Orchestrate HR, Inc. v. Blue Cross Blue Shield Kansas

District Court, D. Kansas·Decided November 1, 2021·No. 5:19-cv-04007·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS

ORCHESTRATE HR, INC, et al.,

Plaintiffs,

v. Case No. 5:19-cv-04007-HLT-TJJ

BLUE CROSS BLUE SHIELD KANSAS,

Defendant.

MEMORANDUM AND ORDER Plaintiffs Orchestrate HR, Inc. and Vivature, Inc. (collectively “Vivature”) filed this diversity action against Defendant Blue Cross Blue Shield Kansas and assert various tort claims. Currently before the Court is Blue Cross’s motion to dismiss Vivature’s third amended complaint. Doc. 277. As discussed below, the Court finds Vivature has plausibly stated additional claims for defamation, tortious interference, and fraud by nondisclosure and denies Blue Cross’s motion. I. BACKGROUND Generally stated, the allegations in this case involve Vivature’s work with universities to help them bill insurers for medical services performed by the universities’ licensed athletic trainers. Vivature contracts with schools and helps them file the insurance claims and receives a share of the billings collected. This dispute arose when Blue Cross denied many of the claims submitted by Vivature for the universities and began labeling the insurance claims as fraudulent or improper. Vivature contends that Blue Cross fraudulently induced it to change its claims-filing practices on a promise that claims would be paid, defamed Vivature to its clients, tortuously interfered with Vivature’s contracts, and fraudulently failed to disclose certain information. The complaint is now on its fourth version. In the third amended complaint, Vivature asserts claims for fraud, defamation, tortious interference with contract, and fraud by nondisclosure. Doc. 262. The Court previously granted in part and denied in part a prior motion to dismiss the first amended complaint and a prior motion to dismiss the second amended complaint. See Docs. 69 and 244.1 Briefly stated, the Court’s prior rulings have limited the claims in this case to certain discrete events, statements, and contracts. See Doc. 69 at 1-2, 19; see also Doc. 244 at 1.

Undeterred, Vivature sought and was granted leave to file a 111-page third amended complaint that asserts somewhere between four and several hundred claims for fraud, defamation, tortious interference with contract, and fraud by nondisclosure. See generally Doc. 262. Blue Cross moves—again—to dismiss the third amended complaint, raising over a dozen arguments against the claims asserted in the third amended complaint. Blue Cross clarifies that it is only seeking dismissal of newly asserted claims and not those previously allowed. Doc. 278 at 4 n.12. II. STANDARD To survive a motion to dismiss under Rule 12(b)(6), “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v.

Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). A claim is plausible if it is accompanied by sufficient factual content to allow a court “to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. The plausibility standard requires “more than a sheer possibility that a defendant has acted unlawfully,” but it “is not akin to a ‘probability requirement.’” Id. “Where a complaint pleads facts that are merely consistent with a defendant’s liability, it stops short of the line between possibility and plausibility of entitlement to relief.” Id. (quoting Twombly, 550 U.S. at 557) (internal quotations omitted). In

1 As the Court noted in its prior order, this case has spawned significant motion practice in addition to these motions to dismiss and consumed an inordinate amount of judicial resources. See Doc. 244 at 2 n.1. undertaking this analysis, a court accepts as true all well-pleaded allegations in the complaint, though it need not accept legal conclusions. Id. Likewise, conclusory statements are not entitled to the presumption of truth. Id. at 678-79. III. ANALYSIS Blue Cross moves to dismiss the newly asserted claims in Vivature’s third amended

complaint, which include additional claims of defamation, tortious interference with contract, and fraud by nondisclosure. Vivature’s claim of fraud is not challenged. A. Defamation “The elements of defamation under Texas law2 are that: (1) the defendant published a statement; (2) that was defamatory concerning the plaintiff; (3) while acting with malice, if the plaintiff was a public figure, or negligence, if the plaintiff was a private individual, regarding the truth of the statement.” Encompass Office Sols., Inc. v. Ingenix, Inc., 775 F. Supp. 2d 938, 958 (E.D. Tex. 2011). Defamation is not subject to the Rule 9(b) standard for pleading, but “pleadings for a defamation claim must be sufficiently detailed to the extent necessary to enable the defendant

to respond.” Id.; Garcia v. Tyson Foods, Inc., 890 F. Supp. 2d 1266, 1270 (D. Kan. 2012) (holding that a defamation claim must supply “sufficient notice of the communications complained” of (internal quotation and citation omitted)). The Court has previously permitted a defamation claim based on a March 7, 2018 letter. Doc. 244 at 7; Doc. 69 at 19. The additional defamation claims Vivature attempted to assert in the second amended complaint were previously dismissed because Vivature only included examples of defamatory statements by reference to Bates numbers, and failed to otherwise allege what was contained in the documents or to whom the statements were made. Doc. 244 at 6-8. The primary

2 Texas law substantively governs this case. See Doc. 69 at 8-9. problem with the defamation claims in the second amended complaint was that the substance of all the newly added claims were incorporated by reference to 1500 pages of exhibits. Id. at 8. In the third amended complaint, the defamation “claim” spans 60 pages. Vivature alleges Blue Cross made “numerous statements to third parties . . . all of which are reasonably capable of a defamatory meaning” as to Vivature. Doc. 262 at ¶ 70. Vivature then lists 21 “communications,”

including the author, recipients, date sent, the alleged defamatory statement made, and how the statements were defamatory. Id. ¶ 73. Vivature also alleges that Blue Cross communicated to other Blue Cross entities that the insurance claims submitted by Vivature were fraudulent by affixing a U602 code on each claim. Id. at ¶¶ 76-79. Vivature alleges “the U602 code is used to designate a claim as being the result of fraud and abuse.” Id. ¶ 79. The third amended complaint then lists 144 “U602 Communications,” including the Blue Cross employee author, the Blue Cross entity institutional recipient, and approximate date. Id. ¶ 83. Vivature also alleges that Blue Cross filed a complaint with the Kansas Insurance Department in or around March 2017 and held a meeting with the same on May 8, 2017, and that by “reasonable conclusion” it believes defamatory

allegations were made. Id. ¶ 87. Finally, the third amended complaint lists four letters and identifies the date, author, recipient, and what allegedly defamatory statement they contained. Id. ¶ 92.3 Vivature contends that each of these statements caused it to suffer reputational and monetary damages, id. ¶ 86, and that Blue Cross failed to act with reasonable care in making these

3 Blue Cross makes a brief argument in its reply brief that these four letters are effectively identical to a letter that the Court previously ruled was outside the statute of limitations. Doc. 286 at 17; see also Doc. 69 at 12.

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