PATRICIA L. COHEN, Magistrate Judge.
This matter is before the Court on Defendant UnitedHealthcare of the Midwest, Inc.'s ("UHC's") motion to stay discovery [ECF No. 66], Plaintiff Physicians Home Health Infusion, P.C.'s ("PHHI's") motion for leave to file corrected reply in support of its motion for sanctions [ECF No. 70], and PHHI's motion to amend the scheduling order [ECF No. 79]. With the exception of PHHI's motion for leave to file corrected reply in support of its motions for sanctions, the motions are opposed. The Court grants PHHI's unopposed motion without further discussion.
When PHHI's original complaint was pending, the Court entered, after conferring with counsel for both parties, a Case Management Order ("CMO") [ECF No. 26] establishing discovery, dispositive motion, and other deadlines for this case. In compliance with the CMO's deadline for amending pleadings, PHHI timely filed a first amended complaint [ECF No. 38].
In its first amended complaint, PHHI asserts several state law claims against UHC arising out of UHC's alleged failure consistently to approve PHHI's claims for reimbursement of spinal infusion services PHHI provides to patients suffering from chronic pain who have insurance through a Medicare Advantage Plan (a Medicare Part C plan) provided by UHC. Specifically, the reimbursement claims at issue are those PHHI submitted to UHC for services designated by codes S9325 and S9328. PHHI seeks monetary and injunctive relief from UHC based on claims for breach of contract (Count I), negligent misrepresentation (Count II), unjust enrichment (Count III), quantum meruit (Count IV), and "preliminary and permanent injunction" (Count V).
In response to PHHI's first amended complaint, UHC filed a motion to dismiss [ECF No. 40] arguing: (1) the Court lacks subject matter jurisdiction under Federal Rule of Civil Procedure 12(b)(1) and (2) the first amended complaint fails to state a claim upon which relief can be granted under Rule 12(b)(6). First, UHC contends that PHHI's state law claims "arise under" the Medicare Act and PHHI did not exhaust, and is not excused from exhausting, applicable administrative remedies. Second, UHC urges that PHHI's state law claims are pre-empted by 42 U.S.C. § 1395w-26(b)(3). PHHI counters that its claims do not arise under the Medicare Act and are collateral to a claim for Medicare benefits. Therefore, PHHI asserts, it need not exhaust administrative remedies before presenting its claims in federal court. PHHI additionally urges its claims are not pre-empted because it is not seeking application of standards contrary to federal standards.
Prior to the filing of the first amended complaint, PHHI requested a status conference to address UHC's objections to PHHI's effort pursuant to Rule 30(b)(6) to depose UHC's corporate representative
Approximately one month later, PHHI filed a motion to compel regarding the Rule 30(b)(6) deposition. The Court granted the motion in part to require Defendant to produce a corporate representative to testify during a videotaped deposition and denied it in part [ECF No. 54]. UHC filed an "emergency motion for reconsideration" of the order compelling the deposition and a request for a hearing [ECF No. 55]. The Court held a telephone conference with the parties the day UHC filed its "emergency motion" [ECF No. 57] and granted the motion in part and denied it in part [ECF No. 59]. Approximately two weeks later, PHHI asked for a status conference to discuss UHC's "production of a completely unprepared witness for" the Rule 30(b)(6) deposition [ECF No. 60]
Shortly after PHHI filed its motion for sanctions, UHC filed a motion requesting a stay of discovery until the Court ruled the motion to dismiss the amended complaint
Within the last month, PHHI filed a motion to compel UHC's responses to PHHI's first interrogatories and first request for production [ECF No. 77]. UHC opposes PHHI's motion to compel.
The same day that PHHI filed its motion to compel, PHHI filed a motion to amend the scheduling order until the Court resolves PHHI's motion for sanctions and UHC's motion to stay discovery [ECF No. 79]. UHC opposes PHHI's motion to amend the scheduling order [ECF No. 82].
UHC asks the Court to stay discovery until, in relevant part, the Court resolves the motion to dismiss because UHC "is likely to succeed on the merits of the motion to dismiss, [it] would face undue hardship and inequity if a stay is not granted, [PHHI] will suffer no prejudice by a stay, and judicial resources would be conserved if a stay were issued." Def.'s mot to stay discovery [ECF No. 66]. PHHI opposes the motion urging the parties' discovery efforts should continue because, regardless of the outcome of the pending motion to dismiss, "the discovery is inevitable [as] PHHI will continue pursuing its claims in this Court or through the administrative process." Pl.'s opp'n motion to stay discovery at 1 [ECF No. 71].
A district court's "power to stay proceedings is incidental to the power inherent in every court to control the disposition of the causes on its docket with economy of time and effort for itself, for counsel, and for litigants."
While the filing of a motion to dismiss is insufficient in and of itself to support a stay of discovery,
In resolving whether to stay discovery pending disposition of a motion to dismiss, a court considers various factors "including: (1) whether the movant has shown a likelihood of success on the merits of the dispositive motion; (2) hardship or inequity to the moving party if the matter is not stayed; (3) prejudice to the non-moving party [if the matter is stayed]; and (4) the conservation of judicial resources."
