John Attenello Md Apc V United Healthcare Insurance Company

Key Facts

Issues

• The court analyzed whether the federal officer removal statute applies to the defendant as a Medicare Advantage Organization. The statute applies to private persons or firms who lawfully assist federal officers in their official duties. The Sixth Circuit has rejected similar arguments, reasoning that MAOs do not act under a federal agency for purposes of this statute because they maintain an arms-length relationship with CMS. The court found this reasoning persuasive and determined the federal officer removal statute does not apply.
• The court addressed whether it has federal question jurisdiction over the plaintiff's state law claims against UnitedHealthcare Insurance Company. The plaintiff alleged underpayment for medical services but asserted solely state law causes of action. The defendant removed the case based on federal question jurisdiction, arguing that federal Medicare issues were central to the claims. The court determined that federal issues cannot be the basis for federal subject matter jurisdiction when they only appear in defenses, not on the face of the complaint. The court found that the plaintiff's suits are based entirely on state law causes of action and none turn on a federal issue on their face.

Holdings

Remedies

Legal Principles

• Under the well-pleaded complaint rule, any federal question must appear on the face of the complaint. Federal defenses cannot establish federal subject matter jurisdiction. A case does not arise under federal law merely because federal issues may require resolution as defenses to state law claims.
• The federal officer removal statute (28 U.S.C. § 1442) applies to private persons or firms who lawfully assist a federal officer in the performance of their official duty. However, Medicare Advantage Organizations do not qualify under this statute because they have an 'arms-length' relationship with CMS despite being subject to regulatory requirements.
• Federal courts are courts of limited jurisdiction and presumptively lack jurisdiction over an action. Under 28 U.S.C. § 1331, federal courts have federal question jurisdiction over actions arising under the Constitution, laws, or treaties of the United States. A case arises under federal law when federal law creates the cause of action asserted, not when federal law provides the basis for a defense.

Precedent Name

• Kaiser v. Blue Cross of Cal., 347 F.3d 1107
• Watson v. Phillip Morris Cos., 551 U.S. 142
• Metro Life Ins. Co. v. Taylor, 481 U.S. 58
• Caterpillar v. Williams, 482 U.S. 386
• Gully v. First Nat'l Bank, 299 U.S. 109
• Franchise Tax Bd. of Cal. v. Constr. Laborers Vacation Tr., 463 U.S. 1
• Grable & Sons Metal Prods., Inc. v. Darue Eng'g & Mfg., 545 U.S. 308
• Ohio State Chiropractic Ass'n v. Humana Health Plan Inc., 647 F. App'x 619
• Kokkonen v. Guardian Life Ins. Co. of Am., 511 U.S. 375
• American Soc'y of Dermatology v. Shalala, 962 F. Supp. 141

Cited Statute

• Medicare Act Jurisdiction
• Physician Payment Coding
• CMS Fee Schedule
• Medicare Assignment Regulation
• Federal Officer Removal Statute
• Federal Question Jurisdiction

Judge Name

Passage Text

• The Sixth Circuit has rejected Defendant's precise argument, however, reasoning that MAOs do not act under a federal agency for purposes of the federal officer removal statute because despite being subject to extensive regulatory requirements, they have an "arms-length" relationship with CMS. The Court finds this reasoning persuasive. Accordingly, the federal officer removal statute does not apply.
• For the foregoing reasons, the Court GRANTS Plaintiff's Motion and REMANDS 2:25-cv-02258-RGK-MAA, 2:25-cv-02259-RGK-MAA, 2:25-cv-02260-RGK-MAA, and 2:25-cv-02261-RGK-MAA to the Small Claims Court of the Superior Court of California, County of Los Angeles for all further proceedings. The Court DENIES each of Defendant's Motions to Dismiss as moot.
• Here, Plaintiff's suits against Defendant are based entirely on state law causes of action. None of these causes of action, on their face, turn on a federal issue. The Court does not have federal question jurisdiction over Plaintiff's lawsuits.

Damages / Relief Type