LPPAS Representative, LLC v. ATH Holding Company LLC

Court of Chancery of Delaware·Decided May 2, 2023·No. C.A. Nos. 2020-0241-KSJM, 2020-0443-KSJM·Published

Opinion

IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE

LPPAS REPRESENTATIVE, LLC, in its ) capacity as authorized agent and ) representative of Luis Perez, Gerardo ) Necuze, and Manuel Enriquez, )

)

Plaintiff, )

)

v. ) C.A. No. 2020-0241-KSJM )

ATH HOLDING COMPANY, LLC, and ) HIGHLAND ACQUISITION ) HOLDINGS, LLC, )

)

Defendants. )

SHAREHOLDER REPRESENTATIVE ) SERVICES LLC, solely in its capacity as ) HealthSun Sellers’ Representative, )

)

Plaintiff/Counterclaim )

Defendant, )

)

v. )

) C.A. No. 2020-0443-KSJM ATH HOLDING COMPANY, LLC and ) HIGHLAND ACQUISITION ) HOLDINGS, LLC, )

)

Defendants/Counterclaim )

Plaintiffs. )

)

MEMORANDUM OPINION

Date Submitted: January 4, 2023 Date Decided: May 2, 2023

Kelly L. Freund, Michelle Morgan, DLA PIPER LLP, Wilmington, Delaware; Counsel for Plaintiff LPPAS Representative, LLC.

A. Thompson Bayliss, E. Wade Houston, Peter C. Cirka, ABRAMS & BAYLISS LLP, Wilmington, Delaware; Counsel for Plaintiff and Counterclaim Defendant Shareholder Representative Services LLC.

Kevin M. Coen, MORRIS, NICHOLS, ARSHT & TUNNELL LLP, Wilmington, Delaware; Thomas Uebler, McCOLLOM D’EMILIO SMITH UEBLER LLC, Wilmington, Delaware; Glenn M. Kurtz, Elizabeth Stainton, WHITE & CASE LLP, New York, New York; Counsel for Defendants and Counterclaim Plaintiffs ATH Holding Company, LLC and Highland Acquisition Holdings LLC.

McCORMICK, C.

This is the latest installation in a dispute arising from an Equity Interests Purchase Agreement (the “Purchase Agreement”) between health insurance providers and healthcare companies. Under Section 10.6 of the Purchase Agreement, the sellers agreed to indemnify the buyer and its parent company for losses arising from certain third-party claims. As to third-party claims brought by government regulators, the Purchase Agreement granted the indemnifying parties the right to participate in the defense strategy.

In 2018, Anthem, the buyer, discovered what it believed to be fraudulent coding practices that the sellers had perpetrated to receive excessive Medicare Advantage reimbursement from the Center for Medicare and Medicaid Services (“CMS”). Anthem reported the information to CMS and the United States Department of Justice (“DOJ”). Anthem later had discussions concerning liability and executed tolling agreements with both agencies. Anthem then noticed indemnification claims relating to the CMS and DOJ investigations, but it did not contact the sellers to allow them to participate in the defense.

The sellers’ representatives, who are the plaintiffs in these actions, have moved for partial summary judgment. They argue that the buyer breached their participation rights by unilaterally steering the defense of the DOJ and CMS claims. There are two plaintiffs— the “HealthSun Plaintiff” and the “Pasteur Plaintiff.” Both seek a declaratory judgment that Anthem breached their participation rights and request contractual fee-shifting under the Purchase Agreement. The Pasteur Plaintiff seeks additional relief. The parties have a complex escrow arrangement to fund the sellers’ indemnification obligations, which this court has described in more detail in prior decisions. The Pasteur Plaintiff argues that

Anthem’s breach of the participation rights requires that Anthem release what funds remain in escrow.

This decision grants the plaintiffs’ motions for summary judgment in part, finding that the buyer breached the plaintiffs’ participation rights and that the plaintiffs are entitled to fee-shifting for that breach. This decision denies the Pasteur Plaintiff’s motion for escrow relief in light of a potentially valid claim against the remaining escrow funds. I. FACTUAL BACKGROUND The background is drawn from the undisputed facts, which are stated in the materials attached to the parties’ briefing on the motions for partial summary judgment.

