John J. Tharp, Jr., United States District Judge.
Plaintiff Barbara Woodruff sued Humana Pharmacy, Inc., in the Circuit Court of
Humana, a private insurer, is a Medicare Advantage Part D
Under the federal officer removal statute, a removing defendant must show that it is a (1) "person" (2) "acting under" the United States, its agencies, or its officers (3) that has been sued "for or relating to any act under color of such office," and (4) has a colorable federal defense to the plaintiff's claim. 28 U.S.C. § 1442(a); Ruppel v. CBS Corp., 701 F.3d 1176, 1180-81 (7th Cir.2012) (citing Mesa v. California, 489 U.S. 121, 132-34, 109 S.Ct. 959, 103 L.Ed.2d 99 (1989)). The plaintiff argues that Humana fails to meet all but the first criteria.
As to the "acting under" prong, the Court disagrees. "Cases in which the Supreme Court has approved removal involve defendants working hand-in-hand with the federal government to achieve a task that furthers an end of the federal government." Ruppel, 701 F.3d at 1181 (further explaining that "`[a]cting under' covers
As to the third element, however, an entity acts "under color of" federal authority only when its challenged actions were derived from its official duties. Ruppel, 701 F.3d at 1182. There must be a "causal connection" between the allegedly tortious conduct and the official authority of the removing defendant. The "under color of" element is analogous to a "scope of employment" inquiry. See 14B Charles Alan Wright, Arthur R. Miller, et al., Federal Practice and Procedure § 3726 at 245 (4th ed. 2009). Here, Humana's federal duties are to administer prescription drug benefits to Medicare patients. Yet Humana does not contend that CMS controls the manner in which Humana provides prescription drug refills; there is nothing to suggest that the manner of physically providing drugs to consumers is controlled by CMS or any federal agency. See Orthopedic Specialists of N.J. PA v. Horizon Blue Cross/Blue Shield of N.J., 518 F.Supp.2d 128, 137 (D.D.C.2007) (explaining, in promissory estoppel case against insurer, that "It is [the] act of purportedly erroneous pre-authorization over which a federal agency or officer must have exercised `direct and detailed' control if this Court is to exercise jurisdiction over Defendant under the federal officer removal statute."). Humana refers generally to "strict rules and guidelines" to which it is subject but does not cite even one that pertains to the manner in which it fills and delivers prescriptions.
Accordingly, the Court concludes that the federal officer removal statute does not permit removal of this case.
Humana alternatively contends that this case is removable under the general removal statute, § 1441, because federal law completely preempts state law with respect to claims for Medicare benefits. Ordinarily, the existence of a federal defense — such as preemption — does not permit removal, but complete preemption is an exception to that rule. Pollitt v. Health Care Service Corp., 558 F.3d 615, 616 (7th Cir.2009); see Caterpillar Inc. v. Williams, 482 U.S. 386, 393, 107 S.Ct. 2425, 96 L.Ed.2d 318 (1987); Crosby v. Cooper B-Line, Inc., 725 F.3d 795, 800 (7th Cir.2013). "Once an area of state law has been completely pre-empted, any claim purportedly based on that pre-empted state law is considered, from its inception, a federal claim, and therefore arises under federal law." Caterpillar Inc., 482 U.S. at 393, 107 S.Ct. 2425. When complete preemption applies, federal law provides the exclusive cause of action for the claim asserted, no matter how it is labelled.
