Gocha et al v. Michigan Reproductive and IVF Center, P.C. et al

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION
VICKTORIA GOCHA, et al.,
Plaintiffs,
v.
MICHIGAN REPRODUCTIVE AND IVF
CENTER, P.C., et al.,
Defendants.
___________________________________/
Case No. 1:25-cv-665
Hon. Hala Y. Jarbou
OPINION
Plaintiffs 	Vicktoria 	and 	Alan 	Gocha 	sought 	fertility 	treatment 	at 	the 	Michigan
Reproductive and IVF Center, P.C. (the “Clinic”). 	After several failed attempts to achieve
intrauterine insemination (“IUI”), and several rounds of attempted in vitro fertilization (“IVF”)
that produced only one fertilized embryo, Plaintiffs raised concerns to the Clinic about its methods.
About a week later, the Clinic told Plaintiffs it was terminating their physician-patient relationship.
This lawsuit followed. Plaintiffs sue the Clinic and three of its employees: Dr. Valerie Shavell,
Dr. Emma Giuliani, and Dawn Stiles. 	Plaintiffs also sue Corewell Health, a healthcare
organization that is allegedly affiliated with the Clinic. Defendants have filed motions to dismiss.
For the reasons herein, the Court will grant the motions and dismiss the case.
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I. BACKGROUND
A. Plaintiffs’ Allegations
1. Initial Treatment
According to the complaint, Vicktoria started treatment at the Clinic in April 2022 due to
a diagnosis of “diminished ovarian reserve” (“DOR”). (3d Am. Compl. ¶¶ 1, 60, ECF No. 89.)
She underwent “multiple IUIs,” without success, until December 2023. (Id. ¶ 60.)
2. IVF Treatment
In July 2024, Vicktoria returned to the Clinic with Alan, her husband, to pursue IVF. Alan
submitted a semen sample that month. 	The following day, the sample results available on the
Clinic’s patient portal listed “azoospermia” and an infection, but the Clinic did not contact Alan
about the results or treat him for these diagnoses. (Id. ¶ 63.) Alan submitted another sample the
following month. Analysis of the second sample showed “normal parameters.” (Id. ¶ 64.)
Vicktoria underwent three rounds of IVF, beginning on March 26, 2025, April 23, 2025,
and May 30, 2025, respectively. (Id. ¶ 65.) Dr. Shavell managed these rounds “with involvement”
by Dr. Giuliani and Stiles, the Clinic’s “practice administrator.” (Id. ¶¶ 6, 66.) Plaintiffs allege
that “[p]rotocols varied materially across rounds without clinical explanation.” 	(Id. ¶ 69.)
Medication that was used in some rounds was not used in others. 	(Id.) 	The timing of the
medication in relation to the cycle also varied. (Id. ¶¶ 69-70.) And some hormone levels were
never measured during the rounds, while other hormones were measured only “sporadic[ally].”
(Id. ¶¶ 67-68, 71-72.)
(a) Round 1
During the first round Dr. Shavell initially recommended use of 300 IU of Follistism, a
follicle-stimulation drug, but then increased the recommended dosage after learning that Vicktoria
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“had previously used a higher dose.” (Id. ¶ 14.) This round produced “seven follicles, two mature
oocytes, and one fertilized embryo”; the embryo was frozen for future implantation. (Id. ¶ 98.)
(b) Round 2
The second round “used a different [hormone] stimulation/suppression approach.” 	(Id.
¶ 77.) 	When Plaintiffs questioned the “early” use of one particular drug, Dr. Shavell told them
that it “addressed elevated FSH,” 1 yet no FSH had been tested. 	(Id.) 	Plaintiffs allege that this
round was “functionally futile” because there were no “mid-stimulation adjustments” in
medication and there was a “lack of response and monitoring.” (Id. ¶ 106.) After the second round
failed, Plaintiffs asked for “written justification for protocol deviations and monitoring gaps.” (Id.
¶ 78.) The Clinic “did not provide a substantive explanation.” (Id.)
On May 2, 2025, Plaintiffs asked about the possibility of a frozen embryo transfer, but
Stiles told them that Bundl, a “financial concierge service” Plaintiffs had contracted with to cover
their fertility care, would not authorize a “second retrieval.” 	(Id. ¶¶ 19, 108-109.) 	When Alan
“referenced the Bundl materials,” the exchange “escalated.” 	(Id. ¶ 109.) 	Stiles allegedly told
Plaintiffs to “get out,” followed them into the hallway, and shouted “get a lawyer.” (Id.) After
that point, “routine access to nurses and staff was curtailed, and communications were funneled to
Dr. Shavell, who was often unavailable.” (Id.) Around that time, Stiles allegedly entered a “hidden
chart note,” “flagging that sharing the note could lead to ‘physical harm.’” (Id. ¶ 112.)
Plaintiffs contacted Bundl directly, which authorized a second retrieval, contrary to Stiles’s
statement.
1 FSH refers to follicle-stimulating hormone. (3d Am. Compl. ¶ 16.)
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(c) Round 3
The third round started on May 30, 2025. (Id. ¶ 113.) It employed a different approach;
this time, there was “no suppression, despite prior assertions that suppression was necessary.” (Id.
¶ 79.) And one particular drug was used earlier in the cycle. (Id.) On June 4, a physician at the
Clinic recommended stopping that round due to “poor [estradiol] response,” but Dr. Shavell
“overrode” that recommendation “while at a conference and without chart access.” 	(Id. ¶¶ 80,
115.) 	The Clinic terminated that round two days later, after an ultrasound “confirmed failure.”
(Id. ¶ 116.) 	Plaintiffs allege that the Clinic failed to “adjust medication dosages mid-cycle in
response to labs or ultrasound findings.” (Id. ¶ 82.) And as with the second round, the third round
“included departures from prior plans/protocols without documented rationale.” (Id. ¶ 117.)