A. The Purchase Agreement And Escrow Agreement Under the Purchase Agreement,1 Defendant Highland Acquisition Holdings, LLC (the “Buyer” or “Highland”) acquired two groups of Florida-based entities (the “Pasteur Entities” and the “HealthSun Entities,” and together, the “Entities”) from their respective owners (the “Pasteur Sellers” and the “HealthSun Sellers,” and, together, the “Sellers”).

The Entities operate as an integrated health plan, medical center network, and pharmacy.2 The HealthSun Entities include a Medicare Advantage Organization (“MAO”) that maintains networks of medical providers to service its Medicare-eligible enrollees.3

1 C.A. No. 2020-0443-KSJM (the “HealthSun Action”), Docket (“Dkt.”) 172, Transmittal Aff. of E. Wade Houston (“Houston Aff.”), Ex. 2 (“Purchase Agreement”); see also C.A. No. 2020-0241-KSJM (the “Pasteur Action”), Dkt. 1 (“Pasteur Compl.”); HealthSun Action, Dkt. 18 (“HealthSun Answer”) ¶ 9. 2 Purchase Agreement at 2; see also Pasteur Action, Dkt. 28 (“Schlegel Decl.”) ¶ 3; HealthSun Answer ¶¶ 25–30. 3 HealthSun Answer ¶¶ 25–27.

Highland’s acquisition of the Entities closed in November 2016.4 Anthem bought Highland in 2017 and now owns the Entities.5 The Purchase Agreement obligated the Sellers to indemnify the Buyer and its successors for any “Losses” arising from breaches or inaccuracies in the Sellers’ representations or warranties.6 All of the representations and warranties at issue are classified in the Purchase Agreement as “Specified Health Care Representations and Warranties” (the “Specified Representations”), under which the Sellers represented that the Entities had complied in all material respects with certain healthcare laws.7 To secure the Sellers’ indemnification obligations under the Purchase Agreement, Highland deposited $100 million of the purchase price into escrow.8 That amount provided a cap on indemnification claims arising from breaches or inaccuracies in the Specified Representations.9

4 Schlegel Decl. ¶ 2; HealthSun Action, Dkt. 1 (“HealthSun Compl.”) ¶ 10; HealthSun Answer ¶ 10. 5 Schlegel Decl. ¶ 4; HealthSun Answer at 1 n.1.

6 Purchase Agreement § 10.3(a).

7 Id. § 10.2(a); see also id. §§ 2.13(e), (g), (h), (i), (l), (m). The Purchase Agreement defines “Health Care Representations and Warranties” as the representations and warranties “set forth in Sections 2.13(e) through 2.13(m).” Id. at A-8 (emphasis omitted). The Specified Representations, as defined in § 10.2(a), are the representations and warranties “set forth in Sections 2.13(e), 2.13(g), 2.13(h), 2.13(i), 2.13(l), 2.13(m) solely with respect to” certain regulatory compliance claims. Id. § 10.2(a) (emphasis omitted). 8 Id. § 1.3(d)(i).

9 Id. § 10.2(c).

The parties agreed that the escrow funds would be released as governed by a November 30, 2016 Escrow Agreement (the “Escrow Agreement”).10 The Purchase Agreement required that the parties enter into the Escrow Agreement, attached the Escrow Agreement as an exhibit, and incorporated it by reference.11 The Escrow Agreement required that the escrow funds be released over four years.12 The releases were to be made annually, beginning in 2017, in contractually specified amounts minus any indemnification claims then “pending.”13 The Purchase Agreement and the Escrow Agreement set out a complicated contractual scheme discussed in greater detail in the legal analysis. The primary right relevant to this decision is found in Section 10.6 of the Purchase Agreement, which governs litigation practices relating to “Third[-]Party Claims” that “may give rise to a claim for indemnification . . . under this Article 10[.]”14 Under Section 10.6(b), when one party indemnifies the other, “[t]he Indemnifying Person shall . . . have the right to defend the Indemnified Person against the Third[-]Party Claim” subject to certain conditions not

Id. § 1.3(d); see also Pasteur Action, Dkt. 9 (“Freund Aff.”), Ex. B (Escrow Agreement); 10

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