SECOND DIVISION
MILLER, P. J.,
RICKMAN and REESE, JJ.
NOTICE: Motions for reconsideration must be
physically received in our clerk’s office within ten
days of the date of decision to be deemed timely filed.
http://www.gaappeals.us/rules
September 20, 2019
In the Court of Appeals of Georgia
A19A0848. CLOUTHIER v. THE MEDICAL CENTER OF
CENTRAL GEORGIA, INC.
MILLER, Presiding Judge.
After Francis Clouthier was involved in a tractor-trailor accident, The Medical
Center of Central Georgia, Inc. (“MCCG”) placed a lien on his causes of action. In
response, Clouthier filed a putative class action against MCCG challenging the lien
and raising numerous claims for damages. Clouthier appeals from the trial court’s
order granting MCCG’s motion to dismiss his complaint, arguing that he pled viable
claims for fraud, negligent misrepresentation, and violations of Georgia’s
Racketeering Influenced and Corrupt Organizations (“RICO”) Act. After a careful
examination of Clouthier’s complaint, we determine that the trial court erred in
dismissing the complaint. Therefore, we reverse.
We review a trial court’s ruling on a motion to dismiss de novo. Roberts v. JP
Morgan Chase Bank, Nat. Assn., 342 Ga. App. 73 (802 SE2d 880) (2017).
A trial court should not grant a motion to dismiss for failure to state a
claim upon which relief may be granted unless: (1) the allegations of the
complaint disclose with certainty that the claimant would not be entitled
to relief under any state of provable facts asserted in support thereof;
and (2) the movant establishes that the claimant could not possibly
introduce evidence within the framework of the complaint sufficient to
warrant a grant of the relief sought. In deciding a motion to dismiss, all
pleadings are to be construed most favorably to the party who filed
them, and all doubts regarding such pleadings must be resolved in the
filing party’s favor. In other words, a motion to dismiss for failure to
state a claim should not be granted unless it appears to a certainty that
the plaintiff would be entitled to no relief under any state of facts which
could be proved in support of his claim.
(Citation omitted.) Ikomoni v. Bank of America, N.A., 330 Ga. App. 776, 776-777
(769 SE2d 527) (2015). We emphasize that we are at the motion-to-dismiss stage,
prior to the completion of discovery, and we are not considering whether Clouthier’s
claims will ultimately prove meritorious or the likelihood that Clouthier will indeed
be able to introduce evidence to support his claims. “If, within the framework of the
complaint, evidence may be introduced which will sustain a grant of relief to the
plaintiff, the complaint is sufficient. (Citation omitted; emphasis supplied.) Id. at 777.
2
Thus, “it is the rare case in which a motion to dismiss for failure to state a claim, as
opposed to a motion for summary judgment, will provide an appropriate procedural
device for securing summary adjudication of the issues raised in a complaint . . . .”
(Citation omitted.) Radio Perry, Inc. v. Cox Communications, Inc., 323 Ga. App. 604,
611 (1) (b) (746 SE2d 670) (2013). Mindful of these principles, we turn to
Clouthier’s complaint.
According to his complaint, Clouthier was injured in a tractor-trailer collision
in August 2016, and an ambulance transported him to MCCG’s emergency room for
treatment. After his discharge from the hospital, MCCG became aware that
Clouthier’s injuries were caused by third parties, and in November 2016, MCCG filed
a hospital lien against Clouthier’s causes of action, in the amount of $56,856.89.
Specifically, the lien affidavit stated that MCCG “claims a lien upon any and all
causes of action accruing to [Clouthier] on account of injuries giving rise to such
causes of action and that necessitated hospital care.” The affidavit also stated that the
lien was claimed “as provided for in the Official Code of Georgia Annotated, Section
44-14-470 et seq.”
