Conn. Gen. Life Ins. Co. v. BioHealth Labs., Inc.

988 F.3d 127
CourtCourt of Appeals for the Second Circuit
DecidedFebruary 10, 2021
Docket20-2312-cv
StatusPublished
Cited by50 cases

This text of 988 F.3d 127 (Conn. Gen. Life Ins. Co. v. BioHealth Labs., Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Conn. Gen. Life Ins. Co. v. BioHealth Labs., Inc., 988 F.3d 127 (2d Cir. 2021).

Opinion

20-2312-cv Conn. Gen. Life Ins. Co. v. BioHealth Labs., Inc.

United States Court of Appeals For the Second Circuit

August Term 2020

Argued: February 1, 2021 Decided: February 10, 2021

No. 20-2312-cv

CONNECTICUT GENERAL LIFE INSURANCE COMPANY, CIGNA HEALTH AND LIFE INSURANCE COMPANY,

Plaintiffs-Appellants,

v.

BIOHEALTH LABORATORIES, INC., PB LABORATORIES, LLC, EPIC REFERENCE LABS, INC., EPINEX DIAGNOSTICS, INC., NJ REFERENCE LABORATORIES, INC., ALETHEA LABORATORIES, INC.,

Defendants-Appellees.

Appeal from the United States District Court for the District of Connecticut No. 19-cv-1324, Janet C. Hall, Judge. Before: JACOBS, SULLIVAN, Circuit Judges, and BROWN, District Judge. *

Plaintiffs – managers of various employee health and wellness plans – sued several laboratory testing companies, alleging that those companies violated federal and Connecticut law by submitting fraudulent or overstated claims for medical services purportedly provided to Plaintiffs’ plan members. The district court (Hall, J.) dismissed the complaint with prejudice, concluding that all of Plaintiffs’ claims were time-barred by Connecticut’s three-year statute of limitations applicable to tort claims. We vacate that decision in part, finding that under Connecticut law Plaintiffs’ equitable claims, which include their federal claims, are subject to no statute of limitations and are instead governed only by the doctrine of laches. We nevertheless affirm the district court’s dismissal of Plaintiffs’ state-law legal claims, and specifically reject Plaintiffs’ argument that the limitations period applicable to those claims was tolled during the pendency of a prior action between the parties. Although Plaintiffs note that several of our sister circuits have tolled limitations periods applicable to compulsory counterclaims as a matter of federal law, the legal claims at issue here are all brought under state law and so are subject only to state-law tolling rules, which provide no relief for Plaintiffs.

VACATED IN PART, AFFIRMED IN PART, AND REMANDED.

EDWARD T. KANG (Emily S. Costin, on the brief), Alston & Bird LLP, Washington, DC, for Plaintiffs-Appellants.

SCOTT M. HARE (Todd M. Brooks, Whiteford, Taylor & Preston LLP, Baltimore, MD, on the brief), Whiteford, Taylor & Preston LLP, Pittsburgh, PA, for Defendants-Appellees.

* Judge Gary R. Brown, District Judge for the Eastern District of New York, sitting by designation.

2 RICHARD J. SULLIVAN, Circuit Judge:

Plaintiffs Connecticut General Life Insurance Company and Cigna Health

and Life Insurance Company (together, “Cigna”) appeal the judgment of the

district court (Hall, J.) dismissing their claims against several laboratory testing

companies (the “Labs”) as time-barred under Federal Rule of Civil

Procedure 12(b)(6). Cigna’s complaint, which asserts various federal and

Connecticut state-law claims, alleges that the Labs submitted fraudulent or

overstated charges for medical testing services that the Labs purportedly provided

to patients covered by benefits plans overseen by Cigna.

On appeal, we are confronted with three issues. First, we must determine

what state-law claim is most analogous to Cigna’s claims under the Employee

Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., and the

Declaratory Judgment Act, 28 U.S.C. § 2201, since those federal claims lack their

own statutory limitations period. Second, we must decide whether, under

Connecticut law, equitable claims are subject to the same statute of limitations that

governs analogous legal claims that were asserted based on the same facts. Third,

we must resolve whether the limitations period applicable to Cigna’s claims was

tolled during the pendency of a prior federal action between the parties since

3 Cigna argues that its current claims were all compulsory counterclaims in that

prior case.

I. Background

Cigna is a managed-care company that insures and administers

employee health and welfare benefit plans. 1 In that role, Cigna serves as claims

administrator, meaning that it exercises discretionary authority and fiduciary

responsibility over the administration of those plans. One of Cigna’s

responsibilities is to control the cost of healthcare for its members. To do so, Cigna

enters into agreements with certain healthcare providers that establish fixed rates

for those providers’ services. While Cigna permits its plan members to use

providers that do not enter into these agreements – so-called “out-of-network

providers” – plan members are required to pay a higher percentage of the charges

from out-of-network providers. In this way, Cigna sensitizes its plan members to

cost control issues and gives them a financial incentive to seek out cost-effective

services.

1Because this appeal arrives before us at the pleading stage, we draw these facts from Cigna’s complaint and accept them to be true. See Iowa Pub. Emps.’ Ret. Sys. v. MF Glob., Ltd., 620 F.3d 137, 139 n.1 (2d Cir. 2010).

4 The defendant Labs in this case are various laboratory testing companies

that are all wholly owned by the same parent company. The Labs are out-of-

network providers under Cigna’s plans.

Cigna’s anti-fraud unit became aware that some of the Labs were engaged

in a potentially fraudulent billing scheme and opened an investigation. That

investigation, which was completed sometime before August 17, 2015, uncovered

three types of fraudulent or improper conduct: fee forgiveness, billing for

unnecessary testing, and unbundling.

Fee forgiveness occurs when an out-of-network healthcare provider does

not bill a patient for the portion of its services not covered by the patient’s

insurance company. While this might sound like a good outcome for patients –

after all, it means that they receive medical services more cheaply – it causes

problems by removing the financial incentive for patients to visit in-network

providers. In other words, fee forgiveness benefits patients in the short term, but

ultimately may result in increased plan costs as insurers pay more for services.

Billing for medically unnecessary testing is just what it sounds like and is largely

self-explanatory. “Unbundling,” however, is the practice of healthcare providers

5 separately billing for individual services that should otherwise be billed together

at a reduced price.

In light of its investigation, Cigna determined that the Labs had improperly

collected over $17 million in fraudulent or overbilled charges. To prevent

additional losses, Cigna began to flag and deny outstanding charges from the Labs

that Cigna had yet to pay.

In August 2015, two of the Labs sued Cigna in federal court in the Southern

District of Florida, alleging that Cigna improperly denied, delayed processing, or

failed to process claims for certain testing services (the “Florida Action”). See

generally Complaint, BioHealth Med. Lab’y, Inc. v. Conn. Gen. Life Ins. Co., No. 15-cv-

23075 (KMM) (S.D. Fla. Aug. 17, 2015), ECF No. 1. Six months later, the district

court dismissed the complaint without prejudice for, among other reasons, failure

to exhaust available administrative remedies.

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