Full opinion text
TJOFLAT, Circuit Judge: Stripped to its essentials, this is a simple medical malpractice case. It was brought, however, as a multi-count RICO prosecution. Suspecting that the ■ claims in the complaint lacked factual bases, the district court took an unusual step and granted the defendants leave to conduct discovery for the purpose of determining whether plaintiffs counsel had violated Rule 11 of the Federal Rules of Civil Procedure. The discovery was to determine whether plaintiffs counsel had conducted an “inquiry reasonable under the circumstances” into the factual support for the claims presented in the complaint. After the court took this step, the plaintiff moved the court to recuse pursuant to 28 U.S.C. § 455. The court denied the motion. During the Rule 11 discovery, the court dismissed the plaintiffs claims against one of the defendants for failure to state a claim upon which relief could be granted. After the discovery was completed, the defendants moved the court to sanction the plaintiff and one of her attorneys pursuant to Rule 11, 28 U.S.C. § 1927, and the court’s inherent power. They contended that, with the exception of the plaintiffs medical malpractice claim, none of the claims presented had a factual basis and the claims had been brought in bad faith for the sole purpose of harassment. The court agreed. In two orders issued sixteen months apart, the court dismissed the remainder of plaintiffs claims, except for the malpractice claim. In addition, it required the plaintiff and her attorney to pay the attorneys’ fees and costs incurred in defending the dismissed claims. Two months after the first order issued, the plaintiff renewed her motion for recusal; as before, the court denied the motion. These consolidated appeals came after the district court issued its second sanctions order. Appellants — plaintiff and one of her attorneys — challenge the denials of the plaintiffs motions for recusal, the dismissal of the plaintiffs claims (except the malpractice claim), and the imposition of monetary sanctions in the form of attorneys’ fees and costs. We organize this opinion as follows. In Part I, we recite the events that led the defendants to seek Rule 11 sanctions early in the case. In Part II, we address the plaintiffs argument that the district court should have recused. In Part III, we consider the propriety of the court’s dismissal of all but the plaintiffs malpractice claim as well as the court’s imposition of monetary sanctions against the plaintiff and her attorney under Rule 11, 28 U.S.C. § 1927, and the court’s inherent power. Finally, in Part IV, we discuss the tools a district court should use in dealing with the types of pleadings filed by the attorneys in this case. ■ I. In September 1992, Debbie Manov (“Manov”), a New Jersey resident suffering from endometriosis, traveled to the Atlanta Center for Fertility and Endocrinology (“the Center”) for corrective lapa-roscopic surgery. Drs. Farr Nezhat and Camran Nezhat, two of the Center’s specialists, performed the surgery at North-side Hospital (“Northside”). Prior to the surgery, the doctors told Manov that her appendix might be infected and that, if infected, it should be removed. She agreed. During the surgery, the doctors determined that the appendix was infected and removed it. Following the surgery, Manov developed an infection, which necessitated her readmission to Northside. Drs. Nezhat treated the infection with antibiotics, which Manov claims contributed to her loss of hearing. In August 1994, Manov, represented by Atlanta attorney Edward Kellogg, filed a medical malpractice suit in the Superior Court of Fulton County, Georgia. Named as defendants were Drs. Farr and Camran Nezhat and the Center. The alleged malpractice was the removal of a healthy appendix (during the laparoscopic procedure) which, in turn, caused an infection requiring further hospitalization. Shortly after filing suit, Manov consulted James Neal (“Neal”), a Pennsylvania lawyer practicing out of his residence in Ohio. At the time, Neal and Michael Mix-son (“Mixson”), an attorney from Monroe, Georgia, were prosecuting two other medical malpractice cases in Atlanta, both filed in December 1993, on behalf of Mary Mullen (“Mullen”). The first lawsuit, brought against Drs. Farr and Camran Nezhat, Dr. Earl Pennington, the Center, and North-side, was pending in the Fulton County Superior Court. The second suit, brought against the members of Northside’s board of directors in their individual capacities, was pending in the United States District Court for the Northern District of Georgia. Because Mullen’s cases are of central importance to the instant case, we relay the history of her cases as follows. In her superior court complaint, Mullen alleged that on December 18, 1991, the Drs. Nezhat and Pennington negligently performed a bowel resection procedure to alleviate rectal endometriosis. Mullen alleged that the procedure was experimental, caused severe physical complications, and that it was performed without her informed consent. Mullen’s complaint contained seven counts, each proceeding on a tort law theory predicated on the bowel resection procedure. In her district court complaint, framed in one count, Mullen alleged that members of Northside’s board were negligent in permitting the doctors to perform an experimental bowel resection without the patient’s informed consent. By the time Manov spoke to Neal, he had amended the allegations in Mullen’s state court suit to add two causes of action, for a total of nine. Counts VIII and IX, brought against the Drs. Nezhat and the Center, sought compensatory and puni-five damages for violations of the Georgia RICO statute, O.C.G.A. § 16-14-4. Count VIII alleged that the defendants were operating a “criminal enterprise” and engaging in “a pattern of racketeering activity,” and that such racketeering activity had caused Mullen injury. The “acts of racketeering” were, among others, that the Drs. Nezhat (1) made false statements in medical journal articles; (2) failed to obtain valid consent for surgical procedures from Mullen and other patients at the Center, thereby committing aggravated battery on the patients; (3) improperly billed insurance companies for experimental surgeries; and (4) improperly used experimental drugs. Mullen v. Nezhat, 223 Ga.App. 278, 477 S.E.2d 417, 419 (1996). Count IX alleged aggravated battery, and federal mail and wire fraud as acts of racketeering. Count IX asserted that the Drs. Nezhat committed aggravated battery by failing to obtain “ Valid informed consent ... by fraudulently misrepresenting the true nature of their experimental surgery, [and] by repetitively performing non-indicated unnecessary surgery’ on Mullen and other patients, thereby ‘deliberately and maliciously causing bodily harm’ amounting to aggravated battery.” The mail and wire fraud allegedly occurred when the defendants “engage[ed] in experimental and non-consensual medical treatment by implanting Estradiol pellets into ‘hundreds if not thousands of women without their knowledge that this hormonal implant was not approved.’ ” Id. Apparently, Manov was impressed with the manner in which Neal was handling Mullen’s cases, so she decided that Neal should take over her lawsuit against the Drs. Nezhat and the Center. Neal said he would take the case, but would need to associate local counsel. Manov agreed. Neal thereafter searched the records of the Fulton County Superior Court for the names of other attorneys who had sued the Nezhats or the Center. He found Michael T. Byrne (“Byrne”), one of the appellants now before us. In the spring of 1995, Byrne appeared as Manov’s counsel in the state court suit, and Edward Kellogg withdrew. Unbeknownst to Manov, the continuation of Neal’s pro hoc vice status in Mullen’s state and federal court eases was being challenged on the grounds that he had violated the courts’ discovery rules and the Code of Professional Responsibility by engaging in malicious and harassing conduct against the Nezhats and the Center. These challenges began in February 1994, when the defendants in both of Mullen’s cases moved the courts to revoke Neal’s pro hoc vice status. In each case, the court denied the motion, but nonetheless condemned Neal’s behavior. The district court’s May 11, 1994 order stated that, although Neal’s “conduct did not conclusively violate the Code of Professional Responsibility .... [his] actions bordered on conduct unbecoming an officer of the Court.” The superior court’s order, issued July 11, 1994, was more explicit. It stated that “Neal’s communication with various counsel for Defendants borders on unprofessional, scurrilous, and distasteful conduct.... [His] conduct has come as close to the line as one could possibly come to violating the Georgia Code of Professional Responsibility.” He communicated with defense counsel “in a cavalier and ‘half-cocked’ manner in an effort to bully the Defendants into a quick and favorable settlement.” As part of his bullying tactics, he “threatened criminal prosecution to gain a civil advantage; threatened to use the media as a sounding board in order to gain a civil advantage; ... engaged in activities to subvert justice; ... [and] threatened to be the causing agent to send some of the Defendants [i.e., the Nezhats] back to their home country.” Notwithstanding such conduct, the court permitted Neal to continue his representation of the plaintiff because “a party should be represented by an attorney of [her] choice whenever possible.” According to the defendants in Mullen’s cases, Neal failed to heed the courts’ act-monitions. They therefore renewed their motions to revoke Neal’s pro hac vice status and to have him disqualified as co-counsel in Mullen’s cases. On August 16, 1995, the superior court barred Neal from further participation in the case. In its order, a part of which we quote in the margin, the court found that “Neal’s continued unethical behavior, ... despite the earlier admonitions, has tipped the balance in favor of ensuring ethical conduct on the part of lawyers over the right of the Plaintiff to have her chosen counsel.” The superior court issued a second order on August 16, 1995 granting the defendants summary judgment on Mullen’s RICO claims. Mullen, now represented solely by Mixson, appealed the judgment. The defendants in Mullen’s district court case also sought Neal’s disqualification. On September 27, 1995, they renewed their motion to revoke his pro hac vice status. Neal promptly withdrew from the case, thereby mooting defendants’ motion. As Neal’s privilege to represent Mullen in her state and federal court cases was coming to an end, Byrne, on July 13, 1995, voluntarily dismissed Manov’s superior court lawsuit. Six months later, on January 12, 1996, one day before the Georgia renewal statute would have barred refiling of Manov’s case, Byrne brought Manov’s malpractice claim to the district court, filing the lawsuit now before us. Although he was Manov’s lawyer, Neal neither signed the complaint nor sought leave to appear pro hac vice. In addition to Drs. Farr and Camran Nezhat and the Center, the complaint named as defendants Dr. Ceana Nezhat, Ali Nezhat, and North-side. As noted above, Manov’s state court complaint contained only one count: the medical malpractice claim. The complaint Manov filed in the district court, however, which consisted of 78 pages and 299 paragraphs, contained eight additional counts. Its centerpiece was Manov’s claims for damages under the state and federal RICO statutes, O.C.G.A. § 16-14-6 and 18 U.S.C. § 1964(c), Counts III and IX, respectively. The allegations of the two RICO counts were essentially the same. According to Manov, each defendant was an “enterprise” which was conducted “through a pattern of racketeering activity.” Each count of the complaint incorporated by reference the allegations of each preceding count. Count I, sounding in negligence, was brought against Northside for failing to monitor and investigate the Nezhats’ practice of surgery at the hospital. Count II alleged medical malpractice on the part of Drs. Farr and Camran Nezhat. Count III sought recovery under the Georgia RICO statute against all of the defendants. Count IV alleged that Drs. Farr and Camran Ne-zhat committed battery by performing an appendectomy without Manov’s consent. Count V alleged that Dr. Farr Nezhat fraudulently misrepresented that Manov’s appendix might be infected and require removal. Count VI alleged that the manner in which Drs. Farr and Camran Ne-zhat, the Center, and Northside billed Manov and other patients for services rendered constituted “theft by deception.” Count VII alleged that Drs. Farr and Camran Nezhat failed to obtain Manov’s “informed consent” to perform an appendectomy. Count VIII sought punitive damages against all defendants. Count IX alleged violations of the federal RICO statute by Drs. Farr, Camran, and Ceana Nezhat, Ali Nezhat, and the Center. The defendants answered Manov’s complaint, asserting several affirmative defenses, including that the complaint failed to state a claim for relief. On May 3, 1996, before any significant discovery had taken place, defense counsel wrote the district court asking leave to engage in Rule 11 discovery. They contended that Neal was Manov’s lawyer; that he had ghostwritten Manov’s complaint; that Byrne had signed it merely in his capacity as local counsel and had not conducted the requisite pre-filing investigation of the facts underpinning the complaint’s claims; that the complaint’s RICO allegations were similar to those Neal had made in the Mullen cases, and that the superior court had barred Neal from further participation in Mullen’s case. Counsel attached to their letter a copy of the superior court’s August 16, 1995 orders (removing Neal from the case and granting the defendants summary judgment on Mullen’s RICO claims), and represented that Neal, through Byrne, was using Manov’s case 'as a vehicle to continue his vendetta against the Nezhats. Counsel pointed out that Manov’s case had begun as a simple, one-count medical malpractice case in the Fulton County Superior Court, but that after Neal entered the picture, it became a “blunderbuss” RICO prosecution aimed at extorting a quick settlement. On June 5,1996, the district court granted the defendants leave to conduct Rule 11 discovery. Three weeks later, on June 26, Manov moved the court to permit her to engage in Rule 11 discovery as well. The requested discovery related to Count I, titled, “Negligence against Northside” specifically alleged in paragraph 158 that “Dr. [Camran] Nezhat has been represented by counsel relating to matters of sexual imposition upon patients,” and Counts III and VIII, alleging violations of the Georgia and federal RICO statutes. On June 28, Manov moved the court for leave to file an amended complaint. At this time, she also