Marilyn Brown v. Gadsden Regional Medical Center LLC

Court of Appeals for the Eleventh Circuit·Decided September 5, 2018·No. 17-14310·Unpublished

Opinion

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

No. 17-14310

Non-Argument Calendar

D.C. Docket No. 4:16-cv-01739-KOB

MARILYN BROWN, AARON R. GRINDSTAFF,

Plaintiffs - Appellants,

versus

GADSDEN REGIONAL MEDICAL CENTER LLC, a foreign limited liability company, PROFESSIONAL ACCOUNT SERVICES INC, a foreign corporation, TRIAD HOLDINGS V LLC, a foreign limited liability company, TRIAD OF ALABAMA LLC, a foreign limited liability company,

Defendants - Appellees,

COMMUNITY HEALTH SYSTEMS INC, a foreign corporation,

Defendant.

Appeal from the United States District Court for the Northern District of Alabama

(September 5, 2018)

Before MARCUS, ROSENBAUM, and EDMONDSON, Circuit Judges.

PER CURIAM:

In this diversity action involving Alabama law, Plaintiffs Marilyn Brown and Aaron Grindstaff appeal the district court’s final judgment in favor of Defendants Gadsden Regional Medical Center, LLC (“GRMC”), Triad Holdings V, LLC, Triad of Alabama, LLC, and Professional Account Services, Inc.1 Reversible error has been shown; we affirm in part, vacate in part, and remand for further proceedings.

Briefly stated, Plaintiffs challenge Defendants’ billing practices following GRMC’s treatment of patients involved in car accidents. Each Plaintiff had personal health insurance through Alabama Blue Cross Blue Shield (“Blue

1 The parties filed in the district court a joint stipulation dismissing Defendant Community Health Systems, Inc.; Community Health Systems, Inc. is no party to this appeal.

Cross”). Plaintiffs assert that -- pursuant to a Participating Hospital Contract (“Provider Agreement”) between GRMC and Blue Cross -- GRMC could seek reimbursement only from Blue Cross. Instead, GRMC filed a hospital lien for the costs of each Plaintiff’s medical treatment.

Plaintiffs filed in state court this putative class action against Defendants, alleging state law claims for breach of express contract, conversion, and breach of fiduciary duty. 2 The case was then removed to federal district court. The district court dismissed without prejudice for lack of standing Plaintiffs’ claim for breach of express contract. The district court dismissed for failure to state a claim Plaintiffs’ conversion claim. The district court then entered judgment in favor of GRMC on Plaintiffs’ claim for breach of fiduciary duty.

I.

Plaintiffs contend Defendants breached the Provider Agreement between GRMC and Blue Cross by seeking reimbursement for Plaintiffs’ medical expenses from sources other than Blue Cross and at a rate higher than the negotiated rate permitted under the Provider Agreement. The district court concluded that,

2 Plaintiffs also alleged against Defendants a claim for breach of implied contract. On appeal, Plaintiffs raise no challenge to the district court’s dismissal of that claim.

because Plaintiffs were no third-party beneficiaries to the Provider Agreement, they lacked standing to enforce its terms. Accordingly, the district court dismissed without prejudice Plaintiffs’ claim for lack of subject matter jurisdiction, pursuant to Fed. R. Civ. P. 12(b)(1).

When reviewing the district court’s dismissal of claims pursuant to Fed. R.

Civ. P. 12(b)(1), we review de novo the district court’s legal conclusions and review the district court’s factual findings for clear error. Williams v. Poarch Band of Creek Indians, 839 F.3d 1312, 1314 (11th Cir. 2016). When a document -- such as the Provider Agreement involved in this appeal -- “is central to the plaintiff’s claim, its contents are not in dispute, and the defendant attaches the document to its motion to dismiss, this Court may consider that document as well.” See Allen v. USAA Cas. Ins. Co., 790 F.3d 1274, 1278 (11th Cir. 2015).

Under Alabama law, “a third person has no rights under a contract between others unless the contracting parties intend that the third person receive direct benefit enforceable in court as opposed to an incidental benefit.” Fed. Mogul Corp. v. Universal Constr. Co., 376 So. 2d 716, 723-24 (Ala. Civ. App. 1979) (emphasis omitted). When the language of the contract is plain and unambiguous, we look only to the contract itself to determine the intent of the contracting parties. H.R.H. Metals, Inc. v. Miller, 833 So. 2d 18, 24 (Ala. 2002). When “two

contracting parties expressly provide that a third party shall have no legally enforceable rights in their agreement, a court must effectuate the expressed intent by denying the third party any direct remedy.” Fed. Mogul Corp., 376 So. 2d at 724.

The Provider Agreement says expressly that “[n]othing herein contained shall be construed to confer any claim, right, action, or cause of action upon any Member or other person . . . other than the Parties signing this Contract.” This contract provision establishes unambiguously that the contracting parties intended no third party to have a legally enforceable right under the contract. The district court, thus, concluded properly that -- as a matter of Alabama law -- Plaintiffs were no third-party beneficiaries to the Provider Agreement. Because Plaintiffs had no legally protected interest in the Provider Agreement, Plaintiffs lacked standing to pursue a claim based on an alleged breach of that contract. The district court committed no error in dismissing without prejudice Plaintiffs’ breach of express contract claim pursuant to Rule 12(b)(1).

II.

In their claim for conversion, Plaintiffs’ complaint alleged in pertinent part that Defendants “knowingly and wrongfully filed hospital liens against Plaintiffs . . . and pursued collection of inflated hospital bills from said patients’ own auto insurance policy such as med pay, PIP and uninsured/underinsured motorist claims . . . rather than file with said patients’ health insurance carrier.” Plaintiffs also alleged that Defendants “wrongfully exercised dominion over Plaintiffs[’] . . . personal property in exclusion or defiance of their rights by unlawfully refusing to submit the patients’ hospital bills to their health insurance carriers . . . .”

The district court dismissed Plaintiffs’ conversion claim under Rule 12(b)(6)

for failure to state a claim. In doing so, the district court construed Plaintiffs’ complaint as purporting to assert a conversion claim based on several possible theories. On appeal, Plaintiffs challenge the district court’s dismissal of their conversion claim based only on the theory that GRMC’s hospital liens interfered unlawfully with Plaintiffs’ rights to their med-pay insurance benefits.

We review de novo a district court’s dismissal for failure to state a claim, accepting all properly alleged facts as true and construing them in the light most favorable to the plaintiff. Butler v. Sheriff of Palm Beach Cnty., 685 F.3d 1261,

1265 (11th Cir. 2012). To survive a motion to dismiss for failure to state a claim, “a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 129 S. Ct. 1937, 1949 (2009) (quotation omitted). To state a plausible claim for relief, plaintiffs must go beyond merely pleading the “sheer possibility” of unlawful activity by a defendant; plaintiffs must offer “factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. “[A] plaintiff’s obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Bell Atl. Corp. v. Twombly, 127 S. Ct. 1955, 1964-65 (2007) (quotations omitted).

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Marilyn Brown v. Gadsden Regional Medical Center LLC, (11th Cir. 2018).

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