Clouthier reached a “confidential” settlement in his collision case
3
and then filed a complaint and petition for class action against MCCG in the Bibb
County State Court. Clouthier alleged that MCCG’s lien and charges were for the
“full chargemaster rate” or “sticker price” of his medical procedures, “which [did] not
represent a reasonable charge for the treatment received.” Clouthier claimed that
MCCG knew that the lien amount was not reasonable, and he raised claims of fraud,
negligent misrepresentation, and violations of the RICO Act.1 Clouthier further
requested punitive damages, an award of attorney fees, and class certification as to
all similarly situated plaintiffs.
MCCG filed a motion to dismiss the complaint for failure to state a claim.
MCCG contended that the Bibb County State Court lacked subject matter jurisdiction
over Clouthier’s complaint because Clouthier’s lawsuit was essentially a request for
equitable relief. MCCG also argued that the lien did not convey any false information.
Following a hearing, the trial court granted MCCG’s motion to dismiss. The
trial court first determined that it had jurisdiction because Clouthier sought an award
of damages. Regarding Clouthier’s claims for fraud, negligent misrepresentation, and
1
Clouthier also raised claims of unjust enrichment, unconscionability, and/or
breach of contract, which the trial court determined were not pleaded as substantive
claims for relief. Clouthier does not raise the dismissal of these claims before this
Court.
4
violations of the RICO Act, the trial court found that they all required a “false
swearing” or “negligent misrepresentation” by MCCG as to the reasonableness of its
charges. The trial court reasoned that the language of the lien affidavit did not show
that MCCG ever swore that the lien amount was reasonable and that MCCG therefore
never made a false statement.2 After the trial court issued a certificate of immediate
review, this Court granted Clouthier’s application for interlocutory appeal, and this
appeal followed.
1. First, Clouthier contends that the trial court erred in dismissing his claims
for fraud and negligent misrepresentation on the basis that MCCG never made a false
statement or negligent misrepresentation. We agree.
“Georgia law gives a hospital a lien for the reasonable charges for its care and
treatment of an injured person against all causes of action accruing to that person on
account of [his] injuries, and establishes a process for the hospital to perfect its lien
for the amount claimed to be due.” Bowden v. Med. Center, Inc., 297 Ga. 285 (773
SE2d 692) (2015). See OCGA § 44-14-470 (b) (explaining that the hospital “shall
have a lien for the reasonable charges”). In order to perfect the lien, the hospital must
2
The trial court noted that the parties still had the opportunity to litigate the
validity and amount of the hospital lien, as MCCG counterclaimed to recover on the
lien.
5
provide written notice to the patient, and must also file “a verified statement” setting
forth “the amount claimed to be due” for the hospital. OCGA § 44-14-471 (a) (1) -
(2).
(a) Turning to Clouthier’s fraud claim, “fraud requires five essential elements:
a false representation, scienter, inducement, reliance, and injury resulting from
reliance on the false representation.” (Citation and punctuation omitted.) Cox v. Bank
of America, N. A., 321 Ga. App. 806, 807 (2) (742 SE2d 147) (2013). “Fraud, though,
does not have to be committed solely by wil[l]ful misrepresentation.” E-Z Serve
Convenience Stores, Inc. v. Crowell, 244 Ga. App. 43, 46 (1) (b) (535 SE2d 16)
(2000). By its very nature, fraud “is subtle and can be accomplished in an infinite
number of ways including signs and tricks and even, in some instances, by silence.”
(Citation omitted.) Id. See Woodall v. Orkin Exterminating Co., 175 Ga. App. 83, 84
(332 SE2d 173) (1985) (explaining that it is “impossible to state any general rule by
which particular frauds are to be identified” because fraud is “exceedingly subtle” in
nature and “almost, if not quite, impossible” to classify). Indeed, fraud may be
consummated by “any . . . unfair way used to cheat another.” (Emphasis supplied.)
