
“stiffness,” in response to the question “describe your pain,” thereby once
again representing to Dr. Pompy that the word “stiff” meant a quality or type
of pain. PX 6, 2016-05-09 “James Stewart” Follow-up Questionnaire.
76. Howell provided a urine sample.
77. Dr. Pompy determined that the result of a urine test was
inconsistent with what he expected to see. He insisted that “James Stewart”
provide a urine sample before leaving and refilled his Norco prescription for
only one week pending the results of the new urine sample.
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78. Thereafter, Howell filled the prescription at a pharmacy and gave
the medication to Moore, who was present at the pharmacy.
May 17, 2016

79. On May 17, 2016, Howell arrived for his sixth appointment as an
IPMA patient. It is believed he again provided the fake license, BCBSM
(a) circled “5” on a scale of 1–10 when asked to describe the intensity of his
pain; (b) represented that his pain had “stayed the same” and he experienced
the pain “daily”; (c) represented that his pain was located in his lower back,
with the note “stiff”; and (d) circled the box labeled “other” and wrote
“stiff,” in response to the question “describe your pain,” thereby once again
representing to Dr. Pompy that the word “stiff” meant a quality or type of
pain. PX 7, 2016-05-17 “James Stewart” Follow-up Questionnaire.
81. Dr. Pompy reviewed “James Stewart’s” paperwork. Because of
an error in the testing of the last urine sample, Dr. Pompy required him to
provide another urine sample for testing. Dr. Pompy prescribed “James
Stewart” another one-week supply of Norco pending the results of the next
urine test.
82. Thereafter, Howell filled the prescription at a pharmacy and gave
the medication to Moore, who was present at the pharmacy.
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83. Because BCBSM and Moore knew that Howell would fail the
next urine test, they terminated the undercover operation to avoid Dr. Pompy
ejecting “James Stewart” from IPMA. If Dr. Pompy ejected him from IPMA,
it would prevent them from obtaining seizure warrants for Plaintiffs’ bank
and securities accounts and persuading prosecutors to file criminal charges
through which restitution and asset forfeiture could be sought.
84. BCBSM arranged for Dr. Carl W. Christensen, a paid BCBSM
consultant, to review the videos of the undercover visits and the paperwork
Howell provided to IPMA and to prepare a critical report of Dr. Pompy’s
services to “James Stewart,” the prescriptions he wrote to “James Stewart,”
and the claims he submitted to BCBSM for payment for those services.
85. Dr. Christensen was an OBGYN-trained doctor who transitioned
into addiction medicine after recovering from an addiction to cocaine. He was
not board certified in anesthesiology or board certified in pain management;
he was unqualified to opine on the services rendered to “James Stewart.” Nor
did Dr. Christensen have any special qualifications to opine on the correctness
of the claims for payment made for the services rendered to “James
Stewart.”
86. With Moore’s knowledge, consent, and/or direction, BCBSM
provided materially false, misleading, and/or incomplete information to Det.
Robert Blair, a MANTIS task force officer, who was directed to prepare search
warrant affidavits to support applications for search warrants directed to
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financial institutions. In addition to the materially false and/or misleading
statements or omissions described in Section E.2 of Count 2, infra, which are
incorporated here by reference, BCBSM Investigator Brian Zasadny and Jim
Gallagher, the Manager of BCBSM’s Clinical Pharmacy Fraud, Waste and
Abuse program, provided cherrypicked and misleading data regarding Dr.
Pompy’s prescribing habits to support the false narrative that Dr. Pompy was
running an illegal pill mill.
87. BCBSM and Moore knew that the fraudulently obtained search
warrants would be used to commit the pattern of racketeering activity
described in Section E.2 of Count 2, infra, which allegations are incorporated
here by reference.
88. BCBSM and Moore’s actions directly and foreseeably injured
IPMA’s business and property. The seizure of its bank and/or securities
accounts deprived IPMA of the use of its funds. This, in turn, rendered
IPMA largely unable to operate its business because it could not pay the costs
of operating the business without access to its funds. As a result, IPMA
suffered lost profits, avoidable stock losses, and, unable to pay its accounts
payable, IPMA incurred adverse civil judgments against it. IPMA went out
of business; BCBSM and Moore’s actions destroyed the value of the business
as a going concern.
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B. No statutory immunity for BCBSM

89. Section 4509 of the Insurance Code of the State of Michigan
generally immunizes anyone cooperating with, furnishing evidence to, or
providing or receiving from regarding suspected insurance to or from an
authorized agency, Mich. Comp. Laws § 4509, but this statutory immunity
does not apply to a person acting with malice.
90. An “authorized agency” means the Michigan Department of
State Police; a county sheriff’s department; a municipal police department; a
federal criminal investigative department or agency; a federal, state, county,
or local prosecuting authority, the Michigan Office of Financial and
Insurance Regulation; or the Michigan Department of State. Mich. Comp.
Laws § 500.4501(a).
91. Multijurisdictional task forces are juridical entities that exist
apart from the agencies that staff them. Manuel v. Gills, 481 Mich. 637,
645–649 (2008). Although MANTIS is a law enforcement agency, it is not
an “authorized agency” within the meaning of Section 4509 of the Insurance
Code.
92. Alternatively, BCBSM’s conspiracy with Moore and others and
its overt acts in furtherance of that conspiracy, as pleaded in Count 1,
establish that BCBSM acted with malice.
93. Alternatively, IPMA contends that RICO preempts state law
immunity where the immune party participates in a pattern of racketeering
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activity under the doctrine of conflict preemption under the Supremacy
Clause in Article VI, Paragraph 2, of the Constitution of the United States,
because the statutory immunity granted by the State of Michigan poses an
obstacle to the accomplishment and execution of the full purposes and
objectives of Congress in authorizing a private right of action against those
who injure another by reason of a pattern of racketeering activity.
C. No qualified immunity for Moore

