Auxiant v. Total Renal Care Inc
Filing
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DECISION AND ORDER signed by Judge Lynn Adelman on 9/13/16 that plaintiffs motion for summary judgment 22 is DENIED and defendants motion for summary judgment 18 is GRANTED. Further ordering that this action is DISMISSED. (cc: all counsel) (dm)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF WISCONSIN
AUXIANT,
Plaintiff,
v.
Case No. 15-CV-404
TOTAL RENAL CARE INC. d/b/a
SHEBOYGAN DIALYSIS,
Defendant.
DECISION AND ORDER
Plaintiff, Auxiant, an administrator of health care plans, brought this action in
state court to recover payments made to defendant Total Renal Care Inc. d/b/a
Sheboygan Dialysis (“Sheboygan”). Defendant, a health care provider, removed the
case based on diversity of citizenship. Before me now are the parties’ cross-motions for
summary judgment.
I. BACKGROUND
From July 2013 to May 2014, Sheboygan provided a patient, David M., with
dialysis treatment. David’s employer, Willman Industries, Inc. (“Willman”), provided a
health insurance plan that covered dialysis. Auxiant administered the plan. Effective
January 2014, Willman amended its plan such that it would only pay $10,000 per month
for dialysis after the first three months. Sheboygan was not advised of the change and
continued to treat David and submit claims to the health plan as it had done previously.
Auxiant continued to pay for David’s dialysis, and its payments exceeded the monthly
cap. In June 2014, Auxiant discovered its error, advised Sheboygan that it had failed to
apply the cap, and requested a refund of $86,693.97 in overpayments offset by
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$10,263.27 in claims it had not yet paid. Sheboygan declined the request, and Auxiant
commenced the present suit.
II. DISCUSSION
I may grant summary judgment only if taking all facts in favor of the non-movant,
no reasonable factfinder could find in its favor. The parties agree that the case is
governed by Wisconsin law. Sheboygan argues that Auxiant’s claims are barred by
Wisconsin’s voluntary payment doctrine, which “preclude[s] actions to recover payments
that parties paid voluntarily, with full knowledge of the material facts, and absent fraud
or wrongful conduct inducing payment.” Putnam v. Time Warner Cable of Se. Wis., Ltd.
P’ship, 649 N.W.2d 626, 631–32 (Wis. 2002) (quoting Putnam v. Time Warner Cable of
Se. Wis., Ltd. P’ship, 633 N.W.2d 254, 258–59 (Wis. Ct. App. 2001)). Auxiant does not
claim that it lacked knowledge of any material facts or that Sheboygan induced payment
by fraud or wrongful conduct, and it continued to pay Sheboygan in full for David’s
dialysis. Thus, it would appear that the voluntary payment doctrine bars any recovery by
Auxiant.
Auxiant argues that the voluntary payment doctrine only applies in cases of
illegal or improper billing. Pl.’s Reply Br., ECF No. 29, at 4 (citing MBS–Certified Pub.
Accountants, LLC v. Wis. Bell, Inc., 809 N.W.2d 857, 864 (Wis. 2012)). This argument,
however, conflates the doctrine itself with specific applications of the doctrine. See, e.g.,
MBS–Certified Pub. Accountants, 809 N.W.2d 857; Putnam, 649 N.W.2d 626. The
doctrine has been applied in a wide variety of contexts, such as “to bar repayment of a
judgment erroneously paid to an attorney; to bar repayment of interest overpaid on a
loan; and to bar repayment of taxes paid on property that was tax-exempt.” Putnam,
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649 N.W.2d at 632 (citations omitted) (citing Gage v. Allen, 61 N.W. 361 (1894); then
citing Burgess v. Commercial Nat’l Bank of Appleton, 128 N.W. 436 (1910); and then
citing G. Heileman Brewing Co. v. City of La Crosse, 312 N.W.2d 875 (Wis. Ct. App.
1981)).
Auxiant also argues that applying the doctrine here would not further its
underlying purpose, which, according to Auxiant, is “to protect large utilities and other
providers so that customers faced with what they believed to be illegal fees could not
pay those fees without first noting there was some type of protest, only to come back
years later and demand widespread repayment.” Pl.’s Reply Br., ECF No. 29, at 5. But
Auxiant too narrowly construes the reasons for the doctrine. One of the primary
justifications is to “allow[] entities that receive payment for services to rely upon these
funds and to use them unfettered in future activities.” Putnam, 649 N.W.2d at 633 (citing
G. Heileman Brewing Co., 312 N.W.2d at 880). When a health care provider in good
faith treats a patient, bills the patient’s health insurer, and receives full payment of the
amount billed it may use those funds without having to worry that the insurer will claw
them back later because of its own mistakes in processing claims.
III. CONCLUSION
THEREFORE, IT IS ORDERED that plaintiff’s motion for summary judgment
(ECF No. 22) is DENIED and defendant’s motion for summary judgment (ECF No. 18)
is GRANTED.
IT IS FURTHER ORDERED that this action is DISMISSED.
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Dated at Milwaukee, Wisconsin, this 13th day of September, 2016.
s/ Lynn Adelman
__________________________________
LYNN ADELMAN
District Judge
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