filed a “Motion for an Order Directing Defendant Ceana Nezhat to provide Sworn Testimony to this Court Within Three Days that He is a Bona Fide Physician.” On July 8, while the foregoing motions were pending, Manov moved the court to recuse, pursuant to 28 U.S.C. § 455(a), on the ground that one of its law clerks, Dan McDevitt (“McDevitt”), had been formerly employed by the law firm representing the Nezhats and the Center. On July 9, after entertaining the argu-merits of counsel, the district court ruled on these motions. The court granted Ma-nov leave to amend her complaint, but denied her other motions. Two months later, on September 6, Byrne filed an amended complaint. The amended complaint contained the same claims as Manov’s original complaint with the exception of Count VI (theft by deception), Count VII (the claim that Drs. Farr and Camran Nezhat had not obtained Ma-nov’s informed consent prior to surgery), and Count IX (the federal RICO claim), which had been deleted. On September 23, 1996, the defendants answered the complaint; their answers once again included the affirmative defense of failure to state a claim for relief. Four days later, on September 27, Byrne, apparently anticipating the defendants’ motions for Rule 11 sanctions, filed a memorandum in support of Manov’s claims. On October 15, Northside moved the court to dismiss Manov’s claims against it in Counts III and IV for failure to state a claim for relief. On November 5, Byrne filed a memorandum in response to Northside’s motion, and on November 11, Byrne and Neal filed a memorandum supplementing Byrne’s September 27 memorandum in support of Manov’s amended complaint. The court granted Northside’s motion to dismiss on December 11, 1996. The court dismissed Count III on the ground that it was time barred, and the claim against Northside in Count IV on the ground that it failed to allege a violation of the Georgia RICO statute by the hospital. Following this ruling, the defendants, including Northside, continued their Rule 11 discovery. On July 8, 1997, Northside moved the district court to sanction Manov and Byrne pursuant to Rule 11, 28 U.S.C. § 1927, and the court’s inherent power. Two days later, the Center and Nezhat defendants filed a similar motion. On July 14, Manov moved the court to defer ruling on the defendants’ motions until she could conduct “Rule 11 defense discovery.” Ma-nov’s motion did not describe the defensive discovery she wished to conduct. The court denied Manov’s motion on July 30. On July 31, Manov supplemented her motion with a request that she be granted leave to obtain (1) records pertaining to the Drs. Nezhats’ medical credentials, (2) reports relating to appendectomies performed by the Nezhats during 1992, and (3) reports relating to bowel resection procedures performed on sixteen patients. Manov contended that these records and reports would demonstrate that Count IV, alleging violations of the Georgia RICO statute, had evidentiary support. On August 6, 1997, the court denied Manov’s motion. On October 15, 1997, Neal, still lacking pro hac vice status but nonetheless appearing for Manov, moved the district court to impose sanctions against two of the Nezhats’ lawyers, Henry D. Green and David F. Walbert, pursuant to the court’s inherent power. Neal’s motion represented that these attorneys had made “25 misrepresentations/material concealments in a May 3, 1996 letter to the Court, which in turn resulted in unilateral [Rule 11] discovery.” On February 23, 1998, the court granted the defendants’ motions for sanctions and denied Neal’s motion for sanctions. Drawing on its authority under Fed.R.Civ.P. 11, 28 U.S.C. § 1927, and its inherent power, the court found that Byrne’s “pre-filing investigation [did] not support the filing of a RICO claim against the Nezhats ... [and that] the claim against the Nezhats was brought without a reasonable factual basis.” The court held Manov and Byrne liable for the defendants’ attorneys’ fees and costs, the amounts to be fixed in a subsequent order. The court also dismissed Manov’s amended complaint with prejudice — save for the medical malpractice claim against the Nezhats and the Center — on the ground that Manov had failed to establish a cognizable claim for relief. The court did so even though the legal sufficiency of Manov’s (dismissed) claims was not formally before it. Finally, on its own initiative, the court ordered Neal “not to participate in any form or fashion” in the prosecution of Manov’s malpractice claim against the Nezhats and the Center. On April 23, 1998, Manov again moved the district court to recuse pursuant to 28 U.S.C. § 455(a). In addition to the circumstance of McDevitt’s former employment with the lawfirm representing the Nezhats and the Center (the basis for Manov’s first motion to recuse), Manov contended that the court’s rulings demonstrated an apparent bias against her. Thus, the court’s “impartiality might reasonably be questioned.” The district court denied the motion on June 1,1998. After the district court dismissed Ma-nov’s claims against Northside under Rule 12(c), as part of the February 23, 1998 sanctions order, and struck all of Manov’s claims against the Nezhats and the Center except the medical malpractice claim, the Nezhats and the Center commenced discovery on the merits of that claim. When Manov refused to comply with a court order requiring her to provide the Nezhats and the Center with the basis for the opinion of her medical expert, they moved on April 21, 1998 to strike the expert from Manov’s list of witnesses. The court granted the motion on May 26, 1998. This left Manov without a medical expert to support her malpractice claim. Since Georgia law requires that a plaintiff suing for medical malpractice produce expert testimony that the physician defendant deviated from the pertinent standard of care, Manov had no case. Accordingly, on July 21, 1998, she moved the court to dismiss her medical malpractice claim with prejudice. The court granted the motion. The district court’s February 23, 1998 sanctions order required the defendants to present “documentation” evidencing the attorneys’ fees and costs they had incurred in defending against Manov’s claims (except her malpractice claim) and conducting their Rule 11 discovery. After the defendants submitted such” proof, the court, on February 17,1999, ordered Byrne and Ma-nov to present evidence of their ability to pay the fees and costs the defendants were requesting. Having received their submissions, on June 24, 1999, the court entered an order setting the amount of monetary sanctions to be levied against Byrne and Manov. The order awarded attorneys’ fees and costs in the amounts of $50,378.22 to Northside, and $332,500.00 to the Ne-zhats and the Center. On September 1, 1999, the court entered final judgment for the defendants and against Manov and Byrne on all claims and closed the case. These consolidated appeals followed. Manov appeals (1) the two orders denying her motions to recuse pursuant to 28 U.S.C. § 455(a), (2) the court’s dismissal of her claims against Northside, (3) the court’s dismissal of all of her claims, except her medical malpractice count, against the Nezhats and the Center, and (4) the court’s imposition of monetary sanctions. Byrne appeals the district court’s imposition of monetary sanctions as well. We consider first Manov’s argument that the district court should have recused. II. Section 