Sunrise Hospital and Medical Center, LLC v. Arizona Physicians IPA, Inc., No. 2:2018cv00341 - Document 34 (D. Nev. 2018)
Court Description: ORDER granting 12 Defendant's Motion to Dismiss. FURTHER ORDERED that plaintiff's complaint is DISMISSED without prejudice. The clerk shall enter judgment accordingly and close the case. Signed by Judge James C. Mahan on 7/13/2018. (Copies have been distributed pursuant to the NEF - MMM)
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Sunrise Hospital and Medical Center, LLC v. Arizona Physicians IPA, Inc. Doc. 34 1 2 3 4 UNITED STATES DISTRICT COURT 5 DISTRICT OF NEVADA 6 *** 7 8 SUNRISE HOSPITAL AND MEDICAL CENTER, LLC, ORDER Plaintiff(s), 9 v. 10 11 Case No. 2:18-CV-341 JCM (GWF) ARIZONA PHYSICIANS IPA, INC., Defendant(s). 12 13 Presently before the court is defendant Arizona Physicians IPA, Inc.’s motion to dismiss. 14 15 16 17 18 19 20 21 22 (ECF No. 12). Plaintiff Sunrise Hospital and Medical Center, LLC filed a response (ECF No. 15), to which defendant replied (ECF No. 18). I. Facts Plaintiff is a medical services provider with its principal place of business in Clark County, Nevada. (ECF No. 2). On an unspecified date or dates, plaintiff provided services to unnamed third parties who required urgent medical treatment.1 Id. These third parties were allegedly enrolled in insurance plans offered by defendant. Id. The complaint does not state whether plaintiff contacted defendant prior to rendering services. Id. Instead, the complaint alleges that 23 “[a]n implied contract was formed between [plaintiff] and [defendant],” and that defendant 24 “fail[ed] to pay all of the amounts due and owing to [plaintiff] for the services provided to 25 [defendant’s] members.” Id. 26 27 28 1 Plaintiff notes that it declined to name the third parties in its publicly-filed complaint for privacy reasons, and asserts that it will provide a list of the third parties under seal “if and when required.” (ECF No. 2). Plaintiff also states that it has provided defendant with a demand letter containing the disputed claims and relevant patient information. Id. James C. Mahan U.S. District Judge Dockets.Justia.com 1 On January 22, 2018, plaintiff filed its complaint in state court. Id. Plaintiff’s complaint 2 alleges causes of action for breach of implied contract, unjust enrichment and declaratory relief. 3 On February 23, 2018, defendant removed the action to this court. (ECF No. 6). 4 II. Legal Standard 5 A court may dismiss a complaint for “failure to state a claim upon which relief can be 6 granted.” Fed. R. Civ. P. 12(b)(6). A properly pled complaint must provide “[a] short and plain 7 statement of the claim showing that the pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2); Bell 8 Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007). While Rule 8 does not require detailed 9 factual allegations, it demands “more than labels and conclusions” or a “formulaic recitation of the 10 elements of a cause of action.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citation omitted). 11 “Factual allegations must be enough to rise above the speculative level.” Twombly, 550 12 U.S. at 555. Thus, to survive a motion to dismiss, a complaint must contain sufficient factual 13 matter to “state a claim to relief that is plausible on its face.” Iqbal, 556 U.S. 662, 678 (citation 14 omitted). 15 In Iqbal, the Supreme Court clarified the two-step approach district courts are to apply 16 when considering motions to dismiss. First, the court must accept as true all well-pled factual 17 allegations in the complaint; however, legal conclusions are not entitled to the assumption of truth. 18 Id. at 678–79. Mere recitals of the elements of a cause of action, supported only by conclusory 19 statements, do not suffice. Id. at 678. 20 Second, the court must consider whether the factual allegations in the complaint allege a 21 plausible claim for relief. Id. at 679. A claim is facially plausible when the plaintiff’s complaint 22 alleges facts that allow the court to draw a reasonable inference that the defendant is liable for the 23 alleged misconduct. Id. at 678. 