Government of Bermuda v. Lahey Clinic, Inc.

CourtDistrict Court, D. Massachusetts
DecidedMarch 8, 2018
Docket1:17-cv-10242
StatusUnknown

This text of Government of Bermuda v. Lahey Clinic, Inc. (Government of Bermuda v. Lahey Clinic, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Government of Bermuda v. Lahey Clinic, Inc., (D. Mass. 2018).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS

GOVERNMENT OF BERMUDA, * * Plaintiff, * * v. * Civil Action No. 17-cv-10242-IT * LAHEY CLINIC, INC., et al., * * Defendants. *

MEMORANDUM AND ORDER March 8, 2018 TALWANI, D.J. The Government of Bermuda (“Bermuda”) brings a federal claim under the Racketeer Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1961 et seq., and state claims under Massachusetts General Laws c. 93A, § 11, and common law theories of conspiracy, fraud, and unjust enrichment against Defendants Lahey Clinic, Inc., and Lahey Clinic Hospital, Inc. (collectively, “Lahey”). Before the court is Lahey’s Motion to Dismiss the Plaintiff’s Complaint Pursuant to Fed. R. Civ. P. 12(b)(6) and 9(b) [#16]. For the reasons set forth below, Lahey’s motion is ALLOWED. I. Standard of Review A motion under Rule 12(b)(6) of the Federal Rules of Civil Procedure to dismiss a complaint for failure to state a claim upon which relief can be granted is properly allowed when the complaint does not contain “sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atlantic Corp. v. Twombly, 550 U.S. 554, 570 (2007)). Considering the complaint in the light most favorable to the plaintiff, see Germanowski v. Harris, 854 F.3d 68, 71 (1st Cir. 2017), the court will “determine whether the factual allegations are sufficient to support the reasonable inference that the defendant is liable.” Saldivar v. Racine, 818 F.3d 14, 18 (1st Cir. 2016) (quoting Cardigan Mtn. Sch. v. N.H. Ins. Co., 787 F.3d 82, 84 (1st Cir. 2015)). II. Allegations in the Complaint

This case involves an alleged conspiracy between Lahey and Dr. Ewart Brown (“Brown”). Brown is the former Premier of Bermuda, a longstanding Member of Bermuda’s Parliament, and the owner of two private health clinics in Bermuda. Compl. ¶ 8 [#1]. Bermuda alleges that Lahey paid Brown bribes disguised as “consulting fees,” gave him discounts on medical equipment and services, and made political donations to his campaign, in return for which Brown ensured Lahey: 1) “made millions of dollars reading and interpreting medically unnecessary MRI and CT scans performed at Brown’s clinics”; 2) “received preferential treatment when bidding on healthcare contracts issued by the Bermudian Government”; and 3) “obtained privileged access to Bermudian patients that it could service at its facilities in Massachusetts and in Bermuda.” Id. ¶ 1; see also ¶¶ 9, 31, 45. The Complaint describes these

three distinct schemes are as follows. A. Scanning Scheme In the “scanning scheme,” Lahey and Brown allegedly conspired to conduct medically unnecessary scans at Brown’s two on-island clinics (the “Brown Clinics”) for profit. Pursuant to exclusive contracts between Lahey and the Brown Clinics, Lahey interpreted imaging results forwarded electronically from the Brown Clinics in Bermuda to Lahey in Massachusetts and sent electronic reports back to the Brown Clinics for a fee. Compl. ¶¶ 70-71. Brown allegedly paid this fee out of the money he received from insurers after submitting claims for reimbursement. Id. ¶ 70. Lahey also assisted with certain scans performed at the Brown Clinics from its campus in Massachusetts “by giving specific instructions on how to carry out the scan including where the patient should be positioned.” Id. ¶ 82. Brown allegedly induced patient referrals for diagnostic scanning at the Brown Clinics “by offering paid kickbacks, which he dubbed ‘commissions,’ ranging from between 5% to 17.5% of reimbursements to local physicians.” Id.

