MEMORANDUM AND ORDER
Defendants Eric Hagerbrant (“Hagerbrant”), Imaging Arts Billing Services, Inc. (“Billing Services”), and Imaging *97 Management Services of America, Inc. (“Management Services,” collectively the “Management Company Defendants”), and Metropolitan Radiological Imaging, P.C. (“Metropolitan”) and Herbert Rabiner, M.D. (“Dr. Rabiner”), move, pursuant to Federal Rules of Civil Procedure (“FRCP”) §§ 12(b)(1) and 12(b)(6) to dismiss this action in its entirety, or in the alternative, to limit this action in accordance with N.Y. Civil Procedure Law & Rules (“NYCPLR”) § 213, which places a six year statute of limitations on actions for fraud, or two years from when the fraud should have been discovered.
BACKGROUND
On January 28, 2010, State Farm Mutual Automobile Insurance Company (“Plaintiff’) commenced this action seeking to recover more than two million dollars ($2,000,000) that it alleges to have paid Metropolitan since April 4, 2002. Plaintiff asserts causes of action for common law fraud (second claim for relief), unjust enrichment (third claim for relief), and seeks a declaratory judgment stating that Metropolitan has no right to receive no-fault insurance payments from Plaintiff (first claim for relief).
Plaintiffs claims arise out of payments it has made since April 4, 2002 for radiology services allegedly rendered to Plaintiffs insureds for diagnostic purposes pursuant to New York State’s no-fault insurance system (hereinafter “No Fault” or the “No-Fault Laws”). (Compl. ¶ 1). Plaintiff alleges that Metropolitan was ineligible to receive these payments because it was fraudulently incorporated by Hagerbrant through defendants Billing Services, a purported billing services company, and Management Services, a purported management and consulting services company. (Compl. ¶¶ 9-11, 26, 27). Plaintiff alleges that Dr. Rabiner, a physician licensed to practice medicine in the State of New York who purports to own Metropolitan, allowed Hagerbrant to use his license to fraudulently incorporate Metropolitan and transfer its profits to the Management Company Defendants in violation of New York Business Corporation Law. (Id.). Plaintiff alleges that Dr. Rabiner has never had a true ownership interest in Metropolitan, and that at all times, all decision-making authority relating to the operation and management of Metropolitan rested with the Management Company Defendants. (Compl. ¶ 27, 29). Plaintiff further alleges that Dr. Rabiner and Metropolitan entered into a series of management, marketing, and billing agreements with the Management' Company Defendants that allowed Hagerbrant to exercise illegal control over Metropolitan and siphon away the revenues Metropolitan received from No-Fault insurance payments from Plaintiff (and other insurance companies). (Compl. ¶¶ 27, 31-35).
Plaintiff claims that defendants’ furthered their fraudulent scheme by submitting claims for services performed by independent contractors, who are ineligible to receive such payments under the No-Fault Laws. (Compl. ¶ 42). Metropolitan allegedly misrepresented that the - services billed for were performed by its employees on claim forms it submitted to Plaintiff. (Compl. ¶¶ 42-47). Plaintiff argues that the claim forms were therefore fraudulent and designed to mislead Plaintiff. (Compl. ¶¶ 48, 49).
Defendants moved to dismiss the com.plaint pursuant to FRCP §§ 12(b)(1) and 12(b)(6) on May 10, 2010. In moving to dismiss, defendants argue that 1) the causes of action for a declaratory judgment, fraud, and unjust enrichment were preempted by New York Insurance Law § 5109, which defendants allege statutorily eliminated any private right of action; 2) *98 New York State Insurance Department’s position regarding the eligibility of independent contractors to receive No-Fault benefits is “illogical” and should not be followed; and 3) New York’s Civil Practice Law and Rules § 213 restricts Plaintiffs recovery until January 28, 2004.
STANDARD OF REVIEW
In considering a motion to dismiss a complaint pursuant to FRCP Rule 12(b)(6), for a “failure to state a claim upon which relief may be granted,” the Court must accept the factual allegations in the complaint as true and draw all reasonable inferences in favor of the Plaintiff. Fed.R.Civ.P. 12(b)(1);
Bolt Elec., Inc. v. City of N.Y.,
Conclusory allegations, however, are insufficient to withstand a motion to dismiss.
See Manos v. Geissler,
Similarly, in considering a Rule 12(b)(1) motion to dismiss for lack of subject matter jurisdiction, a court must assume that all of the factual allegations in the complaint are true.
Shipping Fin. Serv. Corp. v. Drakos,
DISCUSSION
I. Overview of New York State’s No Fault Insurance Law
In 1973, the New York State Legislature enacted the Comprehensive Automobile Insurance Reparations Act (the “Act”).
