Judge Partially Dismisses Claims of Fraudulent Billing


On Thursday, the court issued an opinion in a case between United HealthCare Services and Synergen Health LLC. The opinion, issued in the Northern District of Texas, addresses a suit regarding an intentional scheme to defraud UHC by submitting claims with deliberately incorrect provider information.

Synergen is a revenue cycle management and billing company. In the course of managing this process, According to the opinion, Synergen generated analytics and created schemes to thwart certain anti-fraud provisions and maximize the reimbursement received by their clients. For their client Next Health, and several of the labs operated by Next Health, Synergen began billing claims for medical services that were performed by one lab using the billing numbers and credentials of a different lab. UHC sued Synergen for fraud and negligent misrepresentation regarding these claims.

Synergen filed two motions to dismiss. The first motion, under Rule 12(b)(7), alleged that UHC had failed to join Next Health as a necessary party to the case. The court noted that there is no requirement that a  joint tortfeasor be joined unless the failure to join would cause inconsistent decisions or would result in a party unfairly bearing the burden of the fault. The court noted that there is no risk of one party bearing an unfair burden as Next Health is also facing a separate lawsuit on this issue, and the type of fraud alleged in the case did not necessitate the participation of both parties to result in the fraudulent action.

Synergen also filed a motion to dismiss under Rule 12(b)(6) for both failure to meet the heightened fraud pleading standard as well as for the claims being time-barred under the statute of limitations. The court noted that there was sufficient particularity in the complaint to pursue Synergen for the claims filed on behalf of Next Health, but noted that the complaint was limited to those claims and others would need to be filed in a separate suit. The court also noted that the negligent misrepresentation claims, being under a two year timely filing limit, were time barred and would be dismissed, leaving the fraud claims to stand alone.

Plaintiff UHC is represented by Sinton Scott Minock & Kerew and Figari & Davenport. Synergen is represented by Clark Hill and Rogge Dunn Group