Conn. Gen. Life Ins. v. True View Surgery Ctr. One, LP

14 Citing cases

  1. Rojas v. Cigna Health & Life Ins. Co.

    No. 14-CV-6368 (KMK) (S.D.N.Y. Sep. 28, 2018)   Cited 6 times
    Holding that the plaintiffs’ claims that the defendants billed for medical tests they did not perform were properly brought as fraud claims and were not duplicative of the plaintiffs’ breach of contract claims because the defendants allegedly concealed the actual price and nature of the tests each time they sent bills

    A jury, taking the evidence most favorably to Defendants, could readily find that Plaintiffs misled Defendants about the true cost of the services being rendered in order to receive improper payments. See Connecticut Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F. Supp. 3d 501, 514 (D. Conn. 2015) (finding misstatements wherein the defendant failed to "disclos[e] a waiver of cost-share requirements," and submitted "charges grossly in excess of the amounts quoted" to "sufficiently state false representations"); Oxford Health Plans (N.Y.), Inc. v. BetterCare Health Care Pain Mgmt. & Rehab, PC, 762 N.Y.S.2d 344, 345-46 (App. Div. 2003) (finding fraud adequately stated where the claims "are sufficiently premised on affirmative misrepresentations" as to billing for services not actually rendered and non-medically necessary services).

  2. Blue Cross & Blue Shield of Miss., Ins. Co. v. Sharkey-Issaquena Cmty. Hosp.

    CIVIL ACTION NO. 3:17-CV-338-DPJ-FKB (S.D. Miss. Dec. 13, 2017)   Cited 1 times

    See id. Other courts have reached the same result. See, e.g., Arapahoe Surgery Ctr. v. Cigna Healthcare, Inc., No. 13-CV-3422, 2015 WL 1041515, at *7 (D. Colo. Mar. 6, 2015) (finding no conflict preemption because Cigna's state-law claims were "based on whether [the providers, who were not ERISA entities,] made material misrepresentations"); Advanced Surgery Ctr. Of Bethesda, LLC, 2015 WL 4394408, at *17 (rejecting conflict preemption and noting that "[a]lthough some of the allegations in the complaint reference ERISA plans, the core allegations of misconduct that the Cigna entities have pled for their state law causes of action relate to the fraudulent or negligent misrepresentations"); Conn. Gen. Life Ins. Co. v. True View Surgery Ctr., 128 F. Supp. 3d 501, 517 (D. Conn. 2015) (rejecting conflict preemption because "[t]he crux of the state fraud claim is the surgical centers' alleged misconduct—the fraudulent billing practices—and not the terms of the ERISA-governed plans"); United Healthcare Servs., Inc. v. Sanctuary Surgical Centre, 5 F. Supp. 3d 1350, 1362-63 (S.D. Fla. 2014) (finding no conflict preemption because "this case involves state law tort claims lodged solely against non-ERISA entities"); Aetna Life Ins. Co., 2014 WL 4116963, at *6-7; Fustok v. UnitedHealth Grp., Inc., No. 12-CV-787, 2013 WL 2189874, at *5-6 (S.D. Tex. May 20, 2013) (applying Fifth Circuit case to similar billing-fraud claim and finding no conflict preemption); Ass'n of N.J. Chiropractors, 2012 WL 1638166, at *6; Health Goals Chiropractic Ctr., Inc., 2011 WL 1343047, at *5; see also Pl.'s Mem. [14] at 14 n.3 (collecting additional cases). The Court concludes that the state-law claims are not conflict preempted.

  3. Conn. Gen. Life Ins. Co. v. BioHealth Labs.

    573 F. Supp. 3d 671 (D. Conn. 2021)   Cited 3 times

    "The second circuit had recognized that the requisite intent of the alleged speaker of the fraud not be alleged with great specificity ... for the simple reason that a plaintiff realistically cannot be expected to plead a defendant's actual state of mind." Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F. Supp. 3d 501, 507-08 (D. Conn. 2015) (internal quotations and citations omitted). V. ANALYSIS

  4. Aetna Life Ins. Co. v. Huntingdon Valley Surgery Ctr.

    No. 16-1468 (3d Cir. Jul. 19, 2017)   Cited 2 times
    Vacating grant of summary judgment on insurer's fraud claim where the billing form was ambiguous as to medical provider's disclosure obligations; thus, there was an issue of fact as to whether medical provider submitted fraudulent bills when it listed "total charges" without deducting waived patient fees or informing insurer that it routinely provided such waivers

