Opinion
18-P-1153
09-23-2019
Juliet PENNINGTON-MATTE v. STEWARD HEALTH CARE SYSTEM, LLC & others.
MEMORANDUM AND ORDER PURSUANT TO RULE 1:28
The plaintiff, Juliet Pennington-Matte, brought this action against her medical provider system, Steward Health Care System, LLC (Steward), and Steward's medical records handler, Sharecare Health Data Services, LLC (Sharecare) (collectively, the defendants), seeking declaratory relief and damages pursuant to G. L. c. 93A, based on the defendants' alleged failure to timely produce her medical records for a fair and reasonable fee in violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and G. L. c. 111, § 70E, the patient's bill of rights statute. Darviris v. Petros, 59 Mass. App. Ct. 323, 330, 795 N.E.2d 1196 (2003). The defendants successfully moved to dismiss the complaint pursuant to Mass. R. Civ. P. 12 (b) (6), 365 Mass. 754 (1974). For the reasons that follow, the judgment dismissing Pennington-Matte's complaint is vacated.
During the timeframe pertinent to Pennington-Matte's complaint, Sharecare was known as Bactes Imaging Solutions, LLC. We refer to Sharecare by its current name.
Sharecare's parent company, Sharecare, Inc., also is a named defendant.
1. Background. We summarize the facts contained in the complaint and the attached exhibits. Between 2013 and 2017, Pennington-Matte was a patient at various hospitals and healthcare facilities operated by Steward. On numerous occasions during that time period, Pennington-Matte requested electronic copies of her medical records. Sharecare fulfilled medical records requests on behalf of Steward, and was responsible for responding to Pennington-Matte's requests. Pennington-Matte alleged in her complaint that Sharecare did not always provide the records she requested and some of the records she received were not timely produced. She further alleged that she was consistently overcharged for the copies Sharecare sent to her or to her attorney. According to Pennington-Matte, she was forced to hire an attorney to obtain the requested records and address the overcharges and, as a result, she incurred legal fees and expenses to protect her rights under HIPPA and G. L. c. 111, § 70E.
HIPAA regulations, see 45 C.F.R. 164.524(a)(1) and (c)(4) (2014), and G. L. c. 111, § 70E, both provide patients with the right to inspect and obtain copies of their medical records and further, limit the fees that may be charged to a patient for furnishing those records.
According to the complaint, Pennington-Matte's attorney sent two letters to the defendants regarding her requests for medical records. The first letter was sent on July 3, 2015, and the second letter was sent on November 28, 2016. Initially, the defendants promised to void the charges, but according to Pennington-Matte, they failed to do so and instead continued to overcharge Pennington-Matte when she submitted subsequent requests for medical records. Pennington-Matte's attorney then sent a third letter to the defendants on October 23, 2017, indicating that Pennington-Matte was making a written demand for relief pursuant to G. L. c. 93A. Sharecare responded to this third and final letter by again promising to void the charges.
Shortly thereafter, Pennington-Matte brought this action. She claimed that the defendants' billing practices were unfair and deceptive in violation G. L. c. 93A and, as we have noted, that she incurred legal fees and expenses in her attempt to obtain the records in a timely manner without paying more than what the law required. Sharecare filed a motion to dismiss, which Steward joined, claiming that Pennington-Matte had not alleged an injury. They argued that because Pennington-Matte did not actually pay the overcharges, which Sharecare claims to have voided, Pennington-Matte had not suffered any harm, a necessary element of a claim under G. L. c. 93A, § 9. The defendants also argued that Pennington-Matte was not entitled to declaratory relief because there was no actual controversy between the parties.
See Auto Flat Car Crushers, Inc. v. Hanover Ins. Co., 469 Mass. 813, 823, 17 N.E.3d 1066 (2014) ("plaintiffs proceeding under either § 9 or § 11 of G. L. c. 93A are obligated to allege and ultimately to prove a ‘distinct injury’ ").
