Grange Mutual Casualty Company v. Joni Mack

290 F. App'x 832
CourtCourt of Appeals for the Sixth Circuit
DecidedAugust 26, 2008
Docket07-6145
StatusUnpublished
Cited by1 cases

This text of 290 F. App'x 832 (Grange Mutual Casualty Company v. Joni Mack) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Grange Mutual Casualty Company v. Joni Mack, 290 F. App'x 832 (6th Cir. 2008).

Opinion

JULIA SMITH GIBBONS, Circuit Judge.

Plaintiffs Grange Mutual Casualty Co., Grange Indemnity Insurance Co., and Trustgard Insurance Co. appeal the district court’s Rule 12(b)(6) dismissal of their civil action under the Racketeer Influenced and Corrupt Organizations Act (“RICO”) against defendant Joni L. Mack. Plaintiffs argue that the district court erred in concluding that plaintiffs could not establish a private cause of action under 18 U.S.C. *833 § 1964(c) against Mack. In light of the Supreme Court’s decision in Bridge v. Phoenix Bond & Indemnity Co., — U.S. -, 128 S.Ct. 2131, 2145, 170 L.Ed.2d 1012 (2008), we vacate the district court’s dismissal and remand for further proceedings.

I.

Plaintiffs allege that Mack joined an ongoing conspiracy that involved fraudulently billing plaintiffs for medical expenditures. Although Mack is the only defendant in this case, plaintiffs initiated a separate civil RICO action on December 4, 2002, against Mack’s husband, Greg S. Mack, and other members of a conspiracy allegedly involving a number of medical rehabilitation centers. 1 In this case, plaintiffs allege that Mack joined the same conspiracy, alluding to the suit filed against Greg Mack.

Plaintiffs’ complaint in this case alleges the following facts, which we accept as true for purposes of reviewing this Rule 12(b)(6) dismissal. See Kottmyer v. Maas, 436 F.3d 684, 688 (6th Cir.2006).

Since at least 1998, Greg Mack and other conspirators

creat[ed] and implement[ed][ ] multiple fraudulent schemes to bill Plaintiffs for medical treatments or supplies that were never rendered or supplied, were medically unnecessary or were billed unlawfully. [In addition, these individuals] caused these fraudulent bills to be submitted to Plaintiffs via the United States mail or interstate wire communications.

The schemes were designed to take advantage of Kentucky’s statutory automobile insurance coverage system — which encourages insurers to promptly pay providers for medical costs associated with automobile accidents — in two ways. First, the conspirators coordinated testing services for physicians, which encouraged the physicians to refer patients for unnecessary testing. Second, the conspirators operated clinics — including the Injury & Rehab Centers of Kentucky, PLLC (“IRC”) — to cater to automobile victims. At IRC clinics, physicians and other employees were directed to routinely order diagnostic tests, regardless of whether the tests were warranted. IRC then overcharged the plaintiff insurance companies by: double-billing; manipulating billing codes to account for supplies; providing unnecessary supplies; and billing services provided by unlicensed staff as if they were provided by licensed medial practitioners. In both facets of the scheme, plaintiffs allege that the conspirators mailed insurance forms misrepresenting the services that the physicians and clinics provided, and that plaintiffs paid numerous bills relying on these misrepresentations.

In approximately January 2003, Mack became an employee of IRC and assumed a position of management and control. With respect to Mack’s role in the conspiracy, plaintiffs allege:

Defendant Mack joined the RICO conspiracy at least by January 2003, and thereafter committed or agreed for others to commit acts in furtherance of the conspiracy as described [above]. In particular, the Defendant Mack personally instructed clinic employees to add physical therapy billings for patients regardless of whether the treatment had been prescribed, performed or supervised by a licensed practitioner, in furtherance of the RICO Conspirators’ schemes to defraud Plaintiffs in violation of 18 U.S.C. §§ 1341 or 1343.
Defendant Mack also caused computers to be removed from IRC clinics, and replaced with machines that did not retain all of the data relating to operation of the clinics before the filing of Grange *834 v. Mack [in December 2002], Defendant Mack personally removed, or directed or caused others to remove, computers from clinics and withheld the computers, or directed or caused others to withhold them, from production during discovery in Grange v. Mack. Finally, Defendant Mack also instructed clinic employees to destroy paper documents relating to the treatment of patients in the clinics. Each of these acts constitutes corruptly altering, destroying, mutilating, or concealing an object with intent to impair the objects’ integrity or availability for use in an official proceeding, in violation of 18 U.S.C. § 1512(b) or (c).

Plaintiffs also attached an exhibit that included three bills submitted by IRC during 2003-04.

Mack did not file an answer to plaintiffs’ complaint. Instead, she filed a motion to dismiss, arguing, inter alia, that plaintiffs could not maintain a civil RICO action against her because they did not rely on any of her acts or the acts of the conspiracy after she had joined it in 2003. Plaintiffs filed a response in which they acknowledged that Mack did not join the conspiracy until January 2003 and that they did not rely upon any fraudulent bills after 2002. But plaintiffs claimed that because Mack joined an ongoing conspiracy, the acts for which she is jointly and severally liable, plaintiffs could pursue a civil RICO claim against her. 2

The district court granted Mack’s motion to dismiss. It concluded that plaintiffs could not pursue an action under 18 U.S.C. § 1964(c) because they had not alleged that Mack’s conduct was the proximate cause of plaintiffs’ injuries.

II.

We review a district court’s dismissal of a plaintiffs complaint for failure to state a claim under Rule 12(b)(6) de novo. Marks v. Newcourt Credit Group, Inc., 342 F.3d 444, 451 (6th Cir.2003). A complaint should not be dismissed under Rule 12(b)(6) “unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” Kottmyer, 436 F.3d at 688 (citation and quotation marks omitted). In considering whether to grant a Rule 12(b)(6) motion, we “accept as true all the allegations contained in the complaint and construe the complaint liberally in favor of the plaintiff.” Id.

III.

Plaintiffs argue that the district court erred by concluding that plaintiffs could not pursue an action under 18 U.S.C. § 1964(c) against Mack because they did not establish proximate cause.

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Bluebook (online)
290 F. App'x 832, Counsel Stack Legal Research, https://law.counselstack.com/opinion/grange-mutual-casualty-company-v-joni-mack-ca6-2008.