United States District Court, D. New Jersey
JEFFREY M. AHN, M.D., Plaintiff,
CIGNA HEALTH AND LIFE INSURANCE COMPANY, JANE DOES 1-10, AND ABC CORPORATIONS 1-10, Defendants.
matter comes before the court on the motion of defendant
Cigna Health & Life Insurance ("Cigna") to
dismiss the complaint for failure to state a claim on which
relief may be granted, pursuant to Federal Rule of Civil
Procedure 12(b)(6). (DE 4). The plaintiff, Jeffrey M. Ahn,
M.D., asserts claims under New Jersey common law for
defamation per se, defamation, and tortious
interference. His claims are based on Explanation of Benefits
forms ("EOBs"), sent to Dr. Ann's patients by
Cigna, which allegedly contain false statements to the effect
that Dr. Ahn is not a licensed medical doctor. Alternatively,
Cigna moves for summary judgment pursuant to Fed.R.Civ.P.
12(d) and 56, and for a more definite statement under
reasons explained below, Cigna's motion to dismiss
pursuant to Fed.R.Civ.P. 12(b)(6) is granted in part and
denied in part; its motion for summary judgment pursuant to
Fed.R.Civ.P. 12(d) is denied; and its motion for a more
definite statement under Fed.R.Civ.P. 12(e) is denied.
plaintiff, Dr. Jeffrey M. Ann, M.D., is an otolaryngologist
who treats patients in the New York and New Jersey regions.
(Compl. ¶l). Defendant Cigna is a corporation whose
headquarters is located in Philadelphia, Pennsylvania.
(Compl. ¶2). Now and at all relevant times, Dr. Ahn was
licensed by the New Jersey Board of Medical Examiners and the
New York Department of Health to practice medicine. (Compl.
¶¶8-9). Information on licensing for medical
providers can be verified by going to the New Jersey Division
of Consumer Affairs website and the New York Department of
Health website. (Compl. ¶¶ 19-20).
issue here are certain EOBs sent to Dr. Ahn's patients
who had health insurance through Cigna or a plan administered
by Cigna. (Compl. ¶IO). Dr. Ahn alleges that on or about
46 different occasions, starting from October 21, 2014, Cigna
denied payments to Dr. Ahn for services he provided. The EOBs
stated that the claims were denied because Dr. Ahn was not
licensed to practice medicine. (Compl. ¶l 1). Twenty-two
of those denials occurred within one year preceding the
filing of Dr. Ahn's complaint. (Compl. ¶14).
on EOB sheet provided to Dr. Ahn's patients, Cigna denied
payment based on Code "AO" or Code "XB2."
Code AO is accompanied by the following narrative
Health Care Professional: The patients Cigna-administered
plan doesn't allow payment of claims for services
rendered by unlicensed health care professional or entities.
Customer: See the definitions and/or exclusions pages of your
Cigna-administered plan document. We can't pay a claim if
the health care professional is not licensed. You should
always check to be sure an out-of-network health care
professional is licensed before receiving services.
(Compl. ¶ 16). Code XB2 provides that the
Cigna-administered plan "doesn't allow payment of
claims for services rendered by unlicensed health care
professional or entities." (Compl. ¶17).
alleges that on at least one occasion, he notified Cigna that
the codes were incorrect and were causing him harm. (Compl.
¶12). Cigna allegedly acknowledged that the statements
on the EOBs were untrue and needed to be corrected. Cigna
continued, however, to print the incorrect codes on EOBs.
(Compl. ¶13). Dr. Ahn alleges that he has been
wrongfully denied payment in the amount of $14, 112.00 for
medical services rendered. His practice, he says, has
suffered financially. (Compl. ¶25). And as a result of
Cigna's actions, he alleges, his reputation has been
damaged, especially among the primarily Asian-American
community his practice caters to. (Compl. ¶¶24,
filed a complaint against Cigna in New Jersey Superior Court
alleging defamation per se, defamation, and tortious
interference. Cigna properly removed this action based on
diversity of citizenship. See 28 U.S.C. §
1332(a); Removal at 2. Dr. Ahn seeks to be reimbursed not
just for unpaid services in the amount of $14, 112.00, but
also for the damage done to his reputation, and lost profits
and business opportunities in a total amount to be determined
at trial, but no less than $2, 000, 000, and punitive damages
in the amount of $ 1, 000, 000.
Rule of Civil Procedure 8(a) does not require that a
complaint contain detailed factual allegations. Nevertheless,
"a plaintiffs obligation to provide the
'grounds' of his 'entitlement to relief requires
more than labels and conclusions, and a formulaic recitation
of the elements of a cause of action will not do."
BellAtl. Corp. v. Twombly, 550 U.S. 544, 555 (2007);
see Phillips v. Cnty. of Allegheny, 515 F.3d 224,
232 (3d Cir. 2008) (Rule 8 "requires a 'showing'
rather than a blanket assertion of an entitlement to
relief." (citation omitted)). Thus, the complaint's
factual allegations must be sufficient to raise a plaintiffs
right to relief above a speculative level, so that a claim is
"plausible on its face." Twombly, 550 U.S.
at 570; see also West Run Student Hous. Assocs., LLC v.
Huntington Nat. Bank, 712 F.3d 165, 169 (3d Cir. 2013).
facial-plausibility standard is met "when the plaintiff
pleads factual content that allows the court to draw the
reasonable inference that the defendant is liable for the
misconduct alleged." Ashcroft v. Iqbal, 556
U.S. 662, 678 (2009) (citing Twombly, 550 U.S. at
556). While "[t]he plausibility standard is not akin to
a 'probability requirement'... it asks for more than
a sheer possibility." Id.
12(b)(6) provides for the dismissal of a complaint if it
fails to state a claim upon which relief can be granted. The
defendant, as the moving party, bears the burden of showing
that no claim has been stated. Animal Science Products,
Inc. v. China Minmetals Corp., 654 F.3d 462, 469 n.9 (3d
Cir. 2011). For the purposes of a motion to dismiss, the
facts alleged in the complaint are accepted as true and all
reasonable inferences are drawn in favor of the plaintiff.
New Jersey Carpenters & the Trustees Thereof v.
Tishman Const. Corp. of New Jersey, 760 F.3d 297, 302
(3d Cir. 2014).
deciding a motion to dismiss, a court typically does not
consider matters outside the pleadings. However, a court may
consider documents that are "integral to or explicitly
relied upon in the complaint" or any "undisputedly
authentic document that a defendant attaches as an exhibit to
a motion to dismiss if the plaintiffs claims are based on the
document[.]" In re Rockefeller Ctr. Props., Inc.
Sec. Litig.,184 F.3d 280, 287 (3d Cir. 1999) (emphasis
and citations omitted); see In re Asbestos Prods. Liab.
Litig. (No. VI),822 F.3d 125, 133 n.7 (3d Cir. 2016);
Schmidt v. Skolas,770 F.3d 241, 249 (3d Cir. 2014).
In that regard, courts may consider matters of public record
and exhibits attached to the complaint. Schmidt, 770
F.3d at 249 ("To decide a motion to dismiss, courts
generally consider only the allegations contained in the
complaint, exhibits attached to the complaint ...