K. MICHAEL MOORE, CHIEF UNITED STATES DISTRICT JUDGE.
THIS CAUSE came before the Court upon the following motions: Defendant Metropolitan Health Community Services Corporation's Motion to Dismiss (ECF No. 60), and Defendants Performance Orthopaedics & Neurosurgery, LLC, Physicians Central Business Office, LLC, Mark Cereceda, and Brian Mevorah's Motion to Dismiss (ECF No. 61), to which Defendants, Omni Neurological, Orthopedic & Spine Center, Inc. and Sergio Triana filed a Notice of Joinder (ECF No. 63).
In its Amended Complaint, State Farm Mutual Automobile Insurance Company ("Plaintiff" or "State Farm") alleges a "scheme" involving Defendants Performance Orthopaedics & Neurosurgery, LLC d/b/a Calhoun Orthopaedics & Neurosurgery ("Calhoun"), Omni Neurological, Orthopedic & Spine Center, Inc. ("Omni"), Metropolitan Health Community Services Corporation d/b/a Metropolitan Hospital Of Miami ("Metropolitan"), Surgery Center Of Coral Gables, LLC d/b/a Coral Gables Surgery Center ("Coral Gables"), Physicians Central Business Office, LLC ("CBO"), Mark Cereceda, D.C. ("Cereceda"), Sergio Triana, D.C. ("Triana"), and Brian Mevorah, D.C. ("Mevorah") (collectively, "Defendants"). See Amended Complaint ("Am. Compl.") (ECF No. 56) ¶ 1.
This scheme consisted of two allegedly "unlawful referral arrangements," id. ¶ 121. The first such arrangement (the "Metropolitan Arrangement") took place from early 2012 through April 2014. Id. ¶ 6. During that time, Calhoun, a medical practice which specialized in orthopedic treatment and surgery, referred patients to Metropolitan, a surgical facility where Calhoun's physicians would perform surgery. Id. ¶ 6. Prior to treatment, Calhoun required each patient to execute a Letter of Promise (or "LOP"), which provided that Calhoun would be paid from any settlement, judgment, or verdict rendered in connection with the patient's personal injury claim. Id. ¶ 60; see also id. ¶¶ 39-40. For each referred surgical procedure performed on Calhoun's patients, Calhoun paid Metropolitan an all-inclusive pre-arranged price in full satisfaction of the patient's surgical facility charges. Id. ¶ 6. The amount Calhoun paid was typically pre-negotiated and based on a price list that assigned a specific dollar amount to particular procedures. Id.
Despite this pre-arranged price, however, Metropolitan prepared and sent invoices to Calhoun which reflected an amount for Metropolitan's services that "greatly exceeded" the amount Calhoun actually paid to Metropolitan. Id. These invoices purportedly reflected itemized charges for each of the supplies and services rendered. Id. ¶ 71. These invoices did not include any reference to, or deduction for, the amount that Calhoun actually paid Metropolitan. Id. ¶ 6. Rather, the "invoices" showed the total amount of Metropolitan's itemized charges as an unpaid "balance." Id. ¶ 71.
CBO, a company which performed billing and collections for Calhoun, transmitted the Metropolitan invoices to Calhoun's patients' personal injury attorneys on Calhoun's behalf for inclusion in settlement demands to State Farm. Id. ¶ 6. In its transmittals, Calhoun did not make any reference to, or deduction for, the amount that Calhoun actually paid to Metropolitan. Id. State Farm alleges that it was unaware of this payment arrangement, and was therefore deceived and injured because it made settlement payments based on the "inflated" invoices resulting from this arrangement. Id. ¶ 7; see generally id. ¶¶ 2, 4, 5, 26, 27, 106-08.
Omni submitted the following materials directly to its patients' personal injury attorneys for the inclusion in settlement demands against State Farm: a cover letter on Omni's letterhead, Omni's account ledger reflecting Omni's charges for the professional component of rendered services, and a line item for the surgical charges incurred at Coral Gables, and the operative report. Id. ¶¶ 5, 109-111. The line item on Omni's account ledger for Coral Gables surgery charges reflected the full "usual and customary" amount, but did not disclose the lower, all-inclusive fixed price that the parties allegedly negotiated. Id. ¶¶ 105-107. This resulted in an "enormous difference" between what Omni paid to Coral Gables and "the surgical facility `charges from Coral Gables listed on Omni's ledger.'" Id. ¶ 108
Under both the Metropolitan Arrangement and the Coral Gables Arrangement, the patients' personal injury attorneys utilized the packages from Omni and CBO to create demand packages, and sent those packages to State Farm. Id. ¶¶ 85, 112. The demand packages included a letter allegedly crafted to exert pressure on State Farm to settle the claims within a short time by threatening bad faith claims.
Against this backdrop, State Farm seeks damages under the Florida Deceptive and Unfair Trade Practices Act ("FDUTPA"), Fla. Stat. §§ 501.201-501.213 (Counts I and II) and under the common law theories of fraud and unjust enrichment (Counts III and IV, respectively). Additionally, State Farm seeks a declaration that it is not liable for payment on any as-yet unpaid claims generated by the scheme under the Declaratory Judgment Act, 28 U.S.C. § 2201 (Count V).
The defendants moved to dismiss Plaintiff's Amended Complaint, arguing that Plaintiff has failed to state a claim upon which relief can be granted. See Metropolitan's Motion to Dismiss ("Metropolitan's Motion") (ECF No. 60); Calhoun, CBO, Mevorah, and Cereceda's Motion to Dismiss ("Calhoun's Motion") (ECF No. 61).
Plaintiff filed a response, in which it maintains that it has sufficiently pled facts to survive the Motion to Dismiss and that it did not fail to join any necessary parties. See Plaintiff's Combined Response in Opposition
A motion to dismiss for failure to state a claim merely tests the sufficiency of the complaint; it does not decide the merits of the case. Milburn v. United States, 734 F.2d 762, 765 (11th Cir. 1984). On a motion to dismiss, the Court must accept the factual allegations as true and construe the complaint in the light most favorable to the plaintiff. SEC v. ESM Group. Inc., 835 F.2d 270, 272 (11th Cir. 1988), cert. denied sub nom. Peat Marwick Main & Co. v. Tew, 486 U.S. 1055, 108 S.Ct. 2822, 100 L.Ed.2d 923 (1988).
