Emergency Group of Arizona Professional Corporation v. United Healthcare Incorporated

CourtDistrict Court, D. Arizona
DecidedMarch 25, 2020
Docket2:19-cv-04687
StatusUnknown

This text of Emergency Group of Arizona Professional Corporation v. United Healthcare Incorporated (Emergency Group of Arizona Professional Corporation v. United Healthcare Incorporated) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Emergency Group of Arizona Professional Corporation v. United Healthcare Incorporated, (D. Ariz. 2020).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Emergency Group of Arizona Professional No. CV-19-04687-PHX-MTL Corporation, et al., 10 ORDER Plaintiffs, 11 v. 12 United Healthcare Incorporated, et al., 13 Defendants. 14 15 This case was initiated in Arizona state court by Plaintiffs to recover additional 16 monies from the Defendants, United Healthcare Incorporated and its affiliates. Plaintiffs 17 have already been paid an amount for their out-of-network provider services; an amount 18 that is set by the healthcare benefit plans offered by Defendants to their insureds. These 19 payments, Plaintiffs contend, fall below the usual and customary rate for their services 20 and they are entitled to the difference. Presently before the Court are Plaintiffs’ Amended 21 Motion to Remand (the “Remand Motion”) to state court (Doc. 33) and Defendants’ 22 Motion to Dismiss (Doc. 31). Because the Employee Retirement Income Security Act 23 (“ERISA”) establishes a comprehensive federal-law remedy that completely preempts 24 Plaintiffs’ state causes of action, the Remand Motion is denied and the Motion to Dismiss 25 is granted. 26 I. FACTUAL BACKGROUND 27 The following facts derive from the First Amended Complaint and Answer. (Docs. 28 18 & 44.) Plaintiffs are a collection of professional emergency medicine services groups 1 that contractually provide medical staff to 16 hospitals located throughout Arizona. The 2 Defendants include UnitedHealth Group, Inc., United HealthCare, Inc., and several of 3 their affiliates (collectively “UHC”). According to the First Amended Complaint, UHC is 4 a healthcare insurer and plan administrator that “is responsible for administering and/or 5 paying for certain emergency medical services.” (Doc. 18 at ¶¶ 6-12.) 6 By virtue of federal and Arizona law, hospitals are required to provide medical 7 services to any person who presents at the hospital for emergency treatment.1 As the 8 emergency medical personnel for each contracted hospital, Plaintiffs’ physicians “fulfill 9 this obligation for the hospitals which they staff. In this role, [Plaintiffs’] physicians 10 provide emergency services to all individuals, regardless of insurance coverage or ability 11 to pay, including to Patients with insurance coverage issued, administered and/or 12 underwritten by [United HealthCare].” (Doc. 18 at ¶ 17.) 13 Thus, some patients for whom Plaintiffs must provide emergency medical services 14 are covered by UHC plans. Among the UHC-insured patients are those whose UHC plan 15 does not have a contract with Plaintiffs for medical service payments. Plaintiffs and their 16 medical staff are, therefore, considered “non-participating” or “out-of-network providers” 17 under these circumstances.2 (Doc. 18 at ¶ 38.) Plaintiffs claim that, historically and 18 through 2018, their claims for emergency services were paid at “75-90% of Plaintiffs’ 19 billed charge.” (Id. at ¶ 53.) This includes out-of-network claims submitted to UHC. (Id. 20 at ¶ 52.) According to Plaintiffs, “[t]his longstanding history establishes that a reasonable 21 reimbursement rate for Plaintiffs’ Non-Participating Claims for emergency services is 75- 22 90% of Plaintiffs’ billed charge.” (Id. at ¶ 53.) In early 2019, UHC reduced the out-of- 23 network reimbursement rate for some of Plaintiffs’ services, causing Plaintiffs to earn 24 less money for performing the same services. (Id. at ¶ 54.) 