Quinones v. UnitedHealth Group Incorporated et al

Filing 69

ORDER GRANTING DEFENDANTS' MOTION FOR JUDGMENT ON THE PLEADINGS FOR COUNTS II AND III (ADA AND REHABILITATION ACT) re 34 Motion for Judgment on the Pleadings. Signed by JUDGE LESLIE E. KOBAYASHI on 10/19/2015. (eps)< hr>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
)
)
Plaintiff,
)
)
vs.
)
)
)
UnitedHealth Group
Incorporated;
)
)
UnitedHealthcare, Inc.;
UnitedHealthcare Insurance
)
)
Co.,
)
)
Defendants.
_____________________________ )
Juan Rios Quinones,

CIVIL NO. 14-00497 LEK-RLP

ORDER GRANTING DEFENDANTS’ MOTION FOR JUDGMENT ON THE
PLEADINGS FOR COUNTS II AND III (ADA AND REHABILITATION ACT)
Before the Court is Defendants UnitedHealth Group
Incorporated, UnitedHealthcare, Inc., and UnitedHealthcare
Insurance Company’s (collectively “Defendants”) Motion for
Judgment on the Pleadings for Counts II and III (ADA and
Rehabilitation Act) (“Motion”), filed on April 1, 2015.
no. 34.]

[Dkt.

Plaintiff Juan Rios Quinones (“Plaintiff”) filed his

memorandum in opposition on September 14, 2015, and Defendants
filed their reply on September 21, 2015.

[Dkt. nos. 65, 67.1]

This matter came on for hearing on October 5, 2015.

After

careful consideration of the Motion, supporting and opposing
memoranda, and the arguments of counsel, Defendants’ Motion is
HEREBY GRANTED for the reasons set forth below.
1

Plaintiff filed an errata to his memorandum in opposition.
[Dkt. no. 66.]

BACKGROUND
The relevant factual and procedural background was set
forth in the Court’s 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
(“6/30/15 Order”).

[Dkt. no. 49.2]

The portions of the

Complaint relevant to the instant Motion allege that, by
withholding Medicaid preauthorization for Plaintiff’s Personal
Mobility Device (“PMD”) for a year, Defendants violated Title III
of the Americans with Disabilities Act (“ADA”) (“Count II”) and
Section 504 of the Rehabilitation Act (“§ 504”) (“Count III”).3
[Complaint for Declaratory and Injunctive Relief, and for
Compensatory and Punitive Damages (“Complaint”), filed 10/31/14
(dkt. no. 1), at ¶¶ 161, 173.]

The Complaint also alleges that

Defendants continue to violate Plaintiff’s rights by failing to
preauthorize coverage of a replacement joystick for his PMD.
[Id. at ¶¶ 165, 178.]

Plaintiff is eligible for both Medicaid

and Medicare, making him what is commonly referred to as a “dual
eligible.”

2

[Id. at ¶ 7.]

The Complaint alleges that Defendants

The 6/30/15 Order is also available at 2015 WL 3965961.

3

In addition to violations of the ADA, Count II alleges
violations of “Medicaid law, Defendants’ contract with the State
of Hawai`i, [and] Hawai`i’s statutory medical necessity
requirements.” [Complaint at ¶ 162.] In addition to violations
of § 504, Count III alleges violations of “Federal Medicaid and
Hawai`i State law.” [Id. at ¶ 174.]
2

combined their Medicare and Medicaid plans for dual eligibles to
“ensure prompt, efficient, and effective coordination of Medicare
and Medicaid benefits.”

[Id. at ¶ 26.]

This Court previously

dismissed with prejudice Counts II, III, V, VI, VII, VIII
“insofar as they challenge the coordination of benefits for acts
taken by Defendants as plan providers for Plaintiff’s Medicare
plan.”

[6/30/15 Order at 19-20 (footnote and citations

omitted).]

Plaintiff requests that Defendants be “enjoined and

prohibited” from withholding or delaying benefits to rightful
beneficiaries, [Complaint at ¶¶ 163, 175,] and he also seeks
attorneys’ fees and costs [id. at ¶¶ 166, 179].
DISCUSSION
The standard for a motion brought pursuant to Fed. R.
Civ. P. 12(c) was explained in this Court’s July 24, 2015 Order
Granting Defendants’ Motion for Judgment on the Pleadings for
Count I (§ 1983) (“7/24/15 Order”).
I.

