Wednesday, August 7, 2013

Humana - "We are not a government actor"

TRANSATLANTIC, LLC v. HUMANA, INC., Dist. Court, MD Florida 2013
Case No. 8:13-CV-1925-T-17
United States District Court, M.D. Florida, Tampa Division.
August 1, 2013.

In this case, Humana's Medicare Advantage plans were sued by a managed service organization whose contract was terminated after it was discovered that the MSO had violated Medicare regulations. One of the claims in this lawsuit was that Humana's termination had violated the MSO's First Amendment rights. In order to assert such a constitutional claim, though, the plaintiff must establish that the defendant is a governmental agency or a governmental actor.

The court summarizes Humana's position on this issue:
"Defendant responds that Defendant is not a government actor, and constitutional claims cannot be maintained against a private actor.

"Under limited circumstances, conduct by nominally private actors can be characterized as governmental action for constitutional purposes. However, the limited exceptions are not present in this case. Neither government regulation nor government funding, standing alone, convert a private entity into an arm of the state. See Gonzalez-Maldonado v. MMM Healthcare, Inc., 693 F.3d 244, 250 (1st Cir. 2012)"
The court found it unnecessary to make a determination on this issue, given the nature of the claims presented.

Thus, in the Transatlantic case, Humana asserts that it is not a govermental actor. We agree with that position. That acknowledgement severely undercuts its position in the four reimbursement cases Humana companies have recently filed against companies affiliated with Farmers Insurance.

District Court ruling