Health Republic Insurance Company v. United States

CourtUnited States Court of Federal Claims
DecidedSeptember 30, 2020
Docket16-259
StatusPublished

This text of Health Republic Insurance Company v. United States (Health Republic Insurance Company v. United States) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Health Republic Insurance Company v. United States, (uscfc 2020).

Opinion

In the United States Court of Federal Claims No. 16-259C (Filed: September 30, 2020)

*************************************** HEALTH REPUBLIC INSURANCE * COMPANY, * * Affordable Care Act; RCFC 15(a)(2); Plaintiff, * Motion for Leave to Amend Answer to * Assert Counterclaims for Setoff; Undue v. * Delay; Prejudice; Futility; 28 U.S.C. * §§ 1503, 2508; McCarran-Ferguson Act, 15 THE UNITED STATES, * U.S.C. § 1012(b) * Defendant. * ***************************************

Stephen Swedlow, Chicago, IL, for plaintiff.

Marc S. Sacks, United States Department of Justice, Washington, DC, for defendant.

OPINION AND ORDER

SWEENEY, Chief Judge

This class action suit concerns the risk corridors payments that the government owes to insurers pursuant to the Patient Protection and Affordable Care Act (“ACA”), Pub. L. No. 111- 148, 124 Stat. 119 (2010). Presently before the court is defendant’s motion for leave to amend its answer to assert counterclaims against members of one of the three certified subclasses. For the reasons set forth below, the court grants defendant’s motion.

I. BACKGROUND

Plaintiff Health Republic Insurance Company (“Health Republic”) filed suit in this court in February 2016, alleging, for itself and on behalf of those similarly situated, that the United States did not fully pay the risk corridors payments to which it and other insurers are entitled under the ACA and its implementing regulations. The court certified a class of insurers who did not receive full payment for the 2014 and 2015 benefit years and then, shortly thereafter, denied defendant’s motion to dismiss plaintiff’s complaint on jurisdictional grounds.

Less than two months later, the court approved plaintiff’s class action notice plan and set deadlines for insurers to opt into the class and for plaintiff to certify the final class membership. Defendant then filed an answer in which it asserted two affirmative defenses: failure to state a claim upon which relief could be granted and failure to credit payments made by the government. Four days after defendant filed its answer, plaintiff filed a motion for summary judgment in which it contended that defendant was liable for the unpaid risk corridors payments. Defendant responded with a cross-motion for summary judgment in which it denied liability. In June 2017, after the parties fully briefed both motions, plaintiff certified the membership of the class; defendant had been provided a list of insurers opting into the class in the thirty days prior to the certification.

In the meantime, after plaintiff filed suit, other insurers began to file similar complaints challenging the government’s failure to make risk corridors payments. Unlike in this case, defendant sought to dismiss those complaints on their merits at the outset. The rulings in some of those cases led to the entry of judgment and the filing of appeals. Thus, one month after plaintiff certified the membership of the class in this case, in the interest of judicial economy, the court stayed proceedings on the cross-motions for summary judgment pending the outcome of the appeals. 1 Ultimately, four risk corridors cases reached the United States Supreme Court (“Supreme Court”). The Supreme Court issued a decision on April 27, 2020, in which it concluded that defendant was liable for the unpaid risk corridors payments. See Me. Cmty. Health Options v. United States, 140 S. Ct. 1308 (2020).

In the first joint status report filed by the parties in this case after the Supreme Court’s decision, defendant advised that it would be assessing whether any of the class members owed debts to the United States under other ACA programs (“ACA debts”), whether the parties might be able to resolve any debt-related issues, and whether it would be appropriate to raise defenses or assert counterclaims concerning such debts.

