Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 1 of 45
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`UNITED STATES DISTRICT COURT
`DISTRICT OF CONNECTICUT
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`MURPHY MEDICAL ASSOCIATES, LLC;
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`DIAGNOSTIC AND MEDICAL SPECIALISTS OF
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`GREENWICH, LLC; NORTH STAMFORD MEDICAL
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`ASSOCIATES, LLC; COASTAL CONNECTICUT
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`MEDICAL GROUP, LLC; and STEVEN A.R. MURPHY,
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`MD,
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`: APRIL 16, 2021
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`X
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`3:20-cv-01675-JBA
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`Plaintiffs,
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`V.
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`CIGNA HEALTH AND LIFE INSURANCE COMPANY
`and CONNECTICUT GENERAL LIFE INSURANCE
`COMPANY,
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`Defendants.
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`DEFENDANTS’ MEMORANDUM OF LAW IN SUPPORT OF MOTION TO DISMISS
`PLAINTIFFS’ AMENDED COMPLAINT
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`Of Counsel:
` Theodore J. Tucci
` Patrick W. Begos
` Jean E. Tomasco
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`Robinson & Cole LLP
`280 Trumbull Street
`Hartford, CT 06103
`Telephone: (860) 275-8200
`Fax: (860) 275-8299
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`Attorneys for Cigna Health And Life
`Insurance Company and Connecticut
`General Life Insurance Company
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`

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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 2 of 45
`
`TABLE OF CONTENTS
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`Page(s)
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`
`
`I.
`II.
`III.
`IV.
`V.
`
`C.
`
`D.
`
`E.
`
`INTRODUCTION ............................................................................................................. 1
`SUMMARY OF CLAIMS AND GROUNDS FOR DISMISSAL .................................... 3
`SUMMARY OF PLAINTIFFS’ ALLEGATIONS ........................................................... 5
`LEGAL STANDARD ON A MOTION TO DISMISS ..................................................... 8
`ARGUMENT ..................................................................................................................... 9
`A.
`Plaintiffs Fail to Plead Essential Facts for Out-of-Network Reimbursement ........ 9
`B.
`Plaintiffs Have No Cause of Action Under the CARES Act ............................... 11
`1.
`The FFCRA and the CARES Act Have No Express Private Right
`of Action .................................................................................................. 11
`The FFCRA and the CARES Acts Have No Implied Private Right
`of Action .................................................................................................. 13
`The Amended Complaint Alleges No Facts Concerning Posted
`“Cash Prices” ........................................................................................... 15
`Plaintiffs Lack Standing Under ERISA and Fail to Plead a Plausible
`ERISA Claim ....................................................................................................... 15
`1.
`Plaintiffs Have No ERISA Standing ........................................................ 15
`a.
`Plaintiffs Fail to Adequately Plead A Single Valid
`Assignment .................................................................................. 16
`Neither the FFCRA nor the CARES Act Confer Standing to
`Sue Under ERISA ........................................................................ 18
`Plaintiffs Fail to Allege Sufficient Facts About Any Plan to
`Support a Claim ....................................................................................... 20
`The Second Count—Seeking Reformation of Unidentified ERISA
`Plans—Fails to State a Claim .................................................................. 22
`The Third Count—Seeking Benefits—Fails to State a Claim ................. 23
`The Fourth Count—Seeking Equitable Relief—Fails to Plausibly
`State a Claim ............................................................................................ 25
`Plaintiffs’ CUTPA/CUIPA Claim Fails as a Matter of Law ................................ 26
`1.
`ERISA Preempts CUTPA and CUIPA .................................................... 26
`2.
`Plaintiffs Have Not Pleaded Facts Establishing a CUTPA/CUIPA
`Claim ........................................................................................................ 27
`Plaintiffs’ Unjust Enrichment Claim Fails as a Matter of Law ........................... 28
`1.
`ERISA Preempts the Unjust Enrichment Claim ...................................... 28
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`2.