"To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to `state a claim for relief that is plausible on its face.'" Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (quoting Bell Atl. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). A complaint must contain enough facts to indicate the presence of the required elements. Watts v. Fla. Int'l Univ., 495 F.3d 1289, 1302 (11th Cir. 2007). "[C]onclusory allegations, unwarranted deductions of fact or legal conclusions masquerading as facts will not prevent dismissal." Oxford Asset Mgmt. Ltd. v. Jaharis, 297 F.3d 1182, 1188 (11th Cir. 2002). However, as long as the allegations rise above a speculative level, a well-pleaded complaint will survive a motion to dismiss "even if it appears that a recovery is very remote and unlikely." Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957) (overruled on other grounds by Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 1959-60, 167 L.Ed.2d 929 (2007) (internal quotation marks and citation omitted)).
At the outset, the Court addresses Metropolitan's argument that each of Plaintiff's claims fail because the "scheme" in the Amended Complaint actually describes a common medical billing practice. See Metropolitan's Motion at 5-7. The Court also considers the similar argument that the FDUTPA claims fail because the Amended Complaint "describes the usual and customary practices of medical billing." CG's Motion at 8 n.4. These arguments fail for two reasons.
First, "[i]n evaluating whether a complaint should be dismissed under Rule 12(b)(6) for failure to state a claim, a court is generally limited to reviewing what is within the four corners of the complaint." Hayes v. U.S. Bank Nat'l Ass'n, 648 Fed. Appx. 883, 887 (11th Cir. 2016); see also Tellabs, Inc. v. Makor Issues & Rights, Ltd., 551 U.S. 308, 322, 127 S.Ct. 2499, 168 L.Ed.2d 179 (2007) ("courts must consider the complaint in its entirety, as well as ... documents incorporated into the complaint by reference, and matters of which a court may take judicial notice."). Notably, "[i]ndustry custom and practice" cannot "be the subject of judicial notice" in the absence of evidence or agreement by the parties. See Nadherny v. Roseland Prop. Co., Inc., 390 F.3d 44, 51-52 (1st Cir. 2004).
Metropolitan attempts to evade this restriction by couching its argument in the language found in Ashcroft v. Iqbal, 556 U.S. 662, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) and Bell Atl. Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007). See Metropolitan's Motion at 5.
Relatedly, the Court rejects the argument that Plaintiff's FDUTPA claim fails because Plaintiff — as an experienced insurance company — should be aware of the "usual and customary" billing practices alleged and thus Plaintiff has failed to "reasonably avoid the injury." See CG Motion at 8 n.4 (citing Porsche Cars N. Am., Inc. v. Diamond, 140 So.3d 1090, 1096 (Fla. 3d DCA 2014)). The Eleventh Circuit has made clear that FDUTPA does not require "subjective proof of deception" wherein a "plaintiff could not secure FDUTPA relief" solely because it "knew the defendant's business well enough to manage the risk." Democratic Republic of the Congo v. Air Capital Grp., LLC, 614 Fed.Appx. 460, 471 (11th Cir. 2015). In fact, the Eleventh Circuit explicitly rejected the "subjective element" that some courts (including the Porsche Cars Court) "have injected" into FDUTPA, and, instead, adopted the "objective" standard set forth by the Florida Supreme Court in PNR, Inc. v. Beacon Prop. Mgmt., Inc., 842 So.2d 773, 777 (Fla. 2003). Id. at 471 n.7.
As a result, the "law now permits recovery if the plaintiff proves she was injured by an objectively deceptive act or statement." Id. at 471. "Whether [specific] conduct constitutes an unfair or deceptive trade practice is a question of fact for the jury to determine." Nature's Prod., Inc. v. Natrol, Inc., 990 F.Supp.2d 1307, 1322 (S.D. Fla. 2013); see also Felice v. Invicta Watch Co. of Am., Inc., No. 16-CV-62772-RLR, 2017 WL 3336715, at *4 (S.D. Fla. Aug. 4, 2017) (on motion to dismiss, rejecting argument that a reasonable plaintiff would not have been deceived by misrepresentations); Nationwide Mut. Co. v. Ft. Myers Total Rehab Ctr., Inc., 657 F.Supp.2d 1279, 1290-91 (M.D. Fla. 2009) ("The argument that plaintiff should have reasonably foreseen the deception and mitigated damages is, at best, an affirmative defense which will not support a motion to dismiss.").
Second, even if the alleged billing practice were common, such prevalence would not be dispositive as to its legality. Cf. Grace & Co. v. City of Los Angeles, 278 F.2d 771, 774 (9th Cir. 1960) ("Observance of a custom or practice ... does not conclusively establish the legal standard."); Emmenegger v. Bull Moose Tube Co., 33 F.Supp.2d 1127, 1137 (E.D. Mo. 1998) (finding that certain billing practice is unlawful despite it being the "prevailing practice in this and most other areas"); United States v. Khamsouk, 54 M.J. 742, 747 n.2 (N-M. Ct. Crim. App. 2001), decision set aside on other grounds, 57 M.J. 282 (C.A.A.F. 2002) ("We recognize that simply because this is common practice does not mean that the practice is legally correct."). Defendants have cited no caselaw supporting a contrary position, and the Court is aware of none. Accordingly, the Court rejects, at this stage in the proceedings, arguments for dismissal premised on the allegation that the billing practices at issue are "usual and customary."
Defendants argue that dismissal of Plaintiff's common law fraud claim is appropriate for two reasons. First, Defendants argue the Amended Complaint fails to plead fraud with the particularity required by Federal Rule of Civil Procedure 9(b). Second, the Calhoun Defendants argue that the fraud claim fails because it seeks to create a private right of action for statutes that otherwise do not provide for one. For the reasons set forth below, the Court grants in parts and denies in part Defendants' motions to dismiss the fraud claim.
