Neil Gilmour, Tr. for the Grantor Trusts of Victory Parent Co. v. Conn. Gen. Life Ins. Co. (In re Victory Med. Ctr. Mid-Cities, LP)
Neil Gilmour, Tr. for the Grantor Trusts of Victory Parent Co. v. Conn. Gen. Life Ins. Co. (In re Victory Med. Ctr. Mid-Cities, LP)
Opinion of the Court
On April 24, 2019, the Court held a hearing on the competing motions for summary *741judgment filed by the Plaintiff and the Defendants. One of the hotly contested issues in this fraudulent-transfer suit is whether the Chapter 11 Debtors received reasonably equivalent value in connection with a prepetition settlement agreement they signed with the Defendants. Each party has moved for full or partial summary judgment on this issue. The summary-judgment record establishes that there are no material contested subsidiary facts on this issue and that the Debtors received reasonably equivalent value in the exchange. Therefore, the Court grants the Defendants' motion for summary judgment regarding reasonably equivalent value and denies the Plaintiff's motion for partial summary judgment.
I. JURISDICTION AND VENUE
The Court has jurisdiction over this proceeding pursuant to
II. FACTS
A. Historical relationship between the parties
Connecticut General Life Insurance Company and Cigna Corporation (together, " Cigna ") administers or insures health benefit plans.
B. The 2013 Lawsuit
Victory contends Cigna refused payment on approximately $22.5 million of healthcare service claims submitted by Victory-claims that Victory now values at $9,840,145.
*742More specifically, the majority of the plan documents for the health benefit plans Cigna administers or insures exclude "charges for services that would not have been made in the absence of the plan or for which the patient is not legally obligated to pay."
According to the Plaintiff, in contrast, Cigna's decision to investigate for fee forgiving was based entirely on how much Cigna had paid, and Cigna used unreliable and vague survey questions and responses as a pretext to push Victory to go in-network with Cigna.
According to Cigna, based on the investigation, Ms. Halik concluded that Victory was, in fact, engaged in fee forgiving.
After Cigna began denying the claims submitted by Victory, on June 6, 2013, Victory Medical Center Mid-Cities, L.P. and Victory Medical Center Plano, L.P., among other plaintiffs, filed a lawsuit against Cigna in federal district court (the "2013 Lawsuit ").
Cigna filed a counterclaim seeking a declaration that (i) Victory is not entitled to payments on claims where the member is not being required to pay his or her portion of the charges (i.e. , fee-forgiving); (ii) Victory is not entitled to payment for charges that exceed the plans' provisions for payment of charges for out-of-network services; and (iii) Cigna is entitled to recoup all overpayments made to Victory prior to the flag being placed.
On February 28, 2014, the parties stipulated to dismissal without prejudice of their claims to facilitate settlement negotiations.
C. The in-network agreements
Victory desired to be in-network with Cigna and other payors from day one.
Mr. Helms signed the in-network agreements *744on February 24, 2015.
D. The Settlement Agreement
On March 27, 2015, Victory and Cigna entered the Settlement Agreement, which resolved the disputed claims (the "Exhibit A Claims ").
As a part of the Settlement Agreement, the parties also released all claims they had against each other related to or arising out of the claims that were subject to the Settlement Agreement, including Victory's claims for underpayments and Cigna's claim for overpayments for any Exhibit A Claims that were paid in full prior to the effective date of the Settlement Agreement.
While Victory alleges that the billed charges submitted to Cigna were on the order of $22 million, Victory understood that the amount Victory would actually receive as payment on those claims was significantly less. On May 28, 2015, Kelly Russell, Victory's Director of Revenue Recovery, sent an email to other Victory executives, including Mr. Helms, outlining the Settlement Agreement. Ms. Russell noted that "Cigna will pay the claims based on the newly negotiated in-network payment rates and per the terms and conditions of the benefit plan and Cigna's standard claims payment policies and procedures."
Ms. Russell then completed a "down and dirty calculation" of the "maximum settlement amount," which for Victory
Mr. Helms, the CEO of all Victory entities, when expecting the payments under the Settlement Agreement, responded, "Send the signed documents."
Victory had counsel throughout this process.
