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Hackensack Dental Associates v. Bluecross Blueshield of Illinois

June 13, 2011

HACKENSACK DENTAL ASSOCIATES, PLAINTIFF,
v.
BLUECROSS BLUESHIELD OF ILLINOIS, HEALTH CARE SERVICES CORPORATION AND DENTAL NETWORK OF AMERICA, DEFENDANTS.



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

NOT FOR PUBLICATION

OPINION & ORDER

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

BACKGROUND

Plaintiff Hackensack Dental Associates ("HDA") is a professional dental practice providing dental services to patients in the state of New Jersey. Defendants Bluecross Blueshield of Illinois, Health Care Services Corporation and Dental Network of America are engaged in the business of providing utilization review, administrative, investigative and other related services for employee health plans. Defendants provide payment to HDA for dental services performed that are determined to be "Dentally Necessary," including dental treatment that follows generally accepted dental practice, is required for sound dental health and is prescribed by a qualified dental professional.

In order to receive payment from Defendants for "Dentally Necessary" services, HDA must submit a Request for Pre-Authorization to Defendants which contains detailed clinical information. Defendants review the Request for Pre-Authorization, and -- if Defendants determine that the requested dental services are Dentally Necessary -- Defendants issue a Pre-Authorization form which includes the pre-authorized services and a financial breakdown related to such services. HDA utilizes the Pre-Authorization in its decision to provide dental care to patients.

The Complaint alleges that beginning in 2009, Defendants stopped making payments on the vast majority of claims submitted by HDA, and "would make unreasonable requests for additional information to determine whether the treatment provided was Dentally Necessary."*fn1

The Complaint further alleges that Defendants stopped responding to HDA's Requests for Pre-Authorizations without any proffered justification for their failure to respond. Plaintiff also claims that it lost patients to other providers as a result of Defendants' action.

This action was filed in the Law Division of the Superior Court of New Jersey for Bergen County on January 31, 2011. HDA brings claims for common law fraud, tortious interference with contractual relations, tortious interference with prospective economic advantage, breach of contract, breach of the covenant of good faith and fair dealing, and violation of New Jersey's RICO statute.

On March 25, 2011, Defendants removed the instant action to this Court. HDA now seeks to remand this action to the Law Division of the Superior Court of New Jersey for Bergen County .

DISCUSSION

"The party asserting jurisdiction bears the burden of showing that at all stages of the litigation the case is properly before the federal court." Samuel-Bassett v. KIA Motors Am., Inc., 357 F.3d 392, 396 (3d Cir. 2004).

The removal jurisdiction of the federal courts is derived from statutory authorization. Pursuant to 28 U.S.C. § 1441(a), "any civil action brought in a State court of which the district courts of the United States have original jurisdiction, may be removed by the defendant or the defendants, to the district court of the United States for the district and division embracing the place where such action is pending."

If an action was improperly removed due to lack of federal jurisdiction, then the matter may be remanded to state court ...


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