Securities And Exchange Commission v. Richman

District Court, N.D. California·Decided November 3, 2021·No. 3:21-cv-01911·Unknown

Opinion

SECURITIES AND EXCHANGE Case No. 21-cv-01911-CRB COMMISSION, Plaintiff, ORDER DENYING MOTION TO v. JESSICA RICHMAN, et al., Defendants.

The SEC alleges that Defendants Jessica Richman and Zachary Apte, co-founder’s of uBiome, misled investors about fundamental aspects of uBiome’s business model during the company’s Series C funding round. Complaint (“Compl.”) (dkt. 1). Defendants move to dismiss the complaint, primarily arguing that the SEC fails to support its allegations with the required specifics. Motion to Dismiss (“MTD”) (dkt. 38). After carefully reviewing the parties’ briefs, the Court concludes that oral argument is not necessary. For the reasons set forth below, the Court denies Defendants’ motion to dismiss. I. BACKGROUND uBiome was a biotechnology company that focused on the human microbiome. Compl. ¶¶ 14–15. The company developed tests that individual consumers could use to receive diagnostics on the microorganisms present in their gut and genitals. Id. ¶ 15. The test results could purportedly assist with the diagnosis and treatment of a range of medical conditions, including inflammatory bowel disease and sexually transmitted infections. Id. Richman and Apte co-founded uBiome in October 2012. Id. ¶¶ 12–14. During the life of the company, Richman served as CEO and President, and Apte served as Chief Scientific Officer and, at times, co-CEO.1 Id. Richman and Apte were hands-on managers who “closely monitored and managed every aspect of uBiome’s operations together.” Id. ¶ 16. No “decision about a significant aspect of uBiome’s business was made without the knowledge and approval of at least one of Richman or Apte.” Id. The charges against Richman and Apte stem from events that began in 2015. Id. ¶¶ 17–18. Prior to 2015, uBiome developed and marketed tests for consumers, which consumers paid for out of pocket. Id. ¶ 14. In 2015, uBiome shifted focus to developing tests that could be billed to insurers because “uBiome would be able to charge insurers significantly more money for the tests than it charged consumers.” Id. ¶¶ 17–18. Over the next two years, uBiome developed and released SmartGut and SmartJane, both of which the company described as covered by health insurance. Id. ¶ 19. A. The Alleged Insurance Fraud The thrust of the complaint is that Richman and Apte implemented and oversaw certain improper practices to create the false appearance that SmartGut and SmartJane qualified for insurance reimbursement and that, as a result, uBiome had strong prospects for growth. The allegedly improper practices generally fall into two categories: (1) issues related to uBiome’s doctor network and (2) misrepresentations to insurers. The complaint alleges that Defendants knew or were reckless in not knowing that once these practices came to light, insurers would “reject reimbursement claims for uBiome’s clinical tests,” delivering a body blow to the company’s business model. Id. ¶ 21. 1. Doctor Network The first set of allegedly improper practices centers around uBiome’s doctor network. Id. ¶ 23. To qualify for reimbursement, insurers generally require that a diagnostic test be ordered by a doctor. Id. ¶ 22. To meet this requirement, uBiome created an online portal through which patients could connect with doctors to determine the appropriateness of uBiome’s tests. Id. The doctor network allegedly fell short of insurer standards in two ways. First, the “default” set up was for doctors in the network to prescribe uBiome’s tests “based solely on online questionnaire responses” without any live consultation. Id. ¶ 23. Prescribing tests based solely on online questionnaires raised concerns about whether doctors were prescribing tests without first establishing the requisite doctor-patient relationship. Id. Shortly after the doctor network went live in July 2017, uBiome employees raised this concern with Defendants. Id. ¶ 21. In summer of 2017, for example, the company’s general counsel emailed defendants that “any tests prescribed based solely on consumers’ questionnaires, versus a live consultation between consumer and doctor, would be a reimbursement risk.” Id. ¶ 23. Not only did Defendants continue to use the doctor network despite these concerns, they also allegedly “concealed” the network’s continued use “from the general counsel and the uBiome board.” Id. The second issue with the doctor network concerned tests of “dubious clinical utility.” Id. ¶ 24. The tests of “dubious” utility involved re-testing of old samples that consumers previously submitted. Id. Defendants allegedly orchestrated a scheme whereby consumers were “broadly” advertised the option of retesting their samples. Id. When consumers elected to retest an old sample, the consumer’s request was made to “appear to be requests for tests on new samples” to network doctors. Id. As a result, “at Defendants’ direction, uBiome resubmitted consumers’ originally reported symptoms to the doctors reviewing retest requests as if they were newly reported symptoms.” Id. The practice of presenting retests as requests for new tests also raised concerns among employees. Id. ¶ 24. In 2017, for example, uBiome’s former lab director warned that the “retests lacked ‘current clinical relevance’ and could be fraudulent.” Id. Again, Defendants allegedly disregarded the concerns and continued the practice of retesting old samples “from at least late 2017 through 2018.” Id. 2. Misrepresentations to Insurers The second set of alleged improper practices involved misrepresentations to insurers. The complaint includes specific and general examples of these alleged misrepresentations. Specifically, Defendants learned in May 2018 that certain insurers were requesting medical records “reflecting that doctors had contemporaneously consulted with patients for the billed tests.” Id. ¶ 25. uBiome did not have such records, so Defendants “directed company employees to create and backdate records to make it seem as though doctor-patient consultations had occurred, and then to submit those fake records to insurance companies.” Id. More generally, the complaint alleges that Defendants engaged in various forms of deceptive practices to obtain reimbursement from insurers. Id. ¶¶ 25–26. These practices included billing for tests that had not been performed and “might never be performed because the version of the test to be used had not been proved to work.” Id. ¶ 26. In addition, Defendants oversaw the manipulation of billing codes, including directing employees “to use incorrect insurance billing codes and/or vary the codes when billing for the same type of test to avoid claims rejection, even though there was no legitimate basis for doing so.” Id. As with the doctor network and the practice of retesting old samples, employees expressed worries about the legitimacy of the company’s practices with insurers, but Defendants did not address the issues. Id. The concerns eventually began to extend beyond employees, as multiple insurers began to challenge uBiome’s practices, including one that alleged that the company was engaging in “fraud and abuse.” Id. ¶ 44. B. The Series C Funding Round The various forms of alleged insurance fraud were all underway when the company began its Series C funding round in May 2018. Id. ¶ 34. And the complaint alleges that Defendants’ false and misleading statements to investors during the Series C funding round enabled the company to raise, and Defendants to make, millions of dollars. Defendants’ alleged Series C misrepresentations generally fall into two buckets. First, Defendants told investors that insurance-covered tests were driving the company’s revenue growth. Id. ¶ 27. For example, Richman provided the lead Series C investor with information showing that “uBiome generated nearly 91% of its revenue from health insurance reimbursements by the first quarter of 2018” and that it “projected billing for its clinical tests to increase to approximately 97 percent of its total revenue by 2

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Securities And Exchange Commission v. Richman, (N.D. Cal. 2021).

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