455(a) of the United States Code states: “Any justice, judge, or magistrate of the United States shall disqualify himself in any proceeding in which his impartiality might reasonably be questioned.” On July 8, 1996, one month after the court ordered Rule 11 discovery, Manov moved the district court to recuse pursuant to this statute. The court denied the motion the next day, following a hearing on various matters. Manov renewed the motion on April 23, 1998, two months after the court entered the first sanctions order. The court denied this motion as well. Both of Manov’s motions for recusal were based on the notion that the district court created an appearance of impartiality by having in its chambers a law clerk, McDevitt, who had been employed by one of the law firms representing the Nezhats and the Center in this case and in Mullen’s state court case. Manov’s second motion added another basis for recusal— the court’s rulings against Manov demonstrated that the court’s impartiality might reasonably be questioned. Due to this additional alleged ground for recusal, we address the motions separately. Our standard of review is whether the district court abused its discretion when it denied Manov’s motions. Jaffree v. Wallace, 837 F.2d 1461, 1465 (11th Cir.1988). A. At some time prior to the commencement of his law clerk’s duties with the district court, McDevitt was employed by Sullivan, Hall, Booth & Smith, an Atlanta law firm. The firm served as co-counsel for the Nezhats and the Center in the instant case. The firm also represented the Nezhats and the Center in Mullen’s state court case. The record does not indicate when McDevitt was employed by the Sullivan firm or when he came to work in the district court’s chambers. All we know is that, on January 18, 1996, when Judge Tidwell received the ease on reassignment, McDevitt was one of his law clerks. Judge Tidwell recognized immediately that McDevitt had worked for one of the law firms involved in the case; therefore, he isolated McDevitt from the case and assigned the matter to another law clerk, Nancy Chapman. On July 8, 1996, Judge Tidwell learned from reading Manov’s motion for recusal that McDevitt, while working as a Sullivan associate, had done some work on Mullen’s state court case. After entertaining Manov’s motion for recusal at a hearing the next day, Judge Tidwell said: [I]t seems to have become both fashionable and a fad that when any party is faced with an adverse decision that a motion to recuse follows almost as a matter of course. In this case when the case was filed it was assigned to my law clerk Nancy Chapman because I was aware that Dan McDevitt had been with a firm that had some connection with either this case or with a prior connection. Dan — I didn’t find out until yesterday that I believe it is correct that Dan had worked on some-aspect of this case before he came to work for me. But he has not, will not have any connection with this case. He is and has been and will be completely and totally separated from this case. It is not unusual for me to separate these cases. Many times law clerks have accepted a job offer at the conclusion of the law clerk tenure, and when that happens as similar to the situation in this case, I merely just assign any case to be worked on to the other law clerk. And in this case Dan has not, will not have any part, will not play any part, has not had any input or any connection with this casev since it was filed and assigned to me or any rulings that I have made or will make for that matter. The record before us reveals that McDevitt’s involvement in Mullen’s state court case was limited to the following: McDevitt, as a Sullivan associate, worked for Henry D. Green, a Sullivan partner and co-counsel of record for the Nezhats and the Center. In this' capacity, McDev-itt signed a “Brief in Support of Defendants’ Motion to Strike Plaintiffs Supplemental Affidavits Filed after October 23, 1994.” The brief addressed the issue of whether, under Georgia law, untimely affidavits, filed in opposition to a motion for summary judgment, could be considered by the court in ruling on the motion. In addition to this, McDevitt was shown, along with Green, to have received a copy of one of the orders entered in Mullen’s state court case. The test for determining whether a judge should disqualify himself under section 455(a) is whether a reasonable person knowing all the facts would conclude that the judge’s impartiality might reasonably be questioned. See Hepperle v. Johnston, 590 F.2d 609, 614 (5th Cir.1979). Stated another way, the question is “whether an objective, disinterested, lay observer fully informed of the facts underlying the grounds on which recusal was sought would entertain a significant doubt about the judge’s impartiality.” Carter v. West Pub. Co., No. 99-11959-EE, 1999 WL 994997 (11th Cir. November 1, 1999). Reduced to its essentials, Manov’s argument is that, notwithstanding the district court’s statements at the July 9 hearing, such an observer would entertain a significant doubt as to the court’s impartiality. In other words, the observer would either (1) doubt the court’s statement that McDevitt had been isolated from the case from the outset, or (2) conclude that, despite such isolation, there was a substantial likelihood that McDevitt would impart to the court information he had gleaned while working on Mullen’s state court case, thereby prejudicing the court against Ma-nov. The record contains nothing that would cause a reasonable observer to doubt the truth of the court’s statement that McDev-itt had been, and would continue to be, isolated from the case. Moreover, there is nothing in the record that could cause a reasonable observer to draw the opposite conclusion' — that McDevitt had been serving, and would continue to serve, as the court’s elbow law clerk on the case. This brings us to the second inference Manov would have us draw: McDevitt’s mere presence in the court’s chambers created the appearance that the court was, and would continue to be, partial to the defendants. As an initial matter we note that “[i]f a clerk has a possible conflict of interest, it is the clerk, not the judge who must be disqualified.” Hunt v. American Bank & Trust Co., 783 F.2d 1011, 1016 (11th Cir.1986). Manov contends that because the instant case concerns a law clerk’s former employment, cases, such as Hunt, involving a possible conflict of interest due to a law clerk’s future employment, are inapplicable. Whereas the isolation of a law clerk when future employment is involved alleviates the significant doubt an objective observer would have about the court’s impartiality, Manov says that the same is not true when the case involves former employment. We disagree for two reasons. First, we reject the underlying assumption of Ma-nov’s argument, namely, that when a court employs a law clerk whose former employer appears before the court, there is a stronger basis for questioning the court’s impartiality than when a court employs a law clerk who has accepted future employment with a firm appearing before the court. A law clerk has little incentive to influence a judge in an effort to curry favor with a former employer. Conversely, a law clerk has a financial incentive to benefit a future employer. Given this financial incentive, if ever a law clerk were of a mind to influence his judge, it would likely be for the benefit of a future rather than a former