United States District Court, S.D. Florida, Miami Division
GOVERNMENT EMPLOYEES INSURANCE CO., GEICO INDEMNITY CO., GEICO GENERAL INSURANCE COMPANY, and GEICO CASUALTY CO., Plaintiffs,
BENEFICA HEALTH CENTER, CORP., CARLOS CAMILO PEREZ, M.D., OTTO EL CORO, MERCEDES N. ALONSO, and AGUSTIN DE CARDENAS SANCHEZ, Defendants.
ORDER DENYING DEFENDANTS' MOTION FOR MORE
FEDERICO A. MORENO UNITED STATES DISTRICT JUDGE
case, GEICO alleges that Benefica Health Center Corporation
submitted a massive amount of no-fault billing to GEICO that
falsely represented it was operating in compliance with the
licensing requirements of the Florida Health Care Clinic Act,
and was therefore eligible to collect insurance benefits.
Indeed, GEICO alleges that Benefica is not eligible to
receive reimbursement for its claims because it does not
have, nor did it have, a legitimate medical director as
defined by the Act. The seven-count amended complaint first
seeks a declaratory judgment declaring that Benefica has no
right to receive payment for about $150, 000 in pending bills
submitted to GEICO. The remaining six counts against the
various defendants allege violations of RICO and the Florida
Deceptive and Unfair Trade Practices Act, statutory insurance
fraud, common law insurance fraud, and unjust enrichment for
about $2.9 million of insurance claims that GEICO already
paid. Essentially, GEICO alleges that Benefica pervasively
billed for medically unnecessary and illusory services,
misrepresented the identities of the actual service
providers, and concealed that it was unlawfully billing GEICO
for physical therapy services that were performed by
unlicensed and unsupervised massage therapists.
original complaint was filed on January 12, 2017.
Defendants' answer was originally due February 8, 2017,
but this Court extended the deadline to March 27, 2017. On
that day, Defendants filed their first motion for a more
definite statement. Before this Court ruled on that motion,
Plaintiffs filed an amended complaint. Defendants then filed
this second motion for a more definite statement.
party may move for a more definite statement of a pleading..
.which is so vague or ambiguous that the party cannot
reasonably prepare a response." Fed.R.Civ.P. 12(e).
"Federal Rule of Civil Procedure 8(a)(2) requires only
'a short and plain statement of the claim showing the
pleader is entitled to relief, ' in order to 'give
the defendant fair notice of what the.. .claim is and the
grounds upon which it rests." Bell Atl. Corp., v.
Twombly, 550 U.S. 544, 555 (2007) (quoting Conley v.
Gibson, 355 U.S. 41, 47 (1957)). "The purpose of
the pleading standards under [Federal Rule of Civil
Procedure] 8 is to strike at unintelligibility rather than
want of detail and allegations that are unclear due to a lack
of specificity are more appropriately clarified by discovery
rather than by an order for a more definite statement."
Icon Health & Fitness, Inc., v. IFITNESS, Inc.,
No. 12-20125, 2012 U.S. Dist. LEXIS 46824, at *18 (S.D. Fla.
Apr. 3, 2012) (Moreno, J.) (internal quotations and citations
for more definite statement are disfavored in the federal
system, due to liberal discovery practices." Scouten
v. NCL (Bahamas) Ltd., No. 08-21485, 2009 U.S. Dist.
LEXIS 132535, at *10 (S.D. Fla. Mar. 3, 2009) (Moreno, J.).
"Because pleadings give notice and discovery provides
the intricacies of the issues and evidence for trial, a
[R]ule 12(e) motion will be granted only if the pleading is
so vague or ambiguous that the opposing party cannot respond
in good faith or without prejudice to himself."
Int'l Aero. Grp., Corp. v. Evans Meridian, Ltd.,
No. 16-24997, 2017 U.S. Dist. LEXIS 26189, at *14-15 (S.D.
Fla. Feb. 23, 2017) (King, J.) (internal quotations and
argue that GEICO has failed to "identify with
specificity": (1) the more than $150, 000 in outstanding
and unpaid Benefica billing; and (2) the specific allegedly
fraudulent charges submitted that GEICO already paid.
Further, Defendants argue that GEICO should be required to
identify the patient(s) associated with each claim because
only then can Defendants identify the discrete claims at
issue and determine whether there are any abstention or
statute of limitations defenses.
arguments fail. There are a number of reasons to believe that
the amended complaint provides more than adequate information
at this stage of the dispute. First, it is implausible that
Defendants do not know which claims have been paid by GEICO
and which were not. Even if Defendants truly do not know,
they will learn during discovery. Second, the amended
complaint provides a large representative example-tens of
thousands of claims spanning 814 pages-of alleged fraudulent
claims identified to date, each including the date of the
underlying accident, the type of service allegedly provided,
the date on which services were provided, the approximate
date on which the claim was mailed to GEICO, the amount of
the claim, and the exact claim number used by Defendants.
Armed with this extensive information, it seems implausible
that Defendants are "unable to identify the pending
claims at issue" without the identities of the patients.
amended complaint provides more than adequate information for
Defendants to respond in good faith. Defendants are on clear
notice of their alleged fraudulent conduct as the amended
complaint alleges, inter alia, that Benefica was
unlawfully operating without a legitimate medical director;
that the putative health care services billed through
Benefica were fraudulent; and that Defendants illegally
billed GEICO for services. The amended complaint is not
unintelligible. To the contrary, although it does not specify
all allegedly fraudulent reimbursement claims, it provides
thousands of examples, each containing Benefica's claim
number, the date received, CPT code, and purported date of
service. To the extent any allegations are unclear due to a
lack of specificity, they are more appropriately clarified by
on the foregoing, it is hereby
AND ADJUDGED that Defendants' Motion for More Definite
Statement is DENIED. Defendants shall file a response to