Rickman v. Premera Blue Cross

CourtWashington Supreme Court
DecidedSeptember 17, 2015
Docket91040-5
StatusPublished

This text of Rickman v. Premera Blue Cross (Rickman v. Premera Blue Cross) is published on Counsel Stack Legal Research, covering Washington Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rickman v. Premera Blue Cross, (Wash. 2015).

Opinion

IN THE SUPREME COURT OF THE STATE OF WASHINGTON

ERICKA M. RICKMAN, NO. 91040-5 Petitioner,

v. ENBANC PREMERA BLUE CROSS, Filed - -SEP 1 7 2015 ----- Respondent.

STEPHENS, I.-Plaintiff Erika Rickman brought this suit against her former

employer, Premera Blue Cross, for wrongful discharge in violation of public policy.

Rickman alleges she was terminated in retaliation for raising concerns about potential

violations of the federal Health Insurance Portability and Accountability Act of 1996

(HIPAA), Pub. L. No. 104-191, 110 Stat. 1936, and its Washington counterpart, the

Uniform Health Care Information Act (UHCIA), ch. 70.02 RCW. The trial court

dismissed Rickman's suit on Premera's motion for summary judgment, concluding

Rickman could not satisfy the jeopardy element of the tort because Premera's internal

reporting system provides an adequate alternative means to promote the public policy.

The Court of Appeals affirmed. Rickman v. Premera Blue Cross, noted at 183 Wn.

App. 1015 (2014). Rickman v. Premera Blue Cross, 91040-5

We granted review of this case and two others in order to resolve confusion

with respect to the jeopardy element of the tort of wrongful discharge in violation of

public policy. Rickman v. Premera Blue Cross, 182 Wn.2d 1009, 343 P.3d 759

(2015); see also Becker v. Cmty. Health Sys., Inc., 182 Wn.2d 1009, 343 P.3d 759

(2015); Rose v. Anderson Hay & Grain Co., 182 Wn.2d 1009, 343 P.3d 759 (2015).

Consistent with our decisions in Rose and Becker, we hold that nothing in Premera' s

internal reporting system, nor in HIPAA or its Washington counterpart UHCIA,

precludes Rickman's claim of wrongful discharge. We reverse the Court of Appeals

but remand for that court to address Premera's alternate argument for upholding

the trial court's order of dismissal.

FACTS AND PROCEDURAL HISTORY

Ericka Rickman served as director of Ucentris Insured Solutions from August

2004 until her termination in November 2009. Ucentris, a subsidiary ofPremera, is a

general insurance agency that sells a variety of health care insurance plans and risk

management products to individuals and businesses. Two distinct events transpired

relevant to Rickman's termination.

HIPAA Concerns

In mid-September 2009, Rickman learned about a likely merger between

Pacific Benefits Trust (PBT), a large association underwritten by Premera, and

Washington Grocers Trust, another association underwritten by another insurer. As a

result of the potential merger, Premera would lose PBT membership. Rickman

confirmed the merger with Robin Hilleary, director of Premera's small business

-2- Rickman v. Premera Blue Cross, 91040-5

group. Rickman informed Hilleary that a Ucentris client asked a Ucentris "[c]aptive

agent" 1 to look for non-Premera insurance in light of the merger. Clerk's Papers (CP)

at 187. In response, Hilleary said Premera was putting together a strategy to retain

membership and Rickman should advise Ucentris captive agents not to look

elsewhere for insurance on behalf of clients. Hilleary told Rickman that Pr9mera

planned to use Ucentris captive agents to transfer the memberships of preferred

groups from the merged associations into an association underwritten by Premera. I d.

Rickman had a "gut feeling" the proposed plan involved "risk bucketing," i.e.,

separating riskier policy holders from less risky holders for underwriting, which she

believed might violate HIPAA laws. CP at 271-72, 187. Rickman believed the plan

could disclose private policyholder information. Rickman expressed her concerns to

her supervisor, Rick Grover:

I met with Rick and I said, "Rick, I have a concern about a strategy that may be going on within Premera." I explained I didn't lmow the details other than it had a potential utilization of our agents to move membership[,] and it had HIPAA written all over it. I couldn't say that was illegal because I don't lmow actually what's going to happen, but we did not want to be a part of it.

CP at 271. Rickman suggested to Grover the plan should be reviewed by a superior to

determine its legality. Grover refused, noting that "we don't always tell everything to

[the supervisor]." CP at 188. Rickman told Grover this is the way she had always

done her business, but he said, "Well, there's a new Sheriff in town." 2 Id. Later,

Grover forwarded e-mails to Rickman that confirmed Premera was contemplating a

1 Ucentris hires independent contractors, called "captive agents," to sell insurance products offered only by Premera and its subsidiaries. 2 Grover had recently become Rickman's supervisor.

-3- Rickman v. Premera Blue Cross, 91040-5

risk bucketing plan, which Rickman believed would violate HIPAA. Rickman

reported her concerns only to Grover and did not file a complaint with Premera's

compliance and ethics department.

Several days after Rickman voiced her HIPAA concerns to Grover, he

abandoned the risk bucketing plan, reasoning the plan favored Ucentris over

Premera's other distribution channels. Premera's underwriting department later

determined the risk bucketing plan was not illegal. However, in response to

Rickman's interrogatories, Premera answered, "The group quickly determined that

risk bucketing was not a lawful option for that particular situation." CP at 67

(emphasis added).

Conflict ofInterest Concerns

Rickman's son, Taylor Vidor, had been a captive agent for Ucentris since 2005,

working as an independent contractor. Before Vidor was retained, Rickman disclosed

her relationship with Vidor to her former supervisor, who approved hiring Vidor.

According to Rickman, her former supervisor said Rickman did not need to make

further disclosures because '"[i]t's not an issue. He's a contractor."' CP at 260.

Rickman also disclosed her relationship to a former employee in human resources, but

the employee never responded, and human resources has no record of the

conversation. Rickman did not otherwise disclose her relationship in her annual

conflict questionnaires, to her new supervisor Grover, or to the compliance and ethics

department. Rickman testified that many other Premera employees have family

members ~ho work for or contract with Premera.

-4- Rickman v. Premera Blue Cross, 91040-5

In 2008, Rickman approved the promotion of Vidor from a captive agent to a

"[s]ubject [m]atter [e]xpert[]" (SME), at the recommendation of Ucentris managers.

CP at 182-83, 261-62. Vidor received additional compensation as an SME. When

another SME stepped down, Vidor assumed his workload and Rickman approved an

increase in Vidor's commission from 5 to 10 percent, twice the amount some other

SMEs received. Rickman did not consult with Premera or further disclose her

potential conflict of interest.

On September 11, 2009, around the same time Rickman raised her HIPAA

concerns, someone filed an anonymous complaint against Rickman with the

compliance and ethics department, alleging a conflict of interest existed because of

her son's involvement with Ucentris. The complaint highlighted that Rickman had

elevated Vidor to an SME position, that Vidor had input on which captive agents

received leads, and that the general feeling in the office was that befriending Vidor

curried favor with Rickman.

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