September 2026
TO: ALL INTERSTED PHYSICIANS
As reported in the NY Health Law Journal, in the matter, Hudson Neurosurgery, PLLC v. Archdiocese of New York, the Southern District of New York addressed whether an out-of-network medical provider could pursue an unjust enrichment claim against a plan sponsor after performing surgery on a covered dependent whose insurer denied prior authorization.
The single-physician neurosurgical practice (which did not participate in commercial insurance networks), performed cervical spine surgery on a patient who was insured as a dependent under a group health plan sponsored by the Archdiocese of New York (the Archdiocese) administered by UnitedHealth care.
Prior to surgery, the practice, (Hudson), sought authorization from UnitedHealth care, which was denied on the basis that practice was out-of-network and the patient lacked out-of-network benefits. Hudson, appealed the denial, arguing medical necessity, but did not characterize the surgery as emergent. The surgery was initially canceled but later performed after the patient presented to the hospital, was evaluated by several physicians, and ultimately consented to surgery by Hudson’s physician after discussing alternative treatment options.
Following the procedure, Hudson billed approximately $498,842. Several months later, Hudson entered into a Single Case Agreement (the SCA) negotiated through a third-party. UnitedHealth care subsequently paid Hudson $29,116.67.
Hudson then commenced an action against the archdiocese in New York County Supreme Court asserting a claim for unjust enrichment, alleging that the Archdiocese benefited from the provision of medical services to its plan beneficiary without paying the reasonable value of those services.
The Archdiocese moved the action to federal court and moved for summary judgment, arguing that the SCA constituted an enforceable contract barring any quasi-contract claim and, alternatively, that the surgery was elective and non-emergent, precluding recovery under any emergency-care or equity-based theory.
On summary judgment, the court addressed whether the Single Case Agreement constituted a valid and enforceable contract. The court concluded that it did. UnitedHealth care agreed to pay a negotiated amount, and Hudson agreed to accept that amount as payment in full and not bill the patient for the balance.
The court rejected Hudson’s arguments that the agreement lacked mutuality.
Although the Archdiocese itself was not a party to the SCA, the court explained that the existence of a valid contract governing the same subject matter generally bars an unjust enrichment claim, even against a non-party.
The court then turned to Hudson’s argument that the claim survived because the surgery was required as emergency treatment under the Emergency Medical Treatment and Labor Act (EMTALA). Under EMTALA, hospitals must either stabilize patients who present with emergency medical conditions or transfer the patient to another medical facility. Some courts have recognized that when emergency care is legally required, an insurer may be unjustly enriched if it fails to fully compensate the provider. Thus, whether the surgery was emergent or elective became critical. *
The parties sharply disputed this point. The Archdiocese relied on medical records suggesting the patient was stable and not in an emergency condition, while Hudson relied on testimony and reports from its physician stating that the patient was in severe pain “with a dead right arm,” and required urgent intervention. Because the record contained competing medical evidence and reasonable inferences could be drawn in either direction, the court held that it could not resolve the emergency-versus elective question on summary judgment. Accordingly, while the court ruled as a matter of law that the Single Case Agreement was valid, it denied summary judgment on the unjust enrichment claim to the extent it depended on whether the surgery qualified as emergency treatment. The motion for summary judgment was therefore granted in part and denied in part, and the case was allowed to proceed on the unresolved factual issue.*[1]
Result: Court Upholds Single Case Agreement but Allows Unjust Enrichment Claim To Proceed in Dispute Over if ‘Emergency Surgery’ was warranted.
Respectfully submitted,
Schaum Law
[1] Danya B. Tann, Esq.