XO Health, LLC v. Fountain Health Insurance, Inc. and Fountain Health, LLC

CourtDistrict Court, M.D. Florida
DecidedMarch 20, 2026
Docket6:25-cv-01005
StatusUnknown

This text of XO Health, LLC v. Fountain Health Insurance, Inc. and Fountain Health, LLC (XO Health, LLC v. Fountain Health Insurance, Inc. and Fountain Health, LLC) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
XO Health, LLC v. Fountain Health Insurance, Inc. and Fountain Health, LLC, (M.D. Fla. 2026).

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION XO HEALTH, LLC, Plaintiff, v. Case No: 6:25-cv-1005-JSS-RMN

FOUNTAIN HEALTH INSURANCE, INC. and FOUNTAIN HEALTH, LLC, Defendants. ___________________________________/ ORDER Defendants, Fountain Health, LLC (Fountain Health) and Fountain Health Insurance, Inc. (FHI), move to dismiss the complaint for failure to state a claim. (Dkt. 9.) Plaintiff, XO Health, LLC, opposes the motion. (Dkt. 13.) The magistrate judge assigned to this case recommends that the motion be granted in part and denied in part. (Dkt. 27.) Plaintiff does not object to the recommendation. (See Dkt. 29.) Defendants object in part. (See Dkt. 28.) Upon consideration, and for the reasons outlined below, the court largely overrules Defendants’ objections to the magistrate judge’s recommendation and grants the motion to dismiss in part.

BACKGROUND Plaintiff is a reference-based pricing (RBP) company that helps employer self- funded ERISA1 health plans manage their costs. (See Dkt. 1 ¶¶ 1, 6, 8, 12.) According to the complaint, RBP health insurance plans do not use a specific network of providers. (See id. ¶ 9.) Instead, these plans reimburse providers approximately the

same amount, no matter who a plan member sees. (See id.) Plaintiff “negotiates the resolution of healthcare claims” under these plans. (Id. ¶ 14.) FHI is an affiliate of Fountain Health. (Id. ¶ 25.) It is a health services provider that serves employers who offer certain self-funded RBP plans. (See id. ¶ 12.) In July

2022, FHI hired Plaintiff to negotiate claims on behalf of its clients. (See id. ¶ 15.) For each claim that it settled, Plaintiff received a fee equal to ten percent of the original bill. (Id.) FHI did not pay these fees directly. (See id. ¶ 16.) Rather, the company that managed its client’s healthcare plans, American Plan Administrators (APA), sent FHI monthly invoices for various expenses, including Plaintiff’s RBP fees. (See id.) FHI

then collected the funds to pay APA, which, in turn, paid Plaintiff. (See id.) In addition to negotiating claims, Plaintiff also provided “non-RBP services” for FHI pursuant to a consulting agreement. (See id. ¶ 22.) For these services, FHI purportedly paid Plaintiff $15,000 each month. (See id.) Unlike Plaintiff’s RBP fees, Defendants directly paid Plaintiff’s consulting fees. (See id.)

In February 2023, FHI began scrutinizing its relationship with Plaintiff. (See id. ¶¶ 23–24.) To increase its oversight of Plaintiff’s billing, FHI allegedly proposed paying all of Plaintiff’s fees directly, as it did under the consulting agreement. (See id.

1 The Employment Retirement Income Security Act of 1974 is a federal law that establishes requirements for most voluntary private sector benefit plans. ¶ 24.) Ultimately, the parties failed to reach a compromise and instead agreed to terminate the consulting agreement and “all related agreements between . . . the [p]arties.” (Dkt. 9-1 at 22; see Dkt. 1 ¶ 26.) Under the settlement agreement, FHI

promised to pay Plaintiff $10,000, while several other entities, including APA, agreed to reimburse Plaintiff approximately $90,000. (Dkt. 9-1 at 1.) The agreement further states that: Fountain Health acknowledges and agrees that each third[- ]party administrator of [its] customers’ self- funded . . . healthcare benefit plan shall pay all referenced based pricing fees owed to [Plaintiff] directly to [Plaintiff] for all dates of service that occurred on or before October 1, 2023, and Fountain Health shall not interfere with any such third party administrator’s payments thereof or cause any such third party administrator not to make or delay any such payments directly to [Plaintiff].

