Vestal v. First Recovery Grp., LLC
Vestal v. First Recovery Grp., LLC
Opinion of the Court
*1307This cause comes before the Court without oral argument on the following:
1. Plaintiff's Motion for Remand and Memorandum of Law (Doc. 8), filed September 26, 2017;
2. Defendant First Recovery Group, LLC's Response to Plaintiff's Motion for Remand (Doc. 14), filed October 10, 2017;
3. Defendant First Recovery Group, LLC's Motion to Dismiss (Doc. 3), filed September 5, 2017;
4. Plaintiff's Response to Defendant's Motion to Dismiss (Doc. 27), filed November 6, 2017; and
5. Defendant's Reply in Support of Its Motion to Dismiss (Doc. 35), filed November 27, 2017.
The parties have completed their briefing and the Court is otherwise fully advised on the premises. For the following reasons, Plaintiff's Motion for Remand is due to be denied, and Defendant's Motion to Dismiss is due to be granted in part.
I. BACKGROUND
The present lawsuit relates to an earlier medical malpractice action brought by VEV ("Plaintiff"), a minor, by and through Victoria Vestal and Emmanel Vestal, VEV's parents. On February 22, 2013, VEV was injured in an automobile accident. (Doc. 2, ¶ 8). The complaint alleges that VEV's healthcare providers were negligent, resulting in severe injuries. (Id. ¶ 9). Plaintiff then filed a medical malpractice suit. (Id. ¶ 12). Defendant, Armando Payas ("Payas"), was appointed guardian ad litem to VEV and was a named defendant in the malpractice case. (Id. ¶ 7). Plaintiff alleges Payas is an attorney licensed in Florida, and maintains a regular office in Florida. (Id. ¶¶ 5-6).
On February 7, 2017, Defendant First Recovery Group, LLC ("FRG")
This suit followed. On July 26, 2017, Plaintiff filed a state court complaint seeking a declaratory judgment that FRG is only entitled to recover $14,089.79 for Medicaid claims paid on VEV's behalf. (Id. ¶ 19). On August 29, 2017, FRG removed to this Court on the basis of diversity jurisdiction. (Doc. 1). In the Notice of Removal, FRG asserted that Payas is not a proper defendant, and that the parties are completely diverse if Payas is properly disregarded. (Id. ¶ 11).
II. DISCUSSION
A. Plaintiff's Motion for Remand
Plaintiff now moves to remand to state court, arguing that removal was improper for two reasons: (1) the parties are not completely diverse, and (2) Plaintiff failed to obtain consent from all Defendants to *1308remove. (Id. ¶¶ 18, 37). Plaintiff contends that Payas is a proper defendant in this suit, thus complete diversity of citizenship is absent. (Id. ¶¶ 20, 22, 32, 35). Moreover, because Payas was a proper defendant, FRG was required to obtain Payas' consent as a pre-requisite to removal. (Id. ¶¶ 37-39).
Defendant counters that Plaintiff fraudulently joined Payas to defeat diversity jurisdiction. (Doc. 14, ¶ 6). Defendant avers that no "bona fide controversy" exists between VEV and Payas, VEV's guardian ad litem, thus barring Payas from being joined as a defendant. (Id. ).
1. Fraudulent Joinder
Title
Because removal from state court constitutes an infringement upon state sovereignty, the procedural requirements for removal must be strictly construed, and all doubts about the propriety of removal must be resolved in favor of remand. Russell Corp. v. Am. Home Assurance Co. ,
FRG invokes this Court's diversity jurisdiction pursuant to
Under the fraudulent joinder doctrine, a facially non-diverse action "may nevertheless be removable if the joinder of the non-diverse party ... were fraudulent." Triggs v. John Crump Toyota, Inc. ,
FRG argues there is no possibility that Plaintiff can establish a cause of action against the non-diverse defendant, Payas, therefore his joinder was fraudulent. A "plaintiff need not have a winning case against the allegedly fraudulent defendant; he need only have a possibility of stating a valid cause of action in order for the joinder to be legitimate." Triggs ,
Generally, all defendants must consent to remove an action to federal court. However, "[a] fraudulently joined defendant need not consent to removal." Restivo v. Bank of Am. Corp. ,
B. Defendant's Motion to Dismiss
1. Subject Matter Jurisdiction-Statutory Exhaustion Requirement
FRG first argues that Plaintiff's failure to exhaust administrative remedies in accordance with Florida's Medicaid statute, the Medicaid Third-Party Liability Act ("MTPLA"), deprives this Court of subject matter jurisdiction. (Doc. 3, pp. 7-9).
