Valley Eye Physicians and Surgeons P.C. v. Modernizing Medicine Billing Services LLC

CourtDistrict Court, D. Massachusetts
DecidedJuly 18, 2025
Docket1:25-cv-10774
StatusUnknown

This text of Valley Eye Physicians and Surgeons P.C. v. Modernizing Medicine Billing Services LLC (Valley Eye Physicians and Surgeons P.C. v. Modernizing Medicine Billing Services LLC) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Valley Eye Physicians and Surgeons P.C. v. Modernizing Medicine Billing Services LLC, (D. Mass. 2025).

Opinion

DISTRICT OF MASSACHUSETTS _________________________________________ ) VALLEY EYE PHYSICIANS AND ) SURGEONS P.C. and GISELA ) VELEZ M.D., LLC, ) ) Plaintiffs ) ) v. ) Civil Action No. 25-cv-10774-DJC ) MODERNIZING MEDICINE BILLING ) SERVICES, LLC, ) ) Defendant. ) ________________________________________ )

MEMORANDUM AND ORDER

CASPER, J. July18, 2025 I. Introduction Plaintiffs Valley Eye Physicians and Surgeons P.C. and Gisela Velez (collectively, “Valley Eye”) have filed this lawsuit against Defendant Modernizing Medicine Billing Services, LLC (“ModMed”) alleging fraud in the inducement/misrepresentation (Count I), breach of fiduciary duty (Count II), violation of Mass. Gen. L. c. 93A (“Chapter 93A”) (Count III), interference with advantageous relationship (Count IV), negligence (Count V), as well as seeking a declaratory judgment that the contract at issue is void (Count VI). D. 1-1. ModMed has now moved to dismiss the lawsuit for failure to state a claim pursuant to Fed. R. Civ. P. 12(b)(6). D. 8. For the reasons stated below, the Court ALLOWS the motion to dismiss. Id. II. Standards of Review On a motion to dismiss for failure to state a claim upon which relief can be granted pursuant to Fed. R. Civ. P. 12(b)(6), the Court must determine if the facts alleged “plausibly narrate a claim omitted). Reading the complaint “as a whole,” the Court must conduct a two-step, context-specific inquiry. García-Catalán v. United States, 734 F.3d 100, 103 (1st Cir. 2013). First, the Court must perform a close reading of the claim to distinguish the factual allegations from the conclusory legal

allegations contained therein. Id. Factual allegations must be accepted as true, while conclusory legal conclusions are not entitled credit. Id. Second, the Court must determine whether the factual allegations present a “reasonable inference that the defendant is liable for the conduct alleged.” Haley v. City of Boston, 657 F.3d 39, 46 (1st Cir. 2011) (citation omitted). In sum, the complaint must provide sufficient factual allegations for the Court to find the claim “plausible on its face.” García-Catalán, 734 F.3d at 103 (citation omitted). III. Factual Background The following facts are drawn from Valley Eye’s complaint, D. 1-1, and attached exhibits, and are accepted as true for purposes of resolving ModMed’s motion to dismiss.

ModMed is a business that provides billing services to medical practices. D. 1-1 ¶ 6. Generally, ModMed’s clients are doctors who provides medical services who must submit claims to third-party insurance company payors. Id. ModMed’s clients would submit all necessary information to it which then submits their billings to the appropriate insurance companies or other payors responsible for paying the medical services. Id. Most insurers and other third-party payors have “timely filing” requirements for submission of medical billings and will not pay bills that are not submitted within the required timeframe. Id. ¶ 7. As alleged, ModMed specifically represented to Valley Eye during contract negotiations that it had sufficient staffing and expertise to comply with all third-party payor requirements and that Valley Eye could entrust 100% of their billings to ModMed for submission and collection. Id. ¶ 9. ModMed further represented to Valley

Eye that it had sufficient staffing and oversight, sufficient knowledge of all timely filing medical practices to timely process and collect their accounts. Id. ¶ 10. As alleged, ModMed was aware during contract discussions that Valley Eye’s billing person had left its employ and was aware that Valley Eye was in “dire need of billing support.” Id.

