Case 1:22-cv-00012-RP-SBJ Document 1-1 Filed 08/12/22 Page 1 of 30
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`IN THE IOWA DISTRICT COURT FOR POLK COUNTY
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` No.
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`CLAIMDOC, LLC,
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`Plaintiff,
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`vs.
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`ATHENA HEALTHCARE ASSOCIATES,
`INC.; INNOVATIVE HEALTH PLAN, LLC;
`IDEAL HEALTH INDEMNITY PLAN, LLC;
`HEALTH INFORMATION SERVICES, LLC;
`MARSH MCLENNAN AGENCY; S&S
`HEALTHCARE; MEDXOOM, LLC; and
`ALLEN JACKSON
`Defendants.
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`PETITION IN EQUITY
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`Plaintiff ClaimDOC, LLC (“ClaimDOC”) as former co-fiduciary of the
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`Athena Health Plan (the “Plan”) asserts this Petition against Defendants Athena Healthcare
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`Associates, Inc.; Innovative Health Plan, LLC; Ideal Health Indemnity Plan, LLC; Healthcare
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`Information Services, LLC; Marsh McClennen Agency; S&S Healthcare; Medxoom, LLC; and
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`Allen Jackson and states as follows:
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`SUMMARY OF THE ACTION
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`1.
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`ClaimDOC brings this action in response to Defendants’ conspiratorial actions
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`denying ClaimDOC the benefits of its services agreement (the “Agreement”). Athena Healthcare
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`Associates, Inc. (“Athena”) is named both in its corporate capacity and as plan sponsor. Athena
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`has conspired with other Defendants to engage in the unlawful activity in this petition. Athena is
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`a self-insured employer and is a fiduciary of the Plan. ClaimDOC entered into the Agreement
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`with Athena to obtain increased value for the services provided to Athena’s employees. As a
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`result, ClaimDOC became a co-fiduciary to the Plan. As an ERISA co-fiduciary, ClaimDOC
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`took very seriously its obligation to keep the interest of the hardworking beneficiaries of the Plan
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`in mind. However, after entering a contractual relationship with Athena, ClaimDOC discovered
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`that Athena is an entity which makes contributions to its employee benefit plan only when it is
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`convenient or beneficial to Athena. This is evidenced, in part, by the Department of Labor’s (the
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`“DOL’s”) ongoing investigation of Athena, which has spanned years, and Athena’s willingness
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`to take full advantage of the DOL’s process at the expense of the beneficiaries despite its
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`ongoing assertions of being “financially strong.” When ClaimDOC finally decided it could no
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`longer be associated with Athena and its owner, Lawrence Santilli, ClaimDOC terminated its
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`contract, concluding its status as an ERISA fiduciary with respect to the Plan. At that time, there
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`was over $9 million dollars in claims that Athena refused to fund. In addition, Athena owed
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`ClaimDOC nearly $2 million in fees. Shortly thereafter, Allen Jackson appeared with a number
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`of shell companies, which served as vehicles to interfere with ClaimDOC’s rights. Allen
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`Jackson, Athena, and their co-conspirators devised a plan whereby they would avoid paying the
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`arrears healthcare funds by telling all healthcare providers they had to “resubmit” their claims.
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`This was in conflict with the directive of the DOL to pay oldest health claims first as required by
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`ERISA. In the process of violating its ERISA duties, Athena also breached its contractual duties
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`to ClaimDOC by refusing to pay the nearly $2 million in outstanding fees to ClaimDOC.
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`2.
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`ClaimDOC, LLC is an Iowa limited liability company with headquarters in
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` THE PARTIES
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`West Des Moines, Iowa.
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`3.
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`Athena Healthcare Associates, Inc. is a Connecticut for-profit Corporation based
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`in Farmington, Connecticut with locations in Rhode Island, Massachusetts, and Connecticut.
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`4.