94. As the officer-in-charge of MANTIS, Moore had personal
knowledge and direct involvement with causing Detective Blair to obtain
search warrants using affidavits accusing Plaintiffs of healthcare fraud based
on false statements and material omissions.
95. Plaintiffs have a clearly established Fourth Amendment right to
be free from unreasonable searches and seizures due to an insufficient showing
of probable cause in obtaining the warrant for that search. The Supreme Court
has long stated: “When the Fourth Amendment[’s Warrant Clause] demands
a factual showing sufficient to comprise ʻprobable cause,’ the obvious
assumption is that there will be a truthful showing.” Franks v. Delaware,
438 U. S. 154, 164–65 (1978) (emphasis in original). Specifically, as to IMPA,
“a business establishment . . . enjoys certain protections under the Fourth
Amendment.” See Dow Chem. Co. v. United States, 476 U. S. 227, 235 (1986).
96. Moore’s conduct violated clearly established law. The materially
false and/or misleading statements in the affidavits were made with Moore’s
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knowledge, consent, and/or direction to mislead judicial officers to paint the
desired false picture that IPMA was a pill mill and engaged in a massive
health insurance fraud scheme.
97. Moore knew of, consented to, and/or directed the omission of
material information from the affidavits, and these omissions were critical to
the finding of probable cause for the warrants. See Mays v. City of Dayton,
134 F. 3d 809, 816 (6th Cir. 1998). An omission is considered material if it
casts doubt on the existence of probable cause. United States v. Hampton,
760 F. Appx. 399, 404 (6th Cir. 2019).
98. Without the false statements and material omissions, the
affidavits would have shown the reality of Plaintiffs’ practice—a pain
management clinic serving the underserved community of Monroe County.
99. A reasonable officer in Moore’s position would have known that
he could not obtain search warrants using affidavits accusing Plaintiffs of
healthcare fraud based on false statements and material omissions without
violating Plaintiffs’ clearly established Fourth Amendment rights.
100. Moore is therefore not entitled to qualified immunity.
COUNT 2
RACKETEERING
18 U.S.C. §1962(C)
(BCBSM and Moore)
101. IPMA incorporates each of the prior paragraphs by reference.
102. A private right action exists against a person, employed by or
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associated with an enterprise that is engaged in or affects interstate or
foreign commerce, who conducted or participated in the conduct of the
enterprise’s affairs through a pattern of racketeering activity while acting
with the necessary mens rea, resulting in injury to a plaintiff’s business or
property, in violation of 18 U. S. C. § 1962(c). 18 U. S. C. § 1964(c).
A. BCBSM and Moore are persons

103. A person includes any individual or entity capable of holding a
legal or beneficial interest in property. 18 U. S. C. § 1961(3).
104. BCBSM is an entity capable of holding a legal or beneficial
interest in property. MCL 450.1261.
105. Moore, a natural person, is an individual capable of holding a
legal or beneficial interest in property.
B. MANTIS was the enterprise

106. An enterprise includes any individual, partnership, corporation,
association, or other legal entity, and any union or group of individuals
associated in fact although not a legal entity. 18 U. S. C. §1961(4).
107. MANTIS served as the enterprise. MANTIS was a
multijurisdictional task force that consisted of personnel from federal, state,
county, and local law enforcement agencies organized to investigate unlawful
drug activity.
108. MANTIS was the successor multijurisdictional task force to the
Office of Monroe Narcotics Investigations (“OMNI”), which was disbanded
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after an investigation by the Michigan Department of Attorney General
revealed that officers running OMNI made money off property that was
confiscated during drug raids.
109. Luke Davis, the head of OMNI, and Emmanuel Riopelle, a junior
OMNI officer, pleaded guilty to seizing drugs from the streets and then
reselling them back to the streets. WWJ Staff, 2 Ex-State Cops Sentenced
for Roles in Property Embezzlement Scheme, CBS Detroit (Aug. 10, 2013),
https://perma.cc/GV5M-ZF6Y.
110. Despite this unlawful activity happening while Moore was second-
in-command of OMNI, he was promoted to lead the multijurisdictional task
force, which was rebranded under the new moniker MANTIS.
C. The enterprise affected interstate commerce

111. IPMA provided medical services to beneficiaries of Medicare,
Medicaid, and BCBSM health care benefit programs.
112. Medicare was a federal healthcare benefit program providing
benefits to people over the age of 65 or disabled. Medicare was administered
by the Centers for Medicare and Medicaid Services (“CMS”), a federal
agency under the United States Department of Health and Human Services.
113. Medicaid was a federal and state funded healthcare program
providing benefits to individuals and families who met specified financial and
other eligibility requirements, and certain others who lacked adequate
resources to pay for medical care. Medicaid covered the cost of medical
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services and products ranging from routine preventive medical care for
children to institutional care for the elderly and disabled. CMS was
responsible for overseeing the Medicaid program in participating states,
including Michigan.
114. BCBSM was a private health insurer that provided healthcare
benefits to individuals qualified under their health insurance plans issued by
BCBSM.
115. At all times relevant to this Complaint, Medicare, Medicaid, and
BCBSM were “health care benefit programs,” as defined in 18 U. S. C. § 24(b),
and were engaged in interstate commerce.
116. Plaintiffs’ provision of medical services affected interstate
commerce because IPMA served beneficiaries of those health care benefit
programs and served patients who resided outside of Michigan.
117. Defendants’ unlawful actions through MANTIS, culminating in
the wrongful revocation of Dr. Pompy’s authority to prescribe controlled
substances and in the wrongful suspension of his license to practice medicine
in multiple states, affected interstate commerce by impairing the provision of
healthcare services to the beneficiaries of those health care benefit programs
and to patients who resided outside of Michigan.
118. Defendants’ unlawful actions through MANTIS also chilled the
provision of pain management services in Michigan and nationally. Plaintiffs’
pain patients were stigmatized as drug addicts seeking controlled substances
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for unlawful nonmedical purposes, rather than as people with chronic pain in
need of controlled substances for legitimate medical purposes; other physicians
declined to treat Plaintiffs’ pain patients or would only treat them with non-
controlled substances inadequate to treat their pain for fear of also being
targeted by MANTIS. Some patients unable to obtain treatment or adequate
treatment sought treatment elsewhere in the United States, or they turned to
the illicit drug market, which is or affects interstate and foreign commence.
D. The defendants were employed or associated with MANTIS