OCGA § 23-2-56. Further, even “slight circumstances may be sufficient to carry
conviction of [fraud’s] existence.” (Citation omitted.) Fed. Ins. Co. v. Westside
6
Supply Co., 264 Ga. App. 240, 242 (1) (590 SE2d 224) (2003). Thus, MCCG need
not have overtly and falsely sworn that its claimed lien amount was reasonable in
order for Clouthier to have pleaded a fraud claim, and the trial court erred in ruling
otherwise.
As explained above, MCCG is only allowed a hospital lien for “reasonable
charges,” but MCCG stated in the lien affidavit that its lien was claimed “as provided
for” in the hospital lien statutes. Clouthier alleged that MCCG filed a lien using the
hospital lien statutes knowing that the claimed amount of the lien was excessive and
unreasonable and that MCCG did so with the intent to collect more than a reasonable
charge for the services rendered to Clouthier. Conceivably, evidence may be
introduced that MCCG did the above while knowing that it would not actually be able
to recover on the lien in the amount claimed and also knowing that Clouthier cannot
freely spend the settlement money while the lien is in effect.3 Accordingly, the
complaint sufficiently stated a claim for fraud.4
3
Indeed, MCCG acknowledges that there would be “legal repercussions” if
Clouthier were to spend the settlement money without paying MCCG.
4
MCCG argues that, in the end, it will only be able to enforce a lien for
reasonable charges, and there was no fraud in claiming a lien amount that reflected
the chargemaster rates. This argument does not aid MCCG’s position because it only
points to the crux of Clouthier’s complaint — that MCCG placed the lien on his tort
7
We reject MCCG’s contention that any representation that the lien amount was
reasonable was merely an expression of opinion, which cannot serve as a basis for
fraud. This Court has held that
redress for fraud may also be had where, there being no particular
confidential relation, reliance is placed on the speaker on account of his
special knowledge and the hearer’s ignorance, as where the speaker is
an expert with respect to the transaction involved and the hearer is not;
and in such cases the hearer may without further investigation rely on
the speaker’s statements even where they might otherwise be deemed
mere expressions of opinion . . . or assertions of . . . value. To come
within this rule it is not . . . necessary that the fact misrepresented should
have been exclusively within the speaker’s knowledge.
(Citation omitted; emphasis supplied.) Tri-E. Petroleum Corp. v. Glenn’s Super Gas,
Inc., 178 Ga. App. 144, 146 (342 SE2d 346) (1986).
Clouthier alleged that MCCG collects and accepts as full payment an average
of approximately 29 percent of the chargemaster rates. According to the complaint,
Clouthier only discovered this information through MCCG’s reports for the period
of October 1, 2015 to September 20, 2016. Clouthier also alleged that a law firm
contacted MCCG on his behalf in August 2017, requesting that MCCG provide an
action(s) in the amount of the chargemaster rates in an effort to collect more than
would ultimately be allowed under statute.
8
amount it would accept as full reimbursement for the services he received, had these
services been billed to Medicare or BlueCross/Blueshield. According to the
complaint, however, MCCG refused to provide any information to the law office to
help determine a reasonable charge for Clouthier’s medical bills, and MCCG did not
disclose to Clouthier that it only collected approximately 29 percent of the
chargemaster rates from nearly all of its other patients. Thus, there may be evidence
that MCCG regularly conducts business in medical billing and had specialized
knowledge of which Clouthier was ignorant — i.e., the average amount that would
have been billed for his treatment if he had been insured — and that Clouthier relied
on MCCG’s knowledge.
In light of the exceedingly subtle nature of fraud, “it cannot be said as a matter
of law that it appears beyond doubt that [Clouthier] will not be able to prove” facts
that would entitle him to relief on his fraud claim. Holloway v. Dougherty County
School System, 157 Ga. App. 251, 255 (277 SE2d 251) (1981). Thus, the trial court
erred in granting MCCG’s motion to dismiss as to the fraud claim.
