Homeland Insurance Company of Delaware v. Independent Health Association, Inc.

District Court, W.D. New York·Decided June 5, 2025·No. 1:22-cv-00462·Unknown

Opinion

UNITED STATES DISTRICT COURT W ESTERN DISTRICT OF NEW YORK

HOMELAND INS. CO. OF DELAWARE,

Plaintiff, 22-CV-00462-MAV-HKS v.

INDEPENDENT HEALTH ASS’N, INC., INDEPENDENT HEALTH CORP., DXID, LLC, AND ELIZABETH GAFFNEY,

Defendants/Third-Party Plaintiffs,

v.

ACE AMERICAN INS. CO.,

Third-Party Defendant.

DECISION AND ORDER This case was referred to the undersigned by the Hon. William M. Skretny, pursuant to 28 U.S.C. ' 636(b)(1)(A), for all pretrial matters. Dkt. #20. The case is currently assigned to the Hon. Meredith A. Vacca. (Clerk’s Office Entry of 1/22/2025).

INTRODUCTION This is a declaratory judgment action in which plaintiff Homeland Insurance Company of Delaware (“Homeland”) seeks a declaration that it has no defense or indemnity obligations arising out of an insurance policy it issued to defendant Independent Health Association, Inc. (“IHA”) as to claims asserted against IHA and other insureds1 in a federal qui tam action and related arbitration. Dkt. #1, ¶¶ 1-3. Third-party defendant Ace American Insurance Company (“Ace”) seeks a similar determination as to its indemnity obligations under an excess insurance policy it issued to defendants. Dkt. #30.

This matter is currently before the Court on defendants’ motion to compel (Dkt. #92), Homeland’s motion for attorney fees (Dkt. #95), defendants’ motion for leave to file a surreply (Dkt. #122), Homeland’s motion to compel (Dkt. #125), and Homeland’s motion to seal (Dkt. #130).

BACKGROUND The facts alleged in this matter have been set forth in a previous Decision and Order by the then-presiding district court judge, Dkt. #51, as well as prior Decisions and Orders by the undersigned. Dkt. ##58, 78. Those decisions are incorporated here.

The Claims in this Action Briefly, Homeland and Ace seek declarations that they owe no duty to defend or indemnify defendants relating to an underlying qui tam action pending in this

1 Defendants Independent Health Corporation (“IHC”), DxID, LLC, and Elizabeth Gaffney (“Gaffney”) were also insureds under the Homeland policy. IHC and DxID are or were subsidiaries of IHA. Dkt. #1, ¶¶ 7-8. Gaffney was the Chief Executive Officer of DxID. Dkt. #1, ¶ 9. Court, United States ex rel. Ross v. Indep. Health Corp., Case No. 12-CV-299-WMS, and a related arbitration that was settled in July 2022. Dkt. #51, p. 4.2

In the qui tam action, “the government maintains that Defendants defrauded

the federal Medicare program by submitting false and inflated claims for reimbursement.” Dkt. #51, p. 3. The government’s complaint-in-intervention alleges claims under the False Claims Act (“FCA”), 31 U.S.C. §§ 3729, et seq., and common law. Dkt. #51, p. 2. The arbitration arose, in part, out of the same allegations. Dkt. #51, p. 4.

Homeland and Ace maintain that several exclusions in the Homeland policy preclude coverage for the claims against defendants in those actions. Relevant here is Exclusion D (“the prior knowledge exclusion”), which excludes coverage for any claims, damages, or claims expenses arising out of any actual or alleged act, error, or omission if, before the inception date of the policy, defendants knew or should reasonably have

known that the act, error, or omission would give rise to a claim.3 Dkt. #1, ¶ 46.4

2 The qui tam was settled per a Joint Stipulation of Dismissal entered on January 8, 2025. Case No. 12-CV-299-WMS, Dkt. #189. However, the matter remains open as the parties brief the relator’s request for attorney fees.