See
N.Y. Ins. Law §§ 5101 et seq. (formerly N.Y. Ins. Law §§ 670 et seq.). The Act instituted a system of no-fault insurance that supplanted common-law tort actions for most victims of automobile accidents.
Medical Soc’y v. Serio,
Under New York’s No-Fault Laws, the insured party is permitted to recover from insurers for “basic economic loss,” including medical expenses, that arise out of the use or operation of an insured vehicle. N.Y. Ins. Law § 5102. Medical expenses are reimbursed based upon a fee schedule which specifies the charges permitted for specific services rendered by particular kinds of providers. Id. at § 5108; 11 N.Y.C.R.R. § 65-3.16. A “provider of health care services” is not eligible for reimbursement “if the provider fails to meet any applicable New York State or local licensing requirement necessary to perform such services in New York or meet any applicable licensing requirement necessary to perform such services in any other state in which such service is performed.” Id. at § 65-3.16(a)(12). 1 This regulation was initially promulgated to take effect on September 1, 2001, but implementation was stayed by court order until April 4, 2002.
Relying on 11 N.Y.C.R.R. § 65-3.16(a)(12), the Court of Appeals in
State Farm Mut. Auto. Ins. Co. v. Mallela,
In 2005, shortly after the Mallela decision, New York State’s Legislature passed an amendment to the No-Fault Laws. The amendment, New York State Insurance Law § 5109, requires the Superintendent of Insurance along with the Commissioner of Health and the Commissioner of Education, to create a process for decertifying certain health care providers and rendering said providers ineligible to request payment under the No-Fault Laws. Ins. Law § 5109 (Consol.2005) (effective August 2, 2005).
II. Plaintiff Has Standing to Pursue Its Claim: § 5109 Does Not Appear to Eliminate Any Private Right of Enforcement
Defendants put forth a rather novel argument that any private right of pros
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ecution inferred from the decision in
Mallela,
was statutorily eliminated by the subsequent passage of New York State Insurance Law § 5109 and that Plaintiff therefore lacks standing to pursue its claims. (Def. Mem. of Law at 18). The Court agrees with defendants that a common law private right of action under the No-Fault Laws was first recognized in
Mallela.
There, the Court of Appeals noted that no cause of action for fraud or unjust enrichment would lie for payments made to fraudulently incorporated providers before 11 N.Y.C.R.R. § 65-3.16(a)(12) went into effect.
Id.
at 322,
However, it is not quite as certain that Insurance Law § 5109 was subsequently enacted to stifle this newly created right. As stated in the bill jacket, the purpose or general idea of the § 5109 was to “require[ ] the Superintendent of Insurance to establish a procedure for decertifying health care providers who engage in deceptive billing or fraudulent practices and making them ineligible to submit bills or claims for payment under the no-fault auto insurance program.” Memorandum in Support of Legislation, reprinted in Bill Jacket, ch. 423 L.2005 New York Legislative Service Inc. The purported justification for such an amendment was that “[providers who work with ‘medical mills’ rarely have their licenses revoked, leaving no effective way to prevent them from continuing to submit fraudulent or excessive bills.” Id. In essence, this regulation appears to provide a streamlined process for the decertification of health care providers who commit No-Fault insurance fraud so that such providers will not be able to continue to submit fraudulent claims. There is nothing in either the statutory language or the legislative history, outside of the proximity of its passage to the decision in Mallela, that would lead one to believe the two are related.
“It has long been recognized that ‘the
no-fault law
is in derogation of the common law and it is a firmly established principle of law that statutes in derogation of the common law are to be strictly construed and the common law is never abrogated by implication. In short, the common law must be held to be no further abrogated than the clear import of the language used in the statute absolutely requires.’ ”
Gersten v. American Transit Ins. Co.,
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Furthermore, since the passage of § 5109 in 2005 there have been a number of affirmative lawsuits for fraud brought by private insurance companies that have not been dismissed for lack of standing.
See, e.g., State Farm Mut. Auto. Ins. Co. v. Grafman,
Judge Amon on March 31, 2006) (“The policy of ensuring prompt payment or denial of claims in exchange for a reduction in the number of litigation claims filed is not served by allowing fraudulent schemes to be perpetrated without recourse to the insurer seeking reimbursement for claims wrongly paid as a result of fraud and deceit”). Neither the defendants nor the courts in any of these cases suggested that § 5109 somehow limited a plaintiffs right to pursue claims for fraud and unjust enrichment under the No-Fault Laws. Defendants have not provided, and this Court has been unable to find, any case to support its theory.