Defendants move to dismiss Count III because Plaintiff does not plead the required elements for fraud with sufficient particularity to comply with Federal Rule of Civil Procedure 9(b). Under Florida law,
As Defendants note, the Federal Rules of Civil Procedure require a plaintiff to "state with particularity the circumstances constituting fraud or mistake." See Fed. R. Civ. P. 9(b). Under Rule 9(b), a fraud-plaintiff must allege (a) the precise statements, documents, or misrepresentations made; (b) the time, place, and person responsible for the statement; (c) the content and manner in which these statements misled the plaintiffs; and (d) what the defendants gained by the alleged fraud. Brooks v. Blue Cross & Blue Shield of Fla., Inc., 116 F.3d 1364, 1380-81 (11th Cir. 1997).
Plaintiff alleges two different sets of misrepresentations. First, the Amended Complaint states that the Metropolitan and Coral Gables created invoices, which contained false and/or materially misleading statements. See Am. Compl. at ¶¶ 4-6, 67, 70-72, 103, 105, 107, 108, 120. Second, the Amended Complaint states that Calhoun, Omni, and CBO created demand packages, which contained false and/or materially misleading statements. Id. at ¶¶ 74-83, 102-111, 158.
For the reasons below, the Court finds that the Amended Complaint alleges sufficient details concerning the misrepresentations made by Metropolitan, Omni, CBO, and Calhoun.
Plaintiff alleges that Metropolitan's invoices itemized charges for each patient's surgery and reflected charges for each of the supplies and services purportedly rendered. Id. ¶ 71. The invoices showed the total amount of Metropolitan's charges as an "unpaid balance." Id. ¶ 71. These invoices did not reflect any adjustments or credits to the patient's account for Calhoun's payments or indicate that Metropolitan had been paid by Calhoun and accepted such payments as payment in full. Id. Notably, these invoices affirmatively represented that there were no "adjustments" or "payments" which could have affected the "balance." See Ex. 5 to Am. Compl. at 3. The Complaint includes specifics pertaining to the discrepancy between the amount claimed and the amount actually paid — which sometimes exceeded an order of magnitude. For example, Calhoun performed a surgical procedure on patient M.C.'s neck. Am. Compl. ¶ 72. In connection with this procedure, Metropolitan's invoice reflected charges of $101,938.93, but Calhoun only paid Metropolitan $8,063 for its services. Id.
In addition to identifying the precise misrepresentation made, these allegations satisfy the first two elements of common law fraud. First, Metropolitan allegedly made a false statement of material fact regarding the "balance" owed for its services. Second, drawing all reasonable inferences in Plaintiff's favor,
After receiving Metropolitan's invoices, CBO, on behalf of Calhoun, would package them for transmission to the patients' personal injury attorneys. See Am. Compl. ¶ 74. Calhoun instructed CBO via a Surgery Check List to include in each package, a cover letter, "all ledgers: hospital, professional, and implant" and the operative report. Id. ¶¶ 76-82. CBO followed
The cover letters written on Calhoun letterhead explained: "Please find the attached surgical bills and operative report for your client []. The total charges are divided into two parts: hospital and surgeon's fee. The hospital bill includes ... all services rendered.... Your office will not receive additional billing from any other facility regarding this surgery." Id. ¶ 83; Exhibit 7. These letters did not disclose the amount Calhoun actually paid Metropolitan. Id. ¶ 67, 84. In fact, the example letter attached to the Amended Complaint includes the same amount under hospital fees as is reflected in the "balance" of Metropolitan's invoice. See Ex. 7 to Am. Compl. Because Plaintiff is entitled to all reasonable inferences that can be drawn from the well-pleaded allegations of the Amended Complaint, these communications misleadingly "suggested that [Calhoun] was simply charging the insurers the actual amount that [it] would ultimately pay [Metropolitan]." United States v. Sharp, 749 F.3d 1267 (10th Cir. 2014) (finding that a similar misleading suggestion was sufficient to show fraudulent misrepresentation in a criminal case).
In addition to identifying the precise misrepresentation made, these allegations also satisfy the first two elements of common law fraud as to Calhoun and CBO.
After receiving Metropolitan's and Coral Gables' invoices, Omni would package those invoices for transmission to the patients' personal injury attorneys. See Am. Compl. ¶ 102-105. In both cases, Omni and its owners "knew" these invoices were being delivered so that Omni could attempt to collect the stated charges from the patients after the patients' personal injury attorneys included such charges in a demand to an insurer. Id. ¶ 103, 107.
Omni included Metropolitan's invoices, which purported to show the total amount of Metropolitan's charges as an unpaid
Similarly, after receipt of Coral Gables' invoices, which "purported to reflect the surgical facility's usual and customary charges for the services provided" and "never accounted for the fact that Coral Gables agreed to a pre-arranged price from Omni" for the services it provided, id. ¶ 107, Omni provided packets to patients attorneys. Id. ¶ 109. These packets typically included a cover letter and Omni's account ledger reflecting Omni's charges and a line entry for the charges at Coral Gables. Id. ¶ 109. The packages sent by Omni included the full amount of Coral Gables' bills as a line item in the total amount purportedly due and owing. Id. ¶ 111. As a result, the "surgical facility `charges from Coral Gables listed on Omni's ledger'" were "enormous[ly] differen[t]" from what Omni actually paid to Coral Gables. Id. ¶ 108. The cover letters, which were on Omni letterhead, disclosed that Omni purchased Coral Gables' receivables. Id. ¶ 108, 110; see also Ex. 10 to Am. Compl. However, the letters did not disclose the amount Omni actually paid to Coral Gables was, in at least one case, about one-tenth of the now-claimed amount. Id. ¶ 108, 110.
In addition to identifying the precise misrepresentation made, these allegations satisfy the first two elements of common law fraud as to Omni. They show that Omni made "a false statement of material fact" regarding the amount the patient owed for Coral Gables' and Metropolitan's services. See, e.g., Am. Compl. ¶ 111 ("the packages sent by Omni included the full amount of Coral Gables' bill as a line item in the total amount purportedly due and owing"). Because Plaintiff is entitled to all reasonable inferences that can be drawn from the well-pleaded allegations, Omni's communications plausibly "suggested that [it] was simply charging the insurers the actual amount that [it] would ultimately pay [Coral Gables or Metropolitan]." United States v. Sharp, 749 F.3d 1267 (10th Cir. 2014) (finding that a similar misleading suggestion was sufficient to show fraudulent misrepresentation in a criminal case).
