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United States District Court for the Southern District of Florida
December 3, 2020, Decided; December 3, 2020, Entered on Docket
Case No.: 20-cv-61007-SINGHAL
THIS CAUSE is before the Court on Defendants' Joint Motion to Dismiss Plaintiff's Amended Complaint, [*2] or Alternatively, to Dismiss or Strike the Class Allegations ("Motion") (DE ). Plaintiff South Broward Hospital District ("The District") brings this putative class action to recover additional payments for hospital services it provided to patients covered by certain ERISA1 plans ("ERISA Plans"). The District brings claims under Florida's Deceptive and Unfair Trade Practices Act ("FDUTPA"), see Fla. Stat. §§ 501.201-.203, and for unjust enrichment, against Defendant ELAP Services, LLC ("ELAP"), a co-fiduciary and designated decisionmaker of the ERISA Plans, and Defendant Group & Pension Administrators, Inc. ("GPA"), the ERISA Plans' third-party administrator (collectively, "Defendants"). The District alleges that Defendants deceived it into treating patients by deliberately withholding information about each patient's health plan. It seeks to recover a yet-to-be determined millions of dollars that it contends Defendants have "stolen" from healthcare facilities and providers, and to enjoin Defendants from continuing their unfair and deceptive practices.
The Court has reviewed the Motion, Plaintiff's Response in Opposition ("Response") (DE ), Defendants' Reply in Support ("Reply") (DE ), [*3] a notice of supplemental authority filed by the District (DE ) and Defendants' response (DE ), as well as the relevant case law. Because the District has alleged sufficient allegations at this point of the proceeding, and for the following reasons explored below, the Motion is DENIED.
A. The Parties and Reference-Based Pricing
The District is an independent special tax district, operating as a large, public healthcare system in Broward County, Florida. Am. Compl. ¶ 22 (DE ). It consists of several healthcare providers and facilities, including hospitals, physicians, and outpatient clinics. Id. ELAP holds itself out as providing claim auditing, repricing, and legal services to self-funded ERISA plans. Id. ¶ 29. In short, ELAP touts itself as a corporation that offers businesses assistance in saving money on healthcare by, what it represents as, "fighting excessive hospital bills." Id. ¶¶ 58-60. ELAP becomes the administrator of the self-funded ERISA plans, which gives it authority to make decisions on how each employee's healthcare claim will be paid. Id. ¶ 1. ELAP, in turn, contracts with GPA to provide third-party administrator services for ELAP-designed self-funded [*4] plans. Id. ¶ 31.
Together, ELAP and GPA market themselves as "leaders and co-founders of metric-based pricing," more commonly known as "Reference-Based Pricing." Id. ¶ 32. According to the District, this Reference-Based Pricing is an "arbitrary, uniform, and unilateral" reimbursement model that Defendants use systematically to underpay healthcare providers in Florida and around the country. Id. ¶¶ 33-34. This Reference-Based Pricing model serves as part of the allegations against Defendants in this case.
Full case includes Shepard's, Headnotes, Legal Analytics from Lex Machina, and more.
2020 U.S. Dist. LEXIS 226859 *; 2020 WL 7074645
SOUTH BROWARD HOSPITAL DISTRICT, d/b/a/ Memorial Healthcare System, on its own behalf and on behalf of other similarly situated healthcare facilities, Plaintiff, v. ELAP SERVICES, LLC and GROUP & PENSION ADMINISTRATORS, INC., Defendants.
plans, providers, MultiPlan, deceptive, reimbursement, unfair, preemption, contracts, patient, courts, unjust enrichment, preempted, healthcare, consumer, motion to dismiss, allegations, commerce, healthcare provider, Pricing, plan member, rates, unjust-enrichment, practices, state-law, network, parties, healthcare services, self-funded, facilities, conflict preemption
Business & Corporate Compliance, Pensions & Benefits Law, ERISA, Plan Establishment, Pensions & Benefits Law, Federal Preemption, Deemer Clause, Donovan v. Dillingham Test, Civil Procedure, Defenses, Demurrers & Objections, Motions to Dismiss, Failure to State Claim, Pleadings, Complaints, Requirements for Complaint, Antitrust & Trade Law, Trade Practices & Unfair Competition, State Regulation, Scope, Consumer Protection, Deceptive & Unfair Trade Practices, State Regulation, Trials, Jury Trials, Province of Court & Jury, Governments, Courts, Judicial Precedent, Contracts Law, Remedies, Equitable Relief, Quantum Meruit, Authority to Adjudicate, Contracts Law, Types of Contracts, Express Contracts, Quasi Contracts, Federal & State Interrelationships, Federal Common Law, Preemption, Federal Law Exemption, Constitutional Law, Supremacy Clause, Federal Preemption, Subject Matter Jurisdiction, Federal Questions, Well Pleaded Complaint Rule, State Laws, Evidence, Burdens of Proof, Allocation, Definitions, Healthcare Law, Insurance Coverage, Health Insurance, ERISA, Civil Litigation, Standing, Special Proceedings, Class Actions, Certification of Classes, Prerequisites for Class Action, Adequacy of Representation, Numerosity, Typicality, Commonality