Cardiovascular Specialty Care Center of Baton Rouge, LLC v. United Healthcare of Louisiana, Inc.

Filing 59

RULING and ORDER: Defendant's 35 Motion to Dismiss Pursuant to Rule 12(b)(6) is GRANTED IN PART and DENIED IN PART. Plaintiff's ERISA § 502(a)(3) claim is DISMISSED WITH PREJUDICE. Plaintiff SHALL have until December 8, 2015 to AMEND its 26 Amended Complaint in a way that accords with this Ruling and Order. Signed by Chief Judge Brian A. Jackson on 11/19/2015. (BCL)

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

CARDIOVASCULAR SPECIALITY
CARE CENTER OF BATON ROUGE,
LLC

CIVIL ACTION

VERSUS
UNITED HEALTHCARE OF
LOUISIANA, INC.

NO.: 14-00235-BAJ-RLB

RULING AND ORDER
Before the Court is a Motion to Dis miss Purs uant to Rule 12(b)(6) (Doc.
35) filed by Defendant United Healthcare of Louisiana, Inc. ("Defendant"). Plaintiff
Cardiovascular Specialty Care Center of Baton Rouge, LLC ("Plaintiff') has filed a
memorandum in opposition (Doc. 55), to which Defendant has r eplied (Doc. 58). For
reasons explained herein, Defe ndant's motion is GRANTED IN PART and
DENIED IN PART.
I.

BACKGROUND

Plaintiff asserts t hat according to a Participating Provider Agreement
between it and First Health Group Corporation Services, Defendant owes it money
for medical services render ed to Defenda nt's insureds. (See Doc. 26). Defendant,
unsurprisingly, disagrees and seeks to dispose of Plaintiffs 725-paragraph
Amended Complaint in a Rule 12(b)(6) motion to dismiss that asserts (1) Plaintiffs
five state law claims are belied by the language of the agreements upon which they
rely, (2) Plaintiffs five state law claims are preempted by the Employee Retirement

1

Income Security Act of 1974 ("ERISA"), (3) Plaintiffs ERISA § 502(a)(1)(B) is
improperly pled, and (4) Plaintiffs ERISA§ 502(a)(3) is barred by Plaintiffs ERISA

§ 502(a)(1)(B) claim. (See Doc. 35-1).

II.

STANDARD OF REVIEW

To defeat a Rule 12(b)(6) motion to dismiss, a complain t must (a) stat e a
claim upon which relief can be gran ted, Neitzhe v. Williams, 490 U.S. 319, 326
(1989), and (b) provide the Court with sufficient factua l content from which "to draw
t h e reasonable inference that the defendant is liable for t he misconduct alleged,"

Ashcroft v. Iqbal, 556 U .S . 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550
U.S. 544, 556 (2007)). When evaluating a Rule 12(b)(6) motion to dismiss, t he Court
accepts all well-pleaded facts as true and views th em in a light most favorable to
the plaintiff. Bustos v. Martini Club Inc., 599 F.3d 458, 461 (5th Cir. 2010).

III.

DISCUSSION
A.

Are Plaintiff's five state law claims belied by the
language of the agreements upon which they rely?

Defendant asserts t h at Plaintiffs five state law claims a re belied by the
language of the Pa rticipating Provider 1 and Payor 2 agree ments upon which they
r ely. (See Doc. 35-1 at pp. 6- 10); (See Doc. 58 at pp. 2- 3). However, because both
of these agreements lie outside of the Amended Complaint, they can only be
con sidered to th e exten t that they are (a) central to Plaintiffs claims (b) referred to

' Formally titled the Coventry Health Care of Louisiana, Inc., Participating Ancillary Provider
Agreement. See Doc. 55-1.
2

Formally titled the First Health Group Corp. Services Agreement. See Doc. 54-1.

2

m Plaintiffs Amended Complaint and (c) attached to Defendant's Rule 12(b)(6)
motion to dismiss. Scanlan v. Texas A&M Univ., 343 F.3d 533, 536 (5th Cir. 2003).
After a careful review of the record, the Court finds that neither of t hese
agreements is properly before the Court at this time. The Participating Provider
Agreement was not attached to Defendant's Rule 12(b)(6) motion to dismiss, (See
Doc. 55-1), and the Payor Agree ment is not in any way central to Plaintiffs claims,a

(See Doc. 55 at pp. 14-16) (wherein Plaintiff denies being bound by the Payor
Agreement).
Therefore, Defendant's request that Plaintiffs five state law claims be
dismissed based upon the language of the Participating Provider and Payor
agreements is denied.
B.

