Abira Medical Laboratories LLC v. Meritain Health, Inc.

CourtDistrict Court, E.D. Pennsylvania
DecidedMarch 30, 2026
Docket2:24-cv-03140
StatusUnknown

This text of Abira Medical Laboratories LLC v. Meritain Health, Inc. (Abira Medical Laboratories LLC v. Meritain Health, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania 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. Meritain Health, Inc., (E.D. Pa. 2026).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA

ABIRA MEDICAL LABORATORIES LLC, Plaintiff, Civil No. 24-3140

v.

MERITAIN HEALTH, INC., Defendant.

MEMORANDUM COSTELLO, J. March 30, 2026 Plaintiff Abira Medical Laboratories (“Abira”) performed medical laboratory testing on samples taken from patients insured by Defendant Meritain Health, Inc. (“Meritain”). Abira brought this action after Meritain allegedly refused to pay or underpaid the claims Abira submitted. In its Second Amended Complaint, Abira asserts four causes of action: (1) ERISA benefits; (2) breach of contract for non-ERISA claims, (3) breach of the implied covenant of good faith and fair dealing for non-ERISA claims, and (4) quantum meruit/unjust enrichment for non-ERISA claims. Abira also seeks punitive damages. Meritain has moved to dismiss all claims. For the reasons that follow, the Court will grant Meritain’s motion. I. BACKGROUND Abira performed “clinical laboratory, pharmacy, genetics, addiction rehabilitation, and COVID-19 testing services on specimens submitted by medical service providers” on behalf of Meritain’s insureds. ECF No. 30 ¶ 8. It now seeks payment related to 102 claims based on a purported assignment of benefits in the requisitions, which stated: I hereby assign all rights and benefits under my health plan and direct payments be made to Genesis Diagnostics for laboratory services furnished to me by Genesis Diagnostics. I irrevocably designate authorize and appoint Genesis Diagnostics or its assigned affiliates as my true and lawful attorney-in-fact for the purpose of submitting my claims and pursuing any request, disclosure, appeal, litigation or other remedies in accordance with the benefits and rights under my health plan and in accordance with any federal or state laws.

Id. ¶¶ 9-10. As part of Abira’s business practice and third-party physician requirements, each of the patients referenced in Exhibit 1 of the Second Amended Complaint (“SAC”) “executed or should have executed” an assignment of benefits. Id. ¶ 11. After Abira submitted the claims to Meritain for payment, Meritain allegedly improperly refused to pay. Id. ¶ 15. Abira suggests that Meritain’s refusal to pay was “groundless,” deprived it of thousands of dollars, and is a breach of Meritain’s payment obligations. Id. This Court previously granted Meritain’s motion to dismiss the initial complaint in part, after which Abira filed an Amended Complaint. ECF Nos. 16 & 20. The Court directed the parties to meet and confer regarding any renewed motion to dismiss. ECF No. 26. The Court granted the parties’ request for a schedule that would allow Meritain to produce all plan documents related to the claims in the Amended Complaint before Abira filed its Second Amended Complaint (“SAC”). ECF Nos. 27 & 28. Abira filed its SAC seeking benefits for 102 total claims. ECF No. 30. Of these claims, 62 are related to ERISA plans, 15 claims are Medicare Advantage claims, and Meritain cannot identify the remaining 25 claims. Additionally, 27 plans governing 60 of the 62 ERISA claims contain anti-assignment provisions. ECF No. 31-1 at 2; ECF No. 31-2 at 2-5. Meritain moves to dismiss the SAC in its entirety. In part, Meritain challenges Abira’s standing to bring its ERISA claims, the Court’s subject matter jurisdiction over the Medicare Advantage claims, and the factual sufficiency of the remaining claims and requested punitive damages. See generally ECF No. 31. Abira opposed the motion after this Court ordered it to respond. ECF Nos. 35 & 36. II. LEGAL STANDARD To survive a motion to dismiss, a complaint must include sufficient factual matter, taken

as true, to show that the claim is facially plausible. See Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 556 (2007)). “Factual allegations must be enough to raise a right to relief above the speculative level.” Id. at 555. “Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Iqbal, 556 U.S. at 678. Assessing plausibility under Twombly requires three steps. See Connelly v. Lane Const. Corp., 809 F.3d 780, 787 (3d Cir. 2016). First, the Court must “take note of the elements the plaintiff must plead to state a claim.” Id. (internal quotations and alterations omitted). Next, the

Court must “identify allegations that, ‘because they are no more than conclusions, are not entitled to the assumption of truth.’” Id. (quoting Iqbal, 556 U.S. at 679). Finally, the Court must accept as true all “‘well-pleaded factual allegations,’” draw all reasonable inferences from those allegations, and “‘determine whether they plausibly give rise to an entitlement to relief.’” Id. (quoting Iqbal, 556 U.S. at 679) (alterations omitted). “If the well-pleaded facts do nut nudge the ‘claims across the line from conceivable to plausible,’ the Court must dismiss the complaint.” Lynch v. Tasty Baking Co., 23-4445, 2024 WL 967842, at *2 (E.D. Pa. Mar. 6, 2024) (quoting Twombly, 550 U.S. at 570). III. DISCUSSION A. ERISA Claims Meritain first moves to dismiss Abira’s ERISA claims, arguing that the Court lacks subject matter jurisdiction because Abira lacks both Article III standing and derivative standing

due to enforceable anti-assignment provisions. Meritain also contends that Abira otherwise failed to plead a plausible ERISA claim. 1. Standing and Anti-Assignment Provisions Although Federal Rule of Civil Procedure 12(b)(1) ordinarily governs motions to dismiss for lack of standing, the Third Circuit has clarified that “whether a party has derivative standing to file an ERISA claim ‘involves a merits-based determination,’ such that a motion to dismiss for lack of ERISA standing — like the one at issue — is ‘properly filed under Rule 12(b)(6).’” Univ. Spine Ctr. v. Aetna, Inc., 774 F. App’x. 60, 62 n. 1 (3d Cir. May 16, 2019). ERISA authorizes suit by “participants” and “beneficiaries” of ERISA plans, but “health care providers may obtain standing to sue by assignment from a plan participant.” CardioNet,

Inc. v. Cigna Health Corp., 751 F.3d 165, 176 n.10 (3d Cir. 2014); see also N. Jersey Brain & Spine Ctr. v. Aetna, Inc., 801 F.3d 369, 372 (3d Cir. 2015) (“[W]hen a patient assigns payment of insurance benefits to a healthcare provider, that provider gains standing to sue for that payment under ERISA § 502(a).”). “[A]nti-assignment clauses in ERISA-governed health insurance plans as a general matter are enforceable.” Am. Orthopedic & Sports Med. v. Indep. Blue Cross Blue Shield, 890 F.3d 445, 453 (3d Cir. 2018). This is because “a plan trustee can limit the ability of a beneficiary to assign claims because, among the parties’ ‘power to limit the rights created by their agreement,’. . . is the power to restrict ownership interest to particular holders.” Id. at 454-45 (citing Restatement (Second) of Contracts § 322 cmt. a (1981)). Abira brings 62 claims for ERISA benefits based on alleged assignments.

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Abira Medical Laboratories LLC v. Meritain Health, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/abira-medical-laboratories-llc-v-meritain-health-inc-paed-2026.