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Title: Gateway Rehab and Wellness Center, Inc. v. Aetna Health of California

April 10, 2013

TITLE: GATEWAY REHAB AND WELLNESS CENTER, INC.
v.
AETNA HEALTH OF CALIFORNIA, INC.



The opinion of the court was delivered by: Honorable David O. Carter, Judge

O

CIVIL MINUTES -- GENERAL

PRESENT: THE HONORABLE DAVID O. CARTER, JUDGE

Julie Barrera N/A Courtroom Clerk Court Reporter

ATTORNEYS PRESENT FOR PLAINTIFF: ATTORNEYS PRESENT FOR DEFENDANT: None Present None Present

PROCEEDINGS (IN CHAMBERS): ORDER GRANTING DEFENDANT'S MOTION TO DISMISS

Before the Court is a Motion to Dismiss (Dkt. 6) filed by Defendant Aetna Life Insurance Co. ("Defendant") (erroneously sued as Aetna Health of California, Inc.). After reviewing the Motion, Opposition, and Reply, the Court hereby GRANTS Defendant's Motion to Dismiss. *fn1

I. Background

Plaintiff's Complaint pleads the following facts.

Plaintiff Gateway Rehab and Wellness Center, Inc. ("Plaintiff"), is a medical service provider that offers physical therapy and chiropractic and acupuncture services to the public. Compl. (Dkt. 1 Ex. B) ¶ 5. Between January 2007 and May 2010, Plaintiff provided medical services to patients who were enrolled in health care plans sponsored by, or administered by, Defendant (hereinafter "Audit Patients"). Id. ¶ 6. In May 2010, Defendant claimed to have completed an audit of payments made to Plaintiff for services rendered to Audit Patients, which revealed that Defendant overpaid Plaintiff by $329,338.92. Id. ¶ 7. In June 2010, Plaintiff indicated to Defendant that there was no overpayment and that it would not pay Defendant any of the funds requested. Id. ¶ 8. After September 12, 2012, Plaintiff treated a number of patients insured by Defendant (hereinafter "Patients"). Id. ¶ 9. Plaintiff timely and properly submitted claims to Defendant for repayment of these medical expenses, but Defendant refused to reimburse Plaintiff. Id. ¶¶ 11--12. Plaintiff believes that Defendant refuses to pay Plaintiff for services rendered to Patients because it believes that Plaintiff should repay Defendant for the claims relating to Audit Patients. Id. ¶ 13. As a result, Plaintiff has suffered $156,431 in damages because of the services rendered to Patients. Id. ¶ 14.

a. Procedural History

On September 27, 2012, Plaintiff filed its Complaint in Orange County Superior Court. Not. of Removal (Dkt. 1) at Ex. B. The Complaint included claims for: (1) breach of implied-in-fact contract; (2) common counts; (3) quantum meruit; (4) unjust enrichment; (5) estoppel; and (6) declaratory relief. Defendant then removed the case to this Court on January 17, 2013. Not. of Removal. On January 24, 2013, Defendant filed its Motion to Dismiss all of Plaintiff's claims, except its claim for declaratory relief. Mot. Plaintiff filed its Opposition on February 4, 2013. Opp'n (Dkt. 8). Defendant then filed its Reply on February 11, 2013. Reply (Dkt. 10).

II. Legal Standard

Under Federal Rule of Civil Procedure 12(b)(6), a complaint must be dismissed when a plaintiff's allegations fail to set forth a set of facts which, if true, would entitle the complainant to relief. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007); Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009) (holding that a claim must be facially plausible in order to survive a motion to dismiss). The pleadings must raise the right to relief beyond the speculative level; a plaintiff must provide "more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do." Twombly, 550 U.S. at 555 (citing Papasan v. Allain, 478 U.S. 265, 286 (1986)). On a motion to dismiss, this court accepts as true a plaintiff's well-pled factual allegations and construes all factual inferences in the light most favorable to the plaintiff. Manzarek v. St. Paul Fire & Marine Ins. Co., 519 F.3d 1025, 1031 (9th Cir. 2008). The court is not required to accept as true legal conclusions couched as factual allegations. Iqbal, 556 U.S. at 678.

In evaluating a Rule 12(b)(6) motion, review is ordinarily limited to the contents of the complaint and material properly submitted with the complaint. Clegg v. Cult Awareness Network, 18 F.3d 752, 754 (9th Cir. 1994); Hal Roach Studios, Inc. v. Richard Feiner & Co., Inc., 896 F.2d 1542, 1555 n.19 (9th Cir. 1990). Under the incorporation by reference doctrine, the court may also consider documents "whose contents are alleged in a complaint and whose authenticity no party questions, but which are not physically attached to the pleading." Branch v. Tunnell, 14 F.3d 449, 454 (9th Cir. 1994), overruled on other grounds by 307 F.3d 1119, 1121 (9th Cir. 2002).

A motion to dismiss under Rule 12(b)(6) cannot be granted based upon an affirmative defense unless that "defense raises no disputed issues of fact." Scott v. Kuhlmann, 746 F.2d 1377, 1378 (9th Cir. 1984). For example, a motion to dismiss may be granted based on an affirmative defense where the allegations in a complaint are contradicted by matters properly subject to judicial notice. Daniels--Hall v. Nat'l Educ. Ass'n, 629 F.3d 992, 998 (9th Cir. 2010). In addition, a motion to dismiss may be granted based upon an affirmative defense where the complaint's allegations, with all inferences drawn in Plaintiff's favor, nonetheless show ...


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