Ultimately, Victory received around $3.3 million under the Settlement Agreement and some of that was received after its bankruptcy case was filed.
E. The bankruptcy
Victory considered filing bankruptcy in late April or early May 2015.
*746Victory's First Amended Joint Plan of Reorganization (the "Plan ") was confirmed on March 28, 2016.
F. The adversary proceeding
On January 1, 2017, the Plaintiff filed this adversary proceeding against Cigna, seeking to recover payments for medical services that Victory allegedly provided to the beneficiaries of employee benefit plans administered or insured by Cigna.
Cigna moved to dismiss the Plaintiff's state-law claims for breach of fiduciary duty and unjust enrichment (and the accompanying request for exemplary damages), arguing that these state law claims were preempted by ERISA in that the Plaintiff really sought unpaid benefits under healthcare benefit plans subject to ERISA.
The Court granted in part and denied in part the motion to dismiss the Original Complaint.
Cigna then moved to dismiss Plaintiff's claim for breach of fiduciary duty under ERISA § 502(a)(3), arguing that the Plaintiff cannot seek relief under § 502(a)(3) when the relief the Plaintiff seeks is really a claim for benefits under § 502(a)(1)(B).
*747Thereafter, on February 9, 2018, the Plaintiff dismissed his claim for economic duress, leaving only the Plaintiff's claims for constructive fraudulent transfers under
G. The summary-judgment motions
The parties have now filed competing motions for summary judgment. The Plaintiff contends in his motion ("Plaintiff's Summary-Judgment Motion ")
• the Plaintiff has standing to pursue the claims asserted in this adversary proceeding;
• the transfers made in the Settlement Agreement occurred within two years of the petition date;
• Victory was insolvent when it entered into the Settlement Agreement; and
• with respect to the forty-four claims submitted under fully insured plans, (i) Cigna improperly denied the claims; (ii) such claims had a pre-release value of $1,639,211.19 in the aggregate; (iii) Cigna's post-release payments on such claims were $658,997.32 in the aggregate; and (iv) the post-release payment on any such claim was not reasonably equivalent to its pre-release value.
Based on these alleged undisputed material facts, the Plaintiff argues that he is entitled to judgment as a matter of law on his causes of action for fraudulent transfer in an amount of at least $980,213.87.
Cigna, conversely, contends in its summary-judgment motion ("Cigna's Summary-Judgment Motion ")
III. SUMMARY JUDGMENT STANDARD
Summary judgment is appropriate when there are no genuine issues as to any material facts, and the moving party is entitled to judgment as a matter of law.
If the dispositive issue is one on which the nonmoving party will bear the burden of proof at trial, the moving party may satisfy its burden by merely pointing out that the evidence in the record contains insufficient proof concerning an essential element of the nonmoving party's claim.
The Court's ruling in this matter hinges on whether Victory received reasonably equivalent value in connection with the Settlement Agreement. This Court's determination is a fact issue that is reviewed on appeal for clear error.
IV. ANALYSIS
The Plaintiff seeks to avoid the Settlement Agreement as a constructive fraudulent transfer. An essential element of that claim under both the Bankruptcy Code and the Texas and Business Commerce Code is that the Debtors did not receive reasonably equivalent value in exchange for the obligation incurred or transfer made.
A. Reasonably equivalent value generally
Reasonably equivalent value means "the debtor has received value that is substantially comparable to the worth of the transferred property."
In determining whether reasonably equivalent value was received, the Court may consider an economic benefit flowing from the "debtor's ability to keep his business in operation as a result of his entering into the challenged transaction."
B. Reasonably equivalent value in the settlement context
Because courts-in the nonsettlement context-generally look to see if what the debtor received was "in the range of a reasonable measure of the value of what the debtor transferred,"
Two other legal precepts from bankruptcy settlements appear equally applicable in reviewing a prebankruptcy settlement. First, to determine whether a settlement is fair and equitable, this Court should consider and evaluate the following factors: (i) the probability of success in the litigation, with due consideration for uncertainty in fact and law; (ii) the complexity and likely duration of the litigation and any attendant expense, inconvenience, and delay; and (iii) all other factors bearing on the wisdom of the compromise.
