Court Opinion

ID: 9386904
Source: CourtListenerOpinion
Date Created: 2023-04-14 00:00:25.880881+00
Date Added: 2024-06-11T17:18:09.345874
License: Public Domain

Case: 21-30148        Document: 00516711430             Page: 1      Date Filed: 04/13/2023

             United States Court of Appeals
                  for the Fifth Circuit
                                                                              United States Court of Appeals
                                                                                       Fifth Circuit

                                     ____________                                    FILED
                                                                                 April 13, 2023
                                       No. 21-30148                             Lyle W. Cayce
                                     ____________                                    Clerk

   Mark Wightman, Doctor of Dental Surgery; Courtney
   Wightman, Doctor of Dental Surgery; Wightman Family
   Dental, L.L.C.,

                                                                  Plaintiffs—Appellants,

                                            versus

   Ameritas Life Insurance Corporation; Dentemax,
   L.L.C.,

                                              Defendants—Appellees.
                     ______________________________

                     Appeal from the United States District Court
                        for the Eastern District of Louisiana
                              USDC No. 2:19-CV-11628
                     ______________________________

   Before Wiener, Graves, and Ho, Circuit Judges.
   James E. Graves, Jr., Circuit Judge: *
         We previously certified a question to the Louisiana Supreme Court in
   this matter asking whether claims arising under Louisiana’s Preferred
   Provider Organization Act, La. R.S. 40:2203.1, are delictual or contractual

         _____________________
         *
             This opinion is not designated for publication. See 5th Cir. R. 47.5.
Case: 21-30148        Document: 00516711430              Page: 2     Date Filed: 04/13/2023

                                         No. 21-30148

   for prescriptive purposes. After receiving a response that such claims are
   contractual, we REVERSE the judgment below and REMAND.
                       Facts and Procedural History
         Mark Wightman D.D.S. and Courtney Wightman D.D.S. are dentists
   who own and operate Wightman Family Dental, L.L.C. (collectively referred
   to as “Wightman”) in St. Bernard Parish, Louisiana. On February 16, 2009,
   Wightman and DenteMax, which is not a party to this appeal, entered into a
   Preferred Provider Organization (PPO) agreement to expand Wightman’s
   client base via access to DenteMax’s network. 1 Under the PPO agreement,
   Wightman agreed to join the DenteMax PPO network, discount fees for
   services provided to network participants, and allow DenteMax to grant
   payors and participants access to those discounted rates.
          In May of 2012, Ameritas Life Insurance Corp leased the DenteMax
   PPO network, which granted Ameritas access to the reduced PPO
   reimbursement rate that Wightman had provided to DenteMax.                          The
   network agreement allowed Ameritas to use the DenteMax network rates to
   reimburse any participating provider of services rendered to Ameritas’

         _____________________
         1
             Under Louisiana law, a PPO is defined as:
                   [A] contractual agreement or agreements between a provider or
                   providers and a group purchaser or purchasers to provide for
                   alternative rates of payment specified in advance for a defined
                   period of time in which:
                   (i) The provider agrees to accept these alternative rates of
                   payment offered by the group purchasers to their members
                   whenever a member chooses to use its services.
                   (ii) There is a tangible benefit to the provider in offering such
                   alternative rates of payment to the group purchaser.
          La. R.S. 40:2202(5)(a).

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                                         No. 21-30148

   insureds. The district court found that Wightman received no notice of the
   agreement from DenteMax or Ameritas.
            Later that year, patients presented Ameritas’ benefit cards to
   Wightman. Wightman asserts that it believed it would be reimbursed at the
   standard rate for Ameritas’ insureds, as specified on Ameritas’ cards. But
   Wightman asserts that, after it performed services and sought
   reimbursement, it was paid at a lower rate that was neither disclosed nor
   published on the patients’ cards. After receiving payments at the reduced
   rate, Wightman contacted Ameritas and learned of the leasing agreement
   between Ameritas and DenteMax.                Ameritas also denied Wightman’s
   request to be reimbursed at the standard rate advertised on Ameritas’ benefit
   cards.
            On July 11, 2019, Wightman filed an action against Ameritas and
   DenteMax for breach of contract and violations of Louisiana’s PPO Act,
   which requires insurers to notify health care providers when reimbursing at
   a reduced PPO rate. See La. R.S. 40:2203.1. Ameritas and DenteMax filed
   separate Rule 12(b)(6) motions to dismiss that the district court granted in
   part and denied in part. 2 That order was not appealed. Wightman then filed
   two amended complaints and converted the case into a putative class action.
            Ameritas and DenteMax again moved to dismiss, asserting for the first
   time that Wightman’s claims were prescribed under Louisiana law. After
   notifying the parties, the district court converted the filings into motions for
            _____________________
            2
             Specifically, the district court: (1) determined that dentists were healthcare
   providers within the meaning of the statute; (2) determined the exemption provision in La.
   R.S. 40:2203.1(A) did not apply to DenteMax; and (3) found that Wightman had failed to
   allege contractual privity between themselves and Ameritas, thus, Ameritas could not be a
   “group purchaser” under the language of La. R.S. 40:2202(3). However, the district court
   also noted that, “under a plain reading of La. R.S. 40:2203.1, Ameritas could be ‘deemed’
   a group purchaser ‘for purposes of this Section’ under La. R.S. 40:2203.1(B)(4).”