(b) Clouthier’s negligent misrepresentation claim also survives MCCG’s
motion to dismiss. The essential elements of negligent misrepresentation are “(1) the
defendant’s negligent supply of false information to foreseeable persons, known or
9
unknown; (2) such persons’ reasonable reliance upon that false information; and (3)
economic injury proximately resulting from such reliance.” J. E. Black Const. Co. v.
Ferguson Enterprises, Inc., 284 Ga. App. 345, 348 (643 SE2d 852) (2007). Notably,
“the same principles apply to both fraud and negligent misrepresentation cases and
. . . the only real distinction between negligent misrepresentation and fraud is the
absence of the element of knowledge of the falsity of the information disclosed.”
(Citation and punctuation omitted.) Holmes v. Grubman, 286 Ga. 636, 640-641 (1)
(691 SE2d 196) (2010).
Here, Clouthier claimed that MCCG filed liens in amounts that were excessive
of a reasonable charge for the care and treatment rendered, that MCCG failed to
exercise reasonable care in doing so, and that it was foreseeable that Clouthier would
receive and rely on the lien and the statements in the lien. Given our conclusion in
Division (1) (a), we determine that Clouthier’s negligent misrepresentation claim also
withstands MCCG’s motion to dismiss.
Although MCCG complains that Clouthier did not plead any economic loss as
part of his fraud and negligent misrepresentation claims, “[c]omplaints do not have
to allege facts sufficient to set forth a cause of action and . . . it is no longer necessary
for a complaint to set forth all of the elements of a cause of action in order to survive
10
a motion to dismiss for failure to state a claim.” (Citations omitted.) Scott v. Scott,
311 Ga. App. 726, 729 (1) (716 SE2d 809) (2011). See also Holloway, supra, 157 Ga.
App. at 255 (“[T]he objective of the [Civil Practice Act] is to avoid technicalities and
to require only a short and plain statement of the claim that will give the defendant
fair notice of what the claim is and a general indication of the type of litigation
involved; the discovery process bears the burden of filling in details.”) (citation
omitted).
In his complaint, Clouthier alleged that he was damaged by MCCG’s purported
fraud and negligent representation. Within the framework of his complaint, Clouthier
may be able to introduce evidence that he incurred actual damages and economic loss
as a result of MCCG’s lien on his settlement funds; the possibility that this evidence
exists is sufficient for pleading purposes. See Austin v. Clark, 294 Ga. 773, 775 (755
SE2d 796) (2014) (“At this stage in the litigation, it does not matter that the existence
of [the supporting evidence] is unlikely.”); Marshall v. McIntosh County, 327 Ga.
App. 416, 423 (3) (b) (759 SE2d 269) (2014) (“[I]n light of the minimal requirements
of notice pleading, broad and conclusory allegations are not fatal to a plaintiff’s claim
11
at the motion-to-dismiss stage.”) (citation and punctuation omitted).5 Thus, we
reverse the trial court’s dismissal of Clouthier’s claims for fraud and negligent
misrepresentation.
(c) Next, we determine that the trial court also erred in dismissing Clouthier’s
RICO claim. Even assuming that MCCG did not make a false statement in its lien
affidavit, a careful examination of Clouthier’s complaint reveals that he stated a claim
for relief under Georgia’s RICO Act.
The Act provides:
(a) It shall be unlawful for any person, through a pattern of racketeering
activity or proceeds derived therefrom, to acquire or maintain, directly
or indirectly, any interest in or control of any enterprise, real property,
or personal property of any nature, including money.
...
(c) It shall be unlawful for any person to conspire or endeavor to violate
any of the provisions of subsection (a) . . . of this Code section.
5
For these reasons, we are also unpersuaded by MCCG’s argument that
Clouthier’s claims fail because he did not plead additional elements of fraud and
negligent misrepresentation.
