Aton Center, Inc. v. Carefirst Bluecross Blueshield

District Court, S.D. California·Decided August 3, 2020·No. 3:20-cv-00541·Unknown

Opinion

ATON CENTER, INC., a Case No.: 3:20-cv-00541-WQH-BGS California corporation, Plaintiff, v. CAREFIRST BLUECROSS BLUESHIELD, a corporation; and DOES 1 through 10, inclusive, Defendants. HAYES, Judge: The matter pending before the Court is the Motion to Dismiss filed by Defendants CareFirst of Maryland, Inc., d/b/a CareFirst BlueCross BlueShield; Group Hospital and Medical Services, Inc., d/b/a CareFirst BlueCross BlueShield; and CareFirst BlueChoice, Inc., d/b/a CareFirst BlueCross BlueShield (all erroneously sued as CareFirst BlueCross BlueShield). (ECF No. 6). On February 24, 2020, Plaintiff Aton Center, Inc. commenced this action by filing a Complaint in the Superior Court of California for the County of San Diego, assigned case number 37-2020-00010069-CU-BC-NC, against Defendant CareFirst BlueCross BlueShield and DOES 1 through 10. See ECF No. 1-5 at 2. Plaintiff alleges that Defendants “breached their agreements with Plaintiff and/or committed other wrongful acts and omissions by refusing to pay Plaintiff the represented and agreed upon/represented amount, but rather paid different and significantly lower (and inconsistent) amounts for treatment, leaving an unpaid balance of $238,309.12 owing from Defendants to Plaintiff which has caused Plaintiff substantial hardship.” Id. at 4. Plaintiff brings the following eight causes of action: (1) breach of contract (oral agreement); (2) breach of contract (implied contract); (3) promissory estoppel; (4) quantum meruit; (5) intentional misrepresentation; (6) negligent misrepresentation; (7) intentional concealment; and (8) violation of Business & Professions Code § 17200. See id. at 4-11. Plaintiff seeks “general, special, restitutionary and/or compensatory damages”; prejudgment interest; expenses, attorney’s fees, “and other costs”; “an injunction prohibiting the conduct alleged herein and/or the appointment of a receiver over Defendants”; and “other and further relief as the Court may deem just and proper.” Id. at 11. On March 23, 2020, Defendants CareFirst of Maryland, Inc., d/b/a CareFirst BlueCross BlueShield (“CareFirst of Maryland”); Group Hospital and Medical Services, Inc., d/b/a CareFirst BlueCross BlueShield (“Group Hospital”); and CareFirst BlueChoice, Inc., d/b/a CareFirst BlueCross BlueShield (“CareFirst BlueChoice”) (all erroneously sued as CareFirst BlueCross BlueShield) removed the action to this Court pursuant to 28 U.S.C. § 1332, diversity jurisdiction, 28 U.S.C. § 1441(b), and 28 U.S.C. § 1446. See ECF No. 1 at 2. On April 23, 2020, Defendants CareFirst of Maryland, Group Hospital, and CareFirst BlueChoice and filed a Motion to Dismiss Plaintiff’s Complaint for lack of personal jurisdiction pursuant to Federal Rule of Civil Procedure 12(b)(2). (ECF No. 6). On June 1, 2020, Plaintiff filed a Response in opposition. (ECF No. 9). On June 5, 2020, Defendants filed a Reply. (ECF No. 10). On the same day, Defendants filed an Objection. (ECF No. 11). “Plaintiff is a corporation authorized to do and doing business in the City of Encinitas, County of San Diego, State of California … as an inpatient residential substance abuse treatment facility ….” (ECF No. 1-5 at 2). Plaintiff “provided residential treatment care services which were or should have been covered by health insurance policies which … were provided, sponsored, supplied, underwritten, administered and/or implemented by Defendants ….” Id. at 2-3. “Defendant CareFirst BlueCross BlueShield … is a corporation authorized to do and doing substantial insurance and/or health plan/policy administration business in the city of Encinitas, county of San Diego, and state of California, within the jurisdiction of this court.” Id. at 3 (emphasis omitted). Plaintiff’s “patients were insured under health insurance policies/plans issued by … Defendants ….” Id. “While the subject plans/policies were in effect, patients who were insured under plans issued by Defendants sought treatment with Plaintiff.” Id. “Plaintiff took reasonable steps to verify available benefits, … including calling Defendants at the phone number provided by the Defendants ….” Id. at 3-4. Plaintiff “was advised in these verification of benefit ([“]VOB[”]) calls that the policies provided for and Defendants would pay for inpatient treatment, based on the usual, customary and reasonable rate ([“]UCR[”]) and/or prior payment history.” Id. at 4. “UCR is a certain and well-known term of art, and methodology for determining a payment rate, in the health care industry.” Id. “Plaintiff admitted and treated the patients and submitted claims for payment in accordance with these representations and agreements.” Id. “Based on the representations that the payment would be based on the UCR, prior payment history, authorization and agreement of the Defendants …, Plaintiff provided the agreed upon services and has performed all conditions, covenants and promises required to be performed in accordance with the agreements referred to herein above except, if applicable, those that have been excused, waived or are otherwise inapplicable.” Id. “Defendants breached their agreements with Plaintiff and/or committed other wrongful acts and omissions by refusing to pay Plaintiff the represented and agreed upon/represented amount, but rather paid different and significantly lower (and inconsistent) amounts for treatment, leaving an unpaid balance of $238,309.12 owing from Defendants to Plaintiff which has caused Plaintiff substantial hardship.” Id. “[A]t the time benefits were verified[,] Defendants had information regarding the different/lower daily payment amounts but withheld that information from Plaintiff.” Id. “[A]n unconscionable injury would result to Plaintiff if Defendants are not required to pay the represented/agreed to payment rate based on the UCR and payment history ….” Id. Defendants are “equitably estopped from denying the agreement/obligation to pay that amount.” Id. Under Federal Rule of Civil Procedure 12(b)(2), a defendant may move to dismiss a complaint for lack of personal jurisdiction. See Fed. R. Civ. P. 12(b)(2). In opposing a defendant’s Rule 12(b)(2) motion, “the plaintiff bears the burden of establishing that jurisdiction is proper.” Boschetto v. Hansing, 539 F.3d 1011, 1015 (9th Cir. 2008) (citing Sher v. Johnson, 911 F.2d 1357, 1361 (9th Cir. 1990)). Where the court considers the motion without holding an evidentiary hearing, “the plaintiff need only make a prima facie showing of jurisdictional facts to withstand the motion to dismiss.” Mavrix Photo, Inc. v. Brand Techs., Inc., 647 F.3d 1218, 1223 (9th Cir. 2011) (citing Brayton Purcell LLP v. Recordon & Recordon, 606 F.3d 1124, 1127 (9th Cir. 2010), abrogated on other grounds as recognized by Axiom Foods, Inc. v. Acerchem Int’l, Inc., 874 F.3d 1064 (9th Cir. 2017)). “The plaintiff cannot ‘simply rest on the bare allegations of its complaint,’ but uncontroverted allegations in the complaint must be taken as true.” Id. (quoting Schwarzenegger v. Fred Martin Motor Co., 374 F.3d 797, 800 (9th Cir. 2004)). “[W]e may not assume the truth of allegations in a pleading which are contradicted by affi

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Aton Center, Inc. v. Carefirst Bluecross Blueshield, (S.D. Cal. 2020).

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