The Clinic presented Plaintiffs with paperwork that was “pre-filled” to authorize transfer
of a single embryo, even though Plaintiffs had “stated a willingness” to transfer more than one
embryo “if medically appropriate.” (Id. ¶ 122.) When Alan “flagged [this] discrepancy” on the
paperwork, staff told Plaintiffs to “just sign it,” calling it a “formality.” (Id.)
3. Termination of Treatment
Beginning June 4, 2025, Plaintiffs sent “detailed” messages to staff at the Clinic, “raising
evidence-based concerns about protocol deviations, inconsistent medication sequencing, and the
lack of FSH/LH2 monitoring, and requested written clarification before proceeding.” (Id. ¶ 123.)
Plaintiffs cited “internal notes” indicating that other physicians at the Clinic had recommended
repeating the protocol from the first round, yet the Clinic had changed the protocol without
explanation. (Id. ¶ 124.) The following day, Dr. Giuliani responded that written answers would
require rescheduling their June 9 appointment. 	(Id. ¶ 125.) 	On June 6, Vicktoria sent another
2 LH is luteinizing hormone.
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message asking for written responses. 	On June 8, Plaintiffs again asked about changes in the
sequencing of medication. 	On June 9, Dr. Shavell responded that the protocols used were
“deliberate and individualized” and that she would confer with her colleagues. (Id. ¶ 128.)
On June 10, Alan “noted shifting rationales unmoored from data” and “flagged” that
“elevated FSH” had been used as a justification for early use of a medication in one round even
though FSH had not been tested. (Id. ¶ 129.) In a message to the Clinic, he explained “why LH
monitoring is important in high-dose/off-label cycles” and he asked for confirmation that further
cycles would “include baseline and mid-cycle” monitoring of various hormones. (Id. ¶ 130.)
On June 11, Dr. Shavell canceled a June 12 appointment in order to “review history.” (Id.
¶ 131.) 	Later that day, Alan asked for “administrative review” due to “clinical inconsistencies,
off-label/high-dose use without justification, absent hormone monitoring, rescheduling following
accountability requests, and lack of independent review due to Dr. Shavell’s dual role.” (Id. ¶ 132.)
The following day, Plaintiffs received a letter signed by Stiles stating that the Clinic was
terminating the physician-patient relationship and “imposing a 90-day deadline to transfer”
Plaintiffs’ embryo to another lab. (Id. ¶ 133; see Termination Letter, ECF No. 1-1.) The letter
cited Plaintiffs’ “tone and lack of trust.” (Id. ¶ 134.) The Clinic also ended Plaintiffs’ ability to
use the patient portal for communications with the Clinic.
On June 13, Stiles allegedly entered an internal note “flagging” Alan as “dangerous” and
asserting that “foul language” and “threatening tone[s]” required the note to be withheld from the
patient in order to “prevent harm of [sic] the patient or another person.” 	(Id. ¶ 136.) 	Plaintiffs
claim this note was false.
That same day, Alan emailed Corewell and a billing staffer at the Clinic, complaining about
lack of access to the patient portal and the termination of treatment “during a critical fertility
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window”; he noted Vicktoria’s “disability status” and requested “accommodation” under the
Americans with Disabilities Act (ADA) in the form of “immediate referral and coordinated
records.” (Id. ¶ 139.) Plaintiffs apparently believed that the Clinic was affiliated with Corewell
because Plaintiffs’ appointment confirmations, eCheck-ins, test result notices, billing statements,
and patient surveys related to services received from the Clinic were all branded with the Corewell
name. (Id. ¶ 185.) Also, Corewell’s website listed physicians at the Clinic as being affiliated with
Corewell hospitals. (Id.) However, Corewell responded to Alan’s complaint by stating that the
Clinic was not part of Corewell; the clinic was “outside Corewell’s jurisdiction.” (Id. ¶ 140.)
B. Plaintiffs’ Claims
Based on the foregoing, Plaintiffs assert a total of 17 claims arising under federal or state
law. The federal claims include the following: Count I, violations of the Racketeer Influenced and
Corrupt Organizations Act (RICO), 18 U.S.C. § 1962; Count II, a RICO conspiracy, 18 U.S.C.
§ 1962(d); Count IV, violation of the ADA, 42 U.S.C. § 12181 et seq.; Count V, violation of the
Rehabilitation Act (RA), 29 U.S.C. § 794; and Count VII, violation of the Affordable Care Act
(ACA), 42 U.S.C. § 18116.
The state law claims include the following: Count III, violation of the Michigan Racketeer
Influenced and Corrupt Organizations Act (MRICO), Mich. Comp. Laws § 750.159g; Count VI,
violation of the Michigan Persons with Disabilities Civil Rights Act (PDCRA), Mich. Comp. Laws
§ 37.1101 et seq.; Count VIII, violation of the Elliott-Larsen Civil Rights Act (ELCRA), Mich.
Comp. Laws § 37.2101 et seq.; Count IX, violation of the Michigan Consumer Protection Act
(MCPA), Mich. Comp. Laws § 445.901 et seq.; Count X, fraud, silent fraud, negligent
misrepresentation, fraudulent inducement and/or fraudulent concealment; Count XI, intentional
and/or negligent infliction of emotional distress; Count XII, unjust enrichment and/or quantum
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meruit; Count XIII, promissory estoppel; Count XIV, battery; Count XV, breach of fiduciary duty;
Count XVI, medical malpractice; and Count XVII, civil conspiracy.
Defendants seek dismissal of the federal claims for failure to state a claim. Defendants ask
the Court to decline supplemental jurisdiction over the claims arising under state law.
II. STANDARD
A plaintiff’s complaint must make a “short and plain statement of the claim showing that
the pleader is entitled to relief.” 	Fed. R. Civ. P. 8(a). 	The statement must contain “sufficient
factual matter, accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v.
