Somnia, Inc. v. Change Healthcare Technology Enabled Services, LLC

CourtDistrict Court, S.D. New York
DecidedFebruary 16, 2021
Docket7:19-cv-08983
StatusUnknown

This text of Somnia, Inc. v. Change Healthcare Technology Enabled Services, LLC (Somnia, Inc. v. Change Healthcare Technology Enabled Services, LLC) 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
Somnia, Inc. v. Change Healthcare Technology Enabled Services, LLC, (S.D.N.Y. 2021).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK SOMNIA, INC., Plaintiff, MEMORANDUM OPINION -against- AND ORDER

CHANGE HEALTHCARE TECHNOLOGY 19-CV-08983 (PMH) ENABLED SERVICES, LLC, as successor-in- interest to PST SERVICES, INC., et al., Defendants. PHILIP M. HALPERN, United States District Judge: Plaintiff Somnia, Inc. (“Plaintiff”) initiated this breach of contract action against Defendants Change Healthcare Technology Enabled Services, LLC, as successor-in-interest to PST Services, Inc. (“CHT”) and PST Services, Inc. (“PST” and collectively, “Defendants”) in the New York State Supreme Court, Westchester County, on March 15, 2019. (Doc. 1, “Not. of Rem.”). Defendants removed the action to this Court on September 26, 2019. (Id.). Plaintiff, with leave of Court, filed its First Amended Complaint thereafter on April 20, 2020. (Doc. 33, “FAC”).1 The First Amended Complaint presses two claims for relief: (1) breach of contract (id. ¶¶ 184- 210); and (2) fraud (id. ¶¶ 211-21). Defendants served their motion to partially dismiss the First Amended Complaint under Federal Rules of Civil Procedure 12(b)(6) and 9(b) on July 10, 2020. (Doc. 42; Doc. 43, “Def. Br.”). Plaintiff served its opposition on August 10, 2020 (Doc. 44, “Opp. Br.”), and the motion was briefed fully with service of Defendants’ reply on August 17, 2020 (Doc. 45, “Reply Br.”). For the reasons set forth below, Defendants’ motion to dismiss is GRANTED in part.

1 Judge Karas, before whom this matter proceeded before reassignment to this Court on April 16, 2020, granted Plaintiff leave to file its First Amended Complaint by April 17, 2020. (Doc. 31). The Clerk of the Court rejected Plaintiff’s attempt to file the pleading on that date as deficient. (Apr. 20, 2020 Entry). BACKGROUND I. Plaintiff’s Business Plaintiff, “a nationwide provider of expert and tailored anesthesia services” (FAC ¶ 1), has existed in its current form since at least September 2002 (id. ¶ 24). Among the various services Plaintiff offers its clients is quality management (“QM”), which includes, inter alia, “reporting on the quality, timeliness, and effectiveness of anesthesia care provided by its affiliated providers to government payers (Medicare, Medicaid), commercial payers (e.g., Cigna, Aetna, UnitedHealthcare), the client Facilities, and various accreditation and oversight agencies.” (Id. ¶ 4). QM, in turn, relies on revenue cycle management (“RCM”) (id. ¶¶ 2, 4), which is defined generally as “the administration of transactions . . . from . . . medical encounters . . . .” (id. ¶ 3).

After almost twenty years of handling the services itself (id. ¶ 30), Plaintiff found that “provi[ding] . . . RCM, QM[,] and related operational services for clients was . . . time-consuming and costly” (id. ¶ 32), and “decided to outsource” them (id. ¶ 33). Plaintiff ultimately “issued a nationwide request for proposals from expert anesthesia RCM firms who could handle the volume and complexities associated with anesthesia billing throughout the United States.” (Id. ¶ 35). This search led Plaintiff to PST.2 (Id. ¶ 37). II. Pre-Contract Negotiations Plaintiff alleges that as PST courted Plaintiff, it made a variety of misrepresentations. (See generally id. ¶¶ 38-78). PST’s misrepresentations concerned, inter alia, whether it had ever been

sued (id. ¶¶ 40(a), 42), its technical capabilities and the software employed (e.g., id. ¶¶ 38-39, 43(a), 44, 50, 52, 54, 57-58, 60-65, 74-75), whether it had a “perfect track record” (id. ¶¶ 43(c),

