Baptist Memorial HealthCare Corporation v. CIGNA Health Care of Tennessee

CourtDistrict Court, W.D. Tennessee
DecidedAugust 26, 2024
Docket2:23-cv-02550
StatusUnknown

This text of Baptist Memorial HealthCare Corporation v. CIGNA Health Care of Tennessee (Baptist Memorial HealthCare Corporation v. CIGNA Health Care of Tennessee) is published on Counsel Stack Legal Research, covering District Court, W.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baptist Memorial HealthCare Corporation v. CIGNA Health Care of Tennessee, (W.D. Tenn. 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF TENNESSEE WESTERN DIVISION ______________________________________________________________________________

CIGNA HEALTHCARE OF TENNESSEE ) INC., on behalf of itself and ) its affiliated entities, ) ) Applicant, ) ) v. ) Case Nos. 2:23-cv-2550-JTF-tmp ) 2:23-cv-2500-JTF-tmp BAPTIST MEMORIAL HEALTH CARE ) CORPORATION, ) ) ) Respondent. )

ORDER DENYING MOTION TO REMAND; DENYING MOTION TO DISMISS; ADDRESSING ALL OUTSTANDING PROCEDURAL CHALLENGES

Before the Court are two motions and a litany of tagalong procedural issues raised in filings across the two dockets for this dispute. First is Respondent Baptist Memorial Health Care Corporation’s (“Baptist”) Motion to Remand, filed on September 26, 2023. (ECF No. 14.) Applicant Cigna Healthcare of Tennessee Inc. (“Cigna”) filed its Response on November 6, 2023, and Baptist filed its Reply on November 14, 2023. (ECF Nos. 30 & 34.) Second is Cigna’s Motion to Dismiss its initial petition to vacate, filed on September 8, 2023. (ECF No. 8.) Baptist filed its Response on October 6, 2023, and Cigna replied on November 6, 2023. (ECF Nos. 18 & 31.) For the reasons set forth below, Baptist’s Motion to Remand and Cigna’s Motion to Dismiss are DENIED; and the Court DECLINES to dismiss any part of either action based on the various procedural challenges that the parties have raised outside of these two motions. I. BACKGROUND This case and its consolidated counterpart, CIGNA Healthcare of Tennessee, Inc. v. Baptist Memorial HealthCare Corporation, Case No. 23-cv-2500-JTF-tmp, arise out of a yearslong arbitration that sprawls across thousands of pages and involves a substantial amount of money. The Court lays out the factual and procedural background in depth below.1

A. The Arbitration Agreement Pursuant to federal and state law, all hospitals are required to provide emergency services to anyone in need, regardless of whether they are insured, or their insurance provider is in a contractual relationship with the hospital. (Case No. 23-cv-2500-JTF-tmp; ECF No. 46, 5 & 7 (sealed); hereinafter, (“ECF No. 46”).) Baptist claims that Cigna wrongfully underpaid or denied altogether certain claims for out-of-network emergency services that several of its Memphis, Tennessee metro-area hospitals provided to Cigna members between 2013 and 2019. (Id. at 2.) On November 26, 2019, Baptist and Cigna contractually agreed to arbitrate this dispute (the “Arbitration”). (Id.) The First Amended Arbitration Agreement (“Arbitration Agreement”)

dated February 24, 2020 is the controlling document. (Id.) Under the Arbitration Agreement, the issue to be determined through the Arbitration was “whether Baptist was properly reimbursed for the Arbitration Claims, and if not, what is the amount Cigna owes.” (ECF No. 7-2, 539.) The Arbitration Agreement empowered the Panel “to decide all claims and defenses asserted in the arbitration, as required by law and equity.” (Id. at 541.) The Arbitration Agreement also gave the Panel the authority to bifurcate the arbitration by agreement of the Parties or by order of the Panel upon motion to promote efficiencies and resolution of the Dispute. (Id.)

1 All citations in this Order refer to the ECF docket entry numbers for Case Number 23-cv-2550 unless otherwise noted. The Parties agreed that the Panel would apply federal law to federal substantive legal issues and state law to state substantive legal issues, and that the American Arbitration Association (“AAA”) Commercial Rules would govern procedural and process-related issues. (Id. at 539.) The agreement also indicated that the Panel’s awards would be valid and binding upon the Parties, and

that any challenge to such awards may commence within 90 days of the award subject to and enforced in accordance with the Federal Arbitration Act (“FAA”). (Id. at 542.) Cigna now challenges portions of the arbitration addressing the appropriate reimbursement it owes for out-of-network health care services performed at Baptist’s hospitals. (ECF No. 14, 7.) B. Arbitration Proceedings Baptist asserted four causes of action in the arbitration: (1) a derivative claim for ERISA wrongful denial of benefits; (2) a derivative claim for breach of contract for non-ERISA claims; (3) a direct claim for quantum meruit; and (4) a claim for violation of the Tennessee Prompt Pay Act. (ECF No. 14, 8.) The Arbitration was bifurcated into multiple phases, purportedly to address the complexities of the dispute more efficiently. (Id.) Following discovery, the Phase 1 hearing

