Justice Anil C. Singh Jr.
This dispute over rates paid to a health care provider by an insurance company is an apparent case of first impression. New York City Health and Hospitals Corporation (HHC), a public benefit organization that operates municipal hospitals in New York City, brought action against WellCare of New York Inc., a private insurer authorized under federal law to provide benefits to Medicare recipients. HHC alleged its hospitals provided emergency services to WellCare’s Medicare enrollees, fulfilling its obligation to ensure that its enrollees received such services. HHC further alleged that WellCare had a duty to pay for those services with its own funds, and was unjustly enriched by its calculated underpayment. HHC contended it sought only the amount it expected to be paid, and the amount it billed WellCare, even if it is determined the reasonable value of HHC’s services is higher. The court denied WellCare dismissal. The facts alleged sufficiently state a cause of action for unjust enrichment as physicians in HHC’s emergency rooms were legally required to provide medical services to WellCare’s employees.