On or about February 28, 2022, Valley Eye entered into an agreement with ModMed (the “Boost Contract”). Id. ¶ 13. The Boost Contract requires Valley Eye to submit 100% of their patient billings to ModMed and makes ModMed the sole and exclusive billing service of Valley Eye for one year. Id. ¶¶ 15-16. ModMed commenced its services on April 25, 2022. Id. ¶ 24. As alleged, ModMed repeatedly failed to submit invoices to third party payors in accordance with the timely filing requirements. Id. ¶ 27. Although Valley Eye was able to obtain filing extensions from several third-party payors, ModMed allegedly still failed to submit billings prior to the expiration of the extended deadlines, including over $1,300,000 in submissions. Id. ¶ 28. ModMed allegedly further (i) failed to follow up on rejected invoices and (ii) failed to tell Valley

Eye about the rejections. Id. ¶ 29. As a result, Valley Eye did not know that the invoices were rejected until after the time for re-filing had expired. Id. Further, ModMed did not inform Valley Eye about “practice held” billings (i.e. those billings that were held aside for further information) and, as a result, Valley Eye could not make necessary corrections for timely submissions. Id. ¶ 30. Consequently, Valley Eye’s collections in 2022 allegedly averaged only $600,000 per month, or $7.2 million annually, on billings of nearly $2 million per month, or $24 million per year. Id. ¶ 26. Additionally, when ModMed failed to collect payments from insurers, it often sent large invoices directly to patients even though their claims were already covered by insurance. Id. ¶ 31. As a result, many of Valley Eye’s patients gave dissatisfied reviews of its practice or left its practice. Id. Valley Eye initially filed this action in the Middlesex Superior Court on February 26, 2025. D. 1-1. On April 1, 2025, ModMed removed the case to this Court. D. 1. ModMed now has moved to dismiss the case for failure to state a claim pursuant to Fed. R. Civ. P. 12(b)(6). D. 8.

The Court heard the parties and took the matter under advisement. D. 21. V. Discussion A. Count I: Fraud in the Inducement Under Massachusetts law, “[f]raud in the inducement ‘concern[s] the validity of the formation of the contract[.]’” In re Rowley Solar LLC, 650 B.R. 742, 753 (B.A.P. 1st Cir. 2023) (some alterations added) (quoting Berwind Prop. Grp. Inc. v. Envtl. Mgmt. Grp., Inc., No. 04-cv- 11411-NMG, 2007 WL 4707647, at *3 (D. Mass. Feb 5, 2007)). The tort occurs “when a misrepresentation leads another to enter into a transaction with a false impression of the risks, duties, or obligations involved.” Suliveres v. Commonwealth, 449 Mass. 112, 117 (2007) (quoting

Black’s Law Dictionary 686 (8th ed. 2004)). To plead fraud in the inducement, “a plaintiff must [allege plausibly] ‘1) that the defendant made a false representation of material fact, 2) with knowledge of its falsity, 3) with the purpose of inducing the plaintiff to act thereon and 4) that the plaintiff relied upon the representation to his detriment.’” Griffin v. Coghill, No. 17-cv-11619-IT, 2018 WL 1122361, at *7 (D. Mass. Mar. 1, 2018) (quoting Berwind Prop. Grp. Inc., 2007 WL 4707647, at *3). 1. Failure to Satisfy Rule 9(b) Pleading Under the Fed. R. Civ. P. 9(b), fraud claims are subject to a heightened pleading standard requiring the complaint to allege with particularity the “who, what, where, and when of the

allegedly false or fraudulent representation.” Rodi v. S. New England Sch. Of L., 389 F.3d 5, 15 (1st Cir. 2004) (quoting Alternative Sys. Concepts, Inc. v. Synopsys, Inc., 374 F.3d 23

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Valley Eye Physicians and Surgeons P.C. v. Modernizing Medicine Billing Services LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/valley-eye-physicians-and-surgeons-pc-v-modernizing-medicine-billing-mad-2025.