Iqbal, 556 U.S. 662, 678 (2009). While “[t]he plausibility standard . . . is not akin to a probability
requirement . . . it asks for more than a sheer possibility” that the alleged misconduct occurred. Id.
“Specific facts are not necessary; the statement need only give the defendant fair notice of what
the . . . claim is and the grounds upon which it rests.” Erickson v. Pardus, 551 U.S. 89, 93 (2007)
(quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)).
When considering a motion to dismiss under Rule 12(b)(6), courts “construe the complaint
in the light most favorable to the plaintiff, accepting all well-pleaded factual allegations as true.”
Parrino v. Price, 869 F.3d 392, 397 (6th Cir. 2017). The Court need not accept “threadbare recitals
of the elements of a cause of action, supported by mere conclusory statements,” Iqbal, 556 U.S. at
678, or a “formulaic recitation of the elements of a cause of action,” Twombly, 550 U.S. at 555.
The Court is generally bound to consider only the complaint when resolving a motion to
dismiss under Rule 12(b)(6) unless the Court converts the motion to one for summary judgment.
Wysocki v. IBM Corp., 607 F.3d 1102, 1104 (6th Cir. 2010). 	“However, a court may consider
exhibits attached to the complaint, public records, items appearing in the record of the case, and
exhibits attached to defendant’s motion to dismiss, so long as they are referred to in the complaint
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and are central to the claims contained therein, without converting the motion to one for summary
judgment.” Gavitt v. Born, 835 F.3d 623, 640 (6th Cir. 2016) (internal citations omitted).
III. ANALYSIS – FEDERAL CLAIMS
A. RICO (Count I)
Plaintiffs allege that the Clinic, Shavell, Giuliani, Stiles, and Corewell were engaged in a
common enterprise “to extract fertility payments through misrepresentations, concealment of
clinical deviations, coercive leverage over embryos, and retaliation against patients who
questioned care.” (3d Am. Compl. ¶ 191.) Plaintiffs claim that Defendants’ pattern of conduct in
furtherance of this enterprise gives rise to a RICO claim. RICO provides a civil cause of action to
“[a]ny person injured in his business or property by reason of a violation of section 1962.” 18
U.S.C. § 1964(c).
“[T]o state a civil RICO claim, a plaintiff must allege (1) two or more predicate
racketeering offenses, (2) the existence of an enterprise affecting interstate commerce, (3) a
connection between the racketeering offenses and the enterprise, and (4) injury by reason of the
above.” 	Grow Mich., LLC v. LT Lender, LLC, 50 F.4th 587, 594 (6th Cir. 2022). 	The last
element—suffering injury “by reason of” the defendant’s racketeering—is a “demanding”
requirement. 	Id. 	It requires a plaintiff to show that “the defendant’s racketeering offense ‘led
directly to the plaintiff’s injuries.’” Id. (quoting Anza v. Ideal Steel Supply Corp., 547 U.S. 451,
461 (2006)). 	In other words, a plaintiff “must show ‘that the defendant’s violation was both a
factual and proximate cause of his injury.’” Id. (quoting Gen. Motors, LLC v. FCA US, LLC, 44
F.4th 548, 559 (6th Cir. 2022)).
Among other things, Defendants argue that the complaint fails to allege with specificity
any racketeering activity. 	“The RICO statute sets forth an exhaustive list of “racketeering
activit[ies].” 	Nolt v. Knowles, No. 24-5872, 2025 WL 2748006, at *2 (6th Cir. June 20, 2025)
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(quoting 18 U.S.C. § 1961(1)). 	Plaintiffs apparently contend that Defendants’ racketeering
activity involved “mail and wire fraud, health care fraud, and extortion.” (3d Am. Compl. ¶ 196.)
In their briefing, Plaintiffs add that their complaint also supports the existence of “theft or
embezzlement in connection with a health-care benefit program,” “honest services fraud,”
“witness tampering,” and “obstruction of justice.” 	(Pls.’ Resp. to Clinic’s Mot. to Dismiss 23,
ECF No. 146.) However, the complaint does not supply sufficient allegations to support a claim
under any of these theories.
1. Mail Fraud, Wire Fraud, and Honest Services Fraud
The elements of wire and mail fraud are (1) “a scheme to defraud,” (2) “use of the mails,
or of an interstate electronic communication, respectively, in furtherance of the scheme,” Advocacy
Org. for Patients & Providers v. Auto Club Ins. Assoc., 176 F.3d 315, 322 (6th Cir. 1999), and
(3) “intent to deprive a victim of money or property,” United States v. Robinson, 99 F.4th 344, 354
(6th Cir. 2024) (quoting United States v. Daniel, 329 F.3d 480, 485 (6th Cir. 2003)).
Similarly, the elements of honest services fraud are: “(1) a scheme to defraud and intent to
defraud another; (2) through use of an interstate carrier; and (3) of money, property, or honest
services.” 	United States v. Householder, 137 F.4th 454, 497 (6th Cir. 2025) (Thapar, J.,
concurring). When referring to a deprivation of honest services, Congress intended to cover “only
bribery and kickback schemes.” Skilling v. United States, 561 U.S. 358, 368 (2010).
“A scheme to defraud includes any plan or course of action by which someone intends to
deprive another . . . by deception of money or property by means of false or fraudulent pretenses,
representations, or promises.” Robinson, 99 F.4th at 354 (quoting Daniel, 329 F.3d at 485-86).
As an element of this scheme, there must be proof “that the defendant said something materially
false.” Id. (quoting Daniel, 329 F.3d at 486). The “defendant must knowingly make a material
misrepresentation or knowingly omit a material fact” and “the misrepresentation or omission must
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have the purpose of inducing the victim of the fraud to part with property or undertake some action
that he would not otherwise do absent the misrepresentation or omission.” 	Id. at 357 (quoting
Daniel, 329 F.3d at 487).
