Abira Medical Laboratories, LLC v. Cigna Health And Life Insurance Company

CourtDistrict Court, D. Connecticut
DecidedSeptember 30, 2024
Docket3:23-cv-00830
StatusUnknown

This text of Abira Medical Laboratories, LLC v. Cigna Health And Life Insurance Company (Abira Medical Laboratories, LLC v. Cigna Health And Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Abira Medical Laboratories, LLC v. Cigna Health And Life Insurance Company, (D. Conn. 2024).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

ABRIA MEDICAL LABORATORIES, LLC d/b/a GENESIS DIAGNOSTICS, Plaintiff, No. 3:23-cv-830 (VAB) v.

CIGNA HEALTH AND LIFE INSURANCE COMPANY, AND ITS AFFILIATES, ABC COMPANIES 1-100, AND JOHN DOES 1- 100, Defendants.

RULING AND ORDER ON DEFENDANT’S MOTION TO DISMISS AMENDED COMPLAINT Abria Medical Laboratories, LLC, d/b/a Genesis Diagnostics (“Genesis” or “Plaintiff”) filed this Amended Complaint by and through its attorneys against Cigna Health and Life Insurance Company, and its affiliates, ABC Companies 1-100 and John Does 1-100 (“Cigna” or “Defendants”) for breach of contract (Count I), breach of implied covenant of good faith and fair dealing (Count II), violation of the Families First Coronavirus Response Act (“FFCRA”) and Coronavirus Aid, Relief, and Economic Security (“CARES”) Act (Count III), fraudulent and negligent misrepresentation, equitable and promissory estoppel, unjust enrichment (Count IV), violation of the Connecticut Unfair Trade Practices Act and the Connecticut Unfair Insurance Practices Act (Count V), and violation of ERISA § 502(a)(1)(B) and 29 U.S.C. 1132(a)(1)(B)– Claim for Benefits (Count VI). Defendants have filed a motion to dismiss all counts of Plaintiff’s Amended Complaint. Mot. To Dismiss the Amd. Compl. By Cigna, ECF No. 37 (“Mot.”). For the following reasons, the motion to dismiss is GRANTED, and this case is dismissed with prejudice. I. FACTUAL AND PROCEDURAL BACKGROUND A. Factual Allegations

From the start of the COVID-19 pandemic, Genesis allegedly offered diagnostic testing for the detection of the virus that causes COVID-19, as part of their commitment to combat the COVID-19 pandemic. Amended Complaint, ECF No. 32 ¶ 20 (“Amd. Compl.”). Genesis alleges that these testing services were medically necessary and appropriate, according to recognized medical standards and standards announced by Congress and the Department of Health and Human Services. Id. ¶ 21. Genesis alleges that Cigna blatantly disregarded their express obligation to pay Genesis. Id. ¶ 13. Genesis alleges that Cigna engaged in a years-long campaign designed to deprive Plaintiff of millions of dollars rightfully owed it for services rendered to Cigna’s subscribers/members. Id. ¶ 14. Genesis also alleges that, to advance this campaign, Cigna failed

to respond at all to properly submitted claims or manufactured from whole cloth some other bases to improperly refuse to make payment to Plaintiff. Id. Cigna allegedly provided the following meritless reasons for refusing to process Genesis’s claims for payment: (i) lack of adequate claim information provided by Genesis; (ii) untimely filing of claims; and (iii) lack of coverage by the subscriber/member for the services provided. Id. ¶ 15. According to Genesis, this alleged refusal to process and pay on these bases was groundless and constitutes a material breach of Cigna’s payment obligations. Id. ¶ 16. Congress allegedly prohibited health plans and health insurance issuers from imposing any prior authorization or other medical management requirements on testing for the diagnosis of COVID-19. Id. ¶ 17. And Cigna’s actions allegedly were the antithesis of what Congress intended. Id.

Cigna allegedly has failed to pay or underpaid Genesis for COVID-19 diagnostic testing that Genesis has provided and continues to provide to Cigna’s subscribers and/or members. Id. ¶ 18. Instead, Defendants allegedly violated the FFRCA and CARES Act and acted in bad faith by erecting hurdles to payment without justification and/or for immaterial reasons unrelated to the medical necessity of the testing. Id. Genesis allegedly had every expectation that Cigna would honor their obligations and properly reimburse Genesis for the COVID-19 testing services it provided to Cigna’s subscribers and/or members. Id. ¶ 19. Genesis allegedly has been harmed by Cigna’s failure to pay and/or underpayment of valid COVID-19 testing claims that Genesis submitted to Cigna for reimbursement for services to Cigna’s subscribers/members. Id.

