Baylor University Medical Center v. Epoch Group, L.C.

340 F. Supp. 2d 749, 33 Employee Benefits Cas. (BNA) 2603, 2004 U.S. Dist. LEXIS 16381, 2004 WL 1856833
CourtDistrict Court, N.D. Texas
DecidedAugust 18, 2004
DocketCiv.A.3:03-CV-2392-G
StatusPublished
Cited by17 cases

This text of 340 F. Supp. 2d 749 (Baylor University Medical Center v. Epoch Group, L.C.) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baylor University Medical Center v. Epoch Group, L.C., 340 F. Supp. 2d 749, 33 Employee Benefits Cas. (BNA) 2603, 2004 U.S. Dist. LEXIS 16381, 2004 WL 1856833 (N.D. Tex. 2004).

Opinion

MEMORANDUM ORDER

FISH, Chief Judge.

Before the court is the motion of the defendant Epoch Group, L.C. (“Epoch”) for summary judgment against the plaintiffs Baylor University Medical Center, Our Children’s House at Baylor, Baylor Medical Center at Grapevine, Baylor Medical Center—Irving, and Baylor All Saints Medical (collectively, “Baylor” or “the plaintiffs”), pursuant to Fed. R. Civ. P. 56, or to dismiss the plaintiffs’ claims, pursuant to Fed. R. Crv. P. 12(b)(6). For the reasons set forth below, Epoch’s motion is denied.

I. BACKGROUND

Baylor brought this breach of contract suit against Epoch to recover for medical services it provided to Efrain Delgado and Albertina Delgado (“the Delgados”). See *752 Plaintiffs’ First Amended Complaint (“Complaint”) ¶¶ 4-5. The Delgados, who are participants in an employee welfare benefit plan (“the Plan”) sponsored by Van Enterprises, Inc. (“Van Enterprises”), received medical services from Baylor during the period of December 2001 to June 2002. See Defendant’s Brief in Support of Third Motion to Dismiss/For Summary Judgment (“Motion”) at 3, 4. Epoch, who serves as the “Claims Supervisor for the Plan,” id. at 3, has not paid Baylor for medical services rendered to the Delgados. See id. at 5; see also Plaintiffs’ Brief in Support of Response to Epoch’s Third Motion to Dismiss/For Summary Judgment (“Response”) at 3; Complaint ¶¶ 4,11-15.

Epoch entered into a contract, the Subscriber Services Agreement, with Private Healthcare Systems, Inc. (“PHCS”), effective January 24, 2001. See generally Subscriber Services Agreement, attached to Complaint as Exhibit C. Pursuant to that agreement, Epoch received financial incentives to encourage participants in the Plan to choose treatment from medical providers in the PHCS network of providers. See Motion at 4. Baylor became a part of the PHCS network of providers by signing a Hospital Services Agreement with PHCS, effective January 1, 2002. See Complaint ¶ 5; Motion at 4; see also Hospital Services Agreement at 1, attached to Complaint as Exhibit 2. Pursuant to this agreement, individuals participating in a PHCS-related health plan gain access to Baylor’s hospitals and other health care services. See Complaint ¶ 5; Motion at 4.

The Hospital Services Agreement, ¶ 2.2, requires that PHCS enter into Payor Acknowledgments with its “Payors,” 1 including Epoch, 2 for use of the PHCS provider network. See Complaint ¶ 6. The Hospital Services Agreement provides:

PHCS represents and warrants that it has entered into Payor Acknowledgments with Payors for the use of the PHCS provider network.... Each Payor Acknowledgment between PHCS and a Payor will obligate the Payor (or its designee) to comply with the duties and obligations of this Agreement, including, but not limited to, paying for Covered Services rendered to Members ....

Hospital Services Agreement ¶ 2.2. This agreement also requires Payors to timely pay all clean claims within forty-five calendar days from receipt of the claim:

If Payor (directly or through its desig-nee) does not pay within forty-five (45) days of receipt of a Clean Claim, Payor shall no longer be eligible for the rates set forth on Schedule 1 and shall be obligated to pay Hospital at Hospital’s Normal Billed Charges and Hospital may elect to terminate this Agreement. ...

Id. ¶ 4.4(a); see also Complaint ¶¶ 8-9.

Epoch signed a Payor Acknowledgment on January 29, 2001. See Payor Acknowledgment, attached to Subscriber Services Agreement as Exhibit L. In doing so, Epoch contracted with PHCS “to: (i) pay or arrange to pay PHCS Preferred Providers in accordance with the PHCS Preferred Provider Agreement for such Preferred Provider; and (ii) comply with the applicable terms and conditions of the PHCS Preferred Providers Agreements.... ” Id. ¶ 1.2; see also Complaint ¶ 7.

*753 Baylor alleges that-despite submitting its claims to Epoch for the medical care it provided to the Delgados, Epoch has not paid the charges contractually due. See Complaint ¶ 10. Consequently, on September 11, 2003, Baylor University Medical Center and Our Children’s House at Baylor (together, “the Original Plaintiffs”) filed suit against Epoch in the County Court at Law No. 4 of Dallas County, Texas, asserting a claim for breach of contract. See Plaintiffs’ Original Petition (“Original Petition”), 3 attached to Amended Notice of Removal as Exhibit A-l.

On October 14, 2003, Epoch removed the case to this court pursuant to 28 U.S.C. § 1441. Epoch argues that the court has diversity jurisdiction under 28 U.S.C. § 1332(a), and that the court' has federal question jurisdiction over Baylor’s claims under 28 U.S.C. § 1331 because those claims are completely preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq. See Amended Notice of Removal ¶¶ 3, 4. The plaintiffs concede that there is diversity jurisdiction, as each of the plaintiffs is a Texas non-profit corporation and Epoch is a foreign corporation, and the amount in controversy exceeds $75,000. Response at 2; see also Complaint ¶¶ 1-2. The plaintiffs contest, however, that this court has federal question jurisdiction. Response at 2.

On May 5, 2004, the Original. Plaintiffs, now joined by the newly added plaintiffs Baylor Medical Center at Grapevine, Baylor Medical Center—Irving, and Baylor All Saints Medical, filed their first amended complaint, asserting claims for breach of contract and late payment of claims. See generally Complaint. Baylor seeks recovery of over $115,000 in damages. See id. ¶¶ 11-17. Summarizing its argument, Baylor asserts:

[bjased upon its execution of the Payor Acknowledgment arid the Subscriber Sendees Agreement, Epoch agreed to be bound by the terms and conditions of the Hospital Services Agreement between Baylor and [PHCS] ..., which included paying for health care services rendered to certain individuals' on a timely basis.

Id. ¶ 4.

On May 24, 2004, Epoch filed the instant motion for summary judgment under Fed. R. Crv. P.

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Bluebook (online)
340 F. Supp. 2d 749, 33 Employee Benefits Cas. (BNA) 2603, 2004 U.S. Dist. LEXIS 16381, 2004 WL 1856833, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baylor-university-medical-center-v-epoch-group-lc-txnd-2004.