24 Where the complaint does not permit the court to infer more than the mere possibility of 25 misconduct, the complaint has “alleged—but not shown—that the pleader is entitled to relief.” Id. 26 (internal quotation marks omitted). When the allegations in a complaint have not crossed the line 27 from conceivable to plausible, plaintiff's claim must be dismissed. Twombly, 550 U.S. at 570. 28 James C. Mahan U.S. District Judge -2- The Ninth Circuit addressed post-Iqbal pleading standards in Starr v. Baca, 652 F.3d 1202, 1 2 1216 (9th Cir. 2011). The Starr court stated, in relevant part: 3 First, to be entitled to the presumption of truth, allegations in a complaint or counterclaim may not simply recite the elements of a cause of action, but must contain sufficient allegations of underlying facts to give fair notice and to enable the opposing party to defend itself effectively. Second, the factual allegations that are taken as true must plausibly suggest an entitlement to relief, such that it is not unfair to require the opposing party to be subjected to the expense of discovery and continued litigation. 4 5 6 7 Id. 8 III. 9 Discussion i. Breach of implied contract 10 Here, plaintiff’s complaint contains insufficient allegations to support its theory that an 11 implied contract existed between plaintiff and defendant. The complaint and plaintiff’s response 12 to defendant’s motion rely on the theory that offering services to an insured, without more, 13 constitutes an implied contract between a provider and an insurance company. The court disagrees. 14 “Basic contract principles require, for an enforceable contract, an offer and acceptance, 15 meeting of the minds, and consideration.” May v. Anderson, 119 P.3d 1254, 1257 (Nev. 2005) 16 (citing Keddie v. Beneficial Insurance, Inc., 580 P.2d 955, 956 (Nev. 1978)). A contract implied 17 in fact requires a showing that “the parties intended to contract and promises were exchanged, the 18 general obligations for which must be sufficiently clear.” Certified Fire Prot. Inc. v. Precision 19 Constr., 283 P.3d 250, 256 (Nev. 2012); see Smith v. Recrion Corp., 541 P.2d 663, 664 (Nev. 20 1975) (for a contract to be implied in fact, “the court would necessarily have to determine that both 21 parties intended to contract”); see also Cedars Sinai Medical Center v. Mid-West National Life 22 Ins. Co. of Tenn., 118 F. Supp. 2d 1102, 1108 (C.D. Cal. 2000). 23 In Cedars Sinai, the court addressed implied contracts in the context of an insurance 24 dispute. 118 F. Supp. 2d at 1108. The plaintiff in Cedars Sinai provided medical services to an 25 insured party after obtaining a verification of insurance coverage. Id. at 1006-07. The court 26 granted summary judgment in favor of defendant on plaintiff’s implied contract claim. Id. at 1008. 27 The court held that where there was no authorization provided by the insurer, “verification [alone 28 could not] be construed as a binding contractual agreement.” Id. James C. Mahan U.S. District Judge -3- 1 Here, plaintiff’s complaint does not allege that plaintiff obtained verification of coverage 2 or authorization. The complaint does not even allege that plaintiff contacted defendant at all. 3 There is no reference to a prior course of dealing, or any other facts that would suggest that 4 defendant intended to enter into an agreement with plaintiff. Therefore, because plaintiff has failed 5 to plead that each party manifested an intent to enter into a contractual agreement, plaintiff’s 6 complaint fails to adequately plead the existence of an implied contract.2 Compare Cedars Sinai, 7 118 F. Supp. 2d at 1008, with Summit Estate, Inc. v. Cigna Healthcare of California, Inc., 2017 8 WL 4517111 (distinguishing Cedars Sinai because in Summit plaintiff’s complaint alleged that 9 defendants told plaintiff that “Defendants would pay for treatment at the usual, reasonable and 10 customary rate”), Regents of Univ. of Cal. v. Principal Fin. Grp., 412 F. Supp. 2d 1037, 1042 11 (N.D. Cal. 2006) (holding that a reasonable jury could conclude that insurer-defendants exhibited 12 an intent to contract because “[u]nlike in Cedars Sinai, defendants in this case provided both 13 verification of coverage and explicit authorization for the hospital stay”). The court will dismiss 14 plaintiff’s breach of contract claim for failure to state a claim upon which relief can be granted. 