Taylor v. United States

89 F. Supp. 3d 766, 2014 U.S. Dist. LEXIS 35931, 2014 WL 8028842
CourtDistrict Court, E.D. North Carolina
DecidedMarch 19, 2014
DocketNo. 7:11-CV-268-FL
StatusPublished
Cited by6 cases

This text of 89 F. Supp. 3d 766 (Taylor v. United States) is published on Counsel Stack Legal Research, covering District Court, E.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Taylor v. United States, 89 F. Supp. 3d 766, 2014 U.S. Dist. LEXIS 35931, 2014 WL 8028842 (E.D.N.C. 2014).

Opinion

ORDER

LOUISE W. FLANAGAN, District Judge.

This matter is before the court on defendants’ motions to dismiss plaintiffs second amended complaint. (DE 30, 32). Plaintiff filed a response and defendants replied. In this posture, the issues raised are ripe for ruling. For the reasons that follow, defendants’ motions to dismiss will be granted.

STATEMENT OF THE CASE

Plaintiff filed an amended complaint on March 8, 2012, alleging claims against: (1) defendant United States of America (“United States”), challenging a November 10, 2011, administrative decision of TRI-CARE Management Activity (“TMA”),1 under the Administrative Procedure Act, 5 U.S.C. § 500 et seq. (“APA”); and (2) defendant Health Net Federal Services, LLC (“Health Net”), asserting claims under the TRICARE regulations, 32 C.F.R. § 199.1 et seq.; the Fifth Amendment of the United States Constitution; North Carolina common law defamation; ■ and North Carolina’s Unfair and Deceptive Trade Practices Act (“UDTPA”), N.C. Gen.Stat. § 75-1.1 et seq. Plaintiff, a physician in Onslow County, North Carolina, seeks reinstatement as a. TRICARE authorized provider, declaratory relief, money damages (both compensatory and punitive), and costs.

The United States moved to dismiss plaintiffs claims against it in the amended complaint for failure to state a claim under the APA, and moved for exemption from discovery. Health Net moved to dismiss claims against it for failure to state a claim and for lack of subject matter jurisdiction due to failure to exhaust administrative remedies.2

On November 26, 2012, 2012 WL 5928269, the court denied the United States’s motion to dismiss and granted Health Net’s motion to dismiss for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). The court granted the United States’s motion for exemption from discovery.

[769]*769On November 28, 2012, plaintiff moved to amend the complaint to add allegations that defendant Health Net is a governmental or state actor. On December 5, 2012, the United States moved to vacate the United States’s prior administrative decision and to remand for farther administrative proceedings. On January 18, 2013, the court granted the United States’s motion to remand and invited the parties to renew any matters still pending following the issuance of a new final administrative order.

On March 5, 2013, the United States filed a notice of decision and joint status report. In the notice, the United States reported that on February 19, 2013, TMA issued a “Final Agency Determination of Effective Date of termination of TRI-CARE Authorized Provider Status Following Court Ordered Remand” (hereinafter, the “Final Agency Determination”). (DE 56-1). The Final Agency Determination stated it was issued “to correct the effective date of a May 18, 2011, initial determination issued by a TRICARE contractor [Health Net] that retroactively terminated [plaintiff’s] TRICARE provider status to April 1, 2004.” (Id.). The Final Agency Determination also stated that plaintiffs “status as a TRICARE authorized provider” “is terminated effective 15 calendar days from the date of this determination.” (Id.). The joint status report stated that plaintiff intended to move to amend his complaint, and the court set a schedule for doing so.

Plaintiff filed a motion to amend on April 4, 2013, and the court granted the motion on June 24, 2013. Plaintiffs second amended complaint, filed June 28, 2013, is identical in all material respects to plaintiffs first amended' complaint, except that it adds allegations regarding the Final Agency Determination dated February 13, 2013, (Second Am. Compl. ¶¶ 19-21), and it adds allegations regarding defendant Health Net’s status as a governmental or state actor, (Id. ¶ 3).

On July 19, 2013, the United States filed the instant motion to dismiss for failure to state a claim upon which relief can be granted, pursuant to Rule 12(b)(6), and for lack of subject matter jurisdiction, pursuant to Rule 12(b)(1), and Health Net filed its motion also before the court, pursuant to Rule 12(b)(6).

STATEMENT OF FACTS

As alleged, plaintiff is a physician licensed by the North Carolina Medical Board to practice in the state since 1996, at a full clinical practice level. In 2004, plaintiff applied to become a TRICARE provider through Health Net. TRICARE is a healthcare system for military members and their dependants to obtain medical care that is paid for by the federal government. Health Net is the Managed Care Support Contractor that implements and administers the TRICARE program for the Department of Defense in North Carolina (as part of the TRICARE North Region).

When plaintiff requested to become a TRICARE provider in 2004, the application asked whether plaintiff had any state medical license issues in the past five years, such as suspensions or revocations. Although plaintiff answered “no,” he attached a full explanation of past disciplinary actions with medical boards which had occurred between 1985 and 1995. In 1986 his California license was suspended; in 1987 plaintiffs North Carolina license was revoked; in 1993 his New York license was revoked; and in 1995 he was denied a •medical license in Ohio. Plaintiff has had no problems with his medical license in North Carolina since it was reinstated in . 1996. Based upon his application, which included these disclosures, plaintiff was au[770]*770thorized as a provider in 2004 and his provider status was renewed in 2008.

In 2011, defendant Health Net sent plaintiff a notice that his provider status was being terminated because of the revocation of plaintiffs medical license in New York. Furthermore, the notice stated an intent to sue plaintiff for recovery of funds received from the government while he was an authorized TRICARE provider. Health Net further threatened involuntary collections against plaintiff, despite his repeated attempts to point out that he is a licensed physician and a qualified provider.

At the time that plaintiffs New York license was revoked, he was not an authorized TRICARE provider. That revocation was approximately eleven years before plaintiff applied to become a TRICARE provider. Health Net knew of that revocation when it approved his provider status in 2004, and renewed that status in 2008. Thus, plaintiff practiced’ medicine in North Carolina as an approved TRICARE provider from 2004 to 2011, but had his status retroactively revoked by Health Net. Health Net also communicated to plaintiffs patients that he was not an authorized TRICARE provider and was not entitled to payment for any treatments provided.

Plaintiff engaged in numerous communications with Health Net, which refused to reconsider its position. Furthermore, plaintiffs appeal of Health Net’s decision to TMA in 2012, provided him with no relief. TMA informed plaintiff that it lacked jurisdiction to conduct a hearing because the issues complained of were issues of law, and not of fact. (Second Am. Compl., Exs. F, G). TMA stated that under TRICARE regulations, 32 C.F.R. §§ 199

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Cite This Page — Counsel Stack

Bluebook (online)
89 F. Supp. 3d 766, 2014 U.S. Dist. LEXIS 35931, 2014 WL 8028842, Counsel Stack Legal Research, https://law.counselstack.com/opinion/taylor-v-united-states-nced-2014.