A complaint alleging fraud must satisfy Rule 9(b) of the Federal Rules of Civil Procedure.
“Under that rule, a party ‘alleging fraud’ must ‘state with particularity the circumstances
constituting fraud.’” 	Greer v. Strange Honey Farm, LLC, 114 F.4th 605, 614 (6th Cir. 2024)
(quoting Fed. R. Civ. P. 9(b)). 	Generally, this means that the plaintiff must “specify the ‘who,
what, when, where, and how’ of the alleged fraud.” Id. (quoting Sanderson v. HCA-The Healthcare
Co., 447 F.3d 873, 877 (6th Cir. 2006)). “More specifically, the complaint must (1) specify the
statements that the plaintiff contends were fraudulent, (2) identify the speaker, (3) state where and
when the statements were made, and (4) explain why the statements were fraudulent.” Id. at 614-
15 (quoting New London Tobacco Mkt., Inc. v. Ky. Fuel Corp., 44 F.4th 393, 411 (6th Cir. 2022)
(internal quotation marks omitted)).
(a) Fraud: Corewell Branding
Plaintiffs apparently rely on the fact that some billing notices, invoices, and other
communications from Corewell (or its predecessor, Spectrum Health) to Plaintiffs displayed
Corewell’s (or Spectrum’s) name or logo, suggesting that the Clinic was affiliated with Corewell
when that was not the case. Plaintiffs allege that the Clinic was part of Corewell’s “Community
Connect” program, which allows independent medical practices like the Clinic “to use Corewell’s
name, Epic/MyChart platform, email domains, and patient-facing technology,” in exchange for
compensation from the practice. (3d Am. Compl. ¶¶ 25-26.) Corewell or the Clinic also posted a
YouTube video promoting Dr. Shavell using Corewell’s branding. 	And Corewell allowed the
Clinic to use Corewell-branded “patient registration, billing, scheduling, and records” through
Corewell’s “Epic/MyChart” software, to issue billing statements listing “Corewell” as the
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provider, and to use Corewell’s name in appointment reminders, emails, and texts to Plaintiffs.
(Id. ¶ 27.)
For instance, in 2022 and 2023, before every appointment at the Clinic, Vicktoria received
email appointment confirmations that included Spectrum’s or Corewell’s name in them, along with
a link to Spectrum’s website and a statement saying, “Thank you for partnering with us for your
healthcare needs.” 	(Id. ¶ 28.) 	Also, after each appointment, or when new test results were
available, Spectrum sent Vicktoria an email update or after-visit summary. (Id. ¶¶ 31-32.) When
Vicktoria resumed treatment in 2025, Corewell sent similar communications to her. 	(Id. ¶ 34.)
Vicktoria would also receive surveys from Corewell, stating, “Thank you for your recent Corewell
Health visit,” “We are always looking to make things as easy as possible for our patients,” and
“Thank you for trusting us with your care.” (Id. ¶ 35.)
Plaintiffs do not adequately explain how these statements or the presence of Corewell’s
name or logo in communications or paperwork provided to Plaintiffs amount to intentionally
fraudulent statements, let alone ones that were intended to deprive Plaintiffs of money or property
and that led directly to Plaintiffs’ injuries. Plaintiffs apparently contend that Corewell’s name and
“branding” “created the false impression of Corewell oversight” over the Clinic’s operations, and
that Plaintiffs relied on this impression when “selecting the Clinic, consenting to treatment, using
Corewell-branded systems, and paying invoices.” (Id. ¶¶ 187, 193, 201, 272.) But none of the
alleged statements by Defendants asserted that Corewell exercised oversight over the treatment
Plaintiffs received at the clinic. Conveying a statement that results in a false impression of such
oversight is not the same as making an intentional misrepresentation. Plaintiffs have not alleged
the latter.
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Moreover, such a false impression is not adequate to support a fraud claim under RICO
because it is not tied to any discernible injury suffered by Plaintiffs. Plaintiffs apparently believe
that services overseen by Corewell would have been superior in some way compared to services
they received from an independent clinic. But there are no facts alleged that would support such
a belief.
In addition, as discussed above, a RICO claim requires a direct connection between the
racketeering activity and the injury. Here, Plaintiffs were aware of who provided their services
and the services they actually received. They do not allege any deception or mistake in that regard.
Thus, to the extent they suffered any injury to business or property from those services, it was not
proximately caused by the Corewell branding or any statements Defendants made suggesting an
affiliation between Corewell and the Clinic.
Plaintiffs compare their case to Medical Marijuana, Inc. v. Horn, 604 U.S. 593 (2025), in
which an individual sued the seller of a tincture containing cannabidiol (“CBD”). Id. at 597. The
seller represented that its product contained no tetrahydrocannabinol (“THC”) and was “legal to
consume,” so the purchaser tried some. Id. But the seller’s representation was false, which the
purchaser discovered after failing a drug test administered by his employer. Id. Because he failed
the test, he lost his job and then sued the seller under RICO. Plaintiffs argue that Horn is similar
to their case because Horn involved a RICO action stemming from “false or misleading
advertising.” See id. at 598. But the Supreme Court did not examine whether the false advertising
in that case met the elements of mail or wire fraud. Instead, the court examined only whether the
plaintiff suffered injury to “his business or property,” as is necessary to state a RICO claim. Id. at
599. That analysis does not aid Plaintiffs’ claim.
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Plaintiffs also contend that their case is like those in which medical providers used a
“predetermined protocol” when treating patients, regardless of their patients’ needs, leading to
excessive and unnecessary treatment for the purpose of generating income from an insurer. See,
e.g., Allstate Ins. Co. v. AS Med. Grp., PLC, No. 2:23-CV-10904, 2025 WL 2042262, at *1–2
(E.D. Mich. July 21, 2025); Allstate Ins. Co. v. Ayman Tarabishy, M.D., PLLC, No. 4:22-CV-
12736, 2024 WL 4354699, at *1 (E.D. Mich. Sept. 30, 2024). The health insurance companies in
these cases brought RICO claims against the medical clinics for submitting false medical bills for
services that were not rendered or that were based on fabricated medical records. AS Med. Grp.,