Challenges to subject matter jurisdiction come in two forms: "facial attacks" and "factual attacks." Lawrence v. Dunbar ,
Although FRG frames its failure-to-exhaust argument in terms of subject matter jurisdiction, it is unclear whether the exhaustion requirement is a jurisdictional requirement, or merely a procedural "claim-processing rule[ ]." See Santiago-Lugo v. Warden ,
According to FRG, the MTPLA prescribes an administrative appeals process that must be exhausted before filing a lawsuit, (Doc. 3, pp. 8-9), and Plaintiff's failure to follow that procedure before bringing this action deprives the Court of jurisdiction. (Id. at 9-11). In response, Plaintiff avers that an earlier version of the MTPLA applies which does not require exhaustion of administrative remedies. (Doc. 27, ¶¶ 22-26). Plaintiff asserts that, because the lien at issue attached "on *1310or before March 15, 2013," more than three months before the amended MTPLA went into effect, the pre-amendment MTPLA governs this case. (Id. ¶¶ 9-10).
a. Federal Law
The Medicaid program provides federal and state funding to pay healthcare costs for individuals who cannot afford it. Ark. Dep't of Health & Human Servs. v. Ahlborn ,
The U.S. Code imposes additional obligations:
States must require beneficiaries "to assign the State any rights ... to support (specified as support for the purpose of medical care by a court or administrative order) and to payment for medical care from any third party." States receiving Medicaid must also
"ha[ve] in effect laws under which, to the extent that payment has been made under the State plan for medical assistance for health care items or services furnished to an individual, the State is considered to have acquired the rights of such individual to payment by any other party for such health care items or services."
Wos ,
b. Florida Law
The MTPLA provides that Medicaid is to be "the payor of last resort," and, if a liable third-party makes payments to a beneficiary for expenses paid through Medicaid, then Medicaid is to be repaid from the proceeds of the third-party payment(s).
The amount the State may recover from a Medicaid beneficiary for third-party payments is determined by formula.
*1311prescribes an administrative procedure for challenging § 409.910(11)(f) calculations:
If federal law limits the agency to reimbursement from the recovered medical expense damages, a recipient, or his or her legal representative, may contest the amount designated as recovered medical expense damages payable to the agency pursuant to the formula specified in paragraph (11)(f) by filing a petition under chapter 120 within 21 days after the date of payment of funds to the agency or after the date of placing the full amount of the third-party benefits in the trust account for the benefit of the agency pursuant to paragraph (a). The petition shall be filed with the Division of Administrative Hearings.
c. Present Litigation
The Court first addresses whether the pre- or post-amendment MTPLA applies to this case. The parties dispute which version of the law applies to the instant case, however, the Court is satisfied that the post-amendment law binds.
This very issue was addressed in Suarez v. Port Charlotte HMA, LLC ,
According to the Complaint, Plaintiff's medical malpractice settlement was approved on May 12, 2017, nearly four years after the MTPLA's amendment. (Doc. 2, ¶ 14). Therefore, the post-amendment version of the MTPLA applies. See Suarez ,
The Court now turns to whether Plaintiff was required to exhaust the
FRG cites a number of cases, none of which involve the MTPLA, for the proposition that disputes regarding subrogation liens are subject to administrative exhaustion. (Doc. 3, pp. 7-8). The Court is unpersuaded by these cases. Defendant first cites a Fifth Circuit Court of Appeals case that deals with claims arising under the Employee Retirement Income Security Act, not Medicaid, and is therefore inapposite. Arana v. Ochsner Health Plan ,
FRG next argues that Plaintiff's challenge to the amount of the Medicaid lien requires administrative exhaustion under the MTPLA based on (i) the text of § 409.910(17)(b), and (ii) the holdings in a Florida District Court of Appeals case and a Department of Administrative Hearings Order.
The Court's MTPLA analysis begins with the text of § 409.910(17)(b). "The polestar of a statutory construction analysis is legislative intent." W. Fla. Reg'l Med. Ctr., Inc. v. See ,
*1313The present declaratory judgment action does not implicate MTPLA's administrative exhaustion requirement because it does not involve a challenge to a Medicaid reimbursement calculation . Plaintiff's suit is a collateral attack on a lien asserted by FRG (on behalf of WellCare), and is premised on a reliance theory-to wit, because Plaintiff relied on FRG's February 7, 2017, representation as to the lien amount in settlement negotiations, FRG and WellCare are not entitled to reimbursement exceeding the amount initially requested. Both the plain meaning of § 409.910(17)(b) and the legislative history buttress this conclusion. Plaintiff was therefore not required to exhaust administrative appeals pursuant to § 409.901(17)(b).
