Eide Bailly LLP v. Humphreys

CourtDistrict Court, D. Minnesota
DecidedMarch 29, 2024
Docket0:22-cv-03132
StatusUnknown

This text of Eide Bailly LLP v. Humphreys (Eide Bailly LLP v. Humphreys) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Eide Bailly LLP v. Humphreys, (mnd 2024).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA

Eide Bailly LLP,

Plaintiff and Counter-Defendant,

MEMORANDUM OF LAW AND ORDER v. Civil File No. 22-03132 (MJD/LIB)

Michael Humphreys, Acting Insurance Commissioner of the Commonwealth of Pennsylvania, in his capacity as the Statutory Rehabilitator of Senior Health Insurance Company of Pennsylvania,

Defendant and Counter-Claimant,

Lawrence M. Shapiro, Mark L. Johnson, Aaron P. Knoll, & Emily M. McAdam, Greene Espel PLLP, Counsel for Plaintiff and Counter-Defendant.

Heather L. Marx, Michael Broadbent, Dexter R. Hamilton, & Matthew J. Siegel, Cozen O’Connor, Counsel for Defendant and Counter-Claimant.

I. INTRODUCTION This matter is before the Court on Plaintiff/Counter-Defendant Eide Bailly (“EB”)’s Motion to Dismiss the Amended Counterclaim. (Doc. 40.) For the reasons discussed below, the motion is granted in part and denied in part. For simplicity, the “Amended Counterclaim” is referred to as “the Counterclaim” in

this Order. II. RELEVANT FACTS The facts are taken from the Amended Answer and Counterclaim and are

assumed to be true. The Counterclaim states claims for breach of fiduciary duty, negligence/accounting malpractice, and breach of contract arising out of the Parties’ professional relationship. (Countercl. ¶¶ 180-200.)

A. The Parties 1. Senior Health Insurance Company of Pennsylvania (“SHIP”) SHIP is a long-term care (“LTC”) insurer that has been in rehabilitation under the supervision of the Commonwealth Court of Pennsylvania since

January 2020. (Id. ¶¶ 23-24, 166.) “SHIP” will variously be used to refer to the insurance company and to the Defendant/Counter-Claimant in this action, the Rehabilitator. Rehabilitation “is a court supervised process intended to remedy

the company’s financial deterioration for the benefit of policyholders and creditors. The Rehabilitator is charged with the protection of the company’s

policyholders, creditors and the public. The rehabilitator’s actions are dictated by the laws and regulations of Pennsylvania and are subject to review by the

Commonwealth Court.” https://www.insurance.pa.gov/Regulations/ LiquidationRehab/Documents/GA/GA_FREQUENTLY_ASKED_QUESTIONS_U PDATED_FEBRUARY_12_2020.pdf (last visited March 26, 2024).

SHIP’s recent ownership and operational history is complicated. Until 2008, SHIP was a subsidiary of CNO Financial Group (“CNO”), which

transferred ownership of SHIP to a newly-formed trust, which was then merged into an independent oversight trust, the also newly-formed Senior Health Care Oversight Trust (“SHOT”), due to significant underwriting losses for SHIP

policies. (Countercl. ¶¶ 26-27.) CNO and its subsidiaries made approximately $915 million in capital contributions to SHIP. (Id. ¶ 28.)

SHIP maintained its own operations until 2012, when Fuzion Analytics, Inc. (“Fuzion”) was formed as a wholly-owned subsidiary of SHOT, ostensibly to provide administrative and management services to SHIP and other long-term

care insurance companies. (Id. ¶ 29.) Pursuant to a 2012 Agreement, SHIP conveyed essentially all of its employees and infrastructure to Fuzion in

exchange for agreed-upon cash consideration and Fuzion assumed responsibility for the administration of SHIP’s long-term care policies. (Id. ¶¶ 30-31.) Since 2012, SHIP has had no facilities or employees and relies exclusively on Fuzion

and other vendors for its operations. (Id. ¶ 31.) In August 2019, SHOT transferred all of its interest in Fuzion to SHIP as a capital contribution. Accordingly, Fuzion is now a wholly-owned subsidiary of SHIP. (Id. ¶ 32.)

