Allstate Insurance v. Seigel

312 F. Supp. 2d 260, 2004 U.S. Dist. LEXIS 5550, 2004 WL 719190
CourtDistrict Court, D. Connecticut
DecidedMarch 30, 2004
DocketCIV. 3:03CV577 (MRK)
StatusPublished
Cited by18 cases

This text of 312 F. Supp. 2d 260 (Allstate Insurance v. Seigel) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Insurance v. Seigel, 312 F. Supp. 2d 260, 2004 U.S. Dist. LEXIS 5550, 2004 WL 719190 (D. Conn. 2004).

Opinion

MEMORANDUM OF DECISION

KRAVITZ, District Judge.

In this action, Plaintiffs Allstate Insurance Company and Allstate Indemnity Company (collectively, “Allstate”) have sued Dr. Arthur Seigel (“Seigel”), his medical practice, Arthur M. Seigel, P.C. (“Seig-el P.C.”), and his wife, Ellen Seigel, an employee and shareholder of Seigel P.C., for various alleged violations of the Racketeering Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1961, et seq., the Connecticut Unfair and Deceptive Trade Practices Act, Conn. GemStat. (“CUTPA”), § 42-110a, et seq., the Connecticut Health Insurance Fraud Act (“CHIFA”), Conn. Gen.Stat. § 53-442, and common law fraud. Briefly stated, Allstate alleges, among other things, that Seigel and Seigel P.C. created false and fraudulent invoices and medical reports on patients who had been involved in automobile accidents for the purpose of causing insurers such as Allstate to pay for medical treatments that were either never performed or were incompletely performed *CCCIV and/or to pay inflated amounts for the personal injury claims of those patients. This lawsuit follows Seigel’s plea of guilty to, and conviction on, a single count of mail fraud in violation of 18 U.S.C. § 1341.

Presently before the Court is Defendants’ Motion to Dismiss [doc. # 31]. Defendants assert that Allstate’s 98-page, 452 paragraph, seven-count Amended Complaint is defective in a number of respects. Specifically, Defendants contend that: (1) Allstate lacks standing to pursue certain of its RICO claims because Defendants’ predicate acts were not the proximate cause of certain of Allstate’s alleged injuries; (2) certain of Allstate’s claims for damages are too speculative as a matter of law; (3) Allstate’s claim against Seigel under 18 U.S.C. § 1962(a) fails because Allstate has not alleged an “investment injury” as required by § 1962(a); (4) Allstate’s claim against Seigel under 18 U.S.C. § 1962(b) fails because Allstate has not alleged an “acquisition injury” as required by that section; (5) Allstate’s RICO claim against Seigel P.C. is defective because, under 18 U.S.C. § 1962(c), an entity such as Seigel P.C. cannot be both a RICO “person” and the RICO “enterprise”; (5) Allstate’s common law fraud claim does not sufficiently allege causation; and (6) Allstate’s CUPTA claim does not allege a sufficient nexus between Allstate and the defendants. Alternatively, Defendants move for a more definite statement.

For reasons set forth below, the Court GRANTS IN PART and DENIES IN PART Defendants’ Motion to Dismiss [doc. #31] and DENIES Defendants’ Motion for a More Definite Statement [doc.# 31].

I.

On a motion to dismiss, this Court must accept the factual allegations contained in the Amended Complaint [doc. # 59] (“Amended Compl.”) and exhibits attached thereto, 1 and Amended RICO Statement [doc. # 9] as true and draw all reasonable inferences in favor of Allstate. See Conley v. Gibson, 355 U.S. 41, 45-466, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957); see also Taylor v. Vermont Dep’t Of Educ., 313 F.3d 768, 776 (2d Cir.2002) (stating that, on a motion to dismiss, the Court is “generally limited to the facts presented within the four corners of the complaint, to documents attached to the complaint, or documents incorporated within the complaint by reference”). 2 Although the legal issues in this case are complex the facts are relatively straightforward.

At all relevant times, Seigel was a medical doctor, board certified in neurology and licensed to practice in Connecticut. Amended Compl. ¶ 2. Seigel is the principal of Seigel P.C., and he and Ellen Seigel, Seigel’s wife, are the shareholders of Seig-el P.C.’ Id. ¶ 4. The Amended Complaint alleges, and Seigel has stipulated in a plea agreement with the U.S. Attorney, 3 that *CCCV from in or about December 1996 through in or about August 2000, Seigel knowingly and willfully, and with intent to defraud, devised a scheme to defraud certain entities, including Allstate, by obtaining money from these entities through false and fraudulent pretenses and representations. Amended Compl. ¶¶ 57; see Stipulation of Offense Conduct (“Stip.”) [doc. # 1], Ex. at 8.

As part of his practice, Seigel treated a large number of patients who had been involved in automobile accidents and had been referred by attorneys or chiropractors. See Stip. at 8. He examined these patients for any neurological deficits, performed (or claimed to perform) certain tests and evaluated (or claimed to evaluate) the patients’ conditions. Id. Seigel had training in performing a test called needle electromyography (EMG), a test which requires a physician to insert a needle into the patient’s relaxed muscle in the injured area, moving the needle to record muscle activity. Reading the results from a machine connected to the needle, the physician gains information regarding the health of the muscle. Id. During the relevant period, Seigel submitted bills to various insurance providers, including Allstate, for over 7000 EMG procedures, intending that Allstate and the other insurers pay him for performing said procedures. Stip. at 8. However, many of these billings were fraudulent, as Seigel did not perform the EMG test on a significant number of his patients, but still knowingly billed the insurance providers for the tests. Id.

Seigel is also trained to administer Nerve Conduction Study (“NCS”) testing. 4 Amended Compl. ¶43. NCS testing requires the clinician to measure nerve impulses during stimulation and to obtain information regarding the speed and time of nerve impulses. Id. ¶ 45. Since January 1, 1996, to bill for NCS testing in compliance with the American Medical Association’s CPT protocols, the clinician is required to measure and record amplitude information in the completion of a legitimate NCS test. Id. ¶ 48. Allstate alleges that all NCS tests for which Seigel submitted bills under certain current procedural terminology codes were incomplete. Id. ¶50. Furthermore, Allstate alleges that Defendants intentionally authored medical reports that contained conclusions and recommendations that were false and misleading in light of actual test results. Id. ¶¶ 96(3), 97.

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Bluebook (online)
312 F. Supp. 2d 260, 2004 U.S. Dist. LEXIS 5550, 2004 WL 719190, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-v-seigel-ctd-2004.