Aetna Health Inc. v Rak

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Aetna Health Inc. v Rak 2012 NY Slip Op 33795(U) September 11, 2012 Supreme Court, New York County Docket Number: 652819/2011 Judge: Melvin L. Schweitzer Cases posted with a "30000" identifier, i.e., 2013 NY Slip Op 30001(U), are republished from various state and local government websites. These include the New York State Unified Court System's E-Courts Service, and the Bronx County Clerk's office. This opinion is uncorrected and not selected for official publication. [*FILED: NEW YORK COUNTY CLERK 09/13/2012 1] INDEX NO. 652819/2011 NYSCEF DOC. NO. 57 RECEIVED NYSCEF: 09/13/2012 SUPREME COURT OF THE STATE OF NEW YORK NEW YORK COUNTY PRESENT: •.. ···' PART f-~ Justice INDEX N0.~.2..:f rt!t MOTION DATE _ _ __ ·Y· MOTION SEQ. NO. X> 3 The following papers, numbered 1 to _ _ , were read on this motion t o / f o r - - - - - - - - - - - - - Notice of Motion/Order to Show Cause - Affidavits - Exhibits Answering Affidavits - Exhibits----------------- Replying Affidavits _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Upon the foregoing papers, it is ordered that this motion 19'- ~ I No(s)._ _ _ _ __ I No(s). - - - - - - 1No(s). - - - - ' - - - - l; ~ ~~Ti2.0k~ ~-~~~ u~drA ~ ~lfl-..t w (,) j:: en ~Tl<.6 ~JL~ ~ ::> .., 0 l- ~~<:,~ o w IX 0:: w u.. w er .. >- ~ - ...J ...J z ::> 0 u.. en < (.) w I- w a:: 3i (.') w z a: ~ !Q 0 w ..J "' < (.) ..J 0 LI. - w z :c: 1j:: a: 0 0 :e 0 u. Dated' .~'' 2o11.-- ~) 1. CHECK ONE: ..................................................................... 2. CHECK AS APPROPRIATE: ...........................MOTION L CASE DISPOSED IS: ~-- GRANTED 3. CHECK IF APPROPRIATE: ................................................ C"_J SETTLE r:·J DENIED ORDER [] 00 NOT POST '.]GRANTED IN PART 0 SUBMIT ORDER lJ FIDUCIARY APPOINTMENT [J REFERENCE [* 2] Sl. l'HL\ll ( "Ol 'RJ <lF l"I IE ST:\TE OF Nl~W YORK C<H!'\ I Y OF '\I.\\ YORK: p,\lrl 4S i! .- - . :i --- ----- ------ ---------- -- -----· ---- .. ----------------- -.\ \FTN:\ I ll·.\I Tl I INC. :\ND \l: I '\J'\ U IT l.'\Sl "R:\NCE C0'\·11'/\ '\Y. Ind.:\ "Jo <•S2!'l l (/ '20 I l l'laintilfs. LffClSIO'\ /\NJ) ORDl.~R I l~:\\11\,l R.\K. \1 D .. NU'ROl.O(i!CAL Sl.'RGFRY. l'.C.. JOI l.\J DOFS 1-10. /\NJJ :\HC COIU'ORAlJU'\S 1- l l'. f! ;j ,, ~ Dck11da11h f\lotion Sequence \o. UU.1 ---- --- ----- --------. -... ----. ---- ------ .. ---- . -- ----- -- ..1 ------ --- . -. ---- \ . Ii II I! .\IU.\T\ I.. SCll\Vl·Tln:H •• I.: ln th1~ b1(·ach ni"contrad and tortiot;s JI " intcrkrrnct~ 11 al"ti<>n b:·ought by :\ctna l lcaltb ItK. . :111J ,\ctm l kalth I.itc In~urancc l 'c>m[J:tll\ (c(~llcctivciv ··Aetna") :l!.'.;1in:;t Ramin Rak. M.D. . 11lr Rak). Shuri; lfi~:1mch. i! . . ' \1.D. (Dr. !lishmi:h). Ncumlog1ec1l Surgcry. l'.C. (N:',l'C) and Ll 11 ,, Spmc- Ccnt<:r (Spi11c~l. Aetna sl·cks IP pcrn1,inc:11tly enjoin Jc·l"cndants from hal:11Kc billink' I· ~,cncliciarics nf Ac·tn;i health care plan,; l(>r i! sc,~v!ccs <ilrcauy paid by ,\ct11<.1 pursu::nl to c,intrnct.:J 'I " r:itcs: tu ha\\' the court 1kcl:m: that dcfi:ndants ha\·c 1w cnforccaolc claim fr•r thc-;c ch:mcc'< i ' ,,_c<:i111,.;t plan bcndicianc';: and In recover dam'ligcs and reasonable attorney· s k·c,.; k•r 111jmic'S ~ :1 .\llnJ sufl«:1c·d <1s a ,·csul1 ,,( Jcti:ndant~ · subniissio11 or kalth in,urancc clarnis !o 1\ctn:.1 an, I it' 1! ,, ,\,_:tn,1 !ikli it'; n>mplaint \1 1 ith an Orclc to Sho\\ Cause c:ontaining a l ·L:inpora:·~ !! ]{c~:raininh' Order (TR<)) to temporarily cnioi~ and restrain Dr. I lishmch and Srirn.' (C<'lkc·tivch Ii the.