United States District Court, M.D. Florida, Tampa Division
STEPHEN M. QUILTY, individually and on behalf of others similarly situated, Plaintiff,
ENVISION HEALTHCARE CORP., EMCARE HOLDINGS INC., EMCARE INC., and BAXLEY EMERGENCY PHYSICIANS, LLC, Defendants.
VIRGINIA M. HERNANDEZ COVINGTON UNITED STATES DISTRICT JUDGE.
matter comes before the Court upon consideration of
Defendants Envision Healthcare Corp., Emcare Holdings Inc.,
Emcare Inc., and Baxley Emergency Physicians, LLC's
Motion to Dismiss (Doc. # 44), filed on April 4, 2018.
Plaintiff Stephen M. Quilty responded on May 4, 2018. (Doc. #
54). Defendants replied on May 18, 2018. (Doc. # 58). For the
reasons that follow, the Motion is granted and the case is
is the practice of an out-of-network healthcare provider
billing a patient the difference between the provider's
charge for services and the amount (if any) the provider
recovered from the patient's insurance. Florida law
generally prohibits emergency-care providers from
balance-billing patients for out-of-network emergency care
services they receive. Fla. Stat. §§ 627.64194,
Defendants provide emergency healthcare services.
Specifically, Defendant Envision Healthcare Corp. is a large
“publicly traded for-profit nationwide provider of
healthcare services, including physician services.”
(Doc. # 1 at 4). Defendant EmCare Holdings Inc. is “a
wholly owned subsidiary of Envision.” (Id.).
In turn, Defendant EmCare Inc. is “a wholly owned
subsidiary of EmCare Holdings Inc.” and “a
physician practice management company that provides
outsourced facility-based physician services for clinicians,
hospitals, health systems, and other healthcare clients in
the United States.” (Id.). Among other things,
EmCare Inc. handles “coding and billing services, and
customiz[es] financial and staffing models.”
(Id. at 5). Defendant Baxley Emergency Physicians,
LLC - a wholly owned subsidiary of Defendant EmCare Inc. - is
“a provider of emergency physician services to
to the Complaint, Defendants “have engaged in a
corporate scheme to directly bill insured patients for
out-of-network [emergency department] services, even though
Florida law prohibits such conduct.” (Id. at
11-12). “The purpose of Defendants' actions was to
raise corporate revenue and profits at the expense of
consumers who are ultimately held accountable by Defendants
for the remainder of any unpaid, inflated bills.”
(Id. at 12). Defendants and their employees do not
disclose to patients in the emergency room that the physician
is out-of-network for the patient's insurance.
(Id. at 13). And, when patients later
“contact Defendants with billing questions,
Defendants mislead the patients by failing to inform [them]
that Defendants were not permitted to hold patients liable
for their bills, pursuant to state law.”
(Id.). Defendants thereby induce patients to pay
“the bill, believing that the bill is lawful and
justified and that non-payment would result in the bill being
sent to collections.” (Id.).
2014, Quilty went to the emergency room of a hospital that
was in-network for his HMO plan to treat an injury to his
face. (Id. at 14). Baxley was the treating provider
for that emergency room, but was not in the network for
Quilty's HMO - a fact Quilty was not told.
(Id.). Subsequently, Quilty received a bill from the
hospital for its services. Under the terms of the policy,
Quilty's HMO paid the majority of the bill, and Quilty
paid the remainder. (Id.). Quilty thought that ended
then he received another bill for $2, 255.01 for Baxley's
“out-of-network physician services” provided by a
Dr. Nuss. (Id.). This charge especially surprised
Quilty because he had not interacted with or been treated by
Dr. Nuss - his injury was tended to by a physician's
assistant. (Id.). So Quilty called Baxley and
“asked why he was being billed for services provided by
a physician that never interacted with him.”
(Id.). The Baxley representative responded that
“Dr. Nuss was the on-duty emergency physician at that
time and that he was responsible for payment for services
rendered in the amount specified on the bill.”
(Id. at 15). Fearing the effect of the bill being
turned over to a collection agency, Quilty paid the bill.
(Id.). In short, Quilty alleges that he
“received a balance-bill for out-of-network physician
services rendered by Defendants.” (Id. at 11).
initiated this putative class action against Defendants on
February 8, 2018, asserting claims for violation of
Florida's HMO and PPO balance-billing statutes, Fla.
Stat. §§ 627.64194, 641.3154, and 641.513, and
Florida's Deceptive and Unfair Trade Practices Act
(FDUTPA), Fla. Stat. § 501.201 et seq., as well
as claims for unjust enrichment and declaratory relief. (Doc.
# 1). In the Complaint, Quilty seeks to represent a class
defined as “All commercially insured beneficiaries that
live or reside in Florida who sought emergency medical care
at an in-network hospital managed by Defendants and who were
subsequently balance-billed for the cost of that care.”
(Id. at 15). Defendants moved to dismiss the
Complaint on April 4, 2018. (Doc. # 44). Quilty responded
(Doc. # 54), and Defendants have replied. (Doc. # 58). The
Motion is now ripe for review.
motion to dismiss pursuant to Rule 12(b)(6), this Court
accepts as true all the allegations in the complaint and
construes them in the light most favorable to the plaintiff.
