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Dialysis Newco, Inc. v. Community Health Systems Group Health Plan No. 18-40863

http://www.ca5.uscourts.gov/opinions/pub/18/18-40863-CV0.pdf

Before ELROD, GRAVES, and OLDHAM, Circuit Judges.

REVERSED, VACATED, and RENDERED. (September 11, 2019).

This case involved a three-way dispute between an ERISA plan and its administrator, a third-party processor, and a healthcare provider. At its core, the disagreement arose from a contract dispute over whether the administrator and the third-party processer underpaid the provider for hemodialysis treatments received by an employee of the administrator. The District Court determined that the provider had standing to bring this lawsuit because an anti-assignment provision in the plan was ambiguous or, in the alternative, because the anti-assignment provision was rendered unenforceable by a Tennessee statute. Holding that the plan’s anti-assignment provision unambiguously prohibits assignment, and that the Tennessee statute is preempted by ERISA, the Fifth Circuit reverses, vacates, and renders judgment dismissing the case for lack of jurisdiction.

On Appeals from the United States District Court for the Southern District of Texas (Marina Garcia Marmolejo).
Attorneys for Appellants – Scott Thomas Clark, Harlingen, TX; Scott Burnett Smith, Huntsville, AL
Attorney for Appellee – Michael Lester Hood, Dallas, TX

 

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