Maggie Watts was taken by ambulance to the emergency room of Gwinnett Medical Center “Gwinnett” after sustaining injuries in a vehicular collision. She was treated and released. The total bill for services rendered was $786.10. Ms. Watts had health insurance coverage through Kaiser Permanente Insurance Co. “Kaiser”. Kaiser and Promina Health System, Inc., on behalf of its participating hospitals, including Gwinnett, have entered into an “Agreement for Hospital Services” “Agreement”, which requires Gwinnett to charge a flat fee of $216.00 to Kaiser’s insureds for “any treatments performed in the emergency room that does not result in an admission or any outpatient surgery.” Gwinnett billed Kaiser $786.10; Kaiser paid $166, and Ms. Watts made a co-payment of $50, leaving a balance of $570.10. Gwinnett also filed a hospital lien in the Superior Court of Gwinnett County in the amount of $786.10. Ms. Watts later sued the tortfeasor and settled that action for $15,000.00. Kaiser asserted a subrogation claim for $539.00. Ms. Watts paid the hospital’s lien in full and settled Kaiser’s subrogation claim for $400.00. Gwinnett refunded $50.00 to Ms. Watts and $166.00 to Kaiser. Kaiser thus recovered a total of $566.00.
Ms. Watts then filed suit against Kaiser and Gwinnett. The allegations against Gwinnett include breach of contract for charging fees in excess of the flat fee set out in the Agreement and failing to pay attorney fees under OCGA § 15-19-14 b; breach of good faith and fair dealing; violation of the Georgia Racketeer Influenced and Corrupt Organizations Act RICO; conversion; fraudulent concealment; money had and received; and unjust enrichment. The claims were based on Gwinnett’s recovery of $570.10 more than the flat fee in the Agreement. At the heart of this dispute is Article C, Compensation, Section C-1, which states in relevant part:
