Dane v. UnitedHealthcare Ins. Co.

974 F.3d 183
CourtCourt of Appeals for the Second Circuit
DecidedSeptember 10, 2020
Docket19-2330-cv
StatusPublished
Cited by137 cases

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

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 2 & 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). 3 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.

4 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

5 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.

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