Southern Ohio Medical Center v. Griffith

CourtDistrict Court, S.D. Ohio
DecidedNovember 12, 2019
Docket1:19-cv-00261
StatusUnknown

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

Bluebook
Southern Ohio Medical Center v. Griffith, (S.D. Ohio 2019).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO WESTERN DIVISION SOUTHERN OHIO MEDICAL CENTER, Case No. 19-cv-261 Plaintiff, Dlott, J. Litkovitz, M.J. vs. MARK GRIFFITH and REPORT AND COUNTRYSIDE RENTALS, INC., RECOMMENDATION d/b/a Rent 2 Own, Defendants. This matter is before the Court on plaintiff's motion to remand this case to state court (Doc. 6) and defendant Countryside Rentals, Inc., d/b/a Rent 2 Own (“Countryside”)’s opposing memorandum (Doc. 9). For the reasons stated herein, plaintiff's motion should be denied. I. Procedural background A. Notice of Removal Plaintiff Southern Ohio Medical Center (SOMC) first filed this action in the Scioto County, Ohio Court of Common Pleas in September 2018. (Amended Notice of Removal, Doc. 13, Exh. A). SOMC brought the action to collect $153,656.49 for medical services that it provided to defendant Mark Griffith. SOMC brought two claims against defendants. First, SOMC claimed that defendant Griffith owes SOMC $153,656.49 for the medical services SOMC provided to him. (Count One). Second, SOMC claimed that Griffith’s self-insured employer, Countryside, pre-approved and agreed to pay for those services through its agent and the third- party administrator, Group & Pensions Administrators, Inc. (GPA) (Count Two). SOMC alleged that Countryside “did not have a provider agreement with [SOMC]....” (/d.). SOMC attached a “Notice under the Fair Debt Collection Practices Act” to the complaint which states: “As of

September 2018, you! owe [SOMC] the sum of [$153,656.49]” and that SOMC is the creditor. (Ud., Exh. A, p. 5). Defendant Countryside removed the case to this Court pursuant to 28 U.S.C. §§ 1331 and 1441(a) on the ground SOMC seeks to recover benefits under an employee welfare benefit plan, and plaintiff's claims are completely preempted by the Employee Retirement Income and Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seqg.? (Doc. 1). Countryside contends that SOMC seeks additional payments for services that Countryside allegedly pre-approved for defendant Griffith under Countryside’s self-funded ERISA plan, which Countryside sponsors and administers. Countryside asserts that only the ERISA plan documents govern the amounts that Countryside must pay to SOMC for hospital goods and services provided to plan participants. Countryside alleges that SOMC could have brought its claim against Countryside under 29 U.S.C. § 1132(a)(1)(B) and/or § 1132(a)(3), and SOMC’s claim is not supported by any legal duty arising outside of the ERISA plan. Countryside alleges that plaintiff's claim against it therefore arises under federal law, and the federal court has original jurisdiction over the claim. B. Plaintiff's motion for remand Plaintiff SOMC filed a motion to remand this case to state court on April 18, 2019. (Doc. 6). Plaintiff argues that the federal court lacks subject matter jurisdiction over the complaint because SOMC, a healthcare provider, has no connection to the ERISA plan that provided healthcare coverage for Griffith, Countryside’s employee. SOMC alleges that the “self insured insurance plan” did “not have a provider contract with [SOMC].” Plaintiff alleges that ERISA

' Jou” is not identified in the notice. 2 Section 1331 grants the district courts original jurisdiction over cases arising under the laws of the United States. 28 U.S.C. § 1331. Section 1441 provides in relevant part that “any civil action brought in a State court of which the cinerea of the United States have original jurisdiction, may be removed by the defendant. .. .” 28 U.S.C. §

would be implicated only if Countryside’s employee, Griffith, were to sue Countryside, his employer/insurer, “for coverage problems with his ERISA plan.” Plaintiff contends that because this is instead a collection suit brought against Griffith and his insurer Countryside, which allegedly pre-approved Griffith’s care, the suit has no connection to ERISA. Plaintiff asserts that the case must therefore be remanded to state court. Defendants oppose plaintiff's motion to remand.’ (Doc. 9). Defendants assert that plaintiff's claims involve a dispute as to the amount owed under an ERISA plan for health care services provided by an out-of-network provider (SOMC) for services that the Plan’s third-party administrator, GPA, allegedly pre-approved. Defendants allege that as such, plaintiffs claims are completely preempted by ERISA, and the Court has jurisdiction over plaintiff's claims. Defendants assert that plaintiff was an “out-of-network” provider, meaning SOMC had no agreement with defendants regarding the amount defendants would pay for the services SOMC provided. Defendants allege that plaintiff billed the plan more than $200,000.00 for those services and Countryside paid the benefits authorized under the plan for the reasonable value of the goods and services provided, which totaled “in excess of $60,000.” Defendants contend that SOMC submitted the claims for payment to Countryside pursuant to an assignment of benefits under the plan. (/d., Exh. A). Pursuant to the assignment, Griffith “agree[d] to the assignment of all third-party payor benefits to SOMC” and he further agreed to pay SOMC “for all charges not covered by this assignment of benefits.” (/d.). Defendants argue that plaintiff's claims are preempted by ERISA because plaintiff brings the lawsuit as the assignee of benefits from Griffith’s ERISA plan, and the complaint does not allege that defendants have any independent legal duty. Defendants allege that SOMC has stepped into Griffith’s shoes as the assignee of

3 Defendant Griffith filed the motion, but he presents arguments on behalf of both defendants in the motion.

benefits and seeks to recover additional benefits from Griffith’s healthcare plan as payment for SOMC’s services. Defendants argue that plaintiff's claims arise from and relate to administration of an ERISA plan, and SOMC has standing as an assignee of benefits to bring an ERISA claim to recover benefits allegedly due under the plan. (/d. at 4-6, citing Cromwell v. Equicor-Equitable HCA Corp., 944 F.2d 1272, 1275 (6th Cir. 1991)). II. Applicable law Removal is governed by 28 U.S.C. § 1441, which provides in relevant part: “[A]ny civil action brought in a State Court of which the district courts of the United States have original jurisdiction, may be removed by the. . . defendants, to the district court of the United States for the district and division embracing the place where such action is pending.” 28 U.S.C. § 1441(a). Thus, “[o]nly state-court actions that originally could have been filed in federal court may be removed to federal court by the defendant.” Caterpillar Inc. v. Williams, 482 U.S. 386, 392 (1987). The issue to be resolved on a motion to remand is whether the district court lacks subject matter jurisdiction or, in other words, whether the case was properly removed from the state court. 28 U.S.C. § 1447(c); Weil v.

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Bluebook (online)
Southern Ohio Medical Center v. Griffith, Counsel Stack Legal Research, https://law.counselstack.com/opinion/southern-ohio-medical-center-v-griffith-ohsd-2019.