¶ 92. As a direct result of this scheme, the Brown Clinics allegedly conducted and Lahey interpreted “thousands of medically unnecessary tests” at Bermuda’s expense. Id. ¶ 70. Bermuda paid Brown for these tests when he submitted claims for reimbursement to Bermuda public insurers; Brown in turn paid Lahey’s fees. Id.1 Bermuda alleges Lahey “must have known” these tests were unnecessary “for several years,” due to the fact that Bermuda was conducting scans “at a rate disproportionate to like nations.” Id. ¶ 81. The Complaint alleges a secondary effect of the scanning scheme, namely that “MRI and CT scanning on the island increased exponentially,” causing Bermudian insurance rates to increase. Id. ¶ 70. In Bermuda, insurers are required to provide each insured a minimum package

of medical benefits called Standard Health Benefits. Id. ¶ 83. The government subsidizes payment of Standard Health Benefit “claims” for certain Bermudians. Id. ¶ 84. Each year, the Ministry of Health, Seniors and Environment determines a Standard Premium Rate for the Standard Health Benefits based on the claims experience of all insured participants. Id. ¶ 85. The Complaint alleges that “[i]n part as a result of [the scanning scheme] . . . the Standard Premium Rate for the Standard Health Benefits package provided to each Bermudian citizen more than

1 The Complaint further alleges that Brown “pushed for deep discounts” on the scanning services, which “Lahey willingly granted,” enabling him to keep a larger portion of the reimbursement he received from the Bermudian Government. Compl. ¶ 73. Lahey also allegedly provided Brown with significant extensions on overdue bills. Id. ¶ 74. doubled between Fiscal Year 2007 ($140.92) and Fiscal Year 2016 ($338.07).” Id. ¶ 86. Insured Bermudians paid higher premiums, and Bermuda provided higher subsidies. Id. ¶ 85. Brown allegedly influenced this increase further by “constantly appl[ying] pressure to government officials to increase remuneration for tests undertaken by the Brown Clinics and read by Lahey,

notwithstanding their already high price tag.” Id. ¶ 90. B. Bidding Scheme In the second alleged scheme, Lahey secured several lucrative subcontracts over other healthcare service providers as a result of its relationship with Brown. The Complaint describes subcontracts for two specific projects. The first project was a $13.5 million, five-year contract to develop a long-term healthcare strategy for the island and “revamp” Bermuda’s state-run hospital, King Edward Memorial Hospital (“KEMH”). Brown allegedly “used his role as Premier” to facilitate a meeting between Lahey and the Bermuda Minister of Health to discuss Lahey’s involvement in the “new” hospital. Compl. ¶ 50. Brown then secured the KEMH contract for a U.S.-based healthcare

management and consulting company known as Kurron Shares of America, Inc. (“Kurron America”). Brown allegedly controlled Kurron America through his relationship with its owner, a former business associate, and used this control to facilitate a subcontract on the project with Lahey. Id.2 The second project involved an annual $1.3 million contract with a separate company, Kurron Bermuda, to develop “FutureCare,” a Bermudian public insurance plan for citizens over 65. Id. ¶ 59. Brown allegedly used his “influence and connections to ensure that Lahey was

2 Bermuda allegedly terminated its contract with Kurron America in 2011 because it was “mired in scandal due to high payments to health consultants.” Id. ¶ 52. favored over other potential U.S.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Sedima, S. P. R. L. v. Imrex Co.
473 U.S. 479 (Supreme Court, 1985)
Carnegie-Mellon University v. Cohill
484 U.S. 343 (Supreme Court, 1988)
National Organization for Women, Inc. v. Scheidler
510 U.S. 249 (Supreme Court, 1994)
Bell Atlantic Corp. v. Twombly
550 U.S. 544 (Supreme Court, 2007)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
Skilling v. United States
561 U.S. 358 (Supreme Court, 2010)
Morrison v. National Australia Bank Ltd.
561 U.S. 247 (Supreme Court, 2010)
World Wrestling Entertainment, Inc. v. Jakks Pacific, Inc.
530 F. Supp. 2d 486 (S.D. New York, 2007)
Schaick v. Church of Scientology of California, Inc.
535 F. Supp. 1125 (D. Massachusetts, 1982)
Saldivar v. Racine
818 F.3d 14 (First Circuit, 2016)
Germanowski v. Harris
854 F.3d 68 (First Circuit, 2017)
Wilber v. Curtis
872 F.3d 15 (First Circuit, 2017)
Jorge Yarur Bascuñán v. Daniel Yarur Elsaca
874 F.3d 806 (Second Circuit, 2017)
Elsevier, Inc. v. Grossman
199 F. Supp. 3d 768 (S.D. New York, 2016)
Tatung Co. v. Shu Tze Hsu
217 F. Supp. 3d 1138 (C.D. California, 2016)
Cevdet Aksüt Oğullari Koll. Sti v. Cavusoglu
245 F. Supp. 3d 650 (D. New Jersey, 2017)
RJR Nabisco, Inc. v. European Cmty.
579 U.S. 325 (Supreme Court, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
Government of Bermuda v. Lahey Clinic, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/government-of-bermuda-v-lahey-clinic-inc-mad-2018.