EXHIBIT F

Case 0:20-cv-61007-AHS Document 52-6 Entered on FLSD Docket 04/23/2021 Page 1 of 6
Tal J. Lifshitz, Esq.

tjl@kttlaw.com | 305.372.1800

2525 Ponce de Leon, 9th Floor, Miami, Florida 33134 | Phone 305.372.1800 | Fax 305.372.3508 | kttlaw.com

April 14, 2021

VIA EMAIL

patrick.emery@fisherbroyles.com

kris.alderman@fisherbroyles.com

robert.wright@fisherbroyles.com

irene.oria@fisherbroyles.com

irene.basselfrick@akerman.com

gera.peoples@akerman.com

Re: South Broward Hospital District, d/b/a Memorial Healthcare System, v. 

ELAP Services, LLC, et al., Case No. 20-CV-61007-SINGHAL/VALLE

(S.D. Fla.); April 7, 2021 Meet and Confer

Dear Counsel:

On behalf of South Broward Hospital District, d/b/a Memorial Healthcare System (“Memorial”), 

we write to memorialize the meet and confer discussion between the Parties, including Defendants’ 

representations pertaining to the discovery issues raised by Memorial in its April 2, 2021 

Deficiency Letter and during the April 7, 2021 meet and confer between counsel. If we have 

omitted anything or if you disagree with anything we have set forth below, please let us know.

I. Status of Defendants’ Production

Defendants have not produced any documents responsive to Memorial’s First Requests for 

Production. However, Defendants confirmed during the meet and confer that the first of their 

rolling productions will commence by April 21, 2021. This initial production will consist of 

documents related to Defendants’ self-funded plan identification cards, plan documents, and 

policies and procedures. Additionally, Defendants stated that they would not produce certain 

materials due to HIPAA concerns until the Court enters a HIPAA-Qualified Protective Order. 

Since the meet and confer, the Court has entered a HIPAA-Qualified Protective Order. (See

D.E. 51). Memorial expects Defendants to produce any materials that Defendants were/are 

withholding due to HIPAA concerns. Further, Defendants confirmed that they would prioritize 

and expedite production of marketing materials requested by Memorial in Request Nos. 14 through

17. Please provide a date certain when Defendants will produce these marketing materials. If you 

cannot provide a date certain, please explain why. 

II. Claims at Issue

Several of Memorial’s requests relate to the Claims at issue in this litigation. See, e.g., Request 

Nos. 5, 6, 9, 13, 24, 28, 31, 32. Memorial defines “Claim” or “Claims” as any facility claim that 

Defendants repriced, processed or reprocessed, and/or administered using Reference Based 

Pricing.

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Memorial proposed that Defendants’ production start with Claims that Defendants can identify as 

responsive to Memorial’s individual production requests and related to the allegations of the 

lawsuit. Defendants rejected Memorial’s proposal. Although Defendants confirmed that they are 

capable of identifying and finding Claims and relevant responsive documents, Defendants stated

that they cannot ascertain the Claims at issue and will not attempt to identify them without first 

seeing a list of proposed Claims at issue from Memorial. However, Memorial maintains that 

Defendants are in the best position to identify the relevant Claims, especially since the information 

in their possession might differ between ELAP and GPA.

Defendants proposed that the Parties exchange Claims lists at a date and time after the Court’s 

entry of a HIPAA-Qualified Protective Order, with Memorial providing its Claims list first, then

Defendants providing their Claims list immediately upon receipt of Memorial’s list. The Court has 

now entered its HIPAA-Qualified Protective Order. Memorial will agree to a date and time for 

Memorial and Defendants to simultaneously exchange their respective Claims lists. Please confirm 

whether Defendants accept Memorial’s proposal.

III. Audit Information

In Request No. 37 to ELAP and Request No. 38 to GPA, Memorial asks Defendants to produce 

all documents regarding any external or internal audits that were conducted on or after January 1, 

2015. Defendants objected to these requests, stating that they did not know what Memorial meant 

by external or internal audits. 

Memorial clarified these requests during the meet and confer. The audit information Memorial

seeks relates to Claim audits. Defendants represented that they would produce Claim audits 

responsive to Memorial’s requests, but not until Defendants see Memorial’s Claims list. 

Defendants’ audit information is readily available and accessible to Defendants without having a 

proposed Claims list from Memorial. Moreover, Defendants are in the best position to identify the 

Claims at issue based on the information sought in Memorial’s requests and allegations raised by 

Memorial in this litigation. 

Please provide a date certain for the production of Defendants’ Claim audits. If you cannot provide 

a date certain, please explain why. 

IV. Defendants’ Attempt to Limit Discovery

Defendants’ position is that they will not produce documents related to non-Memorial Claims. At 

the meet and confer, Memorial reiterated to Defendants that limiting discovery in this manner 

would render it impossible for Memorial to certify a class since Memorial’s allegations are not 

limited to Defendants’ deceit of Memorial. The allegations against Defendants center on the

systematic underpayment of healthcare providers in Florida and around the country through 

arbitrary, uniform, and unilateral use of Reference Based Pricing. Proof of the existence of this 

scheme will establish Defendants’ liability and, consequently, Memorial’s and the class members’ 

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entitlement to damages. Thus, Memorial’s discovery requests cannot be limited to Memorial 

Claims only. Defendants’ documentation pertaining to Claims nationwide — particularly its

uniform marketing practices and practices relevant to whether a provider was deceived by 

Defendants’ conduct — are relevant, necessary, and squarely related to the allegations at issue. 