· I l1slm1cli F11tit1csl from balanc:c billing ::my a11d all :\,·tn;i part1cip;mh. Till' p:1rtil·s agreed hl tl11· c~tn . ~ oi':i TRO. and thrn th..: !iishrnch f:ntitics al!rccd to a I , conti1111:~1ion o!'tlic !'RO during ~ [* 3] 1: :1 The I lishmch h1titics n1rn move to \·atatc the TRO on the ground~ that :'\etna .. has not !I met and cannot meet their burden to cstahlish ~mv entitlement to contir1uL.'. .. :·because .-\ctna 11 . '·foiicd to provide any support to show that it l()tdd suffer irn:parahlc injury absent the issuance oftlK TRO. failed to dr:nwnstratc that an awai'd of rno11ctary damages \\Ould not adequate!) 'I 11 curnpcnsatc it fur any allq:cd injury. and failc0 to ucmonstratc a likelihood of success on the 1! 1 nwrits." The Hislm1ch Fntitics also argue that ithc TRO is ··contrary to the law as \\ell as every induslr\· trend. devoid of' anv lc!.!.al basis, and . I. rcouircs the COilllnission of ... a crime by the i.. ·1 • . ~ • 1 1 '1 I' I lishn1l'h l:ntitics.·· finally. the Hishmd1 Entities argue that ''there is no longer an under:ying i! Ii udilln or an action pending !()r a preliminary i11junction'· ~me! ··a lRO cannot ..::.\isl without an :: For the reasons swtt:d herein, the I lishmch Lntities· motion to vacate the TRO is denied. 11 .I I! Bad~ground !11 !OOX. Dr. Rak. a participatinQ (in-rn:iwork) provider of Aetna. entered into a Specialist ~ 11 · ;1 Physici;m·~ /\~m.:crnent (SPA) with A<.:tna in which Dr. Rak spccilically agn:l'.d to '"permit I! 11 rcbundling to the primary procedure those scrvJccs considered part oL incidental to. or inclusive 'I of the primary procedure:· Dr. Rak also agrcc1 that for I LVIO Plans ... [he I would huld rm.:mbcrs harmkss and "in no e\l'nf' \\'Cluld he "'bill. chal·gc, collect a deposit from. s<.:ck Ii ~ rcmu111.~ration or . rcimbmscmcnt lrom. or ha\·e any recourse agai11st a mcmlx:r"' ... and for nnn-11\·10 plans. ~ 1 he "wnuld not pursue a member for non-con~rc <l services unless the member \\US advisL·d in ,1 11 :i writing priur tu the sen ices being rendered that the specific sen ices werc not covered." Finally. I! Ii Dr. R<tk cwrced that he .. ,\ould submit for prior\1pproval lw Com1)anv anv covcraQc ~· ~ 11 1, . . . ' arrangclllents made with a non-participating specialist physician:· and require the non1! ;i ' p;1rticipati11!,'. specialist "'to comply with applicabk h:rms of lthc ISPAil."" Aetna alleges that. [* 4] IJ<ll\\ it!i:<landin,'. Hlcsc ;igrcrn1c11r:;. h;: ..:ngagi1:g in certain practices. I)r Rak and Mr. 11:sl1111ch :1 11 1 .·\ctna allc:o'.es in its complaint that Dr. :Rak. along with his pr{lkssional corporation t•i' II 1icur"Sllrl'.CLlllS. \ S PC and Dr. 11 ishmeh, a noi~-partici1x1tin!!. (nut-of-n<.:t''· ork) ' :1 jlll\VJ(.kr. tn h:11·c 01n-ot~nct\1(1rk proqdcrs hrn'ught in hy in-nctv..ork pnll idcrs (or't<•n Ci\llSpir'' \\ould ' l'!l the tby :1 ,\r surgery 1 Ill pnll iLk treatment ::s co-surgco1i's C'I s111gie.il ~ssistants to patients, 11 ithout the i: patic·nts h;l\ iw2 :1 clwicc t<' decline the ~en-i«es At'ler treatmc11L thes.: out-pf'-nl'lwork 1)ro1·idns , i1 11 1 :illq:cdh· 11ould submit cxccs~11clv hic:h bill< to Aeln:1. and then "thrc':llcn tP halancc bill • :\ctn:: .s rncm l'crs t\ll ' 11 . . i :llcsc exc,·~s11ely lngh a1i10unb un Icss .:\etna pay~ mc1 anJ ;; l)tl\'C ihc lj ma:-:i111u111 all<l\\ab:L· undt:r the mcmbc:"s plan·,-· :\ halancc bill is "a hill s1.