Feldman's Medical Center Pharmacy, Inc. v. Carefirst, Inc.

823 F. Supp. 2d 307, 2011 WL 5433754
CourtDistrict Court, D. Maryland
DecidedNovember 9, 2011
DocketCivil No. SKG-10-254
StatusPublished
Cited by10 cases

This text of 823 F. Supp. 2d 307 (Feldman's Medical Center Pharmacy, Inc. v. Carefirst, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Feldman's Medical Center Pharmacy, Inc. v. Carefirst, Inc., 823 F. Supp. 2d 307, 2011 WL 5433754 (D. Md. 2011).

Opinion

AMENDED MEMORANDUM OPINION AND ORDER

SUSAN K. GAUVEY, United States Magistrate Judge.

On June 1, 2009, Plaintiff Feldman’s Medical Center and Pharmacy, Inc. (“FMCP” or “Plaintiff’) sued Defendant CareFirst, Inc. (“CareFirst” or “Defendant”) in the Circuit Court for Baltimore County for $1,588,127.77 plus interest for breach of contract, unjust enrichment, and bad faith arising out of CareFirst’s denial of reimbursement to FMCP for factor drugs it provided to CareFirst’s insureds. (ECF No. 2). CareFirst removed to this Court pursuant to 28 U.S.C. § 1441. (ECF No. 1). The case was referred to [310]*310the undersigned magistrate judge by consent of the parties pursuant to 28 U.S.C. § 636(c) and Local Rule 301.4. (ECF No. 94).

On March 4, 2011, FMCP moved for summary judgment, seeking as relief: (i) judgment on Counts I through III for nonpayment of invoices in the amount of $109,989.32; (ii) interest on the unpaid contributions in the amount of $886,483.93; (iii) attorneys’ fees and costs; and (iv) such other and further relief as the Court deems just and proper. (ECF No. 100, 1-2). FMCP asserted alternative theories of recovery: Maryland contract law; § 502 of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132; and unjust enrichment. (ECF No. 100-1). FMCP asserted entitlement to prejudgment interest under Md.Code Ann., Insur. § 15-1005 (the “Maryland Prompt Pay Statute”) or, alternatively, under ERISA § 502. (Id.). CareFirst opposed FMCP’s motion for summary judgment and moved for partial summary judgment with respect to FMCP’s claims for reimbursement and prejudgment interest under the Maryland Prompt Pay Statute. (ECF No. 109). CareFirst did not, however, assert entitlement to summary judgment under § 502 of ERISA. See id. The Court held motions hearings on June 9, 2011 and August 11, 2011 pursuant to Local Rule 105.6. (ECF No. 128).

During the pendency of the litigation, CareFirst paid $1,547,054.87 in satisfaction of FMCP’s claims for reimbursement1, as well as $23,017.00 in prejudgment interest.

The parties agree that the only issue presently pending before the Court is FMCP’s claim for prejudgment interest. (ECF No. 121, 2).2 For the reasons set forth herein, the Court GRANTS IN PART FMCP’s motion for summary judgment with respect to its claim for prejudgment interest under ERISA § 502 but [311]*311DENIES IN PART FMCP’s motion for summary judgment with respect to its claim for prejudgment interest under the Maryland Prompt Pay Statute. The Court DENIES IN PART CareFirst’s motion for summary judgment with respect to FMCP’s claim for additional interest.

For the reasons set forth below, the Court orders prejudgment interest under ERISA § 502 at the federal postjudgment rate set forth in 28 U.S.C. 1961. Interest shall be determined on a claim-by-claim basis using the 1-year constant maturity Treasury yield, as published by the Board of Governors of the Federal Reserve System, for the calendar week preceding the date on which interest begins to accrue for each individual claim. For all claims for factor drugs dispensed prior to December 11, 2008, prejudgment interest shall accrue from the 31st day after each individual claim was received by CareFirst until paid. For all claims for factor drugs dispensed after December 11, 2008, with the exception of two claims (invoice numbers 17790 and 17629 for services rendered on April 9, 2009 and March 27, 2009 respectively), prejudgment interest shall accrue from the 31st day after the claim was received by CareFirst until paid. With respect to these two remaining claims, there exists a genuine dispute of material fact regarding whether certain conditions to payment were met and, if so, when they were met. Accordingly, the Court does not award prejudgment interest on these claims at this time. To be clear, prejudgment interest shall cease to run on all claims for which interest is due, whether for factor drugs dispensed before or after December 11, 2008, on the date that each individual claim was paid.3 In addition, CareFirst shall be credited $23,017 for interest already paid to FMCP.

The parties should submit within two weeks of the date of this Memorandum Opinion and Order (“Order”) an accounting of their prejudgment interest calculations for each of the 38 individual claims for which interest is due under this Order, and the total sum due. If either party intends to move for summary judgment with respect to prejudgment interest on the remaining two claims, it should do so within two weeks of this Order. If the moving party believes that resolution requires a hearing, it should make this known to the Court within two weeks as well. Of course, the Court strongly suggests that the parties try to resolve these two remaining claims, without further litigation.

I. HISTORY OF DISPUTE

A. FACTUAL BACKGROUND

FMCP is a Maryland specialty pharmacy that dispenses drugs used to treat hemophilia, von Willebrand disease, hepatitis, and HIV. (ECF No. 2, ¶ 1). CareFirst is a Maryland health insurer and independent licensee of the Blue Cross Blue Shield Association. (Id., ¶ 2). In support of their respective motions for summary judgment, FMCP and CareFirst provided declaration testimony, deposition excerpts, documentary evidence, and correspondence. The essential facts of the case, either undisputed or, where disputed, recited in the light most favorable to the nonmovant, are as follows.

FMCP submitted claims to, and was reimbursed by, CareFirst and its predeces[312]*312sors, starting from FMCP’s inception in the mid-1980s. (SUMF, ECF No. 100-2, ¶ 52; Bostwick Deck, ECF No. 104, ¶ 33). Beginning in the 1990s, FMCP submitted certain prescription drug claims through CareFirst’s “EPIC” contract. (White Deck, ECF No. 120-5, ¶4) (EPIC was a consoi’tium of pharmacies to which FMCP was a party that joined together to obtain certain efficiencies). Under a subscriber agreement dated August 12, 1997 (the “Participating Professional Provider Agreement” or “PPP Agreement”), FMCP became a “participating” or “par” provider in CareFirst’s netwoi'k and secured its entitlement to direct payment for insurance claims submitted for “covered services.” (ECF No. 2, Ex. A); see also (Becker Deck, ECF No. 46-2, ¶ 5). FMCP asserts that it submitted claims to CareFirst directly for sexwices that were not covered by the EPIC contract and that CareFirst paid FMCP directly for these claims pursuant to the PPP Agreement, or if there was no applicable contract, FMCP was paid as a non-participating provider at reimbursement rates set by CareFirst. (White Decl, ECF No. 120-5, ¶4). Care-First does not dispute this.

Factor Health Management (“FHM”), a Florida company, purchased FMCP from its founder in October 2007. (Bostwick Deck, ECF No. 104, ¶ 20).4 Prior to acquisition by FHM, FMCP dispensed prescription drugs and durable medical equipment (“DME”), such as wheelchairs, canes, and catheters. (White Deck, ECF No. 120-5, ¶ 2).

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Bluebook (online)
823 F. Supp. 2d 307, 2011 WL 5433754, Counsel Stack Legal Research, https://law.counselstack.com/opinion/feldmans-medical-center-pharmacy-inc-v-carefirst-inc-mdd-2011.