(Id. at 1–2 (emphasis added).) Fountain Health agreed to pay its portion of the settlement both within three days of the agreement’s execution and on October 1, 2023. (See id.) Plaintiff agreed to notify APA that it was to pay Plaintiff for all “dates of services that occurred on or before October 1, 2023.” (Id.) Accordingly, APA continued to submit funding requests for Plaintiff’s RBP fees. (Dkt. 1 ¶ 29.) Defendants purportedly collected the funds from their clients but

2 When considering a motion to dismiss, the court “may properly consider a document not . . . attached to a complaint under the incorporation-by-reference doctrine if the document is (1) central to the plaintiff’s claims[] and (2) undisputed, meaning that its authenticity is not challenged.” Johnson v. City of Atlanta, 107 F.4th 1292, 1300 (11th Cir. 2024). Plaintiff references the parties’ settlement agreement throughout its complaint, (see Dkt. 1 ¶¶ 25–32, 42–54), and calls the agreement an exhibit, (see id. at 7 n.2). The agreement is central to several of Plaintiff’s causes of action, including its breach of contract claim, (see id. passim), and its authenticity appears uncontested, as it is attached to Defendants’ motion and cited throughout, (see Dkts. 9, 9-1). As a result, the court considers the agreement as incorporated by reference in the complaint. See Johnson, 107 F.4th at 1300. withheld them from APA. (See id. ¶¶ 29, 38–39.) According to the complaint, Defendants kept the funds to “determine how [they] should be distributed,” thereby preventing APA from paying Plaintiff. (Id. ¶¶ 39, 41.)

The complaint asserts five causes of action. (See id. ¶¶ 46–79.) In Count I, Plaintiff alleges that Defendants breached the settlement agreement by interfering with APA’s attempts to pay Plaintiff the RBP fees. (See id. ¶¶ 46–54.) In Count II, Plaintiff claims that Defendants fraudulently induced its ascent to the agreement by

misrepresenting their intent to comply with the non-interference provision. (See id. ¶¶ 55–60.) In Count III, Plaintiff asserts a cause of action for “money had and money received,” which states that Defendants continue to possess Plaintiff’s RBP funds. (See id. ¶¶ 61–63.) In Count IV, Plaintiff contends that Defendants have converted its RBP fees by refusing to pay APA, thereby depriving Plaintiff of the funds. (See id. ¶¶ 64–

70.) Finally, in Count V, Plaintiff alleges that Defendants’ continued retention of the RBP fees constitutes a civil theft. (See id. ¶¶ 71–79.) Plaintiffs seek statutory, compensatory, and punitive damages. (See id. at 16–17.) They alternatively seek rescission of the parties’ settlement agreement and “fraud damages.” (Id. at 17.) Defendant moves to dismiss Counts I, III, IV, and V of the complaint under

Federal Rule of Civil Procedure 12(b)(6). (Dkt. 9.) The magistrate judge recommends that the court grant Defendant’s motion to dismiss Counts III and IV, and deny the motion as to Counts I and V. (See Dkt. 27 at 6.) Plaintiff does not object to the recommendation. (See Dkt. 29.) Defendants object to the extent that the magistrate judge recommends not dismissing Counts I and V. (See Dkt. 28). APPLICABLE STANDARDS

After conducting a careful and complete review of the findings and recommendations, a district judge “may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge.” 28 U.S.C. § 636(b)(1); see also Fed. R. Civ. P. 72. With respect to non-dispositive matters, the district judge “must consider timely objections and modify or set aside any part of the

order that is clearly erroneous or is contrary to law.” Fed. R. Civ. P. 72(a); see Jordan v. Comm’r, Miss. Dep’t of Corr., 947 F.3d 1322, 1327 (11th Cir. 2020).

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XO Health, LLC v. Fountain Health Insurance, Inc. and Fountain Health, LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/xo-health-llc-v-fountain-health-insurance-inc-and-fountain-health-llc-flmd-2026.