Borrero v. United Healthcare of New York, Inc.

610 F.3d 1296, 49 Employee Benefits Cas. (BNA) 1642, 2010 U.S. App. LEXIS 13738
CourtCourt of Appeals for the Eleventh Circuit
DecidedJuly 6, 2010
DocketNos. 08-15264, 08-15265, 08-15267, 08-15271, 08-15273, 08-15274 and 08-15275
StatusPublished
Cited by1 cases

This text of 610 F.3d 1296 (Borrero v. United Healthcare of New York, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Borrero v. United Healthcare of New York, Inc., 610 F.3d 1296, 49 Employee Benefits Cas. (BNA) 1642, 2010 U.S. App. LEXIS 13738 (11th Cir. 2010).

Opinion

DUBINA, Chief Judge:

In this consolidated appeal, three physicians and four representative organizations (“Appellants”) appeal the district court order dismissing their complaints against United Healthcare and its related entities (“United”). The district court held that the Appellants’ contract-based claims were precluded by the judgment in a class action suit based on the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. §§ 1961-1968 (2006) (“RICO”), asserted by physicians against United and other health insurance entities. Appellants dispute both the district court’s subject matter jurisdiction and its substantive decision regarding the claim preclusive effect of the RICO class action judgment. We hold that the district court properly exercised subject matter jurisdiction over all of the claims presented, but reverse its order dismissing those claims based on res judicata.

I. BACKGROUND

Appellants independently brought seven cases against United in various state [1300]*1300courts during the years 2001 and 2002. Appellants, who are healthcare providers or their representative associations, allege that United breached its contracts with them (often called provider or subscriber agreements) by not paying them the full contracted rate for services rendered to United’s insureds, in violation of common and statutory law. United removed all of the cases to federal court, asserting the court’s federal question jurisdiction over matters covered by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a) (2006). At the time the cases were filed, another case was pending in the Southern District of Florida that alleged breaches of contract by various health insurers and a nationwide conspiracy among health insurers, including United, to delay and reduce payment to healthcare providers in violation of various subscriber agreements. See In re Managed Care Litig., 430 F.Supp.2d 1336 (S.D.Fla.2006) (“Shane”), affd sub nom. Shane v. Humana, Inc., 228 Fed.Appx. 927 (11th Cir.2007) (unpublished).

The Joint Judicial Panel on Multidistrict Litigation transferred each of the cases covered by this consolidated appeal to the Southern District of Florida after its removal. There, the cases remained on the “tag-along” docket of the court and were stayed until the disposition of the Shane litigation, despite Appellants’ efforts to remand the cases to state court. After the court entered judgment in the Shane litigation, United moved to dismiss all of the cases underlying this appeal based upon the preclusive effect of Shane. Appellants opposed the motions and argued that remand would be the proper disposition because the court lacked subject matter jurisdiction over their claims. The court held in favor of United and ordered dismissal of all Appellants’ complaints.

The Shane litigation has its own complex procedural history that is exceedingly relevant to the outcome of the present action. In Shane, a group of plaintiffs, initially not including the Appellants, asserted breach of contract and RICO conspiracy claims against a number of health insurers, including United. The plaintiffs in Shane included healthcare providers both with and without contracts with the insurers.

An order compelling arbitration of all contract-based claims between insurers and providers who had an existing contractual relationship, based on the terms of the subscriber agreements, marked the first major procedural step in the Shane litigation. In re Managed Care Litig., 132 F.Supp.2d 989 (S.D.Fla.2000), modified, 143 F.Supp.2d 1371 (S.D.Fla.2001). This order.did not apply to the Appellants in this case because the plaintiffs in Shane had not yet sought class certification. Left remaining in the case were the payment claims asserted by providers who had no contractual relationship with the insurers, as well as the RICO claims asserted by all of the providers.

The plaintiffs in the Shane action next sought class certification for both the remaining payment claims on behalf of the non-participating providers and for the RICO claims asserted by all of the providers. The district court certified both classes, but this court held that only the RICO claims were appropriate for class certification. Klay v. Humana, Inc., 382 F.3d 1241, 1261 (11th Cir.2004). In response, the Shane plaintiffs amended their complaint to include only the class action RICO claims, on which the district court granted summary judgment in Shane, 430 F.Supp.2d 1336. There, the district court granted summary judgment in favor of United and held that the class of physicians had failed to produce sufficient evi[1301]*1301dence that a conspiracy existed amongst the insurers to underpay and otherwise defraud the physicians. Id. at 1357. Following the disposition in Shane, the district court dismissed the underlying cases at issue here, leading to the instant appeal.

II. STANDARD OF REVIEW

We review a district court’s preemption analysis de novo. Ervast v. Flexible Prods. Co., 346 F.3d 1007, 1012 (11th Cir.2003). We also review de novo a dismissal order based on res judicata Kizzire v. Baptist Health Sys., Inc., 441 F.3d 1306, 1308 (11th Cir.2006).

III. DISCUSSION

We confront two primary issues in this appeal: whether the claims of the individual and associational Appellants are completely preempted by ERISA § 502(a), 29 U.S.C. § 1132(a), and thus subject to federal question jurisdiction, and whether the claims pursued by the Appellants are sufficiently related to those resolved in the Shane litigation so as to preclude their assertion here. We conclude that Appellants’ claims are completely preempted by ERISA and thus are subject to federal jurisdiction. Those claims are not, however, subject to claim preclusion because they arise from a nucleus of operative fact distinct from those resolved in the Shane litigation.

A. ERISA Preemption

Section 502(a) of ERISA creates a civil cause of action for participants and beneficiaries of ERISA plans to recover benefits or enforce rights under an ERISA plan. 29 U.S.C. § 1132(a). This section definitively “converts an ordinary state common law complaint into one stating a federal claim for purposes of the well-pleaded complaint rule.” Aetna Health Inc. v. Davila, 542 U.S. 200, 209, 124 S.Ct. 2488, 2496, 159 L.Ed.2d 312 (2004) (quoting Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 65-66,107 S.Ct. 1542, 1547, 95 L.Ed.2d 55 (1987)).

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Related

Borrero v. UNITED HEALTHCARE OF NEW YORK, INC.
610 F.3d 1296 (Eleventh Circuit, 2010)

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Bluebook (online)
610 F.3d 1296, 49 Employee Benefits Cas. (BNA) 1642, 2010 U.S. App. LEXIS 13738, Counsel Stack Legal Research, https://law.counselstack.com/opinion/borrero-v-united-healthcare-of-new-york-inc-ca11-2010.