GPS OF NEW JERSEY M.D., P.C. v. AETNA INC.

CourtDistrict Court, D. New Jersey
DecidedFebruary 5, 2024
Docket2:22-cv-05487
StatusUnknown

This text of GPS OF NEW JERSEY M.D., P.C. v. AETNA INC. (GPS OF NEW JERSEY M.D., P.C. v. AETNA INC.) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
GPS OF NEW JERSEY M.D., P.C. v. AETNA INC., (D.N.J. 2024).

Opinion

Not for Publication

UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY

GPS OF NEW JERSEY MD, P.C.

A/S/O M.K., Civil Action No.: 22-05487 (ES) (JSA) Plaintiff, OPINION v.

AETNA, INC., AETNA LIFE INS. CO. AND ITS AFFLIATES,

Defendants.

SALAS, DISTRICT JUDGE Plaintiff GPS of New Jersey, MD P.C. (“Plaintiff” or “GPS”) initiated this action against Defendants Aetna, Inc. and Aetna Life Insurance Company and its affiliates (collectively, “Defendants”) seeking to vacate an arbitration award entered pursuant to the No Surprises Act, 42 U.S.C. § 300ggg-111, and have this matter remanded back to the arbitrator for reconsideration. (D.E. No. 1 (“Complaint” or “Compl.”)). Before the Court is Defendants’ joint motion to dismiss Plaintiff’s Complaint. (D.E. No. 26). Having considered the parties’ submissions, the Court decides this matter without oral argument. See Fed. R. Civ. P. 78(b); L. Civ. R. 78.1(b). As discussed below, the Court construes Plaintiff’s Complaint as a motion to vacate the arbitration award, DENIES this request, and DISMISSES Plaintiff’s Complaint with prejudice. I. BACKGROUND A. Factual Background On February 9, 2022, Plaintiff, a medical practice, provided emergency plastic surgery services to a patient (hereinafter (“Patient”)). (Compl. at 1 ¶ 1 & 2 ¶ 1).1 Specifically, a physician

in Plaintiff’s practice repaired a 1.2 cm cheek laceration on the Patient. (Mov. Br. at 16). Thereafter, Plaintiff submitted a bill for the rendered services to Defendants, who paid in-part. (Compl. at 2 ¶ 2). Given that Plaintiff is an out-of-network provider with respect to Defendants, and the rendered services were emergency and/or surprise in nature, Defendants’ partial payment was subject to a dispute, negotiation, and arbitration process under the No Surprises Act. (Id. at 2 ¶ 3). After the parties engaged in an unsuccessful negotiation pursuant to the No Surprises Act, Plaintiff filed for arbitration. (Id. ¶ 5). MCMC Services, LLC (“MCMC”) was appointed as the Independent Dispute Resolution (“IDR”) arbitrator. (Id. ¶ 6). The parties engaged in a “baseball- style” arbitration whereby each party submitted a final offer for MCMC to pick between. (Id. ¶ 7). On June 10, 2022, MCMC selected Defendants’ final offer “as the more appropriate out-of-

network rate.” (Id. ¶ 8; D.E. No. 1-3, Exhibit A (“Arb. Dec.”)). B. Procedural Posture On September 10, 2022, Plaintiff initiated this action to vacate the arbitration award and remand the matter back to MCMC for reconsideration pursuant to section 10(a) of the Federal Arbitration Act (“FAA”), 9 U.S.C. § 10(a). (Compl. at 4). Plaintiff alleges that deficiencies in MCMC’s decision prejudiced Plaintiff such that it is entitled to vacatur of the arbitration award.

