Taylor B. Theunissen, MD, LLC v. United States Office of Personel Management
2:24-cv-00531
| E.D. La. | Nov 27, 2024Background
- Plaintiff, Dr. Taylor B. Theunissen, sued as assignee of patient J.C., a federal employee who underwent breast cancer-related surgery and reconstruction covered under a health plan administered by GEHA and overseen by the Office of Personnel Management (OPM).
- After J.C. assigned her benefits, Theunissen performed the procedure and submitted a claim that was allegedly underpaid by GEHA.
- Theunissen claimed the preauthorization (precertification) letter constituted a binding contractual agreement for reimbursement at a “reasonable and customary” rate.
- Administrative appeals were exhausted per FEHBA and OPM denied the appeal in September 2021, advising that judicial review must be sought in federal court.
- Theunissen sued in March 2024 for judicial review (as assignee), and in his individual capacity pursued breach of contract and detrimental reliance claims under state law.
- OPM moved to dismiss based on untimeliness of the judicial review suit and preemption of state law claims by FEHBA; motions were converted to summary judgment due to reliance on matters outside the pleadings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Timeliness of judicial review claim under FEHBA | Prescription period starts at final agency decision (Sept. 2021), so suit (filed in 2024) is timely | Prescription period starts year care was provided (Feb. 2019), making Dec. 2022 the deadline | Judicial review claim is untimely; limitations period begins year care is provided |
| Preemption of state law breach of contract and detrimental reliance claims | Claims not preempted; based on separate contractual obligations arising from preauthorization letter | FEHBA expressly preempts state law claims relating to coverage or benefits under plan | State law claims are preempted by FEHBA; dismissed with prejudice |
Key Cases Cited
- Empire Healthchoice Assurance, Inc. v. McVeigh, 547 U.S. 677 (2006) (explains FEHBA structure, OPM’s authority, and broad FEHBA preemption)
- Coventry Health Care of Mo., Inc. v. Nevils, 581 U.S. 87 (2017) (clarifies the expansive scope of FEHBA preemption over state law)
- Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41 (1987) (discusses broad federal preemption for benefit plans)