SALERNO MEDICAL ASSOCIATES, LLP v. RIVERSIDE MEDICAL MANAGEMENT, LLC

CourtDistrict Court, D. New Jersey
DecidedJune 8, 2021
Docket2:20-cv-10539
StatusUnknown

This text of SALERNO MEDICAL ASSOCIATES, LLP v. RIVERSIDE MEDICAL MANAGEMENT, LLC (SALERNO MEDICAL ASSOCIATES, LLP v. RIVERSIDE MEDICAL MANAGEMENT, LLC) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
SALERNO MEDICAL ASSOCIATES, LLP v. RIVERSIDE MEDICAL MANAGEMENT, LLC, (D.N.J. 2021).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY

SALERNO MEDICAL ASSOCIATES, LLP; SENIOR HEALTHCARE OUTREACH PROGRAM, INC.; and SM MEDICAL LLC, Plaintiffs, v. Civ. No. 20-10539 (KM) (JBC) RIVERSIDE MEDICAL OPINION MANAGEMENT, LLC; UNITED HEALTHCARE COMMUNITY PLAN, INC.; OPTUM, INC.; OPTUM CARE, INC.; UNITEDHEALTH GROUP, INC.; UNITEDHEALTHCARE INSURANCE COMPANY; and JOHN DOES 1–20, Defendants.

KEVIN MCNULTY, U.S.D.J.: Salerno Medical Associates, LLP, Senior Healthcare Outreach Program, Inc., and SM Medical, LLC are medical groups that employ healthcare providers. Those providers had agreements with the health insurer UnitedHealthcare Insurance Company (“UHIC”) to provide healthcare to UHIC beneficiaries. UHIC attempted to remove the providers from its network and directed patients to Riverside Medical Management, LLC, a medical group under the umbrella of UHIC’s parent company. The Medical Groups sued United1 for this move, asserting various state-law claims. United has filed a motion (DE 19)2 to

1 “United” will refer collectively to defendants, including UHIC, Riverside, and two other United entities, UnitedHealth Group, Inc., and UnitedHealthcare Community Plan, Inc., plus Optum, Inc., and Optum Care, Inc., whcih are owned by UnitedHealth Group. 2 Certain citations to the record are abbreviated as follows: (1) dismiss claims against certain defendants for lack of personal jurisdiction, see Fed. R. Civ. P. 12(b)(2); and (2) either (a) compel arbitration of the remaining claims, see 9 U.S.C. § 4; or (b) dismiss the remaining claims for failure to state a claim, see Fed. R. Civ. P. 12(b)(6). For the following reasons, the motion to dismiss for lack of personal jurisdiction is GRANTED as to defendants UnitedHealth Group, Inc., UnitedHealthcare Community Plan, Inc., Optum, Inc., and Optum Care, Inc. The motion to compel arbitration is GRANTED as to UHIC and DENIED as to Riverside. The remaining claims against Riverside are STAYED pending the arbitration, so the motion to dismiss is ADMINSTRATIVELY TERMINATED without prejudice to renewal if appropriate. I. BACKGROUND UHIC3 offers healthcare plans to Medicare and Medicaid recipients. (Compl. ¶¶ 12–14.) To that end, UHIC maintains agreements with healthcare providers to serve its plan members as in-network providers. (Id. ¶ 15.) See