employer. Because preee-dent approves the isolation of a law clerk who has accepted future employment with counsel appearing before the court (see e.g., Hunt, 783 F.2d at 1015-16) it follows that isolating a law clerk should also be acceptable when the clerk’s former employer appears before the court. Second, we note that a law clerk has no incentive to violate a court’s instruction that he isolate himself from the case and thereby subject himself to discharge. In this case, the district judge explained that, as a matter of course, he isolates law clerks from cases involving past or future employers. The obvious purpose of this procedure is to ensure that the appearance of partiality does not arise; as such, only a foolhardy law clerk would purposely circumvent the court’s instruction by attempting to pass on information about a case. In sum, we hold that the district court did not abuse its discretion in denying Manov’s first motion for recusal. B. As noted, Manov’s second motion for recusal cited the district court’s rulings against Manov and asserted that such rulings would lead a reasonable observer to harbor a significant doubt about the court’s impartiality. We are not persuaded. Precedent clearly holds that adverse rulings alone do not provide a party with a basis for holding that the court’s impartiality is in doubt. Carlsen v. Duron, 229 F.3d 1162, No. 99-4065 (10th Cir.2000) (unpub.disp.). Given this precedent, Ma-nov’s argument, that the court’s refusal to recuse was an abuse of discretion, fails. III. We now turn to the remaining issues in this appeal. First, we determine de novo whether the district court erred as a matter of law in dismissing Manov’s claims against Northside in Counts III and IY. See Haitian Refugee Ctr. v. Baker, 949 F.2d 1109, 1110 (11th Cir.1991) (“[I]f the trial court misapplies the law we will review and correct the error without deference to that court’s determination.”). Second, we determine whether the court abused its discretion in imposing sanctions against Manov and Byrne, which, except for Manov’s medical malpractice claim, included the dismissal of the remaining counts of the complaint. See United States v. Sigma Intern., Inc., 244 F.3d 841, 852 (11th Cir.2001) (In determining whether the court abused its discretion we ask whether it “applie[d] the wrong legal standard or ma[de] findings of fact that are clearly erroneous.”) (internal citations omitted). Both of these determinations — whether the court erred as a matter of law in dismissing the claims against Northside or abused its discretion in awarding sanctions' — are guided by the fact that the root of this litigation is the medical malpractice claim that Manov brought against Drs. Farr and Camran Nezhat and the Center in the Fulton County Superior Court in August 1994. Manov alleged that she came to the Center in September 1992 for laproscopic surgery to alleviate endome-triosis. The surgery was to be performed by Drs. Farr and Camran Nezhat. Prior to surgery, they informed her that her appendix may be infected and, if so, it should be removed when they performed the laproscopy. Manov agreed, and executed a consent both to the laproscopic procedure and a “possible appendectomy and any other procedure deemed necessary.” During the laproscopic procedure, the doctors decided that Manov’s appendix was infected and performed the appendectomy. Manov contended that the appendix was not infected and that the doctors were negligent in removing it. They were also negligent, she asserted, in the manner in which they performed the appendectomy because they left a portion of the appendix in her abdomen. This, in turn, caused an infection, which required further hospitalization and caused other complications. As our discussion unfolds, it will become clear that the allegedly botched appendectomy and the resulting complications constitute the sum and substance of the injury Manov suffered in this case. Every count of the complaint, including Manov’s Georgia RICO claim, derives from the appendectomy. With this background in mind, we address the issues posed above. We begin with the dismissal of Manov’s claims against Northside in Counts III and IV. A 1. Count III alleged that Northside breached its “duty of due care to monitor and investigate the ... practice of surgery [by the Drs. Nezhat] at Northside.” Among other things, Northside failed to check the Nezhats’ credentials, protect the Nezhats’ patients from experimental and unnecessary surgery, and prevent the Ne-zhats from ordering nurses to perform medical procedures required by law to be performed by physicians. -But for such negligence, argued Manov, Drs. Farr and Camran Nezhat would not have performed the appendectomy at issue. The district court dismissed Count III pursuant to Rule 12(c) of the Federal Rules-of Civil Procedure as time barred. As noted supra, Byrne voluntarily dismissed Manov’s state court suit against Drs. Farr and Camran Nezhat and the Center on July 13, 1995, and refiled it in the district court on January 12, 1996, one day before the six month period under Georgia’s renewal statute expired. O.C.G.A. § 9-2-61. When Byrne refiled the case in the district court, he added Northside as a defendant. Georgia’s renewal statute provides that when an action is commenced in state court within the proper statute of limitations period, and the plaintiff voluntarily dismisses the action, the plaintiff may recommence the proceeding in federal court within six months after the dismissal. O.C.G.A. § 9-2-61. The district court found that the statute of limitations had expired on Manov’s negligence claim against Northside. Under Georgia law, a plaintiff must bring' a negligence action within two years of the act giving rise to the claim. O.C.G.A. § 9-3-33. Since Ma-nov underwent surgery at Northside in September 1992, her negligence claim against Northside should have been brought by September 1994. She did not bring the claim until January 1996 — thus, it was barred by the statute of limitations. The claim was not saved by Georgia’s renewal statute because the statute only suspends the running of the statute of limitations against defendants named in the original complaint. Cornwell v. Williams Bros. Lumber Co., 139 Ga.App. 773, 229 S.E.2d 551, 552 (1976); Wagner v. Casey, 169 Ga.App. 500, 313 S.E.2d 756, 758 (1984). We agree with the district court’s holdings that the statute of limitations had run on Manov’s Count III claim against Northside and that the renewal statute did not save it. Accordingly, the court did not err in dismissing the count. 