Blue Cross of California v. Smithkline Beecham Clinical Laboratories, Inc.

108 F. Supp. 2d 116, 2000 U.S. Dist. LEXIS 14614, 2000 WL 840001
District Court, D. Connecticut·Decided March 31, 2000·No. 3:97CV1795 AVC·Published·Cited by 9 cases

Opinion

RULING ON THE DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

COVELLO, Chief Judge.

This is a consolidated action for legal and equitable relief in which the plaintiffs, thirty-seven health care insurers, four health care plans, and six individuals, claim that the defendant, SmithKline Beecham *118 Clinical Laboratories, Inc. (SBCL), engaged in, inter alia, fraudulent billing practices. The second amended complaint and the amended class action complaint assert causes of action pursuant to the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C.S 1961 et seq., (“RICO”), the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. (“ERISA”), the Pennsylvania Insurance Fraud Statute, 18 Pa.Con.Stat.Ann. § 4117(a)(2) and under state common law tenets sounding in fraud and unjust enrichment.

On July 2, 1999, the court dismissed the RICO action asserted in counts I, II, and III of the second amended class action complaint, the ERISA action asserted in count IV of the second amended class action complaint to the extent the claims were asserted by 31 of the plaintiff-insurers, and count V alleging federal common law claims. Further, the court dismissed counts I and III of the consolidated class action complaint alleging causes of action under RICO and federal common law, respectively, and dismissed counts IV, V and VI of the consolidated class action complaint to the extent those claims were asserted by the four plaintiff-employee benefit plans.

Pursuant to Federal Rule of Civil Procedure 56(c), SBCL now moves for summary judgment on the plaintiffs-insurers’ state law claims set forth in counts VI, VII and VIII of the second amended complaint. SBCL argues that these claims are barred by the applicable statute of limitations. The issues presented are: (1) whether count VI, which alleges violations of the Pennsylvania Insurance Fraud Statute, 18 Pa.Con.Stat. § 4117(a)(2), is barred by Pennsylvania’s two-year statute of limitations governing fraud claims; (2) whether count VII, which alleges common law fraud, is barred by Connecticut’s three-year limitation period governing fraud claims; and (3) whether count VIII, which seeks recovery under the equitable doctrine of unjust enrichment, should be dismissed when related legal claims are time-barred.

For the reasons hereinafter set forth, counts VII and VIII are time-barred, and count VIII is properly dismissed on grounds that the related legal claims are time-barred. Accordingly, the motion is granted.

FACTS

The facts underlying this case have been set forth in several of the court’s previous decisions, including Blue Cross of California v. SmithKline Beecham Clinical Laboratories, Inc., 62 F.Supp.2d 544, 548 (D.Conn.1998). In light of these decisions, familiarity with which is presumed, the court will recite only those facts essential to the within motion for summary judgment.

Examination of the second amended complaint, affidavits, pleadings, exhibits, supplemental materials, and the Local Rule 9 statements accompanying the motion for summary judgment, and the responses thereto, discloses the following undisputed, material facts:

On August 19, 1997, thirty-seven insurance companies (“the plaintiffs-insurers”) initiated this lawsuit against SBCL. SBCL is a subsidiary of SmithKlein Beecham pic, a British corporation and incorporated in the state of Delaware. SBCL owns and operates one of the nation’s largest chains of clinical laboratories.

On September 19, 1998, the plaintiffs-insurers filed their second amended complaint against SBCL. The gravamen of the second amended complaint is that from 1989 to 1995, SBCL engaged in fraudulent billing practices that resulted in millions of dollars in losses to the plaintiffs-insurers. Specifically, the plaintiffs-insurers allege that SBCL exploited the health care payment system in five fundamental ways: 1) SBCL billed the plaintiffs-insurers for tests that physicians did not order or intend to order and billed for tests that it had led physicians to believe would not *119 result in separate charges (“add-ons”); 2) SBCL offered physicians discounts for certain test packages, but billed the plaintiffs-insurers for the full price for supposedly discount test packages (“selected discounts”); 3) SBCL billed the plaintiffs-insurers separately for expensive constituents of test panels that should have been billed at a single composite rate (“unbun-dling”); 4) SBCL performed and billed for more expensive tests than were ordered (“upcoding”), and in some cases performed; and 5) SBCL inserted fabricated diagnosis codes to obtain reimbursement from third-party payers (“code jamming”).

Without admitting any of the alleged conduct, SBCL has provided the court with an abundance of undisputed evidence indicating the above enumerated “challenged activities” were widespread in the clinical laboratory industry and known to the plaintiffs-insurers long before the filing of the original complaint. In this regard, between 1990 and 1993, the national media and various professional organizations had released to the public volumes of information concerning fraudulent billing practices by several national, clinical laboratories, to include SBCL.

Specifically, as early as May 1990, the Office of the Inspector General (“OIG”) was investigating National Health Laboratories (“NHL”), one of the nation’s largest clinical laboratories, for “false billing and improper use of panel testing.” (SBCL’s Ex. 6, National Health Labs Target of Criminal Probe, Nat’l. Intelligence Rep., May 25, 1990 at 3.) NHL publicly acknowledged the OIG investigation in December 1990. (SBCL’s Ex. 8, National Health Labs, Subject to Federal Grand Jury Probe, Says It will Cooperate With U.S. Attorney, Nat’l Intelligence Rep., Dec. 1990.) Media coverage of the grand jury inquiry continued into the summer of 1992. (SBCL’s Ex. 11, Don Bauder, Speculation Rises on Probe of La Jolla Firm, San Diego Union-Trib., Aug. 12, 1992.) In September 1992, the media reported that NHL was negotiating with federal officials to settle the probe of its laboratory billing practices, including its billing for tests containing improperly added profiles. (SBCL’s Ex. 12, Government May Settle With National Health Labs, Nat’l Intelligence Rep., Sept. 30, 1992.) At the same time, the National Health Care Anti-Fraud Association (“NHCAA”) issued a “Fraud-Alert” to its members, including plaintiffs-insurers BC/BS Texas and BC/BS New Jersey, informing them that several unidentified clinical laboratories were “unbundling” certain tests and billing them separately from profiles in order to “generate substantial additional revenue for the laboratories.” (SBCL’s Ex. 13, NHCAA Fraud Alert # 1992-7.)

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Blue Cross of California v. Smithkline Beecham Clinical Laboratories, Inc., 108 F. Supp. 2d 116, 2000 U.S. Dist. LEXIS 14614, 2000 WL 840001 (D. Conn. 2000).

108 F. Supp. 2d 116 (Blue Cross of California v. Smithkline Beecham Clinical Laboratories, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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