United States District Court, Central District of California
IV Solutions, Inc.
United Healthcare Services, Inc., et al.
ORDER RE: DEFENDANT’S MOTION IN LIMINE NO. 1
GARY ALLEN FEESS, JUDGE
This Order addresses Defendant’s Motion in Limine No. 1 to Exclude Evidence Regarding The
Ingenix Database, Database Actions, and Settlement.
Plaintiff IV Solutions, Inc. (“IV Solutions”) is a medical provider that supplies specialty pharmaceutical products and related in-home infusion services. Defendant United Healthcare Services, Inc. (“United”) is a health care service business that administers ERISA plans. (Id. ¶ 2.)
Despite the florid language of United’s motion, this case presents the Court with little more than a contract dispute between two sophisticated parties. IV Solutions contends that United, through an agent, contracted with IV Solutions for the purchase of medically necessary “specialty blood products” for three patients, A.N., D.H. and M.S., enrolled in ERISA plans administered by United. (Id. ¶¶ 11, 18, 28.) IV Solutions, which was an out-of-network provider, contends that the needed services were not available from in-network providers, which is why it was retained to deliver these products to the three plan participants. Because the retail cost of the products was so expensive, IV Solutions further contends that United negotiated for the delivery of the products and services at a high, but agreed-on discount from IV Solutions’ normal retail price.
The agreements at issue were memorialized in written contracts that purportedly specified the price to be paid for the products provided and services rendered. Once those agreements were signed, United paid the agreed-on price for the delivery of their specialty products to A.N., but eventually balked at the high prices and refused to make any additional payments for services provided to D.H. and M.S. United does not dispute the existence of the contracts but vigorously disputes any obligation to pay for the services and products that IV Solutions claims to have provided under those agreements. Among other things, United contends that: (1) IV Solutions promised to collect deductibles and co-payments from patients D.H. and M.S. but never billed for those amounts, or indeed any amounts; and (2) IV Solutions agreed to be subject to the terms and conditions of the health benefit plans administered by United. United contends that IV Solutions entered into the agreements with no intention of honoring these promises. Accordingly, while IV Solutions seeks amounts it contends are still due and owing for services and products it provided beneficiaries D.H. and M.S., United seeks a determination that it owes nothing to IV Solutions and indeed that IV Solutions must re-pay amounts it received for services rendered to the three patients.
A. The “Ingenix” Litigation and Settlement
In 2000 the American Medical Association, joined several years later by the New York Attorney General, brought suit against United on the ground that its reimbursements were based on a defective and unreliable database that yielded unreasonably low reimbursements to providers who rendered services to health plan members. IV Solutions refers to that database as the Ingenix Database; United refers to it as the PHCS Database. The database litigation was settled for the payment of substantial sums of money, and an agreement to create a new database for determining reimbursements. However, the settlements also provided that United was not admitting the truth of any material allegations regarding the alleged defects in the database. United cites to provisions of the agreement indicating that the settlement agreement could not be used as evidence in any other proceeding.
IV Solutions has alleged details regarding the settlement in its fraud claim in the First Amended Complaint and quotes the governor of New York who characterized United’s conduct (presumably the use of the PHCS database) as a “scam” and “dishonest conduct.” The fraud claim also references New York’s investigation into an “industry-wide” scheme to defraud consumers with a specific reference to an intended suit against United and Ingenix. Finally, United notes that one of IV Solutions’ experts, Dr. Roby, included a discussion of the lawsuits in his expert report. However, Dr. Roby conceded that: (1) United never conceded wrongdoing in that litigation; and (2) that he found no evidence that the Ingenix database was used to price products at issue in this case.
B. United’s Position Regarding Admissibility
Based on the foregoing, United contends evidence regarding the Ingenix database should be excluded. United asserts that it is not relevant to this lawsuit, that the allegations are unproven and not similar to the allegations made here, that the evidence should be excluded pursuant to Rule 403 because it is ...