Abol G. Helmy v. Aetna Health of California, Inc, 2:17-cv-02125

Helmy, after a major stroke, received SNF rehabilitation at a facility; insurer Aetna informed him it likely would not continue coverage past Sept. 2, 2015.
Helmy filed a state-law complaint for breach of the implied covenant of good faith and fair dealing, alleging Aetna’s wrongful termination/delay of SNF coverage caused irreparable harm to his recovery and sought tort damages.
Aetna removed the action to federal court asserting federal-question jurisdiction under the Medicare Act (42 U.S.C. §§ 1395 et seq.).
Helmy moved to remand the case to state court and sought attorneys’ fees and costs under 28 U.S.C. § 1447(c).
The central legal dispute was whether Helmy’s state-law tort claim “arises under” the Medicare Act (i.e., is inextricably intertwined with a claim for Medicare benefits) and whether removal was objectively reasonable for fee purposes.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether federal-question jurisdiction exists because the claim arises under the Medicare Act	Helmy: claim is a state-law tort for damages from wrongful denial/delay of coverage, not a claim for Medicare benefits	Aetna: claim depends on Medicare-covered services and thus arises under the Medicare Act and is inextricably intertwined with Medicare benefits	Court: Remand — claim does not arise under the Medicare Act; Helmy seeks tort damages that cannot be remedied by a retroactive Medicare benefit authorization
Whether plaintiff is entitled to attorney’s fees and costs under 28 U.S.C. § 1447(c)	Helmy: removal was improper so fees and costs should be awarded	Aetna: removal was reasonable	Court: Denied fees — Aetna had an objectively reasonable basis for removal

Kokkonen v. Guardian Life Ins. Co. of Am., 511 U.S. 375 (1994) (federal courts are courts of limited jurisdiction)
Heckler v. Ringer, 466 U.S. 602 (1984) (tests for when claims "arise under" federal statutes)
Ardary v. Aetna Health Plans of California, Inc., 98 F.3d 496 (9th Cir. 1996) (state wrongful-death claims did not arise under Medicare despite relation to benefit denials)
Do Sung Uhm v. Humana, Inc., 620 F.3d 1134 (9th Cir. 2010) (framework for when claims are "inextricably intertwined" with Medicare benefits)
Hofler v. Aetna U.S. Healthcare of Cal., Inc., 296 F.3d 764 (9th Cir. 2002) (post-Ardary discussion that some harms cannot be remedied by retroactive benefit payment)
Gaus v. Miles, Inc., 980 F.2d 564 (9th Cir. 1992) (presumption against removal; burden on removing defendant)
Abrego Abrego v. The Dow Chem. Co., 443 F.3d 676 (9th Cir. 2006) (burden on defendant to establish removal jurisdiction)
Martin v. Franklin Capital Corp., 546 U.S. 132 (2005) (standard for awarding fees under § 1447(c): lack of objectively reasonable basis required)