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Aetna Health Inc. and Aetna Life Insurance Company v. Deepak Srinivasan

December 22, 2010

AETNA HEALTH INC. AND AETNA LIFE INSURANCE COMPANY , PLAINTIFFS,
v.
DEEPAK SRINIVASAN, M.D.; JOHN DOES 1-10; AND ABC CORPORATIONS 1-10, DEFENDANTS.



The opinion of the court was delivered by: Hochberg, District Judge

NOT FOR PUBLICATION

OPINION & ORDER

This matter comes before the Court on Plaintiffs' Motion to Remand the above-captioned action to the Superior Court of New Jersey, Law Division, Camden County. The Court has reviewed the parties' submissions pursuant to Federal Rule of Civil Procedure 78.

BACKGROUND

Defendant Dr. Deepak Srinivasan is a cardiologist at Hackensack Medical Center in Hackensack, New Jersey. Plaintiffs Aetna Health, Inc. and Aetna Life Insurance Company (collectively, "Aetna") are health care benefits and health insurance providers.

Aetna reimburses charges for out of network services, paying the lesser of the provider's actual charge for services or a pre-determined amount set according to the terms of the relevant benefit plan. Srinivasan is a non-participating provider who has not contracted with Aetna. When a non-participating provider like Srinivasan submits claims to Aetna, Aetna is obligated to cover only charges actually incurred by Aetna insureds. The typical claim form contains a certification that the information in the form is complete and accurate and that the relevant services were provided in accordance with the laws governing the practice of medicine in New Jersey.

The Complaint alleges that beginning in 2007, Srinivasan submitted claims for "excessive, manifestly unconscionable and overreaching" fees. (Cmplt. ¶ 44) The Complaint further alleges that Srinivasan did not disclose these fees to patients and, indeed, that he misrepresented his fees. Plaintiffs also claim that the claims Srinivasan submitted exceeded his usual charges for the same services. In submitting these claims, Srinivasan allegedly misrepresented that he was in compliance with the law.

In reliance on the accuracy of the claims submitted by Srinivasan, Aetna paid in excess of $4,900,000 in allegedly unlawful charges between January 1, 2007 and June 30, 2010 and claims to have paid additional unlawful charges since that time.

This action was filed in the Superior Court of New Jersey, Law Division, Camden County on August 13, 2010. Aetna brings claims for insurance fraud pursuant to the New Jersey Insurance Fraud Prevention Act, common law fraud, negligent misrepresentation, tortious interference, and violations of the New Jersey Board of Medical Examiners Regulations. Aetna also seeks declaratory and injunctive relief.

On September 21, 2010, Srinivasan removed the instant action to this Court. Aetna now seeks to remand the action to the Superior Court of New Jersey, Law Division, Camden County.

DISCUSSION

A defendant who seeks to remove a matter to federal court bears the burden of demonstrating jurisdiction. See Samuel-Bassett v. KIA Motors Am., Inc., 357 F.3d 392, 396 (3d Cir. 2004).

"A civil action filed in a state court may be removed to federal court if the claim is one 'arising under' federal law."*fn1 Pascack Valley Hosp., Inc. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 398 (3d Cir. 2004) (citing 28 U.S.C. §§ 1331, 1441(a)).

"Under the well-pleaded complaint rule, a cause of action 'arises under' federal law, and removal is proper, only if a federal question is presented on the face of the plaintiff's properly pleaded complaint." Dukes v. U.S. Healthcare, 57 F.3d 350, 353 (3d Cir. 1995) (citing ...


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