According to Genesis, Cigna’s alleged failure to properly reimburse for COVID-19 testing services violates the reimbursement rules set out in the text of the FFCRA and CARES Act and in a series of “Frequently Asked Questions” (“FAQs”) documents issued and publicly posted by the federal Department of Health and Human Services (“HHS”). Id. ¶¶ 22-28. Cigna allegedly has a duty to engage in good faith and fair dealing, and allegedly breached these duties, causing Genesis to suffer damages.1 Id. ¶ 29.

1 Specifically, Genesis alleges that “In New Jersey, Defendants have a duty to acknowledge and promptly adjudicate claims, in addition to their duties to engage in good faith and fair dealing . . .”. The Court acknowledges that this is most likely a typo that is left over from this case’s former procedural posture in the District of New Jersey. The State of Connecticut does not impose such a “duty to acknowledge and promptly adjudicate claims,” however it does impose a duty to engage in good faith and fair dealing. See Hoskins v. Titan Value Equities Group, Inc., 749 A.2d 1144, 1146 (Conn. 2000) (“It is axiomatic that the implied duty of good faith and fair dealing is a covenant implied into a contract or a contractual relationship.). B. Procedural History On September 20, 2022, Genesis filed a Complaint against Cigna in the Superior Court of the State of New Jersey, Bergen County, Law Division. Abira Medical Laboratories, LLC d/b/a Genesis Diagnostics v. Cigna Health and Life Insurance Company, and its Affiliates, ABC

Companies 1-100 and John Does 1-100, Case No. BER-L-005079-22; see Not. of Removal, ECF No. 1 at 1-2. On November 1, 2022, Cigna filed a notice of removal from the Superior Court of the State of New Jersey-Bergen County to the District Court of New Jersey. Not. of Removal, ECF No. 1. On November 22, 2022, Cigna filed a motion to dismiss the Complaint, or in the alternative, transfer venue in the District Court of New Jersey. Mot. to Dismiss Compl. of in the Alternative Transfer Venue by Cigna, ECF No. 6. On January 20, 2023, Genesis filed a brief in opposition to Cigna’s motion to dismiss in the District Court of New Jersey. Brief in Opp’n by Genesis, ECF No. 10.

On February 14, 2023, Cigna filed a reply brief to Genesis’s brief in opposition in the District Court of New Jersey. Reply Brief to Opp’n to Mot., ECF No. 13. On March 16, 2023, Judge Evelyn Padin of the District of New Jersey granted Cigna’s motion to dismiss, to the extent that it required transfer of this case to the District of Connecticut. Order Granting Mot. to Dismiss, ECF No. 16. On March 16, 2023, the District of New Jersey transferred this case to the District of Connecticut. ECF No. 17. On June 20, 2023, this Court filed a notice that “any pending motions at the time of transfer must be refiled in our district.” ECF No. 22. On September 18, 2023, Cigna refiled their motion to dismiss the Complaint. Mot. to Dismiss Compl. per the Court’s 6/20/2023 Notice 22 by Cigna, ECF No. 28. On October 17, 2023, Genesis filed a motion to amend their Complaint. Motion to Amend/Correct, ECF No. 30.

On October 18, 2023, the Court granted Genesis’ motion to amend their Complaint. Order Granting Motion to Amend/Correct, ECF No. 31. On October 18, 2023, Genesis filed their Amended Complaint. Amd. Compl. On January 8, 2024, Cigna filed a motion to dismiss the Amended Complaint. Mot. On February 12, 2024, Genesis filed a memorandum in opposition of Cigna’s motion to dismiss. Memo in Opp’n re Mot. to Dismiss Amd. Compl., ECF No. 41 (“Opp’n”). On March 11, 2024, Cigna filed a reply to Genesis’ memorandum in opposition of Cigna’s motion to dismiss. Reply to Response to Mot. to Dismiss Amd. Compl., ECF No. 44 (“Reply”).

II.

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