25 II. PROCEDURAL HISTORY 26 Plaintiffs filed their Complaint in Arizona Superior Court on June 10, 2019. It 27 1 See 42 U.S.C. § 1395dd and A.R.S. § 20-2803. 28 2 As opposed to out-of-network providers, an “in-network” provider is a healthcare services provider that has a contract with an insurance plan for payment at specified rates. 1 asserted six claims for relief originating under state law: breach of implied-in-fact 2 contract, breach of the implied covenant of good faith and fair dealing, unjust enrichment, 3 unfair competition under A.R.S. § 20-442, consumer fraud under A.R.S. § 44-1522, and 4 for declaratory judgment under A.R.S. § 12-1831, et seq. (Doc. 1-1.) 5 UHC removed under 28 U.S.C. § 1441(c)(1)(A). (Doc. 1.) The basis for removal, 6 as asserted by UHC, is federal-question jurisdiction under 28 U.S.C. § 1331. (Id. at 2 ¶ 4 7 (“Plaintiffs’ claims against Removing Defendants are removable to this Court because 8 Plaintiffs seek recovery of benefits under an employee welfare benefit plan and such 9 claims for benefits are completely preempted by [ERISA].”)). 10 Plaintiffs’ filed an Amended Complaint on August 9, 2019, which adds a seventh 11 claim for relief for civil racketeering under A.R.S. § 13-2301, et seq. (Doc. 18.) Pursuant 12 to this Court’s order, UHC filed its Answer on October 25, 2019. (Doc. 44.) 13 Plaintiffs filed their Amended Motion to Remand on September 30, 2019. (Doc. 14 33.) The Motion argues that ERISA preemption does not apply because the claims 15 asserted here are limited to state-law causes of action that address the rate of payment 16 chosen by UHC for non-contracted emergency medical services. (Id. and Doc. 42.) UHC 17 opposes the Motion on the basis that § 502(a) of ERISA completely preempts the state- 18 law claims. (Doc. 41.) UHC further argues that the complete preemption doctrine 19 mandates dismissal of the Amended Complaint or, alternatively, that it should be 20 dismissed for pleading deficiencies. (Doc. 31.) 21 III. AMENDED MOTION TO REMAND 22 Plaintiffs allege that, “[b]eginning in January 2019, Defendants have slashed their 23 reimbursement rate for [some] Non-Participating Claims to less than half [of] the average 24 reasonable reimbursement rate.” (Doc. 18 at ¶ 54.) They describe this action as “drastic 25 payment cuts [that] are entirely inconsistent with the established rate and [the] history 26 between the parties.” (Id. at ¶ 55.) Plaintiffs admit that some of their out-of-network 27 claims are paid by UHC “at higher rates and in some instances at 100% of the billed 28 charge,” however, the crux of their claims are that, for many out-of-network claims, UHC 1 is “arbitrarily . . . manipulating the rate of payment for claims submitted by Providers.” 2 (Id. at ¶ 56.) They contend that UHC is taking financial advantage of the absence of a 3 contract establishing payment terms and the legal requirements that hospitals provide 4 emergency services to all patients regardless of their status as insureds. In that regard, 5 UHC, according to Plaintiffs, can establish payment terms in its sole discretion. Thus, 6 Plaintiffs seek to recover amounts due to them at “the usual and customary rate for 7 emergency services [they] provided to their Patients, or, alternatively for the reasonable 8 value of the services provided.” (E.g., Doc. 18 ¶ 62.) They have asserted state law claims 9 to obtain this recovery and look to return to their chosen forum in Arizona state court. 10 UHC disagrees with Plaintiffs’ characterization of the facts. Insofar as the merits 11 go, at this early stage, UHC contends that Plaintiffs are being reimbursed, fairly, as out- 12 of-network providers.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
Emergency Group of Arizona Professional Corporation v. United Healthcare Incorporated, Counsel Stack Legal Research, https://law.counselstack.com/opinion/emergency-group-of-arizona-professional-corporation-v-united-healthcare-azd-2020.