~lll h1 an lout-ufli ' nc\\\()J-k] pr,w1tkr te :1 p,iti<.'nt, which i11cluJes'a11y acceptable dducti!>Jc. co-inrnrnnu:. :md th:ll ,, amou1H ,,(the pn,1·idcr'!< ch:irj,!t:S that c'lcccds'.!the amount ofbcndit paid under the patiem·~ . . I :I · · · · I pan. .. I' l1a I:m.:c bdlmg. Aetna conkn J s 11<.H "J111-nctwNk prov1dcrsj arc usmg their (l\\ll ,,. ,. p':tients "~pawns in a pl11t ll\ C'ltor! amounts ' !';:om ,\ctna that far surpass any amount::; tbat an.: 11 kl!1lirna:L·h· •'W<.:d tt\ tho.: 11ro1'idcrs." Aetna alkl!cs that althnu!.!.h 1t ha» prnJll'rly Jl'\id !Or all . . 1~ • . 'I su1icc~s ~\ursuanl l<' thl' !-:rm, of the SP:\. Dr Rak and :\Sl'C !:an: tlm:atcncd to halam:c hill . :! ·\dna ll1c'mhcr~ for cxccssi1·c kL·s. including tl1c spcci!ic amounts 11f$425.555.S:1. S.'i73.:J>O.'J2. !j and s2_<2.ooo.oo i 11 :\ct11:1 ab,, contends that Dr. l [ishmch !las mil J(h-iscd .·\etn:.1 member~ lhat he \\0111cl be II treat inf! thrn1 <is :.Hi •.>ut-t>i'.·ncl\\llrk provider, the arnoum of the kcs he intrnJcd t,1 hill the 1r rnc·mh..:r<.. t>r th.: pt>lcnti<il ohlif!:ilion of mcmhc~·~ to pay c'lccssi1cly high baLrnce bills. I! Dr. l lishm..:h a:kt.:cdh did ' . :111:- auth1°n1.a:inn to lh't 11otif1 ;\c!.na . th<;~ ~ he would :Kt as Ctl->lill.!C<lll. m1r did lie 1\ht:ii11 ,, do so. ;\ctna conil'lllis that II is a breach of1hc SP.-\ bct\\ccn Dr Rak and [* 5] :\ctna for Dr. l{ak to han; brought an out-or-network pwvidcr . such <1s Dr. I Iishmd1 . in on the 'I 11 I, lJ1\1cc(Iurc~. ' i·I' Ii Proccdi1ral Posture i ' :\s noted. along with its complaint, Aetna also filed an Order to Show Cause containing a I~,I ! RO. which cnjliillcd the defrnJants from bal~~nce billing Aetna participants pending a hc::iring and determination ()f thc motion for a prclimit~~ry injunction. The l !ishmeh Entities filed a ;1 mnti('fl with an Order to Show Cause scckinu t'o sever thl'. Hishmch l:ntitics ~is dcl\:ndants in the ~ 11 u action .. ,,) m oid inherent confusion"' because "the •Jbliuations of co-defendants f\1r. RakJ and I! !NSJ>C I. as in-nd\\ork , .1 providers are cntirclv d~fkrcnt than tlrnsc of the 1-lishmch Entities."' The .. ,. 1i partil's entered into a stipulation in \1arch 201~ (March Stipulation). \\hich SC\cred th\? llishmch I! ~ Entities as dcknJants from the action. The March Sti1,ulation was sie.ncd hut was not ··so .I - I! Ordered' hy thl· court. The court required the !Jarties lo enter into a nc\\ stipul:1tion in which the ~ ,1 original-1.'.aptil'nc<l action would he <liscontinu~d as against the I !ishmch Lntitics without '! 1! prejudice. i1 " The parties then entered into a m:w stip ~ilation in May 2012 (May Stipulation). Linder 1 1! the \by Stipuiation. \i..hich \\'as ··so Ordered" ~y the court. the parties ag.rccd to a :10-day· II sta11dstil I period connrn:nt.:ing on May 20. 201 :i. During the standstill period. Aetna agn::ed not ij I to commence a ne\.\ <.iction aQainst the l lishmel~ Entities so that the parties could continue ~ ncf.!.oti;itiuns tl1 n:ach a n:solution ut'thc remaining issues. The llishmch Entities also aurccd to a .__ 1! ' " ...... 1: cPntinuaiiun uf till'. !RO durin'-! the standstill ~ . J'~riod. lf after the :'!andstili period Aetna sought to ~ wm111L'ncc anv act ion aL'.ainst the I Jishmcb l '.ntttics, Aetna was tn noti l'v the ll1shmch LntiLics. '-.. :i ~ ~ and if the Jiishmeh l·:ntitics opposed the cnntinoation of the TRO, the parties agreed to discuss ' i the timing or an appl kation so as to rt'.ach an agn:cJ upon hearing <late and the TRO \\'as to 4 [* 6] remain in place until that hearing date. Jn the event that the parties \\ac unable to reach an 1! agreement on any remaining issue. the May Stfpulation provided that it was \vithout prejudice to 11 . the I li~.Juneh I:ntities" ri!!.11! to be heard on the h{O. .... 11 " Only the past hillinL' disputes hetwecn Aetna and the Hishmeh Entiti1..~s remain at issue. ,, 11 'I During the months or negotiations. Dr. I lishmc!h agreed to begin providing written notice to Ii II ·\ctna members for future procedures. identi lyihg himself as an out-of-m'twork pro\'idcr. lj indicating that the 1\ctna member will have financial responsibility for some or all of his kcs. ,, . ~ and id1.·11tiJ)·in;; the procedure he intends to pcrf}Jrm with tht: proposed IL-cs included. Aetna has Ii ;igrced to ..\'olun!arily liit the TRO moving fonyard in instances where Ilk liishmeh] properly :1 prm id l's members with his [out-of-nct\.vork l prq)\·idcr status and inCurrnation concerning his fees and the nK·mhcr·s liability thereon." The p;irtics have heen unable to reach at~i agreement on a reconciliation of the historical ' ,,i cl;1ims and paym1:·nts n:garding past Sl'rvices bet~vccn Aetna and the I lishmch Entities. The 11 i<bmeh Entities c.mlend that ·•it is abundantly rkar that the pan ies wi II t>e unable tn reach "" i.lgn.:cmelll on ;.i rt:wm:iliation of the historical cl,~ims and payments betwt:en Aetna and the llishmch f·:ntitic~.·· 1\ccordingly. "Aetna seeks i t}) tempor<u·ily restrain [Dr. I lishmch] from balance billing !\ctna mt:mbcrs for fthcl outrageJlus amounts rcgardingJJ_as! serric:.~:~: for which I! the members haw no actual financial liahilitv.'' I,.: rhe llislllrn.:h Entities. in turn. seek to \'ac:itc the , 1 I RO. ,, 11 t\l'tna ar}.!UCS ~ that the court should not vacate !he TRO because the TRO does not inj urc r .I the l li~hrnch l'.ntitii.:s and that Dr. Hishmeh onl\' ,,\.vants the TRO lifted so it can resume threats , 11 and .. bully his way into a better bargaining positi~)[1 with 1\t:tna." The I lishmch Entities cowllcr I 11 1h01t the TRO must he \'acatcd because the 'J'RO 0;njoins them from balancc billing their patients. 1! 5! [* 7] ~m Jc: \\hich is required uf them under the law iand is expressly acknowlcuged by Aetna ;is 1 ;1 rl appropriate. in .~ituations where a patient ma\' be C\'l'll I! . c I1arL'.cs rncurrcc l _ llll<JWarc of . the exact <lrl10ll11l of the . :l I! 1· . I . J) ISCUSSIOil 1·1 CPU< ('301 sLltcs. i11 relevant pan. tliat,i··ral prelimi11<ir:1· injunction may be: granted in :1 I• <Ill\ . ;1ction \\hen: it ap1'c:1rs tha; the dckndant threatens or is i . ;1ho111 to do. l'l' is dnine or ~ - 11 pn)curinL'. nr suff\:rin:_r to lk' dnnc. - subject (lf :111 ;1ct - in viul;Hion of the 11lai11:iffs ril'.hls rcspcctin!! 1lic i t - - the action. and tending to render the .!udgmcnt indfrctuaL or in any action \\hen: till· Ii 1 plaintiff h::::- i.kmarnkd and \vould he entitled h~ a judgment n:strainin~ the dekndant from the 'I 1, Ct '!11111 ission 01 CO ill i lllld!KC oJ' an act. \\ hicil. j (f omm ii tC'd or continued during the pendcnc:· Of 1, lj the :icti1111. \\Otdd pruducl:' injury to th\.:' plaintin;i /\ tcmporarv reslrnining orJer may be granted II lk'nding a hC'arin~ for a preliminary injunction \~·here i1 appc~lrs that immediate and irreparable 1i inimv. lnss or d;,inweL· "'ill result unless the dclJndanl is n:strnin~xl before thc hc-aring ca11 be • • II ~- ,, ., bd.