Anderson v. Ochsner Health Sys.
| Decision Date | 08 June 2012 |
| Docket Number | CIVIL ACTION No. 11-2236 |
| Parties | YANA ANDERSON v. OCHSNER HEALTH SYSTEM, ET AL. |
| Court | U.S. District Court — Eastern District of Louisiana |
Before the Court is a motion1 to remand the above-captioned matter to state court filed by plaintiff, Yana Anderson ("Anderson"). Defendants, Ochsner Health System and Ochsner Clinic Foundation (together, "Ochsner"), oppose2 the motion. For the following reasons, the motion is GRANTED.
This case arises due to Ochsner's alleged improper billing practices. Anderson claims she was injured in an automobile accident in East Baton Rouge Parish, Louisiana, on August 4, 2010.3 Following the accident, she received medical treatment at an Ochsner facility in Baton Rouge, Louisiana.4 At the time of the accident, Anderson states she was insured under an ERISA5 health insurance policy (the "plan") issued by UnitedHealthcare ("United").6 Shealleges that, pursuant to the terms of the hospital participation agreement (the "contract") between Ochsner and United, Ochsner is required to submit medical bills for United-covered patients to United.7 Anderson contends that Ochsner may not charge her any costs other than her applicable deductible, co-insurance, or other amounts allowed as under the policy or the contract.8 Nevertheless, Anderson claims that Ochsner improperly directly billed her $2,824.99 for the medical services rendered, rather than submitting the claim to United.9 Ochsner's actions, according to Anderson, violate the terms of the contract and the Louisiana Health Care Consumer Billing and Disclosure Protection Act (La. Rev. Stat. §§ 22:1871, et seq.).10
Anderson filed her lawsuit, seeking damages and injunctive relief on behalf of herself and all similarly-situated persons, in the Civil District Court for the Parish of Orleans, Louisiana (Yana Anderson v. Ochsner Health Systems, Inc., Case No. 11-6385).11 Ochsner timely removed the lawsuit to the U.S. District Court for the Eastern District of Louisiana asserting that this Court had federal question jurisdiction pursuant to 28 U.S.C. § 1331. Ochsner argues that Anderson's claims are completely preempted by ERISA - thereby creating a federal question - because they will require the Court to determine whether the services she received from Ochsner were "covered services" as defined in the plan.12 In response, Anderson timely moved toremand. She argues that her claims are not completely preempted by ERISA and, consequently, that this Court lacks subject-matter jurisdiction to hear the above-captioned matter and it must remand it to the Civil District Court for the Parish of Orleans.13
U.S. District Courts have original subject matter jurisdiction over cases "arising under the Constitution, laws, or treaties of the United States." 28 U.S.C. § 1331. A "plaintiff is master of his complaint and may generally allege only a state law cause of action even where a federal remedy is also available." Bernhard v. Whitney Nat'l Bank, 523 F.3d 546, 551 (5th Cir. 2008). "Under this 'well-pleaded complaint' rule, a federal court has original or removal jurisdiction only if a federal question appears on the face of the plaintiff's well-pleaded complaint; generally, there is no federal jurisdiction if the plaintiff properly pleads only a state law cause of action." Id.
A U.S. District Court must remand a case to state court if, at any time before final judgment, it appears that the court lacks subject matter jurisdiction. 28 U.S.C. § 1447(c). The removal statute is strictly construed. Sea Robin Pipeline Co. v. New Medico Head Clinic Facility, 1995 WL 479719, at *1 (E.D. La. Aug. 14, 1995) (Clement, J.) (quoting York v. Horizon Fed. Sav. & Loan Ass'n, 712 F.Supp. 85, 87 (E.D. La. 1989) (Feldman, J.)). When challenged by a plaintiff seeking remand, the defendant attempting to establish removal bears the burden of proof. Wilson v. Republic Iron & Steel Co., 257 U.S. 92, 97, 42 S.Ct. 35, 66 L.Ed. 144 (1921); Sid Richardson Carbon & Gasoline Co. v. Interenergy Res., 99 F.3d 746, 751 (5th Cir.1996). Doubts concerning removal are to be construed against removal and in favor of remand to state court. Manguno v. Prudential Prop. & Cas. Ins. Co., 276 F.3d 720, 723 (5th Cir. 2002) (citation omitted).