2. Count IV alleged that the defendants, including Northside, violated Georgia’s RICO law by engaging in racketeering activity. The district court dismissed Northside as a Count IV defendant on the ground that Northside was not capable of committing a crime. Under Georgia law, a corporation qua corporation, cannot be held to answer for a crime, and therefore could not violate the Georgia RICO statute. O.C.G.A. § 16-2-22(a)(2); Cobb County v. Jones Group, 218 Ga.App. 149, 460 S.E.2d 516, 521 (1995). This is not to say that a corporation may disregard the law with impunity. If a crime has been committed, the agents of the corporation who are responsible are subject to prosecution. Manov’s amended complaint, however, neither alleges nor mentions which Northside agent was responsible for Northside’s violation of the Georgia RICO statute. We, therefore, find no error in the district court’s dismissal of the RICO claim against Northside. B. Having disposed of the first issue posed above, we turn to the second issue: whether the district court abused its discretion when it granted both Northside’s and the Nezhats and Center’s motions for sanctions, required Byrne and Manov to pay the defendants’ attorneys’ fees and costs, and dismissed all but one of Manov’s claims against the Nezhats and the Center. The district court took this action pursuant to three separate sources of authority: Fed.R.Civ.P. 11, 28 U.S.C. § 1927, and the court’s inherent power. In reviewing the award of sanctions, we first discuss these sources of authority. After that, we examine the award of sanctions against Byrne and Manov. Specifically, we determine whether the district court abused its discretion because, as Ma-nov contends, the court erred in concluding that the claims it dismissed (against the Nezhats and the Center) lacked a factual foundation. We have already determined that the court did not err in dismissing her claims against Northside; hence, as to that defendant, the question is whether the court abused its discretion in awarding Northside attorney’s fees and costs. We defer answering that question at this juncture because the answer becomes self-evident after we examine Ma-nov’s complaint as a whole and find it (except for Count I) baseless. 1. In considering a motion for sanctions pursuant to Fed.R.Civ.P. 11, a court conducts a two-step inquiry: “(1) whether the party’s claims are objectively frivolous; and (2) whether the person who signed the pleadings should have been aware that they were frivolous.” Baker v. Alderman, 158 F.3d 516, 524 (11th Cir.1998). When filing a pleading in federal court, an attorney “certifies that he or she has conducted a reasonable inquiry and that the pleading is well-grounded in fact, legally tenable, and ‘is not presented for any improper purpose.’ ” Id. (quoting Fed.R.Civ.P. 11(b)). Thus, if, after dismissing a party’s claim as baseless, the court finds that the party’s attorney failed to conduct a reasonable inquiry into the matter, then the court is obligated to impose sanctions even if the attorney had a good faith belief that the claim was sound. In re Mroz, 65 F.3d 1567, 1573 (11th Cir.1995). Although typically levied against an attorney, a court is authorized to issue Rule 11 sanctions against a party even though the party is neither an attorney nor the signor of the pleadings. See Souran v. Travelers Ins. Co., 982 F.2d 1497, 1508 n. 14 (11th Cir.1993) (“ ‘Even though it is the attorney whose signature violates the rule, it may be appropriate under the circumstances of the case to impose a sanction on the client.’ ” (quoting Fed. R.Civ.P. 11 advisory committee’s note)). The second source of authority for the sanctions levied in this case is 28 U.S.C. § 1927, which states: [a]ny attorney or other person admitted to conduct cases in any court of the United States or any Territory thereof who so multiplies the proceedings in any case unreasonably and vexatiously may be required by the court to satisfy personally the excess costs, expenses, and attorneys’ fees reasonably incurred because of such conduct. As the express language of section 1927 indicates, this sanctioning mechanism is aimed at the unreasonable and vexatious multiplication of proceedings. Unlike Rule 11, which is aimed primarily at pleadings, under section 1927 attorneys are obligated to avoid dilatory tactics throughout the entire litigation. Also unlike Rule 11, “awards pursuant to § 1927 may be imposed only against the offending attorney; clients may not be saddled with such awards.” United States v. Int’l B’hd of Teamsters, Chauffeurs, 948 F.2d 1338, 1345 (2d Cir.1991). The third source of authority for the award of sanctions in this case is the district court’s inherent power. This power is derived from the court’s need “to manage [its] own affairs so as to achieve the orderly and expeditious disposition of cases.” Chambers v. NASCO, Inc., 501 U.S. 32, 43, 111 S.Ct. 2123, 2132, 115 L.Ed.2d 27 (1991). The “inherent power of a court can be invoked even if procedural rules exist which sanction the same conduct.” Chambers, 501 U.S. at 46, 111 S.Ct. at 2133. One aspect of a court’s inherent power is the ability to assess attorneys’ fees and costs against the client or his attorney, or both, when either has “acted in bad faith, vexatiously, wantonly, or for oppressive reasons.” Id. at 45-46, 111 S.Ct. at 2133. This court has explained that “[t]he key to unlocking a court’s inherent power is a finding of bad faith.” Barnes v. Dalton, 158 F.3d 1212, 1214 (11th Cir.1998); see also Mroz, 65 F.3d at 1575 (“Invocation of a court’s inherent power requires a finding of bad faith.”). A court should be cautious in exerting its inherent power and “must comply with the mandates of due process, both in determining that the requisite bad faith exists and in assessing fees.” Chambers, 501 U.S. at 50, 111 S.Ct. at 2132. Because the court’s inherent power is so potent, it should be exercised “with restraint and discretion.” Id. 2. The district court awarded sanctions against Byrne and Manov because the claims in the amended complaint, apart from the malpractice claim, lacked either a legal or a factual basis and because Byrne had failed to conduct a reasonable inquiry into the factual'bases of the claims. As we have concluded, the district court properly dismissed Manov’s claims against North-side. Our ensuing discussion, therefore, concerns Manov’s claims against the Ne-zhats and the Center. The district court found those claims — in Counts II, IV, and V — lacking because “plaintiff and plaintiffs counsel have failed to conduct an investigation that is reasonable, objective and proper under the circumstances before filing ... the complaint[ ]; the [complaint] [is] replete with false and baseless claims and allegations, which plaintiff and her counsel knew or with reasonable investigation should have know [sic] to be irresponsible and baseless.” Reading this language in the light of (1) the defendants’ May 3, 1996 letter to the court, asserting that Byrne had not conducted the sort of independent pre-filing investigation required by Rule 11, and (2) the court’s June 5, 1996 order granting the defendants leave to conduct Rule 11 discovery to determine “if [Byrne had conducted an] appropriate pre-filing investigation of the facts underlying the allegations [of the complaint],” we conclude that the court did not dismiss Counts II, IV, and V because they failed to state claims recognized by the law. Rather, the court dismissed those counts because the Rule 11 discovery revealed that Byrne had not conducted the requisite pre-filing investigation to determine the truth of the factual allegations contained in Manov’s complaint. Our review of the district court’s award of sanctions necessarily begins with an analysis of the complaint, here the amended complaint. We note that, if the facts as pled failed to state a claim for relief, it was irrelevant whether Byrne conducted the requisite Rule 11 pre-filing factual investigation. Identifying Manov’s claims — in terms of their legal underpinnings — is not difficult; the heading of each count announces whether the claim is for negligence, fraud, and so forth. The problem lies in determining which factual allegations of the complaint relate to which cause of action. The amended complaint, containing 6 