Montefiore Medical Center v. Teamsters Local, 272

CourtDistrict Court, S.D. New York
DecidedSeptember 19, 2019
Docket1:09-cv-03096
StatusUnknown

This text of Montefiore Medical Center v. Teamsters Local, 272 (Montefiore Medical Center v. Teamsters Local, 272) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Montefiore Medical Center v. Teamsters Local, 272, (S.D.N.Y. 2019).

Opinion

UNITED STATES DISTRICT COURT DOCUMENT SOUTHERN DISTRICT OF NEW YORK ELECTRONICALLY FILED DOC#: (5 DATE Fitep: 7 [!4 MONTEFIORE MEDICAL CENTER, Plaintiff, No. 09-CV-3096 (RA)(SN) v. LOCAL 272 WELFARE FUND, ef al., Defendants,

MONTEFIORE MEDICAL CENTER, Plaintiff, No. 14-CV-10229 (RA)(SN) v. OPINION & ORDER LOCAL 272 WELFARE FUND, ef ail., Defendants.

RONNIE ABRAMS, United States District Judge: Plaintiff Montefiore Medical Center (“Montefiore”) filed two actions, in 2009 (the “First Action”) and in 2014 (the “Second Action”), against Defendants Local 272 Welfare Fund (the “Fund”) and its manager, Mare Goodman,! In both cases, Montefiore sought payment for medical services that it provided to the Fund’s participants. The Court has resolved the parties’ disputes through numerous decisions issued over the past decade. Montefiore now seeks an award of attorneys’ fees for claims that it litigated in the First and Second Actions that were governed by the Employee Retirement Income Securities Act of

1 Montefiore subsequently filed a third action against the Fund (the “Third Action”), see No. 17-CV- 10213 (RA) (SN) (S.D.N.Y.), which is not at issue here.

1974 (“ERISA”). For the following reasons, Montefiore’s motion is GRANTED in part and DENIED in part. BACIKKGROUND I, Factual! History The Fund, a self-insured employee benefit plan, provides medical coverage to its participants. Between 2003 and 2006, the Fund contracted with a preferred provider- organization, Horizon Healthcare Services of New York, Inc. (“Horizon”). Horizon provided the Fund access to its participating medical providers, which included Montefiore, a nonprofit hospital in the Bronx, New York. The Fund’s relationship with Horizon ended in 2007. As a result, the Fund contracted with MagnaCare Administrative Services (“MagnaCare”), whose provider network also included Montefiore. A year later, in August 2008, Montefiore terminated the Fund’s right to obtain medical services under the MagnaCare contract. After that date, Montefiore was an out-of- network provider to the Fund’s participants. Throughout this period, Montefiore argued that the Fund improperly denied Montefiore’s claims for reimbursement. Specifically, Montefiore raised four types of claims: (1) breach of contract claims that arose during the Horizon contract; (2) breach of contract claims that arose during the MagnaCare contract; (3) ERISA claims that arose during the MagnaCare contract; and (4) unjust enrichment claims, or in the alternative, ERISA claims, that arose after the MagnaCare contract was terminated. The First Action concerned all four types of claims; the Second Action concerned only post-MagnaCare ERISA claims.

Ik. Procedural History A. The First Action Montefiore commenced the First Action on March 11, 2009, in the Supreme Court of the State of New York, Bronx County. Dkt. No. 1.2. The Fund subsequently removed the case to this Court, asserting that Montefiore’s claims were preempted under ERISA. See id) On November 12, 2009, Judge Harold Baer, Jr. denied Montefiore’s motion to remand. Dkt. No. 16. That decision was affirmed by the Second Circuit in April 2011. See Montefiore Med. Ctr. v. Teamsters Local 272, 642 F.3d 321 (2d Cir. 2011). Judge Baer conducted a two-day bench trial in September 2012. Dkt. No. 36-38. After trial, on December 14, the Fund submitted a letter to the Court stating that the Fund had “paid all claims .. . for services rendered after August 13, 2008, when the Fund was terminated from the MagnaCare network.” Dkt. No. 48-2 at 2. The Fund submitted a similar letter on February 7, 2013. Dkt. No. 48-4 at 2. This time, the Fund asserted that it had paid “all claims for services rendered during the period prior to August 13, 2008 . . . except for those claims that were denied for lack of pre-certification.” fd. Montefiore opposed the Fund’s December 14 letter, but it did not respond to the letter submitted in February. See Dkt. No. 48-3 at 4, On June 25, 2013, Judge Baer issued an Opinion and Order dispensing with Montefiore’s claims. See Dkt. No. 45. Based on the Fund’s letters, Judge Baer determined that most of the MagnaCare claims, and all of the post-MagnaCare claims, had been settled. See id. at 5—/. Those claims were dismissed, and the remaining two MagnaCare claims, which were analyzed