2025 WL 2042262, at *1–2; Ayman Tarabishy, 2024 WL 4354699, at *1.
Those cases are distinguishable. 	To start, Plaintiffs’ have not alleged anything like a
“predetermined protocol” in their case. According to Plaintiffs, the Clinic used “varied” protocols
for each round of IVF treatment. (3d Am. Compl. ¶ 69.) Moreover, unlike the foregoing cases,
nothing in the complaint here indicates that Defendants defrauded Plaintiffs by presenting them
with false medical bills for services not rendered, or by providing unnecessary services based on
falsified information. To be sure, Plaintiffs do claim that they incurred expenses for “unnecessary”
medications and treatment. (See id. ¶¶ 116, 176, 198.) However, the complaint does not tie those
unnecessary expenses to any fraudulent scheme by Defendants. 	Instead, Plaintiffs apparently
believe those expenses were unnecessary because Plaintiffs failed to obtain the results they desired;
they blame that failure on treatment decisions made by the Clinic and its physicians. Plaintiffs’
disagreement with the Clinic’s level of care does not plausibly render Defendants’ conduct
fraudulent or part of an intentionally fraudulent scheme to deprive Plaintiffs of money or property
through deception.
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(b) Fraud: Miscellaneous Statements
Plaintiffs also point to a handful of statements or doctor’s notes that they claim were false,
such as: (1) Dr. Shavell “told Vicktoria the [first] cycle would be freeze-all due to elevated
progesterone,” but progesterone had not been tested (3d Am. Compl. ¶ 171); (2) Dr. Shavell stated
that “Ovation3—not the Clinic—decided to freeze the embryo” and that “the protocol was switched
to freeze-all due to lining,” but these decisions had been made by Shavell months earlier (id.
¶ 172); (3) Shavell justified the use of Ganirelex based on “elevated FSH” even though no FSH
testing occurred (id. ¶¶ 173–74); (4) Shavell overrode Dr. Jones’s recommendation to cancel
Round 3 without reviewing Vicktoria’s chart (id. ¶ 175); (5) Dr. Giuliani represented that Round
2 would “replicate Round 1’s protocol, but Round 2 materially deviated” (id. ¶ 177); (6) Stiles told
Plaintiffs that Bundl would not authorize another egg retrieval, which was not true because Bundl
later authorized another retrieval (id. ¶¶ 111, 181); and (7) Stiles wrote in internal Clinic records
that Plaintiffs “used foul language and were dangerous,” but those statements were not true (id.
¶ 182).
Shavell’s statements about the timing, source, or reason for the decision to freeze an
embryo are immaterial. Shavell’s decision to continue Round 3 is not a false statement. Stiles’s
statements about Bundl’s coverage and about Plaintiffs’ conduct in internal notes were harmless
and are not plausibly tied to a scheme to defraud with intent to deprive Plaintiffs money or
property. Similarly, assuming Shavell’s and Giuliani’s statements about the justification for using
Ganirelex and the plan to replicate Round 1’s protocol were false, Plaintiffs fail to allege a
plausible connection between these isolated statements and a fraudulent scheme by Defendants.
As indicated, Plaintiffs were aware of the treatment they received. 	They do not contend that
3 Ovation is “a third-party lab.” (Compl. ¶ 155, ECF No. 1.)
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Defendants fraudulently charged Plaintiffs for services they did not receive. 	Plaintiffs’ claim
amounts to a disagreement with the necessity or efficacy of that treatment, which does not give
rise to a RICO claim based on fraud.
Defendants also note that there are no allegations of bribery or kickback schemes, as
required for honest services fraud. 	In response, Plaintiffs assert that “there were undisclosed
financial arrangements and referral flows from Corewell that funneled patients into Bundl while
concealing constraints on medical judgment and misrepresenting medical necessity.” (Pls.’ Resp.
to Clinic’s Mot. to Dismiss 28, ECF No. 116.) However, “undisclosed financial arrangements”
(which are not alleged with any clarity in the complaint) do not equate to bribery or kickback
schemes that deprived Plaintiffs of Defendants’ “honest services.” 	Thus, for all the foregoing
reasons, Plaintiffs do not state a RICO claim based on fraud.
2. Obstruction & Witness Tampering
Plaintiffs provide no argument or factual support for their assertion that Defendants were
involved in any form of obstruction or witness tampering. 	See 18 U.S.C. §§ 1510 (relating to
obstructions of criminal investigations), 1511 (relating to the obstruction of state or local law
enforcement as to illegal gambling), 1512 (relating to tampering with a witness, victim, or
informant), and 1513 (relating to retaliating against a witness, victim, or informant).
3. Extortion
Plaintiffs claim that Defendants engaged in extortion by issuing the termination letter
“demanding embryo transfer within 90 days,” by “disabling portal communications,” and by
“fabricating chart entries portraying Alan as dangerous.” 	(3d Am. Compl. ¶ 200.) 	“A plaintiff
claiming a Hobbs Act violation of extortion as a predicate act in a civil RICO claim must establish
that the defendant ‘obstruct[ed], delay[ed], or affect[ed] commerce or the movement of any article
or commodity in commerce, by . . . extortion or attempt[ed] or conspir[ed] so to do, or committ[ed]
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or threaten[ed] physical violence to any person or property in furtherance of a plan or purpose to
do [so].’” Heinrich v. Waiting Angels Adoption Servs., Inc., 668 F.3d 393, 406–07 (6th Cir. 2012)
(quoting 18 U.S.C. § 1951(a)). 	Extortion is “the obtaining of property from another, with his
consent, induced by wrongful use of actual or threatened force, violence, or fear, or under color of
official right.” 18 U.S.C. § 1951(b)(2). “Obtaining property requires ‘not only the deprivation but
also the acquisition of property.’” 	Sekhar v. United States, 570 U.S. 729, 734 (2013) (quoting
Scheidler v. Nat’l Org. for Women, Inc., 537 U.S. 393, 404 (2003)). “That is, it requires that the
victim part with his property, and that the extortionist gain possession of it.” Id. (cleaned up).