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`3.
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`2.
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`3.
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`4.
`5.
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`b.
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`i
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`VI.
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 3 of 45
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`2.
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`F.
`G.
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`Plaintiffs Have Not Pleaded Facts Establishing an Unjust
`Enrichment Claim .................................................................................... 29
`There is No “Federal Law” Claim for Reimbursement ....................................... 30
`Plaintiffs’ Tortious Interference Claim Fails as a Matter of Law ........................ 30
`1.
`ERISA Preempts the Tortious Interference Claim................................... 31
`2.
`Plaintiffs Have Not Pleaded Facts Establishing an Tortious
`Interference Claim ................................................................................... 31
`CONCLUSION ................................................................................................................ 33
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`ii
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 4 of 45
`
`TABLE OF AUTHORITIES
`
`
`
`Page(s)
`
`
`
`
`
`
`Cases
`
`Abe v. N.Y. Univ.,
`No. 14-CV-9323, 2016 WL 1275661 (S.D.N.Y. Mar. 30, 2016) ............................................24
`
`Alexander v. Sandoval,
`532 U.S. 275 (2001) .....................................................................................................11, 13, 14
`
`Am. Video Duplicating, Inc. v. City Nat’l Bank,
`No. 2:20-CV-04036, 2020 WL 6882735 (C.D. Cal. Nov. 20, 2020) ......................................14
`
`Apollo MD Bus. Servs., L.L.C. v. Amerigroup Corp. (Delaware),
`No. 1:16-cv-4814-RWS, 2017 WL 10185527 (N.D. Ga. Nov. 27, 2017) ...............................19
`
`Appleton v. Bd. of Educ. of Town of Stonington,
`254 Conn. 205 (2000) ........................................................................................................31, 32
`
`Artie’s Auto Body, Inc. v. Hartford Fire Ins. Co.,
`317 Conn. 602 (2015) ..............................................................................................................27
`
`Ashcroft v. Iqbal,
`556 U.S. 662 (2009) ...................................................................................................................8
`
`Autumn Court Operating Co., LLC v. Healthcare Ventures of Ohio,
`No. 2:20-cv-4901, 2021 WL 325887 (S.D. Ohio Feb. 1, 2021) ..............................................14
`
`Baras v. Baras,
`No. FST-CV-186035174-S, 2019 WL 4668415 (Conn. Super. Ct. Aug. 22,
`2019) ........................................................................................................................................29
`
`Bell Atl. Corp. v. Twombly,
`550 U.S. 544 (2007) ...................................................................................................................8
`
`Biomed Pharm., Inc. v. Oxford Health Plans,
`775 F. Supp. 2d 730 (S.D.N.Y. 2011)....................................................................17, 22, 26, 33
`
`Black & Decker Disability Plan v. Nord,
`538 U.S. 822 (2003) .................................................................................................................23
`
`Brownstone Inv. Grp., LLC. v. Levey,
`468 F. Supp. 2d 654 (S.D.N.Y. 2007)......................................................................................10
`
`Chertkova v. Conn. Gen. Life Ins. Co.,
`No. CV-980486346-S, 2002 WL 1902988 (Conn. Super. Ct. July 12, 2002) .........................31
`
`iii
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 5 of 45
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`
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`Ciambrello v. Cty. of Nassau,
`292 F.3d 307 (2d Cir. 2002).......................................................................................................8
