Krukas v. Aarp

District Court, District of Columbia·Decided March 17, 2019·No. Civil Action No. 2018-1124·Published

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

HELEN KRUKAS,

Plaintiff,

Civil Action No. 18-1124 (BAH)

v.

Chief Judge Beryl A. Howell AARP, Inc., et al.,

Defendants.

MEMORANDUM OPINION

The plaintiff, Helen Krukas, individually, and on behalf of all others similarly situated (except for individuals residing in California), as well as the general public, brings this putative class action against the defendants, AARP Inc., (“AARP”), AARP Services Inc. (“ASI”), and AARP Insurance Plan (“AARP Trust”) (collectively referred to as “AARP”), alleging a violation of the Washington D.C. Consumer Protection Procedures Act (“CPPA”), D.C. CODE § 28-3901 et seq., as well as common law violations of conversion, unjust enrichment, and fraudulent concealment, based on her purchase of a Medicare supplemental health insurance policy, also known as a “Medigap” policy, administered by AARP. See Compl. ¶¶ 1, 16, 17, 88, ECF No. 1. These statutory and common law claims are predicated on the plaintiff’s allegations that she was “fooled into paying AARP an undisclosed 4.95% commission” when purchasing her Medigap policy and, since “AARP is not licensed as an insurance broker or agent,” the defendants “may not legally collect these commissions.” Id. ¶ 1. Pending before the Court is the defendants’ Motion to Dismiss for failure to state a claim upon which relief can be granted under Federal

Rule of Civil Procedure 12(b)(6). See Defs.’ Mot. to Dismiss & Mem. in Supp. (“Defs.’ Mem.”), ECF No. 8.1 For the reasons set forth below, the defendants’ motion is denied.2 I. BACKGROUND The plaintiff challenges AARP’s role in soliciting, marketing, and administering Medigap policies, a state-regulated form of health insurance to supplement Medicare. Since at least 1997, AARP has held, in its name, group Medigap policies underwritten by UnitedHealth Group and UnitedHealthcare Insurance Company (collectively, “UnitedHealth”) and offered participation in those group policies to individual AARP members and the general public. See Compl. ¶¶ 22, 37, 51. The plaintiff alleges that AARP’s administration and provision of other services in support of these group Medigap policies amounted to acting as an unlicensed insurance agent, that the “royalties” paid to AARP as a percentage of premiums constituted illegal commissions, and that AARP materially misrepresented the nature and source of the “royalties,” causing consumers to pay more for AARP Medigap policies than they otherwise would. See Compl. ¶¶ 4–15. The following discussion provides a general overview of Medigap policies and summarizes the plaintiff’s allegations, claims against AARP, and desired relief.

A. Medigap Policies Generally A Medigap policy is insurance offered by a private insurer to help pay for certain “gaps”

in Medicare coverage. See United States v. Blue Cross & Blue Shield of Md., Inc., 989 F.2d 718, 721 (4th Cir. 1993) (citing Pub. L. No. 96-265, § 507, 94 Stat. 441, 476 (codified as amended at

1 At the parties’ request, the deadline to seek class certification has been tolled until resolution of the defendants’ pending Motion to Dismiss. See Min. Order (Aug. 9, 2018) (granting Joint Mot. to Extend (Aug. 9, 2018), ECF No. 12). Accordingly, whether a class should be certified or whether the plaintiff, by herself and absent class certification, would meet the amount-in-controversy requirement for diversity jurisdiction, are issues not addressed herein. 2 The defendants’ request for oral argument is denied because the ample briefing is sufficient to resolve the pending motion. See D.D.C. Local Civil Rule 7(f) (allowance of an oral hearing is “within the discretion of the Court”).

42 U.S.C. § 1395ss)). The Centers for Medicare and Medicaid Services has described a Medigap policy as “health insurance [sold by private insurance companies that] can help pay some of the health care costs that Original Medicare doesn’t cover, like coinsurance, copayments, or deductibles.” CTRS. FOR MEDICARE & MEDICAID SERVS., CHOOSING A MEDIGAP POLICY: A GUIDE TO HEALTH INSURANCE FOR PEOPLE WITH MEDICARE 5 (2019), https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap-guide.pdf [hereinafter “CMS Medigap Guide]; see also Compl. ¶ 29 (“Medigap plans offer extra coverage to Medicare beneficiaries . . . such as first-dollar coverage and reduced co-payment and deductibles.”).3 “Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between [standardized] Medigap policies . . . sold by different insurance companies,” CMS Medigap Guide at 9, because “[d]ifferent insurance companies may charge different premiums for the same exact policy,” id. at 13. Indeed, “big differences” may occur “in the premiums that different insurance companies charge for exactly the same coverage.” Id. at 19. Age, where a person lives, medical underwriting, and discounts may affect an insurance company’s choice of what premium to charge. Id. at 17.

B. AARP’s Alleged Role in Administering UnitedHealth’s Medigap Policies The plaintiff, currently a resident of Boca Raton, Florida, originally purchased a UnitedHealth Medigap policy from AARP in Louisiana in 2012, and continuously maintained

3 While matters “outside the pleadings” generally may not be considered on a Rule 12(b)(6) motion without converting the motion to one for summary judgment, see FED. R. CIV. P. 12(d), this conversion rule is not triggered by consideration of “documents incorporated into the complaint by reference, and matters of which a court may take judicial notice.” Tellabs, Inc. v. Makor Issues & Rights, Ltd., 551 U.S. 308, 322 (2007). Judicial notice is taken of the CMS Medigap Guide, which is issued by a component of a federal agency, the U.S. Department of Health and Human Services. See FED. R. EVID. 201(b); Cannon v. District of Columbia, 717 F.3d 200, 205 n.2 (D.C. Cir. 2013) (taking judicial notice of public records posted online); Johnson v. Comm’n on Presidential Debates, 202 F. Supp. 3d 159, 167 (D.D.C. 2016) (same).

this coverage by paying her monthly premium to AARP until November 2016. See Compl. ¶ 20; Pl.’s Mem. in Opp’n to Mot. to Dismiss (“Pl.’s Opp’n”) at 16, ECF No. 13. Her most recent renewal of her AARP Medigap policy coverage occurred when she resided in Florida. See Compl. ¶ 20; Pl.’s Opp’n at 16. She alleges that “[b]ut for Defendants’ deceptive and unlawful acts . . . [she] would not have agreed to pay an additional 4.95% above the premium for an AARP Medigap policy, and would have sought out other, cheaper and lawful Medigap insurance.” Compl. ¶ 20.

Defendant AARP is a non-profit membership organization for seniors aged 50 years or older, with reportedly over 40 million members, about half of whom are over the age of 65. See id. ¶¶ 2, 21, 25. The organization is organized under the laws of the District of Columbia and maintains its national headquarters and primary place of business in Washington, D.C., id. ¶ 21, which is where AARP establishes its “corporate policies and practices, including those for AARP Medigap policies,” id. Defendant ASI is a wholly owned subsidiary of AARP, organized under the laws of Delaware, with its primary place of business in Washington, D.C. Id. ¶ 22. As AARP’s taxable, “for-profit” division, ASI “negotiates, oversees, and manages lucrative contracts with AARP’s insurance business partners.” Id. AARP created ASI in 1999 pursuant to a settlement agreement with the U.S. Internal Revenue Service (IRS), following an IRS investigation into the income that AARP earned through endorsement deals. See id. ¶¶ 22, 36. Defendant AARP Trust is a grantor trust organized by AARP under the laws of Washington, D.C., where the Trust maintains its primary place of business. Id. ¶ 22.

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