119. Moore was the officer-in-charge of MANTIS.
120. BCBSM associated with MANTIS by assigning Howell to work
with MANTIS as an undercover operative.
E. The defendants conducted or participated in MANTIS’s affairs

through a pattern of racketeering activity.
121. “Racketeering activity” is any activity listed in 18 U.S.C.
§1961(1).
122. A “pattern of racketeering activity” requires at least two acts of
racketeering activity, one of which must have occurred after 1970 and the
last of which must have occurred within 10 years after the commission of a
prior act of racketeering activity. 18 U.S.C. §1961(5).
BCBSM—Felonious Misuse of a Means of Identification

123. An act indictable under 18 U.S.C. §1028 is an act of racketeering
activity. 18 U.S.C. §1961(1)(B).
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131. On about March 22, 2016, Howell again knowingly used the
name James Stewart, this driver’s license, and/or this BCBSM membership
card by presenting it to IPMA as an established patient with the intent to
fraudulently obtain or attempt to obtain a prescription for a controlled
substance from Dr. Pompy, a healthcare provider.
132. On about April 26, 2016, Howell again knowingly used the name
James Stewart, this driver’s license, and/or this BCBSM membership card by
presenting it to IPMA as an established patient with the intent to fraudulently
obtain or attempt to obtain a prescription for a controlled substance from Dr.
Pompy, a healthcare provider.
133. On about May 9, 2016, Howell again knowingly used the name
presenting it to IPMA as an established patient with the intent to fraudulently
obtain or attempt to obtain a prescription for a controlled substance from Dr.
Pompy, a healthcare provider.
134. On about May 17, 2016, Howell again knowingly used the name
presenting it to IPMA as an established patient with the intent to
fraudulently obtain or attempt to obtain a prescription for a controlled
substance from Dr. Pompy, a healthcare provider.
135. Howell had no lawful authority to use the name James Stewart,
the Stewart driver’s license, or the BCBSM membership card to fraudulently
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obtain or attempt to fraudulently obtain a prescription for a controlled
substance.
136. Under the Michigan Public Health Code, a person who fraudulently
obtains or attempts to obtain a controlled substance or a prescription for a
controlled substance from a healthcare provider is guilty of a felony
punishable by imprisonment for not more than four years, a maximum fine of
$5,000, or both. Mich. Comp. Laws §333.7403a(1), (4).
137. Accordingly, Howell’s repeated use of a means of identification
to attempt to fraudulently obtain and to fraudulently obtain a prescription for
a controlled substance constitutes a pattern of racketeering activity by
BCBSM.
BCBSM and Moore—Bank Fraud

