Emergency Health Centre at Willowbrook, L.L.C. v. Unitedhealthcare of Texas, Inc.

892 F. Supp. 2d 847, 2012 WL 3779297, 2012 U.S. Dist. LEXIS 124377
CourtDistrict Court, S.D. Texas
DecidedAugust 31, 2012
DocketCivil Action No. H-10-4559
StatusPublished
Cited by3 cases

This text of 892 F. Supp. 2d 847 (Emergency Health Centre at Willowbrook, L.L.C. v. Unitedhealthcare of Texas, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Emergency Health Centre at Willowbrook, L.L.C. v. Unitedhealthcare of Texas, Inc., 892 F. Supp. 2d 847, 2012 WL 3779297, 2012 U.S. Dist. LEXIS 124377 (S.D. Tex. 2012).

Opinion

MEMORANDUM OPINION AND ORDER

SIM LAKE, District Judge.

Pending before the court is a motion for partial summary judgment (Docket Entry No. 24) filed by defendants UnitedHealthcare of Texas, Inc. and UnitedHealthcare Insurance Company (collectively: “UHC”).1 Plaintiffs Emergency Health Centre at Willowbrook, L.L.C. (“EHC”) and Emergency Willowbrook, P.A. (“PA”) collectively: (“Plaintiffs”) responded2 and UHC replied.3 For the reasons stated [849]*849below, the court- will grant in part and deny in part UHC s Motion.

I.The Plaintiff s’Allegations and Causes of Action

The Plaintiffs allege that EHC “eonduetts] business as a freestanding emergency department or comparable facility,” 4 that PA “provides emergency medical care to patients through physicians licensed to practice medicine within the State of Texas,”5 and that UHC is composed of insurance companies whose members have been treated at EHC.6 EHC makes the following allegations regarding UHC’s payment for services rendered to UHC members:

Initially, beginning in September 2007 when the EHC was formed, UHC paid EHC and P.A. for treating emergency medical conditions at a rate comparable to a hospital emergency department and paid reasonable and customary charges and professional fees for emergency medical services. UHC, however, unilaterally later decided that EHC and P.A. should receive either a reduced payment or no payment at all for their facility or emergency services.7

The Plaintiffs allege that UHC’s refusal to reimburse them violates Texas law.8

Plaintiffs seek “the reasonable, usual and customary charges for treating UHCs’ Plan members for emergency medication conditions comparable to a hospital or hospital affiliated emergency department.”9 Plaintiffs allege violations of the Texas Insurance Code, the Texas Prompt Pay Act and Texas Insurance laws, and quantum meruit.10

A. Count One: Insurance Code Violations (“Chapter 541 Claims”)

Plaintiffs allege that UHC’s actions violate various provisions of the Texas Insurance Code. Specifically, Plaintiffs allege violations of the following statutes (as summarized by the court):

1. Tex. Ins.Code § 541.051 (on misrepresentations concerning a policy);
2. Tex. Ins.Code § 541.052 (on misrepresentations regarding the business of insurance);
3. Tex. Ins.Code § 541.060 (on misrepresentations regarding coverage to a claimant);
4. Tex. Ins.Code § 541.061 (on untrue or misleading statements); and
5. Tex. Bus. & Comm.Code § 17.46 (on deceptive trade practices).11

In the section of the Original Petition setting out the factual basis for the Plaintiffs’ causes of action, the Plaintiffs allege that “UHCs’ acts, omissions and continued refusal to make payment to EHC and P.A. for the valid covered claims violates the Texas Insurance Code § 1271.155 Emergency Care and constitutes a false or misleading act or practice in the business of insurance.”12 The Plaintiffs further allege that “the actions of UHC in refusing to make payments to EHC and P.A. [v]iolate the provisions of the Texas Insurance Code, Chapter 1301 et. seq.”13

[850]*850B. Count Two: Violations of the Texas Prompt Pay Act and Texas Insurance Laws (“Prompt Pay Act Claim”)

Plaintiffs allege that “UHC has intentionally denied or delayed payments of EHC’s and P.A.’s clean claims for emergency medical care.”14 Plaintiffs allege that they are covered by § 1301.069 of the Texas Insurance Code, which provides the following:

The provisions of this Chapter relating to prompt payment by an insurer of a physician or health care provider and to verification of medical care or health care services apply to a physician or provider who:
(1) is not a preferred provider included in the preferred provider network; and
(2) provides to an insured[:]
([A]) care related to an emergency or its attendant episode of care as required by [sjtate or [fjederal law.15

C. Count Three: Quantum Meruit

Plaintiffs allege that “[fjailure to allow Plaintiffs to recover for the reasonable value of their services and supplies would result in the unjust enrichment of Defendants.” 16 Plaintiffs therefore seek “to recover in quantum meruit for the usual, reasonable and customary emergency medical services and supplies provided to the Defendants’ Plan Members which Defendants knowingly and willingly refused to pay or underpaid even though the services and supplies provided to each Plan Member were beneficial, and of substantial value.”17

II. Summary Judgment Standard

Summary judgment is appropriate if the movant establishes that there is no genuine dispute about any material fact and the movant is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(a). Disputes about material facts are “genuine” if the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). The Supreme Court has interpreted the plain language of Rule 56(c) to mandate the entry of summary judgment “after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). In reviewing the evidence “the court must draw all reasonable inferences in favor of the nonmoving party, and it may not make credibility determinations or weigh the evidence.” Reeves v. Sander-son Plumbing Prods., Inc., 530 U.S. 133, 120 S.Ct. 2097, 2110, 147 L.Ed.2d 105 (2000). “[TJhe burden on the moving party may be discharged by ‘showing’-that is, pointing out to the district court-that there is an absence of evidence to support the nonmoving party’s case.” Celotex, 106 S.Ct. at 2554; see

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892 F. Supp. 2d 847, 2012 WL 3779297, 2012 U.S. Dist. LEXIS 124377, Counsel Stack Legal Research, https://law.counselstack.com/opinion/emergency-health-centre-at-willowbrook-llc-v-unitedhealthcare-of-txsd-2012.