Defendants next argue that Plaintiff has failed to specify with particularity the circumstances
The purpose of the particularity rule in fraud actions is to "alert[] defendants to the precise misconduct with which they are charged and [to] protect[] defendants against spurious charges of immoral and fraudulent behavior." Ziemba v. Cascade Int'l, Inc., 256 F.3d 1194, 1202 (11th Cir.2001) (quotations and citations omitted). Courts recognize, however, that if alleged fraudulent conduct occurs over an extended period of time, and the acts are numerous, the specificity requirements of Rule 9(b) are applied less stringently to avoid "substantial unfairness to private litigants who could not possible have detailed knowledge of all the circumstances surrounding the alleged fraud." MeterLogic, Inc. v. Copier Sols., Inc., 126 F.Supp.2d 1346, 1361 (S.D. Fla. 2000) (holding that plaintiff "need not provide the exact time and place"). Moreover, "a court considering a motion to dismiss for failure to plead fraud with particularity should always be careful to harmonize the directives of rule 9(b) with the broader policy of notice pleading" found in Rule 8. Hill v. Morehouse Med. Assocs., Inc., No. 02-14429, 2003 WL 22019936, at *3 (11th Cir. Aug. 15, 2003) (quoting Friedlander v. Nims, 755 F.2d 810, 813 n. 3 (11th Cir.1985))).
Although the Amended Complaint provides some information regarding the time and place of the misleading deceptive claim submissions, it does not allege the exact date and time every false statement was made. However, the Amended Complaint and its attached exhibits, provide patients' initials, claim numbers, the dates of settlements, settlement amounts, the corresponding charges from the Medical Practices and the Surgical Facilities, along with example invoices and demand letters, which include alleged misrepresentations. See, e.g., Exhibits 1, 3-5, 7-11. Taken together, this information is sufficient to "alert" Defendants to the charges they are being accused of fraudulently inflating.
Although Amended Complaint alleges that Metropolitan, CBO, Calhoun, and Omni created false statements, see Section III.B.1.a, supra, Plaintiff admits it does not know the specific persons "employed or utilized by the entity Defendants to make the fraudulent representations." See Opp. at 1317. Plaintiff argues that such allegations are unnecessary at this time. Opp. at 1317.
While the Court agrees that such allegations are unnecessary to establish liability for fraud against the entity defendants here, it disagrees that the fraud claim survives against the Triana, Cerceda, and Mevorah (the "Individual Defendants"). Simply put, there are no well-pleaded allegations specifically claiming that the Individual Defendants created any false statements. Rather, all references to the Individual Defendants are conclusory. See, e.g., Am. Compl. ¶ 160 ("Defendants are jointly liable for the false representations and omissions of material facts contained in the invoices and supporting documentation generated by the Medical Practice because they each played an essential role as the orchestrators of the Unlawful Referral Arrangement.").
The cases that Plaintiff cites — State Farm Mutual Automobile Ins. Co. v. Altamonte Springs Diagnostic Imaging, Inc., No. 611-cv-1373, 2011 WL 6450769, at *4 (M.D. Fla. Dec. 21, 2011) and Gov't Emps. Ins. Co. v. KJ Chiropractic Ctr. LLC, No. 6:12-cv-1138, 2014 WL 12617566, at *4 (M.D. Fla. Mar. 6, 2014)) — are inopposite and do not remedy this defect. In Altamonte Springs, the court specifically found
Accordingly, Count III is DISMISSED WITHOUT PREJUDICE against Mevorah, Cereceda, and Triana.
The Amended Complaint details how the misrepresentations discussed in section III.B.1.a, supra, misled State Farm. State Farm received demand packages from its customers' attorneys, which included materials generated by Metropolitan, CBO (on behalf of Calhoun), and Omni.
In addition to detailing the manner in which Plaintiff was deceived, the Amended Complaint also contains sufficient allegations to satisfy the last two elements of common law fraud. First, the same allegations supporting the manner in which Plaintiff was misled readily demonstrate the "consequent injury by the party acting in reliance on the representation," Butler, 44 So.3d at 105, which is the fourth element of common-law fraud. Specifically, Plaintiff made settlement payments based on misrepresentations found in the invoices and demand packages.
Second, the Court finds that the Amended Complaint also satisfies the third element of common law fraud — an intention that the representation induce another to act on it — against Metropolitan, Calhoun, CBO, and Omni. The Amended Complaint alleges that Defendants created these invoices and caused them to be submitted to State Farm in order to "induce State Farm to pay claims" based upon the misrepresentations contained therein. Am. Compl. ¶ 159. Defendants' "intent to injure, defraud, or deceive" Plaintiff is also readily inferred from the allegations of the Amended Complaint. See, e.g., Am. Compl. at ¶ 26 ("to accomplish their common purpose of defrauding State Farm through the scheme...."); id. ¶ 55 ("Calhoun, its owners, CBO (on behalf of Calhoun), and Metropolitan knew that these invoices
The Amended Complaint alleges that the Surgical Facilities received a guaranteed, albeit secret, cash flow. See, e.g., Am. Compl. (ECF No. 56) at ¶¶ 5, 6, 24, 25, 66-70, 99, 102-107, 133, 140, 145, 151, 156, 157, 160, 163, 166. It also alleges that the Medical Practices received the ability to take possession of the Surgical Facilities bills and, upon settlement, recoup profit over and above the amount of the secret payments it made. (Id. at ¶¶ 5, 6, 57, 60-62, 67, 70, 72, 75, 78, 83, 99, 102, 103, 105-108, 110-112, 133, 140, 145, 151, 160, 166, & Exhs. 6-7, 10). The higher the purported medical expenses, the more likely the insurers would settle the claim for higher amounts. Am. Compl. ¶¶ 1, 40, 59-61, 70, 73, 75-83, 103, 107, 110, 130, Ex. 3, Ex. 6, Ex. 7, Ex. 10. Had State Farm been aware of the arrangements, it would not have paid the settlements featured in Exhibit 11 because, at a minimum, it would have evaluated the claims based on the amounts paid by the Medical Practice to the Surgical Facilities instead of the stated "artificial amounts included in the demand packages." Am. Compl. ¶ 121.