138. An act indictable under 18 U.S.C. § 1344 is an act of racketeering
activity. 18 U.S.C. §1961(1)(B).
139. It is an indictable offense under 18 U.S.C. § 1344(2) to knowingly
execute, or attempt to execute, a scheme or artifice to obtain any moneys,
funds, credits, assets, securities, or other property owned by, or under the
custody or control of, a financial institution, by means of false or fraudulent
pretenses, representations, or promises.
140. Each execution of a scheme is separately indictable under 18
U.S.C. §1344. United States v. Sosa–Baladron, 800 F. Appx. 313, 322–323
(6th Cir. 2020).
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141. Monroe Bank & Trust (“MBT”), Monroe County Community
Credit Union (“M3CU”), E*Trade, and Merrill Lynch are financial
institutions.
142. Dr. Pompy and IPMA owned bank and/or securities accounts at
all four of these financial institutions.
143. As part of their scheme to obtain the funds and securities held in
these accounts as a source for “restitution” to BCBSM and “forfeiture
funds” to MANTIS or its constituent agencies, BCBSM and Moore
knowingly caused Detective Robert Blair of the Monroe County Sheriff’s
Department, who was a MANTIS task force officer, to obtain search warrants
using affidavits accusing Plaintiffs of healthcare fraud based on materially
false or misleading statements and material omissions.
144. For example, on about September 27, 2016, Blair executed an
affidavit in support of an application for a search warrant to seize accounts
and records from bank accounts at MBT owned by Plaintiffs. The affidavit
accused Plaintiffs of healthcare fraud and included the following materially
false and/or misleading statements: (a) “Dr. Pompy . . . prescribed the most
overall prescription medication of the [2,304] providers in his same specialty
during [2014,]” Blair Aff. ¶4.S.1; (b) “Dr. Pompy . . . prescribed the most
controlled prescription medication[s] of the [2,304] providers in his same
specialty during [2014,] id., at ¶4.S.2; (c) “Dr. Pompy . . . prescribed the most
days[’] supply of controlled prescription medication[s] of the [2,304]
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providers in his same specialty during [2014,], id., at ¶4.S.3; (d) “in 2015,
96.13% of [Dr. Pompy’s] 177 patients covered by BCBSM insurance were
prescribed controlled substances . . . a high prescribing rate for a medical
doctor[,]” id., at ¶4.S.5. These averments were materially misleading
because Dr. Pompy was not compared to peers in the same specialty; he was
compared to anesthesiologists. PX 8, BCBSM “All Meds” 2014 Prescriber
Block Analysis; PX 9, BCBSM Unique Members Controlled Substances 2014
Prescriber Block Analysis; PX 10, BCBSM Rank of Controlled Substances
2014 Prescriber Block Analysis; PX 12, BCBSM Rank of Days Supply of
Controlled Substances 2014 Prescriber Block Analysis. These intentionally
and materially misleading comparisons were offered to support the desired
conclusion for persuasive effect: “Affiant knows based on training and
experience that medical doctors who prescribe high amounts of prescribed
controlled medications compared to others in their specialty are often engaged
in unlawfully prescribing controlled substances or healthcare fraud.” Blair
Aff. ¶4.S.6. Anesthesiologists primarily provide in-hospital services and
prescribe limited amounts of controlled substances for acute post-surgical
pain. Interventional pain management specialists primarily provide office-
based services and frequently prescribe controlled substances for chronic
pain, which that is often caused by uncorrectable degenerative conditions,
grows worse with time, and can require stronger controlled substances and
larger doses of medication to manage the pain.
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145. For further example, in the same affidavit, Blair averred that the
“Current Procedural Terminology [“(CPT”)] Coding Guidelines for Office
Visits . . . lists claim codes for different types of office visits and lists the
required face to face time the physician must spend with the patient when
billing for that type of visit,” Blair Aff. ¶4.U.1, before making these
accusations: (a) “on 02/18/2016, BCBSM Investigator Howell stated that
he spent 8 minutes with Dr. Pompy, who filed a claim of 60 minutes of face
time under claim code of 99205”; (b) “on 03/22/2016, BCBSM Investigator
Howell stated that he spent 37 seconds with Dr. Pompy, who filed a claim of
15 minutes of face time under claim code of 99213”; (c) “on 04/26/2016,
BCBSM Investigator Howell stated that he spent 51 seconds with Dr. Pompy,
who filed a claim of 15 minutes of face time under claim code 99213”; (d) on
05/09/2016, BCBSM Investigator Howell stated he spend 1 minute 18
seconds with Dr. Pompy, who filed a claim of 15 minutes of face time under
claim code 99213”; and (e) “on 05/17/2016, BCBSM Investigator Howell
stated that he spent 50 seconds with Dr. Pompy, who filed a claim of 15
minutes of face time under claim code 99213.” Blair Aff. ¶¶4.U.2(a)–
4.U.2(e). These were intentionally and materially false and misleading
statements and/or omissions offered to support the desired conclusion for
persuasive effect: “Based on Affiant’s training and experience, Affiant is
aware that Medical Doctors who bill insurance companies for office visits
longer than actual face to face time are committing crimes under Michigan
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Law.” Blair Aff. ¶5. Billing is based on the complexity of the medical
decision-making, not the time spent with the patient: “The duration of the
visit is an ancillary factor and does not control [the CPT code] to be billed
unless more than 50 percent of the face-to-face time (for noninpatient
service) . . . is spent providing counseling or coordination of care[.]” CMS
Manual Chap. 12, § 30.6.1(B) (2016) (emphasis added). None of Howell’s
visits counseling or coordination of case that involved more than 50% of the
face-to-face time, so time did not control the CPT code to be billed for those
visits. When time does not control, doctors bill based on seven factors:
patient history, physical examination, medical decision making, counseling,
coordination of care, the nature of the patient’s problems, and time estimates.
The first three factors—patient history, physical examination, and medical
decision making—are considered key in selecting the correct billing code.
Moreover, the CPT time estimates are for general practitioners, not
specialists like Dr. Pompy.
146. These intentionally and materially false and misleading
statements and/or omissions persuaded non-attorney magistrate Jessica
Chaffin to issue the requested search warrant, which one or more MANTIS
task force officers executed on MBT. In compliance with the warrant, MBT
froze all of Dr. Pompy and IPMA’s accounts, depriving Dr. Pompy and IPMA
of access to their funds.
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147. On about September 28, 2016, Blair executed additional
affidavits in support of applications for search warrants to seize records and
accounts owned by Dr. Pompy at M3CU, E*Trade, and Merrill Lynch. The
affidavits contained the same intentionally and materially false and
misleading statements and/or omissions found in the affidavit Blair executed
in support of MBT search warrant.
148. These intentionally and materially false and misleading
statements and/or omissions persuaded District Judge Jack Vitale to issue
the requested search warrants, which one or more MANTIS task force
officers executed on M3CU, E*Trade, and Merrill Lynch. In compliance with
the warrant, each institution froze Dr. Pompy and IPMA’s accounts,
depriving Plaintiffs of access to their funds and securities.
149. The execution of each fraudulently obtained search warrant
constituted a separate execution of the scheme or artifice to obtain moneys,
funds, credits, assets, securities, and other property owned by or under the
custody and control of a financial institution by means of false or fraudulent
pretenses or representations. Together, they constituted a pattern of
racketeering activity by BCBSM and Moore.
F. Injury to IPMA’s business or property

IPMA’s business and property. By sending Howell on undercover visits,
BCBSM prevented IPMA from providing care to other patients. The seizure
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of its bank and/or securities accounts deprived IPMA of the use of its funds.
This, in turn, rendered IPMA largely unable to operate its business because it
could not pay the costs of operating the business without access to its funds.
As a result, IPMA suffered lost profits and, unable to pay its accounts
payable, IPMA incurred adverse civil judgments against it. IPMA went out
of business; BCBSM and Moore’s actions destroyed the value of the business
as a going concern.
G. No statutory immunity for BCBSM

151. BCBSM is not entitled to statutory immunity for the reasons
pleaded in Section B of Count 1, supra, which are incorporated by reference.
H. No qualified immunity for Moore

