Quinones v. UnitedHealth Group Incorporated et al

Filing 63

ORDER DENYING PLAINTIFF'S MOTION FOR ORDER CERTIFYING JUNE 30, 2015 ORDER GRANTING IN PART AND DENYING IN PART DEFENDANTS' MOTION FOR JUDGMENT ON THE PLEADINGS AS TO PLAINTIFFS ALLEGATIONS RELATING TO MEDICARE BENEFITS [DKT NO. 49 ] FOR IN TERLOCUTORY APPEAL PURSUANT TO 28 U.S.C. § 1292(B) AND FOR A STAY PENDING RESOLUTION OF § 1292(B) PROCEEDINGS re 52 Motion for Leave to Appeal Signed by JUDGE LESLIE E. KOBAYASHI on 08/12/2015. (eps)CERTIFICATE OF SERVICEParticipants registered to receive electronic notifications received this document electronically at the e-mail address listed on the Notice of Electronic Filing (NEF). Participants not registered to receive electronic notifications were served by first class mail on the date of this docket entry

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF HAWAII
CIVIL NO. 14-00497 LEK-RLP

)
)
Plaintiff,
)
)
vs.
)
)
)
UnitedHealth Group
Incorporated;
)
)
UnitedHealthcare, Inc.;
UnitedHealthcare Insurance
)
)
Co.,
)
)
Defendants.
_____________________________ )
Juan Rios Quinones,

ORDER DENYING PLAINTIFF’S MOTION FOR ORDER CERTIFYING
JUNE 30, 2015 ORDER GRANTING IN PART AND DENYING IN PART
DEFENDANTS’ MOTION FOR JUDGMENT ON THE PLEADINGS AS TO
PLAINTIFF’S ALLEGATIONS RELATING TO MEDICARE BENEFITS [DKT
NO. 49] FOR INTERLOCUTORY APPEAL PURSUANT TO 28 U.S.C. § 1292(B)
AND FOR A STAY PENDING RESOLUTION OF § 1292(B) PROCEEDINGS
On June 30, 2015, this Court issued its Order Granting
in Part and Denying in Part Defendants’ Motion for Judgment on
the Pleadings as to Plaintiff’s Allegations Relating to Medicare
Benefits (“Medicare Act Order”).

[Dkt. no. 49.1]

Before the

Court is Plaintiff Juan Rios Quinones’s (“Plaintiff”) motion to
certify the Medicare Act Order for interlocutory appeal and for a
stay pending the resolution of the appeal (“Appeal Motion”),
filed July 9, 2015.

[Dkt. no. 52.]

On July 24, 2015, Defendants

UnitedHealth Group Incorporated, UnitedHealthcare, Inc., and
UnitedHealthcare Insurance Company (collectively “Defendants”)
1

The Medicare Act Order is also available at 2015 WL
3965961.

filed their memorandum in opposition to the Appeal Motion, and
Plaintiff filed his reply on August 7, 2015.

[Dkt. nos. 58, 60.]

The Court finds this matter suitable for disposition without a
hearing pursuant to Rule LR7.2(d) of the Local Rules of Practice
of the United States District Court for the District of Hawai`i
(“Local Rules”).

After careful consideration of the Appeal

Motion, supporting and opposing memoranda, and the relevant legal
authority, Plaintiff’s motion is HEREBY DENIED for the reasons
set forth below.
BACKGROUND
The relevant factual and procedural background of this
case is set forth in the Medicare Act Order.

In the Medicare Act

Order, this Court concluded that it did not have jurisdiction
over the portions of Plaintiff’s claims that challenge the delay
of the coordination of his benefits because they: were
inextricably intertwined with the denial of his request for
Medicare benefits to cover the new Group 3 Personal Mobility
Device (“PMD”); arose at least in part under the Medicare Act;2
and required administrative review by the Secretary of Health and
Human Services before Plaintiff could file a civil action.
WL 3965961, at *4-7.