`
`Cole v. Aetna,
`70 F. Supp. 2d 106 (D. Conn. 1999) ........................................................................................29
`
`Cole v. Travelers Ins. Co.,
`208 F. Supp. 2d 248 (D. Conn. 2002) ......................................................................................28
`
`Curtis v. Aetna Life Ins. Co.,
`No. 3:19-CV-01579, 2021 WL 1056785 (D. Conn. Mar. 18, 2021) ...................................8, 23
`
`Dekutowski-Cook v. Pavalock,
`No. HHB-CV-054005970-S, 2006 WL 251167 (Conn. Super. Ct. Jan. 9,
`2006) ........................................................................................................................................28
`
`DeSilva v. N. Shore-Long Island Jewish Health Sys., Inc.,
`770 F. Supp. 2d 497 (E.D.N.Y. 2011) .....................................................................................25
`
`Feldman v. Bhrags Home Care, Inc.,
`No. 15CV5834RRMRML, 2017 WL 1274055 (E.D.N.Y. Mar. 10, 2017) .............................10
`
`Ferrari v. U.S. Equities Corp.,
`No. 3:13-CV-00395, 2014 WL 5144736 (D. Conn. Oct. 14, 2014) ........................................27
`
`Forest Ambulatory Surgical Assocs., L.P. v. United Healthcare Ins. Co.,
`No. 10-CV-04911, 2011 WL 2748724 (N.D. Cal. July 13, 2011)...........................................21
`
`Franchise Tax Bd. v. Constr. Laborers Vacation Trust for S. Cal.,
`463 U.S. 1 (1983) .....................................................................................................................15
`
`Frommert v. Conkright,
`433 F.3d 254 (2d Cir. 2006).....................................................................................................26
`
`Gerosa v. Savasta & Co., Inc.,
`329 F.3d 317 (2d Cir. 2003).....................................................................................................26
`
`Gianetti v. Blue Cross & Blue Shield of Connecticut, Inc.,
`No. 3:07-CV-01561, 2008 WL 1994895 (D. Conn. May 6, 2008), aff’d, 351 F.
`App’x 520 (2d Cir. 2009).........................................................................................................27
`
`Giordano v. Thomson,
`564 F.3d 163 (2d Cir. 2009).....................................................................................................23
`
`Glynn v. Bankers Life & Cas. Co.,
`297 F. Supp. 2d 424 (D. Conn. 2003) ......................................................................................27
`
`iv
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 6 of 45
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`Gonzaga Univ. v. Doe,
`536 U.S. 273 (2002) .................................................................................................................13
`
`Healthcare Ventures of Ohio, LLC v. HVO Operations Windup LLC,
`No. 20-CV-04991, 2020 WL 6688994 (S.D. Ohio Nov. 13, 2020) ..................................13, 14
`
`Heimeshoff v. Hartford Life & Acc. Ins. Co.,
`571 U.S. 99 (2013) ...................................................................................................................23
`
`Johnson v. JPMorgan Chase Bank, N.A.,
`488 F. Supp. 3d 144 (S.D.N.Y. 2020)......................................................................................12
`
`Juan Antonio Sanchez, PC v. Bank of S. Texas,
`No. 7:20-CV-00139, 2020 WL 6060868 (S.D. Tex. Oct. 14, 2020) .......................................15
`
`Keller v. Beckenstein,
`117 Conn. App. 550 (2009), cert. denied, 294 Conn. 913 (2009) ...........................................27
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`Kennedy v. Empire Blue Cross & Blue Shield,
`989 F.2d 588 (2d Cir. 1993).....................................................................................................24
`
`Kittay v. Kornstein,
`230 F. 3d 531 (2d Cir. 2000)......................................................................................................8
`
`Law Offices of Frank N. Peluso, P.C. v. Cotrone,
`No. FST-CV-06-5000599-S, 2009 WL 3416247 (Conn. Super. Ct. Sept. 23,
`2009) ........................................................................................................................................32
`