Defendants’ conduct fails to support a RICO claim based on extortion because Plaintiffs
do not allege that Defendants obtained any property, or sought to do so, by requiring transfer of
Plaintiffs’ embryo to another facility, by disabling Plaintiffs’ access to the patient portal, or by
entering information into Plaintiffs’ chart about Alan’s dangerousness. 	Indeed, the termination
letter simply required Plaintiffs to transfer their embryo to another facility within 90 days’ time so
that Plaintiffs could continue their treatment elsewhere. (See Termination Letter.) It also offered
to transfer Plaintiffs’ medical records “at no cost” upon completion of a medical records release
form. 	(Id.) 	It did not threaten to use Defendants’ control over the embryo or over Plaintiffs’
medical records to pressure Plaintiffs to give up property. And there is no suggestion that disabling
Plaintiffs’ access to the portal or entering notes in the Clinic’s internal records induced or required
Plaintiffs to turn over any property. 	Thus, Plaintiffs have not plausibly alleged extortion as a
predicate for a RICO claim against Defendants.
* * *
For the reasons stated, Plaintiffs fail to plausibly allege any racketeering activity that would
give rise to a RICO claim.
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B. RICO Conspiracy (Count II)
Plaintiffs also claim Defendants were involved in a RICO conspiracy. 	This claim fails
because the underlying RICO claim fails. See Courser v. Mich. House of Representatives, 831 F.
App’x 161, 187 (6th Cir. 2020) (“Because Courser’s RICO claim fails, the RICO conspiracy claim
fails too.”).
C. Americans With Disabilities Act (Count IV)
Plaintiffs claim that Defendants discriminated against them on account of their disabilities
or perceived disabilities. Vicktoria claims her DOR is a disability and Alan claims his azoospermia
misdiagnosis caused Defendants to regard him as having a disability. 	Plaintiffs contend that
Defendants discriminated against them when Defendants “refused to adapt treatment protocols to
hormone data and medical history, applied rigid pre-filled plans, denied Plaintiffs’ January 13,
2025 request for medical review, and offered no reasonable basis for refusal.” (3d Am. Compl.
¶ 230.) 	In addition, Defendants “imposed communication barriers” when disabling Plaintiffs’
access to the patient portal and “withheld timely access to records and billing data needed to
coordinate urgent care.” (Id. ¶ 231.)
Title III of the ADA provides that “[n]o individual shall be discriminated against on the
basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges,
advantages, or accommodations of any place of public accommodation by any person who owns,
leases (or leases to), or operates a place of public accommodation.” 42 U.S.C. § 12182(a). “To
state a claim under Title III, a plaintiff must allege ‘(1) that she is disabled within the meaning of
the ADA; (2) that defendants own, lease, or operate a place of public accommodation; and (3) that
defendants discriminated against her by denying her a full and fair opportunity to enjoy the services
defendants provide.’” Powell v. Columbus Med. Enters., LLC, No. 21-3351, 2021 WL 8053886,
at *2 (6th Cir. Dec. 13, 2021) (quoting Camarillo v. Carrols Corp., 518 F.3d 153, 156 (2d Cir.
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2008)). “The ‘professional office of a health care provider’ is considered a public accommodation
for purposes of the ADA.” Id. (quoting 42 U.S.C. § 12181(7)(F)). “Title III does not provide for
money damages to an aggrieved person except in a discrimination action brought by the Attorney
General.” McComb v. Best Buy Co., No. 24-3900, 2025 WL 2940948, at *2 (6th Cir. June 2, 2025)
(quoting Reinoehl v. Whitmer, No. 22-1343, 2023 WL 3046052, at *2 (6th Cir. Apr. 17, 2023)).
Plaintiffs do not plausibly allege that Defendants denied them full and equal enjoyment of
services based on disability. 	Indeed, Plaintiffs’ complaint details the many ways in which
Defendants (particularly the Clinic and its physicians and employees) provided treatment to
address Plaintiffs’ fertility issues. In essence, Plaintiffs’ complaint “voices [their] dissatisfaction”
with Defendants’ care, but that dissatisfaction “necessarily sounds in medical malpractice” and
“‘by itself, does not state a claim under the ADA.’” Powell, 2021 WL 8053886, at *2 (quoting
Jones v. Willie, No. 15-5658, 2016 U.S. App. LEXIS 23617, at *8 (6th Cir. Jan. 28, 2016)); see
Parker v. William Beaumont Hosp., No. 20-12475, 2023 WL 3606653 (E.D. Mich. May 23, 2023)
(“It is well settled that the [Rehabilitation Act and the ADA] do not provide general causes of
action to challenge the sufficiency of medical treatment.”).
To the extent Plaintiffs complain about the termination of access to the patient portal, the
refusal to provide a medical review, or the 90-day embryo-transfer deadline, there are no facts in
the complaint from which to infer that Defendants’ actions were motivated by Plaintiffs’ real or
perceived disabilities.
Plaintiffs also claim that Defendants retaliated against them by terminating care, by
disabling access to the portal, by imposing the 90-day deadline for embryo transfer, and by
“disseminating defamatory” clinical notes. 	(3d Am. Comp. ¶ 236.) 	The ADA’s retaliation
provision states, in relevant part, that “[n]o person shall discriminate against any individual
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because such individual has opposed any act or practice made unlawful by this chapter.” 42 U.S.C.
