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Northwell Health Inc. v. Blue Cross Blue Shield of Tennessee Inc.

Breach, Third Party Beneficiary Claims Survive But Unjust Enrichment Claim Is Duplicative

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ADDITIONAL CASES Northwell Health, Inc., Plaintiff v. Health Care Service Corporation, Defendant; CV 23-602 Northwell Health, Inc., Plaintiff v. Bluecross Blueshield of Florida, Inc., Defendant; CV 23-1765 MEMORANDUM & ORDER Presently before the Court is a joint motion to dismiss filed in each of the three above-listed cases. Docket Entry (“DE”) 36.¹ For the reasons stated herein, that motion is GRANTED in part and DENIED in part. Factual Background All factual allegations are taken from the Amended Complaint and assumed to be true for the purposes of deciding this motion. Plaintiff Northwell Health is a New York not-for-profit corporation that operates hospitals and health care facilities. Amended Complaint, DE 21 1. Beginning in 2000, plaintiff has maintained a contractual relationship with Empire Blue Cross Blue Shield HMO (“Empire”), a health insurance provider based in New York, by which plaintiff agreed to provide medically necessary services for Empire’s patients and Empire agreed to reimburse plaintiff according to a payment schedule. Id.

6-8. The basic contours of this arrangement have remained the same through the years, but the most current version of their agreement is contained in a 2008 document titled Participating Practitioner Group Agreement (hereinafter the “Provider Agreement”) and its subsequent amendment. Id. 18. Empire is a member of the Blue Cross Blue Shield Association (“BCBSA”), a national organization that maintains the Blue Cross Blue Shield trademarks and licenses them to various entities, including Empire; these entities are collectively known as “Blue Card Plans.” Id.

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