New York State Catholic Health Plan, Inc. v. Academy O & P Associates

312 F.R.D. 278, 2015 WL 9267549
CourtDistrict Court, E.D. New York
DecidedDecember 18, 2015
Docket15-CV-3298
StatusPublished
Cited by7 cases

This text of 312 F.R.D. 278 (New York State Catholic Health Plan, Inc. v. Academy O & P Associates) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
New York State Catholic Health Plan, Inc. v. Academy O & P Associates, 312 F.R.D. 278, 2015 WL 9267549 (E.D.N.Y. 2015).

Opinion

MEMORANDUM AND ORDER

JACK B. WEINSTEIN, Senior United States District Judge:

Table of Contents

I. Introduction.. .282

A. Overview.. .282

B. Subject Matter Jurisdiction... 283

II. Factual Allegations.. .283

A. Parties.. .283

1. Plaintiff.. .283

2. Academy Defendants... 284

3. Individual Defendants.. .284

4. Third-Party Defendants Healthflrst and David P. Thomas.. .284

B. Contractual History between Fidelis and Academy.. .285

1. 1995 and 1998 Agreements between Fidelis and Academy Orthotics and Pros-thetics. , .285

2. 2014 Agreement between Fidelis and Academy 0 & P Associates., .285

3. Fidelis’ Termination of 2014 Agreement. . .286

C. Plaintiffs Alegations.. .287

1. Fraudulent Scheme... 287

2. Declaratory Judgment.. .288

3. RICO Claims... 288

4. Common Law Fraud.. .288

5. Unjust Enrichment.. .288

D. Defendants’ Counterclaims and Third-Party Claims.. .288

1. Fidelis Knew that Academy Aways Acted as an IPA.. .288

2. Breach of Contract.. .289

3. Tort Claims... 290

4. Declaratory Judgment... 290

5. Voluntary Dismissal of New York Public Health Law Claim.. .290

III. Procedural History,. .290

A. Motions to Dismiss... 290

B. Defendants’ Motion to Dismiss... 291

1. Claim is for Contract Breach, not Fraud...291

2. RICO Violation Not Plead... 292

3. Particularity Requirements of Rule 9(b)..-293

4. Remaining State Law Claims.. .293

5. Damages.. .293

6. Request to Amend Complaint.. .294

IV. Standard...294

A. Rule 12(b)(6) Failure to State a Claim.. .294

B. Rule 12(b)(1) Lack of Subject Matter Jurisdiction.. .294

C. Rule 12(c) Judgment on Pleadings. . .295

V. Law...295

A. RICO... 295

1. Racketeering Activity Pattern... 295

2. Wire Fraud as “Racketeering Activity”... 296

3. Rule 9(b) Particularity Requirement. . .298

4. Wire Fraud vs. Breach of Contract. . .299

5. Conspiracy.. .299

VI. Application of Law to Facts... 300

A. Plaintiff Failed to Plead RICO Violation. . .300

1. Dispute Contractual,. .300

2. Predicate Acts Not Pled.. .300

3. Conspiracy Claim Fails... 303

VII. State Claims: Supplemental Jurisdiction Denied.. .304

VIII. Leave to Amend Denied., .304

IX. Counterclaims and Third-Party Claims Dismissed.. .304

X. Conclusion.. .304

I. Introduction

A. Overview

Plaintiff relies upon the weak crutch of the Racketeer Influenced and Corrupt Organizations Act (“RICO”) to support a federal civil claim. The RICO statute does not encourage use of the criminal law with treble damages to decide contractual disputes among lawful businesses. There is no support for federal subject matter jurisdiction or a rea[283]*283son to retain state contract claims in this court. The case is dismissed.

Plaintiff New York Catholic Health Plan, doing business as Fidelis (“plaintiff’ or “Fi-delis”), filed a complaint against defendants Academy 0 & P Associates, Academy Or-thotic and Prosthetic Associates IPA, Inc. (“Academy”), Isaac Stein, John Callaghan, Harry Daskel and John Does “1” through “5” on June 5, 2015. See Compl., June 5, 2015, ECF No. 1 (“Compl”).

Fidelis alleges that defendants submitted false claims indicating that Academy was the actual provider of durable medical equipment to Fidelis’ clients when, unbeknownst to plaintiff, Academy was acting as an Independent Practice Association (“IPA”): It was utilizing third-parties within its own network to directly provide the equipment to plaintiffs enrollees. The claim is that plaintiff was injured as a result of the alleged fraudulent scheme; the third-party suppliers were providers that plaintiff would either not have contracted with, or would have contracted with at a lower rate than it did with Academy. There is no dispute between the parties that Fidelis’ enrollees actually needed and received the proper medical equipment.

The claims are cast under RICO, as well as common law fraud and unjust enrichment. The sole basis for this court’s subject matter jurisdiction is plaintiffs allegation of RICO violations. There is no diversity between the parties, and no additional federal claims are being raised.

Together with their answer, defendants asserted counterclaims against Fidelis, as well as third-party claims against David P. Thomas and Healthfirst-related entities — another managed care organization with which Academy contracted for the provision of durable medical equipment. Defendants allege that both Fidelis and Healthfirst knew that Academy was acting as an IPA when the two entities unlawfully terminated their separate contracts with Academy. Defendants argue that the termination was in retaliation for Academy’s “whistleblowing,” which triggered investigations by the United States Attorney’s Office for the Eastern District of New York.

Defendants bring breach of contract and tort claims against Fidelis, Healthfirst and individual defendant Thomas. According to Academy, if the court accepts jurisdiction based on plaintiffs RICO claims, then it has supplemental jurisdiction over its state claims against Fidelis, Healthfirst and Thomas.

B. Subject Matter Jurisdiction

Defendants have moved to dismiss pursuant to Federal Rules of Civil Procedure 9(b), 12(b)(1) and 12(b)(6), or for a judgment on the pleadings pursuant to Rule 12(c). They argue that the court lacks subject matter jurisdiction because plaintiff failed to plead— and cannot prove — a RICO claim, and that this is only a breach of contract dispute.

Defendants’ well-founded motion to dismiss for failure to state a RICO claim is dispositive. The case is dismissed for lack of subject matter jurisdiction.

II. Factual Allegations

A. Parties
1. Plaintiff

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Bluebook (online)
312 F.R.D. 278, 2015 WL 9267549, Counsel Stack Legal Research, https://law.counselstack.com/opinion/new-york-state-catholic-health-plan-inc-v-academy-o-p-associates-nyed-2015.