United States Court of Appeals for the Sixth Circuit; Docket Nos. 97-1821/1832;
Judges Batchelder, Jones, and Ryan; Unanimous; Published
Official Michigan Reporter Citation: 176 F 3d 315; Link to Opinion 
STATUTORY INDEXING:
Providers Entitled to Charge Reasonable Amount for Services [§3157]
Use of Fee Schedules to Determine Reasonable Charges [§3157]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous written Opinion by Judge Batchelder, the Court of Appeals affirmed the opinion of District Judge Robert Holmes Bell, and held that plaintiffs’ complaint did not adequately allege predicate acts constituting “racketeering activity,” or allege that defendants acquired or maintained any interest in or control of an enterprise through racketeering activity, or that plaintiffs suffered injury as a result of defendants' acquiring or maintaining an interest in or control of an enterprise through racketeering activity, and therefore, affirmed the district court's dismissal of plaintiff’s claims of RICO violations in federal district court arising from actions by the defendant insurance companies in using fee schedules to limit payment of medical expense claims in connection with no-fault benefits.
The court held that it was clear that what plaintiffs have sought to cast as RICO violations are in fact disputes over who was entitled to determine what “reasonable” means in the world of health care costs.