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`Athena is a skilled nursing, short-term and post-hospital care rehabilitation
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`facility provider.
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`5.
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`Innovative Health Plan, LLC is a Connecticut-based limited liability company
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`owned and operated by Allen Jackson.
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`6.
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`Ideal Health Indemnity Plan, LLC is a Connecticut-based limited liability
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`company owned and operated by Allen Jackson.
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`7.
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`Healthcare Information Services, LLC is a Connecticut-based limited liability
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`company owned and operated by Allen Jackson.
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`8.
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`Marsh McLennan Agency, LLC is a Delaware limited liability company with
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`headquarters in New York.
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`9.
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`S&S Healthcare Ohio LLC is an Ohio limited liability company with headquarters
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`in Cincinnati, Ohio, with a registered tradename of S&S Healthcare Strategies, LTD.
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`10. Medxoom, LLC is a Delaware limited liability company with its principal place
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`of business in Georgia.
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`JURISDICTION AND VENUE
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`This court has subject matter jurisdiction over Plaintiff’s claims as the contract in
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`11.
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`question was, in part, performed in Polk County, Iowa and the tortious conduct was directed at
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`ClaimDOC in Polk County.
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`12.
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`Venue is proper as ClaimDOC is located in Polk County, Iowa.
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`FACTUAL ALLEGATIONS
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`13.
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`Plaintiff ClaimDOC, LLC is an Iowa limited liability company that services self-
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`funded health plans nationwide.
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`14.
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`Specifically, ClaimDOC provides claim auditing and member advocacy services
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`designed to achieve health benefits that are sustainable.
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`15.
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`ClaimDOC’s approach is member-focused and builds partnerships with members
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`and healthcare providers to reduce overall spending, creating more affordable healthcare to
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`employers and employees, while managing risk as a co-fiduciary.
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`16.
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`Athena is a for-profit skilled nursing, short-term, and post-hospital care
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`rehabilitation facility provider.
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`17.
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`18.
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`19.
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`20.
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`21.
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`Athena sponsors the Plan for its employees and dependents.
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`The Plan is “self-insured” and therefore governed by ERISA.
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`The Plan is regulated by the DOL.
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`ClaimDOC accepted Athena as a client in 2018.
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`ClaimDOC provided claim review services to Athena pursuant to the Agreement
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`attached as Exhibit A.
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`22.
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`Athena and ClaimDOC executed the Agreement, making both the Plan and
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`Athena responsible for ClaimDOC’s fees. Schedule A of the Agreement provides that Athena is
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`obligated to pay said fees in the event the Plan fails to make such payment.
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`23.
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`24.
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`ClaimDOC and Athena served as ERISA co-fiduciaries to the Plan.
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`As a co-fiduciary of the Plan, ClaimDOC’s goal was to provide reasonable and
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`necessary healthcare benefits to the hardworking healthcare professionals who work for Athena
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`by ensuring Athena and its beneficiaries paid an accurate, consistent, and fair price for their
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`healthcare needs.
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`25.
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`Innovative Health Plan, LLC is a Connecticut LLC that, together with Ideal
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`Health Indemnity Plan, LLC and Healthcare Information Services, LLC, is owned and operated
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`by Allen Jackson (“Jackson”).
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`26.
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`Jackson is known in the industry as an unscrupulous and aggressive competitor
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`and marketer.
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`27.
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`28.
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`In this case, Jackson saw an opportunity to make a quick profit.
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`Jackson teamed up with Athena-owner Lawrence Santilli in an effort to deny
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`Athena beneficiaries over $9 million dollars in healthcare benefits and to avoid nearly $2 million
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`dollars in contractual obligations to ClaimDOC.
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`29. Marsh McLennen Agency (“Marsh”) is an international insurance sales related
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`services company.
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`30. Marsh assisted, aided, abetted, and took part in the breach of fiduciary duty and
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`the interference with the ClaimDOC contract with Athena.
