Cox v. Blue Cross Blue Shield

166 F. Supp. 3d 891, 60 Employee Benefits Cas. (BNA) 2207, 2015 WL 5302819, 2015 U.S. Dist. LEXIS 120436
CourtDistrict Court, E.D. Michigan
DecidedSeptember 10, 2015
DocketCase No. 14-cv-13556
StatusPublished
Cited by3 cases

This text of 166 F. Supp. 3d 891 (Cox v. Blue Cross Blue Shield) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cox v. Blue Cross Blue Shield, 166 F. Supp. 3d 891, 60 Employee Benefits Cas. (BNA) 2207, 2015 WL 5302819, 2015 U.S. Dist. LEXIS 120436 (E.D. Mich. 2015).

Opinion

OPINION AND ORDER GRANTING DEFENDANT’S MOTION TO DISMISS (Dkt. 17)

MARK A. GOLDSMITH, United States District Judge

I. INTRODUCTION

Plaintiffs Kimberly Cox and Heather Claus initiated this putative class action under the Employment Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., alleging that Defendant Blue Cross Blue Shield of Michigan (“BCBSM”) breached its fiduciary duty by [893]*893charging Plaintiffs’ respective ERISA plans “hidden” fees. BCBSM filed a motion to dismiss (Dkt.17), claiming that Plaintiffs lack standing to bring this action. The issues have been fully briefed, and a hearing was held on May 7, 2015.1 For the reasons explained fully below, the Court grants BCBSM’s motion to dismiss.

II. BACKGROUND

During the period relevant to this action, BCBSM was a non-profit healthcare corporation organized under the laws of the State of Michigan. Third Am. Compl. ¶ 11 (Dkt.13).2 BCBSM administered and processed claims for various ERISA welfare benefit plans, including self-insured (or “self-funded”) health benefit plans. Id. ¶¶ 16, 19. In a self-funded plan, “the employer elects to pay the health care costs of its covered employees using its own funds, rather than paying premiums to an insurer in exchange for the insurer’s assumption of the risk to pay the cost of employer-promised health care.” Loren v. Blue Cross Blue Shield of Michigan, 505 F.3d 598, 601 (6th Cir.2007); Third Am. Compl. mi, 25.

From at least February 1, 1994 to January 1, 2014, Genesys Regional Medical Center (“Genesys”) provided its employees with healthcare coverage through a BCBSM-administered self-funded plan. Third Am. Compl. ¶ 8. Plaintiff Kimberly Cox has been an employee of Genesys since June 2005, and she was a participant and beneficiary of the Genesys plan from that time until January 1, 2014, on which date BCBSM ceased to administer the plan. Id. ¶¶ 7, 8,16.

From at least October 1, 1996 to the present, Operating Engineers Local 324 (“Operating Engineers”) provided its members with healthcare coverage through a BCBSM-administered self-funded plan. Id. ¶ 10. Plaintiff Heather Claus’s husband was a member of Operating Engineers from 2000 until his death in June 2009. Id. ¶ 18. Plaintiff Claus was, and continues to be, a beneficiary of the Operating Engineers plan. Id. ¶¶ 9, 10, 18-20.

Plan sponsors for the Genesys plan and the Operating Engineers plan entered into Administrative Services Contracts (“ASCs”) with BCBSM. Ml 21. Pursuant to these ASCs, BCBSM would act as a third-party administrator for the plans by paying covered employee healthcare claims, using money paid to BCBSM by plan sponsors and participants. Id. ¶¶ 22-25. In exchange for these services, BCBSM was entitled to administrative fees, in accordance with a “Schedule A,” which contained “specific line items for administrative charges, and other specific charges where applicable, and the specific dollar amount for each charge.” Id. ¶¶ 26-27, 52. However, neither the ASCs nor the Schedule As “disclosed the dollar amount or the method of calculation for all of the fees BCBSM paid itself out of plan assets.” Id. ¶ 29. The plan sponsors were required to make periodic administrative payments to BCBSM, which they did. Id. ¶¶ 34, 38.

Plaintiffs allege that, in 1993, BCBSM. began secretly misappropriating funds under the ASCs and Schedule As. Id. ¶ 42. According to an internal memo, in order to appear to be a low-cost provider and compete with other third-party administrators that might underbid it, BCBSM would fraudulently misrepresent that it would take a smaller administrative fee than it would ultimately charge plans. Id. ¶44. BCBSM actually took a higher fee, dis[894]*894guising the overcharges as hospital-claims costs. Id. BCBSM would then keep the difference between the amounts it was actually paying for hospital claims and the amounts it reported it was paying for those claims. Id. Plaintiffs refer to the allegedly misappropriated plan assets as “hidden fees.” Id. ¶ 46. BCBSM purportedly charged self-funded plans these hidden fees from 1993 through at least 2011. Id. ¶ 49.

On September 12, 2014, Plaintiffs filed this putative class action pursuant to 29 U.S.C. § 1132(a)(3), seeking injunctive and other equitable relief. Plaintiffs allege that BCBSM engaged in self-dealing and breached its fiduciary duties owed to participants and beneficiaries of self-funded health plans under ERISA. More specifically, Plaintiffs allege that BCBSM “maliciously exercised control over the health plans [and used] plan funds to pay itself fees that it failed to disclose to its principals!” Id. ¶ 2. Plaintiffs also claim that BCBSM took affirmative steps to conceal its self-dealing and breaches of its fiduciary duty. Id. ¶¶ 3, 4. Plaintiffs seek to represent a class of all participants and beneficiaries of ERISA self-funded plans, as well as the plans themselves, for which BCBSM was a third-party administrator, and in which BCBSM assessed “charges in excess of the amount of healthcare claims paid by BCBSM.” Id. ¶ 82.

III. ANALYSIS

BCBSM’s motion to dismiss contends that Plaintiffs lack two types of standing that are relevant to this action: statutory standing and constitutional standing under Article III. To pursue their ERISA claims, Plaintiffs must possess both. Bender v. Williamsport Area Sch. Dist., 475 U.S. 534, 541, 106 S.Ct. 1326, 89 L.Ed.2d 501 (1986).

Statutory standing concerns whether a plaintiff has a cause of action under a particular statute and is distinct from Article III standing. See Roberts v. Hamer, 655 F.3d 578, 580 (6th Cir.2011) (citing Steel Co. v. Citizens for a Better Env’t, 523 U.S. 83, 97 n. 2, 118 S.Ct. 1003, 140 L.Ed.2d 210 (1998)). To establish statutory standing, a plaintiff must show that his or her claim comes within § 502(a)(3) of ERISA, codified at 29 U.S.C. § 1132(a)(3), which authorizes a participant, beneficiary, or fiduciary to bring a civil action: “(A) to enjoin any act or practice which violates any provision of this subchapter or terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan.”

Constitutional standing is derived from Article III of the United States Constitution, which limits the jurisdiction of federal courts to justiciable cases and controversies. Hollingsworth v. Perry, — U.S. —, 133 S.Ct. 2652, 2661, 186 L.Ed.2d 768 (2013) (citing U.S. Const, art. Ill, § 2); Simon v. E. Ky. Welfare Rights Org.,

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Related

Cox v. Blue Cross Blue Shield of Michigan
216 F. Supp. 3d 820 (E.D. Michigan, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
166 F. Supp. 3d 891, 60 Employee Benefits Cas. (BNA) 2207, 2015 WL 5302819, 2015 U.S. Dist. LEXIS 120436, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cox-v-blue-cross-blue-shield-mied-2015.