Neither opinion cited by Plaintiff on this issue affect the foregoing analysis. The Division of Administrative Hearings Order merely applied the statutory framework to a Medicaid beneficiary's challenge of a
d. Administrative Appeal Under WellCare's Staywell Plan
FRG further argues the Complaint should be dismissed because Plaintiff failed to exhaust administrative appeals mandated by WellCare's Staywell Plan. (Doc. 3, p. 10). In support, FRG counsels that the "Court may consider WellCare's Staywell Florida Medicaid Member Handbook because the document is central to the claim and its authenticity is not challenged." (Doc. 3, p. 10 (citing Day v. Taylor ,
2. Stating a Claim-FRG as an Improper Defendant
FRG argues that Plaintiff's Complaint should be dismissed for failure to state a claim because FRG is an improper defendant. (Doc. 3, p. 11). A Rule 12(b)(6) motion to dismiss tests the legal sufficiency of the plaintiff's complaint. In order to survive the motion, the complaint must "state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly ,
The Complaint alleges FRG "was and is retained by WellCare, a Medicaid plan, to represent WellCare in connection with their rights of subrogation and/or recovery regarding medical claims paid on behalf of" Plaintiff. (Doc. 2, ¶ 4 (emphasis added) ).
*1314Because the right of repayment at issue in this suit "belongs to WellCare, a Medicaid plan," FRG contends that Plaintiff failed to state a claim against FRG or demonstrate an adverse relationship between FRG and Plaintiff. (Doc. 3, p. 12). Plaintiff responds that FRG is a properly-named Defendant, as evidenced by FRG's representations that they were representing WellCare in connection with their subrogation rights and FRG's directions that all correspondence regarding the disputed lien be sent solely to FRG. (Doc. 27, ¶ 48).
Declaratory judgment is proper only where an actual controversy is before the court. The Florida Supreme Court has held that all "antagonistic and adverse interest[s]" must be present in an action as a precondition to the entry of declaratory judgment. May v. Holley ,
The Court agrees that FRG is the improper Defendant in this action. The Complaint alleges that FRG acted as an agent to represent WellCare in connection with subrogation and/or lien rights belonging to WellCare. FRG has no legal claim to the funds purportedly subject to WellCare's lien. Therefore, in this action seeking a declaration as to the amount of WellCare's statutory lien, the proper Defendant is Wellcare, not FRG. That FRG acted as WellCare's agent does not disturb the conclusion that Plaintiff and WellCare are the parties with antagonistic legal interests.
III. CONCLUSION
For the aforementioned reasons, it is ORDERED AND ADJUDGED that:
1. Plaintiff's Motion for Remand and Memorandum of Law (Doc. 8) is DENIED ;
2. Defendant's Motion to Dismiss (Doc. 3) is GRANTED IN PART .
3. The Complaint (Doc. 2) is DISMISSED WITHOUT PREJUDICE . Plaintiff has fourteen (14) days from the date of this Order to file an Amended Complaint consistent with this Order.
DONE AND ORDERED in Orlando, Florida, on February 12, 2018.
FRG was retained by WellCare, a Medicaid plan, to represent it in connection with WellCare's rights to subrogation or reimbursement in connection to Medicaid claims paid on behalf of VEV. (Id. ¶ 4).
At all times material hereto, in reliance on the amount of the subrogation lien asserted in Defendant, FIRST RECOVERY GOUP, LLC, February 7, 2017 correspondence, Defendant, ARMANDO PAYAS, on behalf of Plaintiffs settled their medical malpractice lawsuit against all healthcare providers who rendered negligent care and treatment to [VEV].
...
At all times material hereto, Plaintiffs and ARMANDO PAYAS relied on the representation by Defendant, FIRST RECOVERY GROUP, LLC, on February 7, 2017.
(Doc. 2, ¶¶ 12, 15).
In Bonner v. City of Prichard ,
(a) Any and all causes of action, suits, claims, counterclaims, and demands that accrue to the recipient or to the recipient's legal representative, related to any covered injury, illness, or necessary medical care, goods, or services that necessitated that Medicaid provide medical assistance.
(b) All judgments, settlements, and settlement agreements rendered or entered into and related to such causes of action, suits, claims, counterclaims, demands, or judgments.
(c) Proceeds, as defined in this section.
In Wos , the Supreme Court struck down a North Carolina statute that required "up to one-third of any damages recovered by a beneficiary for a tortious injury be paid to the State to reimburse it for" Medicaid payments it made for treatment of the injury.
"Because the settlement ... was not reached until 2014, [the State] had no right to recovery until that time. Accordingly, the 2013 version of this statute controls."
The Department of Administrative Hearings is the administrative body tasked with adjudicating administrative appeals.
In a decision interpreting an earlier version of Florida's declaratory judgment statute, the court set forth the elements that must be present to demonstrate that the action is "judicial in nature" and that a declaratory judgment is within the constitutional authority of the court. Importantly, the court stated:
Before any proceeding for declaratory relief should be entertained it should be clearly made to appear ... that there is some person or persons who have, or reasonably may have an actual, present, adverse[,] and antagonistic interest in the subject matter, either in fact or law; that the antagonistic and adverse interests are all before the court by proper process or class representation and that the relief sought is not merely the giving of legal advice by the courts or the answer to questions propounded from curiosity.
Reference
- Full Case Name
- Victoria VESTAL and Emmanuel Vestal v. FIRST RECOVERY GROUP, LLC and Armando Payas
- Cited By
- 1 case
- Status
- Published