Advanced Reimbursement Solutions LLC v. Spring Excellence Surgical Hospital LLC

District Court, D. Arizona·Decided February 6, 2020·No. 2:17-cv-01688·Unknown

Opinion

WO

Advanced Reimbursement Solutions LLC, No. CV-17-01688-PHX-DWL

Plaintiff, ORDER

v.

Spring Excellence Surgical Hospital LLC,

Defendant. Pending before the Court is Plaintiff Advanced Reimbursement Solutions, LLC’s (“ARS”) motion for partial summary judgment on damages. (Doc. 224.) The Court previously held that Defendant Spring Excellence Surgical Hospital, LLC (“SESH”) was liable to ARS for breach of contract. (Doc. 215.) For the following reasons, ARS’s motion will be granted. I. Factual Background ARS is a medical billing service that contracts with medical providers to process and bill out-of-network insurance claims. (Doc. 98 ¶ 5; Doc. 98-2 at 49.) SESH owns and operates a hospital in Texas. (Doc. 98-1 at 10.) When it was formed, SESH’s sole manager was Excellence Medical Group, LLC (“EMG”). (Doc. 98 ¶ 8; Doc. 98-2 at 55.) ARS and SESH formed a valid contract—the Billing Agreement—no later than September 26, 2016.1 (Doc. 215 at 7-8.) The Billing Agreement laid out the terms of the

1 ARS, in its prior motion for partial summary judgment, argued that a contract could be found on three different grounds. (Doc. 215 at 7.) The Court found it unnecessary to business relationship between the two parties. (Doc. 98-4 at 15-26.) The gist of the Billing Agreement was that ARS, the exclusive provider of out-of-network claims services for SESH, was to timely recover amounts owed to SESH by private health insurance providers in exchange for a cut of the amounts ARS recovered. (Id. at 15, 18.) Specifically, the terms of the contract entitled ARS to 17.5% of reimbursements it helped recover for SESH from insurance providers, 25% of amounts SESH received following an appeal or redetermination, and costs incurred by ARS in performing its services. (Id. at 16, 18.) ARS was to bill SESH monthly and payment was due from SESH no later than ten business days after the date of invoice. (Id. at 18.) If SESH failed to remit payment within the specified time limits, ARS was permitted to charge SESH a late fee. (Id. at 18-19.) The late fee entitled ARS to (1) the greater of $150 or 10% of the amount overdue and (2) interest accruing at an annual rate of 18%. (Id.) Following execution of the Billing Agreement, ARS began performing under the contract by collecting patient and medical services information from SESH via a secure computer system connection and preparing and filing medical claims for reimbursement with health insurance providers. (Doc. 98-2 at 49.) Between approximately December 1, 2016 and December 1, 2017, ARS sent invoices to SESH seeking a total of over $700,000 in compensation. (Doc. 98 ¶ 46; Doc. 98-6 at 2-15; Doc. 224-1 at 3-24.) The invoices attached to the earlier motion for partial summary judgment included EMG’s address in Houston, Texas, but the invoices attached to the present motion include SESH’s address in Spring, Texas. (Compare Doc. 98-6 at 2-15 with Doc. 224-1 at 3-24.) SESH has yet to send any money to ARS in response to these invoices. (Doc. 98 ¶ 47; Doc. 98-2 at 49.) On February 23, 2017, Dr. Mirza Baig, SESH’s then-interim CEO, sent a letter requesting that ARS “immediately cease and desist providing all billing and collections services for [SESH].” (Doc. 98-6 at 17-18.) The letter asserted that “ARS began materially breaching the Agreement as early as the first month of the term of the Agreement” and

address all three arguments, finding that SESH ratified the Billing Agreement at a board meeting on September 26, 2016. (Id.) stated, in support of this assertion, that “an independent audit of the claims processed by ARS under the Agreement from the beginning of the Agreement through February 17, 2017 demonstrate[d] that ARS has failed to perform under its primary obligation under the Agreement at Section 1 in at least 95% of the claims it agreed to properly process under the Agreement.” (Id.) The letter thus contended that the “ongoing material breach by ARS excuses SESH’s performance under the agreement.” (Id. at 18.) If ARS had, in fact, materially breached the Billing Agreement, the end date of the contract would have been April 23, 2017. (Doc. 98-4 at 19 [specifying that if ARS is in material breach of the contract, the Billing Agreement terminates at the end of the 60-day cure period].) On February 27, 2017, ARS sent a response letter demanding that SESH remit payment of the past-due amounts (at the time, over $125,000) by no later than March 10, 2017. (Doc. 98-6 at 20-22.) In this letter, ARS also disputed SESH’s claim that it had breached the Billing Agreement and asserted that SESH hadn’t complied with the Billing Agreement’s termination provision. (Id.) On March 23, 2017, SESH’s counsel responded to ARS’s letter by proposing a settlement offer and noting that the Billing Agreement “was executed and agreed to by the CEO of [EMG] without any agency or corporate authority to bind SESH to the terms of the agreement in question.” (Doc. 98-6 at 24.) Notwithstanding the cease and desist letter and the settlement offer, ARS continued sending SESH invoices every month until December 2017. (Doc. 224-1 at 3-24.)2 As of May 31, 2019—the date ARS filed the pending motion—ARS claimed SESH owed $734,934.03 in unpaid principal, late fees of $73,493.41, and interest accruing at 18% annually. (Doc. 224 at 9.)

2 ARS included, as an attachment to its present motion, an “Outstanding Claims Report” that purportedly shows that it stopped engaging in billing and claims processing activities on SESH’s behalf by March 15, 2017. (Doc. 224-2 at 41-51; Doc. 224-3 at 1- 13.) However, after SESH questioned the trustworthiness and admissibility of this document (Doc. 229 at 10-13), ARS made only a half-hearted attempt (in a footnote) to address those arguments, instead stating that the Court could rule in its favor without considering the Outstanding Claims Report. (Doc. 230 at 11 & n.6.) Accordingly, the Court will not consider the Outstanding Claims Report for purposes of its analysis here. II. Procedural History On May 31, 2017, ARS initiated this action by filing a complaint for breach of contract, breach of the implied covenant of good faith and fair dealing, and, in the alternative, unjust enrichment. (Doc. 1.)3 On August 18, 2017, SESH filed an answer to the amended complaint. (Doc. 21.) On June 8, 2018, ARS filed a motion for partial summary judgment limited to the issue of liability for breach of contract, or, in the alternative, unjust enrichment. (Doc. 97.) On April 12, 2019, SESH filed a response to that motion. (Doc. 211.) On April 26, 2019, ARS filed a reply to SESH’s response. (Doc. 212.) On May 10, 2019, the Court granted ARS’s motion for partial summary judgment as to the liability of SESH on the breach of contract claim and denied the claim for unjust enrichment as moot. (Doc. 215.) On May 31, 2019, ARS filed another motion for partial summary judgment limited to the measure of damages. (Doc. 224.) 4 On July 8, 2019, SESH filed a response to that motion. (Doc. 229.) On July 25, 2019, ARS filed a reply to SESH’s response. (Doc. 230.) On August 13, 2019, with leave of the Court, SESH filed a surreply. (Doc. 233.) I. Legal Standard A party moving for summary judgment “bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of ‘the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,’ which it believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). “In order to carry its burden of

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Advanced Reimbursement Solutions LLC v. Spring Excellence Surgical Hospital LLC, (D. Ariz. 2020).

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