-· ii. I; CPU\ 6~ I~ (a) st:1ks that ~ "li!L tl!l <t rndion ' ' for a prclimin:ir: iniullction. the plaintiff !i . II shall shll\\ th:ll 1rnrncdiat..: and irre11:1rnble inJ.lJr\.1• - "f loss or cbmaL'cs \\·ill re-suit unless the ~ dcfc11da11t is restrained hcli.>1T a h~arirw can be lwd, a tcnvxmirv rcstrninin~ order ma\ he - i t ' ' - ~r:1mcd \\itlwul noticc. l lpon granting a tcmpot!~ry restraining order. the court shall I: lj SL'! lhl' . hc:irinL'. li1r thl' 11r1.:limi11an inju11cti1Hl :ll the earliest possible time ... :· , . - II i\ tcm1)urar\ rcstrainine order ma\' h<: ednt..:d when a ninvant ucnwnstralcs ( 1) a - likelihood ot' suc1.·css on the , . 111~·rits: injunction: and(~) <l balancing - II (2) irrcparab.\c injury absent granting the prclirnimr) ,, 'I or the cquiti<:s in ::favor or injunctiH~ n:lid~. {See :I S!'ogi. :i2 :\Y~d 4')h. 517 ( 19811: CPLR 6301. 1: IY. r Gram ( ·u. I' [* 8] The l fish1nch entities :.irguc that Aetna, cannot meet its burden to establish <:m entitlement 1 lo continue the TRO under CPLR ~630 l becadsc it cannot establish irreparable harm. They I! . 1. \ · I CO!ll('ll(! l Jl:t[ Ill' Cl1tm:ty () .· ctna S • · . 1rrcparahi C;!II· 1al"ll1 argumcnl · /ll"~'llllSCu 011 the theory that J[S · IS .J · Ii. members. lk I lishmch's patients. would suffc~ sci;erc distress. li:ar and consternation amon!2Ii ~ ,1 other cmot1onal maladies. The I lishrnd1 Entities also point out that Actna's argument, \\hich . " ;; 11 -;!ates lhC1t ali(lwing l)r. llishmch to halancc bill Aetna members inflated amounts w(iuld cause .. injury 11.i 1! i\l~lna. Actna·s mcn1bcrs. and the rctaiionship between Aetna and its members. is ncot II II valid hcc1t1sc Ille 1lllh harm 1hat could result fr~m1 this action. ifJ.n\·. would be to Actna·s 1! • mrn1bcrs. and nnt to Act11a. rhis argument lai!L ;1 'i - 1 . . lhe court hn'; discrdio11 to u.r:rnt or den\· a J)fcliminarv injunction. The I fohmd1 Entities an.: correct that a preliminary injunction may ot~~I; be granted if the plaintiff. Aetn:1 (and not just : 'I ,\ctna·s mcmb1.Ts). is irrcp:irahly h<irmed. Ho,,:0vcr. in this exceptional situ~ltion, the court 1! vic,,·s !\cma and ib . trn:mbcrs as cxislin12 in such an incxtricablv inll'rl\\·incd health - r::laiinnship that if J\c111a's members arc :\ctna also is irrcparahl\ harmed therdw. . . !I . CaJ\.' pbn . irrcpar~bly harmed as a result of being balanci.: hilled. ,, /\ctn'~ argues con~1 incinglv that its members arc . ~ assured \\hen thcv become Actna's insureds thai thev \Vil! in.cur no •· II • responsibility lh:m their numinal co-payment. rt ~rcatcr linancial - such, because the Hishmch h1tities alkgcdI: i 11 h~l\ L' fodt~d tn inl(inn /\ctna's members - Dr. I lishmeh's patients·· of excessive fees to which I; 1•. . . ' .I l. these p:1'.1-.·nts m<i) l)C :-illOJCC!. t Iiat !f ..11 L'\)mcs toji pass 111at t 1 an: confront<x1. w111 cxon!la111 K'Y 1 1' kcs ;_hat they indeed were u1\dwarc oL their cntii:·e emotional and physical well-hc1ng 1· • 1s placed in ~ Sl'\erejcl1pardy. 