United States District Court, W.D. North Carolina, Asheville Division
SANDRA M. PETERS, on behalf of herself and all others similarly situated, Plaintiff,
AETNA INC., AETNA LIFE INSURANCE COMPANY, and OPTUMHEALTH CARE SOLUTIONS, INC., Defendants.
MEMORANDUM OF DECISION AND ORDER
REIDINGER UNITED STATES DISTRICT JUDGE
MATTER is before the Court on the Plaintiff's
Motion for Leave to File First Amended Class Action Complaint
[Doc. 128]; the Parties' Joint Motion for Leave to File
Under Seal Portions of Plaintiff's Motion for Leave to
File a First Amended Class Action Complaint and Proposed
First Amended Class Action Complaint [Doc. 127]; and the
Defendants' Motion for Leave to File under Seal Portions
of Defendants' Combined Opposition to Plaintiff's
Motion for Leave to File First Amended Class Action Complaint
and Exhibits C and D [Doc. 132].
12, 2015, the Plaintiff Sandra M. Peters filed this putative
class action against the Defendants Aetna, Inc., Aetna Life
Insurance Company (collectively, “Aetna”), and
OptumHealth Care Solutions, Inc. (“Optum”),
asserting claims pursuant to the Racketeer Influenced and
Corrupt Organizations Act, 18 U.S.C. § 1961, et seq.
(“RICO”) and the Employee Retirement Income
Security Act of 1974, as amended, 29 U.S.C. § 1001, et
seq. (“ERISA”). [Doc. 1]. In her Complaint, the
Plaintiff alleged that Aetna engaged in a fraudulent scheme
with Optum and other subcontractors, which were employed to
process and administer health care claims, whereby insureds
were caused to pay the subcontractors' administrative
fees because the Defendants misrepresented such fees as
medical expenses. The Plaintiff alleged that these
misrepresentations allowed Aetna to illegally (i) obtain
payment of the subcontractors' administrative fees
directly from insureds when the insureds' deductibles
have not been reached; (ii) use insureds' health spending
accounts to pay for these fees; (iii) inflate insureds'
co-insurance obligations using administrative fees; (iv)
artificially reduce the amount of available coverage for
medical services when such coverage is subject to an annual
cap; and (v) obtain payment of the administrative fees
directly from employers when an insured's deductible has
been exhausted or is inapplicable. [Id.].
Plaintiff asserted two claims based on RICO violations. In
Count I of the Complaint, the Plaintiff alleged that Aetna
and its subcontractors, including Optum, violated 18 U.S.C.
§ 1962(c) by engaging in acts of mail and wire fraud in
furtherance of a common purpose to collect administrative
fees from Aetna insureds and plans by improperly
characterizing them as payment for covered medical expenses,
and as such, constitute an associated-in-fact
“enterprise” as defined in 18 U.S.C. §
1961(4). Alternatively, the Plaintiff alleged that Aetna has
conducted multiple bilateral association-in-fact RICO
enterprises with each of its subcontractors. In Count II of
the Complaint, the Plaintiff alleged that the Defendants
conspired to violate 18 U.S.C. § 1962(c), in violation
of 18 U.S.C. § 1962(d). The Plaintiff also asserted two
claims under ERISA, alleging that the Defendants breached
their fiduciary duties as plan administrators, in violation
of 29 U.S.C. § 1132(a)(2) (Count III) and 29 U.S.C.
§ 1132(a)(1), (a)(3), and/or 29 U.S.C. § 1104
and Optum moved to dismiss the action pursuant to Rules
12(b)(1) and 12(b)(6) of the Federal Rules of Civil
Procedure, arguing that the Plaintiff lacked standing to
assert her claims and that her Complaint otherwise failed to
state claims upon which relief can be granted. [Docs. 37,
39]. On August 31, 2016 the Court entered an Order, granting
in part and denying in part the Defendants' motions.
