The plaintiffs are plaintiffs in a civil conspiracy action against Multiplan. There are five elements for an allegation of civil conspiracy in Missouri: (1) two or more people; (2) an objective to be achieved; (3) a meeting of heads on the objective or procedure; (4) one or more illegal acts; and (5) damages. Lyn-Flex West, Inc. vs. Dieckhaus, 24 s.W.3d 693, 700 (Mo. App. E.D. 1999). Multiplan being the parent company PHCS, they must not conspire.
Copperweld Corp. v. Independence Tube Corp., 467 U.P. 752, 771 (1984). Therefore, any conspiracy should exist between multi-plan and third-party payers and insurance brokers. Crutcher claims that the protocol establishes that Multiplan and third parties conspired to lease discount rates to downstream quadrupteurs, which deliberately breached the supplier agreement, and that this is sufficient to support a civil conspiracy action. The second complaint is that Multiplan allegedly lied to the complainants and payers about the availability of contractual discounts for downstream payers under the network agreement, in order, in turn, to illegally discount payments to TLDI. For the reasons set out below, the Court agrees with the applicants that Multiplan breached the contractual terms by granting access to the rebate to payers without a payment agreement. However, an offence as such does not constitute evidence of fraud. A fraud action requires proof of both a plan and intent to fraud. Lally, 863 F.2d to 613.
The evidence relied on by the applicants in support of their rico complaint is a convincing argument that Multiplan breached its contract with TLDI in various locations. However, what the applicants cannot present is evidence of intentional misconduct necessary to conclude that these offences were the result of a plan or plan of fraud, contrary to inattention or a simple misunderstanding of the terms of the contract. In this case, although Multiplan breached the contract, there is no evidence that the breach was intentional or was the result of a TLDI fraud plan or plan. The applicants assert that Multiplan entered into several network agreements allowing downstream payers, without a contractual link to Multiplan, to apply the discount rate in breach of the provider agreement. One such network agreement existed between Multiplan and Coventry, Inc. In order to explain the facts, the Court considers that the content of the network agreement between Multiplan and Coventry is similar to that of the other network agreements. TLDI did not participate in a network agreement. After carefully reviewing the evidence, the Tribunal finds that an agreement has been reached between TLDI and Multiplan.
The court`s finding is influenced by letters sent by Crutcher to Multiplan in May and June requesting that Branson Imaging be replaced by TLDI in its supplier directory. These letters clearly show Crutcher`s desire to retain its diagnostic imaging business in the supplier agreement. Although Multiplan did not respond positively to Crutcher`s correspondence, it made the desired change in its system, as stated in its supplier directory. This act clearly constitutes acceptance of the applicants` offer to replace Branson Imaging subject to the same contractual conditions. At that time, a head meeting was held and a contract between TLDI and Multiplan came into effect. As regards the pleadings, the applicants rely in several places on cases in which Multiplan made substantial omissions and misrepresentations. In paragraph 74 of their complaint, the claimants state: „For example, multiplan and PHCS applied and/or reassessed illegally unauthorized discounts on medical claims filed by CRUTCHER/TRI-LAKES to insurance payers. In the correspondence, MULTIPLAN and PHCS also stated that there was a valid contractual agreement between MULTIPLAN/PHCS and CRUTCHER/TRI-LAKES, which contained discounts on CRUTCHER/TRI-LAKES` medical claims, although there was no valid contractual agreement between MULTIPLAN/PHCS and CRUTCHER/TRI-LAKES. Second, the applicant`s allegation that some patients referred by Cox HealthPlans to TLDI were treated as network companions to apply discounts on bills sent by payers to TLDI, but outside the network to bill customers of those agencies, resulting in increased care costs for those patients. .