2. Discussion. "In ruling on a motion to dismiss a complaint we must assume as true the allegations contained in the ... complaint and accompanying [exhibits]" (quotation and citation omitted). 285 Lynn Shore Drive Condominium Trust v. Automatic Sprinkler Appeals Bd., 47 Mass. App. Ct. 437, 440, 713 N.E.2d 1014 (1999). "To survive a motion to dismiss, the facts alleged and the reasonable inferences drawn therefrom must ‘plausibly suggest ... an entitlement to relief.’ " Coghlin Elec. Contrs., Inc. v. Gilbane Bldg. Co., 472 Mass. 549, 554, 36 N.E.3d 505 (2015), quoting Flagg v. Alimed, Inc., 466 Mass. 23, 26-27, 992 N.E.2d 354 (2013). "A court may grant the radical relief of dismissal only if the plaintiff can set forth no set of facts which would entitle her to relief." Coraccio v. Lowell Five Cents Sav. Bank, 415 Mass. 145, 147, 612 N.E.2d 650 (1993). We review the allowance of the defendants' motion to dismiss de novo. Coghlin Elec. Contrs., Inc., supra at 553, 36 N.E.3d 505.
a. G. L. c. 93A. The primary question on appeal is whether Pennington-Matte has alleged a cognizable injury under G. L. c. 93A. She claims that she has, and points to the legal fees and expenses she incurred in obtaining her medical records and disputing the amounts charged. The defendants argue that attorney's fees are not recoverable as damages under G. L. c. 93A, and that Pennington-Matte thus needed to allege some other injury. But, as we recently explained in Montanez v. 178 Lowell St. Operating Co., LLC, 95 Mass. App. Ct. 699, 703, 129 N.E.3d 885 (2019), if a c. 93A violation forces an individual to incur legal fees and expenses that are not simply those incurred in vindicating that person's rights under the statute, those fees may be treated as actual damages. In Montanez, we held that because the plaintiff who hired an attorney to obtain medical records pursuant to certain Federal regulations sought to vindicate her rights under those regulations, and not under G. L. c. 93A, the plaintiff's attorney's fees could be treated as actual damages in the same way as other losses of money or property are treated as damages under c. 93A. Id. The circumstances presented here are similar to those present in Montanez, and therefore we are constrained to reach the same result. See McLaughlin v. American States Ins. Co., 90 Mass. App. Ct. 22, 33, 55 N.E.3d 1007 (2016) ; Siegel v. Berkshire Life Ins. Co., 64 Mass. App. Ct. 698, 703, 835 N.E.2d 288 (2005). See also Columbia Chiropractic Group, Inc. v. Trust Ins. Co., 430 Mass. 60, 63, 712 N.E.2d 93 (1999) (legal expenses paid to defend against "unreasonable or unnecessary medical bills" were recoverable as damages under G. L. c. 93A).
Here, the complaint alleged that Sharecare did not produce certain of the requested records, delayed producing some records, and overcharged Pennington-Matte for the records that were produced. In order to obtain complete copies of her records and determine the proper amount she owed for the copies, Pennington-Matte hired an attorney to contact the defendants and intervene on her behalf. Assuming these allegations to be true, Pennington-Matte was defending against improper claims for payment and vindicating her rights under HIPAA and G. L. c. 111, § 70E, not vindicating her rights under G. L. c. 93A. See Montanez, 95 Mass. App. Ct. at 703, 129 N.E.3d 885. See also Columbia Chiropractic Group, Inc., 430 Mass. at 63, 712 N.E.2d 93. Thus, should Pennington-Matte prevail, the legal fees and expenses she incurred would amount to actual damages. "Costs like these incurred as a result of the underlying violative conduct are recoverable as damages." Montanez, supra.
We take no view on whether Pennington-Matte will be successful beyond the preliminary stage of demonstrating that her complaint stated a cause of action.
b. Declaratory relief. We next turn to Pennington-Matte's request for declaratory relief and the defendants' arguments regarding the lack of an actual controversy and standing. The defendants' sole ground in support of their position is their unsubstantiated claim that the bills they sent to Pennington-Matte have been voided. This contention, however, contradicts the allegations in Pennington-Matte's complaint, which control at this stage. See 285 Lynn Shore Drive Condominium Trust, 47 Mass. App. Ct. at 440, 713 N.E.2d 1014. Pennington-Matte has alleged that at the time she filed her complaint, several of the requested records had not been produced and the defendants continued to send her invoices and reminders for fees. These allegations are sufficient to present an actual controversy and confer standing. See Carlton Hotel, Inc. v. Abrams, 322 Mass. 201, 202-203, 76 N.E.2d 666 (1948) (dispute regarding amount owed presented actual controversy).
In light of our conclusion, we need not address Pennington-Matte's claim that she should have been permitted to amend her complaint. Nor is it necessary to address any alleged discovery violations which Pennington-Matte claims occurred when the case was transferred to the business litigation section.
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Judgment vacated.