York v. Saint Elizabeth Medical Center, Inc.

CourtDistrict Court, E.D. Kentucky
DecidedApril 22, 2024
Docket2:21-cv-00125
StatusUnknown

This text of York v. Saint Elizabeth Medical Center, Inc. (York v. Saint Elizabeth Medical Center, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
York v. Saint Elizabeth Medical Center, Inc., (E.D. Ky. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY NORTHERN DIVISION AT COVINGTON

CIVIL ACTION NO. 21-125-DLB-CJS

SARAH YORK PLAINTIFF

v. MEMORANDUM OPINION AND ORDER

SAINT ELIZABETH MEDICAL CENTER, INC. DEFENDANT

*****************

This matter is before the Court upon Plaintiff’s Motion for Class Certification. (Doc. # 78). Defendant having filed its Response (Doc. # 82), and Plaintiff having filed her Reply (Doc. # 92), this Motion is ripe for review. For the following reasons, this Motion is denied. I. FACTUAL AND PROCEDURAL BACKGROUND Plaintiff Sarah York brought this putative class action alleging that Defendant engaged in fraudulent billing. Plaintiff alleges in the Amended Complaint that she is “one of thousands of patients who received a bill from St. Elizabeth that was inflated” based on the charges she should have incurred for her care. (Id. at 1). On May 6, 2021, Plaintiff delivered a baby at St. Elizabeth. (Id. ¶ 28). She received two bills from St. Elizabeth for her stay from May 6 to May 7, 2021. (Id. ¶ 29). The first bill was for a total charge of $15,136.37, $11,250.54 of which was paid by Plaintiff’s insurer, United Health Care (“UHC”). (Id. ¶ 30). The second bill was for a total of $4,497.71, $1,066.34 of which was paid by UHC. (Id. ¶ 32). Plaintiff alleges the “true charges” of these bills were $8,452.03 and $2,590.37, respectively. (Id. ¶¶ 30, 32). Plaintiff alleges these bills were inflated based upon an “all-inclusive billing” policy at St. Elizabeth. (Id. ¶ 34). In support, Plaintiff alleges facts based on information purportedly gathered from Valerie Rose. Rose worked at St. Elizabeth from 2007 to 2021

as a Revenue Enhancement Analyst and later as a Revenue Integrity Analyst. (Id. ¶¶ 8- 9). In this role, Rose reviewed medical documents, hospital billing records, the appropriateness of services rendered to patients, validated coding accuracy, and performed insurance audits. (Id. ¶¶ 10, 12). Plaintiff alleges that an internal meeting at St. Elizabeth was called because “a patient called and said that she had ‘delivered a baby at St. Elizabeth’” and she didn’t understand why her bill was “like over $30,000” for a two-night stay. (Id. ¶ 15). Rose allegedly looked at this patient’s file and did not think the $28,000 charge seemed “correct, allowed by contract, or lawful.” (Id. ¶ 16). However, Rose was allegedly told by Bill Banks,

Vice President of Managed Care at St. Elizabeth, that this charge is part of St. Elizabeth’s “all-inclusive billing.” (Id. ¶¶ 11, 18). Plaintiff alleges that Defendant’s actions taken to implement its all-inclusive billing policy are fraudulent, illegal, and violate the contracts and agreements between the parties. (Id. ¶ 20). The extensive procedural history in this case was recently reviewed in detail by Magistrate Judge Candace J. Smith in her March 29, 2024 Memorandum Order addressing multiple additional filings by Plaintiff. (See Doc. # 97). In the Order, Judge Smith noted the many delays in discovery caused by class counsel. In denying Plaintiff’s Motion to File a Second Amended Complaint, Judge Smith highlighted “York’s lack of diligence in pursuing the discovery depositions.” (Id. at 23). Most relevant to this Motion is the procedural history that reflects that Plaintiff has a professional relationship with class counsel. On September 22, 2021, the original Complaint was filed by Dominick Romeo of Deters Law. (See Doc. # 1-1 at 23). Plaintiff

