La Frontera Center, Inc. v. United Behavioral Health, Inc.

268 F. Supp. 3d 1167
CourtDistrict Court, D. New Mexico
DecidedJune 1, 2017
DocketNo. CIV 16-0187 JB/WPL
StatusPublished
Cited by16 cases

This text of 268 F. Supp. 3d 1167 (La Frontera Center, Inc. v. United Behavioral Health, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
La Frontera Center, Inc. v. United Behavioral Health, Inc., 268 F. Supp. 3d 1167 (D.N.M. 2017).

Opinion

JAMES 0. BROWNING, UNITED STATES DISTRICT JUDGE

AMENDED MEMORANDUM OPINION AND ORDER1

THIS MATTER comes before the Court on the Defendants’ Motion to Compel Arbitration, filed March 31, 2016 (Doc. 3)(“Motion”). The Court held a hearing on July 26, 2016. The primary issues are: (i) whether Plaintiff La Frontera Center, Inc. entered a binding arbitration agreement with Defendants United Behavioral Health, Inc., United Healthcare Insurance Company, Inc., Optumhealth New Mexico d/b/a United Behavioral Health, Inc., and Black and- White Corporations (collectively “United Health”); (ii) whether the arbitration agreement applies to all claims that La Frontera asserts against United Health; and (iii) whether the Court should stay these proceedings pending the resolution of arbitration. The Court concludes: (i) that La Frontera entered an enforceable arbitration agreement with United Behavioral Health; and (ii) that La Front-era’s claims against each of the United Health Defendants are subject to mandatory arbitration. Accordingly, the Court grants the Motion and stays proceedings over La Frontera’s claims.

FACTUAL BACKGROUND

This case arises from a complaint that La Frontera filed on February 9, 2016, in the Second Judicial District Court, County of Bernalillo, State of New Mexico, alleging various state law tort, contract, and [1175]*1175restitutionary claims against United Health. See Complaint for Fraud; Fraudulent Misrepresentation; Negligent Misrepresentation; Breach of Contract;. Breach of the Covenant of Good Faith and Fair-Dealing; Breach of Contract — Intended Third-Party Beneficiary; and in the Alternative Promissory Estoppel; and Quantum' Meruit/Unjust Enrichment, filed March 14, 2016 (Doc. l)(“Complaint”). On March 14, 2016, La Frontera filed in the Second Judicial District Court an amended complaint, adding claims under New Mexico’s Insurance Code, N.M. Stat. Ann. §§ 59A-16-20, 59A-16-30, and New Mexico’s Unfair Practices Act, N.M. Stat, Ann. §§ 57-12-1 to 57-12-26. See First Amended Complaint for Fraud; Fraudulent Misrepresentation; Negligent Misrepresentation; Breach of Contract; Breach of the Covenant of Good Faith and Fair Dealing; Breach of Contract — Intended Third-Party Beneficiary; Violation of the New Mexi-. co Unfair Practices Act; Violation of the Unfair Claims Practices Section; and in the Alternative, Promissory Estoppel; and Quantum Meruit/Unjust Enrichment, filed March 14, 2016 (Doc. l-l)(“First Amended Complaint”). Also, on March ■ 14, 2016, United Health removed the action to federal court, based on diversity .jurisdiction. See Notice of Removal at ¶¶ 5-6, at 2, filed March 14, 2016 (Doc. l)(“Notice of Removal”). The Court draws the facts from La Frontera’s First Amended Complaint; the Defendants’ Motion; the Plaintiffs Response to Defendants’ Motion to Compel Arbitration [Doc. 3], filed May 9, 2016 (Doc. 13)(“Response”);. and the Defendants’- Reply in Support of Motion to Compel Arbitration, filed June 10, 2016 (Doc. 16)(“Reply”). ■

1. United Health’s Statewide Contract to Provide State and Federally-Funded Behavioral Health and Substance Abuse Services in , New Mexico.