15 See Starr v. Baca, 652 F.3d 1202, 1216 (9th Cir. 2011). 16 ii. Unjust enrichment 17 Under Nevada law, unjust enrichment is an equitable doctrine that allows recovery of 18 damages “whenever a person has and retains a benefit which in equity and good conscience 19 belongs to another.” Unionamerica Mortgage & Equity Trust v. McDonald, 626 P.2d 1272, 1273 20 (Nev. 1981); see also Asphalt Prods. v. All Star Ready Mix, 898 P.2d 699, 701 (Nev. 1995). To 21 state an unjust enrichment claim, a plaintiff must plead and prove three elements: 22 24 (1) a benefit conferred on the defendant by the plaintiff; (2) appreciation by the defendant of such benefit; and (3) an acceptance and retention by the defendant of such benefit under circumstances such that it would be inequitable for him to retain the benefit without payment of the value thereof. 25 Takiguchi v. MRI Int’l, Inc., 47 F. Supp. 3d 1100, 1119 (D. Nev. 2014) (citing Unionamerica, 626 26 P.2d at 1273). 23 27 28 James C. Mahan U.S. District Judge Plaintiff’s response to defendant’s motion requests leave to amend. (ECF No. 15). As plaintiff has not filed the appropriate motion, the court will not consider plaintiff’s request. 2 -4- 1 Here, plaintiff has not adequately pleaded an unjust enrichment claim. First, plaintiff’s 2 complaint does not allege that plaintiff conferred a benefit onto defendant or that defendant 3 appreciated such a benefit. Instead, plaintiff asserts that it conferred a benefit onto third parties 4 who held insurance policies with defendant at the time plaintiff provided medical services to these 5 third parties. Cf. Valley Health Sys. LLC v. Aetna Health, Inc., case no. 2:15-cv-01457-JCM-NJK, 6 2016 WL 3536519, at *3-4 (D. Nev. June 28, 2016) (dismissing plaintiff’s unjust enrichment claim 7 in the medical insurance context because “Valley Health has failed to identify any way in which 8 Aetna has been enriched independently of the benefit its members received as a result of being 9 provided with emergency medical services.”). Second, the complaint does not allege that retention 10 of any purportedly-conferred benefit would be inequitable in these circumstances. Therefore, the 11 court will grant defendant’s motion to dismiss as to plaintiff’s unjust enrichment claim. See Valley 12 Health, 2016 WL 3536519, at *3-4. iii. 13 Declaratory relief 14 Finally, the court will dismiss claim (3) of plaintiff’s complaint, which requests declaratory 15 relief. “[A] ‘claim’ for declaratory relief is not a substantive cause of action at all; it is merely a 16 prayer for a remedy.” Pettit v. Fed. Nat’l Mortg. Ass’n, no. 2:11-cv-00149-JAD-PAL, 2014 WL 17 584876 (D. Nev. Feb. 11, 2014); see Wells Fargo Bank, N.A. v. SFR Invs. Pool 1, LLC, no. 2:15- 18 cv-02257-JCM-CWH, 2017 WL 1902158, at *4 (D. Nev. May 9, 2017) (citing Stock West, Inc. v. 19 Confederated Tribes of the Colville Reservation, 873 F.2d 1221, 1225 (9th Cir. 1989)); see also 20 Centex Homes v. Everest Nat’l Ins. Co., no. 2:16-cv-01275-GMN-CWH, 2017 WL 4349017 (D. 21 Nev. Sept. 29, 2017) (“[T]he Court will interpret Plaintiff’s claim for declaratory relief as a request 22 for a remedy rather than a separate cause of action . . . .”). As plaintiff’s third cause of action 23 requests a remedy of declaratory relief, and is not a substantive cause of action, the court will 24 dismiss the claim to the extent it purports to create a cause of action. See Wells Fargo, 2017 WL 25 1902158, at *4. 26 ... 27 ... 28 ... James C. Mahan U.S. District Judge -5- 1 IV. Conclusion 2 Accordingly, 3 IT IS HEREBY ORDERED, ADJUDGED, and DECREED that defendant’s motion to 4 5 6 dismiss (ECF No. 12) be, and the same hereby is, GRANTED. IT IS FURTHER ORDERED that plaintiff’s complaint be, and the same hereby is, DISMISSED without prejudice. 7 The clerk shall enter judgment accordingly and close the case. 8 DATED July 13, 2018. 9 10 __________________________________________ UNITED STATES DISTRICT JUDGE 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 James C. Mahan U.S. District Judge -6-
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