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Carefirst of Maryland, Inc. v. Recovery Village at Umatilla, LLC

Florida Court of Appeals, Fourth District

May 23, 2018

CAREFIRST OF MARYLAND, INC., Appellant,
v.
RECOVERY VILLAGE AT UMATILLA, LLC., et al., Appellees.

         Not final until disposition of timely filed motion for rehearing.

          Appeal of non-final order from the Circuit Court for the Seventeenth Judicial Circuit, Broward County; Jack B. Tuter, Judge; L.T. Case No. 15 008975 CACE (07).

          Daniel L. Wallach of Becker & Poliakoff, Fort Lauderdale, Patrick de Gravelles, Washington, DC, and Anthony F. Shelley of Miller & Chevalier Chartered, Washington, DC, for appellant.

          Glenn J. Waldman of Waldman Trigoboff Hildebrandt & Calnan, P.A., Fort Lauderdale, for appellees.

          MAY, J.

         Personal jurisdiction is contested in this appeal from an order denying a motion to dismiss a second amended complaint. Appellant Carefirst ("the defendant") argues the trial court erred in finding specific personal jurisdiction over it. We agree and reverse.

         The defendant is a Maryland-based insurance company that sells health insurance policies to Maryland residents and Maryland companies that may have employees outside of Maryland. It is a licensee of Blue Cross and participates in the Blue Card Program, which allows members to receive treatment nationwide while allowing the defendant to charge the in-state discounted rates that Blue Cross uses in that state. See St. Luke's Episcopal Hosp. v. La. Health Serv. & Indem. Co., No. H-08-1870, 2009 WL 47125, *7 (S.D. Tex. Jan. 6, 2009). It also offers plans with out-of-network benefits at higher premiums.

         The defendant does not own property in Florida, maintains no office in Florida, and does not advertise in the state. But, its customers can access a list of Florida providers on their website that directs them to Blue Cross's National Doctor and Hospital Finder through a link to the defendant as a licensee.

         The defendant contracts with Florida Blue for Florida Blue to pay the health care providers, such as the plaintiff, a scheduled price determined by Florida Blue through the Blue Card program. The defendant then reimburses Florida Blue for paying the provider on its behalf. Appellee Recovery Village ("the plaintiff") is unable to contract directly with the defendant; it must contract with Florida Blue. The plaintiff is not in the Florida Blue network and allegedly did not agree to accept anything less than the full price for its services.

         Between January 2014 and the present, eight of the defendant's members (all residents of Maryland) received treatment from the plaintiff, a Florida-based substance abuse and eating disorder facility. The plaintiff alleges that before providing services to the defendant's members, it contacted the defendant to verify their eligibility under their respective insurance policies. The defendant, or its agent, Magellan Healthcare, preauthorized treatment for three members.

         The parties disagree about how the contact happened. The defendant argues the system is almost completely automated, and it is unlikely that any "person" approved the treatment. The plaintiff claims that it called the defendant multiple times for each member to get approval at various stages of treatment. The plaintiff also alleges the defendant initiated phone calls to it on several occasions.

         In May 2015, the plaintiff filed suit against numerous defendants participating in the Blue Card Program, including the defendant, for underpayment on contracts. In February 2016, the plaintiff filed its first amended complaint for: (1) breach of express contract; (2) breach of implied-in-fact contract; (3) breach of implied-in-law contract; and (4) civil conspiracy.

         The defendant moved to dismiss, arguing the first amended complaint did not allege sufficient grounds for specific personal jurisdiction. The trial court granted the defendant's motion. The court indicated the motion and appended affidavit were sufficient to rebut the plaintiff's prima facie jurisdictional claim.

         The plaintiff then filed a second amended complaint, adding a description of the relationship between the defendant and Florida Blue that allegedly constituted minimum contacts sufficient to establish specific jurisdiction. The added allegations outlined the above-described relationship. It also ...


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