X hits on this document

60 views

0 shares

0 downloads

0 comments

8 / 20

who participate in their scheme, (id. ¶ 20); and (5) submit reimbursement requests to State Farm

that are inflated artificially by the costs of the unnecessary and/or unperformed medical

procedures, (id. ¶¶ 24-28). Finally, State Farm contends that counterclaim-defendants acted

knowingly and with the intent to induce5 State Farm to reimburse them for the unnecessary

and/or unperformed procedures. (Id. ¶¶ 12, 25, 36.) Accepting these allegations to be true, as I

must for purposes of this motion, these allegations sufficiently demonstrate the framework of a

scheme to commit insurance fraud. An alleged framework, however, is not enough to make out,

with particularity, a claim for fraud. Rather, to satisfy Rule 9(b), State Farm must make

allegations as to the misrepresentation(s) that counterclaim-defendants allegedly “uttered.”

The remaining Rule 9(b) issue, then, concerns the purported fraudulent

misrepresentation(s). See Lum, 361 F.3d at 224 (requiring plaintiff to plead the “general content”

of the misrepresentation itself). Although State Farm adequately sketches the alleged scheme, I

find that State Farm is far less precise in pleading the fraudulent misrepresentation(s) on which

its fraud claim is premised. This much is clear: State Farm avers that the fraudulent

misrepresentations appeared in the reimbursement requests “and/or” other similar documents it

received from counterclaim-defendants. (Countercl. ¶¶ 24-28.) The court, however, is only

able to discern the “general content” of the misrepresentation(s) with respect to those

reimbursement requests listed in paragraphs nineteen or twenty-five or both of State Farm’s

counterclaim. Paragraph nineteen states in part:

[T]he following persons for whose treatment bills were submitted by Allied to [State Farm] did not receive the treatment documented in the records and bills

5 “Malice, intent, knowledge, and other conditions of a person’s mind may be alleged generally.” Fed. R. Civ. Pro. 9(b).

8

Document info
Document views60
Page views60
Page last viewedSat Dec 03 20:22:50 UTC 2016
Pages20
Paragraphs418
Words5403

Comments