DE = docket entry Compl. = Complaint (DE 14-2) Mot. = United’s Brief in Support of its Motion to Dismiss (DE 19-1) Opp. = Medical Groups’ Brief in Opposition to United’s Motion to Dismiss (DE 21) Reply = United’s Reply Brief in Support of its Motion to Dismiss (DE 23) Salerno I, DE _ = docket entries in Salerno v. UnitedHealthcare Grp., Inc., Civ. No. 19-18130 (D.N.J.) Agreement = Physician Contract (DE 19-3) Nielsen Decl. = Declaration of Michele Nielsen (DE 19-2) 3 The Complaint makes its allegations collectively against the defendants (except Riverside). But the contracts that form the basis of this case, and which I may consider, see Doe v. Univ. of Scis., 961 F.3d 203, 208 (3d Cir. 2020), make clear that the Medical Groups’ providers dealt with UHIC. (See Nielsen Decl. ¶ 10; Agreement at 1.) generally MHA, LLC v. Amerigroup Corp., Civ. No. 18-16042, 2021 WL 1976787, at *1 (D.N.J. May 17, 2021). The Medical Groups employ healthcare providers in New Jersey, and their providers had such in-network agreements with UHIC. (Compl. ¶¶ 20, 26; see Nielsen Decl. ¶ 10; Agreement at 1.) UHIC would directly pay the Groups, which would then pay their providers, or else UHIC would pay the providers and the Groups would share the revenue. (Id. ¶ 28.) UHIC informed providers within the Medical Groups that they would not remain in-network following expiration of their agreements. (Id. ¶ 40.) This decision allegedly lacked any proper basis and flouted procedural requirements applicable to Medicare plans. (Id. ¶ 42.) UHIC mailed letters to the providers’ patients informing them of the upcoming termination. (Id. ¶ 46.) UHIC also informed patients that they could not transfer to other providers in the same medical group. (Id.) Thereby, UHIC allegedly tried to steer patients to a United- affiliated provider, Riverside. (Id. ¶¶ 85–92.) In response, the providers and Medical Groups sued most of the defendants here and moved for a temporary restraining order preventing them from dropping the providers. (Id. ¶ 51; see generally Salerno v. UnitedHealthcare Grp., Inc. (Salerno I), Civ. No. 19-18130 (D.N.J.).) The Salerno I plaintiffs noted that the in-network agreements had an arbitration clause but argued that such clauses were unenforceable because they did not clearly express their purpose. (Salerno I, DE 1-1 at 22.) The defendants responded that a TRO should be denied because the in-network agreements required arbitration, and the arbitrability of the claims was an issue reserved, per the arbitration clause, to the arbitrator. (Salerno I, DE 4 at 1, 6–7.) No party distinguished between the Groups and the providers for purposes of the arbitration issue. (See id. at 4–5; Salerno I DE 1-1 at 1.) At the end of a hearing, I explained that the proper remedy appeared to be an order preventing changes to the UHIC network for 30 days so that any plaintiffs could bring their claims before an arbitrator who could decide arbitrability. (Salerno I, DE 21 at 30:14–15, 31:13–17.) I directed the parties to draft an order to that effect. (Id. at 42:7–8.) I entered an order that, among other things, (1) “referred” “Plaintiffs’ claims in this case” to arbitration for “an initial determination of arbitrability,” (2) prevented defendants from dropping any providers until a ruling on arbitrability, and (3) stayed and administratively terminated the case without prejudice to reopening if any claims were found not to be arbitrable. (Salerno I, DE 25.) Some providers, but not the Medical Groups, then pursued arbitration, resulting in an award reinstating those providers to UHIC’s network. (Compl. ¶¶ 54–66.) UHIC then reinstated the remaining providers (id. ¶ 66) without the necessity of a court order. Although the providers were and remain reinstated, the Medical Groups have brought this action to recover damages arising from UHIC’s attempted terminations. (See id. ¶ 111.) The Groups bring claims under state law for (1) civil conspiracy, (2) tortious refusal to deal with the Groups, (3) unfair competition, (4) unjust enrichment, (5) tortious interference with contracts and prospective economic advantage, and (6) misappropriation of trade secrets and/or proprietary and confidential information. (Id. ¶¶ 119–43.) United moves to (1) dismiss for lack of personal jurisdiction, (2) compel arbitration, and/or (3) dismiss for failure to state a claim. (Mot.) II. DISCUSSION A. Personal Jurisdiction I first take up personal jurisdiction. See Lightfoot v. Cendant Mortg. Corp., 137 S. Ct. 553, 562 (2017) (“A court must have . . . power over the parties before it (personal jurisdiction) before [the court] can resolve a case.”). United’s personal jurisdiction challenge pertains to four defendants: UnitedHealth Group, UnitedHealthcare Community Plan, Optum, and Optum Care. (Mot. at 7–9.) A federal court may exercise personal jurisdiction over a defendant to the extent authorized by state law. Fed. R. Civ. P. 4(k)(1)(A). New Jersey provides for jurisdiction coextensive with constitutional due process. Miller Yacht Sales, Inc. v. Smith, 384 F.3d 93, 96 (3d Cir. 2004) (citing N.J. Ct. R. 4:4-4).

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Bluebook (online)
SALERNO MEDICAL ASSOCIATES, LLP v. RIVERSIDE MEDICAL MANAGEMENT, LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/salerno-medical-associates-llp-v-riverside-medical-management-llc-njd-2021.