    Aetna relies on five district court opinions from various jurisdictions that allowed fraud claims to survive motions to dismiss since the insurer-plaintiffs alleged sufficient facts to establish that the providers had a duty to bill for their actual charges and committed fraud by failing to disclose routine waivers of patient fees. See Tri State Advanced Surgery Ctr., LLC v. Health Choice, LLC, 112 F. Supp. 3d 809, 816 (E.D. Ark. 2015); Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F. Supp. 3d 501, 506 (D. Conn. 2015); Conn. Gen. Life Ins. Co. v. Advanced Surgery Ctr. of Bethesda, LLC, No. 14-cv-2376, 2015 WL 4394408 (D. Md. July 15, 2015); Almont Ambulatory Surgery Ctr., LLC v UnitedHealth Grp., 121 F. Supp. 3d 950, 971-79 (C.D. Cal. 2015); Nutrishare, Inc. v. Conn. Gen. Life Ins. Co., No. 13-cv-2378, 2014 WL 1028351, at *4 (E.D. Cal. Mar. 14, 2014). These motions to dismiss survived because the plaintiffs alleged that the billing forms required the providers to list their actual charges; that is, the fraud arose because, accepting plaintiffs' allegations as true, the district courts determined that the providers' billing practices did not, as a factual matter, accord with their disclosure obligations.

  5. Roumeliotis v. Nash Eng'g Holdings (In re Nash Eng'g Co.)

    CIVIL 3:24-CV-00640 (JCH) (D. Conn. Jul. 15, 2024)

    .” Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F.Supp.3d 501, 507-08 (D. Conn. 2015) (internal quotations and citations omitted).

  6. Roumeliotis v. Nordenson

    CIVIL 3:23-CV-01366 (JCH) (D. Conn. Jul. 15, 2024)

    .” Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F.Supp.3d 501, 507-08 (D. Conn. 2015) (internal quotations and citations omitted).

  7. Advanced Reimbursement Sols. v. Aetna Life Ins. Co.

    No. CV-19-05395-PHX-DLR (D. Ariz. Mar. 25, 2022)   Cited 2 times

    See, e.g., Connecticut Gen. Life Ins. Co. v. Elite Ctr. for Minimally Invasive Surgery LLC, No. 4:16-CV-00571, 2017 WL 1807681, at *2 (S.D. Tex. May 5, 2017); Almont Ambulatory Surgery Ctr., LLC v. UnitedHealth Grp., Inc., 121 F.Supp.3d 950, 985 (C.D. Cal. 2015); Connecticut Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F.Supp.3d 501, 512 (D. Conn. 2015); Nutrishare, 2014 WL 1028351, at *3.

  8. ML Fashion, LLC v. Nobelle GW, LLC

    CIVIL 3:21-CV-00499 (JCH) (D. Conn. Feb. 2, 2022)   Cited 2 times

    Fed. R. Civ. Pro. 9(b). “The second circuit has recognized that the requisite intent of the alleged speaker of the fraud need not be alleged with great specificity . . . for the simple reason that a plaintiff realistically cannot be expected to plead a defendant's actual state of mind.” Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F.Supp.3d 501, 507-08 (D. Conn. 2015) (internal quotations and citations omitted).

  9. Cigna Healthcare of Tex., Inc. v. VCare Health Servs.

    Civil Action No. 3:20-CV-0077-D (N.D. Tex. Jun. 29, 2020)   Cited 5 times

    See, e.g., Funk v. Cigna, 648 F.3d 182, 194-95 (3d Cir. 2011) (holding that the relevant language of the agreement between the parties, which stated the plaintiff would be responsible for "reimburse[ment of] the full amount of any overpayment," was sufficient to create an equitable lien by agreement), abrogated on other grounds by Montanile v. Bd. of Trustees of Nat'l Elevator Indus. Health Benefit Plan, ___ U.S. ___, 136 S. Ct. 651, 656-57 & n.2 (2016); Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F.Supp.3d 501, 511-12 (D. Conn. 2015) (holding that plan language stating that "[w]hen an overpayment has been made by CIGNA, CIGNA will have the right at any time to . . . recover that overpayment from the person to whom or on whose behalf it was made," (italics omitted) created an equitable lien by agreement); but cf. Conn. Gen. Life Ins. Co. v. Advanced Surgery Ctr. of Bethesda, LLC, 2015 WL 4394408, *8-10 (D. Md. July 15, 2015) (construing plan language contained in Cigna plan and holding "[t]he language used in the Overpayment Provision cannot be understood by a plan member—or a provider that is not a party to the plan—as asserting an equitable lien or constructive trust on plan overpayments to providers.").

  10. Tyll v. Stanley Black & Decker Life Ins. Program

    No. 3:17-cv-1591 (VAB) (D. Conn. Sep. 10, 2018)

    Defendants claim that dismissal is warranted here because "[t]he fraud alleged is therefore that the Plan is relying on the plan terms" and that a "[m]ere inconsistency in terms between plan documents and summary documents, without alleging any facts to establish that the statements were fraudulent or made with intent to deceive or knowledge of the falsity, is insufficient to allege fraud." Defs. Mem. at 5 (citing Conn. Gen. Life Ins. Co. v. True View Surgery Ctr. One, LP, 128 F.Supp. 3d 501, 507 (D. Conn. 2015)).