Government Employees Insurance Company v. Barron Chiropractic & Rehabilitation, P.C.
1:16-cv-10642
D. Mass.Aug 16, 2017Background
- GEICO sued Barron Chiropractic and individual chiropractors alleging a systematic scheme to submit false or inflated Massachusetts PIP medical claims, including up‑coding, fabricated patient complaints, billing for services by unlicensed staff, and billing for in‑office care that should have been home care.
- Complaint included 12 detailed exemplar claims and an exhibit listing roughly 181 total claims; GEICO relied on patient testimony (examinations under oath) and other investigation to support allegations.
- GEICO asserted state-law claims: common-law fraud, civil conspiracy, money had and received (unjust enrichment), Mass. Gen. Laws ch. 93A, breach of contract, and tortious interference; sought damages, fees, and injunctive relief.
- Barron moved to dismiss under Massachusetts Anti‑SLAPP statute and under Fed. R. Civ. P. 12(b)(6); raised additional defenses including abstention (Colorado River), preemption by the PIP scheme, statute of limitations, Rule 9(b) pleading defects, lack of standing to enforce regulations, and that GEICO had adequate legal remedies.
- Court denied the Anti‑SLAPP motion (saying GEICO’s claims target fraudulent conduct, not protected petitioning) and granted the 12(b)(6) motion in part: dismissing Counts II (conspiracy), III (money had and received), V (breach of contract), and VI (tortious interference); denying dismissal as to Counts I (fraud) and IV (Chapter 93A). GEICO may move to amend on conspiracy and interference counts.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Applicability of Anti‑SLAPP statute | Barron argued earlier PIP lawsuits against GEICO are protected petitioning; this suit targets those suits | GEICO: claims arise from fraudulent billing underlying the suits, not from petitioning | Denied — court: complaint targets fraudulent conduct, not petitioning activity alone |
| Sufficiency of fraud pleading (Rule 9(b)) | GEICO pleaded scheme plus 12 detailed exemplars and exhibit listing claims; systemic fraud justifies less granular detail | Barron: must plead each fraudulent bill with particularity; many allegations are opinion/medical judgment | Denied as to fraud and 93A — court: scheme + exemplars satisfy Rule 9(b) for systemic fraud claims |
| Abstention / Preemption / Statute of limitations | GEICO: federal suit proper; discovery rule tolled limitations; PIP statute doesn’t preempt common‑law claims | Barron: Colorado River abstention warranted; PIP scheme preempts remedies; claims time‑barred based on 2010 investigations | Abstention denied; preemption rejected (statute does not foreclose fraud claims); statute of limitations not resolved at MTD stage (discovery rule may apply) |
| Contractual and equitable claims (breach, money had & received, interference, conspiracy) | GEICO: may assert contract‑based and equitable remedies and interference/conspiracy tied to fraud scheme | Barron: no contract with GEICO under §34M; equitable remedies unavailable with adequate legal remedies; conspiracy/interference pleadings insufficient under 9(b) | Dismissed Counts III, V, II, VI (money had & received, breach of contract, conspiracy, tortious interference); plaintiff may amend conspiracy and interference allegations |
Key Cases Cited
- Blanchard v. Steward Carney Hosp., Inc., 75 N.E.3d 21 (Mass. 2017) (anti‑SLAPP two‑step burden and petitioning activity analysis)
- Universal Health Servs., Inc. v. United States, 136 S. Ct. 1989 (2016) (conditions of payment and fraudulent coding can form basis for false‑claims style liability)
- Columbia Chiropractic Grp., Inc. v. Trust Ins. Co., 712 N.E.2d 93 (Mass. 1999) (insurer may bring Chapter 93A claim based on excessive/unreasonable chiropractic billing)
- Keystone Freight Corp. v. Bartlett Consol., Inc., 930 N.E.2d 744 (Mass. App. Ct. 2010) (claims grounded in billing misconduct, not litigation activity, are not SLAPP suits)
- KPS & Assocs., Inc. v. Designs By FMC, Inc., 318 F.3d 1 (1st Cir. 2003) (factors for Colorado River abstention analysis)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (pleading must be plausible; not merely conclusory)