`Lopez v. Jet Blue Airways,
`662 F.3d 593 (2d Cir. 2011).....................................................................................................13
`
`In re Managed Care Litig.,
`No. 00-1334, 2009 WL 742678 (S.D. Fla. Mar. 20, 2009)......................................................20
`
`Markowitz v. Villa,
`No. CV-166060963-S, 2017 WL 960769 (Conn. Super. Ct. Jan. 26, 2017) ...........................29
`
`Martin v. American Equity Ins. Co.,
`185 F. Supp. 2d 162 (D. Conn. 2002) ......................................................................................28
`
`Mastafa v. Chevron Corp.,
`770 F.3d 170 (2d Cir. 2014)...........................................................................................8, 24, 27
`
`Matava v. CTPPS, LLC,
`No. 3:20-CV-01709, 2020 WL 6784263 (D. Conn. Nov. 18, 2020) .................................12, 14
`
`MC1 Healthcare, Inc. v. United Health Group, Inc.,
`No. 3:17-CV-01909, 2019 WL 2015949 (D. Conn. May 7, 2019) .......................16, 17, 20, 21
`
`v
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`

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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 7 of 45
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`
`
`McCullough Orthopaedic Surgical Servs., PLLC v. Aetna, Inc.,
`857 F.3d 141 (2d Cir. 2017).....................................................................................................18
`
`Merrick v. UnitedHealth Grp., Inc.,
`175 F. Supp. 3d 110 (S.D.N.Y. 2016)................................................................................18, 20
`
`Mescall v. U.S. Dep’t of Justice,
`No. 2:20-CV-13364, 2021 WL 199277 (E.D. Mich. Jan. 19, 2021) .......................................14
`
`Michael E. Jones M.D., P.C. v. UnitedHealth Grp., Inc.,
`No. 19-CV-7972, 2020 WL 4895675 (S.D.N.Y. Aug. 19, 2020) ............................................21
`
`Michel v. Bridgeport Hosp.,
`No. FST-11-6015195-S, 2011 WL 1176885 (Conn. Super. Ct. March 7, 2011) ....................32
`
`Mills v. Bluecross Blueshield of Tenn., Inc.,
`No. 3:15-CV-552, 2017 WL 78488 (E.D. Ten. Jan. 9, 2017)..................................................14
`
`Montefiore Med. Ctr. v. Teamsters Local 272,
`642 F.3d 321 (2d Cir. 2011).....................................................................................................16
`
`N.R. v. Raytheon Co.,
`No. 20-10153-RGS, 2020 WL 3065415 (D. Mass. June 9, 2020) ...........................................19
`
`Neurological Surgery, P.C. v. Aetna Health Inc.,
`No. 2:19-CVx-4817, 2021 WL 26097 (E.D.N.Y. Jan. 4, 2021) ............9, 10, 16, 17, 18, 27, 31
`
`New York State Psychiatric Ass’n, Inc. v. UnitedHealth Grp.,
`798 F.3d 125 (2d Cir. 2015).....................................................................................................21
`
`Paese v. Hartford Life & Acc. Ins. Co.,
`449 F.3d 435 (2d Cir. 2006).....................................................................................................23
`
`Papasan v. Allain,
`478 U.S. 265 (1986) ...................................................................................................................8
`
`Paskiewicz v. Brower,
`No. 2:20-CV-02238, 2020 WL 7074605 (E.D. Cal. Dec. 3, 2020) .........................................13
`
`Pettengill v. Fireman’s Fund Ins. Co.,
`No. 3:13-CV-154, 2013 WL 4054635 (D. Conn. Aug. 12, 2013) ...........................................28
`
`Physicians Multispecialty Grp. v. Health Care Plan of Horton Homes, Inc.,
`371 F.3d 1291 (11th Cir. 2004) ...............................................................................................18
`
`Pilot Life Ins. Co. v. Dedeaux,
`481 U.S. 41 (1987) ...................................................................................................................19
`
`vi
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 8 of 45
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`Prof’l Orthopaedic Assocs., PA v. 1199 SEIU Nat’l Benefit Fund,
`697 F. App’x 39 (2d Cir. 2017) ...............................................................................................16
`
`Prof’l Staff Cong./CUNY v. Rodriguez,