12
(Emphases supplied.) OCGA § 16-14-4.6 Theft by deception, or even an attempt
thereof, may constitute racketeering activity. OCGA § 16-14-3 (5) (A) (xii). And, “[a]
person commits the offense of theft by deception when he obtains property by any
deceitful means or artful practice with the intention of depriving the owner of the
property.” OCGA § 16-8-3 (a). Such deception includes
(1) Creat[ing] or confirm[ing] another’s impression of an existing fact
or past event which is false and which the accused knows or believes to
be false; [and]
(2) Fail[ing] to correct a false impression of an existing fact or past
event which he has previously created or confirmed[.]
OCGA § 16-8-3 (a) (b) (1) - (3).
Here, Clouthier alleged that, in furtherance of violating OCGA § 16-14-4 (a),
MCCG attempted to commit theft by deception. Specifically, Clouthier claimed that
6
“[A] corporation is a ‘person’ for purposes of the Georgia civil RICO Act.”
Williams Gen. Corp. v. Stone, 280 Ga. 631 (632 SE2d 376) (2006). We also note that
“a violation of OCGA § 16-14-4 (a) does not require that there be proof of an
‘enterprise,’ but only that the accused through a pattern of racketeering activity or
proceeds derived therefrom, acquire or maintain, directly or indirectly, any . . . real
property or personal property of any nature, including money.” (Citation and
punctuation omitted.) Cobb County v. Jones Group P.L.C., 218 Ga. App. 149, 152-
153 (2) (460 SE2d 516) (1995).
13
MCCG has a practice of filing sworn liens for the chargemaster rates, that he and
other putative class members had no knowledge of this scheme or any reason to
believe that MCCG would file liens for far more than the reasonable rates for the
services rendered, and that MCCG did not disclose to them that it only collected
approximately 29 percent of the chargemaster rates from nearly all of its other
patients. Clouthier also claimed that when he asked MCCG to reduce its lien to a
reasonable amount, MCCG said that it would reduce the lien by 10 percent for
immediate payment, and then reduced the lien to $45,485.51.
Clouthier may introduce evidence that, in order to gain a greater percentage of
his tort recovery, MCCG either created or confirmed the false impression that it had
claimed a lien amount that was commensurate with the amounts billed to most of its
other patients, even though MCCG knew this to be untrue. Alternatively, there may
be evidence that MCCG created or confirmed such a false impression and then failed
to correct it. Also, evidence may be introduced that MCCG did the same with other
14
patients, all in an attempted theft by deception.7 Thus, we conclude that Clouthier
sufficiently stated a claim for a violation of Georgia’s RICO Act.8
In sum, it does not appear to a legal certainty that Clouthier would be entitled
to no relief under any state of facts which could be proved in support of his claims,
and therefore we reverse the trial court’s dismissal of the complaint.
Judgment reversed. Rickman and Reese, JJ., concur.
7
In Medical Center, Inc. v. Bowden, 348 Ga. App. 165, 185-186 (3) (a) (820
SE2d 289) (2018) (physical precedent only), this Court held that the hospital
defendant was entitled to summary judgment on the plaintiff’s RICO violations claim
because, “[a]ssuming [the hospital’s] lien amounts were unreasonable, such does not
render the practice of filing liens, as permitted by statute, one of the RICO predicate
offenses.” Insofar as that holding can be read to apply here in the context of a motion
to dismiss, we note that that decision was non-binding physical precedent and the
Court did not undertake the specific analysis set forth in this case. See Court of
Appeals Rule 33.2 (a) (1). Thus, we are not compelled to reach a different result
based on the holding in Bowden, supra, 348 Ga. App. at 185-186 (3) (a).
8
As amici curiae, the Georgia Hospital Association and the Georgia Alliance
of Community Hospitals argue that we should nevertheless affirm the dismissal of
Clouthier’s claims because they are based on an alleged violation of the lien statutes,
and such a violation does not give rise to a private cause of action. As MCCG
concedes, however, Clouthier did not purport to sue for a violation of the lien statutes
themselves.
15