499 F.Supp.3d 350
W.D. Tex.2020Background
- Plaintiffs (Mission Toxicology, LLC and Sun Clinical Laboratory, LLC) are out-of-network labs that arranged with two rural hospitals (Newman Memorial and Community Memorial) to provide most laboratory testing; an entity called Integrity submitted claims using the hospitals’ provider names and billing credentials.
- UnitedHealthcare (United) administratively insured the hospitals and paid claims; United alleges the Labs schemed to divert payments and to interfere with United’s contracts with the hospitals.
- This matter is a consolidation of an ERISA suit by the Labs (lead case) and a diversity-member case by United asserting state-law claims (including tortious interference and money had and received) against the Labs and certain individuals.
- United moved for partial summary judgment (seeking judgment on tortious interference, money-had-and-received, and individual liability), and also moved to strike certain declarations and audit-response evidence; Labs sought leave to file a surreply.
- The central factual disputes are whether (a) the Labs intentionally interfered with United’s contracts and (b) the Labs acted as agents of the hospitals (which would preclude tortious-interference liability absent proof of self‑interest).
- The Court denied United’s partial summary judgment motion and the motions to strike, but granted the Labs’ motion for leave to file a surreply.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Motion to strike marketers’ declarations and audit-response evidence | Evidence inadmissible and not disclosed in discovery; should be struck | Evidence may be considered or exclusion is not warranted at this stage | Motion to strike denied as unnecessary; Court considered motion for SJ without that evidence |
| Motion for leave to file surreply | N/A | Labs sought leave to respond to new arguments/evidence in United’s reply | Leave granted; proposed surreply accepted for consideration |
| Tortious interference with contracts | United: Labs intentionally interfered with United–hospital contracts by causing billing outside permitted terms and frustrating protocols | Labs: they acted as agents of hospitals and/or lacked knowledge of contract terms; genuine dispute of intent/agency exists | Summary judgment denied — genuine disputes exist as to intent and agency, precluding judgment as a matter of law |
| Money had and received (equitable restitution) | United: Labs received funds that in equity belong to United (alleged illegal referrals/solicitations) | Labs: Texas law does not clearly confer private right under the cited statute; facts differ from cases United relies on; disputes of fact exist | Summary judgment denied — genuine dispute whether funds belong to United in equity; United not entitled to judgment as a matter of law |
| Personal liability of individual defendants (Murphy, Saucedo) | United: individuals are personally and jointly liable as co-conspirators who authorized/were involved in wrongdoing | Labs: no established wrongdoing proven on summary judgment record; factual disputes remain | Summary judgment denied as premature — underlying claims not established as a matter of law |
Key Cases Cited
- Erie R.R. Co. v. Tompkins, 304 U.S. 64 (federal courts apply state substantive law in diversity cases)
- Gasperini v. Ctr. for Humanities, 518 U.S. 415 (relationship between Federal Rules and Erie doctrine)
- Anderson v. Liberty Lobby, 477 U.S. 242 (standard for genuine dispute at summary judgment)
- Celotex Corp. v. Catrett, 477 U.S. 317 (movant’s initial burden on summary judgment)
- Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (nonmovant must show evidence permitting reasonable jury finding)
- Prudential Ins. Co. of Am. v. Fin. Review Servs., Inc., 29 S.W.3d 74 (Tex. 2000) (elements of tortious interference)
- Holloway v. Skinner, 898 S.W.2d 793 (Tex. 1995) (agent/principal rule: agent generally cannot tortiously interfere with principal’s contract)
- Community Health Sys. Prof’l Servs. Corp. v. Hansen, 525 S.W.3d 671 (Tex. 2017) (agent/stranger analysis in tortious interference context)
- Flourine on Call, Ltd. v. Flourogas Ltd., 380 F.3d 849 (5th Cir. 2004) (applying Texas law on interference elements)