1\clna then is placed in the pos /tion ofatlempling to pl\llcct i1s members from 1 L this extraordinary Ji stress. and or suffering its o~vn injury by hcinµ forced to make paymrnb I' ··whid1 arc n<ll due and owin•e' under the nlans a(!issue ... Rcl!arJkss of whether Aetna choosl's tn t ,1 Ii 11 7 i! [* 9] :i suffer such injury 1 !(1 prnwct its rncmhcrs, thcrc ;is nL1 doubt that Aetna its.:lf is hcing irrcparabl) i harrnc<l because its relationship of trust and coi'ifidcm:c with its mcm bcrs undoubted I\' will su lier •I , 1j sc\ ere disruption and injurv in Lhcsc circumsta11ccs. . • i Ii ;\s a:i insuranc,~ company. Actna·s busi pcss and personal rcbtionsliips with ib insureds 1 Ii is onl' of vital trust and cunlicknce. To lift the I'i!'RO at this point undoubtcdlv would do great to , Ii " !wrm ·\ctna ·s rclutionsh1p with its insureds in a: manner \\'here money damages alone clearly 1; . .I . . i . . wnu l c. bc an ll1'1{ Iequate rcmcuv to repair t l us harm. 'f"nus. in tI1c corni . s view. Aetna I1as . Ii rnd . 1h 11 '1 hurdrn o( dcn:o11strnt111g tlicit it will sutfrr irrcp~irablc injury''1nd it h;1s met this prong <•f th-.' n~o ~ n:,pti l'l'lll,'llh ' !i '\ext. tlw l lishmch Entities ar!.!UC that . ·- ;\Lna cannot establish a l1!-;clilmod of sucu.'ss on 11 11 the n1r:rih hl'cm1sc .-\ctna's claims arc hased on • hcnns1)iracv cm1sc of "clion alk!.!.cd onlv upon lj ' . ~ 11 i:1l(inm1tion and belier The I lishmch Lntities also ..:onteml that i\.:tna fails to anicul<lt1.: wlw ii i . hclic\'\·s !ht· --r:wc.:si'c kc-; .. in qucsti<)n :.ire unhn., rul ar;d unrcasunahlc. The I Iishmch Fn:ities ,, 1! .:rgu<-' th:1t 1\ctna must allege specifically that thcl contract 1\uuld not ha\l' been breached but for II tl!L' I lish111ch Fnlitics curnJuct. and that •I ((l ;l\oid 'Uismiss:ll :1 must support ii;.; daim \\ith more than 111<..'1\: or a tortiPUS in1erfrrcncc claim. Aetna spcJulation. which ,\ctn:i alkgcJly has no!. l his 'I 11 ::1rgunh.:nt fails ;1::. 1\cll. Ii 11 :1 '; ··111 ,1rcicr tu establish :i cause 0! actinn I\")\- toni<lllS inlcr/Crenc,~ \\ith 1.:011tractu;1J n:lati1ms. 1: 1! Jplaint1 If i:-;J rcqui1-,,:d w dlkgc and prnn:: ( 1) thc ;cxistcncc 0L1 'al id contract ... : I ' 1 (.2) ldl'fcndant:--·J knm,Jcdf.'.l' oi'tlt<it contract: (3)'ifdcfcnd<Jnts· intentional prncurin~ of the bn.:ach •• !j I' nt' lhat nmtr;1ct: and 1..+) . 1 d;1mw.!.cS. ~ Click .Hodel .\,I Iam1'!_eme111. Inc . i: Williams. J67 AD::'d 27'1 Ii ( l :-. Dept J <)<)(J). appeal denied. 77 l\Y2d 805 (I ~91 ): sec olsu A-la11!1i11ton Center/or Fwly i l.«ttming in" 1· ;\','\I !wk Child l!.c1011ra.1· Ccmilr. Inc. i! '; ,1 8 11 ~ II !j Ii ,j 'I ' )l) .\D3d 365 ( J st Dept 2(H)')). ,\ctna [* 10] has supported its claims \vith 111nrc than mere speculation and has 11n1r1crlv alkeed iH hrL~ach of :1 < • ,1 •'llllt ract and tort ious i ntl.'rkrcncc \\ ith ils co11tr ~1ct '' ith Dr. Rak by Dr. 1lislimch. Aetna ha.' 1 alk~;.-d that Dr. Rdk br;.-achcd the SPA hy not <~htaining prior appnnal ro allO\v out-of'-m·t\vork 11 :-pccialists t\1 use th,·ir SLT\ ices on .·\ctna·s mc111bcrs. and b\· 1 ' . · .. ~ 1 nc t \\l'n' pr1l\ I( lcrs or to cnsun: t l1at ouHll-nct\\;ort\· foiiitH! ~ w • w obt<1i11 con~r~l!..!C from in~ Icrs '" I1osc scn·1cL'S Dr. Ra· sof1citcd . . k . prnYtt 'I 11 ould " not bi 11 .c\ctna · s mcmhcrs. c\i..'tna con1cr1:ds that despite Dr. 1-lishmch ·s knowledge ot' till· SP:\ het1,cc11 .\ct:1<1 and Tk Rak. he ;md otht:r kimilar providers regularly :issistcd Dr. Rak 011 proc(·dur,'.s pcrl(1rmcd on !