Crutcher et al v. Multiplan, Inc et al

Filing 398

ORDER and JUDGMENT in favor of Plaintiffs against Multiplan, Inc. Signed on 11/9/2020 by District Judge M. Douglas Harpool. (Maerz, Mary)

IN THE UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF MISSOURI
SOUTHERN DIVISION
KRIS CRUTCHER, et al.,
Plaintiff,
v.
MULTIPLAN, INC., et al.,
Defendant.

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Case No. 6:15-cv-03484-MDH

ORDER AND JUDGMENT
Before the Court is Plaintiffs’ Precise Requested Damages Award and Related Motion for
Clarification. (Doc. 393). On August 4, 2020, this Court entered its Order (Doc. 388) on the parties’
respective motions for summary judgment in this action (Docs. 294, 300, 370 and 379), wherein
the Court granted in part Plaintiffs’ motion for summary judgment as to their claim against
Defendants for breach of contract under Missouri law, and granted in part Defendants’ motion for
summary judgment as to said claim. Specifically, the Court found that the applicable discount rate
under the governing UP&UP Network Agreement (“the Network Agreement”) had been legally
modified from the 25% discount rate set forth in the contract’s original written terms to a fee
schedule-based discount method using the SSRIM fee schedule. Based on this finding, the Court
concluded that MultiPlan did not breach the Network Agreement when it applied discounts to
Plaintiffs’ medical claims using the SSRIM fee schedule instead of the 25% discount rate.
The Court, however, found that the subsequent change to the discount methodology by
MultiPlan when it implemented the SRAD90 fee schedule did not constitute a legal modification
of the Network Agreement. Accordingly, the Court held that MultiPlan did breach the terms of the

Network Agreement when it applied discounts to Plaintiffs’ claims using the SRAD90 fee
schedule. (Doc. 388, 26-27). The Court further found that MultiPlan breached the terms of the
Network Agreement by allowing downstream payors that did not have an active payor agreement
with MultiPlan to access Plaintiffs’ discount rate, as well as by making Plaintiffs’ discount rate
available to payors who sold or leased MultiPlan’s list of providers to other payors or brokers in
violation of the Network Agreement’s anti-leasing provision. (Doc. 388, 29-30).
The main three points that Plaintiffs ask for clarification are: (1) whether Plaintiffs should
recover the full amount of each discount applied by payors who did not have a payor agreement
with MultiPlan; and (2) whether Plaintiffs should recover for the difference between the SRAD90
fee schedule and the contract rate, or whether Plaintiffs should recover for the difference between
the SRAD90 fee schedule and the SSRIM fee schedule; and (3) whether Plaintiffs are entitled to
recover the full amount of each SRAD90 discount MultiPlan applied after disenrollment, or
whether Plaintiffs are to be reimbursed at the contract rate.
With respect to the damages Plaintiffs recover from discounts applied by payors who did
not have a payor agreement with MultiPlan, Plaintiffs are awarded the difference between TriLakes Diagnostic Imaging’s (“TLDI”) billed charges and the amount allowed as payable under the
NetWork Agreement. The total claim charges were $36,025.00, and the total claim allowed
charges were $8,452.38. The total damages award for these unauthorized payor discounts is
therefore $27,572.62. See Defendants’ Suggestions (Doc. 395) p. 9-10.
With respect to the damages Plaintiffs recover on the SRAD90 fee schedule claim,
Plaintiffs are awarded the difference between the allowed amount under the SRAD90 fee schedule
and the allowed amount under the SSRIM fee schedule. The total SSRIM fee schedule allowable
is $17,744.83, and the total SRAD90 fee schedule allowable is $15,212.69. The total damages

award for the SRAD90 fee schedule modification breach of contract claim is therefore $2,532.14.
See Defendants’ Suggestions (Doc. 395) p. 10.
With respect to whether Plaintiffs recover for SRAD90 discounts applied after Plaintiffs’
disenrollment, the Plaintiffs are awarded the entire amount of each of the discounts applied after
September 8, 2015, as supported by the record. See Plaintiffs’ Requested Damages (Doc. 393), p.
5. In the Court’s previous Order (Doc. 388), the Court found that Plaintiffs sent a letter to MultiPlan
dated August 13, 2015 that included a demand that MultiPlan cease applying future discounts to
Plaintiffs’ claims, and that in response to the letter, MultiPlan sent a letter to Plaintiffs dated
September 14, 2015 wherein it “stated it would remove TLDI from its PPO network and cease
applying discounts to invoices from payors, effective September 8[,]” 2015. Id. at 7. The Court
further found that despite these representations, “payors continued to apply in-network PPO
discounts to its EOBs for more than eight months after Multiplan’s letter.” Id. at 21.
Defendants argue that the Court’s finding should not apply to Plaintiffs’ award for breach
of contract damages, because the Court’s finding was made in the context of deciding Plaintiffs’
fraud claim. (Doc. 395, 5). Defendants further argue that Plaintiffs did not raise the application of
discounts after the September 8, 2015 disenrollment date as a basis for their breach of contract
claim. Id. The Court is not convinced by Defendants’ distinction between the fraud and breach of
contract claims, and the Court’s previous findings relating to the disenrollment applies to
Plaintiffs’ damages award.
With respect to the discounts applied by payors after disenrollment starting September 8,
2015, Plaintiffs are awarded $10,890.22. The Court studied the record in order to identify a way
to calculate the appropriate award here. In Plaintiff’s Suggestions in Opposition to Defendant’s
Motion for Summary Judgment (Doc. 315), Plaintiff lists several examples of discounts being

applied after the disenrollment. (Doc. 315, xix-xxii). Of those listings, many showed that the
“source of discount identified” was specifically Multiplan. The sum of those discounts applied on
those listings that explicitly identify Multiplan as the source of the discount is $10,890.22.
Lastly, Plaintiff is awarded interest from the date of filing the Complaint, which was filed
on November 6, 2015. The prejudgment interest is nine percent (9%) simple interest to the total
combined damages awarded above for the period beginning November 6, 2015. Mo. Rev. Stat.
§ 408.020. Interest calculated on the above awarded sums ($40,994.98) is $18,447.74.
CONCLUSION
For the reasons set forth in this Order, the Plaintiff is awarded (1) $27,572.62 for Plaintiff’s
breach of contract claim relating to discounts that were accessed by payors without a direct, active
payor agreement, in violation of the NetWork Agreement ; (2) $2,532.14 for Plaintiff’s breach of
contract claim relating to the SRAD90 fee schedule modification; (3) $10,890.22 for discounts
applied by Multiplan after the disenrollment date; and (4) $18,447.74 in interest. The total award
of damages is $59,442.72.
IT IS SO ORDERED.
Dated: November 9, 2020

/s/ Douglas Harpool______
DOUGLAS HARPOOL
United States District Judge