The Calhoun Defendants next argue that the fraud claim fails because it seeks to create a private right of action for statutes that otherwise do not provide for one. See Calhoun's Motion at 6-8. The Court disagrees. Under Florida law, "[w]hether a statutory remedy is exclusive or merely cumulative depends upon the legislative intent as manifested in the language of the statute." Thornber v. City of Ft. Walton Beach, 568 So.2d 914, 918 (Fla. 1990). "Even where the legislature acts in a particular area, the common law remains in effect in that area unless the statute specifically says otherwise." State v. Ashley, 701 So.2d 338, 341 (Fla.1997); see also Essex Ins. Co. v. Zota, 985 So.2d 1036, 1048 (Fla.2008) ("A statute.... designed to change the common law rule must speak in clear, unequivocal terms, for the presumption is that no change in the common law is intended unless the statute is explicit in this regard." (quoting Carlile v. Game & Fresh Water Fish Comm'n, 354 So.2d 362, 364 (Fla.1977))). "Unless a statute unequivocally states that it changes the common law, or is so repugnant to the common law that the two cannot coexist, the statute will not be held to have changed the common law." Thornber, 568 So.2d at 918. None of the statutes featured in the Amended Complaint explicitly precludes an insurer from bringing a claim for common law fraud.
Accordingly, the Court declines to dismiss Plaintiff's Count III on those grounds, and it survives as to Defendants CBO, Calhoun, Metropolitan, and Omni.
Plaintiff lodges two claims under the Florida Deceptive and Unfair Trade Practices Act (or "FDUTPA"), Fla Stat. § 502.201 et seq. The first is against Calhoun, Omni, Metropolitan, CBO, Cereceda, Triana, and Mevorah (Am. Compl. ¶¶ 131-142); the second is against Omni, Triana, and Coral Gables (Am. Compl. ¶¶ 143-153).
Defendants argue that Plaintiff's FDUTPA claims fail for three reasons. First, Metropolitan argues that FDUTPA does not apply to the conduct at issue because such conduct does not constitute "trade or commerce." Second, Metropolitan and Calhoun Defendants argue that the FDUTPA claims fail because they lack a statutory predicate. Third, Calhoun Defendants argue that the FDUTPA claim fails because the Amended Complaint fails to plead with the particularity required by Rule 9(b). For the reasons discussed below, dismissal of the FDUTPA claims (Counts I and II) against Metropolitan, CBO, Calhoun, and Omni is inappropriate, but dismissal of those Counts is appropriate against Cereceda, Triana, and Mevorah.
Metropolitan argues that FDUTPA does not apply to the conduct alleged in the Amended Complaint because conduct in pursuit of legal remedies, such as a settlement, is not `trade or commerce' under FDUTPA. Metropolitan's Motion at 13.
FDUTPA prohibits "[u]nfair methods of competition, unconscionable acts or practices, and unfair or deceptive acts or practices in the conduct of any trade or commerce." Carriuolo v. Gen. Motors Co., 823 F.3d 977, 983 (11th Cir. 2016) (alteration in original) (quoting Fla. Stat. § 501.204(1)). FDUTPA defines "[t]rade or commerce" as "the advertising, soliciting, providing, offering, or distributing, whether by sale, rental, or otherwise, of any good or service, or any property, whether tangible or intangible, or any other article, commodity, or thing of value, wherever situated." Fla. Stat. Ann. § 501.203(8). "As such language clearly indicates, the definition of `trade or commerce' is quite broad." Alvi Armani Med., Inc. v. Hennessey, 629 F.Supp.2d 1302, 1305 (S.D. Fla. 2008). Additionally, FDUTPA requires that its provisions "be construed liberally" to, inter alia, "protect the consuming public and legitimate business enterprises from those who engage in unfair methods of competition, or unconscionable, deceptive, or unfair acts or practices in the conduct of any trade or commerce." Fla. Stat. § 501.202(2).
Heeding these provisions of FDUTPA, accepting the facts alleged in the Amended Complaint as true, and construing all reasonable inferences therefrom in the light most favorable to Plaintiff, the Court finds that the conduct alleged in the Amended Complaint falls within the definition of "trade or commerce." The Medical Practices and Surgical Centers provide healthcare to patients in exchange for a portion of their patients' legal recovery (in the form of settlement or otherwise) under the Letters of Protection. Am. Compl. ¶ 60-62. The Medical Practices and the Surgical Facilities have an arrangement under which the Medical Practices provide referrals to the Surgical Facilities in exchange
At a minimum, the Surgical Centers' creation of the inflated bill pursuant to an alleged arrangement with the Medical Centers involves commerce. See James D. Hinson Elec. Contracting Co., Inc. v. Bell-South Telecommunications, Inc., 642 F.Supp.2d 1318 (M.D. Fla. 2009) (finding "bill" sent by utility to excavator for repair of underground cable, that did not disclose corporate overhead and claims processing charges, was in "trade and commerce," as required for claim under FDUTPA); see also State Farm Mut. Auto. Ins. Co. v. Med. Serv. Ctr. of Florida, Inc., 103 F.Supp.3d 1343, 1354 (S.D. Fla. 2015) ("Fraudulent conduct in the context of billing for PIP benefits qualifies as a deceptive act for purposes of FDUTPA." (citations omitted)); Baker v. Baptist Hosp., Inc., 115 So.3d 1123, 1126 (Fla. Dist. Ct. App. 2013) ("[B]illing practices are considered part of `trade or commerce.'"). Additionally, the rendering of healthcare services also falls within the definition of "trade or commerce." See, e.g., State Farm Mut. Auto. Ins. Co. v. Med. Serv. Ctr. of Florida, Inc., 103 F.Supp.3d 1343, 1354 (S.D. Fla. 2015) ("Defendants engaged in unfair and deceptive acts and practices in the conduct of their trade and commerce by unlawfully operating medical clinics, in violation of Florida law."); see also Fla. Stat. § 501.203(8) (defining "[t]rade or commerce" as the "providing" of "any ... service").