Are Plaint iff's five stat e la w cla ims
E RISA?4

p reempted

by

Defendan t asserts t h at Plaintiffs five state law claims are completely and
expressly preempted by ERISA. (See Doc. 35-1 at pp. 10- 15); (See Doc. 58 at pp.
4-5). However, that cannot be true given the fact that Plaintiff's five state law
claims incorporates both right-to -paymentG and rate-of-paymen t 7 allegations. The

The fact that the Payor Agreement is central to Defendant's defense does not make it reviewable
under Scanlan.

3

4

Under this Court's March 3, 2015 Ruling and Order, (Doc. 23), the plans at issue are ERISA plans.
See Doc. 26 at,[ 710.

s See Doc. 26

at ~,[

665, 683, 687, 697, 703.

See Doc. 26 at,[,[ 79-319; Doc 55 at p. 5 (\vherein Plaintiff asserts that paragraphs 79-319 of its
Amended Complaint describe claims for which Defendant has made "no reimbursement . . .
whatsoever").

6

7

See Doc. 26 at

~ ,[

320- 664.

3

former are preempted. See Aetna Health Inc. v. Davila, 542 U.S. 200, 210 (2004).
The latter are not. See Lone Star OBIGYN Associates v. Aetna Health Inc., 579 F.3d
525, 530 (5th Cir. 2009); Mem 'l Hermann Hosp. Sys. v. Aetna Health Inc., No. 11CV-267, 2011 WL 3703770, at *3 (S.D. Tex. Aug. 23, 2011).
Therefore, rather than step into Plaintiffs shoes, the Court will grant
Plaintiffs request for leave to amend,B at which point the Court assumes Plaintiff
will confine its right-to-payment9 allegations to its ERISA § 502(a)(1)(B) claim.IO
Yet, in the meantime, Defendant's request that Plaintiffs five state law claims be
dismissed as completely and expressly preempted by ERISA is denied.
C.

Is P l aintiff's ERI SA§ 502(a)(1)(B) cla i m improperly p led?

Defe ndant asserts t hat Plaintiffs ERISA § 502(a)(1)(B)ll claim is improperly
pled. (See Doc. 35-1 at pp. 15-19). That is, in all but one instance,l2 untrue.l3
Plaintiffs ERISA § 502(a)(1)(B) claim asserts that as a third-party
administrator, (Doc. 26 at ,, 33), Defendant exercised actual control over the

a See Doc. 55 at p. 20.
9

See Doc. 26 at 1111 708-723.

10

Given that the next complaint will be Plaintiffs third, the Court is not inclined to grant any
additional motions to amend. See Schiller u. Physicians Res. Grp. Inc., 342 F.3d 563, 567 (5th Cir.
2003) (affirming the district court's decision to dismi ss plaintiffs third amended complaint with
prejudice).
II The Court accepts, as true, that Plaintiff has "derivative standing'' to bring the ERISA §
502(a)(l)(B) claim that it pled. See Doc. 26 at 1! 711; Tango Tra.nsp. u. Healthcare Fin. Serus. LLC,
322 F .3d 888, 891 (5th Cir. 2003).
12 See Doc. 26 at 11 97 (wherein Plaintiff asserts that the Government Employees Health Association,
Inc. refused to pay Plaintiff the $22,441.98 that it is allegedly owed) (emphasis added).

13

This, of cow·se, presumes that Plaintiff will amend its Amended Complaint in a way that confines
its right-to-payment allegations to its ERISA § 502(a)(l)(B) claim.

4

benefits claims process, (Id.

at~~

83, 89, 103, 122, 127, 141, 147, 152, 157, 162, 167,

172, 177, 182, 187, 192, 197, 202, 207, 212, 224, 232, 238, 244, 250, 259, 276, 285,
297, 310), which is precisely the type of claim th at LifeCare Mgmt. Servs. LLC v.

Ins. Mgmt. Adm 'rs Inc., 703 F.3d 835, 844-46 (5th Cir. 2013), permits.1 4 Plain tiffs
ERISA § 502(a)(1)(B) claim also asserts t hat the exh austion of administrative
r emedies would, in t his case, be futile, 15 (See Doc. 26 at

~

716), given t he fact t ha t

Defendant has already said th at it "cannot continue to divert and devote its .. .
personnel resources towar d t he investigation of wh at" it considers to be "wh olly
unsubstantiated claim[s]," (Id. at,, 715).
Because Rule 8 requires nothing more, See Iqbal, 556 U.S. at 678,
Defen dan t's request t hat Plaintiffs ERISA § 502(a)(1)(B) claim be dismissed as
imp roperly pled is denied.
D.

