Mission Toxicology, LLC v. UnitedHealthcare Insurance Company

CourtDistrict Court, W.D. Texas
DecidedNovember 4, 2020
Docket5:17-cv-01016
StatusUnknown

This text of Mission Toxicology, LLC v. UnitedHealthcare Insurance Company (Mission Toxicology, LLC v. UnitedHealthcare Insurance Company) is published on Counsel Stack Legal Research, covering District Court, W.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mission Toxicology, LLC v. UnitedHealthcare Insurance Company, (W.D. Tex. 2020).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF TEXAS SAN ANTONIO DIVISION

MISSION TOXICOLOGY, LLC, et al.,

Plaintiffs,

v. Case No. 5:17-CV-1016-JKP

UNITEDHEALTHCARE INSURANCE (Consolidated with COMPANY, et al., Case No. 5:18-CV-0347-JKP)

Defendants.

MEMORANDUM OPINION AND ORDER This consolidated action involving millions of dollars in alleged damages by both sides pits a group of related insurance entities against various lab-service providers and other involved entities and individuals. The lead case arises under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq. Plaintiffs, Mission Toxicology, L.L.C. (“Mission”) and Sun Clinical Laboratory, L.L.C. (“Sun Clinical”) (collectively “Plaintiffs” or “the Labs”), therein seek to recover unpaid claims from Defendants (four affiliates of United Healthcare) on behalf of Defendants’ insureds. In the member case, the consolidated plaintiffs, Unitedhealthcare Insurance Company, Inc. and Unitedhealthcare Services, Inc. (collectively “United”),1 sue the Labs, several individuals, and other entities (collectively “the Lab Defendants”)2 for various claims under state law, including (1) tortious interference with contract against all Lab Defend- ants except the last two listed in footnote 1 and (2) money had and received against all Lab De-

1 Although “United” refers collectively to multiple affiliates, the Court will generally refer to United in a singular sense as United does in its briefing. 2 The Lab Defendants are Mission; Sun Clinical; Michael L. Murphy, MD (“Dr. Murphy” or “MM”; Jesse Saucedo (“Saucedo” or “JS”); Samantha Murphy (“SM”); Lynn Murphy “LM”; Julie Pricer; Sun Ancillary Management, LLC (“SAM”); Integrity Ancillary Management, LLC (“Integrity” or “IAM”); Alternate Health Labs, Inc.; and LMK Management, LLC. fendants. The consolidated action has spawned several pending motions, four of which the Court addresses in this Memorandum Opinion and Order: (1) United’s Motion for Partial Summary Judgment (ECF Nos. 173 (redacted) and 179 (unredacted and sealed)),3 (2) United’s Motion to Strike Defendants’ “Declarations of Marketers Involved in Lab Outreach Program” (ECF Nos.

201 (redacted) and 212 (unredacted and sealed)), (3) United’s Motion to Strike Defendants’ Evi- dence of “Audit Responses” (ECF No. 204), and (4) Lab Defendants’ Opposed Motion for Leave to File Sur-Reply (ECF No. 220). To avoid potential confusion, the Court may cite these filings by their docket number (redacted version if more than one filing), but a generic citation to “Mot.,” “Resp.,” or “Reply” will refer to briefing related to the motion for summary judgment. The motions are fully briefed, including evidence submitted by both sides.4 The Lab De- fendants have responded to the summary judgment motion, see ECF Nos. 184 (redacted), 193 (unredacted and sealed) and both motions to strike, see ECF Nos. 215 (redacted response to ECF