§ 12203(a). To state a retaliation claim under the ADA, Plaintiffs must allege facts to establish
that they “engaged in a protected activity that the defendants were aware of, the defendants took
an adverse action against [them], and there was a causal connection between the protected activity
and the adverse action.” Harmon v. Waterman, No. 24-5773, 2025 WL 2434374, at *3 (6th Cir.
June 6, 2025). “Protected activity typically refers to action taken to protest or oppose a statutorily
prohibited discrimination.” Rorrer v. City of Snow, 743 F.3d 1025, 1046 (6th Cir. 2014) (quoting
Goonan v. Fed. Reserve Bank of N.Y., 916 F. Supp. 2d 470, 484–85 (S.D.N.Y. 2013)).
Here, Plaintiffs do not allege any protected activity taken to “protest or oppose”
discrimination on the basis of disability. Their complaint makes a vague reference to “protected
accommodation requests” (3d Am. Compl. ¶ 249), but it provides few specifics. The complaint
mentions a “June 13, 2025 ADA/Section 504 request” (id. ¶ 249), but that allegation appears to
refer to a “June 13, 2025 request for medical review” (id. ¶ 230). A request for medical review
does not meet the definition of protected conduct under the ADA; it has no connection to any of
Plaintiffs’ rights under the ADA. And at any rate, almost all the allegedly retaliatory actions—
terminating the patient-physician relationship, disabling portal access, and imposing a 90-day
deadline for embryo transfer—occurred before that request. (See id. ¶¶ 133-36.) Plaintiffs cannot
complain that Defendants retaliated against Plaintiffs for making this request when the purported
retaliation occurred before the request. 	Although Stiles entered an internal note about Alan’s
language and threatening tone that same day as this request, that internal note was not an adverse
action, and there is no indication that Stiles was aware of the request for review, let alone that the
request motivated her note.
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The same logic applies to Alan’s June 13, 2025, email to Corewell and to the Clinic’s
billing staffer, asking for an “accommodation” in the form of “immediate referral and coordinated
records.” 	(Id. ¶¶ 138–39.) 	It is not clear how that request would constitute protected conduct
under the ADA, but even if it is protected, Plaintiffs offer no plausible connection between this
request and any adverse conduct by Defendants, which had already occurred before the request.
Thus, for all the foregoing reasons, Plaintiffs do not state either a retaliation claim or a
discrimination claim under the ADA.
D. Rehabilitation Act (Count V)
The RA provides that a qualified individual with a disability shall not, “solely by reason of
her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected
to discrimination under any program or activity receiving Federal financial assistance.” 29 U.S.C.
§ 794(a). Plaintiffs’ RA claim fails for the same reasons as their ADA claim. Plaintiffs have not
plausibly alleged that Defendants denied them the benefits of a program receiving federal
assistance or otherwise discriminated against them because of a disability. Plaintiffs’ challenge to
the care they received does not give rise to an RA claim. See Reed v. Correct Care Sols., No. 20-
11523, 2023 WL 3168658, at *3 (E.D. Mich. Apr. 28, 2023) (“[T]he law is well-settled that claims
made under the ADA, the Rehabilitation Act, or the other discrimination-based statutes generally
cannot be based on medical treatment decisions concerning the alleged medical needs of allegedly
disabled prisoners.”). And as discussed above, Defendants provided care to Plaintiffs in response
to Plaintiffs’ asserted (or perceived) disabilities; none of the facts alleged permit a plausible
inference of discrimination against Plaintiffs on account of those disabilities.
Insofar as Plaintiffs claim that Defendants retaliated against them in violation of the RA,
the Sixth Circuit recently held that the RA “does not provide a private right of action for
retaliation.” Smith v. Mich. Dept. of Corrs., --- F.4th ---, No. 24-1439, 2025 WL 3251117, at *14
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(6th Cir. Nov. 21, 2025). 	And even if such a claim was available, it would fail for the reasons
discussed above with regard to Plaintiffs’ retaliation claim under the ADA. See A.C. ex rel J.C. v.
Shelby Cnty. Bd. of Ed., 711 F.3d 687, 696 (6th Cir. 2013) (applying the same analysis to retaliation
claims under the ADA and the RA). Thus, Plaintiffs do not state a claim under the RA.
E. Affordable Care Act (Count VII)
Plaintiffs assert a claim under Section 1557 of the ACA, 42 U.S.C. § 18116, which
prohibits discrimination under “any health program or activity . . . receiving Federal financial
assistance” on any ground “prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C.
§ 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. § 1681 et seq.), the
Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.),” or Section 504 of the RA. 42 U.S.C.
§ 11186(a). “In other words, Section 1557 prohibits discrimination in the provision of healthcare
based on ‘race, color, and national origin (Title VI); sex (Title IX); age (Age Discrimination Act);
and disability (Rehabilitation Act),’ and it incorporates the ‘enforcement mechanisms’ provided
for under these statutes.” Galuten ex rel. Galuten v. Williamson Cnty. Hosp. Dist., No. 21-5007,
2021 WL 3043275, at *4 (6th Cir. July 20, 2021) (quoting Doe v. BlueCross Blue Shield of Tenn.,
Inc., 926 F.3d 235, 238 (6th Cir. 2019)).
Drawing on the prohibition of sex discrimination in Title IX, Plaintiffs claim that
Defendants discriminated against them on account of sex when providing healthcare services. In
particular, Plaintiffs contend that terminating their treatment and their access to the patient portal
was a form of sex discrimination because their treatment was for DOR, which is a sex-specific
condition. 	While there might be some circumstances where an outright refusal to treat a sex-
specific condition is evidence of sex discrimination, Defendants did not refuse to treat Vicktoria.
Instead, they ended treatment after multiple attempts failed (or led to only one embryo), and after
Plaintiffs complained and demanded that Defendants follow Plaintiffs’ preferred protocols when
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providing future treatment. Notably, Defendants treated both Plaintiffs (a male and a female) alike
when 	terminating 	the 	patient 	relationship 	and 	disabling 	access 	to 	the 	portal. 	In 	these
circumstances, the sex-specific nature of Vicktoria’s treatment could not, by itself, give rise to a
plausible inference of sex discrimination.