2015

Further, this Court concluded that waiver

of the exhaustion requirement was not appropriate in this case.

2

Title XVIII of the Social Security Act, 79 Stat. 291 as
amended, 42 U.S.C. § 1395 et seq., is commonly referred to as the
“Medicare Act.”
2

Id. at *7–8.

This Court therefore dismissed with prejudice the

portions of Counts II, III, V, VI, VII, and VIII that challenge
the coordination of benefits for Defendants’ actions as plan
providers for Plaintiff’s Medicare plan.

Id. at *9.

The

Medicare Act Order states:
This includes, but is not limited to, the process
by which Defendants denied Plaintiff’s initial
requests for a new Group 3 PMD, the denials
themselves, and any delay in submission of the
request to Plaintiff’s Medicaid plan. Insofar as
Plaintiff challenges decisions made and actions
taken by Defendants in their roles as coverage
providers under Plaintiff’s Medicaid Plan, those
claims remain.
Id.
In the Appeal Motion, Plaintiff asks this Court to
certify the Medicare Act Order for interlocutory appeal pursuant
to 28 U.S.C. § 1292(b) because it “has the effect of
imposing a Medicare Act administrative procedure before the
furnishing of a benefit covered by the Medicaid plan may be
expected, but 42 U.S.C. § 1396a(a)(8) specifically bars delays
due to administrative procedure,” and this Court’s decision will
cause “substantial prejudice” to Plaintiff and a “substantial
benefit” to Defendants.

[Appeal Motion at 2.]

Plaintiff also

asks this Court to stay the district court proceedings pending
the outcome of the interlocutory appeal.

3

DISCUSSION
Section 1292(b) states:
When a district judge, in making in a civil action
an order not otherwise appealable under this
section, shall be of the opinion that such order
involves a controlling question of law as to which
there is substantial ground for difference of
opinion and that an immediate appeal from the
order may materially advance the ultimate
termination of the litigation, he shall so state
in writing in such order. The Court of Appeals
which would have jurisdiction of an appeal of such
action may thereupon, in its discretion, permit an
appeal to be taken from such order, if application
is made to it within ten days after the entry of
the order: Provided, however, That application for
an appeal hereunder shall not stay proceedings in
the district court unless the district judge or
the Court of Appeals or a judge thereof shall so
order.
This district court stated:
Thus, pursuant to 28 U.S.C. § 1292(b), a
district court may certify an interlocutory appeal
if it is of the opinion that (1) the order
involves a controlling question of law, (2) there
is substantial ground for difference of opinion,
and (3) an immediate appeal from the order may
materially advance the ultimate termination of the
litigation.
The party seeking an interlocutory appeal
bears the “burden of demonstrating ‘exceptional
circumstances’ justifying a departure from the
basic policy of postponing appellate review until
a final judgment has issued.” Madoff [v. Bold
Earth Teen Adventures, Civil No. 12–00470
SOM/RLP], 2013 WL 3179525, at *3 [(D. Hawai`i
June 20, 2013)]. Because § 1292(b) “is a
departure from the normal rule that only final
judgments are appealable”, it “must be construed
narrowly.” James v. Price Stern Sloan, Inc., 283
F.3d 1064, 1068 n.6 (9th Cir. 2002).

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Whether to certify an order for interlocutory
appeal is “within the sound discretion of the
district court.” Envtl. Prot. Info. Ctr. v. Pac.
Lumber Co., No. C 01–2821, 2004 WL 838160, at *2
(N.D. Cal. Apr. 19, 2004). “Even where the
district court makes such a certification, the
court of appeals nevertheless has discretion to
reject the interlocutory appeal, and does so quite
frequently.” James, 283 F.3d at 1068 n.6.
Hawai`i Wildlife Fund v. Cty. of Maui, Civil No. 12–00198
SOM/BMK, 2015 WL 1608430, at *1 (D. Hawai`i Apr. 9, 2015).
As to the first factor - whether there is a controlling
question of law, this Court finds that the issue of whether
Plaintiff’s claims regarding the coordination of benefits must be
exhausted pursuant to the Medicare Act is a significant issue in
this case, but this Court also finds that the issue is not a
purely legal issue.

