COUNTY OF MONMOUTH v. RITE AID CORPORATION

CourtDistrict Court, E.D. Pennsylvania
DecidedMarch 31, 2023
Docket2:20-cv-02024
StatusUnknown

This text of COUNTY OF MONMOUTH v. RITE AID CORPORATION (COUNTY OF MONMOUTH v. RITE AID CORPORATION) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
COUNTY OF MONMOUTH v. RITE AID CORPORATION, (E.D. Pa. 2023).

Opinion

INTHEUNITEDSTATESDISTRICTCOURT FORTHEEASTERNDISTRICTOFPENNSYLVANIA

COUNTYOFMONMOUTHandDIANE SCAVELLO,IndividuallyandonBehalfof AllOthersSimilarlySituated, Plaintiffs, CivilAction v. No. 20-cv-2024 RITEAIDCORPORATION,etal., Defendants.

MEMORANDUMOPINION Goldberg,J. March31,2023 The County of Monmouth, New Jersey (“Monmouth”) and Diane Scavello have brought a

putativeclassactionforfraudandrelatedclaimsallegingthatDefendantRiteAidCorporationand associatedentities(collectively“RiteAid”)madefalserepresentationswhensubmittinginsurance claimsforprescriptiondrugs. Monmouthsponsorsahealthplanthatcovereddrugpurchasesfrom Rite Aid pharmacies. Scavello is a Rite Aid customer who maintains health insurance but is not insuredbyMonmouth.1 RiteAidhasmovedtocompelScavellotoarbitrateherclaims. RiteAiddoesnotallegethat

Scavellosignedanagreementtoarbitrate. Instead,RiteAidseekstoholdScavellotoanarbitration provisioninacontractsolelybetweenRiteAidandOptumRx,Inc.(“Optum”),apharmacybenefits

1 Both Monmouth and Scavello seek to represent classes of similarly situated plan sponsors and RiteAidcustomers. manager(PBM).TheOptum–RiteAidcontract,whichdoesnotmentionScavello,establishesRite AidasamemberofOptum’spharmacynetwork. Rite Aid acknowledges that a party is usually not bound by a contract they never assented

to,butnonethelessarguesthatScavelloisboundbytheOptum–RiteAidcontractunderthedoctrine of “equitable estoppel,” which sometimes requires a non-signatory to arbitrate when they have “reaped the benefits of a contract containing an arbitration clause.” Griswold v. Coventry First LLC, 762 F.3d 264, 272 (3d Cir. 2014). According to Rite Aid, Scavello reaped such benefits because she bought prescription drugs at reduced prices, such that she must now adhere to the Optum–RiteAidcontract’sterms.

Forthereasonsexplainedbelow,IfindthatequitableestoppeldoesnotbindScavellotothe Optum–RiteAidcontractandwillthereforedenyRiteAid’smotiontocompelarbitration. I. FACTS A. Scavello’sClaims Rite Aid’s equitable estoppel argument hinges on the nature of Scavello’s claims against

Rite Aid and the relation of those claims to the Optum–Rite Aid contract. See E.I. DuPont de Nemours & Co. v. Rhone Poulenc Fiber & Resin Intermediates, S.A.S., 269 F.3d 187, 202 (3d Cir. 2001) (considering “the thrust of the [plaintiff’s] claims” in relation to the arbitration agree- ment). I therefore summarize what Scavello alleges Rite Aid did wrong and how Scavello claims shewasharmedbyit.

(1) AllegedMisrepresentations Rite Aid is a pharmacy that sells prescription drugs. When an insured customer makes a purchase, Rite Aid transmits information about the purchase to the customer’s insurer or the insurer’s agent. The insurer (or its agent) will then send a message back “indicating whether the drugandconsumerarecoveredand,ifso,theamountthepharmacymustcollectfromtheconsumer asacopayment,coinsurance,ordeductibleamount.”(AmendedComplaint¶¶6-7,11,36.)

According to Scavello, Rite Aid uses an industry standard form to transmit information to customers’ insurers. One of the fields in that standard form contains the pharmacy’s (in this case Rite Aid’s) “usual and customary” price for the drug being sold. Scavello alleges that “usual and customary” is widely understood in the industry to mean “the cash price charged to the general public, exclusive of sales tax or other amounts claimed.” Scavello cites various sources for this allegedunderstanding. (AmendedComplaint¶¶35-36,39-47.)