Second, while a court must evaluate all factors relevant to a fair and full assessment of the wisdom of the proposed compromise,
Finally, "in the context of a fraudulent transfer action seeking to set aside a settlement, the Court finds that it is appropriate to take into account the strong public policy favoring settlement agreements."
C. Review of reasonably equivalent value in connection with the Settlement Agreement
The Plaintiff alleges that Victory received reasonably equivalent value in exchange for the Settlement Agreement in three principal forms: (1) the in-network agreements entered into with Cigna; (2) the reprocessing of Victory's claims under the Settlement Agreement, which resulted in the payment of more than $3.3 million to Victory; and (3) mutual releases, including a release from Cigna as to Cigna's claims to recover amounts that had been previously paid to Victory. Each is discussed below.
1. In-network agreements entered into with Cigna
Cigna first points to the benefits Victory received by going in-network with Cigna, including expected significant volume in growth as well as benefit-reimbursement certainty. Although the in-network agreements did not become effective until April 1, 2015, Mr. Helms signed the in-network agreements for Victory on February 24, 2015. Nothing in the summary-judgment record suggests that the parties' entry into the in-network agreements was contingent upon entry into the Settlement Agreement. Because Victory earned its rights and benefits under the in-network agreements-at least for business going forward-before entering into the Settlement Agreement, they were not legally part of the consideration for the Settlement Agreement and cannot be included in the reasonably-equivalent-value determination.
2. Reprocessing of Victory's claims under the Settlement Agreement
Cigna next points to the reprocessing of the Exhibit A Claims under the Settlement Agreement, which resulted in the in-network-rate payment of more than $3.3 million to Victory. Victory, on the other hand, relies on the expert report of Cynthia Seale, who assumed an out-of-network-rate and opined as follows:
After reviewing the underlying information in this matter, it is my opinion that the Victory North Facilities did not receive a reasonably equivalent value in the Settlement Agreement. I conclude that the total value of the Cigna Settlement Claims is $10,994,843, based on the historical average amounts Cigna had allowed and paid for these types of claims. I removed patient responsibility of $1,154,698 and Cigna insurance payments of $3,376,535 to determine the Victory North Facilities' unrealized value of $6,474,049 on these claims ....100
Ms. Seale noted Cigna's fee-forgiveness investigation in her report, but did not (and could not, as a nurse and CPA) take into consideration the legal risk to Victory of the fee-forgiveness issue. Instead, Ms. Seale made this assumption:
*751My understanding of Cigna's utilization of the SIU is that they applied a wholesale approach to these claims and did not process or pay them. My approach was to value these claims based on historical amounts, namely the allowable amounts determined by Cigna for claims not placed into Cigna's SIU. I conclude that this is an appropriate way to determine the claims' values based on Cigna's failure to process them.101
The Court assumes-for purposes of the competing requests for summary judgment-that Ms. Seale's nonlegal analysis and calculations are correct regarding the pre-release, out-of-network value of the Exhibit A Claims. The Court agrees with Cigna, however, that the $3.3 million "post-release value" of the Exhibit A Claims, coupled with Victory's avoidance of a significant fee-forgiveness legal risk (that could potentially result in zero payments to Victory), make the Settlement Agreement fall well within the range of reasonableness.
The following legal and factual issues and sub-issues (among others) are hotly contested by the parties, and were all put to rest by the Settlement Agreement after litigation and negotiation between sophisticated parties with counsel:
• Whether Victory was engaged in fee-forgiveness.
• Whether Cigna used the fee-forgiveness investigation as a pretext to push Victory to go in-network with Cigna.
• Whether Cigna accurately and timely determined covered charges so that Victory could calculate the patient's out-of-pocket responsibility and reasonably bill the patient.
• Whether the surveys Cigna sent to patients during its investigation were vague and whether patient responses were reliable.
• Whether Cigna conducted a fair-minded investigation to look for documentary evidence of fee forgiveness.
• Whether a court should use a de novo standard of review or an abuse-of-discretion standard of review when determining if Cigna properly denied the forty-four claims submitted under fully insured plans.
• Whether Cigna's construction of the plans' exclusionary language was legally incorrect.
