Enigma Management Corp. v. Multiplan, Inc.

994 F. Supp. 2d 290, 57 Employee Benefits Cas. (BNA) 2488, 2014 WL 297269, 2014 U.S. Dist. LEXIS 9738
CourtDistrict Court, E.D. New York
DecidedJanuary 27, 2014
DocketNo. 13-CV-5524 (ARR)(JO)
StatusPublished
Cited by11 cases

This text of 994 F. Supp. 2d 290 (Enigma Management Corp. v. Multiplan, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Enigma Management Corp. v. Multiplan, Inc., 994 F. Supp. 2d 290, 57 Employee Benefits Cas. (BNA) 2488, 2014 WL 297269, 2014 U.S. Dist. LEXIS 9738 (E.D.N.Y. 2014).

Opinion

MEMORANDUM AND ORDER

ROSS, District Judge.

Plaintiff, Enigma Management Corp., a/k/a Enigma Laboratories (“Enigma”), originally brought this action in the Supreme Court of the State of New York, Kings County, against defendants Multiplan, Inc. (“Multiplan”) and United Healthcare Insurance Company of New York (“United”). Enigma alleges that United failed to provide full payment on claims for health care services that Enigma provided to participants in United’s health insurance plans. Enigma brings a cause of action for breach of contract against Multiplan and causes of action for unjust enrichment and fraudulent misrepresentation against United.

United removed the action to this court, asserting that Enigma’s claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq. Now before the court is Enigma’s motion to remand the action to state court. For the reasons set forth below, I find that Enigma’s causes of action against United are preempted by ERISA, thereby giving this court federal subject matter jurisdiction over the action. Accordingly, the motion to remand is denied.

BACKGROUND

Enigma is a health care provider that performs laboratory services. On or about February 2, 2005, Enigma entered into an agreement with Multiplan, a preferred provider organization, to become a member of Multiplan’s preferred provider network. Compl., Dkt. # 1, Ex. A, ¶ 10. Multiplan establishes networks of doctors, hospitals, and other providers who agree to perform health care services at discounted rates. Id. In turn, Multiplan enters into separate agreements with clients such as insurers, self-insured employers, and other entities that administer benefit programs. Id. Through these agreements, participants in their clients’ benefit programs receive access to health care services from providers in Multiplan’s network at the agreed-upon discounted rates. Id. ¶¶ 10-11. United, a health insurance company, is one of Multiplan’s clients. Id. ¶ 12. By entering into the agreement with Multiplan, Enigma became an “approved out-of-network provider” for participants in United health insurance plans and agreed to perform health care services for those participants at the discounted rates set out in its agreement with Multiplan. Id. ¶¶ 8, 17-18. United’s benefit plans require participants to contribute certain payments, referred to as deductible and coinsurance payments, when they receive health care services. Id. ¶ 32.

At issue in this litigation are claims for health care services provided by Enigma to participants in United’s benefit plans between June 2012 and May 2013. Enigma states that it provided services at the agreed-upon discounted rates and submitted claims to United within the specified [294]*294time limits. Id. ¶¶ 20-21. United denied full payment on the claims on the grounds that Enigma had failed to collect participants’ required deductible and coinsurance payments. Id. ¶ 24. Enigma asserts that United withheld a total of $1,225,163.57 that Enigma is owed based on the rates set out in the preferred provider agreement between Enigma and Multiplan. Id. ¶ 49.

The complaint appears to raise two distinct arguments for why Enigma was entitled to full payment on the claims. First, Enigma asserts that it was not required to collect participants’ deductible and coinsurance payments as a condition of receiving payment from United. Enigma maintains that it was each participant’s responsibility to make his or her own deductible and coinsurance payments. Id. ¶ 32. Enigma states that “services provided by Enigma to United’s participants were not contingent on the participant’s obligation to pay their deductible as a prerequisite,” and “payment to Enigma for services provided to United’s participants was not contingent upon United receiving proof of payment by a participant.” Id. ¶¶ 22-23. Therefore, Enigma argues, even if Enigma had failed to collect participants’ deductible and coinsurance payments, this would not constitute grounds for United to deny full payment on the claims.

Second, Enigma asserts that, in any event, it did collect participants’ deductible and coinsurance payments but had a dispute with United over how to submit proof of those payments. United required Enigma to submit checks or credit card statements for the participants’ payments, but Enigma maintained that this information was “private and proprietary.” Id. ¶¶ 26-27. Instead, Enigma offered to submit invoices that Enigma had sent to participants, but United refused to accept the invoices as proof of payment. Id. ¶¶ 29-30. Enigma denies improperly waiving participants’ payments and states that United has accused it of “wrongdoing” without providing any proof. Id. ¶¶ 25, 28.

Enigma asserts three causes of action. First, Enigma asserts a claim for breach of contract against Multiplan. Enigma cites a provision of its agreement with Multiplan stating that if a dispute arises between Enigma and one of Multiplan’s clients, Multiplan will “make its best efforts to facilitate resolution of the dispute.” Id. ¶ 19. Enigma asserts that Multiplan failed to meet this contractual obligation because it has not resolved the dispute between Enigma and United regarding the claims for Enigma’s services. Id. ¶¶ 51-55. Enigma seeks monetary damages in the amount of $1,225,163.57 plus interest. Id. ¶ 56.

Second, Enigma brings a claim for unjust enrichment against United. Enigma asserts that United “has been enriched by withholding funds due to Enigma for Enigma’s performance of health care services for United’s insured participants.” Id. ¶ 58. Enigma seeks monetary damages in the amount of $1,225,163.57 plus interest. Id. ¶ 61.

Third, Enigma asserts a claim for fraudulent misrepresentation against United. Enigma asserts that United “enticed” Enigma to enter into the preferred provider agreement with Multiplan by promising to pay Enigma for its services. Id. ¶ 63. Enigma asserts that United “intentionally withheld from Enigma its scheme” to require proof that participants had made the deductible and coinsurance payments as a condition for paying Enigma’s claims. Id. ¶¶ 64-65. Enigma asserts that United “made the misrepresentation willfully and with the intent to deceive Enigma.” Id. ¶ 67. Enigma further states that it relied upon this representation and would not have entered into the agreement with Mul[295]*295tipian if it had known of the requirement to show proof of participants’ payments. Id. ¶¶ 66, 68. Enigma seeks monetary damages in the amount of $1,225,163.57 plus interest. Id. ¶ 70.

Enigma filed this action in state court on or about August 12, 2013. On October 4, 2013, United removed the action to this court, arguing that the benefits at issue in the litigation arise under employee welfare benefit plans governed by ERISA and that all, or at least some, of Enigma’s claims are preempted by ERISA. Notice of Removal, Dkt. # 1. Multiplan consented to removal. Id. ¶ 7 & Ex. B. On October 11, 2013, Enigma moved to remand the action to state court on the ground that removal was untimely. Pl.’s Mot. to Remand, Dkt. # 3. In subsequent briefing on the motion to remand, Enigma also argued that its claims are not preempted by ERISA. PL’s Reply in Further Supp. of Mot. to Remand, Dkt. # 14, at 6.

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994 F. Supp. 2d 290, 57 Employee Benefits Cas. (BNA) 2488, 2014 WL 297269, 2014 U.S. Dist. LEXIS 9738, Counsel Stack Legal Research, https://law.counselstack.com/opinion/enigma-management-corp-v-multiplan-inc-nyed-2014.