United States District Court, N.D. Alabama, Southern Division
MITCHELL MCATEER, on Behalf of Himself and All Others Similarly Situated, Plaintiff,
DCH REGIONAL MEDICAL CENTER; DCH HEALTH SYTEMS; AVECTUS HEALTHCARE SOLUTIONS, LLC, Defendants.
MEMORANDUM OPINION AND ORDER
MADELINE HUGHES HAIKALA, UNITED STATES DISTRICT JUDGE.
class action suit comes before the Court on a renewed motion
to dismiss filed by defendants DCH Regional Medical Center
and DCH Health Systems, (Doc. 42), and a motion to dismiss
filed by defendant Avectus Healthcare Solutions, LLC, (Doc.
46). On behalf of a proposed plaintiff class, Mitchell
McAteer alleges that DCH and Avectus wrongfully billed and
collected payments from insured patients and collected
payments that exceeded what the DCH defendants were entitled
to recover under their contracts with Blue Cross/Blue Shield
of Alabama and other insurers. (Doc. 40, pp. 1, 3,
¶¶ 3, 11).
McAteer seeks recovery on seven counts: (1) violation of
Alabama Deceptive Trade Practices Acts (“ADTPA”);
(2) tortious interference with contractual
relationship/business expectancy; (3) unjust enrichment; (4)
money paid by mistake; (5) civil conspiracy; (6) breach of
contract; and (7) injunctive relief. (Doc. 40, pp. 11-18).
DCH and Avectus argue that the Court may not exercise
jurisdiction over these state law claims under CAFA's
home-state exception. For the reasons stated below, the Court
STANDARD OF REVIEW
12(b)(6) of the Federal Rules of Civil Procedure enables a
defendant to move to dismiss a complaint for “failure
to state a claim upon which relief can be granted.”
Fed.R.Civ.P. 12(b)(6). When evaluating a Rule 12(b)(6) motion to
dismiss, a district court accepts as true the allegations in
the complaint and construes the allegations in the light most
favorable to the plaintiff. See Brophy v. Jiangbo Pharms.
Inc., 781 F.3d 1296, 1301 (11th Cir. 2015). The Court
reviews Mr. McAteer's factual allegations accordingly.
Health Systems, Inc. provides medical services and operates a
medical facility called DCH Regional Medical Center. (Doc.
40, p. 2, ¶ 7). Defendant DCH Regional Medical Center is
affiliated with DCH Health Systems, Inc. (Doc. 40, p. 2,
¶ 8). DCH entered into contracts with health
insurance providers, including Blue Cross/Blue Shield of
Alabama, to provide medical services to insured patients at
contracted rates. (Doc. 40, p. 3, ¶ 12). Those
agreements obligate DCH to provide medical services to
patients at the contract rate, bill the patients'
insurance carriers, and accept payment from the patients'
insurance carriers in satisfaction of the patients'
debts. (Doc. 40, pp. 3-4, ¶ 12).
patient arrives at the hospital, DCH screens the patient to
determine why the patient requires treatment and
“whether payment sources other than health insurance
are available.” (Doc. 40, p. 4, ¶ 15). If DCH
classifies a patient's account as part of its
“accident claims group, ” then that patient's
account is added to a “work list” that DCH
provides to Avectus. (Sealed Doc. 48-1, p. 4; Sealed Doc.
48-2, p. 2). According to the agreement between Avectus and
DCH, the phrase “accident claims group” refers to
“those accounts of [DCH] which are identified as claims
in which the patient's medical treatment is actually or
potentially related to an accident or injury.” (Sealed
Doc. 48-2, p. 2). The agreement also provides that
“[t]he parties have established a criteria for
identifying these claims, which is attached hereto as Exhibit
‘B'.” (Sealed Doc. 48-2, p. 2). Exhibit
“B” is a list of billing codes that cause a
patient's file to be flagged for inclusion on ACH's
“work list.” (Sealed Doc. 48-2, p. 7; see
also Sealed Doc. 48-1, p. 4).
places a patient's account on the “work list,
” then DCH submits that patient's files to Avectus
rather than the patient's insurance carrier. (Doc. 40, p.
4, ¶¶ 16-17). When it receives a file, Avectus
evaluates the file and determines whether the patient has
sources of payment other than health insurance. (Doc. 40, p.
4, ¶¶16-17). If other payment sources exist, then
Avectus contacts the patient and demands full payment for the
medical services performed by DCH. (Doc. 40, p. 5, ¶
19). In some cases, Avectus files and perfects liens on a
patient's third-party tort claims; in others, Avectus
seeks medical payment benefits from an auto insurer. (Doc.
40, p. 5, ¶ 20). Ultimately, Avectus negotiates with a
patient and, according to Mr. McAteer, determines whether,
and for what amount, to settle with that patient. (Doc. 40,
p. 5, ¶ 21). For these services, Avectus receives from
DCH a percentage of every dollar Avectus recovers. (Doc. 40,
p. 5, ¶ 22; Sealed Doc. 48-2, p. 7).
November of 2015, Mr. McAteer received emergency medical care
at DCH for injuries resulting from an automobile accident.
(Doc. 40, p. 6, ¶ 24). At the time, Mr. McAteer was
insured with Blue Cross/Blue Shield of Alabama. (Doc. 40, p.
6, ¶ 25). Mr. McAteer provided his health insurance
information to DCH. (Doc. 40, p. 6, ¶ 25). Three months
later, Avectus began contacting Mr. McAteer and his attorney
for information about his accident and insurance claims
related to the accident. (Doc. 40, p. 7, ¶ 31). During
these interactions, Avectus notified Mr. McAteer of a
hospital lien asserted against him for $4, 321.50. (Doc. 40,
p. 7, ¶¶ 32- 33). Mr. McAteer “paid $2,
881.00 to satisfy DCH's lien.” (Doc. 40, p. 7,
McAteer alleges that DCH and Avectus gave him false or
misleading information about DCH's billing practices and
Avectus's involvement in the collection process.
Specifically, Mr. McAteer alleges:
• “At the time of treatment, DCH never informed
Plaintiff that it would not accept Plaintiff's health
insurance. DCH never explained that it would be seeking the
balance of Plaintiff's medical bills from him personally
or by asserting a lien against his third-party tort claim.
DCH failed to inform Plaintiff that DCH would be asserting a
third-party lien against his personal injury recovery.”
(Doc. 40, p. 6, ¶ 26);
• “DCH . . . did not inform Plaintiff that it had
a contract with BCBSAL, requiring Plaintiff's charges be
submitted to BCBSAL for payment and that DCH was precluded
from pursuing any charges from Plaintiff and/or any asset of
Plaintiff.” (Doc. 40, p. 6, ¶ 28);
• “Although Avectus represented that it was
communicating with DCH concerning negotiation of the full
amount of charges, Avectus acted independently in negotiating
and reducing the amount of the lien. . . . Avectus never
communicated with DCH about negotiation or settlement of
Plaintiff's lien prior to ...