Cedars-Sinai

BACKGROUND

I. Factual Background

Cedars-Sinai is a licensed hospital and non-profit Califor- nia corporation. PBP Health is a professional organization CEDARS-SINAI v. NAT’L LEAGUE OF POSTMASTERS 9633 that administered a federal health benefit plan (“the Plan”). The Plan was created pursuant to FEHBA, which authorizes the U.S. Office of Personnel Management (“OPM”) to con- tract with insurance carriers to provide health benefits for fed- eral employees. The Plan was formed by contract between OPM and PBP Health. Under the terms of the contract, PBP Health was the administrator of the Plan and was responsible for managing and paying claims for benefits owed to enroll- ees. Cedars-Sinai and PBP Health entered into a separate con- tract that governs the payment of services rendered by Cedars-Sinai to members of the Plan.

On four separate occasions between October 18, 2001, and January 24, 2002, patient “S.M.,” an enrollee and participant in the Plan, went to Cedars-Sinai for treatment. On all four occasions, PBP Health verified that S.M. was a Plan partici- pant and authorized Cedars-Sinai to perform medical services. Cedars-Sinai submitted claims totaling $742,217.93,…