Summary
The United States District Court for the Central District of California denied Plaintiff John Attenello, MD’s motion to remand and granted Aetna Life Insurance Company’s motion to dismiss. The court held that removal was proper under the federal officer removal statute because Aetna operates as a Medicare Advantage Organization acting under the Centers for Medicare and Medicaid Services. The court dismissed the action without prejudice and with leave to amend, concluding that Plaintiff’s reimbursement claims were subject to Medicare Act administrative-exhaustion requirements and were inadequately pleaded.
Court
United States District Court for the Central District of California
Jurisdiction
United States District Court for the Central District of California
Decision date
September 16, 2025
Docket number
2:25-cv-04869-WLH-E
Disposition
dismissed
Questions Presented
- Whether removal was proper under the federal officer removal statute, 28 U.S.C. § 1442(a)(1).
- Whether the claims arose under the Medicare Act and were subject to the Act's administrative exhaustion requirements.
- Whether the complaint adequately stated claims for breach of contract, quantum meruit or unjust enrichment, and detrimental reliance or promissory estoppel.
Holdings
- Removal was proper under 28 U.S.C. § 1442(a) because Aetna is a Medicare Advantage Organization acting under the Centers for Medicare and Medicaid Services in administering Medicare benefits, and the statutory removal requirements were satisfied.
- The claims arose under the Medicare Act because they sought additional reimbursement for Medicare-covered services and were inextricably intertwined with a claim for Medicare benefits. Judicial review was therefore subject to the Medicare Act's administrative exhaustion requirements, and the claims had to be dismissed without prejudice for failure to allege exhaustion.
- The breach-of-contract claim was inadequately pleaded because Plaintiff did not identify the contractual provision requiring Aetna to pay the services in full or at all.
- The quantum-meruit and unjust-enrichment theories were inadequately pleaded because Plaintiff had an adequate potential remedy at law and did not allege facts showing that restitutionary relief was necessary or nonduplicative.
- The detrimental-reliance theory failed to state a claim for promissory estoppel because Plaintiff alleged neither a clear and unambiguous promise nor detrimental reliance.
Court Document
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