I s Plaintiff's ERISA § 502(a)(3) b a rred by P l a intiff's
ERISA § 502(a)(1)(B) claim?

Defendant asserts t hat Plaintiffs ERISA § 502(a)(3) claim is barred by
Plaintiffs ERISA§ 502(a)(1)(B) claim. (See Doc. 35-1 at pp. 19-22); (See Doc. 58 at
pp. 6-8). With th at, the Court cannot disagree. See Tolson v. Avondale Indus., I nc.,

14 The Court notes, in response to Defendant's argument, (See Doc. 35·1 at pp. 16-17), that the
third-party administrator held liable in LifeCare was not an administrator under 29 U.S .C. §
1002(16)(A). See 29 U.S.C. § 1002(16)(A)(i) (defining, to the exclusion of all others, an administrator
as "the person specifically so designated by the terms of the instrument under which the plan is
operated"); LifeCa.re Mgmt. Serus. LLC, 703 F.3d at 839 (noting that the patients' employers were
the designated administrators under the terms of the plans).

15 The Court finds that Plaintiffs blank assertion that it has exhausted all administrative remedies,
(See Doc. 26 at~ 714), is not facially plausible under Rule 8. See Iqbal, 556 U.S. at 678 . The Court
further finds that Plaintiffs assertion that it has "no obligation to exhaust administrative remedies,"
(See Doc. 55 at p. 17), may be true in some cases, (See, e.g., Doc. 26 at ,1
,1118- 123), but certainly is
not true in others, (ld. at , ,,! 83, 89).

5

141 F.3d 604, 610 (5th Cir.1998); Mathews v. M etro. Life Ins. Co. , No. 05-CV-2128,
2006 WL 2700056, at *2 (E.D. La. Sept. 16, 2006); Metro. Life Ins. Co. v. Palmer,
238 F. Supp. 2d 831, 835 (E. D. Tex. 2002). The question, however , is whether
Plaintiffs § 502(a)(3) claim should be dismissed now, upon the filing of a Rule
12(b)(6) motion to dismiss, or later, upon t he filing of a Rule 56 motion for summary
judgment.
It is true, as Plaintiff points out, (See Doc. 55 at pp. 19-20), t hat N. Cypress

Med. Ctr. Operating Co. v. CIGNA Healthcare, 782 F. Supp. 2d 294, 309 (S.D. Tex.
20 11), aff'd sub nom. N. Cypress Med. Ctr. Operating Co. v. Cigna Healthcare, 78 1
F.3d 182 (5th Cir. 2015)), permitted ERISA § 502(a)(1)(B) and § 502(a)(3) claims to
be simultaneously pled. It is also true, based upon the Court's own research , th at

Tolson,lG Palmer,l7 and Matthews lB were all dismissed upon the filing of Rule 56
motions for summa ry judgment r ather th a n Rule 12(b)(6) motions to dismiss.
However knowing, as a ll within the Fifth Circuit do, that § 502(a)(3)'s preclusion
does not in any way depend upon § 502(a)(1)(B)'s success, Tolson, 141 F.3d at 610,
the Court sees no reason to h ave t he parties en gage in the type of "needless
discovery and fact-finding" 19 that Rule 12(b)(6) was intended to prevent.
Therefore, Defendant's request th at Plaintiffs ERISA § 502(a)(3) claim be
dismissed as barred by Plaintiffs ERISA § 502(a)(1)(B) cla im is gran ted.
IG S ee Tolson u. Avondale Ind us., Inc., 97-CV-896, 1997 WL 539919, at **7-8 (E.D. La. Aug. 29,
1997).
11

238 F. Supp . 2d at 835.

1s 2006 WL 2700056 at *2.
19

Neitzke, 490 U.S. at 327.

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IV.

CONCLUSION

Accordingly,
IT IS ORDERED that Defendant's Motion to Dismiss Pursuant to Rule
12(b)(6) (Doc. 35) is GRANTED IN PART and DENIED IN PART.
IT IS FURTHER ORDERED that Plaintiffs ERISA § 502(a)(3) claim is
DISMISSED WITH PREJUDICE.
IT IS FURTHER ORDERED that Plaintiff SHALL have until December 8,
20 15 to AMEND its Amended Complaint (Doc. 26) in a way th at accords with this
Ruling and Order.
Baton Rouge, Louisiana, this

;q::fday of November , 2015.

BRIAN A. JACK ON, CHIEF JUDGE
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

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