Managed Care Advisory Group, LLC v. Cigna Healthcare, Inc.

939 F.3d 1145
CourtCourt of Appeals for the Eleventh Circuit
DecidedSeptember 18, 2019
Docket17-13761
StatusPublished
Cited by28 cases

This text of 939 F.3d 1145 (Managed Care Advisory Group, LLC v. Cigna Healthcare, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Managed Care Advisory Group, LLC v. Cigna Healthcare, Inc., 939 F.3d 1145 (11th Cir. 2019).

Opinion

Case: 17-13761 Date Filed: 09/18/2019 Page: 1 of 34

[PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT ________________________

No. 17-13761 ________________________

D.C. Docket No. 1:00-md-01334-FAM

MANAGED CARE ADVISORY GROUP, LLC,

Plaintiff - Appellee,

versus

CIGNA HEALTHCARE, INC.,

Defendant - Appellant,

EPIQ SYSTEMS, INC., DAVID GARCIA, NEIL MANNING, IMEDECS, MILLENNIUM HEALTHCARE CONSULTING, INC., MARY FALBO,

Interested Parties - Appellants. Case: 17-13761 Date Filed: 09/18/2019 Page: 2 of 34

________________________

Appeals from the United States District Court for the Southern District of Florida ________________________

(September 18, 2019)

Before JILL PRYOR and BRANCH, Circuit Judges, and REEVES,* District Judge.

PER CURIAM:

Medical providers filed several class action lawsuits against managed care

insurance companies, including CIGNA Healthcare, Inc. (“CIGNA”). These

actions alleged that the insurers improperly processed and rejected certain

physicians’ claims for payment. The actions were consolidated into Multidistrict

Litigation (“MDL”) before the United States District Court for the Southern

District of Florida. The class and CIGNA reached a settlement after extensive

litigation and the district court subsequently approved the parties’ Settlement

Agreement.

Following the settlement, Managed Care Advisory Group, LLC (“MCAG”),

acting on behalf of class members, entered into an arbitration agreement with

CIGNA in an attempt to resolve a dispute over a portion of the settlement funds.

* The Honorable Danny C. Reeves, United States Chief District Judge for the Eastern District of Kentucky, sitting by designation.

2 Case: 17-13761 Date Filed: 09/18/2019 Page: 3 of 34

The Settlement Agreement did not provide for arbitration and MCAG was not a

party to it. Instead, MCAG claimed to represent class members who were parties

to the Settlement Agreement. The arbitrator summonsed the settlement claims

administrator and independent review entities (“IREs”) 1 to appear for a live

hearing and video conference and to bring with them certain documents. MCAG

filed a motion to enforce the arbitral summonses in the district court approximately

three years after it had closed all proceedings involving the MDL. CIGNA

responded to MCAG’s motion to enforce the arbitral summonses with a motion to

strike the summonses. The district court referred the matter to a magistrate judge

who denied CIGNA’s motion and granted MCAG’s request to enforce the

summonses. CIGNA and the summonsed parties appealed the magistrate judge’s

decision to the district court and, at the district court’s suggestion, CIGNA filed a

motion to enforce the settlement and compel an accounting.

The district court affirmed the magistrate judge’s decision, enforcing the

arbitral summonses, but denied CIGNA’s motion to enforce the Settlement

Agreement and compel an accounting stating, “[t]he Arbitrator shall be allowed to

arbitrate the claims in the manner he sees fit.” After careful review of the record

1 The IREs are organizations selected by mutual agreement of counsel for the parties to the Settlement Agreement. Their role is to review CIGNA’s disposition of insurance claims submitted pursuant to the Settlement Agreement. 3 Case: 17-13761 Date Filed: 09/18/2019 Page: 4 of 34

and with the benefit of oral argument, we reverse enforcement of the arbitral

summonses. Additionally, we reverse and remand the denial of the motion to

enforce the Settlement Agreement and compel an accounting to the extent that it

relates to a portion of settlement funds previously paid.

I. BACKGROUND

Medical providers filed several class actions against managed care insurance

companies, including CIGNA, starting in 1999. The matters were consolidated

into an MDL proceeding in the United States District Court for the Southern

District of Florida in April 2000. MCAG was not a party, class member, or class

counsel in any of the lawsuits consolidated into the MDL, nor was it a party to the

MDL itself. The parties later moved for preliminary approval of a settlement, and

the district court granted their request.

The district court approved the settlement on January 30, 2004, following a

class action fairness hearing. The court noted, however, that it retained jurisdiction

for “all matters relating to [] the interpretation, administration, and consummation

of the Agreement . . . .” The settlement included monetary relief to the class

members as well as the ability to either (1) participate in a $30,000,000 fund that

would be distributed to class members or (2) seek recovery from an uncapped fund

for claims that were previously denied or reduced. As relevant to this appeal,

“Category Two” claims sought recovery from the uncapped fund. To seek 4 Case: 17-13761 Date Filed: 09/18/2019 Page: 5 of 34

compensation for Category Two claims, the class members would submit their

claims to the settlement administrator, who would forward them to CIGNA upon

verification that the claim was accompanied by sufficient supporting documents.

If CIGNA determined that a claim was not payable, it would be reviewed by the

independent settlement administrator or the IRE (collectively, “the Reviewers”),

depending on the reason for the denial. After evaluating these claims, the

Reviewers would make a final, independent decision regarding whether the claims

should be paid.

Class member Texas Children’s Pediatric Associates (“TCPA”) moved for

enforcement of the settlement on July 14, 2005, asserting that CIGNA obstructed

the process for Category Two claims, causing the Reviewers to improperly process

claims. TCPA requested in the motion for enforcement of the settlement that the

district court direct CIGNA to pay its claims. However, TCPA subsequently

withdrew its motion on November 16, 2005, noting that MCAG and CIGNA

agreed to binding arbitration of the matter.

The notice of withdrawal indicated that the parties agreed that the district

court “should, consistent with the Settlement Agreement, Final Judgment and the

Arbitration Agreement, retain jurisdiction over the parties and this matter for

purposes of confirming, modifying and/or vacating that Arbitration Award (as well

as any pre-Award decisions) in accordance with the FAA [Federal Arbitration 5 Case: 17-13761 Date Filed: 09/18/2019 Page: 6 of 34

Act].” However, the Settlement Agreement did not require arbitration and did not

have an arbitration provision. Instead, the arbitration agreement between CIGNA

and MCAG was separate and apart from the Settlement Agreement, to which

MCAG was not a party. The Reviewers were not parties to the binding arbitration

and the arbitration agreement was solely between MCAG and CIGNA.2

During the arbitration, the arbitrator required CIGNA to allow reprocessing

of certain claims; however, problems supposedly arose. The arbitrator issued non-

party summonses to the following third parties requiring them to participate in the

arbitration hearing: (1) Epiq, the settlement administrator; (2) David Garcia, a

project director at Epiq; (3) Neil Manning, an ex-employee of Epiq; (4)

IMEDECS/Millennium Healthcare Consulting, Inc., the IRE; and (5) Mary Falbo,

the IRE’s founder and CEO (collectively, “the summonsed parties”).

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Cite This Page — Counsel Stack

Bluebook (online)
939 F.3d 1145, Counsel Stack Legal Research, https://law.counselstack.com/opinion/managed-care-advisory-group-llc-v-cigna-healthcare-inc-ca11-2019.