The gist of Scavello’s fraud and other misrepresentation claims is that Rite Aid submitted “usualandcustomary”pricestoinsurersthatwerenotactuallythepricesRiteAidwouldchargethe generalpublicforthesamedrugs. AccordingtoScavello’sallegations,RiteAidoffereduninsured customers discounts on prescription drugs. Thus, Scavello asserts, those discounted prices—not the listed retail prices—were Rite Aid’s “usual and customary” prices for the drugs it sold. But when submitting information to a customer’s insurer, Rite Aid allegedly reported a price that was much higher than the discounted price a cash-paying customer would pay. Scavello alleges that

this report, submitted to the insurer, was false. And, because Rite Aid was aware that the prices it reportedwerenotaccurate,Scavelloassertsthatthesemisrepresentationsweremadefraudulently. (AmendedComplaint¶¶48-51,54-55,60,123-26.) (2) AllegedHarmtoScavello

Scavello maintains health insurance but does not allege that Rite Aid offered false “usual andcustomary”pricestoherpersonally. Instead,sheallegesthatRiteAid’sfalsereportstoinsurers harmed her because they caused her to pay higher copayments than she would have otherwise. According to Scavello, her copayment was “calculated based on the [usual and customary] price reported by Rite Aid.” Thus, she alleges that “Rite Aid knowingly based ... [her] payment on a

purported [usual and customary] price that was fraudulently inflated above Rite Aid’s true [usual and customary] price,” causing her to be charged a copayment that was “also artificially inflated.” (AmendedComplaint¶¶2,20,38,60,308.) Scavello further alleges that she was unaware that “the copayment demanded and charged wasnotaccurate.”Thus,sheclaimsthat“RiteAid...madepricerepresentationsto[her]...atthe pointofsale”andthatthesewere“false.”AndScavelloassertsthatout-of-pocketcharges(suchas

copayments) “cannot” exceed the usual and customary price for a drug but that she was charged copaymentsthatdidexceedRiteAid’strueusualandcustomarypricesforthedrugsshepurchased. (AmendedComplaint¶¶20,38,67,310.) Based on these allegations, Scavello brings claims for fraud, negligent misrepresentation, violation of Pennsylvania’s Unfair Competition and Consumer Protection Law, and unjust enrich- ment.

B. TheOptum–RiteAidContract Rite Aid introduces the following additional facts that are not contained in the complaint. Forpurposesofthismotion,Scavellodoesnotdisputethesefacts2: Scavello was insured under a Blue Cross Medicare Part D health plan when she made

2 AlthoughthefactspertainingtotheOptum–RiteAidcontractareoutsidethepleadings,Scavello does not object to their consideration. See Guidotti v. Legal Helpers Debt Resol., LLC, 716 F.3d 774-76(3dCir.2013)(motiontocompelarbitrationmayconsiderfactsoutsidethepleadingsunder asummaryjudgmentstandard);Fed.R.Civ.P.56(a)(summaryjudgmentisproperwhen“thereis nogenuinedisputeastoanymaterialfact”). the purchases at issue in this case. (Rite Aid’s Memorandum at 6-7.) Blue Cross does not transact withRiteAiddirectlybutoperatesthroughanintermediaryknownasapharmacybenefitsmanager (PBM), in this case Optum. Rite Aid attaches a substantially redacted copy of a contract between OptumandRiteAidtoitsmotiontocompelarbitration(the“Optum–RiteAidcontract”).3

The Optum–Rite Aid contract incorporates a document that required Optum and Rite Aid to arbitrate their disputes. Specifically, the contract incorporates the terms of Optum’s “provider manuals,” and a document that Rite Aid represents to be Optum’s 2017 Provider Manual includes aprovisionstating,inrelevantpart: Other than with respect to issues giving rise to immediate termination hereof or non-renewal hereof, the parties will work in good faith as set forth below to resolve any and all issues and/or disputes between them (hereinafter referred to as a “Dispute”) including, but not limited to all questions of arbitrarily [sic], the existence, validity, scope, interpretation or termination of the Agreement, PM [presumably Provider Manual] or any term thereof prior to the inception of any litigationorarbitration. ...

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