\ctna·s members without disclosinu their out-nt'-nct\\nrk stat11-; to I! thc~c tnl'mhcrs. • /\ctna also has alkecd 1lmt thc'Ji lishmeh Fntitics arc intcrfcrinu . ._. Ii L ,\c!na and \\ilh II i1s rnernl~crs h\ tlircalL'ninL'. to balance bill i\ctn11's members for ·\.:xL'cssin: fees.·· Aetna has ~ . I! : cstahlishcd a ckar li].;clihtiod of success on the i11crits bec:111st: Aetna h<1s propcrlv alleL'.ed that 11 , ..._, 11 Dr. Rak hrl'.;ichcd th1.· SPA. ~md i\ctna has met t\1c required ckmcnts I inn ious lj i 111..::rkrenec. . t'' properly allcgo: e1 ·~·!aim or i i~I; l inall>. undn CPI R ~<1301. the l lish111c ,h Fntitics argue 1hat .. the balanct: of equities 1 :: d1lt'S nnl 1;1\ er tht: t'litry or '1 [TROJ or prclim111Jry 111Jll1Ktion prcvcllting Dr. J lishmeh fwm I 'I lj. blancc billin.u. I he I l1shrrn:h 1-:ntitics contend ihal :\ct1w has offcrl'd nu 1m)t>rsw.'J!estirn.>. that - iis n1c111hl~ro; ''crt: i '' ' II tlil<l\\di'L' nl'tlK· arnounts of Dr'. lfishmch's bills. The Hishm~h Entitil~S also I! attcm11t l<' L''rnlai11 thal bcctUSl~ :\ctn;-i clcarh sta'tcs on its website that ··t\ctn~1 mcmhers arc • . !! :1 :-.pct:ilically a\.\ arc 01'1hcir "0U1-Pl'..11ctwork hcnclits and lww reimbursement to ·\Hll-of-ncl\\ork .. lj providers is c~1kulatnl.·· .\ctna·s members wcrc!m\afL' or the amounts n!' Dr. l-lishmch's hills. 1: 11 !'he l lislm1ch Fn!itics foil to acknowlcd;!c rhat c\cn ii' r\ctn;i's members were .. Sf)Ccificalh II • ~ 1; ;mmc of tlK·ir .. <1ut-of-ncT\\'Prk hcnclit~; and hO\\j~rcimburscrncnt lo ..out-of-ncl\\\)rk" pn\\ idcrs is I • L·akula!Ld." .. \et11a 111c111bers \\\.'re not prepared t~) pa~ these bills becau:-.c the! \\ere Ii II 9 1101 aware [* 11] that Dr. I Iishr1lL·li (~md olher sp~cialistsl wcrc out-of-net\\ Ork Jnctors. Funhcrnwn:. thcsL' tllL'llliKTs may no~ have hL'L'll av\ arc I! that Dr. Jfo;fum:h \\Ou!d perform his sen ices on thcm. !I f)r Hislim ..:h :idrnitted that '"certain circumstances mav lh;:in:: existed] which could ha\e ,, . ,J II in:pactcd lmyl ~ibility to comnH111icatc spccific information about f1m I rec to the patient. such as i ''her ..~ I I j ''as ell kd in as a :-.ccond ~ sur~i:llll at ,;:,, timl' \\hen till- patient was already prepped for 11 sur~ery "lh•s provides lurthcr support that ar kast some 1hc amounts fn ()r ~ Dr. I !ishmd1·s bills. members \\"Crc tin:tW<U"e (i!" . i ~1ddi!it1n lo th'-· I lishmch Lntitics· 0f Actna·s arg:irmcnt that there is no proof 1\c111:1·s rnl'mb ..·rs l \\CJ\: UIWWilll' of' the ::irnounls or Dr. l lishmdi"sl1bil!s. the I lishmcli Entities also an.we !hnt .. lhc II . , only purpose the: C\mtinu<iti,)n of thc TRO could serve would be to ht:nc!it :\ctna. and 1101 its ~ 11 mvrn bcrs." !11 rcs1wnsc i L) i\ctna · s aruumcn! tha! Dr. I Jishmch hus foiled to l"lai m that ihc TR 0 ·- !I is causinh' him ~my type of harn1. till' I lishmch !:'lnitics assert th:n ·'sincL~ AL~lna·s !'RO p1-..:\1.'llts II II Dr. 1lishm.:h from seek in~ lo rnllcct over a million dollars said harm fis] sclfc\ idcni.·· L"mlcr - ~ this rt·as,•:1i11u. the l lishmeh I:ntitics should clcal·!y umkrst:md that it is •just as sclr-cvidcnt that ._ ri.. II bal;mcl'-billing patients "c.\ccssi\c airwt111is:· of'l\\hich thL'y were unaware. :md not prepared to I ' p<1y. is :ill thl' nwn: h:mnful ;o Aclna · s mcmbcrJ under the ci re um stances. As such. !he ,, 11 conti11u<1tion ol' the TRO ;tlso Sl'JTes IL1 benclit ,.