MIAMI —A federal judge granted a motion to remand a case back to state court, ruling the defendant failed to prove the federal court had jurisdiction.
U.S. District Judge Rodney Smith agreed to remand the case back to the 15th Judicial Circuit in Palm Beach County, stating in the order that the defendant did not meet its burden of establishing jurisdiction in U.S. District Court for the Southern District of Florida, according to the March 6 order.
The complaint was filed by Dr. Richard Kaplan against Blue Cross and Blue Shield of Florida. Kaplan claimed that he provided emergency medical services to a patient, known as R.G., who was insured by the defendant, according to the order.
Kaplan claimed the defendant paid him at a rate that was below the usual provider charges and below the reasonable value of the services, which caused him damages.
He claims even though he is not a participating provider in the defendant's plan and did not agree to accept a discounted rate of reimbursement, Blue Cross paid him at a discounted rate.
Blue Cross removed the suit to federal court. It argued that payment for covered expenses weren't to be assigned to non-participating providers.
Smith wrote in the order that it is the defendant's burden to prove the case belongs in federal court and that it failed to do so.
Blue Cross argued that the case fell under the federal Employee Retirement Income Security Act (ERISA), but Kaplan argued that the issue is the rate of reimbursement and not the right to reimbursement action, which doesn't fall under ERISA.
"While case law indicates that a valid assignment from a beneficiary to a provider can confer standing under ERISA, it is not clear that Plaintiff has a valid assignment," Smith wrote. "Despite language in the Claim Form, the Plan language does not permit assignments to non-participating providers, such as Plaintiff."
Smith believes that based on the claim form and the anti-assignment provisions in the plan, the plaintiff doesn't have a valid assignment and, because of that, lacks standing under ERISA.
Smith remanded the case back to the state court and denied a request for attorneys' fees and costs.