Liberty Mutual Fire Insurance Company v. Maple Manor Neuro Center Inc.

District Court, E.D. Michigan·Decided September 20, 2022·No. 2:20-cv-13170·Unknown

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION

LIBERTY MUTUAL FIRE INSURANCE COMPANY, LM GENERAL INSURANCE COMPANY, and SAFECO INSURANCE COMPANY OF ILLINOIS

Plaintiffs/Counter-Defendants, Civil Case No. 20-13170 v. Honorable Linda V. Parker

MAPLE MANOR NEURO CENTER INC., STELLA EVANGELISTA, and JOSE L. EVANGELISTA,

Defendants/Counter-Plaintiffs.

________________________________/

OPINION AND ORDER GRANTING PLAINTIFFS’ MOTION TO DISMISS (ECF NO. 31) AND DENYING DEFENDANTS’ MOTION TO AMEND (ECF NO. 33) AND MOTION TO ADD PARTIES (ECF NO. 34)

This dispute arises from no-fault insurance benefits that Plaintiffs/Counter- Defendants (collectively, “Liberty Mutual”) paid to Defendants/Counter-Plaintiffs (hereafter collectively, “Maple Manor”) for the treatment of its insureds pursuant to Michigan’s No-Fault Act. Liberty Mutual is an insurance company providing no-fault insurance coverage in Michigan. Defendants/Counter-Plaintiffs Stella Evangelista and Jose Evangelista own Maple Manor Neuro Center Inc. (“Neuro Center”). On December 2, 2020, Liberty Mutual filed a Complaint alleging that Maple Manor engaged in a scheme to submit false and fraudulent medical records, bills, and invoices through interstate wires, which sought payment for treatment

and services from an unlicensed healthcare provider. (ECF No. 1.) Liberty Mutual alleges that Maple Manor’s conduct violates the federal Racketeer Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1962(c) and (d), and state law.

On January 10, 2022, this Court denied Maple Manor’s motion to dismiss and held that Liberty Mutual had sufficiently pleaded its claims. (ECF No. 23.) Shortly thereafter, Maple Manor filed an Answer to the Complaint and Counterclaim alleging claims of (1) breach of contract (Count I), (2) declaratory

judgment (Count II), and (3) abuse of process (Count III). (ECF Nos. 24, 25 (“corrected”).) On February 4, 2020, Liberty Mutual filed a motion to dismiss Maple Manor’s counterclaim, which the Court dismissed as moot because Maple

Manor filed a First Amended Answer and Counterclaim as a matter of course, under Federal Rule of Civil Procedure 15(a)(1). (ECF No. 30.) In the First Amended Counterclaim, Maple Manor alleges claims of (1) breach of contract (Count I), (2) unjust enrichment (Count II), and (3) abuse of process (Count III).

(Id.) The matter is presently before the Court on Liberty Mutual’s motion to dismiss Maple Manor’s First Amended Counterclaim pursuant to Federal Rule of

Civil Procedure 12(b)(6). (ECF No. 31.) The motion is fully briefed. (ECF Nos. 32, 35.) Further, Maple Manor filed a motion to amend its counterclaim (ECF No. 33) and a “Motion to Add and/or Amend Parties and/or for Intervention of

Necessary Parties” (ECF No. 34), which Liberty Mutual has responded to (ECF Nos. 36, 37). Maple Manor also filed a reply brief supporting its motion to amend its counterclaims. (ECF No. 38.) Finding the facts and legal arguments

sufficiently presented in the parties’ briefs, the Court is dispensing with oral argument pursuant to Eastern District of Michigan Local Rule 7.1(f). Motion to Dismiss I. Standard for Rule 12(b)(6) Motion

A motion to dismiss pursuant to Rule 12(b)(6) tests the legal sufficiency of the complaint. RMI Titanium Co. v. Westinghouse Elec. Corp., 78 F.3d 1125, 1134 (6th Cir. 1996). Under Federal Rule of Civil Procedure 8(a)(2), a pleading must

contain a “short and plain statement of the claim showing that the pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2). To survive a motion to dismiss, a complaint need not contain “detailed factual allegations,” but it must contain more than “labels and conclusions” or “a formulaic recitation of the elements of a cause

of action . . ..” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007). A complaint does not “suffice if it tenders ‘naked assertions’ devoid of ‘further factual enhancement.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting

Twombly, 550 U.S. at 557). As the Supreme Court provided in Iqbal and Twombly, “[t]o survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as

true, to ‘state a claim to relief that is plausible on its face.’” Id. (quoting Twombly, 550 U.S. at 570). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is

liable for the misconduct alleged.” Id. (citing Twombly, 550 U.S. at 556). The plausibility standard “does not impose a probability requirement at the pleading stage; it simply calls for enough facts to raise a reasonable expectation that discovery will reveal evidence of illegal [conduct].” Twombly, 550 U.S. at 556.

In deciding whether the plaintiff has set forth a “plausible” claim, the court must accept the factual allegations in the complaint as true. Erickson v. Pardus, 551 U.S. 89, 94 (2007). This presumption is not applicable to legal conclusions,

however. Iqbal, 556 U.S. at 668. Therefore, “[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Id. (citing Twombly, 550 U.S. at 555). II. Factual Background

Liberty Mutual is an insurance company authorized to conduct business in Michigan. (ECF No. 30 ¶¶ 2-5, at Pg ID 655.) Neuro Center, as an unlicensed billing agent, billed Liberty Mutual for treatment on behalf of the licensed medical

providers, Maple Manor Rehab Center of Novi Inc. and Maple Manor Rehabilitation Center LLC (“Maple Manor Provider Entities”). (Id. ¶ 1.) Nuero Center has no employees and does not render care or treatment to patients. (Id.)

The Maple Manor Provider Entities are licensed skilled nursing facilities doing business in Michigan. (Id. ¶ 8, at Pg ID 656.) “Maple Manor Provider Entities provided care and treatment to patients in

the ordinary course in exchange for payment from [Liberty Mutual].” (Id. ¶ 8, at Pg ID 656.)1 That was done “in direct and substantial reliance upon the fact that the Insurance Company Counter-Defendants would continue to make payments in exchange for the services provided to the patients.” (Id. ¶ 11.) On November 13,

2020, Liberty Mutual requested via a demand email to “claw back” amounts paid for rendered care and treatment of patients. (Id. ¶ 13, at Pg ID 658.) The patients who had been in vehicle accidents “were statutorily and contractually entitled to

recover no-fault personal protection insurance benefits from the [Liberty Mutual], pursuant to the provisions of the No-Fault Act, including ‘allowable expense’ benefits as defined in [Mich. Comp. Laws] §3107(1)(a) consisting of ‘all

1 ¶ 10 of the First Amended Counterclaim “intentionally omits” an allegation. (ECF No. 30 at Pg ID 657.) This is also done in ¶ 45 of First Amended Counterclaim. (ECF No.

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Liberty Mutual Fire Insurance Company v. Maple Manor Neuro Center Inc., (E.D. Mich. 2022).

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