As an initial matter, Woodruff takes the position that Humana has abandoned its complete preemption argument by not addressing it in its response to her motion to remand. See Reply, Dkt # 18 at 1-2. The Court agrees. Humana amended its notice of removal to add federal-officer removal as a basis for removal, Dkt. # 7, and although it also included its argument that the case was removable under § 1441 because this Court has original jurisdiction under § 1331 due to the claim arising under the Medicare Act rather than Illinois common law in the notice, it failed to respond at all to Woodruff's argument that her state law claim was not preempted and that removal under § 1441 was therefore improper. Instead, Humana's response to the remand motion maintains that it "properly removed" the case pursuant to the Federal Officer Removal Statute and "other alternative grounds." Mem., Dkt # 15 at 2. It does not identify any "other alternative grounds," however, and develops no argument concerning complete preemption. Thus, Humana has waived its argument that complete preemption permits removal under § 1331. See, e.g., C & N Corp. v. Kane, 756 F.3d 1024, 1027 (7th Cir.2014) (failure to make argument in response to summary judgment motion constituted waiver; "we will not find that an argument was adequately preserved solely because a party's opponent defended against the argument");
The Court need not definitively resolve the question of whether Humana's waiver of a complete preemption argument deprives this Court of jurisdiction, however, because the Court would not have jurisdiction even if the preemption argument has not been waived — indeed, even if it is correct. Humana's notice of removal asserts that § 1331 provides the basis for original federal jurisdiction because the claim arises under the Medicare Act. Dkt. # 14-3 at ¶ 6 ("the complaint asserts claims arising under ... the Medicare Act"). But if the claim does arise under the Medicare Act, then § 1331 cannot be the basis of jurisdiction. Under 42 U.S.C. § 405(g) and 405(h), the procedure for judicial review of a decision of the Secretary of Health and Human Services
It is difficult to imagine how the plaintiff could present her claim against Humana for negligent delay in filling her prescription to the Secretary for adjudication and a final decision in the first instance, but that only goes to show that there is not a persuasive argument that the claim is preempted. "A claim `arises under' the Medicare Act when both the standing and the substantive basis for the presentation of the claims stem from the Medicare Act." Ancillary Affiliated Health Servs. v. Shalala, 165 F.3d 1069, 1070 (7th Cir.1998) (internal quotation marks and citations omitted). The cases that discuss Medicare exhaustion look at payment decisions: that is, whether the plaintiff is, at bottom, making a claim for benefits, such as complaining about the lack of coverage for some service or a claim for payment, such as a by a provider seeking reimbursement. But Woodruff received her benefits — federally subsidized prescription drugs, which she obtained pursuant to her Part D plan with Humana. She is not seeking an injunction or declaration regarding the coverage provided by Humana, nor is she attempting to be reimbursed for out-of-pocket expenses that she believes should have been covered. She alleges that Humana negligently failed to fill and deliver her medications in a timely way, causing her to suffer a stroke. That is not something she can bring before the Secretary for a "final decision" (as to what?) that may then be challenged in court under § 405's judicial review procedure. A lawsuit against the Secretary would be inapt when the underlying claim is "wholly collateral" to any decision on a claim for benefits. Cf. Heckler, 466 U.S. at 614, 104 S.Ct. 2013 (explaining that the plaintiffs' claims were not wholly collateral to a statutory scheme of administrative and judicial review of Medicare payment decisions, because their constitutional and statutory challenge to the procedure for reaching payment decisions was "at bottom" an attempt to reverse the agency's decision to deny payment).
In that sense the case is analogous to Ardary v. Aetna Health Plans of California, Inc., 98 F.3d 496 (9th Cir.1996), in which the Ninth Circuit answered "no" to the question whether section 405(h) applied "to preclude the heirs of a deceased Medicare beneficiary from bringing state law claims for wrongful death against a private Medicare provider when those claims do not seek recovery of Medicare benefits but instead seek compensatory and punitive damages on the grounds that the provider both improperly denied emergency medical services and misrepresented its managed care plan to the beneficiary." Id. at 499. The Court held that the plaintiffs' claims were not inextricably intertwined with the denial of benefits, id. at 499-500, and it further noted that that the "removal of the right to sue the private Medicare provider for its torts would result
Thus, either: (1) Woodruff's claim arises under the Medicare Act (as Humana contends), and this Court lacks subject-matter jurisdiction because § 1331 is abrogated and this is not a suit against the Secretary for review of a final administrative decision; or (2) the claim does not arise under the Medicare Act (as Woodruff argues), and this Court lacks subject-matter jurisdiction because there is no basis such as diversity for bringing her state-law claim in federal court. Either way, removal under § 1441 is not proper. See Dial v. Healthspring of Alabama, Inc., 541 F.3d 1044, 1047-48 (11th Cir.2008).
Because Humana has failed to establish that either the federal officer removal statute or the general removal statute provide a basis for removing Woodruff's purported negligence claim, Woodruff's motion to remand is granted. Humana's motion to dismiss is denied as moot.