Plaintiffs argue in their response brief that access to the patient portal was “necessary to
coordinate treatment and transfer reproductive materials.” (Pls.’ Resp. to Corewell’s 2d Mot. to
Dismiss 3, ECF No. 122.) That assertion is not supported by the complaint and defies common
sense. Plaintiffs do not contend that Defendants cut off all communication with them and thereby
prevented them from transferring care to another provider. But even if that had happened, it would
not plausibly suggest that Defendants discriminated against Plaintiffs on the basis of sex. In short,
Plaintiffs make no allegations from which to infer that Defendants terminated treatment due to
Plaintiffs’ sex or otherwise discriminated against them on the basis of sex in the provision of
healthcare services. Accordingly, Plaintiffs’ ACA claim fails.
* * *
For the reasons discussed above, the Court will dismiss Plaintiffs’ claims arising under
federal law—Counts I, II, IV, V, and VII of the third amended complaint—for failure to state a
claim.
IV. ANALYSIS - STATE LAW CLAIMS
After dismissal of the federal claims, Plaintiffs’ remaining claims arise under state law.
Ordinarily, where a district court has exercised jurisdiction over a state-law claim solely by virtue
of supplemental jurisdiction and the federal claims are dismissed prior to trial, the court will
dismiss the remaining state-law claims. See Experimental Holdings, Inc. v. Farris, 503 F.3d 514,
521 (6th Cir. 2007) (“Generally, once a federal court has dismissed a plaintiff's federal law claim,
it should not reach state law claims.”) (citing United Mine Workers of Am. v. Gibbs, 383 U.S. 715,
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726 (1966)); see also Southard v. Newcomb Oil Co., LLC, 7 F.4th 451, 455 (6th Cir. 2021) (citing
Moon v. Harrison Piping Supply, 465 F.3d 719, 728 (6th Cir. 2006) (recognizing that once a
federal court no longer has federal claims to resolve, it “should not ordinarily reach the plaintiff's
state-law claims”)); Landefeld v. Marion Gen. Hosp., Inc., 994 F.2d 1178, 1182 (6th Cir. 1993).
In determining whether to retain supplemental jurisdiction, “[a] district court should consider the
interests of judicial economy and the avoidance of multiplicity of litigation and balance those
interests against needlessly deciding state law issues.” Landefeld, 994 F.2d at 1182. Dismissal,
however, remains “purely discretionary.” Carlsbad Tech., Inc. v. HIF Bio, Inc., 556 U.S. 635, 639
(2009) (citing 28 U.S.C. § 1367(c)); Orton v. Johnny’s Lunch Franchise, LLC, 668 F.3d 843, 850
(6th Cir. 2012). 	At this stage of the case, the balance of considerations weighs against the
continued exercise of supplemental jurisdiction over the state-law claims.
Even if the Court was not dismissing all the federal claims, it would decline to exercise
supplemental jurisdiction because the state-law claims “substantially predominate” over the claims
arising under federal law in terms of proof and the scope of the issues raised. 	See 28 U.S.C.
§ 1367(c)(2). There is some overlap between the federal claims and some of the state-law claims,
particularly those involving fraud and discrimination, but other state-law claims delve into issues
like medical malpractice, promissory estoppel, unjust enrichment, battery, and infliction of
emotional distress, which far exceed the scope of the federal claims. Consequently, declining to
exercise supplemental jurisdiction over the state-law claims is also warranted under 28 U.S.C.
§ 1367(c)(2).
V. AMENDMENT OF THE COMPLAINT
In passing, Plaintiffs’ response briefs request leave to amend their complaint to correct any
deficiencies. A response brief is not the appropriate place to make such a request. “‘If plaintiffs
believe they need to supplement their complaint with additional facts to withstand [a motion to
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dismiss] . . . they have a readily available tool: a motion to amend the complaint under Rule 15.’
They cannot ‘amend their complaint in an opposition brief or ask the court to consider new
allegations (or evidence) not contained in the complaint.’” 	Waskul v. Washtenaw Cnty. Cmty.
Mental Health, 979 F.3d 426, 440 (6th Cir. 2020) (quoting Bates v. Green Farms Condo. Ass’n,
958 F.3d 470, 483 (6th Cir. 2020) (citations omitted)); see also Tucker v. Middleburg-Legacy
Place, 539 F.3d 545, 552 (6th Cir. 2008) (collecting cases for the proposition that a plaintiff is not
entitled to amend their complaint where no motion to amend has been filed).
Moreover, the Court’s local rules require a party to file a proposed amended complaint
when seeking leave to amend. W.D. Mich. LCivR 5.7(f). Plaintiffs have not complied with that
requirement.
Finally, the Court notes that Plaintiffs have already amended their complaint twice, and
they filed their most recent version after Defendants had filed motions to dismiss (ECF Nos. 69,
71). Those motions put Plaintiffs on notice of many of the deficiencies in the previous version of
their complaint. But even with that notice, the federal claims in the latest version cannot survive
dismissal. The Court is not persuaded that “justice so requires” another opportunity to amend. See
Fed. R. Civ. P. 15(a)(2). Accordingly, the Court will dismiss the complaint without granting leave
to amend.
VI. CONCLUSION
The Court will grant Defendants’ motions to dismiss. The Court will dismiss the claims
arising under federal law for failure to state a claim. 	The Court will dismiss the claims arising
under state law because the Court declines to exercise supplemental jurisdiction over them.
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The Court will enter an order and judgment consistent with this Opinion.
Dated: December 18, 2025 	/s/ Hala Y. Jarbou
HALA Y. JARBOU
CHIEF UNITED STATES DISTRICT JUDGE
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