152. Moore is not entitled to qualified immunity for the reasons
pleaded in Section C of Count 1, supra, which are incorporated by reference.
I. Timely claim
153. Civil RICO actions are subject to a four-year limitations period.
Agency Holding Corp. v. Malley–Duff & Associates, Inc., 483 U. S. 143 (1987).
154. This claim accrued, at the earliest, when the search warrants
were executed on MBT, M3CU, E*Trade, and Merrill Lynch on about
September 28, 2016.
155. IPMA first asserted, or attempted to assert, this claim in the
original pleading filed in this action on February 4, 2019, a date within four
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years of the earliest possible accrual date. ECF No. 1, PageID.144, 178,
¶¶1124, B. Although this claim was dismissed without prejudice as to IPMA
because IPMA was not represented by counsel, ECF No. 32, PageID.516–
517, neither BCBSM nor Moore is a new defendant and this is not a new claim.
Accordingly, this claim benefits from the relation-back rule in Rule 15(c)(1)(B)
of the Federal Rules of Civil Procedure as to both BCBSM and Moore.
156. The statute of limitations is not jurisdictional, and it is “hornbook
law that limitations periods are customarily subject to equitable tolling.”
Young v. United States, 535 U. S. 43, 49 (2002) (cleaned up). Federal courts
may exercise equitable powers to “relieve hardships which, from time to
time, arise from a hard and fast adherence to more absolute legal rules,
which, if strictly applied, threaten the evils of archaic rigidity.” Holland v.
Florida, 560 U. S. 631, 650 (2010).
157. Regardless of the date on which the claim accrued, the Court
should equitably toll the limitations period from February 4, 2019, until
April 17, 2023, the date on which counsel appeared for IPMA. Before then,
IPMA was unable to retain counsel because of the seizure of funds caused by
the racketeering activity pleaded in this claim, and IPMA was prevented by
law from appearing and litigating this claim without assistance of counsel.
ECF No. 32, PageID.516–517.
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COUNT 3
CONSPIRACY
42 U.S.C. § 1983
(Moore Only)
158. Plaintiffs incorporate each of the prior paragraphs by reference.
159. To prevail on a claim of civil conspiracy under 42 U. S. C. § 1983,
a person must prove that a plan existed among conspirators, who shared a
conspiratorial objective to deprive the person of a constitutional right, and
that an overt act in furtherance of the conspiracy caused the person injury.
Robertson v. Lucas, 753 F.3d 606, 622 (6th Cir. 2014).
160. BCBSM and Moore conspired to deprive Plaintiffs of their right
to be free from unreasonable searches and seizures under the Fourth
Amendment to the Constitution of the United States.
161. The plan to achieve this objective was to conduct the joint
investigation and to obtain search warrants through materially false and/or
misleading statements and material omissions, all as described in the
Introduction, Count 1, and Count 2, supra.
162. BCBSM and Moore, acting under color of state law, engaged in
the overt acts as pleaded in Section A of Count 1 and Section E of Count 2,
supra, in furtherance of the conspiracy.
IPMA’s business and property. The seizure of its bank and/or securities
accounts deprived Plaintiffs of the use of their funds.
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164. This left Dr. Pompy unable to pay his personal debts, resulting in
adverse civil judgments against him and being forced to liquidate assets not
seized to provide for his basic needs and his criminal defense.
165. IPMA was largely unable to operate its business because it could
not pay the costs of operating the business without access to its funds. As a
result, IPMA suffered lost profits and, unable to pay its accounts payable,
IPMA incurred adverse civil judgments against it. IPMA went out of
business; BCBSM and Moore’s actions destroyed the value of the business as
a going concern.
167. The limitations period for claims arising under 42 U.S.C. § 1983
is three years. Wolfe v. Perry, 412 F.3d 707, 714 (6th Cir. 2005).
168. As to Dr. Pompy, this claim is timely because it benefits from the
relation-back rule in Rule 15(c)(1)(B) of the Federal Rules of Civil Procedure.
169. As to IPMA, this claim is timely because it benefits from the
relation-back rule in Rule 15(c)(1)(B) of the Federal Rules of Civil Procedure
or from equitable tolling for the same reasons alleged in Section I of Count 2.
COUNT 4
DEPRIVATION OF CIVIL RIGHT
42 U.S.C. § 1983
(Moore Only)
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171. A person is liable under 42 U. S. C. § 1983 if he deprives or causes
another to be deprived of a right secured by the Constitution of the United
States while acting under color of state law.
172. On information and belief, Moore, acting under color of state law,
knew of, consented to, and/or directed Blair to prepare affidavits with
information Moore knew to be materially false and/or misleading and with
material omissions, as alleged in Section A of Count 1 and Section E of
Count 2.
173. As a result, search warrants authorizing the seizure of Plaintiffs’
bank and securities accounts were fraudulently obtained and executed,
violating Plaintiffs’ right to be free from unreasonable searches and seizures
under the Fourth Amendment to the Constitution of the United States.
174. Moore’s actions directly and foreseeably injured IPMA’s business
and property. The seizure of its bank and/or securities accounts deprived
Plaintiffs of the use of their funds.
175. This left Dr. Pompy unable to pay his personal debts, resulting in
adverse civil judgments against him and being forced to liquidate assets not
seized to provide for his basic needs and his criminal defense.
176. IPMA was largely unable to operate its business because it could
not pay the costs of operating the business without access to its funds. As a
result, IPMA suffered lost profits and, unable to pay its accounts payable,
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IPMA incurred adverse civil judgments against it. IPMA went out of business;
Moore’s actions destroyed the value of the business as a going concern.
178. The limitations period for claims arising under 42 U.S.C. § 1983
is three years. Wolfe v. Perry, 412 F.3d 707, 714 (6th Cir. 2005).
179. As to Dr. Pompy, this claim is timely because it benefits from the
relation-back rule in Rule 15(c)(1)(B) of the Federal Rules of Civil Procedure.
180. As to IPMA, this claim is timely because it benefits from the
relation-back rule in Rule 15(c)(1)(B) of the Federal Rules of Civil Procedure
or from equitable tolling for the same reasons alleged in Section I of Count 2.
COUNT 5
BREACH OF CONTRACT
(BCBSM Only)
182. Dr. Pompy and BCBSM were parties to the “Blue Cross and Blue
Shield of Michigan Trust Network Practitioner Affiliation Agreement”
(revised Jan. 2012), which constitutes a contract between Dr. Pompy and
BCBSM (the “Contract”). PX 13, Contract, ¶7.10; see also ECF No. 35-2.
IPMA was at least an intended third-party beneficiary to the Contract, Mich
Comp. Laws § 600.1405. See id., at ¶3.4f (requiring Dr. Pompy to notify
BCBSM of any changes to his business—i.e., IPMA).
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183. The Contract designates Dr. Pompy as “an approved non-
exclusive preferred provider” of covered services to members of BCBSM. Id.,
at ¶2.1.
184. Under the Contract, Dr. Pompy had a contractual right to provide
covered services to BCBSM members. Id., at ¶3.4d.
185. On information and belief, IPMA and BCBSM were also parties
to a separate agreement under which it had a right to receive payments from
BCBSM due for services rendered by Dr. Pompy under the Contract. Plaintiffs
are unable to locate a copy of the agreement but offer a “Provider Electronic
Funds Transfer” printout from BCBSM, which was produced by the United
States in the criminal case against Dr. Pomp, to meet the plausibility standard
under Rule 8 of the Federal Rules of Civil Procedure. PX 14, BCBSM Provider
Electronic Funds Transfer. Plaintiffs believe BCBSM has a copy of the
separate agreement in its records.
186. BCBSM had a contractual duty to pay, and Plaintiffs had a
contractual right to be paid, for covered services that Dr. Pompy performed
on BCBSM members. BCBSM admits the Contract “governs payments to
Plaintiffs for services rendered to Blue Cross patients.” BCBSM Mot. to
Dismiss, ECF No. 35, PageID.564.
187. The Contract contemplates that disputes may arise between
BCBSM and Plaintiffs over the validity of a claim for payment for covered
services and provides a comprehensive claims dispute and appeals process.
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BCBSM had a right to audit claims for payment; whereas, Plaintiffs had a
right to appeal adverse claim and audit determinations through BCBSM’s
internal process, with a right to further appeal to an independent review panel
for a binding determination as to the validity of a disputed claim. Id. at ¶5.1.
188. Plaintiffs were never afforded the right to exercise these
procedural protections to challenge BCBSM’s claim and audit determinations.
Instead, BCBSM worked with MANTIS and other law enforcement to seek
criminal charges against Dr. Pompy to shut down IPMA and seek restitution
from him.
189. Under Michigan law, there is an “implied promise in every
contract that neither party shall do anything which will have the effect of
destroying or injuring the right of the other party to receive the fruits of the
contract.” Trzeciak v. Allstate Prop. & Cas. Ins. Co., 569 F. Supp. 3d 640, 646
(ED Mich. 2021).
190. BCBSM had a contractual right to conduct onsite audits during
regular business hours, but the exercise of that right came with a contractual
duty to give “reasonable notice of dates and times” to Plaintiffs for any such
audits. See, e.g., id., at ¶4.2.
191. BCBSM’s undercover investigation by BCBSM Investigator
James Howell, while surreptitiously recording and providing a false identity
and medical history, constituted onsite audits by BCBSM.
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192. BCBSM breached its duty to give reasonable notice of the dates
and times of those onsite audits.
193. BCBSM breached its duty to pay Plaintiffs by working with
MANTIS and other law enforcement to bring criminal charges against Dr.
Pompy to claw back validly earned payments under the guise of “restitution.”
194. BCBSM destroyed or injured the contractual right to perform
covered services and therefore the right to earn payment for those services by
MANTIS and other law enforcement to bring criminal charges against Dr.
Pompy, which resulted in the suspension of Dr. Pompy’s medical license and
the revocation of his DEA registration, and Plaintiffs’ inability to receive the
fruits of the contracts.
195. BCBSM was required to provide written notice of termination of
the Contract to Dr. Pompy. Id., at ¶6.3. Dr. Pompy never received any written
notice of termination of the Contract until Dr. Pompy’s medical license was
suspended on about August 7, 2017.
196. These failures by BCBSM individually and collectively constitute
breaches of the Contract.
197. Contract claims are subject to a limitations period of six years.
Mich. Comp. Laws § 600.5807(9). This contract claim accrued no earlier
than September 26, 2016, when Dr. Pompy was arrested and Plaintiffs were
