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Sanjay Ghosh, M.D v. Aetna Health of California

October 2, 2012

SANJAY GHOSH, M.D.,
PLAINTIFF,
v.
AETNA HEALTH OF CALIFORNIA, INC.; CIGNA HEALTHCARE OF CALIFORNIA, INC.; LABORERS NATIONAL HEALTH WELFARE FUND; DELTA HEALTH SYSTEMS; MULTIPLAN SERVICES CORPORATION; INTEGRATED HEALTH PLAN, INC.; AND DOES 1 THROUGH 20, INCLUSIVE, DEFENDANTS.



The opinion of the court was delivered by: Hon. Jeffrey T. Miller United States District Judge

ORDER REMANDING CASE TO STATE COURT

On May 17, 2012, Plaintiff Dr. Sanjay Ghosh filed a complaint in the Superior Court of the State of California, County of San Diego, raising state law claims including the unauthorized use of his name for commercial benefit, interference with contractual and economic relationships between Plaintiff and his patients, and fraudulent and unfair business practices. (Dkt. 1, Ex. 3.) On June 25, 2012, Defendant Aetna Health of California ("Aetna") removed this action to federal court on the basis of federal question jurisdiction, 28 U.S.C. § 1331, claiming that Plaintiff's claims are completely preempted by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. because Plaintiff is actually seeking benefit payments as an assignee of ERISA-governed health plans. (Dkt. 1.) On July 25, 2012, Plaintiff filed a motion to remand, explaining that his claims were wholly based on state law and did not relate to plan terms between patient and insurers. Rather, Plaintiff asserts that his claims are based on Defendants' duty to him and that he could not have raised these claims under ERISA § 502(a)(1)(B) (Dkt. 13 at 7-14). Plaintiff also argues that Defendant Aetna Health of California, Inc.'s ("Aetna") motion for removal is defective because Aetna failed to obtain the consent of all defendants. (Dkt. 13 at 5.)

On August 15, 2012, Aetna filed an amendment to its notice of removal, claiming that Aetna had recently learned facts leading it to believe that complete diversity existed and that this court therefore had subject matter jurisdiction under 28 U.S.C. § 1332.*fn1 But on September 10, 2012, Defendant filed another amendment to its notice of removal withdrawing its assertion of complete diversity because it believed that Plaintiff had incorrectly asserted a claim against Defendant Delta Health Systems. Aetna instead believes that Plaintiff should have asserted a claim against Wm. Michael Stemler Incorporated (d/b/a Delta Health Systems), which is a California corporation.

For the reasons stated below, the motion for remand is GRANTED.

I. BACKGROUND

Plaintiff is a California licensed physician and certified neurosurgeon who serves patients in San Diego County. Compl. ¶ 1. Plaintiff serves as both a shareholder and director for both Senta Clinic, Inc., a medical practice specializing in skull base surgery and neurological medical care, and SDNT San Diego Neurotrama Associates, Inc. ("SDNT"), which operates a medical practice specializing in providing emergency department and trauma coverage in skull base surgery and neurological medical care for hospital and health systems in San Diego County. (Dkt. 1, Compl. ¶ 25, 26.)

Defendants Aetna, Cigna Healthcare of California, Inc. ("CIGNA"), United Healthcare of California ("UHC"), Laborers National Health & Welfare Fund ("Laborers"), and Delta Health Systems ("Delta") (collectively "Insurers") provided medical insurance to one or more patients whose medical bills are presently at issue. Plaintiff has no current contractual relationship with any of the Insurers, but previously had contractual relationships with Aetna, Cigna, and UHC.

Plaintiff terminated these contractual relationships on November 11, 2010, January 4, 2011, and December 3, 2010 respectively. (Dkt. 1, Exs. 3B, 3C, 3D.)

Defendants Integrated Health Plan, Inc. ("IHP") and Defendant Multiplan Services Corporation ("Multiplan") maintain a network of contracted physicians (often referred to as "contracted providers") and "acquire the right to sell, lease, or transfer access to discount rates for those physicians to insurers and other payors which are responsible for medical bill payments but do not have a direct contractual relationship with the doctors or provider of medical services that would allow them to take such a discount." (Dkt. 1, Ex. 3 at ¶ 10.) IHP is wholly owned by Multiplan. (Dkt. 1, Ex. 3 at ¶ 9.) "IHP and Multiplan are the networks through which Aetna, UHC, CIGNA, Laborers, and Delta claim to have a right to obtain a discount on the rates charged by Dr. Ghosh for the medical services he provided to the patients whose medical bills are at issue in this case." (Dkt. 1, Ex. 3 at ¶ 11.)

Plaintiff has never had a direct contractual relationship with Multiplan or IHP. (Dkt. 1, Compl. ¶ 33.) Even though he never entered into a contract with Multiplan, Plaintiff also sent a termination letter to Multiplan on November 3, 2008 because he became aware that Multiplan was holding him out as a contracted provider. (Dkt. 1, Ex. 3 at ¶ 35;Dkt. 1, Ex. 3E.) After discovering that Multiplan was still holding out Plaintiff as a contracted provider, Plaintiff sent Multiplan a cease-and-desist letter on March 12, 2010. (Dkt. 1, Ex. 3F.) Plaintiff believes that Multiplan and IHP are still holding Plaintiff out as a contracted provider. (Dkt. 1, Ex. 3 at ¶ 36.)

From late 2010 through early 2012, Plaintiff cared for various patients covered by the Insurers. (Dkt. 1, Ex. 3A.) These patients each provided their medical insurance information and acknowledged responsibility for paying any portion of their bill not covered by medical insurance. (Dkt. 1, Ex. 3 at ¶ 28.) Following Plaintiff's provision of services to these patients, SDNT billed the Insurers according to its usual and customary rates. (Dkt. 1, Ex. 3 at ¶ 29.) The Insurers, however, only paid Plaintiff at discounted rates and refuse to pay the full amount due to Plaintiff for the medical services he provided to his patients. The Insurers also informed Plaintiff's patients that they owed Plaintiff nothing further for his service as he is a contracted provider. (Dkt. 1, Ex. 3 at ¶ 44.)

Plaintiff claims to have appealed the underpayment of these claims, repeatedly telling Insurers that he has no contractual relationship with them, Multiplan, or IHP. However, these appeals and explanations have fallen on deaf ears. (Dkt. 1, Ex. 3 at ¶ 43.) Plaintiff also sought payment for the difference from his patients, who similarly refuse to pay the outstanding sums. (Dkt. 1, Ex. 3 at ¶ 45.)

Accordingly, Plaintiff has brought nine causes of action: (1) use of name or likeness (Cal. Civ. Code § 3344) against Defendants; (2) commercial appropriation (Cal. Civ. Code § 3294) against Aetna, Cigna, UHC, Laborers, Multiplan, and IHP; (3) inducing breach of contract against Defendants; (4) intentional interference with contractual relationships against Defendants; (5) intentional interference with prospective economic relations against Defendants; (6) negligent interference with prospective economic relations; (7) unfair business practices (Cal. Bus. & Prof. Code § 17200 et seq.) against Defendants; (8) ...


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