Fairview Health Services v. Armed Forces Office of the Royal Embassy of Saudi Arabia

District Court, D. Minnesota·Decided December 7, 2023·No. 0:21-cv-02666·Unknown

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA

Fairview Health Services, doing business as University of Minnesota Medical Center, File No. 21-cv-2666 (ECT/TNL)

Plaintiff and Counter- Defendant,

v. OPINION AND ORDER

Armed Forces Office of the Royal Embassy of Saudi Arabia,

Defendant, Counter-Plaintiff, and Third-Party Plaintiff,

v.

Medical Cost Advocate, Inc., Global Medical Services, LLC, and International Medical Center of Minnesota, LLC, formerly doing business as Minnesota International Medicine,

Third-Party Defendants. ________________________________________________________________________ David P. Bunde, Pari McGarraugh, Jacob Patsch Harris, and William Thomas Wheeler, Frederickson & Byron, Minneapolis, MN, for Plaintiff Fairview Health Services.

Cormac Connor, George Edward Stewart, III, and Julia Anne Bonestroo Banegas, Husch Blackwell LLP, Washington, D.C., and Aaron B. Chapin, Husch Blackwell LLP, Chicago, IL, for Defendant Armed Forces Office of the Royal Embassy of Saudi Arabia.

Charles E. Jones, Sara Filo, Kelly C. Engebretson, and Megan Renslow, Moss & Barnett, Minneapolis, MN, for Third-Party Defendant Medical Cost Advocate, Inc. Plaintiff Fairview Health Services brought this case seeking to recover more than $1.3 million in medical bills from Defendant Armed Forces Office of the Royal Embassy of Saudi Arabia. The bills are for medical services Fairview provided to two Saudi citizens.

The basic suit-provoking problem is that, when the Armed Forces Office mailed payment for this amount to Fairview, it omitted particular addressee information on the package and named the wrong payee on the checks. Fairview did not cash the checks. It forwarded them to the listed payee, who took the money. The core issue is who is responsible for this mix up.

This is the case’s second round of dispositive motions. In the first round, the Armed Forces Office sought dismissal on alternative jurisdictional, procedural, and merits grounds. This motion was denied. Fairview Health Servs. v. Armed Forces Off. of the Royal Embassy of Saudi Arabia. --- F. Supp. 3d ---, No. 21-cv-2666 (ECT/TNL), 2023 WL 4203035 (D. Minn. June 27, 2023). The Armed Forces Office subsequently filed a

responsive pleading that includes counterclaims and third-party claims. In this second round, Fairview and a third-party defendant, Medical Cost Advocate, Inc., seek dismissal of the counterclaims and third-party claims asserted against them under Federal Rule of Civil Procedure 12(b)(6). The motions will be granted. The Armed Forces Office’s claims lack plausible factual support. Regardless, the claims will be dismissed

without prejudice to permit the Armed Forces Office the opportunity, if it chooses, to seek leave to amend in the ordinary course before Magistrate Judge Tony N. Leung. The original deadline established by the scheduling order for such motions has not passed. It runs December 29. I1 The parties are a healthcare provider, a foreign sovereign, and various intermediaries. Fairview, which does business as the University of Minnesota Medical

Center, is a nonprofit healthcare corporation providing services in Minnesota. Countercl. [ECF No. 42] ¶ 4.2 The Armed Forces Office is part of the Kingdom of Saudi Arabia’s embassy and diplomatic mission in the United States. Id. ¶ 2. Medical Cost Advocate, Inc. (“MCA”) is a New Jersey corporation. Id. ¶ 7. The Armed Forces Office retained MCA as an agent “to assist with medical bill review and negotiation services related to

treatment of various patients by various healthcare providers in the United States.” Id. ¶ 24. The other third-party defendants are Minnesota International Medicine (“MIM”) and Global Medical Services, LLC (“GMS”). MIM was a Minnesota limited liability company that acted as an intermediary between Fairview and the Armed Forces Office. Id. ¶¶ 5, 15. GMS acquired MIM in May 2018. Id. ¶¶ 6, 23.