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`31. Marsh’s primary actors in this case were Lawrence Cass, Jason Daniewicz, and
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`William Dardani, all having been willing participants in this conspiracy.
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`32. Medxoom provides a computer-based application for the beneficiaries who are the
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`victims of Athena’s conspiracy.
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`33. Medxoom, upon information and belief, either negligently or intentionally
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`participated in the conspiracy.
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`34.
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`A recurring theme in this conspiracy is Jackson’s involvement.
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`35.
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`Jackson, along with Jason Daniewicz, William Dardani, Laurence Cass, and
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`Marsh (collectively the “Brokers”), has been knowingly interfering with ClaimDOC’s contract
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`with Athena.
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`36.
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`Upon information and belief, the Brokers have engaged in acts aimed at assisting
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`Athena to avoid or improperly delay payment of nearly $2 million dollars in obligations to
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`ClaimDOC.
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`37.
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`38.
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`The Brokers knowingly conspired with the Defendants to avoid these payments.
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`On August 31, 2021, ClaimDOC placed Athena on notice of termination of its
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`services after Athena failed to timely issue funding to the Third-Party Administrators (the
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`“TPAs”) to satisfy its ERISA obligations as Plan Sponsor to pay medical claims. Athena had also
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`failed to satisfy its contractual obligations to pay ClaimDOC fees pursuant to the Agreement.
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`39.
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`40.
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`Athena has never disputed any of ClaimDOC’s fees or services.
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`At the time of the notice, Athena had failed to fund the Plan and faced a six-
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`month deficit. Throughout this time period, the Brokers represented that Athena was “financially
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`strong” despite its refusal to pay medical claims.
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`41.
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`At the time of notice, Athena had failed to pay ClaimDOC nearly $2 million in
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`fees as required by the Agreement.
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`42.
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`ClaimDOC was concerned that Athena would unlawfully interfere with the
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`beneficiaries’ rights. ClaimDOC was also concerned Athena’s contractual arrears would
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`increase.
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`43.
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`44.
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`ClaimDOC provided a notice period of thirty days to cure.
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`At the end of the notice period, Athena and ClaimDOC agreed to a payment plan
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`to allow Athena to come within good standing.
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`45.
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`On September 15, 2021, Plaintiff ClaimDOC entered into an amendment of the
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`Agreement (the “Amended Agreement”), which adjusted ClaimDOC’s fees due to Athena’s prior
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`payment failure.
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`46.
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`ClaimDOC entered into the Amended Agreement in order to assist the
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`beneficiaries of the Plan and ensure the beneficiaries received their benefits.
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`47.
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`The Amended Agreement provided a means for ClaimDOC to continue services
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`with Athena.
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`48.
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`The Amended Agreement, and the fees set forth therein, governed the relationship
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`between ClaimDOC and Athena into 2022.
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`49.
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`In fall 2021, ClaimDOC learned that Allen Jackson and Innovative Health Plan
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`were marketing competitive services to ClaimDOC, in violation of ClaimDOC’s
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`Producer/marketing agreement with Jackson-owned Healthcare Information Services (“HIS”),
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`which required that HIS use ClaimDOC as its preferred vendor for IHP.
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`50.
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`Upon learning of this violation, ClaimDOC terminated its agreement with HIS for
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`cause on December 29, 2021, and Jackson’s revenue share for fees associated with Athena ended
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`as well.
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`51.
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`At the start of the 2022 calendar year, Athena was briefly in compliance with
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`ERISA and the Amended Agreement by making timely payment requirements (for the first time
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`in six months) after its final “catch-up” payment in late December.
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`52.
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` Athena’s January 2022 payments immediately fell behind, causing Athena to
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`once again be outside of compliance with the law and the Amended Agreement.
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`Case 1:22-cv-00012-RP-SBJ Document 1-1 Filed 08/12/22 Page 8 of 30
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`53.
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`On February 9, 2022, ClaimDOC provided notice to Athena that it had fallen
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`outside of ERISA requirements for timely payment of medical claims and thereby breached the
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`Amended Agreement.
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`54.
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`55.
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`56.
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`ClaimDOC provided an opportunity to cure with a deadline of February 18, 2022.
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`Athena failed to cure in accordance with ClaimDOC’s February 9, 2022 notice.
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`On March 1, 2022, ClaimDOC provided a detailed communication to Athena
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`outlining Athena’s obligations as Plan Sponsor to ensure all fiduciary services provided by
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`ClaimDOC were identified and replaced upon its termination.
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`57.
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`In doing so, ClaimDOC offered certain transition services to ensure that members
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`and healthcare providers were not harmed more than they already had been by Athena’s abusive
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`payment practices.
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`58.
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`In pertinent part, ClaimDOC offered to continue providing pricing for medical
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`claims with access to its healthcare provider contracts, giving members continued access to care
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`through the end of the plan year on May 31, 2022.
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`59.
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`ClaimDOC also offered to render these services on a reduced fixed cost,
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`recognizing it was not offering its full spectrum of services.
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`60.
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`Athena rejected this offer and instead announced it would be transitioning
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`services prior to the end of the plan year to a new administrator, S&S Healthcare.
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`61.
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`ClaimDOC provided pricing services and access to contracts through this
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`transition date of April 1, 2022.
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`62.
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`ClaimDOC submitted invoices according to the terms of the Amended Agreement
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`and confirmed with MMA, IHP, and Athena of the same and its expectations that Athena would
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`Case 1:22-cv-00012-RP-SBJ Document 1-1 Filed 08/12/22 Page 9 of 30
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`pay ClaimDOC owed fees.
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`63.
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`Athena did not dispute at any time that it owed ClaimDOC fees during this
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`transition period nor did it request ClaimDOC stop services.
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`64.
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`Plaintiff ClaimDOC recognizes that transitioning beneficiaries is delicate when it
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`occurs prior to the expiration of a plan year.
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`65.
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` For that reason, ClaimDOC, with the full knowledge of Marsh, took steps to
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`ensure a smooth transition beyond that which was called for by contract and ERISA. While
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`ClaimDOC is a for-profit corporation, it took seriously its fiduciary duty to make sure the
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`beneficiaries of the Plan were provided for.
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`66.
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`Transition prior to the end of a plan year creates significant work related to claims
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`management and accumulator tracking compared with transitioning at the end of the plan year
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`and creates additional disruption to the beneficiaries and unnecessary additional stress to
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`healthcare providers under the circumstances.
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`67.
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`This mid-year transition was communicated to ClaimDOC through MMA, the
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`Brokers, IHP, and Allen Jackson.
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`68.
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`Athena would also be using Medxoom as a customer service platform moving
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`forward, adding to its prior services it was providing to Athena when ClaimDOC co-serviced the
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`account.
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`69. When ClaimDOC requested information from MMA, IHP, and S&S related to the
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`transfer of customer service inquiries from members and providers, a Medxoom phone number
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`was provided.
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`70.
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`By email, ClaimDOC outlined details related to the transition to ensure all parties
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`were under the same understanding.
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`71. MMA agreed to ClaimDOC’s proposed details regarding the transition, and
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`Athena never clarified or corrected the information within that communication, despite having
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`numerous opportunities and sufficient time to do so.
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`72. MMA expressed to ClaimDOC that it had reviewed the information with Athena
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`as its consultant and it was unaware why Athena did not respond to the request for confirmation.
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`73.
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`ClaimDOC attempted to communicate with S&S Healthcare throughout the
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`transition period to coordinate on the compliance issues Athena was facing as its new client.
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`74.
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`Despite multiple efforts, S&S ignored ClaimDOC’s requests to discuss Athena’s
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`lack of compliance and funding deficiencies.
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`75.
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`In fact, during one implementation call intended to discuss basic business needs
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`for the transition to ensure proper handling of member and provider inquiries, S&S stopped the
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`call and requested ClaimDOC leave the call per the request of Jackson.
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`76.
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`During this transition, Allen Jackson led the discussions regarding transition and
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`implementation with the new vendors and the prior TPA.
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`77. MMA, through Larry Cass, indicated that Allen Jackson was putting the new
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`vendor platform together.
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`78.
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`ERISA dictates that an employer/fiduciary like Athena is required to fund its
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`claims in the order received without discrimination.
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`79.
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`As a result, although Athena’s agreement with its co-fiduciary ClaimDOC had
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`been terminated, Athena was required to pay the $9 million dollars in healthcare fees it had
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`neglected for half a year.
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`10
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`Case 1:22-cv-00012-RP-SBJ Document 1-1 Filed 08/12/22 Page 11 of 30
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`80.
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`Because ClaimDOC is a co-fiduciary of the Plan, ClaimDOC was concerned that
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`Athena might not pay the required healthcare fees.
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`81.
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`ClaimDOC’s concerns were confirmed and expanded when it learned that there
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`was a potential scheme underfoot.
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`82.
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`Claims awaiting funding through the “requests for funding” (the “RFFs”) issued
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`by Amwins Connect, the TPA to Athena prior to April 1, 2022, were fully processed and
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`ClaimDOC had earned its contractual fees – the requests simply needed Athena to fund them to
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`complete adjudication.
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`83.
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`On April 14, 2022, Laurence Cass requested specific claim information to
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`“evaluate” the RFFs for Athena.
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`84.
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`Cass indicated they needed the information to “recommend” Athena pay these
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`amounts.
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`85.
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`86.
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`Cass then requested Allen Jackson obtain this information from ClaimDOC.
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`Allen Jackson requested claim information, including a detailed itemization of
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`ClaimDOC fees from January 1, 2022 be produced.
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`87.
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`88.
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`89.
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`Claim DOC produced this claim-level detail on April 15, 2022.
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`Athena’s current deficit is over $6 million.
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`Athena’s $6 million deficit includes medical claims for its members stretching to
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`February RFF dates as well as ClaimDOC fees for the same period.
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`90.
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`All other vendors, including MMA, IHP, and Medxoom, are paid on a fixed cost
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`basis and, upon information and belief, have been paid in full.
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`91.
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`In effect, Athena has prioritized payment to the Defendants assisting it in
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`11
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`avoiding the payment of medical claims, and those Defendants are accepting said funds at the
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`expense of the Athena beneficiaries.
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`92.
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`On May 4, 2022, one of ClaimDOC’s contracted healthcare providers reached
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`out expressing a need for assistance with Medxoom’s website.
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`93.
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`ClaimDOC contacted Medxoom, MMA, IHP/Ideal Health/Allen Jackson and
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`S&S Healthcare for assistance.
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`94.
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`In response, Medxoom presented ClaimDOC with a “Provider Letter” that was
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`being disseminated to care providers when they entered their email address to the “provider
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`portal”.
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`95.
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`The Provider Letter directed providers to “resubmit” all claims that remained
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`unpaid prior to April 1, 2022 and explained that S&S would “reprocess” these claims.
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`96. Medxoom’s Provider Letter clearly articulated the step-by-step scheme by which
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`the Defendants intended to further the conspiracy aimed at allowing Athena to avoid the RFFs of
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`processed claims, fraudulently delay paying providers by making them resubmit claims that had
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`previously been properly received and processed, as well as avoid paying ClaimDOC fees.
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`97.
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`The denial of payment has cheated ClaimDOC out of fees it has earned under
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`Agreement and Amended Agreement.
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`98.
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`ClaimDOC is owed approximately $1.7 million in related fees that are processed
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`through the RFFs.
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`99.
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`By requesting providers resubmit claims, this conspiracy was intended to allow
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`Athena—with the direct assistance and facilitation of these vendors—to not only delay or avoid
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`paying medical claims, but also avoid paying ClaimDOC fees.
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`12
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`E-FILED 2022 JUN 07 2:19 PM POLK - CLERK OF DISTRICT COURT
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`FIRST CLAIM FOR RELIEF
`(Against Defendant Athena Healthcare Associates, Inc. for Breach of Contract)
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`100. Plaintiff ClaimDOC incorporates the allegations it has set forth above, as if
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`fully set forth herein below.
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`101. At all relevant times, Athena was a party to the Agreement and Amended
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`Agreement with ClaimDOC.
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`102. At all relevant times, Defendant Athena was plan sponsor and separately a
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`fiduciary with respect to the Plan pursuant to ERISA.
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`103. Pursuant to the terms and conditions of the Agreement and the Amended
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`Agreement, Athena—in both its corporate capacity and its capacity as Plan Sponsor— was
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`required to pay ClaimDOC fees according to the established fee schedule.
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`104. ClaimDOC has performed all terms and conditions required of it by the
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`Agreement and the Amended Agreement, entitling ClaimDOC to certain fees.
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`105. As of the date of this Petition, Athena has failed to pay nearly $2 million of
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`ClaimDOC’s earned fees.
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`106.
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`In creating, orchestrating, facilitating, and/or participating in the aforementioned
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`neglect-of-ERISA duty scheme; in failing to pay ClaimDOC the outstanding fees; and with each
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`aforementioned act of fraud, Defendant Athena breached the terms and conditions of the
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`Agreement and the Amended Agreement.
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`107. By virtue of these breaches, ClaimDOC has been damaged in the loss of fees in
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`the amount of nearly $2 million owed for services rendered.
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`WHEREFORE, ClaimDOC respectfully requests the Court enter judgment against
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`Defendant Athena Healthcare Associates, Inc, in both its corporate capacity and its capacity as
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`Plan Sponsor, in an amount established in these proceedings, including costs and attorneys’ fees
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`and expenses incurred in this action, and for such other relief as the Court deems just and
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`necessary.
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`SECOND CLAIM FOR RELIEF
`(Against Defendants Innovative Health Plan, LLC; Ideal Health Indemnity Plan, LLC;
`Health Information Services, LLC; Marsh McLennon Agency; S&S Healthcare;
`Medxoom, LLC; and Allen Jackson for Damages for Intentional
`Interference with Contract)
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`108. Plaintiff incorporates the allegations of the previous paragraphs of this
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`Petition as if fully set forth herein.
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`109. At all relevant times, the Defendants Innovative Health Plan, LLC; Ideal Health
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`Indemnity Plan, LLC; Health Information Services, LLC; Marsh McLennon Agency; S&S
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`Healthcare; Medxoom, LLC; and Allen Jackson knew of the Agreement and the Amended
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`Agreement between ClaimDOC and Athena.
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`110. Defendants Innovative Health Plan, LLC; Ideal Health Indemnity Plan, LLC;
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`Health Information Services, LLC; Marsh McLennon Agency; S&S Healthcare; Medxoom,
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`LLC; and Allen Jackson exercised control over the Plan and created, orchestrated, facilitated,
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`and/or participated in a scheme by which Defendant Athena refused to pay healthcare providers
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`and ClaimDOC nearly $9 million while the Defendants themselves received financial gain.
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`111.
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`In creating, orchestrating, facilitating, and/or participating in the aforementioned
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`neglect-of-ERISA duty scheme and with each aforementioned act of fraud, Defendants
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`Innovative Health Plan, LLC; Ideal Health Indemnity Plan, LLC; Health Information Services,
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`LLC; Marsh McLennon Agency; S&S Healthcare; Medxoom, LLC; and Allen Jackson
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`14
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`Case 1:22-cv-00012-RP-SBJ Document 1-1 Filed 08/12/22 Page 15 of 30
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`intentionally interfered with the Agreement and the Amended Agreement.
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`112. This intentional interference facilitated Defendant Athena’s breach of the
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`Agreement and the Amended Agreement.
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`113. Through this intentional interference, ClaimDOC has been damaged in the loss of
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`fees in the amount of nearly $2 million owed for services rendered.
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`WHEREFORE, ClaimDOC respectfully requests the Court enter judgment against
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`Innovative Health Plan, LLC; Ideal Health Indemnity Plan, LLC; Health Information Services,
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`LLC; Marsh McLennon Agency; S&S Healthcare; Medxoom, LLC; and Allen Jackson in an
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`amount established in these proceedings, including costs and attorneys’ fees and expenses
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`incurred in this action, and for such other relief as the Court deems just and necessary.
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`THIRD CLAIM FOR RELIEF
`(Against Defendant Athena Healthcare Associates, Inc. for Fraud)
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`114. Plaintiff incorporates the allegations of the previous paragraphs of this
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`Petition as if fully set forth herein.
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`115. Defendant Athena represented to Plaintiff that the Plan’s claims would be
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`processed in the order received.
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`116. Defendant Athena’s representation was false.
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`117. Defendant Athena’s representation was material.
`118. Defendant Athena intended to deceive Plaintiff.
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`119. Plaintiff justifiably relied on Defendant Athena’s misrepresentation by continuing
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`its services until April 1, 2022.
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`120. Plaintiff was damaged when Defendant Athena and its co-conspirators directed
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`providers to resubmit their claims, causing ClaimDOC to lose fees in the amount of nearly $2
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`million owed for services rendered.
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`121. Defendant Athena’s misrepresentation was a proximate cause of this damage.
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`122. Defendant Athena’s actions were done with willful and wanton disregard of
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`Plaintiff’s rights.
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`WHEREFORE, ClaimDOC respectfully requests the Court enter judgment against
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`Defendant Athena Healthcare Associates, Inc. in its corporate capacity in an amount established
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`in these proceedings, including costs and attorneys’ fees and expenses incurred in this action, and
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`for such other relief as the Court deems just and necessary.
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`FOURTH CLAIM FOR RELIEF
`(Against Defendants Allen Jackson; Innovative Health Plan, LLC; Ideal Health Indemnity
`Plan, LLC; and Healthcare Information Services, LLC for Unjust Enrichment)
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`123. Plaintiff incorporates the allegations of the previous paragraphs of this
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`Petition as if fully set forth herein.
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`124. As a result of Defendants Allen Jackson; Innovative Health Plan, LLC; Ideal
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`Health Indemnity Plan, LLC; Healthcare Information Services, LLC and their co-conspirators
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`directing healthcare providers to re-submit their claims, Defendants Allen Jackson; Innovative
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`Health Plan, LLC; Ideal Health Indemnity Plan, LLC; and Healthcare Information Services, LLC
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`received fees to which ClaimDOC was entitled.
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`125. The enrichment of Defendants Allen Jackson; Innovative Health Plan, LLC; Ideal
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`Health Indemnity Plan, LLC; and Healthcare Information Services, LLC was at the expense of
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`ClaimDOC.
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`126.
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`It is unjust to allow Defendants Allen Jackson; Innovative Health Plan, LLC;
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`Ideal Health Indemnity Plan, LLC; and Healthcare Information Services, LLC to retain the
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`benefit they have received from ClaimDOC under the circumstances described herein.
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`WHEREFORE, ClaimDOC respectfully requests the Court enter judgment against
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`Defendants Allen Jackson; Innovative Health Plan, LLC; Ideal Health Indemnity Plan, LLC; and
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`Healthcare Information Services, LLC in an amount established in these proceedings, including
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`costs and attorneys’ fees and expenses incurred in this action, and for such other relief as the
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`Court deems just and necessary.
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`FIFTH CLAIM FOR RELIEF
`(Against All Defendants for Preliminary and Permanent Injunctive Relief)
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`127. Plaintiff incorporates the allegations of the previous paragraphs of this
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`Petition as if fully set forth herein.
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`128. Defendants have disseminated the Provider Letter to healthcare providers,
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`directing them to resubmit all claims that remained unpaid prior to April 1, 2022.
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`129. The Provider Letter is in direct violation of ERISA, the directive of the DOL, the
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`Agreement, and the Amended Agreement.
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`130. Should healthcare providers continue to resubmit claims pursuant to the Provider
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`Letter, ClaimDOC will be cheated out of fees it earned by providing its services pursuant to the
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`Agreement and the Amended Agreement.
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`131. On information and belief, the Defendants will continue to disseminate the
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`Provider Letter or otherwise direct, suggest, or indicate that providers should resubmit claims
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`governed by the Plan that were previously submitted for processing prior to April 1, 2022.
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`132. Upon information and belief, Defendants will dissipate any fees received from
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`claims resubmitted pursuant to the Provider Letter, greatly and irreparably harming ClaimDOC.
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`133. ClaimDOC requests this Court issue a preliminary and permanent injunction
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`enjoining the Defendants from disseminating the Provider Letter or otherwise directing,
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`suggesting, or indicating directly or indirectly that providers should resubmit claims governed by
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`the Plan that were previously submitted for processing prior to April 1, 2022.
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`134. The balance of harms is substantially greater to ClaimDOC if the Defendants are
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`enjoined as requested.
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`WHEREFORE, Plaintiff prays for an order entering a temporary injunction restraining
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`Defendants from requesting providers resubmit claims that had previously been properly
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`received and processed.
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`SIXTH CLAIM FOR RELIEF
`(Against Defendant Athena Healthcare Associates, Inc. for Preliminary and Permanent
`Injunctive Relief)
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`135. Plaintiff incorporates the allegations of the previous paragraphs of this
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`Petition as if fully set forth herein.
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`136. Defendants have disseminated the Provider Letter to healthcare providers,
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`directing them to resubmit all claims that remained unpaid prior to April 1, 2022.
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`137. The Provider Letter is in direct violation of ERISA, the directive of the DOL, the
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`Agreement, and the Amended Agreement.
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`138. As a result of Defendants’ scheme, providers have resubmitted claims pursuant to
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`the Provider Letter and ClaimDOC has been cheated out of fees it earned by providing its
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`services pursuant to the Agreement and the Amended Agreement.
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`139. Upon understanding and belief—discovered after ClaimDOC ended services—
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`Defendant Athena is on the brink of insolvency despite the Brokers’ prior representations.
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`140.
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` If Defendant Athena transfers, disposes of, or pays any amount to newer claims
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`or discriminatorily pays medical benefit claims inconsistent with the Department of Labor’s
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`directive to pay claims chronologically in the order that they were approved, it will have
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`committed an act violating Plaintiff’s rights respecting the subject of this action and tending to
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`make a judgment in Plaintiff’s favor ineffectual.
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`141. The balance of harms is substantially greater to Plaintiff if the Defendants are
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`enjoined as requested.
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`142. Plaintiff is willing to post a bond, in an amount sufficient to satisfy Iowa Rule of
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`Civil Procedure 1.1508, if required by the Court.
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`WHEREFORE, Plaintiff ClaimDOC respectfully requests that this court enter
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`preliminary injunction enjoining Defendant Athena Healthcare Associates, Inc. from
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`transferring, disposing of, or paying any amount to newer claims or from discriminatorily paying
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`medical benefit claims inconsistent with the Department of Labor’s directive to pay claims
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`chronologically in the order that they were approved. Plaintiff further prays that this Court enter
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`a permanent injunction in this regard and further award it its court costs, attorney’s fees, and
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`such other relief as this Court deems just.
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`Respectfully submitted,
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