The Court rejects Metropolitan's arguments to the contrary, which invoke cases that either do not stand for the broad proposition claimed, or are entirely inapposite. For example, Metropolitan relies on Kelly v. Palmer, Reifler, & Assocs., P.A., 681 F.Supp.2d 1356, 1376 (S.D. Fla. 2010), for the proposition that the solicitation or offer of a legal release in exchange for money does not equate to a "thing of value" as that term is used in the "trade or commerce" provision of FDUTPA. See Metropolitan's Motion at 13. However, the gravamen of the Kelly complaint was "the Palmer Law firm collects information from its retail clients and, utilizing sophisticated software, automatically generates misleading demand letters, calculates demand amounts and affixes a local attorney's signature to the demand letter, all without attorney review." Id. at 1363.
Accordingly, the Court does not find it appropriate to dismiss Plaintiff's FDUTPA
Metropolitan and Calhoun Defendants argue that the FDUTPA claims
A FDUTPA claim does not necessarily require the violation of a predicate statute. In order to state a FDUTPA claim, a plaintiff "must allege (1) a deceptive act or unfair trade practice; (2) causation; and (3) actual damages." Dolphin LLC v. WCI Communities, Inc., 715 F.3d 1243, 1250 (11th Cir. 2013). The first element may be satisfied in one of two ways: a per se violation or a traditional violation. See, e.g., Parr v. Maesbury Homes, Inc., No. 609CV-1268-ORL-19GJK, 2009 WL 5171770, at *7 (M.D. Fla. Dec. 22, 2009). In their motions, Metropolitan and Calhoun Defendants focus only on the first way: the per se FDUTPA violation, which requires a violation of a predicate statute. See Fla. Stat. § 501.203(3)(c) (a violation of any "law, statute, rule, or ordinance which proscribes unfair methods of competition, or unfair, deceptive, or unconscionable acts or practices" may serve as a predicate for a FDUTPA claim). However, a FDUTPA plaintiff may also satisfy the first element by showing a traditional violation, alleging defendants engaged in "[u]nfair methods of competition, unconscionable acts or practices, and unfair or deceptive acts or practices in the conduct of any trade or commerce." See Fla. Stat. § 501.204(1).
Here, Plaintiff alleges that Defendants violated four statutes,
Although the statute does not define "unfair and deceptive act or practice," the provisions of the act are to be "construed liberally." Intercoastal Realty, Inc. v. Tracy, 706 F.Supp.2d 1325, 1333 (S.D. Fla. 2010) (quoting Fla. Stat. § 501.202(2)). A practice is unfair under the FDUTPA if it "offends established public policy" or is "immoral, unethical, oppressive, unscrupulous, or substantially injurious to consumers." Beacon Prop. Mgmt., Inc., 842 So.2d at 777. A deceptive act occurs when a defendant makes "a representation, omission, or practice that is likely to mislead the consumer acting reasonably in the circumstances, to the consumer's detriment." Caribbean Cruise Line, Inc. v. Better Bus. Bureau of Palm Beach Cty., Inc., 169 So.3d 164, 169 (Fla.
For the reasons discussed in Section III.B., supra, the Court concludes that the Amended Complaint sufficiently pleads that CBO, Calhoun, Metropolitan, and Omni have engaged in fraudulent practices via their invoices. Courts have held misrepresentations regarding invoices may support FDUTPA claims. See, e.g., James D. Hinson Elec. Contracting Co., Inc. v. BellSouth Telecommunications, Inc., 796 F.Supp.2d 1341, 1353 (M.D. Fla. 2011) (inclusion of unrecoverable charges for "claims processing" in costs of damage to underground facilities billed to excavators); Turner Greenberg Assocs., Inc. v. Pathman, 885 So.2d 1004, 1008 (Fla. 4th DCA 2004) (furniture store's collection of a freight/insurance charge in connection with financed furniture sales was a deceptive and unfair trade practice; fee was in reality a customer surcharge); Latman v. Costa Cruise Lines, N.V., 758 So.2d 699, 703 (Fla. 3d DCA 2000) (charges invoiced as "port charges" but kept as profit held to violate FDUTPA).
Although not raised by Defendants, the Court notes that the causation and damages prongs for a FDUTPA claim are also satisfied here. Defendants allegedly submitted surgical charges for more than $3.8 million pursuant to the Metropolitan Arrangement and more than $172,000 pursuant to the Coral Gables Arrangement. Am. Compl. ¶ 10; see also Ex. 1 to Am. Compl. (containing chart of charges and settlements pursuant to each arrangement). State Farm claims representatives relied on the representation that the patients owed the amounts listed on the Medical Practice and/or Surgical Facilities' invoices or in the medical records, even though due to the scheme, the patient did not owe those amounts. Am. Compl. ¶ 116.
Accordingly, the FDUTPA claims do not fail for a lack of statutory predicate.
Calhoun Defendants and Coral Gables argue that the FDUTPA claims should be dismissed because they are not pled with the particularity required by Rule 9(b).
Where a claim is grounded in fraud, the complaint must also comply with the heightened pleading requirements of Federal Rule of Civil Procedure 9(b). See Curtis Inv. Co., LLC v. Bayerische Hypound Vereinsbank, AG, 341 Fed.Appx. 487
Here, Plaintiff's Amended Complaint "sounds in fraud," Llado, 2011 WL 705403 at *5. The gravamen of the Amended Complaint is that Defendants engaged in a "fraudulent scheme" to "grossly inflate[]" the value of their patients' personal injury claims so that State Farm would "pay significant settlement amounts based upon false information." See, e.g., Am. Compl. ¶¶ 6-7. Accordingly, Rule 9(b) requires the allegations supporting the FDUTPA Counts to be pleaded with particularity.
For the reasons discussed in Section III.B.1 and III.C.2, the Court finds that the FDUTPA claims are adequately pled under Rule 9(b) against CBO, Metropolitan, Calhoun, and Omni. However, there are no well-pleaded allegations detailing the Individual Defendants' participation in any unfair or deceptive act. Rather, all references to the Individual Defendants are conclusory. See, e.g., Am. Compl. ¶ 160. Accordingly, the FDUTPA claims survive as to CBO, Metropolitan, Calhoun, and Omni but are DISMISSED WITHOUT PREJUDICE as to Cereceda, Triana, and Mevorah.