• Even if Cigna's construction of the plans' exclusionary language was legally incorrect, whether Cigna's interpretation still fell within its discretion.
• Whether Cigna's sweeping response to Victory's charges was based on substantial evidence.
• Whether the facts of the underlying dispute are similar to, or distinguishable from, the facts in Connecticut General Life Insurance Company v. Humble Surgical Hospital ,102 where the Fifth Circuit upheld Cigna's fee-forgiveness determination that Cigna made after an investigation that involved reviewing patient survey responses.
The Court need not conduct a trial to determine all of these legal and factual issues. Instead, the Court has canvassed the issues and is satisfied that the Settlement Agreement allowed Victory to avoid risky (and potentially lengthy and costly) litigation and to obtain a relatively quick infusion of $3.3 million of cash to save its *752business. The Court is convinced that the settlement was well within the range of reasonableness. Victory received reasonably equivalent value under the Settlement Agreement.
3. Mutual releases, including a release from Cigna as to Cigna's claims to recover amounts that had been previously paid to Victory
Victory's evidence indicates that the amount previously paid to Victory on the Exhibit A Claims was only in the $7-8,000 range.
D. Can the Court make the reasonably-equivalent-value determination at this summary-judgment stage?
There are cases where the material subsidiary facts about the value given and received in a prebankruptcy settlement are disputed so that the court cannot make a reasonably-equivalent-value finding at the summary-judgment stage.
E. What about Victory's request for partial summary judgment as to the forty-four claims submitted under fully insured plans?
As noted above, with respect to the forty-four claims submitted under fully insured plans, Victory asks for partial summary judgment that (i) Cigna improperly denied the claims; (ii) such claims had a pre-release, out-of-network value of $1,639,211.19 in the aggregate; (iii) Cigna's post-release payments on such claims (based on an in-network valuation) were $658,997.32 in the aggregate; and (iv) the post-release payment on any such claim was not reasonably equivalent to its pre-release value. The Court rejects Victory's request for two reasons.
First, the Court is not trying the merits the underlying disputes that were settled under the Settlement Agreement, including whether Cigna improperly denied the forty-four claims. Instead, the Court is reviewing the consideration given and received by Victory under the Settlement Agreement to determine whether Victory received reasonably equivalent value. As noted above, part of the consideration Victory received was avoiding significant litigation risks on fee-forgiveness. The Court has canvassed that issue and all other relevant issues in the reasonably-equivalent-value determination.
Second, the Court need not determine whether there were 317 individual fraudulent transfers when the Exhibit A Claims were settled, or even whether there were two fraudulent transfers: one for the forty-four claims submitted pursuant to fully insured plans, and one for the 273 claims that were submitted pursuant to self-funded plans. There was a single Settlement Agreement that Victory seeks to unwind. That single Settlement Agreement resolved all of the parties' disputes in one package deal. The Court has reviewed that package deal and determined that Victory received reasonably equivalent value in the exchange.
V. OBJECTIONS TO SUMMARY JUDGMENT EVIDENCE
The Court overrules all parties' objections to summary judgment evidence, including the Defendants' Objections to Plaintiff's Summary Judgment Evidence ,
VI. CONCLUSION
For all the reasons detailed above, Cigna is entitled to summary judgment that Victory received reasonably equivalent value under the Settlement Agreement. In light of the Court's ruling, the Court need not consider Cigna's other arguments in support of its request for summary judgment. The Court denies the Plaintiff's Summary-Judgment Motion because the reasonably-equivalent-value issue (an essential element of its constructive fraudulent-transfer claims) has been determined against the Plaintiff, rendering the balance of the Plaintiff's arguments moot.
Therefore, the Court hereby ORDERS AS FOLLOWS:
1. Cigna's Summary-Judgment Motion [Adv. ECF No. 120] is GRANTED in part as set forth above.
2. Victory's Summary-Judgment Motion [Adv. ECF No. 116] is DENIED .
3. The Defendants' Objections to Plaintiff's Summary Judgment Evidence [Adv. ECF No. 128] are OVERRULED.
4. The Trustee's Motions for Opportunity to Properly Support Facts Pursuant to Fed. R. Civ. P. 56(e)(1) [Adv. ECF Nos. 134, 136] are GRANTED .