testified that at that time, she was a paralegal at Deters Law. (Doc. # 61 at 61-62). Plaintiff had worked at Deters Law since 2011. (Id. at 66). Mr. Romeo subsequently filed the First Amended Class Action Complaint (“Amended Complaint”) on August 1, 2022,1 (Doc. # 19 at 21), which had the effect of dismissing the Individual Defendants identified in the original Complaint. (See Doc. # 18). The Amended Complaint stated that “Class counsel is Deters Law Firm II and Alan Statman.” (Doc. # 19 ¶ 51). However, the undersigned attorney was still Dominick Romeo of Deters Law. (Id. at 21). On January 5, 2024, over two years after the case was initiated, Plaintiff filed her Motion for Class Certification. Plaintiff seeks certification of the following class:

Plaintiff and all current and former patients of St. Elizabeth Medical Center, Inc., who were private payers or whose bills were paid in full or in part by a private insurance payor, whose bills were inflated, by the addition of variable charge so as to match a selected reimbursement rated for Diagnosis- Related Groups (“DRG”) through “All-Inclusive Billing” (excluding members of the Court and its staff, and Counsel for Plaintiffs and their staffs, Counsel for Defendant and its staff, and Board members, Officers, and Employees of Defendant).”

1 This Amended Complaint is the operative pleading for purposes of this Motion. In her Motion for Class Certification, Plaintiff references the Proposed Modified Second Amended Complaint under the assumption that the Court would grant leave to file it. (Doc. # 78 at 1, n. 1). However, Magistrate Judge Candace J. Smith mostly denied this request. (See Doc. # 97 at 27). In her Order, Judge Smith only granted this request for the limited purpose of omitting the COVID- 19 and negligence per se claims of relief. (Id.). (Doc. # 78 at 1). Plaintiff alleges the following claims are common to the class: (1) promissory estoppel; (2) unjust enrichment; (3) conversion; (4) violations of the Kentucky Consumer Protection Act; (5) fraud; and (6) declaratory and injunctive relief. II. ANALYSIS A. Standard of Review

“The class action is ‘an exception to the usual rule that litigation is conducted by and on behalf of the individual named parties only.’” Wal-Mart Stores, Inc. v. Dukes, 564 U.S. 338, 348 (2011) (quoting Califano v. Yamasaki, 442 U.S. 682, 700-01 (1979)). Rule 23 “serves as the gatekeeper to class certification” by setting forth the requirements that must be met to justify certification. In Re Ford Motor Co., 86 F.4th 723, 726 (6th Cir. 2023). However, “Rule 23 does not set forth a mere pleading standard.” Dukes, 564 U.S. at 350. Rather, the party seeking certification must “affirmatively demonstrate his compliance with the Rule.” Id. This “requires a named plaintiff to offer ‘[s]ignificant’ evidentiary proof that he can meet all [Rule 23 requirements], where they are contested.”

In Re Ford Motor Co., 86 F.4th 723, 726 (6th Cir. 2023) (internal citations omitted). “A district court has broad discretion to decide whether to certify a class.” In re Whirlpool Corp. Front-Loading Washer Prod. Liab. Litig., 722 F.3d 838, 850 (6th Cir. 2013) (citing In re Am. Med. Sys., Inc., 75 F.3d 1069, 1079 (6th Cir.1996)). Certification is “proper only if ‘the trial court is satisfied, after rigorous analysis, that the prerequisites of Rule 23(a) have been satisfied.’” Dukes, 564 U.S. at 350-51 (quoting General Telephone Co. of Southwest v. Falcon, 457 U.S. 147, 161 (1982)). Such a “rigorous analysis” will often “entail some overlap with the merits of the plaintiff’s underlying claim.” Id. at 351; see also Falcon, 457 U.S. at 160 (“[T]he class determination generally involves considerations that are enmeshed in the factual and legal issues comprising the plaintiff’s cause of action.”). However, district courts must not “engage in free-ranging merits inquiries at the certification stage.” Amgen Inc. v. Conn. Ret.

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York v. Saint Elizabeth Medical Center, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/york-v-saint-elizabeth-medical-center-inc-kyed-2024.