2 Although Plaintiff named CHT (PST’s successor-in-interest) as a Defendant, for ease of reference, understanding, and continuity, because Plaintiff contracted with PST, the Court refers to that entity herein. 44), its personnel (e.g., id. ¶¶ 47-48, 51), its expertise (e.g., id. ¶¶ 38-39, 47, 49), its employee turnover (id. ¶¶ 48, 51), whether Plaintiff would have to secure funding for the transition of services (e.g., id. ¶¶ 43(b), 53, 55), and whether the transition would increase collection rates (e.g., id. ¶¶ 43(a), 44). Accepting these representations, Plaintiff disbanded its “RCM offices and [terminated] the more than 140 people it employed there, and transitioned away QM personnel, due to the redundancy in operations.” (Id. ¶ 78; see also id. ¶ 125). This decision rendered Plaintiff completely reliant on PST for RCM and QM services. (Id. ¶ 78). III. The Master Services Agreement and Deterioration of the Parties’ Relationship The parties executed a contract, the Master Service Agreement (“MSA”), on December 23,

2013. (Id. ¶ 79; see also MSA Pt. 1 at 1).3 Under the MSA, PST agreed to perform a variety of services, including, inter alia: (1) enrolling and recredentialing providers (MSA Pt. 1 at 17); (2) managing payer contracts and, on request, negotiating contracts and performing “deep dive” analyses (id. at 18-19); (3) providing quality control services (id. at 21); (4) “implement[ing] and maintain[ing] a billing regulatory compliance program,” which encompassed using specific programs “to identify billing and remittance patterns that deviate from the norm” (id. at 24); (5) providing staff trained and certified to provide services, along with an assigned client manager (id. at 7, 10); (6) performing RCM services (id. at 13-16); and (7) providing staff trained to handle the transition from in-house operations (id. at 5-6; MSA Pt. 2 at 1). Plaintiff maintains that PST breached each of these, and other, terms. (See FAC ¶ 197).

3 The MSA was annexed to the First Amended Complaint. The main body of the contract, Exhibit 2 to the First Amended Complaint, was filed over two docket entries. For ease of reference, Doc. 33-2 (which contains the first thirty-one pages) will be cited as “MSA Pt. 1,” and Doc. 33-3 (which contains the last twenty-seven pages) will be cited as “MSA Pt. 2.” PST’s Request for Proposals Response (“RFPR”), Exhibit 1 to the First Amended Complaint and Attachment 2 to the MSA, was filed as Doc. 33-1. References to the MSA and RFPR will correspond to the pagination for that particular docket entry generated by ECF. Although the MSA began on March 1, 2014 and called for an initial term of five years (MSA Pt. 1 at 10), the parties terminated their relationship on July 1, 2018. (FAC ¶ 140). According to Plaintiff, the four years during which the MSA governed the parties’ relationship were marred with PST’s deficient performance and attempts to undermine Plaintiff’s business relationships. (See id. ¶¶ 92-139). In fact, Plaintiff contends that on at least one occasion, one of PST’s agents contacted one of Plaintiff’s clients and advocated PST’s “ability to directly provide anesthesia billing and related services.” (Id. ¶ 139; see also id. ¶ 204). As a result of PST’s breaches, Plaintiff maintains it suffered myriad damages, specifically: (1) lost revenues and profits in connection with collection rates (id. ¶¶ 143-50); (2) lost reputation and good will (id. ¶¶ 151-58); (3) lost revenue

associated with payer contract mismanagement (id. ¶¶ 159-62); (4) unnecessary fees, interest, and expenses which decreased Plaintiff’s valuation by approximately thirty to fifty million dollars (id. ¶¶ 163-68); (5) loss of capital to invest in client relationships (id. ¶¶ 169-71); (6) terminations and downsizing (id. ¶ 172); (7) lost financial incentives from government medial programs (id. ¶¶ 173- 77); (8) time spent rectifying PST’s errors (id. ¶ 178); (9) its inability to mitigate damages (id. ¶¶ 179-81); and (10) reducing Plaintiff’s ability to offer services to the public (id. ¶¶ 182-83). When the parties separated, Plaintiff’s valuation had fallen from a pre-relationship estimation of $55,000,000 to approximately $20,000,000. (Id. ¶ 164).

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Somnia, Inc. v. Change Healthcare Technology Enabled Services, LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/somnia-inc-v-change-healthcare-technology-enabled-services-llc-nysd-2021.