was held in February and March of 2021 and focused on underpaid claims from the “Top 16” Accounts and Counts I (breach of contract for non-ERISA plans) and IV (wrongful denial of benefits under ERISA). (ECF No. 46, 2.) Following this hearing, the Panel issued its “Phase 1 Tentative Rulings” which were subject to reconsideration at the conclusion of Phase 2. (Id. at 3 & ECF No. 13-3, 3.) On November 2, 2021, the Panel entered “Order No. 13 – Case Management for Phase 2 Hearing” (“Phase 2 CMO”) in which it exercised its authority to further bifurcate the arbitration based on its findings in Phase 1. (ECF No. 46, 3.) The Phase 2 CMO also stated that “the Phase 2 Hearing shall result in final rulings on all claims and defenses that have been addressed to date.” (Id.) The Arbitration then entered Phase 2, which culminated in a nine-day evidentiary hearing in November and December of 2021. (Id. at 4.) The Panel issued its Phase 2 “Partial Final Award” on September 7, 2022. (Case No. 23-cv-2500-JTF-tmp; ECF No. 47, 3 (sealed); hereinafter, (“ECF No. 47”).) The Phase 2 Award resolved all issues between the Parties related to liability for the

claims at issue in Phases 1 and 2, including Baptist’s derivative causes of action on behalf of Cigna members, and its quantum meruit cause of action, which it brought directly against Cigna. (ECF No. 46, 91.) The Panel found in Cigna’s favor on Baptist’s derivative causes of action. (Id.) They also determined that under Tennessee law, quantum meruit applied to the out-of-network emergency services at issue, that such relief was not preempted by ERISA, and that Cigna was liable under Baptist’s quantum meruit cause of action. (Id. at 86, 91.) However, the Panel left the determination of the reasonable value of the services provided and any additional issues for a future hearing. (Id. at 91.) On July 11, 2023, the Panel entered its “Partial Final Award for Phase 3(a).” (ECF No. 47, 2.) The purpose of Phase 3(a) was to determine the “reasonable value” of the out-of-network

emergency services Baptist was required by law to provide. (Id. at 3.) Additionally, this hearing was to address the correct reference point “for any award to Baptist, namely whether it should be expressed as a percentage of Baptist’s billed charges or rather a multiple of what Medicare would pay, and various issues relating to whether Baptist’s costs and profits should be considered in assessing reasonable value.” (Id.) The Panel ultimately determined that the value corresponding to 78.5% of Baptist’s billed charges represented the reasonable value of the out-of-network emergency services. (Id. at 17.) The Panel indicated that there would be a Phase 3(b) hearing in which they would consider whether their quantum meruit ruling would extend to “emergency inpatient” claims. (Id. at 18.) C. Procedural History On December 6, 2022, Cigna filed a “short form” petition in state court, challenging the Panel’s Phase 2 Partial Final Award. (ECF No. 7.) This filing came one day before Cigna’s three- month window for challenging a final award closed under the FAA (if the challenge window

commenced). On June 13, 2023, Cigna filed a more detailed petition after the Parties negotiated about appropriate redactions to that award.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Mason City & Fort Dodge Railroad v. Boynton
204 U.S. 570 (Supreme Court, 1907)
Shamrock Oil & Gas Corp. v. Sheets
313 U.S. 100 (Supreme Court, 1941)
Metropolitan Life Insurance v. Taylor
481 U.S. 58 (Supreme Court, 1987)
Beneficial National Bank v. Anderson
539 U.S. 1 (Supreme Court, 2003)
Aetna Health Inc. v. Davila
542 U.S. 200 (Supreme Court, 2004)
Hall Street Associates, L. L. C. v. Mattel, Inc.
552 U.S. 576 (Supreme Court, 2008)
Chase Bank USA, N.A. v. City of Cleveland
695 F.3d 548 (Sixth Circuit, 2012)
Gunn v. Minton
133 S. Ct. 1059 (Supreme Court, 2013)
Gregerson v. Vilana Financial, Inc.
446 F. Supp. 2d 1053 (D. Minnesota, 2006)
Farmers-Peoples Bank v. Clemmer
519 S.W.2d 801 (Tennessee Supreme Court, 1975)
Loubna Naji v. Andrew Lincoln
665 F. App'x 397 (Sixth Circuit, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
Baptist Memorial HealthCare Corporation v. CIGNA Health Care of Tennessee, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baptist-memorial-healthcare-corporation-v-cigna-health-care-of-tennessee-tnwd-2024.