`478 F. Supp. 3d 509 (S.D.N.Y. 2020)......................................................................................12
`
`Profiles, Inc. v. Bank of Am. Corp.,
`453 F. Supp. 3d 742 (D. Md. 2020) ...................................................................................13, 14
`
`Progressive Spine & Orthopaedics, LLC v. Empire Blue Cross Blue Shield,
`No. 16-CV-01649, 2017 WL 751851 (D.N.J. Feb. 27, 2017) ...........................................17, 18
`
`Rep. of Iraq v. ABB AG,
`768 F.3d 145 (2d Cir. 2014)...............................................................................................11, 13
`
`Robert S. Weiss & Assoc., Inc. v. Wiederlight,
`208 Conn. 525 (1988) ..............................................................................................................31
`
`Rojas v. Cigna Health & Life Ins. Co.,
`793 F.3d 253 (2d Cir. 2015).........................................................................2, 16, 17, 19, 20, 22
`
`Sanctuary Surgical Ctr., Inc. v. UnitedHealthcare, Inc.,
`No. 10-81589-CV, 2011 WL 6935289 (S.D. Fla. Dec. 30, 2011) ...........................................20
`
`Shehan v. U.S. Dep’t of Justice,
`No. 1:20-CV-00500, 2020 WL 7711635 (S.D. Ohio Dec. 29, 2020) ......................................14
`
`Simon v. Gen. Elec. Co.,
`263 F.3d 176 (2d Cir. 2001) (per curiam) ..........................................................................15, 16
`
`Smith v. United Healthcare Ins. Co.,
`No. 18-CV-06336-HSG, 2019 WL 3238918 ...........................................................................19
`
`Steven L. Steward & Assocs., P.A. v. Truist Bank,
`No. 6:20-CV-1083, 2020 WL 5939150 (M.D. Fla. Oct. 6, 2020) ...........................................13
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`Stewart v. Nat’l Educ. Ass’n,
`404 F. Supp. 2d 122 (D.D.C. 2005), aff’d, 471 F.3d 169 (D.C. Cir. 2006) .............................23
`
`Sullivan v. Allstate Ins. Co.,
`No. CV-054008548, 2006 WL 1000236 (Conn. Super. Ct. Mar. 28, 2006) ...........................28
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`US Airways, Inc. v. McCutchen,
`569 U.S. 88 (2013) ...................................................................................................................23
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`Varity Corp. v. Howe,
`516 U.S. 489 (1996) .................................................................................................................26
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`vii
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`Vertex, Inc. v. Waterbury,
`278 Conn. 557 (2006) ..............................................................................................................29
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`Wegmann v. Young Adult Inst., Inc.,
`No. 15-CV- 3815, 2016 WL 827780 (S.D.N.Y. Mar. 2, 2016) ...............................................25
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`Wisniewski v. Rodale, Inc.,
`510 F.3d 294 (3d Cir. 2007).....................................................................................................14
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`Statutes
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`29 U.S.C. § 1132(a)(1)(B) (ERISA § 502(a)(1)(B) ..............................3, 15, 16, 19, 23, 24, 25, 26
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`29 U.S.C. § 1132(a)(3) (ERISA § 502(a)(3) ...........................................................3, 15, 19, 25, 26
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`29 U.S.C. § 1132(g) (ERISA § 502(g)..........................................................................................33
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`29 U.S.C. § 1133 (ERISA § 503) .................................................................................................24
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`29 U.S.C. § 1185d (ERISA § 711)................................................................................................19
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`Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Act, Pub. L.
