Keith Feder, M.D., Inc. v. Nestle USA, Inc.

District Court, C.D. California·Decided January 13, 2025·No. 2:24-cv-06817·Unknown

Opinion

UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CIVIL MINUTES —- GENERAL ‘Oo’ JS-6 Case No. 2:24-cv-06817-CAS(BFMx) Date January 13, 2025 Title Keith Feder, M.D., Inc. v. Nestlé USA, Inc. et al

Present: The Honorable CHRISTINA A. SNYDER Catherine Jeang Laura Elias N/A Deputy Clerk Court Reporter / Recorder Tape No. Attorneys Present for Plaintiffs: Attorneys Present for Defendants: Jonathan Stieglitz Douglas Smith Proceedings: ZOOM HEARING RE: MOTION TO REMAND (Dkt. 21, filed on November 28, 2024) I. INTRODUCTION On July 10, 2024, Keith Feder M_D., Inc. (“plaintiff”) filed a complaint in Los Angeles Superior Court against Nestlé USA, Inc. (“defendant”) and ten doe defendants, asserting three claims for relief: (1) negligent misrepresentation; (2) promissory estoppel; and (3) enforcement pursuant to 29 U.S.C. § 1132(a)(1)(B) for failure to pay Employee Retirement Income Security Act (“ERISA”) plan benefits. Dkt. 1-2 (“Compl.”) 4] 60-79. On August 12, 2024, defendant removed the case to this Court on the basis of federal question jurisdiction and diversity jurisdiction. Dkt. 1 (“Notice of Removal”). On October 16, 2024, defendant filed a motion to dismiss. Dkt. 19. On November 28, 2024, plaintiff filed a motion for leave to file a first amended complaint. Dkt. 20. The same day, plaintiff filed its first amended complaint. Dkt. 22 (“FAC”). On December 9, 2024, the Court granted plaintiff leave to file its FAC, nunc pro tunc, and denied defendant’s motion to dismiss as moot. Dkt. 24. Plaintiff's FAC amended the cover page’s claimed damages to $50,000 from $25,000 and eliminated its ERISA claim. See generally FAC. Also on November 28, 2024, plaintiff filed the instant motion to remand the case to Los Angeles Superior Court. Dkt. 21 (“Mot.”). On December 23, 2024, defendant filed its opposition. Dkt. 29 (“Opp.”). On December 24, 2024, plaintiff filed its reply. Dkt. 30 (“Reply”).

UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CIVIL MINUTES —- GENERAL ‘Oo’ JS-6 Case No. 2:24-cv-06817-CAS(BFMx) Date January 13, 2025 Title Keith Feder, M.D., Inc. v. Nestlé USA, Inc. et al

On December 19, 2024, defendant filed a motion to dismiss plaintiff's FAC. Dkt. 27. On December 22, 2024, plaintiff filed its opposition. Dkt. 28. A hearing on defendant’s motion to dismiss 1s set for January 27, 2025. On January 13, 2025, the Court held a hearing. Having carefully considered the parties’ arguments and submissions, the Court finds and concludes as follows. II. BACKGROUND Plaintiff is a California medical corporation. FAC § 1. In his FAC, plaintiff alleges that defendant’s representative and agent is Anthem Blue Cross Life and Health Insurance Co. Id. 43. Plaintiff alleges that he did not have a written contract with the relevant health plan and received no referrals therefrom. Id. § 10. Plaintiff explains that insurers use the terms usual, reasonable, customary, and allowed “all to mean an average payment for a procedure provided by similarly situated medical providers within similarly situated areas or places of practice.” Id. J 13. These terms are abbreviated “UCR” by the industry. Id. Plaintiff alleges that when a provider like plaintiff is told that defendant or Anthem is going to pay a claim based on UCR, plaintiff expects that defendant or Anthem will use the Fair Health database to calculate the exact dollar amount that plaintiff will be paid. Id. § 19. Plaintiff alleges that on September 13, 2022, patient BS received a surgical procedure from plaintiff. Id. 921. Prior to the procedure, on September 8, 2022, plaintiff alleges that an employee of plaintiff obtained representations from an Anthem representative regarding how plaintiff would be paid for its services, clarifying the patient’s responsibility and defendant’s responsibility for payment. Id. 4] 22-25. Plaintiff alleges that at no time prior to the provision of services was plaintiff advised that patient’s “policy or certificate of insurance was subject to certain exclusions, limitations, or qualifications, which might result in the denial of coverage, limitation of payment or any other method of payment unrelated to the UCR rate.” Id. § 32. Plaintiff claims that despite Anthem’s representations on its behalf, defendant knew it would be paying the Medicare rate rather than the UCR rate and intended to induce plaintiff to provide the medical services on the basis of its misrepresentations. Id. 4 34-36. Following the procedure, plaintiff alleges, it submitted to defendant through Anthem the requisite billing information and bill totaling $50,000. Id. 4 39. Plaintiff claims that defendant “processed the bills and made a payment of $621.99.” Id. § 41.

UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CIVIL MINUTES — GENERAL ‘Oo’ JS-6 Case No. 2:24-cv-06817-CAS(BFMx) Date January 13, 2025 Title Keith Feder, M.D., Inc. v. Nestlé USA, Inc. et al

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