In re Oxford Health Plans, Inc.

187 F.R.D. 133, 1999 U.S. Dist. LEXIS 9010, 1999 WL 412773
CourtDistrict Court, S.D. New York
DecidedJune 8, 1999
DocketNo. MDL-1222 (CLB)
StatusPublished
Cited by114 cases

This text of 187 F.R.D. 133 (In re Oxford Health Plans, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re Oxford Health Plans, Inc., 187 F.R.D. 133, 1999 U.S. Dist. LEXIS 9010, 1999 WL 412773 (S.D.N.Y. 1999).

Opinion

MEMORANDUM & ORDER

BRIEANT, Judge.

Presently before the Court in these cases alleging securities fraud, which have been consolidated for pre-trial purposes, see May 25, 1999 Memorandum and Order, In re Oxford Health Plans, Inc., Sec. Litig., 182 F.R.D. 42 at n. 1 (S.D.N.Y.1998), is the motion pursuant to Rule 12(b)(6) and Rule 9(b), Fed.R.Civ.P., of defendants Oxford Health Plans, Inc. (“Oxford”), and the individual defendants Stephen Wiggins, the former Chairman of Oxford’s Board of Directors (the “Board”) and CEO; William Sullivan, Oxford’s President and former CEO; Andrew Cassidy, Oxford’s former Executive VP and CFO; Jeffery Boyd, Executive VP and General Counsel; Robert Smoler, former Executive VP and CEO of Oxford’s New York Region; David Finkel, former Vice President, Operations; Dr. Benjamin Safirstein, a member of the Board and former Regional Vice President and Medical Director; Brendan Shanahan, Vice President and Controller; Dr. Thomas Travers, former Vice President, Medical Delivery Systems; and Robert Milligan, an outside member of the Board (the “Individual Defendants”). Oxford and the Individual Defendants seek dismissal of the Complaint on the grounds that (1) plaintiffs fail to allege scienter with sufficient particularity under the Private Securities Litigation Reform Act (the “PSLRA”); (2) Oxford disclosed the information allegedly concealed; (3) Oxford’s forward-looking statements are protected by the “safe harbor” provision of the PSLRA; (4) puffery is not actionable; (5) plaintiffs’ § 20(a), 15 U.S.C. § 78t(a), claim fails because plaintiffs fail to allege an underlying violation, and fail to allege any control or participation; (6) plaintiffs’ § 20A, 15 U.S.C. § 78t-l, claim fails because plaintiffs fail to allege that each individual defendant was in possession of insider information and that plaintiffs traded on the same day as the individual defendants sold; and (7) plaintiffs’ claim on behalf of persons who purchased or sold Oxford options fails because trading in options does not meet the “in connection with” requirement of § 10(b) and no lead plaintiff traded in Oxford options. At the hearing, defendants agreed that the Court need not address the argument with respect to options trading (ground number seven above) at this time. (April 28, 1999 Hearing Transcript at 42).

FACTUAL BACKGROUND

Plaintiffs are persons and entities who allegedly purchased publicly-traded securities of Oxford during the period from November 6, 1996 through December 9, 1997 (the “Class Period”). Plaintiffs purport to bring this complaint on behalf of themselves and all others who purchased Oxford securities during the Class Period, as well as on behalf of a sub-class of all persons and entities who purchased Oxford common stock contemporaneously with sales by certain individual defendants during the Class Period.

Defendant Oxford is a managed care company that provides its members in New York, New Jersey, Pennsylvania and Connecticut, with comprehensive health care services on a prepaid basis through a network of medical service providers. The individual defendants were at all times during the Class Period officers and directors of Oxford. Defendant KPMG is a firm of certified public accountants that was Oxford’s independent auditor from 1985 to 1998.

Plaintiffs allege that Oxford’s press releases and SEC filings during the Class Period contained false or misleading information or omitted material information about the accuracy of the Company’s earnings and enrollment figures, and its progress in remedying [137]*137delays in billing and claims processing associated with a conversion of its computer system. Plaintiffs allege that the Individual Defendants were aware or recklessly disregarded that the financial statements were in violation of Generally Accepted Accounting Principles (“GAAP”) and based on inherently unreliable information, that the Individual Defendants were responsible for the dissemination of the false and misleading information, and that the Individual Defendants traded on inside information during the Class Period.

Oxford’s 1996 financial statements allegedly violated GAAP for each of the following reasons:

(i) Oxford fraudulently recognized and reported premium revenue; (ii) Oxford failed to adequately reserve for uncollectible premiums receivable; (iii) Oxford fraudulently accounted for its RBNP (reported but not paid) and IBNR (incurred but not reported) claims and thereby materially understated its medical costs payable and health care services expense; (iv) Oxford failed to disclose loss contingencies required to be disclosed by GAAP and SEC regulations; and (v) Oxford was unable to quantify its Class Period premium revenue and health care services expense.

(Complaint ¶ 213). According to the plaintiffs, the 1996 financial statements were based on corrupted and unreliable data because during 1996, Oxford’s internal accounting and control systems were in “shambles.” Doctors and other medical service providers were not being paid timely; more than half of all claims logged into Oxford’s system were not paid within thirty days and many were not paid within sixty days; health care services expenses were mounting; invoices were not sent timely or were sent to persons who were no longer Oxford members; and membership rolls were outdated.

In October 1996, Oracle Corporation (“Oracle”), a computer consulting company, spent two weeks at Oxford and determined that Oxford’s computer system was so deficient that Oxford should stop adding functions and related data to it. By December 1996, Oxford had approximately $108 million in suspended claims but could not determine the age and in some instances the source of these claims. Because Oxford was unable to determine how much money it owed to health service providers, it began the extraordinary practice of making providers interest-free loans in the form of cash advances. Providers who were not getting paid and former members who were still being billed began complaining to the New York Attorney General’s Office (the “NYAG”) and as a result, the NYAG conducted an investigation of Oxford.

Nonetheless, on November 6, 1996, Oxford issued a press release announcing its financial results for the third quarter of 1996 ended September 30, 1996, boasting of Oxford’s increased earnings and financial health but saying nothing of the unreliability of the available financial information and accounting data. The press release was attached to a Form 8-K signed by Cassidy and the information in the release was repeated in the Form 10-Q signed by Cassidy and Wiggins. On February 18, 1997, Oxford issued a press release announcing its financial results for the fourth quarter and year ended December 31, 1996, stating that revenues, earnings per share and enrollment figures had increased but again not disclosing the unreliability of the underlying accounting data. This release was attached to a Form 8-K signed by Cassi-dy and the information in the release was repeated in Oxford’s 1996 Form 10-K and annual report. In late February 1997, Oxford claimed falsely that the backlog would be back to normal within six weeks and the conversion problems would be resolved by the second quarter.

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Bluebook (online)
187 F.R.D. 133, 1999 U.S. Dist. LEXIS 9010, 1999 WL 412773, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-oxford-health-plans-inc-nysd-1999.