Defendant’s use of
Rocanova v. Equitable Life Assur. Soc. of U.S.,
While the Court agrees with defendants that, like the Workman’s Compensation scheme, 3 only the Superintendent of Insurance is authorized to decertify a profes *102 sional medical corporation, decertification is not at issue here. Defendants appear to have pulled their argument out of thin air and then resorted to fourberie to piece together unrelated case law that purports to support their position, but provides them no real support at all. § 5109 creates a mechanism to decertify fraudulently incorporated practices, relieving insurance companies of the obligation to pay their claims; however, it does not provide a way for insurance companies to recoup funds that have already been paid out as a result of such fraud. Adopting the position defendants advocate would not only fly in the face of established law, it would allow fraudulently incorporated medical practices to continue to be unjustly enriched by their actions. This the Court will not condone.
That Plaintiff seeks a declaratory judgment, in addition to damages, does not change the analysis. New York courts have maintained that insurers have the right to seek a judgment that a medical provider is ineligible to receive No-Fault benefits, even after the passing of § 5109.
See Dynamic Medical Imaging, P.C., as Assignee of Staffa Pasqualino v. State Farm Mut. Auto. Ins. Co.,
To state a claim for a declaratory judgment, a plaintiff must allege that there is a substantial controversy, between the parties having adverse legal interests, of sufficient immediacy and reality to warrant the issuance of a declaratory judgment.
Niagara Mohawk Power Corp. v. Tonawanda Band of Seneca Indians,
Plaintiff also sufficiently alleges a claim of unjust enrichment. Unjust enrichment is an equitable principle, an obligation which the law creates, in the absence of any agreement, when and because acts of the parties or others have placed in the possession of one person money ... under such circumstances that in equity and good conscience he ought not to retain it.
Mfrs. Hanover Trust Co. v. Chem. Bank,
As described above, defendants ignore that, under Mallela and New York law, Plaintiff is not required to pay monies to an improperly licensed professional corporation. By continuing to hold Metropolitan out as something Plaintiff argues its not (a company run by licensed medical professionals), defendants seem to believe they can continue mulcting insurance companies for their No-Fault funds without recourse. In reality, if Plaintiffs allegations are true, it is entitled to recoup any payments made. This unjust enrichment cause of action is thus adequately pled.
In light of the above discussion, defendants’ motion to dismiss Plaintiffs claims for common law fraud, unjust enrichment, and a declaratory judgment against Metropolitan is DENIED.
III. The Court Credits New York State Insurance Department’s Position on the Eligibility of Independent Contractors to Receive No-Fault Benefits
It is well-settled that an administrative agency’s construction and interpretation of its own regulations is entitled to the greatest weight.
Matter of Herzog v. Joy,
11 N.Y.C.R.R § 65-3.11(a) was promulgated by the Department of Insurance, the administrative agency empowered to implement and interpret the No-Fault Laws.
See Ostrer v. Schenck,
IV. Defendant’s Statute of Limitations Argument is Premature
As Plaintiff and defendants correctly note, the statute of limitations for
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a fraud or unjust enrichment claim is six (6) years in New York. N.Y. C.P.L.R. § 213(8) (Consol.2004) (effective Aug. 17, 2004). A cause of action based upon such claims must be brought within six years of the commission of the fraud, or two years from the date the fraud could have been discovered, whichever is later.
Id.
Thus, “[t]he first step in the statute of limitations analysis is to determine when the [plaintiffs] sustained the alleged injury for which they seek redress.”
In re Merrill Lynch Ltd. Partnerships Litigation,
Next, the Court is required to determine when Plaintiff “discovered or should have discovered th[e] injury.”
Bankers Trust Co. v. Rhoades,
In light of Plaintiffs allegations, it is plausible that Plaintiff could not discover defendants’ fraudulent acts until sometime after the actual injury occurred.
See Allstate Ins. Co. v. Ahmed Halima, M.D.,
No. 06-CV-1316,
CONCLUSION
For the foregoing reasons, defendants’ motion is DENIED in its entirety. The parties are directed to contact Magistrate Judge Reyes’s Chambers in order to proceed expeditiously with discovery.
SO ORDERED.
Notes
. New York permits licensed professionals to incorporate if they are the sole organizers, owners and operators of the corporation. See Business Corporation Law ("BCL”) §§ 1503(a),(b), 1508. To incorporate, the licensed individual(s) must obtain a “certificate ... issued by the Department of Education certifying that each of the proposed shareholders, directors and officers is authorized by law to practice a profession which the corporation is being organized to practice.” Id. at § 1503(b). Once the corporation is formed, shareholders may not transfer their voting power to any person who is not a licensed professional in the field. See BCL § 1507. New York law prohibits non-physicians from sharing ownership in medical service corporations. BCL §§ 1507, 1508, and Education Law § 6507(4)(c).
. An issue the Legislature should address given this era of incessant fraud, waste, and abuse.
. Under New York State Workers’ Compensation Law § 13-d, only the Chair of the Worker’s Compensation Board may removed a provider from the list of those eligible to receive worker's compensation benefits.
