Toby Cohen v. Empire Blue Cross and Blue Shield

176 F.3d 35, 43 Fed. R. Serv. 3d 903, 1999 U.S. App. LEXIS 8186, 1999 WL 248968
CourtCourt of Appeals for the Second Circuit
DecidedApril 28, 1999
DocketDocket 97-7005
StatusPublished
Cited by10 cases

This text of 176 F.3d 35 (Toby Cohen v. Empire Blue Cross and Blue Shield) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Toby Cohen v. Empire Blue Cross and Blue Shield, 176 F.3d 35, 43 Fed. R. Serv. 3d 903, 1999 U.S. App. LEXIS 8186, 1999 WL 248968 (2d Cir. 1999).

Opinion

KEARSE, Circuit Judge:

Plaintiff Toby Cohen appeals from a judgment entered in the United States District Court for the Southern District of New York, Allen G. Schwartz, Judge, dismissing her complaint alleging that defendant Empire Blue Cross and Blue Shield (“Empire”) failed, in its capacity as a fiscal intermediary for Medicare, to pay Cohen’s Medicare claims, and that Empire failed to process claims properly in its capacity as her private insurer. The district court granted Empire’s motion to dismiss the complaint on grounds of immunity, lack of subject matter jurisdiction, and failure to state a claim on which relief can be granted. On appeal, Cohen contends that the district court erred in dismissing with prejudice her claims against Empire as a private insurer. Empire contends, inter alia, that the appeal must be dismissed for lack of appellate jurisdiction because the notice of appeal filed by Cohen, proceeding pro se in the district court, was filed some 57 days after the entry of judgment. Cohen argues that her notice of appeal was timely because the United States is a party to this action. The United States, as amicus curiae, urges dismissal on the ground that it is not a party. For the reasons that follow, we conclude that the United States is not and was not a party to the action, and that the appeal must be dismissed.

I. BACKGROUND

Cohen commenced the present action pro se in New York City Civil Court in December 1993, using a form provided by that court to describe her claim. Her claim, which named Empire as the only defendant, alleged

[flailure to provide proper services, failure to pay for insurance claim, breach of contract. Blue Cross refuses to reimburse any Medicare claims because it is under the erroneous impression that I have another policy....

Empire promptly removed the case to the district court, invoking 28 U.S.C. § 1441(b) on the ground that the complaint related to the federal Medicare program, that Empire processed claims under that program as an agent of the United States pursuant to a contract entered into with the Department of Health and Human Services (“HHS”) in accordance with the Medicare statute, and that the matter thus arose under federal law.

A. Proceedings in the District Court

Cohen’s original complaint asserted that Empire, as fiscal intermediary for Medicare, was refusing to process or pay her Medicare claims. The provenance of her assertions was that prior to April 1993, Empire also had provided private health insurance coverage to Cohen; that because the premium due in April 1993 was not paid, Empire canceled the policy; and that the cancellation, retroactive to April 1993, apparently took place in August 1993. In the meantime, from April 1993 until December 1993, Empire as Medicare intermediary denied Cohen’s Medicare claims on the basis that she still had primary private insurance coverage. (See Letter from plaintiff to district court dated January 22, 1996, at 5 (“The private branch of Blue Cross knew that I had Medicare.... It also knew that Medicare would not pay any of my claims until it was notified that my private policy was canceled, and that Medicare was now my primary insurer, and hence the one responsible for 80 percent of my medical bills. I assumed— given such knowledge — that the private branch of Blue Cross would have informed the Medicare branch that it had canceled my private plan. But apparently it felt under no such obligation.... I and the *37 physicians and hospitals treating me then spent the next eight months writing to the Medicare branch of Blue Cross telling it that the private branch of Blue Cross had canceled the policy... .”)•)

Soon after removal of the case to federal court, Cohen’s Medicare claims were resolved. In January 1994, Assistant United States Attorney (“AUSA”) Lorraine S. No-vinski, representing Donna E. Shalala, Secretary of HHS (“the Secretary” or “the government”), wrote the district judge to whom the case was first assigned, requesting that Empire be given an extension of its time to answer or move with respect to the complaint, in anticipation that those claims might be resolved:

I have been advised that Blue Cross is reviewing its actions on plaintiffs Medicare claims, but I do not yet know the results of that review. Of course, if the review results in a decision to pay the claims, no litigation would be necessary.

(Letter from AUSA to district court dated January 25, 1994, at 1.) The AUSA also indicated that since the Secretary is responsible for Medicare and “is the real party in interest in any litigation involving administration of the program,” if continued litigation of the Medicare claims were necessary the AUSA would “move to intervene on behalf of the Secretary.” (Id.)

In a February 9, 1994 status conference with the court, attended by the parties and the government, it transpired that Cohen’s Medicare claims would be paid, but that those payments would not end the litigation:

THE COURT: .... As I understand the plaintiffs complaint to me, she incurred some medical expenses, she understands that her Blue Cross policy was not in effect at the time these expenses were incurred, and that she then sought Medicare] coverage, that Medicare keeps telling her, your primary carrier has to pay its part first, so she is going around in a circle, where no one is attempting to identify where that circle stops.
Can you two sort this out for her in an expeditious manner?....
MS. NOVINSKI [AUSA]: I believe it’s been done. They are reprocessing all the Part A and Part B claims. I think one has been paid. The rest are in process or being processed. It’s my understanding they have resolved the problem. They have currently resolved all the claims. The computer now recognizes she is insured by Medicare and by nobody else, and some of the earlier claims have been reprocessed, others are now being reprocessed.
THE COURT: Well, Ms. Cohen, does that answer your problem, or what remains then of this case?
MS. COHEN: Well, the only thing, your Honor, is this is the second time this has happened. I brought with me court papers that I filed in 1986 when I had this problem with Empire Blue Cross, and it took a year before that SNAFU was unraveled. I have been hounded by collection agencies. It’s disrupted my relationship with doctors. People like to get paid for their services, and I would ask this court to award me punitive and compensatory damages.

(Hearing Transcript, February 9, 1994 (“Feb. 1994 Tr.”), at 2-3.) In response to Cohen’s request for damages, the AUSA stated that

[u]nder the statute she would have no right to any sort of damages under Medicare. Medicare is a federally established program, the Secretary has a sovereign immunity defense. There is no statutory grant of damages for any problems here.
Now, Empire is a private corporation, something that I can’t speak to, so I don’t know what sort of remedy she could have against them.

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176 F.3d 35, 43 Fed. R. Serv. 3d 903, 1999 U.S. App. LEXIS 8186, 1999 WL 248968, Counsel Stack Legal Research, https://law.counselstack.com/opinion/toby-cohen-v-empire-blue-cross-and-blue-shield-ca2-1999.