The Second Circuit affirmed the underlying facts—that Mayzenberg's clinics paid kickbacks for referrals—but found the relationship between those violations and no-fault reimbursement eligibility to be an unsettled question of state law. The panel remanded the case without resolving GEICO's alternative fraud and RICO theories, leaving those claims available for further proceedings once the state's highest court addresses the certification question.
The ruling significantly constrains insurers' ability to deny no-fault claims unilaterally based on provider misconduct. It shifts enforcement authority toward state regulators and strengthens reimbursement defenses for providers facing kickback allegations. With no-fault reimbursements exceeding $1 billion annually in New York, the decision affects hundreds of similar cases and substantially reduces the leverage GEICO's initial district court win had provided to the insurance industry in combating provider fraud.