`No. 116-136, 134 Stat. 281 (March 27, 2020) .....................................11, 12, 13, 14, 15, 18, 30
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`Conn. Gen. Stat. § 38a-816 (CUIPA) ........................................................................................3, 27
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`Conn. Gen. Stat. § 42-110b(a) (CUTPA) ......................................................................3, 26, 27, 29
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`ERISA .................................................................................................................................... passim
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`Families First Coronavirus Response Act (“FFCRA”), Public Law 116-127, 134
`Stat. 178 (March 18, 2020)
` …………………………………………………...……………3, 4, 7, 8, 11, 12, 13, 15, 18, 22, 30
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`Other Authorities
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`29 C.F.R. § 2560.503-1 ..................................................................................................................31
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`Federal Rule of Civil Procedure 12(b)(6) ..............................................................................1, 8, 11
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`Federal Rules of Civil Procedure Rule 8 ...................................................................................8, 27
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`http://coronatestct.com .................................................................................................................1, 7
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`https://hipaa.jotform.com/MurphyMA/Register ............................................................................11
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`https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html ......................7
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 10 of 45
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`INSIDE EDITION, Nov. 12, 2020, https://www.insideedition.com/family-says-
`nearly-7000-covid-19-test-bill-includes-480-charge-for-phone-call-telling-
`them-results ................................................................................................................................1
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`Thomas Breen, Covid-Test Doc’s Woes Mount UNH Bails, New Haven
`Independent, Nov. 16, 2020,
`https://www.newhavenindependent.org/index.php/archives/entry/murphy_upd
`ate/ ..............................................................................................................................................1
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`Jean M. Connors & Jerrold H. Levy, COVID-19 and Its Implications for
`Thrombosis and Anticoagulation ...............................................................................................6
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`Bangshun He, et al., Tumor Biomarkers Predict Clinical Outcome of COVID-19
`Patients .......................................................................................................................................6
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`Sarah Kliff, These Towns Trusted a Doctor to Set Up Covid Testing Set Up Covid
`Testing. Sample Patient Fee: $1,944, N.Y. TIMES, Nov. 10, 2020 (updated
`Nov. 12, 2020) ...........................................................................................................................1
`
`Thirumalaisamy P. Velavan & Christian G. Meyer, Mild Versus Severe COVID-
`19: Laboratory Markers ............................................................................................................6
`
`
`
`ix
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 11 of 45
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`
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`Pursuant to Federal Rule of Civil Procedure 12(b)(6), Defendants, Cigna Health and Life
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`Insurance Company and Connecticut General Life Insurance Company (collectively, “Cigna”),
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`move to dismiss the Amended Complaint in its entirety, and with prejudice (Doc. No. 29;
`
`hereinafter “AC”). As this Memorandum demonstrates, the Amended Complaint fails to allege the
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`factual and legal basis necessary for viable claims against Cigna.
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`I.
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`INTRODUCTION
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`Distilled to its essence, the Amended Complaint conveys the story of an opportunistic medical
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`provider who followed the old adage of never letting a crisis go to waste. Plaintiffs portray
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`themselves as “answer[ing] the call of towns and institutions . . . about the desperate need for
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`timely COVID-19 testing.” (AC, ¶ 14). In reality, the Amended Complaint details an elaborate
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`business enterprise to exploit a national health emergency for profit.
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`Plaintiffs’ own public communications demonstrate a practice of gross over-charging for
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`testing services, demanding that insurers pay $1,500 for Plaintiffs’ in-house test, while at the same
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`time acknowledging that a SARS-CoV-2 test costs only “$200 to $600” at the outside lab Plaintiff
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`also used. See http://coronatestct.com. Plaintiffs’ price gouging has attracted widespread press
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`coverage and numerous complaints by the people they tested,1 as well as the interest of the
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`Connecticut Attorney General’s Office, which stated in November 2020: “we have received
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`complaints and have an active, ongoing investigation[.]”2 Beyond COVID-19 price gouging,
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`1 See, e.g., Sarah Kliff, These Towns Trusted a Doctor to Set Up Covid Testing. Sample Patient Fee: $1,944, N.Y.
`TIMES, Nov. 10, 2020 (updated Nov. 12, 2020), https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-
`fees.html; see also Inside Edition Staff, Family Says Nearly $7,000 COVID-19 Test Bill Includes $480 Charge for
`Phone Call Telling Them Results, INSIDE EDITION, Nov. 12, 2020, https://www.insideedition.com/family-says-nearly-
`7000-covid-19-test-bill-includes-480-charge-for-phone-call-telling-them-results.