3 The Homeland policy was issued on August 1, 2013 and renewed on August 1, 2014. Dkt. #1, ¶¶ 13-14.

4 Other exclusions are: Exclusion A, which excludes coverage for intentionally fraudulent acts that are established by a final adjudication, Dkt. #1, ¶45; Exclusion J, which excludes coverage for any claims, damages, or claim expenses brought by, or on the behalf of, certain governmental or regulatory bodies or agencies, Dkt. #1, ¶ 47; and Exclusion K, which excludes coverage for certain claims, damages, or claims expenses for liabilities arising under any indemnification agreement, Dkt. #1, ¶ 48. Facts Relevant to the Present Discovery Disputes Defendant’s Discovery Requests to Homeland and Ace On June 2, 2023, defendants served Homeland and Ace with interrogatories and document requests. Dkt. ##92-13, 92-26, 102-2, 102-3.

Interrogatory No. 3 requests that Homeland and Ace “[i]dentify all Communications and Documents concerning [their] basis for denying the Policyholders coverage under the [Homeland and Ace] Policies.” Dkt. ##92-12, p. 8, 92-13, p. 8. These interrogatories define “Homeland Policies” as the two specific policies—identified by policy number—that Homeland issued to defendants on August 1, 2013 and August 1, 2014, respectively. Dkt. #102-2, p. 5. In response to Interrogatory No. 3, Homeland and Ace identified a variety of documents related to their coverage positions. Dkt. ##92-12, p. 9, 92-13, p. 8.

Interrogatory No. 5 states: “Identify all Communications and Documents addressing, describing, reflecting, analyzing, supporting, or contradicting [Homeland’s and Ace’s] position regarding the meaning, scope, and application of each of Exclusion A, Exclusion D, Exclusion J, and/or Exclusion K of the Homeland Policies.” Dkt. ##92-12, p. 10, 92-13, p. 10. After asserting objections, Homeland responded by referring to its response to Interrogatory No. 3. Id. In turn, Ace asserted objections and referred to documents produced in the litigation. Dkt. #92-13, p. 10. Defendants’ requests for production to Homeland and Ace sought “[a]ll Documents and Communications identified” in their responses to defendants’ first set of interrogatories. Dkt. ##92-25, p. 15, 92-26, p. 13.

Homeland produced documents to defendants in January, March, and April 2024. Bentley Decl., ¶ 6.

On June 3, 2024—nearly nine months after Homeland served its responses and objections to defendants’ requests—defendants’ counsel stated in an email to Homeland’s counsel that Homeland “appears to be withholding interpretive materials” regarding when government investigations “can reflect an intent by the government to bring a claim.” Dkt. #92-3, p. 3. Defendants’ counsel stated that such materials would include written interpretations of coverage for investigations brought against other insured Medicare Advantage Organizations (“MAOs”). Id. Counsel asserted that such materials

were responsive to, inter alia, Interrogatory No. 5. Id.

On June 10, 2024, Homeland’s counsel responded: “Any non-privileged ‘interpretive materials,’ as you term them, would have been produced had they existed. Any privileged communications that exist would have been properly logged on our privilege log.” Dkt. #102-5, p. 2.

On June 12, 2024, defendants’ counsel again emailed Homeland’s counsel. Dkt. #102-6. Defendants’ counsel stated that defendants believed that Homeland was still withholding documents concerning qui tam actions against other Homeland insured MAOs, and that Homeland’s written interpretations of coverage in such actions “are directly relevant to Homeland’s position that the Prior Knowledge Exclusion bars coverage here, as those coverage interpretations would speak to when those

investigations evinced awareness of a “Claim” for purposes of coverage.” Dkt. #102-6, p. 2.5 Defendants’ counsel further asserted that such materials were relevant to their document requests and Interrogatory No. 5. Id.

Two days later, defendants’ counsel emailed counsel for both Homeland and Ace stating: Additionally, we have reason to believe that Chubb/Ace is withholding relevant documents and information regarding United States v. Anthem, Inc., No.

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