BERMUDEZ v. BLUE CROSS & BLUE SHIELD OF NEW JERSEY

CourtDistrict Court, D. New Jersey
DecidedJuly 21, 2020
Docket1:19-cv-21637
StatusUnknown

This text of BERMUDEZ v. BLUE CROSS & BLUE SHIELD OF NEW JERSEY (BERMUDEZ v. BLUE CROSS & BLUE SHIELD OF NEW JERSEY) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
BERMUDEZ v. BLUE CROSS & BLUE SHIELD OF NEW JERSEY, (D.N.J. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY CAMDEN VICINAGE

: FELOGINA BERMUDEZ, : : Plaintiff, : Civil No. 19-21637 (RBK/KMW) : v. : OPINION : BLUE CROSS AND BLUE SHIELD OF : NEW JERSEY, : :

: Defendant. : : :

KUGLER, United States District Judge: This matter comes before the Court upon Defendant’s Motion to Dismiss (Doc. 2). For the reasons expressed herein, Defendant’s motion is GRANTED. I. BACKGROUND1 This action arises out of Plaintiff Felogina Bermudez’s employment with and subsequent termination from Defendant Horizon Healthcare Services, Inc. d/b/a Horizon Blue Cross Blue Shield of New Jersey (“Defendant”). Plaintiff alleges that, after twenty-seven years of employment, Defendant terminated her because of her age and in retaliation for her reporting of various fraudulent activities. (Doc. 1-1 (“Compl.”) ¶48.) Plaintiff began working for Defendant in November 1991; she was promoted several times throughout her employment and received high scores on her performance reviews in 2016 and 2017. (Compl. ¶¶11, 41–42.) At the time of her firing, Plaintiff was a Medical Policy Analyst. (Id.

1 On this motion to dismiss, the Court accepts as true the well-pleaded facts in the operative Complaint (Doc. 1-1) and construes them in the light most favorable to Plaintiff. See Phillips v. Cty. of Allegheny, 515 F.3d 224, 231 (3d Cir. 2008). ¶11.) Within Plaintiff’s department, there were two other Medical Policy Analysts and two Medical Utilization Analysts, all of whom performed essentially the same tasks. (Id. ¶30.) All employees within this division reported to Alicia Springer, the manager of the Service Division. (Id. ¶11.) Beginning in early 2018, Plaintiff began to question some of the actions her superiors took.

(Compl. ¶¶11–13.) According to Plaintiff, both Ms. Springer and Elizabeth Ferrara, a Medical Utilization Analyst, gave directives that contradicted federal medical rules and regulations. (Id. ¶12.) Plaintiff recounts several incidents from April to August 2018 where, under the guidance of Ms. Springer and Ms. Ferrara, Defendant gave lifetime approval for high dollar specialty drugs, approved opioid medications indefinitely, and approved specialty drug use for patients who did not have recent or sufficient medical records. (Id. ¶13.) Plaintiff discussed her concerns about this allegedly fraudulent behavior with Ms. Springer and Ms. Ferrara on several occasions. (Id. ¶¶14– 17.) During a May 14, 2018 phone call with Ms. Springer, Plaintiff was advised not to report any fraud directly, but to submit any concerns to Ms. Springer. (Id. ¶15.) On August 2, 2018, Plaintiff

was given a poor score on her mid-year performance review despite her productivity being above the team average. (Id. ¶16.) During this review, Ms. Springer told Plaintiff, “I don’t expect you to be here by the end of the year.” (Id.) In the fall of 2018, Plaintiff was reprimanded for insubordination and received a written warning. (Compl. ¶¶20, 22.) On November 29, 2018, Plaintiff reported her concerns regarding the allegedly fraudulent behavior. (Id. ¶23.) On December 3, 2018, Ms. Springer discontinued the work-from-home privileges that Plaintiff had enjoyed since 2007. (Id. ¶45.) Three days later, Defendant terminated Plaintiff’s employment, citing reorganization. (Id. ¶25.) Out of the three Medical Policy Analysts in her department, Plaintiff was the only one fired; however, nineteen total employees were terminated. (Id. ¶¶25, 35; Compl. Ex. F at 32–40.) Plaintiff was told she was selected for termination after Defendant’s consideration of “business needs, job performance, skill set, and position elimination.” (Id. ¶35.) At the time of her termination, Plaintiff was the oldest and most experienced Medical Policy Analyst reporting to Ms. Springer. (Id. ¶¶32, 39.) On December 6, 2018, Plaintiff was given a four-page form titled Waiver and Release

Agreement (“the Agreement”). (Compl. ¶¶26–27; Compl. Ex. D at 21.) Plaintiff signed the Agreement on January 10, 2019. (Compl. ¶26.) Under the terms of the Agreement, Plaintiff waived and released all claims arising out of her employment and separation through the date of the agreement. (Compl. Ex. D at 21.) In return, the Agreement stated that Plaintiff would receive a $57,173 lump sum severance payment. (Id.) On May 30, 2019, Defendant hired a new, younger employee to perform Plaintiff’s previous job. (Compl. ¶27.) On November 6, 2019, Plaintiff filed suit pro se against Defendant in the Superior Court of New Jersey, alleging violations of the Conscientious Employee Protection Act (“CEPA”), the Age Discrimination in Employment Act (“ADEA”), and the New Jersey Law Against

Discrimination (“NJLAD”). (Compl. ¶¶49–64.) Plaintiff alleges that Defendant impermissibly terminated her based on her age, as well as in retaliation for her reporting allegedly fraudulent activity. (Id.) On December 19, 2019, Defendant removed the matter to this Court, and on December 20, 2019 it filed a motion to dismiss. (Docs. 1, 2.) II. LEGAL STANDARD When deciding a motion to dismiss a complaint pursuant to Federal Rule of Civil Procedure 12(b)(6), the court limits its review to the face of the complaint. Barefoot Architect, Inc. v. Bunge, 632 F.3d 822, 835 (3d Cir. 2011). The Court must accept as true all well-pleaded factual allegations and must construe them in the light most favorable to the plaintiff. Phillips v. Cnty of Allegheny, 515 F.3d 224, 228 (3d Cir. 2008). In other words, a complaint is sufficient if it contains enough factual matter, accepted as true, to “state a claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009); Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007). “The inquiry is not whether [a plaintiff] will ultimately prevail in a trial on the merits, but whether [he or she] should be afforded an opportunity to offer evidence in support of [his or her] claims.” In

re Rockefeller Ctr. Prop., Inc., 311 F.3d 198, 215 (3d Cir. 2002). However, legal conclusions and “[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Iqbal, 556 U.S. at 678. To determine whether a complaint is plausible on its face, courts conduct a three-part analysis. Santiago v. Warminster Twp., 629 F.3d 121, 130 (3d Cir. 2010). First, the court must “tak[e] note of the elements a plaintiff must plead to state a claim.” Id. (quoting Iqbal, 556 U.S. at 675). Second, the court should identify allegations that, “because they are no more than conclusions, are not entitled to the assumption of truth.” Id. at 131 (quoting Iqbal, 556 U.S. at 680). Finally, “where there are well-pleaded factual allegations, a court should assume their

veracity and then determine whether they plausibly give rise to an entitlement for relief.” Id. (quoting Iqbal, 556 U.S. at 680). This plausibility determination is a “context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Iqbal, 556 U.S. at 679. A complaint cannot survive where a court can infer only that a claim is merely possible rather than plausible. Id.

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BERMUDEZ v. BLUE CROSS & BLUE SHIELD OF NEW JERSEY, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bermudez-v-blue-cross-blue-shield-of-new-jersey-njd-2020.