Not all of the facts included here are material, but they are included for background.
See Pl.'s 1st Am. Compl. ¶ 16, Adv. ECF No. 33. When an employer offers health benefits to its employees, it can elect to fund the plan itself or to purchase an insurance policy to fund the plan. The plan is "administrative services only" or "ASO" when the employer funds the plan and simply contracts with Cigna to administer the plan, rather than insure the plan. E.g. , N. Cypress Med. Ctr. Operating Co. v. Cigna Healthcare ,
See Pl.'s 1st Am. Compl. ¶ 15.
Id. ¶¶ 16, 21.
Defs.' App. 203:7-25; Defs.' App. 166:2-5. The Defendants' Appendix is filed at Adv. ECF No. 122.
Pl.'s 1st Am. Compl. ¶¶ 13-14; Defs.' App. 1-2. See also Supplemental Expert Report of Cynthia Seale, Adv. ECF No. 117-1, at 37 of 60 (valuing Victory's pre-release claims at $10,994,843, less patient responsibility of $1,154,698, for a total of $9,840,145).
Defs.' App. 185:5-24.
Defs.' App. 182:18-25.
Defs.' App. 182:24-25-App. 183:6; see also Defs.' App. 219; Defs' App. 4-25.
Defs.' App. 183:23-App. 184:3.
Defs.' App. 188:2-App. 189:2; see also Defs.' App. 219, App. 4-25.
Defs.' App. 219-220; Defs.' App. 4-25.
Defs.' App. 190:5-7.
See generally Pl.'s 1st Am. Compl. ¶¶ 22-40.
Defs.' App. 186:23-App. 187:5; Defs.' App. 171:14-17.
Defs.' App. 172:1-App. 173:7.
Defs.' App. 174:8-13.
Defs.' App. 174:25-App. 175:1.
Defs.' App. 176:2-22; Defs.' App. 177:4-10; Defs.' App. 180:22-App. 181:16.
Defs.' App. 177:4-10.
Defs.' App. 178:8-App. 179:9.
See Victory Medical Center Plano, L.P. et al. v. Cigna , No. 4:13-cv-1654 (S.D. Tex.).
See generally 2d Am. Compl. in the 2013 Lawsuit, No. 4:13-cv-1654 (S.D. Tex.), ECF No. 25.
See generally Answer in the 2013 Lawsuit, No. 4:13-cv-1654 (S.D. Tex.), ECF No. 28.
See Stipulation in the 2013 Lawsuit, No. 4:13-cv-1654 (S.D. Tex.), ECF No. 31; Defs.' App. 212:10-App. 213:14.
See Order in the 2013 Lawsuit, No. 4:13-cv-1654 (S.D. Tex.), ECF No. 33.
Defs.' App. 196:16-22.
Defs.' App. 204:7-20; Defs.' App. 208:16-25.
Defs.' App. 205:15-App. 206:18.
Defs.' App. 207:1-9; Defs.' App. 167:17-21 (noting that in-network agreements have value because they generate increased volume). As noted below, however, the parties' entry into the in-network agreements in February 2015-by itself-could not have been part of the reasonably-equivalent-value exchange when the settlement agreement was signed on March 27, 2015.
Defs.' App. 26, 43.
Defs.' App. 65-66.
Defs.' App. 65.
Defs.' App. 67.
Defs.' App. 211:6-9.
See generally Defs.' App. 69-83. The 317 claims were listed in an Exhibit to the Settlement Agreement. Defs.' App. 69 (describing "Exhibit A Claims"), Defs.' App. 77-83. Under the Settlement Agreement, Victory also agreed to submit, and Cigna agreed to process, claims for Cigna customers with dates of service from March 1, 2015 through March 31, 2015 (the "Supplemental Claims ") at the newly negotiated in-network rates.
See Defs.' App. 70-73; Defs.' App. 191:15-24.
The parties dispute the standard of review a court should use when reviewing whether Cigna properly denied the 44 claims submitted under fully insured plans, either de novo (the Plaintiff's contention) or abuse of discretion (Cigna's contention). The Court need not decide that issue; it is enough to note that the parties resolved any such hotly contested issues when they settled prior to bankruptcy.