1 In reviewing a motion to dismiss for failure to state a claim under Rule 12(b)(6), a court must accept as true all of the factual allegations in the challenged pleading and draw all reasonable inferences in the plaintiffs’ favor. Gorog v. Best Buy Co., Inc., 760 F.3d 787, 792 (8th Cir. 2014) (citation omitted). In accordance with these rules, the background facts are taken from the Answer, Affirmative Defenses, Counterclaims, and Third-Party Claims [ECF No. 42] filed by the Armed Forces Office and documents necessarily embraced by that pleading. See Zean v. Fairview Health Servs., 858 F.3d 520, 526 (8th Cir. 2017).

2 The Armed Forces Office’s responsive pleading [ECF No. 42] contains several separately numbered sections of paragraphs. Citations to the responsive pleading in this opinion and order refer to paragraphs in the “Counterclaims and Third-Party Complaint” section at pages 13–46. Fairview provided healthcare to Saudi citizens. In 2018 and 2019, the Armed Forces Office arranged for two Saudi children, R.A. and L.A., to receive specialized medical treatment at a Fairview hospital. Id. ¶¶ 13–14. The treatment ultimately generated

$1,301,272.95 in negotiated charges. See id. ¶ 39. The parties used intermediary agents to arrange treatment, negotiate billed charges, and facilitate payment. Fairview and the Armed Forces Office did not interact directly. Fairview’s bills were funneled through an intermediary who provided translation and negotiation services. Id. ¶¶ 15, 21. Before the spring of 2018, Fairview used MIM as

an intermediary. Id. ¶¶ 16, 100. Fairview would create invoices and send them to MIM, who in turn would send them to the Armed Forces Office. Id. ¶ 16. The Armed Forces Office would submit payment to MIM, who would in turn submit payment to Fairview. Id. ¶ 17. The Armed Forces Office and MIM entered into a series of “Financial Guarantees,” whereby the Armed Forces Office agreed to pay MIM for Fairview’s medical services upon

receipt of specific billing information. Id. ¶¶ 94–95. After GMS acquired MIM in May 2018, Fairview did not renew its agreement for foreign intermediary billing services with GMS. Id. ¶ 23. The Armed Forces Office entered into an agreement with another intermediary, MCA, to serve as its agent, assisting with medical bill review and negotiation. Id. ¶¶ 24–25a. According to the Armed Forces Office, “MCA held itself out

. . . as being able to help guide the [Armed Forces Office] through the complexities of the health care system in the United States and to be able to use its experience and expertise to help the [Armed Forces Office] obtain discounts and rate reductions.” Id. ¶ 26. MCA represented that its services would be “managed by a US Attorney.” Id. ¶ 25c; Ex. R [ECF No. 44-9] § 1.3. Under their agreement, if MCA negotiated a rate reduction, it would present the Armed Forces Office with a “Preferred Rate Agreement” to memorialize the negotiated terms. Countercl. ¶ 25d. The Armed Forces Office paid MCA hourly for

negotiations that did not result in reduced prices, and a twenty percent commission for those that did result in a reduction. Id. ¶ 25e. The Armed Forces Office and MCA agreed to hold each other’s confidential information in “strict confidence.” Id. ¶ 25g–f. Fairview billed the Armed Forces Office for the care it provided to R.A. and L.A. MIM sent invoices for R.A. and L.A.’s medical care to the Armed Forces Office throughout

2018 and 2019. See Exs. A–P [ECF Nos. 43-1–44-7] (at page 1 of each exhibit). MCA, on behalf of the Armed Forces Office, began negotiating with Fairview regarding the R.A. and L.A. invoices in mid-2019. Id. ¶ 27. On June 20, 2019, MCA and the Armed Forces Office entered into Preferred Rate Agreements for certain invoices. Id. ¶ 28; Exs. A–P. Fairview sent payment instructions to MCA.

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