counts, consists of 32 pages and 126 paragraphs. The amended complaint was drafted like the original complaint, in that each of the counts following Count I incorporated by reference every paragraph, and therefore every count, preceding it. Each count added a few paragraphs, which, in turn, were incorporated into the next count. In drafting a complaint this way, the pleader inevitably incorporates into a count factual allegations, and even defendants, that are not germane to the cause of action purportedly stated in that count. Accordingly, to determine whether a claim was legally cognizable, we must strip the claims to their essentials, which, in this case, requires considerable weeding. Having done so, we conclude that Count II, fraud, Count IV, Georgia RICO, and Count V, battery, were properly dismissed because they lacked factual support. Moreover, even if we accept Count IV’s factual allegations as true, the count still fails because it failed to state a cause of action. a. The district court had no difficulty, and neither do we, in discerning the allegations that relate to Count I, the medical malpractice claim. Given the circumstances set forth above surrounding the September 1992 surgery performed by Drs. Farr and Camran Nezhat at Northside, the court properly held that Count I stated a claim for relief. b. Count II — fraud on the part of Drs. Farr and Camran Nezhat and the Center — and Count V — battery on the part of Drs. Farr, Camran, and Ceana Nezhat— are based almost exclusively on the facts giving rise to Count I. In Count II, Manov alleged that the defendants Nezhat obtained her consent to the appendectomy by fraudulently misrepresenting the potential presence of endometriosis on her appendix. In other words, the doctors knew that her appendix was healthy and lied when they told Manov that it might be infected. Their motive for lying, Manov alleged, was their “desire for continued financial gain at the expense of [Manov’s] health and safety.” In Count V, Manov alleged that the above fraudulent misrepresentation “vitiated” her consent; thus, in performing the appendectomy, the doctors committed a battery. The district court properly found that Manov consented to the appendectomy. Manov does not dispute that she signed a consent form agreeing to the procedure. Thus, a contract between Manov and Drs. Farr and Camran Nezhat (the defendants who performed the appendectomy) was formed. Mattair v. St. Joseph’s Hospital, Inc., 141 Ga.App. 597, 598, 234 S.E.2d 537 (1977). In entering into the contract, the physicians implicitly promised to exercise the care and skill required by the medical profession in the community. Id. Count I of the complaint alleged that the Drs. Farr and Camran Nezhat and the Center breached this duty of care. Under Georgia law, one who consents to a surgical procedure cannot thereafter sue the surgeon for battery. Battery is an unlawful touching, so one who consents to being touched cannot claim a battery. Manov, however, attempted to circumvent this bar by contending that the physicians procured her consent through fraud — by stating falsely that her appendix might be infected. The district court rejected Manov’s attempt because there is nothing in the record — save a bald assertion in her complaint — to support her allegation that the doctors knew in advance that her appendix was healthy • and should not be removed. In any event, the doctors statements constituted reasoned medical opinions about what they might find once the laproscopic procedure was undemay. Such statements do not amount to fraud. Cannon v. Smith, 187 Ga.App. 434, 370 S.E.2d 529, 531 (1988) (“At best, [such] allegations might establish negligence but not fraud.”). In sum, both Count II-Fraud and Count V-Battery were nothing more than thinly veiled attempts to recast the malpractice claim. As such, these counts were not factually supportable. c. Finally, we turn to the meat of Manov’s amended complaint: Count IV alleging the violation of the Georgia RICO statute by all defendants. The statute makes it “unlawful for any person” (a) ... through a pattern of racketeering activity or proceeds derived therefore, 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. (b) ... employed by or associated with any enterprise to conduct or participate in directly or indirectly, such enterprise through a pattern of racketeering activity- (c) ... to conspire or endeavor to violate any of the provisions of subsection (a) or (b) of the Code section. O.C.G.A. § 16 — 14—4. Neither Count IV nor any other part of the amended complaint cites which of these provisions the defendants allegedly violated. We rule out a violation of subsection (c) because neither the count nor the amended complaint speaks of a conspiracy. Due to the pleader’s failure to track any of the statutory language — with the exception of the words “enterprise” and “pattern of racketeering activity” — we cannot say with confidence whether Manov meant to allege a violation of subsection (a) or (b) or both. While never identifying which subsection of O.C.G.A. § 16-14-4 the defendants allegedly violated, both the original complaint and the amended complaint alleged that each defendant was an “enterprise” and engaged in a “pattern of racketeering activity.” The racketeering activity pled in the amended complaint consisted of eleven separate acts. The ensuing discussion depicts these acts in greater detail; we list them briefly here by means of an introduction. The racketeering acts were introduced with headings. The first was “18 U.S.C. 1341.” It was followed by “FALSE/FRAUDULENT BILLING,” “$200.00 INITIAL HOSPITAL CHARGE,” “SERVICES PROVIDED BY ONLY ONE PHYSICIAN,” “SERVICES PROVIDED BY NON-PHYSICIANS,” “SEVERITY OF DISEASE/’22’ MODIFIERS,” “INSURANCE FORM INFORMATION,” “ESTROPEL,” “HOSPITAL COMPLICITY,” “EVIDENCE TAMPERING,” and “INFLUENCING WITNESSES.” Finally, we note that Count IV incorporates by reference all prior counts; therefore, it includes Count I-Malpractice, Count II-Fraud, and Count III-Negligence by Northside. Counts II and III do double service in that Count IV explicitly states that they also constituted acts of racketeering. Count V, the battery count, while not incorporated by reference, nonetheless serves as the basis for an act of racketeering as well. With these observations in mind, we examine the legal sufficiency of Count IV, specifically, each act of racketeering. We dispose easily of the alleged acts of racketeering that amount to nothing more than the same fraud and battery charged in Counts II and V. Our prior discussion of these counts demonstrates they were pled without a factual basis. Similarly, the act of racketeering entitled “Hospital Complicity” is legally insufficient because, as discussed supra Part III.A.2, the pleader did not identify the Northside agent(s) responsible for the allegedly unlawful conduct. The remaining acts of racketeering are all anchored on the federal mail fraud statute, 18 U.S.C. § 1341. To determine if these acts of racketeering were pled with legal or factual sufficiency, we review this circuit’s requirements for pleading mail fraud in civil RICO cases. Mail fraud occurs when a person (1) intentionally participates in a scheme to defraud another of money or property and (2) uses the mails in furtherance of that scheme. See Pelletier, 921 F.2d at 1498; United States v. Downs, 870 F.2d 613, 615 (11th Cir.1989). Pelletier explains that in a criminal