1 The Complaint contains two sets of numbered paragraphs 1–4. First, on page one of the Complaint, under the subheading, “The Parties,” the Complaint provides numbered paragraphs 1–4. Second, on page two of the Complaint, under the subheading “Anatomy of the Claim,” the Complaint provides numbered paragraphs beginning again with paragraph 1. Thereafter, all paragraphs continue consecutively throughout the Complaint. For ease of reference, when citing to paragraphs 1–4 of the Complaint, the Court additionally provides the page number. For paragraphs 5–18, which are not repeated, the Court provides only the paragraph number. (Id. ¶¶ 15–18). Plaintiff filed an order to show cause for vacation of an arbitration award pursuant to 9 U.S.C. § 10(a) with its Complaint. (D.E. Nos. 1-1, 1-2, & 1-3). Accordingly, on November 22, 2022, Defendants filed a joint cross-motion to dismiss Plaintiff’s Complaint and opposition to Plaintiff’s order to show cause. (D.E. No. 13). However, on December 20, 2022, before Plaintiff

responded, the Court held a telephone conference to address the propriety of using an order to show cause as a vehicle for requesting vacatur of an arbitration award. (D.E. No. 17). At the conference, Plaintiff agreed to withdraw its order to show cause. (D.E. No. 18). On January 19, 2023, Plaintiff opposed Defendants’ cross-motion to dismiss (D.E. No. 19) and on February 24, 2023, Defendants filed a reply. (D.E. No. 22). Thereafter, the Court issued a letter order denying Defendants’ cross-motion to dismiss for procedural deficiencies. (D.E. No. 23). Specifically, the Court noted that in seeking to vacate the arbitration award entered by MCMC, “Plaintiff should have proceeded by filing either (i) a petition to vacate the arbitration award in lieu of a complaint, or (ii) a complaint followed by a motion to vacate the arbitration award.” (Id.¶ 5). Instead, Plaintiff filed a Complaint and order to show

cause, which it later withdrew. However, though the parties agreed to proceed on Defendants’ cross-motion to dismiss notwithstanding Plaintiff’s improper filing, Defendants failed to include in their cross-motion a basis under the Federal Rules of Civil Procedure for dismissing the Complaint. (Id.¶ 6). Accordingly, the Court denied Defendants’ motion without prejudice and granted Defendants leave to re-file their motion to dismiss providing a basis under the Federal Rules of Civil Procedure for dismissal. (Id. at 3). On June 16, 2023, Defendants did just that. (D.E. No. 26). The motion is fully briefed. (See D.E. No. 26-1 (“Mov. Br.”); D.E. No. 27 (“Opp. Br.”); D.E. No. 28 (“Reply”)). On September 26, 2023, Defendants filed a notice of supplemental authority directing the Court to a recent decision in the District of New Jersey. (D.E. No. 29 (directing the Court to GPS of New Jersey M.D., P.C. A/S/O/T.U. v. Horizon Blue Cross Blue Shield, No. 22-6614, 2023 WL 5815821, at *1 (D.N.J. Sept. 8, 2023)). In their moving brief, Defendants first argue that Plaintiff’s Complaint should be dismissed because “there is no legally cognizable claim or cause of action that can vacate an award under the

[Federal Arbitration Act].” (Mov. Br. at 11). Specifically, Defendants point to case law from the Eleventh Circuit and the Southern District of New York in support of the proposition that “[c]ourts may dismiss or strike an improperly filed complaint that seeks to vacate an arbitration” and “a complaint seeking to vacate an arbitration award fails to state a claim as a matter of law under Federal Rule of Civil Procedure 12(b)(6).” (Id. at 10–11 (first citing Kruse v. Sands Bros. & Co., Ltd, et al., 226 F. Supp. 2d 484, 486–87 (S.D.N.Y. 2002) and then citing O.R. Sec., Inc. v. Pro. Plan. Assoc., Inc., 857 F.2d 742, 745 (11th Cir. 1988)). Second, Defendants argue that the Court may choose to construe Plaintiff’s Complaint as a petition or motion to vacate an arbitration award, and, if it does so, the Court should deny Plaintiff’s request because (i) Plaintiff identifies only errors of fact and law which are not grounds for vacating an arbitration award and (ii) even if the

Court could consider such factual and legal errors in vacating an arbitration award, Plaintiff has failed to show that the arbitrator made any mistakes. (Id.

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