`
`2 Breen, Thomas, Covid-Test Doc’s Woes Mount; UNH Bails, New Haven Independent, Nov. 16, 2020,
`https://www.newhavenindependent.org/index.php/archives/entry/murphy_update/.
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`1
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 12 of 45
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`Plaintiffs also charged insurers for tests, consultations, and other services that either were
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`unnecessary or were never provided.
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`Faced with Plaintiffs’ blatant overbilling and improper billing, Cigna took the entirely
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`reasonable step of requesting that Plaintiffs provide records to document that they performed the
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`services for which they billed. (AC, ¶¶ 2, 60, 61). Plaintiffs were unable or unwilling to do so,
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`which led Cigna to, inter alia, demand repayment of amounts previously paid. (AC, ¶ 64, n. 12).
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`Plaintiffs seek to indict Cigna for requesting documentation to support their claims for plan
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`benefits, even in the face of substantial reasons to question the veracity and validity of those claims.
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`Such requests for information are necessary and appropriate. See, e.g., Rojas v. Cigna Health &
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`Life Ins. Co., 793 F.3d 253, 255 (2d Cir. 2015) (“Cigna regularly investigates its in-network
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`physicians regarding reimbursement claims that may be inconsistent with Cigna’s coverage
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`regarding medical necessity.”). In fact, Cigna owes fiduciary duties to the plans it administers –
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`many of which are self-funded by the employers who hire Cigna to provide administrative services
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`– to ensure that it authorizes payment only of legitimate claims for covered services.
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`Plaintiffs complain that the “burden” of furnishing proof to confirm and support the need for
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`and performance of the services they billed for would cause their “testing operation … to grind to
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`a halt.” (AC, ¶¶ 60-61). Purported inconvenience to Plaintiffs’ business enterprise is hardly
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`justification to preclude Cigna from confirming that millions of dollars in fees were legitimate and
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`billed properly. In fact, Plaintiffs bragged of “transform[ing]” their “traditional medical practice
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`overnight” by assembling “the clinical and administrative staff needed to operate the [testing]
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`sites[.]” (AC ¶¶ 22, 24). Presumably such efforts included staff necessary to support billing
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`functions.
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`2
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 13 of 45
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`Finally, this lawsuit has nothing whatever to do with protecting the interest of Cigna members
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`in obtaining SARS-CoV-2 testing. As Plaintiffs admit, “the Murphy Practice has not and will not
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`bill a Cigna member … for any of these services.” (AC, ¶ 100). Thus, this dispute is simply about
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`the financial interests of an out-of-network provider.
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`As the discussion below demonstrates, the Amended Complaint is long on rhetoric but
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`woefully short on required facts. In particular, the Amended Complaint does not identify a single
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`one of the “over 4,000” Cigna members it allegedly tested, and for whom it seeks payment.3
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`Neither is there any legal support for Plaintiffs’ contention that they have a direct right to sue
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`health plans and plan administrators for bills for SARS-CoV-2 testing services. The FFCRA, the
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`CARES Act, and abundant caselaw addressing express and implied causes of action, plainly lead
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`to the conclusion that Congress did not provide a private right of action.
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`II.