See Leite v. Crane Co., Civil No. 11–00636

JMS/RLP, 2012 WL 1982535, at *5 (D. Hawai`i May 31, 2012)
(discussing the standard for determining what is a controlling
question of law).

This Court therefore finds that the first

§ 1292(b) factor is not met in this case.
This Court also finds that the second § 1292(b) factor
is not met in this case.

There is no substantial ground for a

difference of opinion because there is clear case law governing
the exhaustion of claims under the Medicare Act.

See Couch v.

Telescope Inc., 611 F.3d 629, 633 (9th Cir. 2010) (“To determine
if a ‘substantial ground for difference of opinion’ exists under

5

§ 1292(b), courts must examine to what extent the controlling law
is unclear.”).
Further, this Court finds that the third § 1292(b)
factor is not met in this case.

The proposed interlocutory

appeal would not materially advance the ultimate termination of
the litigation because the Medicare exhaustion issue does not
affect Counts I and IV, which allege claims under the Medicaid
Act,3 and the portions of Counts II, III, V, VI, and VII, and
VIII that challenge Defendants’ actions and decisions as coverage
providers under his Medicaid Plan.

Allowing Plaintiff to take an

interlocutory appeal of the Medicare exhaustion issue would
result in disruptive, piecemeal litigation.

Cf. Pac. Union

Conference of Seventh–Day Adventists v. Marshall, 434 U.S. 1305,
1309 (1977) (“The policy against piecemeal interlocutory review
other than as provided for by statutorily authorized appeals is a
strong one.” (citation omitted)).
Insofar as this Court has found that Plaintiff has not
established any of the requirements for an interlocutory appeal,
this Court FINDS that the instant case does not present the type
of exceptional circumstances which warrant certification of an
interlocutory appeal.

This Court CONCLUDES that Plaintiff should

not be allowed to file the proposed interlocutory appeal in this

3

Title XIX of the Social Security Act, 42 U.S.C. § 1396 et
seq., is commonly referred to as the “Medicaid Act.”
6

case.

In light of this Court’s conclusion, it does not need to

reach Plaintiff’s request for a stay.
CONCLUSION
On the basis of the foregoing, Plaintiff’s Motion for
Order Certifying June 30, 2015 Order Granting in Part and Denying
in Part Defendants’ Motion for Judgment on the Pleadings as to
Plaintiff’s Allegations Relating to Medicare Benefits [Dkt No.
49] for Interlocutory Appeal Pursuant to 28 U.S.C. § 1292(b) and
for a Stay Pending Resolution of § 1292(b) Proceedings, filed
July 9, 2015, is HEREBY DENIED.
IT IS SO ORDERED.
DATED AT HONOLULU, HAWAII, August 12, 2015.

/s/ Leslie E. Kobayashi
Leslie E. Kobayashi
United States District Judge

JUAN RIOS QUINONES VS. UNITEDHEALTH GROUP INCORPORATED, ET AL.;
CIVIL 14-00497 LEK-RLP; ORDER DENYING PLAINTIFF’S MOTION FOR
ORDER CERTIFYING JUNE 30, 2015 ORDER GRANTING IN PART AND DENYING
IN PART DEFENDANTS’ MOTION FOR JUDGMENT ON THE PLEADINGS AS TO
PLAINTIFF’S ALLEGATIONS RELATING TO MEDICARE BENEFITS [DKT NO.
49] FOR INTERLOCUTORY APPEAL PURSUANT TO 28 U.S.C. § 1292(B) AND
FOR A STAY PENDING RESOLUTION OF § 1292(B) PROCEEDINGS
7