[Dkt. no. 57.4]

ADA
Title III of the ADA provides, in relevant part, that

“[n]o individual shall be discriminated against on the basis of
disability in the full and equal enjoyment of the goods,
services, facilities, privileges, advantages, or accommodations
of any place of public accommodation by any person who owns,
leases (or leases to), or operates a place of public
4

The 7/24/15 Order is also available at 2015 WL 4523499.
3

accommodation.”

42 U.S.C. § 12182(a).

For purposes of the ADA,

the following are “public accommodations” if their operations
affect commerce:
(A) an inn, hotel, motel, or other place of
lodging, except for an establishment located
within a building that contains not more than five
rooms for rent or hire and that is actually
occupied by the proprietor of such establishment
as the residence of such proprietor;
(B) a restaurant, bar, or other establishment
serving food or drink;
(C) a motion picture house, theater, concert hall,
stadium, or other place of exhibition or
entertainment;
(D) an auditorium, convention center, lecture
hall, or other place of public gathering;
(E) a bakery, grocery store, clothing store,
hardware store, shopping center, or other sales or
rental establishment;
(F) a laundromat, dry-cleaner, bank, barber shop,
beauty shop, travel service, shoe repair service,
funeral parlor, gas station, office of an
accountant or lawyer, pharmacy, insurance office,
professional office of a health care provider,
hospital, or other service establishment;
(G) a terminal, depot, or other station used for
specified public transportation;
(H) a museum, library, gallery, or other place of
public display or collection;
(I) a park, zoo, amusement park, or other place of
recreation;
(J) a nursery, elementary, secondary,
undergraduate, or postgraduate private school, or
other place of education;

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(K) a day care center, senior citizen center,
homeless shelter, food bank, adoption agency, or
other social service center establishment; and
(L) a gymnasium, health spa, bowling alley, golf
course, or other place of exercise or recreation.
42 U.S.C. § 12181(7).
In Weyer v. Twentieth Century Fox Film Corp., the Ninth
Circuit Court of Appeals considered whether the plaintiff had a
cognizable claim for discrimination under the ADA for a benefit
plan that provided more benefits for physical disabilities than
mental disabilities.

198 F.3d 1104, 1107 (9th Cir. 2000).

The

Ninth Circuit held:
Certainly, an insurance office is a place where
the public generally has access. But this case is
not about such matters as ramps and elevators so
that disabled people can get to the office. The
dispute in this case, over terms of a contract
that the insurer markets through an employer, is
not what Congress addressed in the public
accommodations provisions.
Id. at 1114.
Like Weyer, the instant matter is not about Plaintiff’s
access to a place of public accommodation, but about Defendants’
alleged withholding of preauthorization of coverage for
Plaintiff’s PMD.

[Complaint at ¶¶ 161, 173.]

cognizable claim under Title III of the ADA.

This not a
See,

e.g., Dicrescenzo v. UnitedHealth Grp., Inc., CIVIL NO. 15-00021
DKW-RLP, 2015 WL 5472926, at *7 (D. Hawai`i Sept. 16, 2015)
(stating that defendants are “not a place of public

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accommodation, and thus, cannot have violated Title III of the
ADA pursuant to Weyer” (citations omitted)).

This Court FINDS

that there is no issue of material fact and Defendants are
entitled to judgment as a matter of law.

See, e.g., Jackson v.

Barnes, 749 F.3d 755, 763 (9th Cir. 2014).

Because it is not

possible to cure the defects in this claim by amendment,
Plaintiff’s ADA claim is DISMISSED WITH PREJUDICE.

See, e.g.,

Pac. W. Grp., Inc. v. Real Time Solutions, Inc., 321 F. App’x
566, 569 (9th Cir. 2008) (holding that in the Rule 12(c) context,
leave to amend should be granted unless amendment would be
futile).
II.

Section 504
Section 504 prohibits entities and programs that

receive federal funding from discriminating against individuals
based on their disability status.

The statute states, in

relevant part:
No otherwise qualified individual with a
disability in the United States, as defined in
Section 705(20) of this title, shall, solely by
reason of her or his disability, be excluded from
the participation in, be denied the benefits of,
or be subjected to discrimination under any
program or activity receiving Federal financial
assistance or under any program or activity
conducted by any Executive agency or by the United
States Postal Service. . . .
29 U.S.C. § 794(a).
plaintiff to show:

A claim for relief under § 504 requires a
“(1) that he is handicapped within the

meaning of the act, (2) that he is otherwise qualified for the
6

services sought, (3) that he was excluded from the services
sought solely by reason of his handicap, and (4) that the program
in question receives federal financial assistance.”