UHC urges PHHI's state law "claims — which all seek payment for services alleged[ly] provided to Medicare Advantage patients — arise under the Medicare Act as the Supreme Court has expansively interpreted that term." [ECF No. 67 at 7.] Furthermore, UHC asserts, PHHI has not and cannot plead "administrative exhaustion," and "does not meet a single one of the requirements necessary to waive the exhaustion requirement." [
PHHI counters that its state law claims "do not arise under the Medicare Act" but instead only present issues whether UHC's conduct "in denying and reimbursing identical claims caused" PHHI harm. [ECF No. 71 at 6.] Because the claims do not arise under the Medicare Act, Plaintiff urges, "
To satisfy the "likelihood of success" factor for a stay of discovery, a litigant "must show more than the mere possibility" of success on its motion to dismiss, but "is not required to demonstrate a greater than fifty percent probability" that the motion to dismiss will be successful.
"Judicial review of claims arising under the Medicare Act is available only after the Secretary renders a final decision on the claim, in the same manner as is provided in 42 U.S.C. Section 405(g) for old age and disability claims arising under Title II of the Social Security Act."
The Eighth Circuit in
Here, PHHI seeks monetary relief "related to the non-payment of goods and services" in Counts I (breach of contract claim), III (quantum meruit claim), and IV (unjust enrichment claim) of its first amended complaint. In Count V, Plaintiff seeks an injunction preventing UHC "from wrongfully denying claims for services" under the two specified codes at issue in this case. Under
If PHHI's pending state law claims arise under the Medicare Act, then PHHI had to exhaust administrative remedies, and obtain a final decision from the Secretary, before presenting the claims in federal court.
At this stage, PHHI's argument that its claims do not arise under the Medicare Act and do not require the Court to ascertain whether the two codes at issue were payable under the Act are not persuasive in light of the above-cited case law. Under the circumstances and for purposes of the motion to stay discovery only, UHC has shown a likelihood of success on the merits of its motion to dismiss. Therefore, this factor weighs in favor of granting a stay of discovery.
UHC states its efforts to comply with PHHI's Rule 30(b)(6) deposition notice and PHHI's failure to provide a list of the relevant reimbursement claims at issue in this case (that PHHI stated in its original and first amended complaints it would provide after the Court entered a protective order)
In
While the argument that a pending Rule 12(b)(1) motion does not necessarily support a stay of discovery when the dismissed claims may be filed in another court is persuasive, it is not as persuasive when, as here, the dismissal may result in the pursuit of administrative proceedings that may not allow consideration of information acquired through discovery, such as the Rule 30(b)(6) deposition. Absent PHHI's citation of authority allowing use of discovery acquired in this lawsuit during any administrative proceedings that may be required prior to judicial review of PHHI's claims, the Court finds this factor weighs, at least minimally, in favor of granting a stay.
UHC asserts that PHHI is not prejudiced by a stay because discovery is not needed to address the motion to dismiss. UHC's 12(b)(1) motion presents a facial challenge, rather than a factual challenge, to the Court's subject matter jurisdiction.
PHHI asserts it is prejudiced by a stay of discovery because it continues to service patients and submit claims under codes S9325 and S9328 that UHC inconsistently grants or denies. PHHI's need to provide services, submit claims under the two codes, and pursue appeals of any denials of those claims, however, exists regardless of whether the Court stays discovery. Nothing about the issuance of a stay of discovery in this case precludes PHHI from submitting such claims or pursuing its appeal(s) of UHC's decisions. Nor does any stay of discovery in this proceeding adversely affect those submissions or appeals. Nor does an absence of a stay of discovery enhance PHHI's claims submission and appeal effort.
Under the circumstances, this factor does not weigh against granting a stay.
"In determining whether a stay of discovery until the resolution of a pending dispositive motion would conserve judicial resources, a court examines the breadth of any pending discovery and whether the pending dispositive motion has the potential to resolve the litigation."
UHC asserts this factor supports a stay. PHHI did not explicitly discuss this factor. Under the circumstances, due to the potential for success of the pending motion to dismiss, the fact all the claims will be resolved if the motion to dismiss is granted, and the Court's experience with the parties' discovery efforts in the instant lawsuit, this factor weighs in favor of granting the motion to stay.
Having considered the relevant factors, as set forth in
PHHI seeks an extension of the discovery and dispositive motion filing deadlines until the Court resolves UHC's motion to stay and PHHI's motion for sanctions [ECF No. 79]. PHHI also asks that the Court give the parties seven days after disposition of those two motions for the parties "to confer and [submit] an Amended [CMO] with new . . . deadlines." UHC counters that, if the Court denies UHC's motion to dismiss, UHC "will confer with [PHHI] regarding the current scheduling order to mutually agree on new deadlines" and "then submit [a] proposed scheduling order to the Court" [ECF No. 82 at 4].
Due to the stay of discovery, the Court vacates the discovery and dispositive motion filing deadlines in the CMO. If this case remains pending after the Court resolves the motion to dismiss, then, within twenty-one days after the Court resolves the motion to dismiss, the parties shall confer regarding their proposed new discovery and other deadlines and submit their proposed scheduling order for the Court's consideration. Therefore, the Court grants PHHI's motion to amend scheduling order in part.
After careful consideration,
PHHI also cited several other distinguishable decisions issued by the Eastern District of Missouri: