The owners of a medical lab are seeking at least $78 million against an insurer’s senior leadership and their attorneys from a midsize law firm, who together allegedly falsified laboratory billing information, which was then ultimately used to allegedly secure a judgment for health care fraud.
Top leadership from Elevance Health and two partners from Robins Kaplan’s Minneapolis office were sued in the U.S. District Court for the Middle District of Florida under federal racketeering laws. In the lawsuit, the defendants are being accused of falsifying an Excel spreadsheet to create the appearance of laboratory billing spikes at a blood testing lab. The defendants allegedly used the falsified document to, among other things, obtain a nearly $26 million judgment that included punitive damages against the plaintiffs and their company, the complaint said.
The plaintiffs, Mark Blake and Beau Gertz, are being represented by Howard Foster, of Foster PC in Chicago, who in July sued a Denver-based midsize commercial litigation firm. That suit also raised fraud allegations.
The suit against Elevance officials, Blake v. Goldner, was surfaced by Law.com Radar, ALM’s source for immediate alerting on just-filed cases in federal and state courts.
The plaintiffs, owners of SeroDynamics, filed sued Dec. 29, asserting claims under RICO. Robins Kaplan partners Jeffrey Gleason and Nathaniel Moore are named as defendants, along with Elevance senior associate general counsel Steven Cohen, senior in-house attorney Linda Kearney, business information developer Paul Burns, employee Nancy Oser and emergency medicine specialist David Goldner.
According to the complaint, the scheme allegedly began in 2016 when Cohen directed Kearney to investigate a spike in billing from laboratory claims by Florida and Missouri hospitals.
The complaint said Blake and Gertz submitted claims for insurance reimbursement for their health care services, however, the billing information on the claims was reportedly changed after it was out of the plaintiffs’ control and after Elevance had paid them.
The complaint said this allegedly led Burns to create the false Excel spreadsheet, which supposedly showed that SeroDynamics was charging inflated prices for its services. The document, the complaint said, seemingly represented fraudulent insurance claims.
Moore then allegedly used the false spreadsheet to build a suit against Blake and Gertz filed in the Western District of Missouri in July 2018. During trial, Gleason allegedly presented the falsified spreadsheet into evidence. Oser then authenticated the document for the court, while supposedly knowing it was falsified, the complaint alleged.
In September 2021, the jury in that cases handed up their award, which included $7.6 million in punitive damages and over $18 million in compensatory damages. Blake and Gertz appealed, but late last year, the U.S. Court of Appeals for the Eighth Circuit affirmed the district court’s ruling upholding the award.
The RICO suit against the Elevance officials seeks $25.9 million in damages—the amount that the jury awarded in the civil suit—trebled for RICO claims, plus attorney fees and costs, totaling at least $78 million.
In their complaint, the two cited the Health Information Technology for Economic and Clinical Health (HITECH) Act for HIPAA Privacy, Security, and Breach Notification Rules preventing insurance carriers from changing data elements that hospitals use for submitting claims for medical services.
“I have been a RICO lawyer for a long time, and I have had the occasion of bringing cases against lawyers,” Foster told Law.com. “It never shocks me when lawyers do bad things. Lawyers do bad things; not all lawyers, but there are a lot of lawyers out there who will do bad things to help their clients.”
Neither Gleason nor Moore from Robins Kaplan responded to a request for comment. A spokesperson for Elevance Health also did not return a request for comment.
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