Plaintiff lodges an unjust enrichment claim against all Defendants. Id. ¶¶ 162-168. To state a cause of action for unjust enrichment, a complaint must allege that: (1) the plaintiff has conferred a benefit on the defendant; (2) the defendant has knowledge of the benefit; (3) the defendant has accepted or retained the benefit conferred; and (4) the circumstances are such that it would be inequitable for the defendant to retain the benefit without paying fair value for it. Merle Wood & Assocs., Inc. v. Trinity Yachts, LLC, 714 F.3d 1234, 1237 (11th Cir. 2013) (citation omitted).
Metropolitan and Calhoun Defendants argue that the claim fails for four reasons. First, Metropolitan and Calhoun Defendants argue that the claim fails because it relies on statutes which do not provide for a private right of action. Second, Metropolitan argues that the claim fails to state a claim because the Amended Complaint never alleges that it conferred any benefits to Metropolitan. Third, Calhoun Defendants argue that Plaintiff cannot pursue a quasi-contract claim for unjust enrichment because an express contract exists concerning the same subject matter. Fourth, Calhoun Defendants argue that the unjust enrichment claim fails because Plaintiff has received adequate consideration for the benefit conferred — namely the release of claims by the patients.
Defendants argue that Plaintiff cannot base its unjust enrichment claim on conduct that violates statutes for which there is no private right of action. However, "even though the statutes in question
A review of the Amended Complaint reveals that Plaintiff does not attempt to assert a private cause of action for Defendants' violation of the Patient-Brokering, Anti-Kickback, Anti-Rebate, or Insurance Fraud Statutes, but rather contends that Defendants' conduct in violation of these statutes is unjust such that it would be wrong for them to retain benefits they received as a result of their wrongful conduct. See, e.g., Am. Compl. ¶¶ 123-130; 162-168. Accordingly, the fact that Plaintiff alleges conduct in violation of statutes, which do not provide for a private right of action, is not fatal to Plaintiff's unjust enrichment claim.
Plaintiff alleges that it conferred a benefit upon Defendants by making payments on claims "which were not owed because they were the product of the Unlawful Referral Arrangement orchestrated by the Defendants." Am. Compl. ¶ 163. Essentially, State Farm argues that it "owed absolutely nothing for Defendants' services," Opp. at 1329-30, because such services are "the product of an arrangement prohibited by Florida Statutes §§ 395.0185, 456.054, 817.505, 502.201 et. seq., and 817.234," Am. Compl. ¶ 174; see also id. ¶ 121 (alleging that the "unlawful nature of the brokering ... makes all such claims not compensable.").
On first blush, Plaintiff's unjust enrichment theory fits within the framework outlined in Silver Star, 739 F.3d at 583-84. In that case, the Eleventh Circuit found that a defendant's violation of a licensing statute could provide a basis for an unjust enrichment claim because the defendant "accepted payments" that it was "not entitled to under Florida law" due to its violation of that statute. Id. The Court noted that the statute explicitly provided that "[a]ll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part, but that is not so licensed, or that is otherwise operating in violation of this part, are unlawful charges, and therefore are noncompensable and unenforceable." Id. at 583. The Court reasoned that because the plain language of the statute provided that any charge or reimbursement claim by an unlicensed clinic was "unlawful ... noncompensable and unenforceable," it "would make no sense to read into" the statute a "provision that courts lack the authority to decide the crucial question on the lawfulness, compensability and enforceability" of such a claim. Id.
However, on a motion to dismiss, Plaintiff's legal conclusions are "not entitled to the assumption of truth," Iqbal, 556 U.S. at 680, 129 S.Ct. 1937, including Plaintiff's assertion that these statutes make any amount paid by State Farm to Defendants "not owed," Am. Compl. ¶ 163. Assuming without deciding that the Amended Complaint sufficiently alleges violations of each of those statutes, the Court does not agree that Plaintiff owed nothing for Defendants' services merely because of these violations.
As mentioned previously, the Court in Silver Star permitted an unjust enrichment
There are many statutes in which the legislature has made the determination to make certain charges noncompensable and unenforceable — including in the insurance context.
Because Plaintiff has not alleged a benefit conferred and accepted, which would be unjust for Defendants to retain, Plaintiff fails to state a claim for unjust enrichment. Accordingly, Plaintiff's claim for unjust enrichment (Count IV) is DISMISSED WITHOUT PREJUDICE.
Plaintiff lodges a claim for declaratory relief pursuant to 28 U.S.C. § 2201 against Calhoun, Omni, Metropolitan, and Coral Gables. Am. Compl. ¶¶ 169-174. Specifically, State Farm seeks a judgment declaring that any "unpaid charges of the Medical Practice and the Surgical Facilities that have been submitted or are submitted during the pendency of this litigation for services rendered pursuant to the Unlawful Referral Agreement, as alleged herein, are not owed because they are the product of an arrangement prohibited by Florida Statutes §§ 395.0185, 456.054, 817.505, 502.201 et. seq., and 817.234." Id. ¶ 174.
The Florida Supreme Court held that "an insurer may pursue a declaratory action
The Calhoun Defendants argue that the Amended Complaint should be dismissed, pursuant to Federal Rules of Civil Procedure 12(b)(7) and 19, for failure to join indispensable parties — the accident victims with pending claims. First, Calhoun Defendants argue the accident victims are a necessary party because they were "active participants," Calhoun's Motion at 3, 19. Second, Calhoun Defendants contend that the accident victims with pending claims are "parties required to be joined in the action" because "their ability to protect their interests is impeded or impaired if they are not joined in the action...." Calhoun's Motion at 19 (citing Fed. R. Civ. P. 19(a)(1)(B)(i)). Third, Calhoun Defendants appear to argue that the Court cannot "accord complete relief among the existing parties" without joining the accident victims with pending claims. Id. (citing Fed. R. Civ. P. 19(a)(1)(A)).