prosecution “the government ... is not required to show that the intended victim was actually deceived and suffered injury.” Id. at 1499; United States v. Dynalectric Co., 859 F.2d 1559 (11th Cir.1988). A private plaintiff, however, such as Manov, must show not only that the mail fraud statute has been violated, but that she suffered injury as a result of the violation. Pelletier, 921 F.2d at 1499-1500 (stating that “when the alleged predicate act is mail ... fraud, the plaintiff must have been a target of the scheme to defraud and must have relied to his detriment on misrepresentations made in furtherance of that scheme”). In that the mail fraud statute “has been interpreted by the Supreme Court and lower courts to include a proximate cause requirement — the plaintiffs injury must have been proximately caused by the commission of the predicate acts.” Pelletier, 921 F.2d at 1499. This court’s restrictive view of the proximate cause requirement means that a plaintiff has standing to sue only if his injury flowed directly from the commission of the predicate acts. Id; see also Gently v. Volkswagen of Am., Inc., 238 Ga.App. 785, 521 S.E.2d 13, 19 (1999). As such, a plaintiff lacks standing to assert, as the basis for mail fraud, misrepresentations directed toward another person or entity. See Johnson Enter. v. FPL Group, Inc., 162 F.3d 1290, 1313 (11th Cir.1998); see also Gentry v. Volkswagen of Am., Inc., 238 Ga.App. 785, 521 S.E.2d 13, 19 (1999) (citing Pelletier and Johnson Enterprises for the proposition that, “[t]he question is whether the injury was directly caused by any RICO violation, not whether the injury was reasonably foreseeable ... In this case, the alleged misrepresentations were directed to [a non-party, not the plaintiff] ... [Therefore,] [t]he [plaintiff] lacks standing to pursue a RICO claim based on those misrepresentations”). The following analysis of the remaining acts of racketeering reveals that they fail for either or both of the following reasons: (1) they do not state an injury to Manov or (2) they assert injuries allegedly suffered by third persons (namely Mullen). We consider these acts of racketeering in turn. One alleged act of racketeering, pled in paragraphs 59-65 of the amended complaint, was that the defendants Nezhat committed medical journal fraud. The crux of this allegation is that the Nezhats used their medical journal articles as part of a marketing scheme to obtain money by false pretenses. In short, the amended complaint alleged that the defendants Nezhat used “the popular media” to advertise falsely their credentials and success rates. In particular, it alleged that the Nezhats falsely advertised that they developed the use of “surgery via laparoscope with a picture on a television screen” and that their work produced the highest pregnancy rates ever reported. The amended complaint further alleged that the Nezhats hired a public relations firm to ensure that their surgical successes were published in the popular media and that they authored a series of medical journal articles in which they claimed to have developed new, successful procedures. According to the amended complaint, the Nezhats’ representations to the media and in their journal articles were false because (1) the Nezhats could not produce a list of patients referenced in their articles without considerable effort, and (2) potential co-authors withdrew from the articles because the Nezhats were unable to verify patient data. Manov alleged that the Nezhats devised this marketing scheme to entice patients to travel to Atlanta, and that they executed the scheme in violation of the federal mail fraud statute, 18 U.S.C. § 1341. Manov alleged that she “was attracted to Atlanta by virtue of the aforementioned scheme, which included the use of the U.S. mails in furtherance of the scheme, and was injured thereby.” Manov is not a victim of a fraudulent misrepresentation. She sought the services of the Nezhats so they could surgically alleviate her endometriosis. The Ne-zhats represented to Manov that they would perform surgery to rectify her en-dometriosis and remove her appendix if it was infected. Any alleged injury Manov suffered as a result of this representation would be the result of malpractice, not fraud. In an attempt to recover treble damages under the Georgia RICO statute, however, the amended complaint’s allegations about the Nezhats’ purported misrepresentations reach far beyond her surgery to alleviate her endometriosis — the allegations encompass utter irrelevancies. For instance, Manov’s surgery was conducted with a laparoscope; beyond this fact, there is no connection between her surgery and an allegation that the Nezhats falsely claimed to have invented laparoscopic surgery. Furthermore, claims of surgical success in medical journals and popular magazines seem more akin to puffing than actionable misrepresentations. The label attributed to the Nezhats’ statements, however, is unimportant because (1) none of the alleged misrepresentations were made to Manov, and (2) the alleged misrepresentations were unrelated to any harm suffered by Manov. Thus, insofar as Manov’s mail fraud claim is based on medical journal and media fraud, it fails as a matter of law because the facts do not support a prima facie case for fraud. Finally, we note that Neal asserted this same medical journal fraud claim as an act of racketeering in Mullen’s state court case. The Fulton County Superior Court dismissed Mullen’s RICO claim on summary judgment, and the Georgia Court of Appeals affirmed on October 22, 1996, shortly after Manov filed the amended complaint now before us. Paragraphs 66-68 of the amended complaint bore the heading “FALSE/FRAUDULENT BILLING.” None of the eleven instances of fraudulent billing listed under this heading, however, injured Manov. The amended complaint never specified how the supposed acts of fraudulent billing even related to Manov. Because “a civil RICO plaintiff must show ... that he was injured by reason of the defendant’s acts of deception,” Pelletier, 921 F.2d at 1499, this allegation fails as a matter of law. Paragraphs 69-71 of the amended complaint bore the heading “$200.00 INITIAL HOSPITAL CHARGE.” While these paragraphs alleged an injury to Manov in that she contends she was billed for a service she did not receive, this claim fails as an act of racketeering, because the allegations did not demonstrate how the billing constituted mail fraud. “When the alleged predicate act is mail ... fraud, the plaintiff must have been a target of the scheme to defraud and must have relied to his detriment on misrepresentations made in furtherance of that scheme.” Tom’s Amusement Co., Inc. v. Total Vending Serv., 243 Ga.App. 294, 533 S.E.2d 413, 419 (2000) (citing Pelletier, 921 F.2d at 1499). The amended complaint neither alleged that Manov was a target of the Nezhats’ scheme to defraud patients by billing an initial hospital charge, nor that Manov relied on the misrepresentation to her detriment and suffered harm as a result. In fact, in her deposition (taken during Rule 11 discovery), she admitted that regarding “the monies she was charged for the services that were performed by the Nezhats, ... she was not out of pocket for any of those medical services.” Furthermore, Manov’s allegations that Mullen and Judy Glatzer, another Nezhat patient, may have been billed an initial hospital charge for care they did not receive is of no moment. A