Davita Inc. v. Marietta Memorial Hospital Employee Health Benefit Plan

District Court, S.D. Ohio·Decided June 28, 2024·No. 2:18-cv-01739·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO EASTERN DIVISION

DAVITA INC., et al.,

Plaintiffs,

v. Civil Action 2:18-cv-1739 Judge Sarah D. Morrison Magistrate Judge Kimberly A. Jolson MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN, et al.,

Defendants.

ORDER AND OPINION Before the Court is Plaintiffs’ Motion for Attorney Fees (Doc. 138). For the following reasons, the Motion is GRANTED in part and DENIED in part. I. BACKGROUND This Court has previously summarized the events and allegations giving rise to this action: This action concerns claims brought under 29 U.S.C. § 1182 and the Employee Retirement Income Security Act of 1974 (ERISA) § 502. Plaintiffs are dialysis care providers who provided care to Patient A while Patient A was suffering from end-stage renal disease. (Doc. 62 at ¶¶ 11–12). In April 2017, when Plaintiff DaVita began providing dialysis care to Patient A, Patient A was a participant in the Marietta Memorial Hospital Employee Health Benefit Plan[.] (Id. at ¶¶ 20, 29). Defendant Marietta Memorial Hospital . . . established and maintains the Plan, and Defendant Medical Benefits Administrators, Inc. . . . serves as the Plan’s medical benefits manager. (Id. at ¶¶ 13–15).

Plaintiff DaVita alleges that the Plan “reimburses dialysis services at a depressed rate.” (Doc. 95 at 2 (internal quotation omitted)). More specifically, Plaintiffs say that the Plan offers no network of contracted dialysis providers and instead provides reimbursement “based on a reasonable and customary fee if a provider is out-of- network.” (Doc. 62 at ¶ 25–26). But unlike other out-of-network services, the Plan provides “an alternative basis of payment applicable only to dialysis-related services and products.” (Id. at 26–27 (internal quotations omitted)). According to Plaintiffs, “[t]he Plan will reimburse out-of-network dialysis providers a reasonable and customary amount that will not exceed the maximum payable amount applicable[,] which is typically one hundred twenty-five percent (125%) of the current Medicare allowable fee.” (Doc. 95 at 3 (internal citations and quotations omitted)). For dialysis services, the Plan “pays 70% of the 125% of the Medicare rate,” which is “already far below the industry-wide definition of a ‘reasonable and customary’ fee.” (Id., quoting Doc. 62 at ¶¶ 25–28). Accordingly, Plaintiffs allege “that the Plan discriminate[s] against its enrollees suffering from [early onset renal disease] by eliminating network coverage for enrollees with [early onset renal disease] and, by extension, by exposing enrollees to higher costs.” (Doc. 62 at ¶ 73).

(Doc. 120 at 1–2).

The instant Motion for Attorney Fees relates to the parties’ months-long discovery dispute. On February 9, 2024, Plaintiffs filed a Motion to Compel discovery responses from Defendants Marietta Memorial Hospital Employee Health Benefit Plan (“the Plan”), Marietta Memorial Hospital (“Marietta”), and Medical Benefits Mutual Life Insurance Co. (“MedBen”). (Doc. 114). By that time, Plaintiffs had sent Defendants multiple letters outlining alleged deficiencies with Defendants’ discovery responses, and the parties had engaged in two telephone conferences. (See Docs. 143 at 15 (discussing the parties’ conferral efforts before Plaintiffs’ Motion to Compel); 114-3 (Plaintiff’s September 2023 letter to Defendants regarding discovery requests); 114-10 (Defendants Marietta and the Plan’s letter to Plaintiffs); 114-15 (emails exchanged between the parties on discovery requests); 114-18 (Plaintiffs’ January 2024 letter to Defendants Marietta and the Plan); 114-19 (Plaintiffs’ January 2024 Letter to Defendant MedBen); 114-20 (Defendants Marietta and the Plan’s response to the January letter); 114-21 (Defendant MedBen’s response to the January letter)). After Plaintiffs filed the Motion to Compel, the Court ordered the parties to engage in further conferral efforts. (Doc. 116 at 1–2). When those efforts failed, the parties filed a joint status report outlining their differences. (Doc. 119). First, Plaintiffs requested from Defendant MedBen records and information relating to dialysis claims for Marietta clients since 2012. (Id. at 2). But Defendant MedBen offered to produce records from 2014 to 2016 only. (Id.). Next, Plaintiffs sought similar records for clients other than Marietta dating back to 2012, which Defendant MedBen refused to produce wholesale. (Id.). Finally, Plaintiffs expressed concern over the limited electronically stored information (ESI) produced by all Defendants. (Id. at 3–4). Consequently, Plaintiffs requested an order from the Court compelling Defendants to meet and confer over methods used to search for emails and ESI and to produce all non-privileged emails and ESI located through those conferral efforts. (See id. at 3–4; Doc. 114-1 at 14–15). After this status report, the Court granted Plaintiffs’ Motion in part and denied it in part. (See Doc. 120). On balance, the Court found the parties needed to do more to resolve their disputes. (See generally id.). First, the Court granted Plaintiffs’ Motion as it related to records for Marietta’s clients and ordered Defendant MedBen to produce “records, documents, and other information in its custody related to the Plan and its dialysis claims dating back to January 1, 2012.” (Id. at 6). For other clients, the Court ordered the parties to confer further, noting that while the information Plaintiffs sought was relevant, it was “not certain that the likely benefit of the materials outweigh[ed] the burden or expense of production for all of [Defendant MedBen’s] 180 clients.” (Id. at 8). Specifically, the Court noted that Plaintiffs’ request should be limited to Defendant MedBen’s “comparable clients, meaning those have implemented similar alternative dialysis payment plans to the Plan in this case since 2012.” (Id. (emphasis in original)). Lastly, the Court denied Plaintiffs’ request to compel information about Defendants’ litigation holds but ordered the parties to work on their ESI issues. (Id. at 10–11). For the next month, the parties negotiated (see Docs. 121, 124, 127), and the Court ordered them to file another joint status report by April 8, 2024. (See Docs. 122, 124). At this point, it appeared that Plaintiffs and Defendant MedBen were finding compromises. (Doc. 124 at 2). But the Court had to intervene on ESI issues between Plaintiffs and Defendants Marietta and the Plan. In the April 8 status report, Plaintiffs explained that after the Court’s previous order, Plaintiffs had “identified additional custodians that were not included in Marietta’s prior [ESI] search and collection and provided additional search terms for Marietta to use if it insisted” on using Microsoft Outlook’s basic search function to find responsive emails. (Doc. 124 at 3 (noting that Defendants Marietta and the Plan refused to use a litigation platform that supports Boolean search methods)). For weeks, Plaintiffs received no response from Defendants Marietta and the Plan. (Id. at 3). After Plaintiffs sent another letter on April 1, Defendants responded without answering several of Plaintiffs’ questions. (Id.). For example, Defendants did not identify any coworkers of Tricia Engfehr, a critical custodian whose emails and files had long been deleted. (Doc. 124 at 3 n.1; see Doc. 119 at 3–4). Defendants also did not explain whether they use an email archiving system or whether other responsive emails dating back to 2012 might exist. (Doc. 124 at 3 n.1). These explanations were crucial because Defendants Marietta and the Plan previously represented that Tricia Engfehr was the decision-maker on the challenged Plan terms, but her emails had been deleted years before this litigation began. (Doc. 119-1 at 16–19).

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Davita Inc. v. Marietta Memorial Hospital Employee Health Benefit Plan, (S.D. Ohio 2024).

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