Ochsner alleges that this case is properly before the Court because the Court has federal question subject-matter jurisdiction - i.e., that the case is one "arising under the Constitution, laws, or treaties of the United States." 28 U.S.C. § 1331. Nevertheless, "[i]t is well settled that a cause of action arises under federal law only when the plaintiff's well-pleaded complaint raises issues of federal law." Heimann v. Nat'l Elevator Indus. Pension Fund, 187 F.3d 493, 499 (5th Cir. 1999); see also Caterpillar Inc. v. Williams, 482 U .S. 386, 392, 107 S.Ct. 2425, 96 L.Ed.2d 318 (1987) (). A defendant who seeks removal bears the burden of demonstrating that a federal question exists. In re Hot-Hed Inc., 477 F.3d 320, 323 (5th Cir. 2007).
The doctrine of complete pre-emption is an exception to the well-pleaded complaint rule. " '[W]hen a federal statute wholly displaces the state-law cause of action through complete pre-emption,' the state claim can be removed." Aetna Health Inc. v. Davila, 542 U.S. 200, 207-08, 124 S.Ct. 2488, 159 L.Ed.2d 312 (2004) (quoting Beneficial Nat'l Bank v. Anderson, 539 U.S. 1, 8, 123 S.Ct. 2058, 156 L.Ed.2d 1 (2003)). Complete pre-emption enables removal because "[w]hen the federal statute completely pre-empts the state-law cause of action, a claim which comes within the scope of that cause of action, even if pleaded in terms of state law, is in reality based on federal law." Id. at 207-08. ERISA is such a statute. Id. at 208.
ERISA provides a uniform regulatory regime over employee benefit plans. "To this end, ERISA includes expansive pre-emption provisions, see ERISA § 514, 29 U.S.C. § 1144, which are intended to ensure that employee benefit plan regulation would be exclusively a federal concern." Id. Section 502(a) of ERISA sets forth a detailed civil enforcement mechanism that reflects Congress's enactment of a comprehensive statute for the regulation of employee benefit plans. Id. "[A]ny state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted." Id. at 209.
State law causes of action are completely preempted by ERISA § 502(a)(1)(B), thereby establishing federal question removal jurisdiction,14 only when "an individual, at some point in time, could have brought his claim under ERISA § 502(a)(1)(B),15 and where there is no other independent legal duty that is implicated by a defendant's actions." Id. at 210. By contrast, ERISA's broader conflict preemption provision, ERISA § 514, 29 U.S.C. § 1144,16 does not provide removal jurisdiction, but merely serves as an affirmative defense to claims that are notcompletely preempted. See, e.g., Giles v. NYLCare Health Plans, Inc., 172 F.3d 332, 336-37 (5th Cir. 1999). "When a complaint raises both completely-preempted claims and arguably conflict-preempted claims, the court may exercise removal jurisdiction over the completely-preempted claims and supplemental jurisdiction (formerly known as 'pendent jurisdiction') over the remaining claims." Id. at 337-38 (footnote omitted). Accordingly, as long as ERISA completely pre-empts at least one claim, this Court has subject-matter jurisdiction over the above-captioned matter. Davila, 542 U.S. at 209.
With respect to Anderson's contract claim and her right to sue for breach of that contract as a third-party beneficiary, Ochsner argues that the contract incorporates the definition of "covered services" as set forth in Anderson's ERISA policy. Consequently, in order for Anderson to establish Ochsner's liability for allegedly breaching that contract, the Court would be required to interpret the ERISA policy, thereby creating federal subject-matter jurisdiction.17
The U.S. Court of Appeals for the Fifth Circuit has distinguished between claims regarding the "rate of payment" versus "right of payment." "[W]here claims do not involve coverage determinations, but have already been deemed 'payable,' and the only remaining issue is whether they were paid at the proper contractual rate, [complete] ERISA preemption does not apply." Lone Star OB/GYN Assoc. v. Aetna Health Inc., 579 F.3d 525, 532 (5th Cir. 2009). Ochsner contends that Anderson's claims implicate the "right of payment" - that is, whether thetreatments she received at Ochsner's facility were "covered services" within the meaning of her ERISA policy.
The contract's plain language does incorporate Anderson's ERISA policy. The contract provides that Ochsner "shall provide Health Services to all Members" and that Ochsner "shall submit claims for Health Services to Plan."18 "Health Services" are defined as "health care services and supplies covered by the Member's Benefit Contract."19 A "Member" is an "individual who is properly covered under a Benefit Contract."20
Ochsner admits that Anderson was insured under a United plan at the time she received treatment at its facility.21 The contract further provides that:
To determine whether an individual is a Member and, therefore, entitled to receive Health Services, [Ochsner] shall ask the individual to present his or her identification card, which shall be provided to all Members by Payors, unless because of the type of Benefit Contract under which the Member has coverage no identification card applies. In addition, [Ochsner] may contact [United] to obtain [United's] most...
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