Dane v. UnitedHealthcare Ins. Co.

974 F.3d 183
Court of Appeals for the Second Circuit·Decided September 10, 2020·No. 19-2330-cv·Published·Cited by 137 cases

Opinion

19-2330-cv Dane v. UnitedHealthcare Ins. Co., et al.

UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT

August Term 2019

(Argued: February 6, 2020 Decided: September 10, 2020)

Docket No. 19-2330-cv

MARK DANE, individually and on behalf of all others similarly situated, Plaintiff-Appellant,

v.

UNITEDHEALTHCARE INSURANCE COMPANY, UNITEDHEALTH GROUP, INC., AARP, INC., AARP SERVICES, INC., AARP INSURANCE PLAN,

Defendants-Appellees.

ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF CONNECTICUT

Before: JACOBS, CALABRESI, AND CHIN, Circuit Judges.

Appeal from a judgment of the United States District Court for the District of Connecticut (Underhill, C.J.), dismissing, pursuant to Federal Rule of Civil Procedure 12(b)(6), plaintiff-appellant's amended complaint asserting that

defendants-appellees violated Connecticut and District of Columbia law in entering into a licensing agreement with respect to a group plan for Medicare supplement insurance. Plaintiff-appellant alleged that defendants-appellees' royalty fee arrangement constituted an unlawful "premium rebate" in violation of Connecticut and District of Columbia anti-rebating insurance laws. The district court rejected the claim as well as plaintiff-appellant's remaining consumer fraud, statutory theft, and common law claims.

AFFIRMED.

ANDREW S. LOVE (Susan K. Alexander, Stuart A.

Davidson, Christopher C. Gold, and Dorothy P.

Antullis, on the brief), Robbins Geller Rudman & Dowd LLP, San Francisco, California and Boca Raton, Florida, and Sean K. Collins, Law Offices of Sean K. Collins, Boston, Massachusetts, for Plaintiff-Appellant.

MEAGHAN VERGOW (Brian D. Boyle, Samantha M.

Goldstein, and Jennifer B. Sokoler, on the brief), O'Melveny & Myers LLP, Washington, D.C. and New York, New York, for Defendants-Appellees United HealthCare Insurance Company and UnitedHealth Group, Inc.

Jeffrey S. Russell, Noah M. Weissman, and Alec Winfield Farr, Bryan Cave Leighton Paisner LLP, St. Louis, Missouri, New York, New York and Washington, D.C., and James T. Shearin, Pullman

& Comley, LLC, Bridgeport, Connecticut, for Defendants-Appellees AARP, Inc., AARP Services, Inc., and AARP Insurance Plan.

CHIN, Circuit Judge:

In 1997, UnitedHealthcare Insurance Company ("UnitedHealthcare")

entered into an agreement with AARP Insurance Plan (the "Plan") to license the intellectual property of AARP, Inc. ("AARP") for use with its Medicare supplement insurance program (the "1997 agreement"). Under the terms of the 1997 agreement, the Plan was permitted to deduct a royalty fee from member premiums in exchange for the license. Although the royalty fee is not described in the policies, UnitedHealthcare's advertisements identify and explain the royalty fee arrangement.

Plaintiff-appellant Mark Dane, individually and on behalf of all others similarly situated, commenced this action alleging that defendants- appellees UnitedHealthcare, UnitedHealth Group, Inc., AARP, AARP Services, Inc., and the Plan (collectively, "defendants"), participated in a unlawful royalty fee arrangement in violation of the Connecticut and District of Columbia ("D.C.") anti-rebating statutes. The district court dismissed the amended complaint for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6).

As discussed more fully below, we hold that Dane did not state an unlawful rebate claim under Connecticut or D.C. law because he failed to plausibly allege any ascertainable loss or injury as a result of his purchase of Medicare supplement insurance ("Medigap") or the AARP royalty fee. We also agree with the district court that Dane failed to plausibly allege consumer fraud, statutory theft, or common law claims. Accordingly, the district court's judgment dismissing the amended complaint is AFFIRMED.

BACKGROUND

The facts alleged in the amended complaint are assumed to be true.

UnitedHealth Group, Inc., an insurance company incorporated in Minnesota with its headquarters in Minnesota, conducts substantial business in Connecticut and maintains a wholly owned subsidiary, UnitedHealthcare, based in Hartford, Connecticut (collectively, "United"). UnitedHealthcare provides Medigap coverage to individual AARP members through a group plan. An individual can purchase a Medigap policy, sold by a private company (such as UnitedHealthcare), to help pay health care costs that are not covered by original Medicare. See 5 Soc. Sec. Law & Prac. § 66:36 (2020). State and federal law comprehensively regulate Medigap insurance policy terms, rates, and marketing.

See 42 U.S.C. § 1395ss; see also Vencor Inc. v. Nat'l States Ins. Co., 303 F.3d 1024, 1026 (9th Cir. 2002) (describing regulatory scheme governing Medigap insurance).

AARP is a non-profit corporation organized under D.C. law, with its primary place of business in Washington D.C., that advocates for the interests of seniors. The Plan is a third-party grantor trust organized by AARP. The Plan serves as the group policy holder for AARP members enrolled in United's Medigap insurance. As the group policy holder, the Plan collects premium payments from member insureds (known as the "member contributions") and pays United the group plan premium.

Under the 1997 agreement, United is responsible for administering the Medigap program, including obtaining regulatory approvals for advertising materials and premium rates charged to insureds. The 1997 agreement instructs the Plan to deduct a 4.9% royalty fee and certain expenses from the AARP member contributions before transmitting the remaining funds to United. The royalty fee is a payment to license AARP's intellectual property in connection with the United Medigap program. See J. App'x at 247 (1997 Agmt. § 6.1 ("AARP shall be entitled to receive an allowance for AARP's sponsorship . . . and the

license to use the AARP Marks.")). The royalty payments are then transmitted from the Plan to AARP.

United's Medigap advertisements and disclosures identify and explain the AARP royalty fee arrangement and its purpose. See Dist. Ct. Dkt. 64- 12 ("AARP endorses the AARP® Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company . . . . UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property."); 64- 13 ("The AARP Medicare Supplement Insurance Plans carry the AARP name and UnitedHealthcare pays a royalty fee to AARP for use of the AARP intellectual property."). 1 Dane is an AARP member and United Medigap insured residing in Connecticut. He has been enrolled in United's Medigap plan in Connecticut since January 1, 2014. Dane has paid the premium for his coverage and has not alleged that he purchased or received his policy in D.C. Dane was alerted to

1 This Court may review United's publicly filed Medigap advertisements and disclosures on a motion to dismiss because they are integral to the amended complaint concerning the royalty fee arrangement between United and AARP. See Cohen v. Rosicki, Rosicki & Assocs., P.C., 897 F.3d 75, 80 (2d Cir. 2018) ("A complaint is also deemed to include any written instrument attached to it as an exhibit, materials incorporated in it by reference, and documents that, although not incorporated by reference, are integral to the complaint." (quoting L-7 Designs, Inc. v. Old Navy, LLC, 647 F.3d 419, 422 (2d Cir. 2011))).

defendants' allegedly unlawful scheme in March 2018 through his counsel. Dane alleges that "[b]ut for [d]efendants' unlawful and deceptive acts," he "would not have willingly agreed to pay an illegal 4.9% charge above the premiums due to" United. J. App'x at 22.

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Dane v. UnitedHealthcare Ins. Co., 974 F.3d 183 (2d Cir. 2020).

974 F.3d 183 (Dane v. UnitedHealthcare Ins. Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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