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                                      No. 21-30148

   partial summary judgment after deciding that it might consider exhibits in
   deciding the prescription arguments. While those motions were pending,
   Ameritas also filed a motion for partial summary judgment on the claims for
   unjust enrichment and injunctive relief.
          On October 27, 2020, the district court granted Ameritas’ motions
   and dismissed Wightman’s claims for violations of La. R.S. 40:2203.1, unjust
   enrichment, and injunctive relief. Specifically, the district court determined
   that claims under La. R.S. 40:2203.1 are delictual claims subject to
   prescription of one year rather than contractual claims subject to the ten-year
   prescriptive period for personal actions. See La. C.C. art. 3492, 3499; see also
   La. C.C.P. art. 422. The district court also determined that Wightman could
   not bring an unjust enrichment claim against Ameritas because, but for
   prescription, they would have had a chapter 40 claim. The district court
   dismissed Ameritas from this case on March 11, 2021, and Wightman
   appealed.
                                    Discussion
          We review a grant of summary judgment de novo, applying the same
   criteria as the district court in the first instance. See Causey v. Sewell Cadillac-
   Chevrolet, Inc., 394 F.3d 285, 288 (5th Cir. 2004); see also Austin v. Kroger
   Texas, L.P., 864 F.3d 326, 328 (5th Cir. 2017). However, “[f]irst we consult
   the applicable law to ascertain the material factual issues.” Stewart Title
   Guar. Co. v. Old Republic Nat’l Title Ins. Co., 83 F.3d 735, 738 (5th Cir. 1996).
   We also consider questions of law or mixed questions of law and fact de novo.
   House v. Am. United Life Ins. Co., 499 F.3d 443, 448 (5th Cir. 2007).
   Summary judgment is proper when “the movant shows that there is no
   genuine dispute as to any material fact and the movant is entitled to judgment
   as a matter of law.” Fed. R. Civ. P. 56(a).

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                                         No. 21-30148

           As stated previously, the district court gave notice and converted the
   motions to dismiss into motions for partial summary judgment only for
   purposes of deciding whether the claims were prescribed. Because the
   Louisiana Supreme Court had not ruled on the prescription issue, the district
   court made an Erie guess that such claims were delictual. On appeal, we
   certified the following question to the Supreme Court of Louisiana: “Are
   claims arising under the Louisiana’s Preferred Provider Organization Act,
   La. R.S. 40:2203.1, delictual or contractual for prescriptive purposes.” No.
   21-30148, 2022 WL 610795, at *5 (5th Cir. Mar. 2, 2022).
           In October 2022, the Supreme Court of Louisiana answered the
   certified question, holding that claims under La. R.S. 40:3303.1 are
   contractual, and the prescriptive period for such claims is ten years as set out
   in La. C.C. art. 3499. Wightman v. Ameritas Life Ins. Corp., 2022-364, p. 10-
   11 (La. 10/21/22); 351 So. 3d 690, 696-7. Accordingly, we now REVERSE
   the district court’s grant of partial summary judgment and dismissal of
   Ameritas and REMAND for further proceedings consistent with this
   opinion. 3 The Appellants’ opposed motion for judicial notice is DENIED.

           _____________________
           3
              We recognize that the parties make additional arguments. However, prescription
   is the dispositive issue for purposes of this summary judgment. Thus, we decline to address
   any additional issues at this stage, and we make no determination as to whether they are
   properly before this court.

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