no longer able to perform, exercise, or assert their rights under the Contract.
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198. This contract claim was first asserted in the initial complaint
filed on February 4, 2019. ECF No. 1-1, PageID.180. The Court dismissed
IPMA’s claims without prejudice for lack of counsel on April 4, 2019. ECF
No. 32, PageID.516. Dr. Pompy renewed the claim in his first amended
complaint filed on January 28, 2020. ECF No. 66, PageID.915–16. The
Court dismissed it without prejudice for want of jurisdiction on October 27,
2020. ECF No. 105, PageID.1614–1616. The filing of the initial complaint
tolled the statute of limitations.
199. As to Dr. Pompy, this claim either benefits from the relation-back
rule in Rule 15(c) of the Federal Rules of Civil Procedure or it is timely
because less than six years have elapsed since the date of the arrest after
subtracting the tolled period.
200. As to IPMA, this claim should benefit from the relation-back
rule or be equitably tolled for the same reasons as Counts 1 and 2.
201. BCBSM’s breaches of the Contract damaged Plaintiffs in an
amount exceeding $75,000.00.
COUNT 6
TORTIOUS INTERFERENCE WITH
BUSINESS RELATIONSHIPS
(BCBSM and Moore)
202. Plaintiffs incorporate each of the prior paragraphs by reference.
203. Plaintiffs had contractual and/or business relationships similar
to the Contract with other health insurers, including at least with Aetna,
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Cigna, Cofinity, the Health Alliance Plan of Michigan (“HAP”), Medicare,
Medicaid, Meridian, Paramount, Priority Health, Blue Cross Complete, and
Ohio Worker’s Compensation (collectively, the “other healthcare insurers”),
under which Plaintiffs provided healthcare services to the insureds of the
health care benefit plans offered by such others health insurers.
204. Plaintiffs submitted claims to, and were paid by, the other
healthcare insurers for covered services provided to Plaintiffs’ patients.
205. The value of such claims, and the amounts paid on them,
exceeded $75,000. For example, from January 2012 to October 2016, IPMA
submitted about $16.8 million in gross claims just to Medicare, Medicaid,
and BCBSM. See United States v. Pompy, No. 2:18-cr-20454 (ED Mich.),
ECF No. 41, PageID.415, ¶8.
206. BCBSM knew of Plaintiffs’ contractual or business relationships
with the other healthcare insurers. The Contract designated Dr. Pompy “as
an approved non-exclusive preferred provider” of services to BCBSM members,
Contract, at ¶2.1 (emphasis added); it is standard industry practice for
physicians and medical practices like IPMA to accept a wide range of
insurance plans from their patients; and, on information and belief, from its
participation in the wrongful conduct pleaded in the Introduction, Count 1,
and Count 2, BCBSM would have learned through its joint investigation with
MANTIS that Plaintiffs accepted other forms of insurance and that they
served patients who were not BCBSM members.
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207. As the officer-in-charge of MANTIS, Moore would have learned
and had knowledge of Plaintiffs’ contractual or business relationships with
the other healthcare insurers through the joint investigation by MANTIS.
208. Plaintiffs also had contractual and/or business relationships with
insured, underinsured, and uninsured patients to provide healthcare services
in exchange for payment (e.g., copays, deductibles, and the fees and costs for
services not covered by their respective insurance). The value of such
services, and the amounts that patients paid for them, exceeded $75,000.
209. From its contractual and business relationship with Plaintiffs,
BCBSM knew that some of its members were Plaintiffs’ patients. From its
participation in the wrongful conduct pleaded in the Introduction, Count 1,
and Count 2, BCBSM would have learned through its joint investigation with
MANTIS that Plaintiffs accepted other forms of insurance and that they
served patients who were not members of BCBSM. BCBSM also knows that
insurance plans impose deductibles and copays; this is standard industry
practice. BCBSM also knows that insurance plans do not cover all medical
services and that not every patient has insurance, such that underinsured and
uninsured patients pay some or all of the fees and costs of healthcare services
directly to private medical offices like IPMA.
210. By the wrongful conduct pleaded in the Introduction, Count 1,
and Count 2, BCBSM and Moore intentionally and improperly interfered with
Plaintiffs’ contractual or business relationships with the other healthcare
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insurers, and with its patient-physician relationships to wrongly claw back
validly earned payments under the guise of “restitution,” and to facilitate the
revocation of Dr. Pompy’s DEA registration and medical license to wrongly
chill how other physicians practice medicine for BCBSM’s financial benefit
and for Moore’s career advancement.
211. BCBSM’s and Moore’s actions were wrongful per se.
212. Alternatively, if BCBSM’s and Moore’s actions were lawful, their
actions were unjustified and done with malice.
213. BCBSM’s and Moore’s tortious conduct was an actual and
proximate cause of the other healthcare insurers terminating their
agreements with Plaintiffs, which precluded Plaintiffs from providing and
being compensated for healthcare services that would otherwise have been
provided to beneficiaries of those insurers.
214. For example, on October 3, 2016, HAP summarily suspended
Plaintiffs as a provider for HAP and its affiliates because of Dr. Pompy’s
arrest, effective immediately. PX 15, HAP Ltr. (Oct. 3, 2016).
215. As a further example, on October 4, 2016, Paramount terminated
its agreements with Plaintiffs because of Dr. Pompy’s arrest, effective
immediately. PX 16, Paramount Ltr. (Oct. 4, 2016).
216. As a further example, on August 11, 2017, Aetna terminated
Plaintiffs’ network participation in Aetna’s Medicare Advantage products and
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commercial networks because of Dr. Pompy’s arrest, effective immediately.
PX 17, Aetna Ltr. (Aug. 11, 2016).
217. As a further example, on August 11, 2017, Cofinity terminated
its agreement with Plaintiffs because of the suspension of Dr. Pompy’s
license. PX 18, Cofinity Ltr. (Undated).
218. BCBSM’s and Moore’s tortious conduct was an actual and
proximate cause of the revocation of Dr. Pompy’s DEA registration, the
suspension of his medical licenses in each of the states in which he was
licensed to practice medicine, and the loss of his board certifications in
anesthesiology and pain medicine, which prevented Plaintiffs from providing
healthcare services to their patients who desired to keep Plaintiffs as their
healthcare provider.
219. Plaintiffs suffered and continue to suffer the loss of millions of
dollars in payments from the other healthcare insurers for covered services
that could not and can no longer be rendered to the beneficiaries, resulting in
lost profits.
220. Plaintiffs suffered and continue to suffer the loss of deductibles,
copays, and fees and costs paid by patients for services not covered by
insurance.
221. Plaintiffs suffered humiliation, sense of outrage, indignity, and
injury to reputation because of BCBSM’s and Moore’s malicious, willful, and
wanton actions, entitling him to exemplary damages.
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222. The limitations period for tortious interference claims is three
years. Mich. Comp. Laws §600.5805(3); Blazer Foods, Inc. v. Restaurant
Props., Inc., 259 Mich. App. 241, 253 (2003).
223. Plaintiffs first sought damages for the termination of contracts
and/or business relationships with non-BCBSM insurers in the initial complaint
filed on February 4, 2019. ECF No. 1-1, PageID.180. The Court dismissed
IPMA’s claims without prejudice for lack of counsel on April 4, 2019. ECF
No. 32, PageID.516. Dr. Pompy renewed the claim in his first amended
complaint filed on January 28, 2020. ECF No. 66, PageID.915–16. The
Court dismissed it without prejudice for want of jurisdiction on October 27,
2020. ECF No. 105, PageID.1614–1616. The filing of the initial complaint
tolled the statute of limitations.
224. As to Dr. Pompy, this claim should benefit from the relation-back
rule.
225. As to IPMA, this claim should benefit from the relation-back rule
or be equitably tolled for the same reasons as Counts 1 and 2.
226. BCBSM and Moore’s tortious interference resulted in Plaintiffs
suffering damages in an amount exceeding $75,000.00.
227. BCBSM and Moore are joint and severally liable for these
damages.
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COUNT 7
BIVENS CLAIM
(Bishop Only)
228. Defendant Brian Bishop was, at the time relevant to this claim, a
DEA diversion investigator.
229. On September 26, 2016, from about 10:00 a.m. to 12:00 p.m.,
members of MANTIS, supported by county and local enforcement agencies,
executed a search warrant on Dr. Pompy’s home at 533 North Monroe Street
in Monroe, Michigan 48162. Bishop did not participate in this raid on Dr.
Pompy’s home.
230. The raid team searched and removed property from his home.
Having broken into the home to execute the warrant, the raid team secured
the home when leaving to prevent unauthorized entry.
231. Later that same day, after the raid team finished the search,
secured Dr. Pompy’s home and left, Bishop entered Dr. Pompy’s home without
an additional search warrant.
232. During this unlawful entry into Dr. Pompy’s home, Bishop
searched his belongings without Dr. Pompy’s consent and seized property
from the home.
233. The property has never been returned to Dr. Pompy.
234. Any reasonable law enforcement officer would have understood
that, absent exigent circumstances, a warrantless entry into a private
residence without the consent of the homeowner violates the Fourth
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Amendment. “[I]n the absence of consent or exigent circumstances . . . [the
Supreme Court of the United States has] consistently held that the entry into
a home to conduct a search or make an arrest is unreasonable under the
Fourth Amendment unless done pursuant to a warrant.” Steagald v. United
States, 451 U. S. 204, 211 (1981).
235. By entering Dr. Pompy’s home without a warrant in the absence
of exigent circumstances, Bishop violated Dr. Pompy’s clearly established
Fourth Amendment right to be free from unreasonable searches.
236. Likewise, any reasonable law enforcement officer would have
understood that a warrantless seizure of property from a private residence
without the consent of the homeowner violates the Fourth Amendment: “In
terms that apply equally to seizures of property and to seizures of persons,
the Fourth Amendment has drawn a firm line at the entrance to the house.
Absent exigent circumstances, that threshold may not reasonably be crossed
without a warrant.” Payton v. New York, 445 U. S. 573, 590 (1980).
237. By seizing property from Dr. Pompy’s home without a warrant,
Bishop violated Dr. Pompy’s separate clearly established right to be free from
unreasonable seizures.
238. Dr. Pompy has been suffered damages by Bishop’s violations of
his Fourth Amendment rights in an amount to be proved at trial.
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PRAYER FOR RELIEF
WHEREFORE, Plaintiffs Lesly Pompy and Interventional Pain

