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GEICO alleges $4 million no-fault pharmacy fraud scheme in Queens

It outlines alleged high-priced scheme exploiting New York no-fault system

Claims

By Tez Romero

Dec 01, 2025Share

GEICO is accusing a Queens pharmacy of a multimillion-dollar no-fault drug billing scheme built on high-priced pain medications and collusive referrals.

In a filing dated November 26, 2025, in the United States District Court for the Eastern District of New York, Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company and GEICO Casualty Company set out detailed allegations against United Pharmacy NYC Inc., its owner, Irina Alishayeva, two nurse practitioners, and a series of unnamed “John Doe” defendants.

At the heart of the case is New York’s no-fault auto insurance system. GEICO alleges the defendants exploited individuals involved in motor vehicle accidents who were eligible for Personal Injury Protection benefits by systematically dispensing certain prescription drugs without regard to genuine patient care.

According to the filing, the defendants submitted more than $4 million in pharmaceutical claims through United Pharmacy under GEICO policies. The insurer alleges that the pharmacy, working with prescribing providers and clinic controllers, overwhelmingly focused on a limited group of products: Lidocaine 5% Ointment, Diclofenac Sodium 2% Solution, Diclofenac Sodium Gel 3%, and Naproxen-Esomeprazole tablets.

Those drugs, GEICO says, accounted for approximately 84 percent of the billing submitted through United Pharmacy to the company. The filing describes charges typically ranging from $1,887.13 to $2,358.92 per prescription of Diclofenac Sodium Gel 3%; $2,686.36 or $2,636.38 for Diclofenac Sodium 2% Solution; $1,218.97 to $1,904.65 for Lidocaine 5% Ointment; and $2,680.78 for Naproxen-Esomeprazole.

The insurer alleges these pharmaceuticals were prescribed and dispensed pursuant to predetermined fraudulent protocols and unlawful, collusive referral arrangements, rather than individualized medical judgment. It also alleges the defendants intentionally targeted these high-priced products, acquired at low cost, in place of other effective but much less costly prescription and non-prescription drug products, including over-the-counter items that are not covered expenses under the no-fault laws.

GEICO further describes what it characterizes as unlawful, collusive referral arrangements. The filing alleges that Alishayeva and United Pharmacy, together with unknown associates, entered into financial arrangements with nurse practitioners Gaetan Jean-Marie and Shai Bikel and with clinic controllers at multidisciplinary no-fault clinics. According to the filing, those arrangements led to large volumes of prescriptions for the same set of drugs being directed to United Pharmacy, including, in some instances, prescriptions that were illegal, invalid or unauthorized and issued using another provider’s credentials.

For insurance professionals, the case also draws attention to New York’s pharmacy fee schedule. Under 12 N.Y.C.R.R. §§ 440.5(a) and (d), reimbursement is based on the Average Wholesale Price associated with a drug’s National Drug Code on the day of dispensing, minus a specified percentage, plus a single dispensing fee. GEICO alleges the defendants intentionally selected a specific set of pharmaceutical products with extremely expensive average wholesale prices that could be obtained at a fraction of that cost, enabling what the filing describes as “exorbitant charges” to insurers.

GEICO states it has already paid approximately $2.3 million on United Pharmacy’s bills and that approximately $1.4 million in additional claims for the same types of products remain pending. The insurer is asking the court to declare that United Pharmacy has no right to payment for any pending bills for these pharmaceuticals, to order repayment of the amounts already paid under claims including common law fraud and unjust enrichment, and to award treble damages, costs and attorneys’ fees under the federal Racketeer Influenced and Corrupt Organizations Act.

These remain allegations drawn from GEICO’s filing. The court has not made findings on the facts, and no final determination has been issued on GEICO’s claims or on the defendants’ liability.

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