United HealthCare Services Inc v. Synergen Health LLC

District Court, N.D. Texas·Decided June 26, 2023·No. 3:20-cv-00301·Unknown

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF TEXAS DALLAS DIVISION UNITED HEALTHCARE SERVICES, § INC. et al., § § Plaintiffs, § § Civil Action No. 3:20-CV-0301-X v. § § SYNERGEN HEALTH LLC, § § Defendant. § MEMORANDUM OPINION AND ORDER United Healthcare Services, Inc. and UnitedHealthcare Insurance Company (collectively, “United”) sued Synergen Health LLC (“Synergen”), alleging that Synergen worked with Next Health LLC (“Next Health”) to defraud United. Synergen now brings a Motion for Summary Judgment [Doc. 101], a Motion to Designate Responsible Third Party [Doc. 100], a Motion to Exclude Expert Testimony [Doc. 98], and an Objection to a Magistrate Judge’s Order [Doc. 120]. For the reasons below, the Court DENIES those motions and OVERRULES Synergen’s objections. I. Factual Background Next Health owned five laboratories—called United Toxicology (“UT”), US Toxicology (“UST”), Medicus, American Laboratories Group (“ALG”), and True Labs—and it routinely submitted claims to United for its services for United’s insureds. Starting in 2014, Next Health retained Synergen, a billing company, to submit its claims to United. 1 In August 2015, United became concerned that the UT laboratory didn’t exist, so it stopped paying claims from that lab on August 31, 2015. To circumvent that newfangled restriction, starting in September 2015, Next Health and Synergen

allegedly began submitting claims for services performed at the UT laboratory by representing that those services were really performed at (1) the UST laboratory and, (2) starting in December 2015, the Medicus laboratory. By January 2016, United had determined that the UT laboratory did, in fact, exist. But during its investigation of the UT laboratory in January 2016, United discovered that Next Health also owned the UST laboratory, so United started investigating that lab as well. Later, in the summer of 2016, United received a

complaint that physicians had ordered unwanted testing and had billed United for those tests out of the UT, UST, and Medicus laboratories. Accordingly, United stopped paying claims from all three laboratories. Stymied in its alleged attempt to funnel UT-laboratory claims through the UST and Medicus laboratories, Next Health started billing for services in the UT and UST laboratories using another laboratory—the ALG laboratory. Likewise, in August

2016, Next Health allegedly began submitting false bills claiming that its True Labs laboratory performed services that it never performed. United sued Next Health in 2017.1 During discovery in that case, United discovered Next Health’s communications with Synergen and decided to sue

1 UnitedHealthcare Ins. Co. v. Next Health, et al., No. 3:17-CV-0243-X (Jan. 26, 2017), ECF 1. 2 Synergen as well. Two relevant events ensued. First, United retained Jacob Adams, a data analyst and fraud examiner, to analyze Synergen’s process for extracting claims data from Next Health and submitting it to United. Second, in its privilege

log and during deposition testimony, United asserted privilege. Synergen moved to compel production of those privileged materials, and a United States Magistrate Judge denied that motion. II. Analysis Synergen (1) moves for summary judgment, (2) moves to exclude Adams’s testimony, (3) moves to designate Next Health as a responsible third party, and (4) objects to the Magistrate Judge’s ruling. The Court considers each in turn.

A. Motion for Summary Judgment Courts can grant summary judgment only if the movant shows “there is no genuine dispute as to any material fact.”2 “[T]he mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine [dispute] of material fact.”3 Although the movant has the burden, “the summary

judgment movant may satisfy its burden by pointing to the mere absence of evidence supporting the non-movant’s case.”4 Synergen claims that (1) there’s no evidence of fraud and (2) the statute of limitations bars United’s fraud claim.

2 FED. R. CIV. PROC. 56(a). 3 Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247–48 (1986). 4 Soto v. William’s Truck Serv., Inc., No. 3:11-CV-3242-B, 2013 WL 487070, at *1 (N.D. Tex. Feb. 8, 2013) (Boyle, J.). 3 1. No Evidence of Fraud “To prevail on a fraud claim, a plaintiff must show: (1) the defendant made a material representation that was false; (2) the defendant knew the representation

was false or made it recklessly as a positive assertion without any knowledge of its truth; (3) the defendant intended to induce the plaintiff to act upon the representation; and (4) the plaintiff actually and justifiably relied upon the representation and suffered injury as a result.”5 Synergen attacks elements two and four. Synergen attacks the second element—intent—claiming that “UHC’s evidence is so circumstantial that any inference that Synergen committed fraud would be

nothing more than conjecture.”6 To begin, Synergen’s criticism of circumstantial evidence is misguided: “Since intent to defraud is not susceptible to direct proof, it invariably must be proven by circumstantial evidence.”7 Regardless, United provides enough evidence to create a genuine factual dispute regarding Synergen’s scienter.8 Synergen also attacks the fourth element—justifiable reliance. Although “[j]ustifiable reliance usually presents a question of fact . . . . the element can be

5 JPMorgan Chase Bank, N.A. v. Orca Assets G.P., L.L.C., 546 S.W.3d 648, 653 (Tex. 2018) (cleaned up). 6 Doc. 102 at 17. But see Int’l Shortstop, Inc. v. Rally’s, Inc., 939 F.2d 1257, 1265 (5th Cir. 1991) (“[C]ases which turn on the moving party’s state of mind are not well-suited for summary judgment.”). 7 Spoljaric v. Percival Tours, Inc., 708 S.W.2d 432, 435 (Tex. 1986). 8 See, e.g., Doc. 112-2 at 69 (depicting Synergen employee’s request to Next Health to “provide us with the information to setup [sic] more . . . newer entities” in order to “further distribute the claims and as a result stay below the radar” and statement that “the sooner we breakdown the ALG volume into other entities, the better we will do in avoiding any attention on ALG”); id. at 66 (depicting 4 negated as a matter of law when circumstances exist under which reliance cannot be justified.”9 Here, Synergen claims that United’s reliance could not have been justified because it “had a comprehensive system set up to detect . . . fraud.”10 But Synergen

cites no case holding that an entity’s fraud department—no matter how sophisticated—renders it impotent to pursue fraud claims. And that’s likely because a defendant can negate justifiable reliance only by pointing to, inter alia, the plaintiff’s “appreciation of facts and circumstances” showing that it “is extremely unlikely that there is actual reliance.”11 So Synergen can’t categorically negate justifiable reliance by touting United’s fraud department: It needs to point to specific facts and circumstances that should have alerted United to the fraud.

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United HealthCare Services Inc v. Synergen Health LLC, (N.D. Tex. 2023).

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