\'ltna·s members. ii [t· 11 h1rthcrnwrc. tht' ll<O docs not prevent I lishmch from seeking to coilcct O\ cr ;\ milhin d<illars as lhe l lishmL·h Lntitics have stat~·d. The TRO nnly te111pur:lrily prc\·cnrs I' " Dr. l !ish111d1 fnim scd.ing to col lee! !l\er a milli\m dollars umil there is a final rcsolutiun <ti'lcr 11 lull diSCll\'t:'l'). so that till' Sl<llllS ljll(\ 'i is prcscncd1during the pl'.ndency or thi:~ aelion. Thl' :! balancing of thi..· '-'quiti1.·s also fonffs lhc continuation of the TRO because Dr. I lishmch \\ill mil . 1i : suff,.-r l1ardship sinu.: Le is not bein!.~ permanently~ restric!ed from balancL~-bi!Jing the pa1irn1s in i J{) [* 12] question. In rnntrasl. as discussed above. i\e11,a (including Aetna·s patients). \\OU!d he ~I irreparably hmrm:d absl·nt the continuation of the TRO. Thus. Aetna has met its hurdcn to ;1 'I cs!ablish an cntitlcmcn! to continue the TRO Uildcr CPLR ~6301. ·1·1 ic 11 1s I1111c Ii 1· . . a1so anwc t liat t1!I cntrv lll · t I1c ·I'J>() rc:c1u1rcs t.ric comm1ss1m1 o f a · · · · · · ~n:1t1cs ' 1c , ~ 11 . 1 crime by the f lish111l'l1 Entities because they mJ st be permitted to balance bill in all instances so 11 1 as tn avoid any potential criminal or ci,·il L~xpos urc. which could exist absent b;.ilance billing. :1 Tlk: comt disagrees. In any event. llllLkr the TRO. the I lishml.'!1 Fntitics arc only temporarily i prcvcniccl from balance bi 11i11g for past services(cnclcrcd to the speci !il'd pal ien!s in quest ion u1~til flll1hcr l'Ollrt J)n1ceedin!2.s arc ctinducted. . 11 I ·! Finally. the l lishrnch Entities argue thcr~ is no longer an underlying action against them II or a preliminary injunction hearing. and a TRO prns cannot exist without such an underlying i <1ctio11. f hcv an.'.u~· that. as a result. it thus is conccivabk that the TRO mav c(lntinue without .... 1t .. 'my further h..:aring ever taking place. particular!'y bcc<i11se the Hishmch Cntities ar..: no !tingcr I ran i<:s tn th is action. But. the 11 ishmch i':!Hit ies~i were well a\\ are \vhc11 they were severed <~s 11 defendants in th is act ion. but aL'.rccd ~ llC\ crt he less to the cntrv of the TR 0. that /\ctn a 11 , 011 lv • al2.n:cd -- ,, 'oluntari Iv to scvu the claims aeainst the I lishn1eh Entities fwm the causes of action asserted • ~ •I !i aL'.<tin~t Dr. R:..ik on the undcrstandinl! that the Tl~O aQainst the I lishmeh l-ntitics would remain in •. ~ Ii ~ effect unless or until a new :1ction was comnwn~'cd. Aetna now has the option ol' Ii ling a new ·1 ~J . I . r . . . . cla;m agatnst tie I l1s I11llc l1 cnt1l1es w I wre a llC\\· ate for a 1·u111 1canng 1 . reg.an1·mg a prl.'. l'1mtnary 1 :I injunction can be r::l]Ucstcd. OniY if :\ctna 1;1ils to do so. will the TRO la11se and. toward that . . ~ i1 end. rhc CtHlrt lkTL~in nmv rcc1uires that Ar.:tna must Jilc a rencv.ccl action auainst the 1lishmeh i ' Fnritics seeking a 1m·lirninary injunction no latci::than twenty <lays i'ollo\\'illg tli<.: entry of this [* 13] Decision ;md Order in onkr to keep this TRO 1 place. ;\ct11a's failure to du so shall :iu1ornatically render the rn.o null and void. !\ccordingly. it is ( )R DLR FU that \he I lishmd1 [ntitics' notion to vacalc the !'RO is denied. subject to the !1 • Ii lcrrns or this Decision and Order rcµ.arding plai!~tiffs· rccommcm:cmcn1 oLt lawsuit against the I! l l1sh111ch Fntitics. ~ !: Dated: Scptcmb...:r : I. 2012 '1 I! .l.S C MELVIN L. SCHWEITZEF J.S.C. 12 I'I II :1 I'I I' .I ,, 11 .1

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