[Doc. 54]. Specifically, the Court concluded that the
Plaintiff had standing to assert claims regarding Aetna's
actions with respect to Optum but that the Plaintiff lacked
standing to assert any claims with respect to Aetna's
interactions with other subcontractors. [Id. at
18-20]. The Court, however, dismissed the Plaintiff's
RICO claims with prejudice, reasoning as follows:
A contractual arrangement through which a claims
administrator contracts with a network of providers at a
negotiated flat rate hardly suggests the existence of a RICO
enterprise. Aetna's purpose in its contractual
relationship with Optum is to have insurance claims
administered. Optum's purpose is to provide claims
administration services for a fee. The fact that a small part
of their arrangement deflects responsibility for the fee to
an improper party does not transform their otherwise
legitimate contractual arrangement into a criminal
enterprise. The interactions between Aetna and Optum show
only that the defendants had a commercial relationship, not
that they had joined together to create a distinct entity for
purposes of the allegedly wrongful activity. Without an
indication that the cooperation in this case exceeded that
inherent in every commercial transaction, the Complaint
provides no basis for inferring that the Defendants were
conducting the enterprise's affairs and not their own,
[Id. at 25-26]. The Court denied the Defendants'
motions with respect to the Plaintiff's ERISA claims.
[Id. at 34].
November 21, 2016, the Court entered a Pretrial Order and
Case Management Plan, setting a fact discovery deadline of
June 1, 2017 and a class certification motion deadline of
October 10, 2017. [Doc. 61]. In April 2017, upon motion of
the parties, the Court amended the Case Management Plan to
extend the fact discovery deadline to October 1, 2017 and the
class certification motion deadline to February 16, 2018.
[Doc. 66]. In September 2017, the Case Management Plan was
modified again at the parties' request to extend these
deadlines to December 15, 2017 and May 9, 2018, respectively.
[Doc. 72]. In November 2017, the Case Management Plan was
modified a third time at the request of the parties to extend
the fact discovery deadline to January 31, 2018 and the class
certification motion deadline to June 22, 2018. [Doc. 77]. In
January 2018, the Court granted the parties' fourth
request for a modification of the Case Management Plan,
extending the fact discovery deadline to March 8, 2018 and
the class certification motion deadline to August 3, 2018.
[Doc. 81]. In the Order, however, the Court cautioned that
“[a]bsent a showing of extraordinary circumstances, no
further extensions of [these] deadlines will be
permitted.” [Id. at 2].
29, 2018, the Plaintiff filed the present motion seeking
leave to file an Amended Complaint. For grounds, the
Plaintiff contends that she “has uncovered evidence in
discovery showing that Defendants . . . have coordinated in
establishing and directing a RICO enterprise to illegally
collect Optum's charges from members and plans under the
guise that the charges are medical expenses.” [Doc. 128
at 1]. Accordingly, the Plaintiff seeks leave to amend her
Complaint to “reflect these new facts about
Defendants' enterprise and to test her RICO claims on the
merits.” [Id. at 1-2]. The Defendants oppose
the Plaintiff's motion. [Doc. 135].
Court dismissed the Plaintiff's RICO claims more than two
years ago. By dismissing these claims with prejudice, the
Court declined to grant the Plaintiff any leave to amend or
replead these claims. See United States v. Union
Corp., 194 F.R.D. 223, 236 (E.D. Pa. 2000). As the
Court's Order did not dismiss all of the Plaintiff's
claims, however, it was not a final judgment and therefore
remained subject to modification. See Fed.R.Civ.P.
54(b). The Plaintiff, however, never sought reconsideration
of this dismissal order.
Plaintiff argues that she was not required to seek
reconsideration of the dismissal. Rather, she contends that
she could properly seek amendment pursuant to Rule 15(a),
which provides that amendments may be made with leave of
Court and that such leave should be given freely “when
justice so requires.” Fed.R.Civ.P. 15(a).
of the appropriate procedural vehicle for the Plaintiff's
request, the fact remains that amendment of the
Plaintiff's Complaint would only be proper if such
amendment were not futile. Here, the Plaintiff asserts that
her amended pleading is based on evidence which was disclosed
during discovery in this litigation. These “newly
discovered facts, ” however, are not ...