A settlement binds the Plaintiffs as much as it binds the Defendants. That includes a settlement and Release in a Class Action filed by Doctors against Health Insurance Companies. One of the Plaintiff Doctors was not done filing lawsuits. He filed similar Claims including regarding Claims Handling and alleged Bad Faith in the New York State Supreme Court. The United States District Court for the Southern District of Florida held in that case that the Plaintiff was bound by his Class Action Settlement and Release.
As the United States Magistrate Judge found:
Now turning to the specific allegations asserted by Plaintiff under each count, it is clear that Counts II-IV and VI-X all pertain to Empire's allegedly improper claims handling:
• Count II (Declaratory Judgment)-Arising out of Empire's alleged failure to reimburse Plaintiffs “per a consistent fee-for-service formula for services rendered to patients subscribed to Empire.” Id. ¶ 57.
• Count III (Declaratory Judgment)-Requiring that Empire “disclose the formula, scheme or payment allowance guidelines for each subscriber's policy and procedure code, such that Empire must explicitly reveal and clear: a) the CPA code used for each subscriber; b) the explicit basis for allowance; c) the explicit basis for rejecting procedures; and d) the explicit basis for rejecting reimbursements.”
Id. ¶ 63.
• Count IV (Unjust Enrichment)-Arising out of Empire's improper underpayment for professional services rendered to its subscribers.
Id. ¶ 68.
• Count VI (Fraud)-Arising out of Empire's alleged “repeated false statements in its explanations of benefit sent to Dr. Artandi as justifications for payments made” to him.
Id. ¶ 74. The FAAC further alleges that “Empire has intentionally and repeatedly made false and dishonest calculations in justifying its reimbursement amounts to Dr. Artandi.”
Id. ¶ 75.
• Count VII-VIII (Monetary and Punitive Damages)-As previously stated, these counts do not recite cognizable causes of action. Instead, they merely recite the types of legal remedies that Plaintiff is seeking as a result of Empire's alleged “long pattern of intentional, bad-faith, oppressive, malicious and outrageous misconduct in failing to pay and underpaying Dr. Artandi for services rendered to patients subscribed to Empire, according to an erratic, inconsistent and arbitrary scheme.”
Id. ¶ 84.
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• Count IX (Unfair and Deceptive Business Practices Under
N.Y. Gen. Bus. L. § 349)-Arising out of Empire's alleged “false, misleading and deceptive statements of fact” intended to mislead a reasonable consumer.
Id. ¶¶ 88-90.
• Count X (Breach of Contract)-Arising out of Empire's alleged failure “to reimburse Dr. Artandi as a non-participating physician for medically necessary services rendered, in a fair, reasonable, statutorily timely, consistent and legally acceptable manner, based on a fee-for-service formula calculated under the UCR, RC or prevailing fee standard.”
Id. ¶ 97.
Clearly, a careful analysis of the allegations raised in the FAAC suggests that Counts II-IV and VI-X clearly fall under the scope of Released Claims under the Final Approval Order because they all relate to the denial, delay, and diminishment of physicians' fee for service claims. In other words, “but for” Empire's alleged improper claims processing schemes, Counts II-IV and VI-X would simply not survive on their own. Allowing these claims to go forward will require litigating the merits of the alleged improper claims handling practices, clearly an issue addressed and settled by the Final Approval Order. Indeed, the Eleventh Circuit has recently emphasized the broad language of the
Love Settlement and instructed us that the release “extends to any and all causes of action of whatever kind, source, or character that are related to matters addressed in the class action.”
Thomas v. Blue Cross and Blue Shield Ass'n, 594 F.3d 814, 822 (11th Cir.2010) (finding Plaintiff Kolbusz's claims of tortious interference and defamation released under the
Love Settlement regardless of the fact that these claims might “depend on a different legal theory than the claims asserted in the class action or require [plaintiff] to prove matters in addition to or different from the claims asserted in the class action”). Thus, Claims II-IV and VI-X are Released Claims and Plaintiff should be enjoined from pursuing them in the New York Supreme Court.
In his Order Adopting Magistrates Report and Recommendation and Granting Motion to Enforce Injunction, the District Judge provided the Plaintiff with a time limit within which to withdraw the offending Claims, or face the possibility of sanctions if he did not do so:
Plaintiff shall have twenty (20) days from the date of this Order to withdraw the Counts II-IV and VI-X from the First Amended Answer and Counterclaim. If Plaintiff fails to voluntarily withdraw these claims, Empire's contempt motion shall be revisited by this Court.
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