Management Associates, P.C., respectfully pray that judgment enter in their
favor as follows:
1. As to Counts 1 and 2, award IPMA its actual and consequential
damages, trebled pursuant to 18 U.S.C. § 1964(c), together with interest,
costs, and attorneys’ fees;
2. As to Count 3 and4, award Plaintiffs their actual and
consequential damages, together with interest, costs, and attorneys’ fees
pursuant to 42 U. S. C. § 1988;
3. As to Counts 5–6, award Plaintiffs their actual and consequential
damages in an amount to be determined at trial, together with exemplary
damages, interest, costs, and attorneys’ fees;
4. As to Count 7, award Dr. Pompy his actual and consequential
damages in an amount to be determined at trial, together with punitive
damages, interest, costs, and attorneys’ fees; and
5. Grant all other relief this Court deems equitable and just.
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DEMAND FOR JURY TRIAL
Plaintiffs demand a trial by jury on all claims.
Respectfully submitted,
BUTZEL
Dated: June 9, 2023 /s/ Joseph E. Richotte

JOSEPH E. RICHOTTE (P70902)
STEVEN R. EATHERLY (P81180)
Columbia Center
201 W. Big Beaver Rd. #1200
Troy, MI 48084
(248) 258-1616
[email protected]
[email protected]
100293286.1 Counsel for Plaintiff Lesly Pompy
– 60 –