2 Unless stated otherwise, docket citations refer to the First Action, No. 09-CV-03096 (RA) (SN) (SDNY).

under ERISA, were denied on the merits. See id. at 9. Montefiore appealed, and on January 21, 2015, the Second Circuit vacated the judgment in its entirety. See Montefiore Med. Ctr v. Teamsters Local 272, 589 F. App’x 32 (2d Cir. Jan. 21, 2015). The Second Circuit held that the “District Court’s decision to credit one party’s assertion that certain claims had been ‘settled’

was clearly erroneous.” Jd. at 34. On remand, Magistrate Judge Sarah Netburn issued a Report and Recommendation addressing the majority of Montefiore’s claims. Dkt. No. 106. Specifically, Judge Netburn recommended that Montefiore be awarded: (1) $42,698.03 for its breach of contract claims under the Horizon contract; and (2) $641,326 for its breach of contract and ERISA claims under the MagnaCare contract, Id at 25. Because a related decision from the Second Action was pending before the Court of Appeals, the post-MagnaCare claims — which Montefiore had since decided

were governed only by ERISA — were held in abeyance. id. at 6; Dkt. No. 83 at 3. On April 3, 2018, this Court adopted Judge Netburn’s decision in its entirety. Dkt. No. 111. B. The Second Action Montefiore commenced the Second Action on December 31, 2014. No, 14-CV-10229, Dkt. No. 1. Lhe complaint included only post-MagnaCare ERISA claims; that is, ERISA claims that arose after the MagnaCare contract was terminated. fd. The parties cross-moved for summary judgment in the summer of 2016, Interpreting the Fund’s Summary Plan Description (“SPD”), Judge Netburn found that, in deciding how much to

pay an out-of-network provider, the Fund was required to “determine what it pays its various in- network providers for a particular service” and then select the “maximum, or highest, amount.” No. 14-CV-10229, Dkt. No. 68 at 13 (internal quotation marks omitted). As a result, Judge Netburn recommended granting Montefiore’s motion for summary judgment. /d. at 19-20. The

Court adopted this recommendation in its entirety on March 31, 2017, which was affirmed by the Second Circuit on February 28, 2018. No. 14-CV-10229, Dkt. No. 73; Montefiore Med. Ctr. v. Local 272 Welfare Fund, 712 F. App’x 104 (2d Cir. Feb. 28, 2018). C. Consolidated Proceedings On May 3, 2018, Judge Netburn directed the parties to file consolidated briefing for all outstanding issues in the First and Second Actions. Dkt. No. 116. Following the appeal in the Second Action, the Fund agreed to pay the majority of the post-MagnaCare ERISA claims from the First Action, which had previously been held in abeyance and were governed by the same analysis. See Dkt. No. 127 at 7 & n.3; Dkt. No. 88 at 3-4. Thus, only four issues remained; First, whether Montefiore is entitled to reimbursement on six post- MagnaCare ERISA claims: five from the First Action, and one from the Second Action. Second, whether Montefiore is entitled to prejudgment interest on its post-MagnaCare ERISA claims from both the First and the Second Actions, Third, whether Montefiore is entitled to reasonable attorney’s fees. And fourth, whether Montefiore properly calculated its prejudgment interest on its breach of contract claims in the First Action. Dkt. No. 140 at 5. On January 25, 2019, Judge Netburn issued a Report and Recommendation addressing these issues. See Dkt. No. 140.

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