Jackson v. Bellsouth Telecomms., 372 F.3d 1250, 1262
(11th Cir. 2004). Further, this Court favors the plaintiff
with all reasonable inferences from the allegations in the
complaint. Stephens v. Dep't of Health & Human
Servs., 901 F.2d 1571, 1573 (11th Cir. 1990). But,
[w]hile a complaint attacked by a Rule 12(b)(6) motion to
dismiss does not need detailed factual allegations, a
plaintiff's obligation to provide the grounds of his
entitlement to relief requires more than labels and
conclusions, and a formulaic recitation of the elements of a
cause of action will not do. Factual allegations must be
enough to raise a right to relief above the speculative
Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555
(2007)(internal citations omitted). Courts are not
“bound to accept as true a legal conclusion couched as
a factual allegation.” Papasan v.
Allain, 478 U.S. 265, 286 (1986). The Court must limit
its consideration to well-pleaded factual allegations,
documents central to or referenced in the complaint, and
matters judicially noticed. La Grasta v. First Union
Sec., Inc., 358 F.3d 840, 845 (11th Cir. 2004).
motions to dismiss for lack of subject matter jurisdiction
pursuant to Rule 12(b)(1) may attack jurisdiction facially or
factually. Morrison v. Amway Corp., 323 F.3d 920,
924 n.5 (11th Cir. 2003). Where the jurisdictional attack is
based on the face of the pleadings, the Court merely looks to
determine whether the plaintiff has sufficiently alleged a
basis of subject matter jurisdiction, and the allegations in
the plaintiff's complaint are taken as true for purposes
of the motion. Lawrence v. Dunbar, 919 F.2d 1525,
1529 (11th Cir. 1990).
make numerous arguments for why the various counts of the
Complaint should be dismissed. The Court will address them
Defendants challenge Quilty's standing to bring any
claims based on violation of Section 627.64194, Fla. Stat.,
which is the PPO balance-billing statute. (Doc. # 44 at 5-6).
“A plaintiff's standing to bring and maintain her
lawsuit is a fundamental component of a federal court's
subject matter jurisdiction.” Baez v. LTD Fin.
Servs., L.P., No. 6:15-cv-1043-Orl-40TBS, 2016 WL
3189133, at *2 (M.D. Fla. June 8, 2016)(citing Clapper v.
Amnesty Int'l USA, 133 S.Ct. 1138, 1146 (2013)). The
doctrine of standing “limits the category of litigants
empowered to maintain a lawsuit in federal court to seek
redress for a legal wrong.” Spokeo, Inc. v.
Robins, 136 S.Ct. 1540, 1547 (2016), as revised
(May 24, 2016).
establish standing, “[t]he plaintiff must have (1)
suffered an injury in fact, (2) that is fairly traceable to
the challenged conduct of the defendant, and (3) that is
likely to be redressed by a favorable judicial
decision.” Id. “‘The party
invoking federal jurisdiction bears the burden of
establishing' standing.” Clapper, 133
S.Ct. at 1148 (quoting Lujan v. Defs. of Wildlife,
504 U.S. 555, 561 (1992)).
injury-in-fact requirement is the most important element.
Spokeo, 136 S.Ct. at 1547. An injury in fact is
“‘an invasion of a legally protected
interest' that is ‘concrete and particularized'
and ‘actual or imminent, not conjectural or
hypothetical.'” Id. at 1548 (quoting
Lujan, 504 U.S. at 560). The injury must be
“particularized, ” meaning it “must affect
the plaintiff in a personal and individual way.”
Spokeo, 136 S.Ct. at 1548 (quoting Lujan,
504 U.S. at 560 n.1). Additionally, the injury must be
“concrete, ” meaning “it must actually
exist.” Spokeo, 136 S.Ct. at 1548. The Supreme
Court in Spokeo emphasized that a plaintiff cannot
“allege a bare procedural violation, divorced from any
concrete harm, and satisfy the injury-in-fact requirement of
Article III.” Id. at 1549.
point out that Quilty's injury (being balance-billed)
occurred in 2014 - two years before the PPO balance-billing
statute, Fla. Stat. § 627.64194, was enacted. (Doc. # 44
at 6). Defendants reason: “As Plaintiff's alleged
experience occurred two years before Section 627.64194 was
enacted and there is no indication the statute has
retroactive effect, he cannot have standing to assert a claim
thereunder.” (Id.). Furthermore, according to
Defendants, “[t]he allegations in the Complaint
establish that [Quilty] experienced no violation of the PPO
balance-billing statute because [he] was not insured through
a PPO at the time.” (Id.).
acknowledges that he had an HMO, not a PPO, when he was
balance-billed in 2014. (Doc. # 54 at 2). So Quilty does not
contest that he was not balance-billed in violation of the
PPO balance-billing statute. But he insists that he
nevertheless has standing to represent the putative class
members who have PPO coverage and were balance-billed.
(Id. at 3-5). Quilty argues that “the standing
requirement for a class representative at the motion to
dismiss stage” is “a less significant burden than
at class certification.” (Id. at 3). According
to Quilty, “the proper analysis is whether putative
class members were similarly harmed by ...