SHIP began experiencing a material increase in financial difficulties “[a]t least by 2015, and perhaps earlier,” that led to the rehabilitation proceedings

described in the Counterclaim. (Id. ¶ 45.) Thus, during the relevant time period, SHIP was an LTC company in run-off, i.e., only a fraction of its business remains in force, and it will not generate any new business. (Id. ¶¶ 25, 38.) SHIP blames

its deterioration, “at least in part [on] diminished assets caused by poor management, imprudent investment decisions, and insufficient premiums and

premium rate increases, coupled with increased liabilities caused, in part, by demographic and market changes that led to higher than planned benefits costs.” (Id. ¶ 45.)

SHIP asserts that it was advised by a series of third-party consultants, including EB, that “provided overly optimistic, inappropriate, or inaccurate

estimates, assumptions, and calculations related to SHIP’s financial health” and “failed to notify SHIP or regulatory authorities of red flags that they knew or should have known existed regarding SHIP’s financial condition.” (Id. ¶ 46.)

SHIP states that it relied on “the purported expertise, advice, and opinions of EB to help make critical financial decisions in the management of its business and to ensure that SHIP reported and provided accurate, complete, and truthful

information to SHIP’s domestic regulator, the Pennsylvania Insurance Department [(“PID”)], and other regulatory authorities.” (Id. ¶ 47.)

2. Eide Bailly (“EB”) EB was SHIP’s independent auditor from 2013 to 2020. (Id. ¶ 33.) In that role, EB provided audit services required under Pennsylvania law, “including to

provide an independent opinion as to whether SHIP’s financial statements presented its financial condition and the results of its operations and cash flows fairly in all material respects.” (Id. ¶ 35.) In relevant part, Pennsylvania law

states that “every insurer . . . [shall] have an annual audit performed by an independent certified public accountant and shall file as instructed by the

Commissioner an audited financial report for that year on or before June 1 for the year ending December 31 immediately preceding unless an extension is granted . . . .” 31 Pa. Code § 147.3. (Id. ¶ 33 (ellipses in original).)

As an independent auditor, EB was required to adhere to Generally Accepted Accounting Standards (“GAAS”) when conducting audits. (Id. ¶ 36.) EB’s audit opinions each covered two years and its audit opinions from 2013-20

for fiscal years 2013-19 stated that the audits were conducted in accordance with GAAS. (Id. ¶¶ 34, 36, 121.) At the time that EB became SHIP’s auditor, the LTC industry was having financial difficulties, “largely stemming from aggressive

actuarial assumptions which resulted in inadequate policy pricing and materially understated loss reserves . . . .” (Id. ¶ 38.) Therefore, EB had to “understand the

risks of SHIP being a [sic] LTC company in run-off” and the “key vendors and consultants upon which SHIP relied,” including SHIP’s appointed actuary, Milliman, USA. (Id.)

B. Relevant Background Information and Entities 1. Milliman USA (“Milliman”) and Lewis and Ellis (“L&E”) SHIP engaged Milliman USA as its actuary from as early as 2008 until at

least 2019. (Id. ¶¶ 38, 48.) During three years of litigation in another case, the Commonwealth Court of Pennsylvania criticized and, in 2012, “rejected” Milliman’s actuarial work for two other Pennsylvania LTC insurers “before and

after the start of the receivership, finding that Milliman’s analyses and calculations ‘fluctuated wildly’ and ‘violently in a short period of time,’ and that

Milliman’s projections were ‘inherently unreliable.’” (Id. ¶¶ 41-42.) In its decision denying the insurers’ request for liquidation and requiring

rehabilitation in that case, the word “Milliman” appeared 295 times. (Id. ¶ 42.) 2. Issues with Milliman’s Work for SHIP In this case, Milliman provided 2015 assumptions that misrepresented

SHIP’S financial health, “potentially concealing a massive deficit that SHIP should have recognized in its financial statements.” (Id.

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