Filed: Apr. 09, 2020
Latest Update: Apr. 09, 2020
Summary: NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS APR 9 2020 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT BLUE OAK MEDICAL GROUP, a No. 18-56610 California Medical Corporation, D.C. No. Plaintiff-Appellant, 2:18-cv-03867-RGK-SK v. MEMORANDUM* STATE COMPENSATION INSURANCE FUND, a California Corporation; et al., Defendants-Appellees. Appeal from the United States District Court for the Central District of California R. Gary Klausner, District Judge, Presiding Submitted
Summary: NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS APR 9 2020 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT BLUE OAK MEDICAL GROUP, a No. 18-56610 California Medical Corporation, D.C. No. Plaintiff-Appellant, 2:18-cv-03867-RGK-SK v. MEMORANDUM* STATE COMPENSATION INSURANCE FUND, a California Corporation; et al., Defendants-Appellees. Appeal from the United States District Court for the Central District of California R. Gary Klausner, District Judge, Presiding Submitted F..
More
NOT FOR PUBLICATION FILED
UNITED STATES COURT OF APPEALS APR 9 2020
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
BLUE OAK MEDICAL GROUP, a No. 18-56610
California Medical Corporation,
D.C. No.
Plaintiff-Appellant, 2:18-cv-03867-RGK-SK
v.
MEMORANDUM*
STATE COMPENSATION INSURANCE
FUND, a California Corporation; et al.,
Defendants-Appellees.
Appeal from the United States District Court
for the Central District of California
R. Gary Klausner, District Judge, Presiding
Submitted February 12, 2020**
Pasadena, California
Before: BYBEE, COLLINS, and BRESS, Circuit Judges.
Blue Oak Medical Group (“Blue Oak”) appeals the district court’s dismissal
under Federal Rule of Civil Procedure 12(b)(6) of Blue Oak’s first amended
complaint against Express Scripts, Inc. (“Express Scripts”) and State Compensation
*
This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
**
The panel unanimously concludes this case is suitable for decision
without oral argument. See Fed. R. App. P. 34(a)(2).
Insurance Fund (“State Fund”). We have jurisdiction under 28 U.S.C. § 1291 and
affirm.
Blue Oak is a network of occupational medical clinics in Southern California
that provides treatment for workers injured on the job. State Fund is a state-created
non-profit workers’ compensation insurer. See Cal. Ins. Code §§ 11770, 11775.
State Fund has allowed Blue Oak to participate in its network of medical providers.
Express Scripts is a nationwide pharmacy service that serves as State Fund’s
designated “pharmacy benefit network.” See Cal. Lab. Code § 4600.2(a); Cal. Code
Regs. tit. 8, § 9792.27.8(d).
In its first amended complaint, Blue Oak alleged that State Fund and Express
Scripts violated the Racketeer Influenced and Corrupt Organizations Act (RICO),
18 U.S.C. § 1962(c), by fraudulently inducing Blue Oak to dispense patient
medications and then failing to reimburse Blue Oak. Blue Oak also asserted a RICO
conspiracy claim,
id. § 1962(d), and a claim under California Business and
Professions Code § 17200, which were both derivative of the underlying RICO
claim.
Reviewing de novo, Eclectic Props. E., LLC v. Marcus & Millichap Co.,
751
F.3d 990, 995 (9th Cir. 2014), we agree with the district court that Blue Oak failed
to state a claim upon which relief can be granted. One of the several elements a
RICO plaintiff must allege is “racketeering activity.” 18 U.S.C. § 1962(c); Eclectic
2
Props., 751 F.3d at 997. Here, Blue Oak alleged that State Fund and Express Scripts
had engaged in the predicate “racketeering activity” of mail and wire fraud. See 18
U.S.C. §§ 1341, 1343. Mail and wire fraud require Blue Oak to allege, among other
things, “a scheme to defraud,” Eclectic
Props., 751 F.3d at 997, which “covers any
scheme to deprive another of money or property by means of false or fraudulent
pretenses, representations, or promises.” United States v. Brugnara,
856 F.3d 1198,
1207 (9th Cir. 2017) (quotations omitted). Fraud must also be pleaded with
particularity under Federal Rule of Civil Procedure 9(b). See Odom v. Microsoft
Corp.,
486 F.3d 541, 553–54 (9th Cir. 2007) (en banc).
Blue Oak’s operative first amended complaint fails to plead a scheme to
defraud Blue Oak into supplying medications with the promise of reimbursement.
It is undisputed that State Fund could contract with a pharmacy benefit network like
Express Scripts to be its exclusive provider of medications. See Cal. Lab. Code
§ 4600.2(a); Cal. Code Regs. tit. 8, § 9792.27.8(d). In its first amended complaint,
Blue Oak expressly alleged it was aware that State Fund had entered into such an
arrangement with Express Scripts: “[O]n or about November 1, 2015, [State Fund]
had announced a policy that all prescription drugs must be dispensed only through
Express Scripts.”
In addition, State Fund’s written responses to Blue Oak’s requests for
authorization—which Blue Oak relied upon in its amended complaint and which the
3
district court could therefore consider in ruling on a motion to dismiss, see United
States v. Ritchie,
342 F.3d 903, 908 (9th Cir. 2003)—specifically stated:
“Authorization of medication does not constitute approval to dispense medications
from the physician’s office. All medication should be filled by an Express Scripts
Network pharmacy.” Under these circumstances, Blue Oak has not alleged any
scheme to defraud or false statements to the effect that Blue Oak would be
reimbursed for medications it provided. Moreover, to the extent that Blue Oak
experienced persistent difficulties in dealing with Express Scripts after medications
were approved, Blue Oak has failed to allege sufficient facts to establish that the
approvals were thereby fraudulent when issued.
Because Blue Oak’s other claims are derivative of its RICO claim, those
claims fail as well. See Howard v. Am. Online Inc.,
208 F.3d 741, 751 (9th Cir.
2000); Smith v. State Farm Mut. Auto. Ins. Co.,
113 Cal. Rptr. 2d 399, 414 (Cal. Ct.
App. 2001).
The district court also did not abuse its discretion in denying leave to amend.
Allen v. City of Beverly Hills,
911 F.2d 367, 373 (9th Cir. 1990). The district court
had previously allowed Blue Oak to amend once. See Zucco Partners, LLC v.
Digimarc Corp.,
552 F.3d 981, 1007 (9th Cir. 2009). In seeking leave to amend a
further time, Blue Oak “did not propose any new facts or legal theories” to remedy
the deficiencies in its first amended complaint. Gardner v. Martino,
563 F.3d 981,
4
991 (9th Cir. 2009).
AFFIRMED.
5