Docketed Ford Vs BC Bs

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Case 2:23-cv-11286-LVP-EAS ECF No. 11, PageID.

59 Filed 06/16/23 Page 1 of 294

UNITED STATES DISTRICT COURT FOR THE

Ford Motor Company, :

Motion for Intervention of Right Pursuant to Federal Rules of Civil Procedure

Intervenor Felix Brizuela D.O. (“Intervenor”), is an American physician of Hispanic

allow intervention by right and permission for purposes of judicial economy.

Association described herein which are intentional, reckless, and/or malicious.

13,146 case results, “BC/BS” – 2,320 case results.

health care treatments, again, in a discriminatory manner.

others, especially to minority groups and economically disadvantaged groups in

power. See (https://www.bcbssettlement.com/), (https://www.kff.org/interactive/premiums-and-

Company (BCBSMMIC) and IBC’s and BCBSMMIC’s co-owned insurance company,

reduce additional patient deaths nationwide.

Brizuela a conditional right to intervene in the instant case against BCBSA.

LEGAL STANDARD OF REVIEW

Blue Cross Blue Shield of Michigan

(“BCBSMMIC”), Independence Blue Cross (“IBC”), Highmark Blue Cross (“Highmark”),

Insurance Company aided, abetted, and ratified the restraint of trade.

methods of physicians involved in the treatment of pain and addiction, 3) coordinate

insurance premiums simultaneously. BCS Insurance Company provide insurance and

reinsurance services of the various Blue Cross Plans.

Qlarant (formerly Health Integrity NBI Medic), General Dynamics Information

BSBSMMIC is a mutual insurance company, headquartered, domiciled, with its principle

policy holders and owners represent an expense to BCBSMMIC.

fraudulent submissions of rate increases to insurance regulators, so that it would be allowed to

BCBS intentional misrepresentation of federal statutes, induces false reliance by law

on the misrepresentation, in generating manufactured probable cause, in physicians selected for

federal indictment, which constitutes Fraud. As a result of the misrepresentation, Intervenor

Brizuela suffered pecuniary and property loss.

or would operate as a fraud or deceit upon any person,”

the intervention of Dr. Felix Brizuela by right.

police of criminal investigations, 2) into governmental prosecutorial functions by coordinating

prescription drug diversion.

A public/private partnership named HFPP (Healthcare Fraud Prevention Partnership),

partnership is composed of a small group of people. The industry-wide standard selects

class of physicians. The opioid monitoring software is defective on an industry-wide basis.

HFPP marketed, compiled, summarized, and disseminated the information to the

committed by the others.

B . Potential Conflicts of Interest and Massive Corruption

run for office quoting:

Department of Licensing and Regulatory Affairs (LARA) — a $518-million agency with

providers. Hawks, of Okemos, is married to Michael Hawks, an owner and principal of

such as the Michigan Cannabis Development Association, CannArbor Inc., MedFarm of

Michigan LLC, and PSI Labs, state records show.

significant contributions to the Whitmer campaign. The Whitmer campaign subsequently

for a seat at the table.

reaching state government departments is married to an owner of one of Lansing's biggest

gubernatorial opponents, Whitmer refused to campaign on single-payer healthcare, telling Metro

occasionally objected to salaries, although she would not provide examples.”

companies under this brand are:

• BCSI (BSC Insurance)

BCSI has three divisions in their company that include:

• Commercial Division Insurance

• Professional Liability Products for Blue Cross & Blue Shield

State of Michigan. BCBSMMIC is sufficiently intertwined with The Michigan Health

Endowment Fund, and various state functions, to be considered as a state actor.

inception of the “HEALTH ENDOWMENT FUND CORPORATIONS. “The Michigan Health

Company (“BCBSMMIC”). The law requires BCBSMMIC to contribute up to $1.56 billion