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`SUMMARY OF CLAIMS AND GROUNDS FOR DISMISSAL
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`The eight count Amended Complaint asserts: (1) a private right of action under the Families
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`First Coronavirus Response Act, Public Law 116-127 (“FFCRA”), and Section 3202(a) of the
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`Coronavirus Aid, Relief, and Economic Security Act (“CARES”) Act; (2) equitable reformation
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`of unidentified ERISA plans; (3) ERISA benefits claims for unidentified beneficiaries unsupported
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`by assignments of ERISA rights, 29 U.S.C. § 1132(a)(1)(B); (4) a claim for equitable relief under
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`29 U.S.C. § 1132(a)(3), to remedy alleged violations of ERISA procedures on unidentified claims
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`for unidentified beneficiaries; (5) a claim under the Connecticut Unfair Trade Practices Act
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`(“CUTPA”), C.G.S. § 42-110b et seq., for violation of the Connecticut Unfair Insurance Practices
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`Act (“CUIPA”), C.G.S. § 38a-816; (6) a claim for unjust enrichment; (7) a claim for
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`3 On April 9, 2021 (a week before this motion was due and over five months after they commenced this action),
`Plaintiffs disclosed purported details on services provided to approximately 2,600 individuals – far short of the 4,000
`that are supposedly at issue in this case. Plaintiffs have asserted that these are all outstanding claims to date, thus the
`Amended Complaint substantially over-states the number of Cigna members Plaintiffs allegedly tested.
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`3
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 14 of 45
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`reimbursement mandated by unspecified “federal law”; and (8) a claim for tortious interference
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`with contractual relationships. The Amended Complaint must be dismissed in its entirety for the
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`following reasons:
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`First, the Amended Complaint fails to plead essential facts necessary to recover
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`reimbursement from Cigna. Plaintiffs want payment of “more than $6 million” for COVID-19-
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`related health services provided to “over 4,000 members or beneficiaries” of Cigna plans (an
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`average charge of $1,500 per person). (AC, ¶ 64).4 But the Amended Complaint does not identify
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`a single individual Plaintiffs tested for whom Cigna did not pay. Plaintiffs cannot require Cigna to
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`guess which of the hundreds of thousands of claims it has received and administered since the
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`pandemic began are at issue in this action. The law requires out-of-network providers like Plaintiffs
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`to plead facts identifying patients and plans at issue, services provided, and the amounts billed and
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`owed.
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`Second, Plaintiffs have no private right of action – either express or implied – under FFCRA
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`or the CARES Act.
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`Third, Plaintiffs cannot recover under ERISA. The Amended Complaint alleges, in conclusory
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`fashion, that Plaintiffs received assignments from some Cigna members, but fails to identify any
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`specific assignment, the plan under which rights were assigned, or valid assignment language. Nor
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`is there a valid claim that the FFCRA or CARES Act grants Plaintiffs ERISA standing or requires
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`equitable reformation of unidentified ERISA plans. Further, the Amended Complaint fails to state
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`an ERISA claim for benefits or for equitable relief.
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`4 The number of alleged Cigna members has decreased from “over 4,400” to “over 4,000,” while the amount Plaintiffs
`seek to recover increased from $4.6 million to “more than $6 million.” Compare, Complaint, ¶ 9 with AC, ¶ 64.
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`4
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`Case 3:20-cv-01675-JBA Document 30-1 Filed 04/16/21 Page 15 of 45
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`Fourth, ERISA preempts Plaintiffs’ common-law claims for reimbursement of employee
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`benefits. Further, Plaintiffs have not pleaded facts establishing plausible claims for
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`CUTPA/CUIPA, unjust enrichment, or tortious interference. Nor can Plaintiffs rely on a
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`conclusory allegation that “federal law requires Cigna to pay” Plaintiffs for the benefits they
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`allegedly provided to Cigna, when Cigna’s obligations are governed by ERISA and the
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`unidentified plans covering the individuals Plaintiffs tested.
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`III.
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`SUMMARY OF PLAINTIFFS’ ALLEGATIONS 5
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`Plaintiffs, Murphy Medical Associates, LLC, Diagnostic and Medical Specialists of
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`Greenwich, LLC, North Stamford Medical Associates, LLC, and Coastal Connecticut Medical
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`Group, LLC (collectively, the “Murphy Practice”), seek payment for services related to SARS-
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`CoV-2 testing provided to over 4,000 unidentified individuals participating in