Dempsey v.

Ladd, 840 F.2d 638, 640 (9th Cir. 1987) (citations and internal
quotation marks omitted).

In Alexander v. Choate, the United

States Supreme Court stated that “Section 504 seeks to assure
evenhanded treatment and the opportunity for handicapped
individuals to participate in and benefit from programs receiving
federal assistance.”
omitted).

469 U.S. 287, 304 (1985) (citation

The main focus of § 504 was access to federally-funded

programs and benefits.

Id. at 309 (“The State has made the same

benefit – 14 days of coverage – equally accessible to both
handicapped and nonhandicapped persons, and the State is not
required to assure the handicapped ‘adequate health care’ by
providing them with more coverage than the nonhandicapped.”).
Here, it is undisputed that Plaintiff is disabled for
purposes of § 504, and that the program in question, Medicaid,
receives federal financial assistance.

However, Plaintiff cannot

show that he was “excluded from the services sought solely by
reason of his handicap.”

See Dempsey, 840 F.2d at 640.

The

Complaint alleges that “[t]he discrimination . . . occurred not
as a part of plan design . . . but as a result of discriminatory
choices in how the benefits were administered.”
¶ 3.]

[Complaint at

Plaintiff did not bring the instant case because he was

7

denied access to healthcare benefits based on his disability, but
because he did not receive preauthorization for his PMD – an
issue that concerns level of care, not access to Medicaid
itself.5

See Choate, 469 U.S. at 303 (“Medicaid programs do not

guarantee that each recipient will receive that level of health
care precisely tailored to his or her particular needs.”).

If a

federally-funded program “does not deny the handicapped access to
or exclude them from the particular package of Medicaid
services,” a plaintiff cannot establish a prima facie case under
§ 504.6

Id. at 309; see also Dicrescenzo, 2015 WL 5472926, at *8

(“Rather, Section 504 assures that both disabled and non-disabled
individuals will have equal access to the plan’s health benefits
package.”).
This Court FINDS that there is no issue of material
fact and Defendants are entitled to judgment as a matter of law.
Because it is not possible to cure the defects in this claim by
amendment, Plaintiff’s § 504 claim is DISMISSED WITH PREJUDICE.

5

At the hearing, Plaintiff agreed that the his § 504 claim
is about the level of care provided to him.
6

To the extent that Plaintiff argues that Olmstead v. L.C.
ex rel. Zimring, 527 U.S. 581 (1999), supports his position,
[Complaint at ¶ 49,] he is incorrect. Olmstead concerned the
“unjustified institutional isolation of persons with
disabilities,” 527 U.S. at 600 (emphasis added), and not, as
Plaintiff asserts, “[u]nnecessary and unwanted segregation and
isolation of people with disabilities as a result of improper or
inappropriate administration of benefits” [Complaint at ¶ 49].
8

III. Leave to Amend
To the extent that Plaintiff’s memorandum in opposition
requests leave to amend to name additional defendants, [Mem. in
Opp. at 22,] the request is improper.

Plaintiff must do so by

filing the proper motion pursuant to Fed. R. Civ. P. 15(a)(2) and
Rule LR10.3 of the Local Rules of Practice of the United States
District Court for the District of Hawai`i.
IV.

Summary and Application
This Court FINDS that, insofar as Count II arises under

the ADA, it does not state a cognizable claim and is DISMISSED
WITH PREJUDICE.

Further, this Court FINDS that, insofar as

Count III arises under § 504, it fails to state a cognizable
claim and is DISMISSED WITH PREJUDICE.
CONCLUSION
On the basis of the foregoing, Defendants Motion for
Judgment on the Pleadings for Counts II and III (ADA and
Rehabilitation Act), filed April 1, 2015, is HEREBY GRANTED, and
Count II, as it relates to Title III of the Americans with
Disabilities Act, and Count III, as it relates to § 504 of the
Rehabilitation Act, are DISMISSED WITH PREJUDICE.
IT IS SO ORDERED.

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DATED AT HONOLULU, HAWAII, October 19, 2015.

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

QUINONES VS. UNITEDHEALTH GROUP, INC., ET AL.; CIVIL 14-00497
LEK-RLP; ORDER GRANTING DEFENDANTS’ MOTION FOR JUDGMENT ON THE
PLEADINGS FOR COUNTS II AND III (ADA AND REHABILITATION ACT)

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