Dismissal under Rule 12(b)(7) is a "two-step inquiry." Molinos Valle Del Cibao, C. por A. v. Lama, 633 F.3d 1330, 1344 (11th Cir. 2011). First, the party moving to dismiss an action for failure to join an indispensable party must establish the absent party is a "required" party as defined by Federal Rule of Civil Procedure 19(a). Id. The moving party "bears the burden of proof in establishing that the non-party is needed for a just adjudication." Rodriguez v. Niagara Cleaning Servs., Inc., No. 09-22645-CIV, 2010 WL 11505477, at *4 (S.D. Fla. Jan. 11, 2010). "Generally, an absent party is not required simply because its joinder would be convenient to the resolution of the dispute." Clay v. AIG Aerospace Ins. Servs., Inc., 61 F.Supp.3d 1255, 1266 (M.D. Fla. 2014). Instead, an absent party is required where (1) the court cannot accord complete relief among the existing parties; (2) prejudice would result to the absent party's ability to protect itself in the instant action; or (3) the nonparty's absence would create a substantial risk that the existing parties would incur inconsistent or duplicative obligations. Raimbeault v. Accurate Mach. & Tool, LLC, 302 F.R.D. 675, 682-83 (S.D. Fla. 2014); see also City of Marietta v. CSX Transp., Inc., 196 F.3d 1300, 1305 (11th Cir. 1999).
Second, if the court determines that the absent party is required, it "must order that party joined if its joinder is feasible." Raimbeault, 302 F.R.D. at 682; see also Fed. R. Civ. P. 19(a)(2). If for some reason the party cannot be joined, i.e., if joining the party would deprive the court of subject matter jurisdiction, "the court must analyze the factors outlined in Rule 19(b) to determine whether `in equity and good conscience the action should proceed among the parties before it, or should be dismissed, the absent person thus regarded as indispensable.'" Laker Airways, Inc. v. British Airways, PLC, 182 F.3d 843, 847 (11th Cir. 1999) (quoting Fed. R. Civ. P. 19(b)). Conversely, if the court determines the absent party is not required under Rule 19(a), the lawsuit continues. Id.
The Court rejects Calhoun Defendants' argument that the accident victims
The case Calhoun Defendants cite for this argument — Laker Airways Inc., 182 F.3d at 848 — does not support their contention that the accident victims were active participants here. Rather, Laker Airways held that an absent party will be considered a necessary party when it is a "joint tortfeasor" and has actively participated in the allegations made in the complaint. Id. at 848 (citing Haas v. Jefferson National Bank, 442 F.2d 394, 398 (5th Cir. 1971)). For example, in Laker Airways, the missing party in that case was alleged to have "conspired" with one of the defendants and to have played an essential role in the conspiracy. Id. ("[The absent party] is the only entity that can allocate slots at Gatwick Airport. Without [absent party], [Defendant] would not be able to manipulate ... the slot allocation process."). There are no allegations that the accident victims participated in any alleged tortious acts here. In fact, the Amended Complaint expressly alleges that Plaintiff is "unaware of any patient ever being informed of the scheme. See Am. Compl. ¶¶ 102, 105.
Accordingly, the Court does not find that the accident victims are necessary parties under the "active participant" rule articulated in Laker Airways.
The Court also rejects Calhoun Defendants' argument that the accident victims with pending claims are "required to be joined in the action" because "their ability to protect their interests is impeded or impaired if they are not joined" in the action. Calhoun's Motion at 19 (citing Fed. R. Civ. P. 19(a)(1)(B)(i)).
Joinder pursuant to Rule 19 section (a)(1)(B)(i) is "contingent [] upon an initial requirement that the absent party claim a legally protected interest relating to the subject matter of the action." Northrop Corp. v. McDonnell Douglas Corp., 705 F.2d 1030, 1043 (9th Cir. 1983), cert. denied, 464 U.S. 849, 104 S.Ct. 156, 78 L.Ed.2d 144 (1983); see also United States v. Janke, No. 09-14044-CIV, 2009 WL 2525073, at *2 n.1 (S.D. Fla. Aug. 17, 2009) (same).
Here, the accident victims have not claimed a legally protected interest relating to the subject matter of this action. "Quite simply, where the individual insureds do not claim an interest ... [Calhoun Defendants] cannot claim one for them." W. Coast Life Ins. Co. v. Life Brokerage Partners, LLC., No. 08-80897-CIV, 2009 WL 10668605, at *2 (S.D. Fla. Nov. 9, 2009), report and recommendation adopted sub nom. W. Coast Life Ins. Co. v. Life Brokerage Partners, LLC, No. 08-80897, 2010 WL 11504833 (S.D. Fla. Jan. 7, 2010).
Accordingly, Calhoun Defendants cannot invoke the necessary party rule set forth in Rule 19(a)(1)(B). See, e.g., ConnTech Dev. Co. v. Univ. of Connecticut Educ. Properties, Inc., 102 F.3d 677, 683 (2d Cir. 1996) (rejecting Defendant's "self-serving attempts to assert interests on behalf of" absent party).
Finally, the Court rejects Calhoun Defendants' argument that the accident victims are necessary parties under Rule 19(a)(1)(A) because the Court "cannot accord complete relief among existing parties."
Calhoun Defendants have the burden of demonstrating that the accident victims qualify as "necessary" under 19(a)(1). Liberty Mut. Fire Ins. Co. v. Int'l Video Distributors, L.L.C., No. 14-60955-CIV, 2014 WL 11776959, at *3 (S.D. Fla. July 2, 2014). However, in support of their argument, Calhoun Defendants conclusorily cite Rule 19(a)(1)(A) without addressing whether the Court can accord complete relief among existing parties in the absence of the accident victims. Calhoun Defendants, therefore, have not met their burden under this prong of Rule 19. See Combe v. Flocar Inv. Group Corp., 977 F.Supp.2d 1301, 1305 (S.D. Fla. 2013) (finding that the defendants did not meet their burden because they failed to explain why the court could not accord complete relief among the parties).
Moreover, Plaintiff seeks only monetary relief in the remaining claims in this action — Fraud (Count III) and FDUTPA (Counts I and II).
For the foregoing reasons, it is hereby ORDERED AND ADJUDGED that
(1) Defendant Metropolitan's Motion to Dismiss (ECF No. 60) is GRANTED IN PART AND DENIED IN PART;
(2) Calhoun Defendants' Motion to Dismiss (ECF No. 61) is GRANTED IN PART AND DENIED IN PART;
(3) All Counts are DISMISSED WITHOUT PREJUDICE as to Defendants Merovah, Cerceda, and Triana;
(4) Counts IV and V of the Amended Complaint are DISMISSED WITHOUT PREJUDICE.
(6) Plaintiff has 30 days from the date of this order to file an amended complaint curing the deficiencies described above.
DONE AND ORDERED in Chambers at Miami, Florida, this