The State of -New Mexico, Human Services Department (“HSD”) and its sixteen-member Inter-Agency Behavioral Health Purchasing Collaborative (“Collaborative”)2 awarded United Health a contract to act as New Mexico’s “Statewide Entity” to establish, operate, and manage behavioral and substance' abuse services to children, families, and adults enrolled (henceforward “Enrollees”) through the Collaborative’s various agency programs. First Amended Complaint ¶¶ 5, at 2-3. To acquire the Statewide Entity contract, United Health represented to the Collaborative that United Health had national experience in implementing successful statewide Medicaid and state-funded programs, as well as expertise in delivering behavioral health managed care. See First Amended .Complaint ¶23, at 7. United Health executed the Statewide Entity contract on January 22, 2009. See First Amended Complaint ¶ 19, at 6.

Under the Statewide Entity contract, United Health “agreed to implement and manage New Mexico’s Medicaid and State funded programs to deliver services and [1176]*1176pay providers for supplying behavioral health and substance abuse services-to En-rollees” from July 1, 2009, through June 30, 2013. First Amended Complaint at ¶ 13, at 4. The contract also obligated United Health to employ a “dedicated ’Statewide Contract Compliance Officer,” and prohibited United Health “from assigning or delegating this key management function.” First Amended'Complaint ¶ 24, at 7. Under the contract, United Health promised to

ensure that quality behavioral- health services,-including services funded-by Medicaid and various State funding sources, are provided to Medicaid and non-Medicaid consumers; provider network and out-of-network providers are reimbursed timely and accurately; and that services'would be delivered to promote prevention, recovery, resilience, and the efficient, use of available resources.

First Aménded Complaint ¶ 26, at 7. The Statewide Entity contract'recognized “that United would deliver services'through'subcontracted providers,” but United Health undertook responsibility to fulfill all of the contract’s performance requirements. First Amended Complaint ¶ 31, at 8. HSD, on the Collaborative’s behalf, paid United Health approximately $370 million annually to perform as New Mexico’s Statewide Entity, - See First Amended Complaint 1Í13, at 4. HSD paid United Health on the first Friday of every month based on the total number of Enrollees with United Health. See First Amended Complaint ¶ 34, at 9.

United Health , had problems with its subcontractors. See First Amended Complaint ¶¶ 35-49, at 10-12. Within six months of executing the Statewide Entity contract, “the Collaborative-fined'United $i million for not timely paying its subcontracted providers for the services they rendered' to United’s Enrollees.” First Amended Complaint ¶ 35, at 10. Moreover, in 2012, United Health learned, of suspected billing errors, but United Health did not notify its subcontracted providers of these suspected billing, errors. See First Amended Complaint. ¶ 37, at 10. Nor did United Health notify the Collaborative that it had detected certain billing errors until September or October 2012. See First Amended- Complaint ¶ 37, at 10. In December 2012, and January 2013, United Health investigated several of its subcontracted behavioral health and substance abuse providers, and identified,-in a pre-audit investigation, “what • United called billing errors by its subcontracted providers during United’s entire tenure as New Mexico’s Statewide Entity.” First Amended Complaint ¶ 38, at 10-11.

United Health gave' the Collaborative the results of this pre-audit investigation in January 2013, and the Collaborative contracted with the Public Consulting Group, Inc. (“PCG”) to conduct a confidential audit of fifteen of United Health’s subcontracted providers. See First Amended Complaint ¶¶ 38-39, at 10-11. The PCG audit concluded that United Health overpaid fifteen of its subcontracted providers $37.3 million over a three-and-a-half year period. See First Amended Complaint ¶ 40, at 11. “On June 24, 2013, it was publically announced that New Mexico received ‘credible allegations’ that 15 of United’s contracted non-profit providers of behavioral health service had defrauded the program out of $36 million over a three-year period.” First Amended Complaint ¶ 40, at 11.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
268 F. Supp. 3d 1167, Counsel Stack Legal Research, https://law.counselstack.com/opinion/la-frontera-center-inc-v-united-behavioral-health-inc-nmd-2017.