Ultimately, the parties filed a motion in which they requested that the previously certified class be divided into three subclasses: a subclass consisting of the class members who had no further dispute with the government and for which judgment could be entered, a subclass consisting of a single class member who required the approval of a state court before judgment could be entered, and a “Dispute Subclass” consisting of four class members who had a dispute with the government regarding the amount they were owed. With respect to the Dispute Subclass, the parties indicated that the subclass members “dispute the amount due to the entity under Section 1342 of the Affordable Care Act, and/or dispute the government’s right to offset debts against a judgment pursuant to Section 1342, and/or dispute the extent of any such offset.” They further indicated that defendant intended to seek leave to amend its answer to assert counterclaims to recover the delinquent ACA debts from the Dispute Subclass. The court granted the parties’ motion, certified the three subclasses, 2 directed the entry of judgment for the

1 While those proceedings were stayed, the court granted two unopposed motions to add members to the class. 2 The Dispute Subclass includes Colorado Health Insurance Cooperative, Inc.; Freelancers CO-OP of New Jersey, Inc. (“Freelancers”); Meritus Health Partners; and Meritus Mutual Health Partners. In its response to defendant’s motion for leave to amend its answer, the Dispute Subclass indicates that Freelancers reached an agreement in principle with the government to resolve their dispute and that the parties intended to jointly move to place Freelancers in a separate subclass. The parties have not yet done so (although they moved to -2- subclass without any dispute with the government, and set a briefing schedule for defendant’s motion for leave to amend its answer. Defendant filed its motion, which is now fully briefed.

II. DISCUSSION

A. Motions for Leave to Amend a Pleading

Under Rule 15(a)(2) of the Rules of the United States Court of Federal Claims (“RCFC”), “a party may amend its pleading” with the court’s leave, and “[t]he court should freely give leave when justice so requires.” See also RCFC 7(a) (defining a “pleading” as including “an answer to a complaint”); 3 James Wm. Moore, Moore’s Federal Practice § 15.02[1] (3d ed. 2012) (“Amendments may relate to . . . claims and may serve such purposes as to add claims or defenses . . . .”). As the Supreme Court stated in the context of a plaintiff seeking to amend her complaint:

If the underlying facts or circumstances relied upon by a plaintiff may be a proper subject of relief, he ought to be afforded an opportunity to test his claim on the merits. In the absence of any apparent or declared reason––such as undue delay, bad faith or dilatory motive on the part of the movant, repeated failure to cure deficiencies by amendments previously allowed, undue prejudice to the opposing party by virtue of allowance of the amendment, futility of amendment, etc.––the leave sought should, as the rules require, be “freely given.” Of course, the grant or denial of an opportunity to amend is within the discretion of the District Court, but outright refusal to grant the leave without any justifying reason appearing for the denial is not an exercise of discretion; it is merely abuse of that discretion and inconsistent with the spirit of the Federal Rules.

Foman v. Davis, 371 U.S. 178, 182 (1962).

B. Setoffs and Counterclaims

The United States “has the same right ‘which belongs to every creditor, to apply the unappropriated moneys of his debtor, in his hands, in extinguishment of the debts due to him.’” United States v. Munsey Tr. Co. of Wash., D.C., 332 U.S. 234

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Gratiot v. United States
40 U.S. 336 (Supreme Court, 1841)
Cherry Cotton Mills, Inc. v. United States
327 U.S. 536 (Supreme Court, 1946)
United States v. Munsey Trust Co.
332 U.S. 234 (Supreme Court, 1947)
Foman v. Davis
371 U.S. 178 (Supreme Court, 1962)
Scheuer v. Rhodes
416 U.S. 232 (Supreme Court, 1974)
Harlow v. Fitzgerald
457 U.S. 800 (Supreme Court, 1982)
Atkins v. Parker
472 U.S. 115 (Supreme Court, 1985)
Bell Atlantic Corp. v. Twombly
550 U.S. 544 (Supreme Court, 2007)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
J.G.B. Enterprises, Inc. v. United States
497 F.3d 1259 (Federal Circuit, 2007)
Applied Companies v. United States
144 F.3d 1470 (Federal Circuit, 1998)
Cencast Services, L.P. v. United States
729 F.3d 1352 (Federal Circuit, 2013)
Meyer Group, Ltd. v. United States
115 Fed. Cl. 645 (Federal Claims, 2014)
King v. United States
119 Fed. Cl. 51 (Federal Claims, 2014)
Alta Wind I Owner Lessor C v. United States
125 Fed. Cl. 8 (Federal Claims, 2016)
Hanover Insurance Company (The) v. United States
134 Fed. Cl. 51 (Federal Claims, 2017)
Moda Health Plan, Inc. v. United States
892 F.3d 1311 (Federal Circuit, 2018)

Cite This Page — Counsel Stack

Bluebook (online)
Health Republic Insurance Company v. United States, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-republic-insurance-company-v-united-states-uscfc-2020.