3 The filing is actually titled as a “Memorandum in Support” of the motion, but there is no separate motion as sug- gested by the title. 4 United has filed an Appendix (ECF No. 174, 179-1 (sealed exhibits to Decl. Jeffrey S. Gleason, 411 pages), 179-2 (sealed Decl. R. Dean Graves), 179-3 (sealed Decl. Jennifer A. Shimek) with its motion for partial summary judg- ment. It has also filed appendices with its motions to strike. See ECF Nos 202 (redacted), 205 (redacted), 206 (sealed portions of ECF No. 205 permitted by Text Order), 212-1 to -3 (sealed portions of ECF No. 202). The parties cite to United’s appendix as “APP” and the Court will at times include that in its citations. The Lab Defendants have likewise supported their response with an Appendix (ECF Nos. 186 (redacted as to Exs. D through H; N through S; V; and NN through ZZ) and 193-2 (unredacted and sealed as to exhibits redacted in ECF No. 186)), which resulted in United’s motions to strike the declarations of marketers (Ex. MM to Decl. of Bridget Zerner (ECF Nos. 186-35, 193-2) and evidence of audit responses (Exs. N through S of Decl. Lynn Murphy and related paragraphs of that declaration; ¶ 15 of Decl. of Michael Murphy; and ¶ 11 of Decl. of Saucedo) within the appendix. The Lab Defendants have also supported their responses to the motions to strike with an appendix. See ECF Nos. 218 (redacted Ex. N2); 221-2 (sealed as to Ex. N2 of ECF No. 218). United has also filed a Supplemental Appendix (ECF Nos. 210 (redacted), 214-1 (sealed Exs. 6-7, 9-15 to Second Decl. Jeffrey S. Gleason); 214-2 (sealed email identified as LD0195810); 214-3 (sealed email identified as LD0104263); 214-4 (sealed provider agreement between Aetna and Newman identified as LD0104297); 214-5 (sealed email identified as LD0104323); 214-6 (sealed email identified as LD0104372); 214-7 (sealed email identi- fied as LD0106993); 214-8 (various sealed documents) with its reply brief. No. 204), 217 (response to ECF No. 201), 221 (unredacted and sealed response to ECF No. 204). United has filed reply briefs (ECF Nos. 208 (redacted version of reply to motion), 214 (unredact- ed and sealed version of reply), 222 (reply to ECF No. 201), and 223 (reply to ECF No. 204) to support each of their motions and a response to the Lab Defendants’ motion for leave, see ECF No. 225. The Lab Defendants have filed a reply brief (ECF No. 228) to the response to their mo-

tion for leave to file a surreply. I. BACKGROUND The current motions concern the member case brought by United after the Labs brought the lead action. In an order denying a motion to dismiss, the Court previously set out a thorough background based upon the allegations of the Second Amended Complaint filed by the Labs. See Order Denying Defs.’ Mot. Dismiss (Dkt. # 47) (ECF No. 115). There is no reason to reiterate that background here. Nor is there reason to delve deeply into the various allegations asserted by United against the Lab Defendants. The Court will provide necessary background information as needed to resolve the pending motions. At his point, suffice to say that this case involves a com- plex billing arrangement involving two non-party, rural hospitals (Newman Memorial Hospital

(“Newman”) and Community Memorial Hospital (“Community” or “CMH”) (collectively “the Hospitals”), the Lab Defendants, and United. Like most cases, this one has both disputed and undisputed facts. One disputed aspect is the nature and existence of a “Lab Outreach Program” in which the Labs claim to have endeav- ored to assist vulnerable rural hospitals at the request of the Hospitals and their management company, People’s Choice Hospital, LLC (“PCH”). United describes this program as made-up and fraudulent, which is consistent with its numerous allegations and claims asserted against the Lab Defendants. Of course, the summary judgment context requires the Court to view the facts in the light most favorable to the non-movant. Regardless of the existence or nature of such a program, the parties do not dispute that the Labs are non-contracted (also known as out-of-network) providers that entered into arrangements with the Hospitals, which had in-network contracts with United. Further, the parties agree that, the Labs (or referred third-party laboratories) performed most la-

boratory testing, not the Hospitals. And they agree that, after such testing, Integrity, an entity formed by the owners of Sun Clinical (Dr. Michael Murphy) and of Mission (Jesse Saucedo), would submit claims for services allegedly provided by the Labs to beneficiaries of ERISA plans administered or insured by United on behalf of, and using the names and billing credentials, of the Hospitals.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Richardson v. Oldham
12 F.3d 1373 (Fifth Circuit, 1994)
Bank of Saipan v. CNG Financial Corp.
380 F.3d 836 (Fifth Circuit, 2004)
Fluorine On Call Ltd v. Fluorogas Limited
380 F.3d 849 (Fifth Circuit, 2004)
Price v. City of San Antonio
431 F.3d 890 (Fifth Circuit, 2005)
Camacho v. Texas Workforce Commission
445 F.3d 407 (Fifth Circuit, 2006)
Rogers v. McDorman
521 F.3d 381 (Fifth Circuit, 2008)
Pasco Ex Rel. Pasco v. Knoblauch
566 F.3d 572 (Fifth Circuit, 2009)
Jones v. Cain
600 F.3d 527 (Fifth Circuit, 2010)
Erie Railroad v. Tompkins
304 U.S. 64 (Supreme Court, 1938)
Hanna v. Plumer
380 U.S. 460 (Supreme Court, 1965)
Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
Burlington Northern Railroad v. Woods
480 U.S. 1 (Supreme Court, 1987)
Scott v. Harris
550 U.S. 372 (Supreme Court, 2007)
RSR Corp. v. International Insurance
612 F.3d 851 (Fifth Circuit, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
Mission Toxicology, LLC v. UnitedHealthcare Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mission-toxicology-llc-v-unitedhealthcare-insurance-company-txwd-2020.