See Defs.' App. 71-74; Defs.' App. 192:2-17.
Defs.' App. 84.
Defs.' App. 84.
Ms. Russell's email also addresses a separate Settlement Agreement with Victory affiliates in Houston and Beaumont. The plaintiffs in this suit, Victory, are referred to as "North."
Defs.' App. 84.
Defs.' App. 86.
Defs.' App. 209:10-App. 210:18.
Defs.' App. 210:21-24; Defs.' App. 197:10-App. 202:12.
Defs.' App. 216:15-18.
Defs.' App. 214:3-14, 18-22; Defs.' App. 168:12-17.
Defs.' App. 214:25-App. 215:7.
Defs.' App. 169:16-22.
Defs.' App. 218:14-18.
1st Am. Compl. ¶¶ 6-9.
Defs.' App. 164:17-App. 165:5.
Bankr. ECF No. 969 (confirmation order, with First Amended Joint Chapter 11 Plan attached as Exhibit A).
Id. at 150.
See generally Orig. Compl., Adv. ECF No. 1.
See generally id.
See generally Mot. Dismiss, Adv. ECF Nos. 17, 18.
See Order Granting in Part and Denying in Part Motion to Dismiss , Adv. ECF No. 49.
Adv. ECF No. 33.
See generally Mot. Dismiss, Adv. ECF No. 37.
See generally id.
See Order Granting Motion to Dismiss , Adv. ECF No. 57.
See Defs.' App. 136-37.
See Stipulation of Dismissal of Cigna's Counterclaims and Plaintiffs' Counts 2, 3, 4 and 6 , Adv. ECF No. 88.
Adv. ECF No. 116.
Adv. ECF Nos. 117, 137.
The Plaintiff's Summary-Judgment Motion asks for $972,976.00, which the Court understands to be a mathematical error.
Adv. ECF No. 120.
Adv. ECF No. 121.
Fed. R. Civ. P. 56(a) ; Fed. R. Bankr. P. 7056.
Little v. Liquid Air Corp. ,
Norwegian Bulk Transp. A/S v. Int'l Marine Terminals P'ship ,
In re Dunham ,
In re TransTexas Gas Corp. ,
In re Calvillo ,
In re 1701 Commerce, LLC ,
In re Calvillo ,
United States v. Loftis , 3:06-CV-1633-P,
ASARCO LLC v. Americas Mining Corp. ,
In re Mirant Corp. ,
See In re Cajun Electric Power Coop. ,
Nellis v. Shugrue ,
In re Xtra Petroleum Transp., Inc. , No. 11-12639-J11,
In re Hefner ,
Adv. ECF No. 117-1, at 37 of 60. Cigna retained a rebuttal expert, Phil Hurd, who criticized Ms. Seale's expert opinion but did not offer his own estimate of the value of Victory's pre-release claims. Adv. ECF No. 117-2, at 59-60 of 60, through Adv. ECF No. 117-3, at 1-16 of 60. Cigna does not rely on Mr. Hurd's expert report in support of its request for summary judgment.
Adv. ECF No. 117-1, at 37 of 60.
See, e.g. , In re Xtra Petroleum Transp., Inc. , No. 11-12639-J11,
See Declaration of Kelly Russell, found at Adv. ECF No. 133 (pages 247-50 of 311 of PDF file), marked as "Exhibit 32" (3TA761-3TA764).
See, e.g. , In re Taylor ,
Cf. In re Worldwide Diamond Ventures, LP ,
Even if the Court were to conduct two or even 317 mini-evaluations on reasonably equivalent value, the Court's conclusion would be the same: that Victory received reasonably equivalent value when considering all of the relevant factors.
Adv. ECF No. 128.
Adv. ECF Nos. 134, 136.
Reference
- Full Case Name
- IN RE: VICTORY MEDICAL CENTER MID-CITIES, LP, Debtors. Neil Gilmour, Trustee for the Grantor Trusts of Victory Parent Company, LLC v. Connecticut General Life Insurance Company and Cigna Corporation
- Cited By
- 1 case
- Status
- Published