Healthcare Venture Partners, LLC v. Anthem Blue Cross and Blue Shield

CourtDistrict Court, S.D. Ohio
DecidedNovember 8, 2021
Docket1:21-cv-00029
StatusUnknown

This text of Healthcare Venture Partners, LLC v. Anthem Blue Cross and Blue Shield (Healthcare Venture Partners, LLC v. Anthem Blue Cross and Blue Shield) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Healthcare Venture Partners, LLC v. Anthem Blue Cross and Blue Shield, (S.D. Ohio 2021).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO WESTERN DIVISION

HEALTHCARE VENTURE PARTNERS, LLC, d/b/a THE RIDGE Case No. 1:21-cv-29 Plaintiff, JUDGE DOUGLAS R. COLE

v.

ANTHEM BLUE CROSS AND BLUE SHIELD, et al.,

Defendants. OPINION AND ORDER This cause comes before the Court on Plaintiff Healthcare Venture Partners’ (“the Ridge”) Motion to Remand and for Fees and Costs (the “Motion”) (Doc. 10), following Defendants Community Insurance Company1 and Blue Cross and Blue Shield of Maine’s (collectively “BCBS”2) removal (Doc. 1) of this action from state court on January 14, 2021. For the reasons below, the Court GRANTS the Ridge’s Motion (Doc. 10) and accordingly REMANDS the case to Clermont County Court of Common Pleas. However, the Ridge’s request for attorneys’ fees is DENIED.

1 In the Ridge’s Complaint, it improperly names Anthem Blue Cross and Blue Shield, which is a d/b/a/ for Community Insurance Company, another named defendant. (Notice of Removal (“Notice”), Doc. 1, #1 n.1). 2 The Ridge’s Complaint also names as defendants Blue Cross and Blue Shield Association, Blue Cross and Blue Shield of Texas, and other Blue Cross Blue Shield Companies to be added as discovery proceeds. (Doc. 2, #413–14). For the sake of simplicity, the Court will continue to refer to all defendant entities collectively as “BCBS.” BACKGROUND The Ridge is a healthcare provider in Milford, Ohio. It has allegedly treated members of healthcare plans issued or administered by BCBS. (Compl., Doc. 2, #414– 15). The Ridge does not have a contract with BCBS and, thus, is an “out-of-network

provider.” (Opp. to Mot. (“Opp.”), Doc. 17, #490). Instead of billing BCBS directly when the Ridge treats one of its members, the Ridge alleges that it receives an assignment of the patients’ rights to receive benefits (“benefit claims” or “BCs”). (Id.). The Ridge states that, although BCBS has “paid [the Ridge] directly for the [benefit claims] in some instances … [,] in most other instances, [BCBS has] underpaid the claim, not paid the claim, or directly paid the [insured] the claim payment.” (Compl.,

Doc. 2, #415). On September 11, 2020, the Ridge wrote a letter to BCBS “advising [it] regarding the large account receivable due and owing the Ridge by [BCBS].” (Id. at #417). In response, BCBS requested a “listing of [benefit] claims which were not appropriately paid.” (Id.). On September 24, 2020, the Ridge sent BCBS a spreadsheet (“the Spreadsheet”) containing a list of benefit claims that the Ridge alleges had not been paid. (Id.). The Spreadsheet features prominently in the

arguments regarding remand. On December 10, 2020, having not received payment, the Ridge filed a lawsuit in the Court of Common Pleas of Clermont County, Ohio. (Id. at #413). The Ridge’s Complaint alleged eight causes of action, including an action on account, an action for an accounting, conspiracy to underpay or not pay claims, declaratory judgment, unjust enrichment, breach of contract, promissory estoppel, and tortious interference with contract. (See id.). All of the counts related to BCBS’s alleged failure to pay the BCs to the Ridge. On January 14, 2021, BCBS removed the case to this Court. (Notice, Doc. 1).

In its Notice of Removal, BCBS states that the case is removable on two separate grounds. (Id. at #1). First, BCBS argues that some of the BCs on which the Ridge sought recovery from BCBS arose under plans governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), and thus the case is removable under 28 U.S.C. § 1441(a) pursuant to the doctrine of complete ERISA preemption. (Id.). Second, BCBS asserts that some of the claims as to which payment is sought were assigned to the Ridge by participants under plans governed by the Federal Employees

Health Benefits Act (“FEHBA”), and thus the case is removable under 28 U.S.C. § 1442(a)(1), the federal officer removal statute. (Id.). BCBS acknowledges that some of the BCs at issue were assigned by participants under plans governed neither by ERISA, nor by FEHBA. But BCBS nonetheless argues that the entire case is removable, either based on supplemental jurisdiction under 28 U.S.C. § 1367, or because federal officer removal provides for removal of an entire case, not merely the

claims directed against the federal officer. (Id. at #4). The Ridge moved to remand to state court on February 11, 2021, arguing that neither § 1441(a), nor § 1442(a)(1), provides for removal on the facts here. (Doc. 10). The Ridge also requests the attorneys’ fees it incurred in connection with seeking remand. (Id. at #469). LAW AND ANALYSIS A. Removal Was Not Proper Under The Doctrine Of Complete ERISA Preemption. Under 28 U.S.C. § 1441(a), a defendant may remove “any civil action brought in a State court of which the district courts of the United States have original jurisdiction.” A district court has original jurisdiction over “all actions arising under the Constitution, laws, or treaties of the United States.” 28 U.S.C. § 1331. To determine if a case arises under federal law, ordinarily courts are restricted

to the face of the plaintiff’s well-pleaded complaint. K.B. v. Methodist Healthcare, 929 F.3d 795, 799 (6th Cir. 2019). An exception to this rule arises, however, when Congress “passes a statute so broad that it ‘wholly displaces … state-law cause[s] of action through complete pre-emption.’” Id. (citing Beneficial Nat’l Bank v. Anderson, 539 U.S. 1, 8 (2003)). In cases where complete preemption applies, a defendant may remove a case even if the face of the complaint does not implicate federal law. Id. ERISA is one statute that gives rise to complete preemption. As the Sixth Circuit has

explained, “[a] state suit may be completely preempted (and subject to removal) if it asserts a state law cause of action to enforce the terms of an ERISA plan and that suit conflicts with or duplicates the federal cause of action provided in ERISA’s enforcement provision….” Id. at 800. Stated alternatively, “any state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy

exclusive and is therefore pre-empted.” Hogan v. Jacobson, 823 F.3d 872, 879 (6th Cir. 2016) (quoting Aetna Health Inc. v. Davila, 542 U.S. 200, 209 (2004)). That in turn means that any suit asserting such a claim constitutes an action “arising under” federal law, and is thus subject to removal under 28 U.S.C. § 1441. Here, BCBS argues that complete ERISA preemption applies based on the

Spreadsheet the Ridge sent BCBS and later referenced in its Complaint. Specifically, BCBS points to paragraph 33 in the Complaint, in which the Ridge states: “on September 24, 2020, The Ridge sent [BCBS] a spreadsheet containing a listing of claims which have not been paid.” (Doc. 2, #417, ¶ 33).

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Healthcare Venture Partners, LLC v. Anthem Blue Cross and Blue Shield, Counsel Stack Legal Research, https://law.counselstack.com/opinion/healthcare-venture-partners-llc-v-anthem-blue-cross-and-blue-shield-ohsd-2021.