Defendants’ attempt to limit discovery of non-Memorial Claims is an improper attempt to bifurcate 

class discovery from merits discovery. Memorial must be able to take sufficient discovery that will 

involve both class and merits issues. 

In response to Memorial’s position, Defendants agreed to produce a sample of non-Memorial 

Claims once a HIPAA-Qualified Protective Order was in place. Now that the Court has entered 

the HIPAA-Qualified Protective Order, Memorial looks forward to receipt of Defendants’ sample. 

Please provide a date certain for Defendants’ production of a sample of non-Memorial Claims. If 

you cannot provide a date certain, please explain why. 

Memorial remains hopeful that this issue can be resolved amongst the Parties. However, to the 

extent this issue cannot be resolved and given the time limitations set forth in S.D. Fla. Local Rule 

26.1(g)(1), Memorial will seek guidance from the Court to preserve its position. 

V. Defendants’ Expected Production 

Request No. 1 — Memorial requested that Defendants produce “[d]ocuments sufficient to identify 

all of [ELAP’s and GPA’s] subsidiaries, affiliates, owners, shareholders, and officers.” Defendants 

confirmed that they would produce these documents. Please provide a date certain for the 

production of documents responsive to this request. If you cannot provide a date certain, please 

explain why. 

Request No. 6 — Memorial requested that Defendants produce “[d]ocuments sufficient to identify 

any Claim that the Clients paid additional monies on after a healthcare provider appealed the 

Claim, including, but not limited to, all Claims that [ELAP and GPA] authorized the payment of 

additional monies on after a healthcare provider appealed the Claim.” Defendants stated that they

will produce documents that reflect Claims where Defendants had to pay additional monies after 

Claims were appealed. Memorial asked Defendants during the call to provide a date when the 

documents would be produced. Defendants represented that they were unable to do so at this time. 

Defendants have now had a week to address this issue. Please provide a date certain for 

Defendants’ production of documents that reflect Claims where Defendants had to pay additional 

monies after Claims were appealed. If you cannot provide a date certain, please explain why. 

Request No. 9 — Memorial requested that Defendants produce all documents and communications 

between Defendants and anyone, including, but not limited to, the Clients, the Members, ELAP, 

GPA, SpringTide, MultiPlan, and PHCS related to the Claims. Defendants stated that they cannot 

produce any responsive documents until Memorial identifies what Claims are at issue. As 

explained in Section II, supra, Memorial will agree to a date and time for Memorial and Defendants 

to simultaneously exchange their respective Claims lists. Once the Claims lists are exchanged, 

Memorial anticipates the production of documents responsive to this request. Please confirm 

whether Defendants accept Memorial’s proposal. 

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Request No. 10 — Memorial requested that Defendants produce all documents and 

communications between Defendants and anyone, including, but not limited to, the Clients, the 

Members, ELAP, GPA, SpringTide, MultiPlan, and PHCS related to the MultiPlan or PHCS 

network. Defendants initially represented that an exchange of search terms would be appropriate 

in responding to this request and others like it, and agreed to provide Memorial with an initial 

proposal of terms by the close of business on April 9, 2021. Then, on April 9, 2021, Defendants 

instead emailed Memorial the following proposal: “Before we dive into search terms (and since 

we’re waiting on the claim lists anyway), we think it makes sense to have a call soon to discuss 

the parties’ systems, databases, search capabilities, and the like.” Memorial agreed to a call with 

Defendants and proposed a date for the Parties to discuss this issue. 

Request No. 11 — Memorial requested all documents and communications between Defendants

and anyone, including, but not limited to, the Members, GPA, SpringTide, MultiPlan, and/or 

PHCS related to the Clients. Defendants represented that they are already in the process of 

collecting documents responsive to this request, but only as to Memorial Claims. Please provide a 

date certain for Defendants’ production of the documents and communications related to the 

Clients. If you cannot provide a date certain, please explain why.

Request No. 12 — Memorial requested that Defendants produce all internal communications 

referring or relating to (a) “Reference-Based Pricing,” (b) the Clients’ self-funded plan 

identification cards, (c) the “allowed amount,” and (d) obtaining elective services from healthcare 

providers. Defendants said that they will produce “high level communications” responsive to this 

request. In response to Memorial’s request for clarification, Defendants confirmed that “high level 

communications” include communications with employees of Defendants that have influence over 

the strategy related to Reference Based Pricing. However, Defendants also stated that they would 

not be producing internal communications regarding Defendants’ Reference Based Pricing model 

and how that model is applied, because that purportedly broad reading of the request arguably 

includes all communications. Please confirm that any objection related to the Reference Based 

Pricing model and how it was applied will not impact the search term protocol that the Parties are 

negotiating.

Request No. 13 — Memorial requested that Defendants produce all policies, procedures, and 

guidelines relating to ten enumerated areas. Defendants represented that they would produce all 

“final” policies and procedures — namely, all official, implemented policies, procedures, and 

guidelines. These documents are readily accessible to Defendants. Please provide a date certain 

for Defendants’ production of documents responsive to this request. If you cannot provide a date 

certain, please explain why.

Request Nos. 14 & 17 — Defendants withdrew their objections to Requests 14 and 17 but would 

not commit to produce responsive documents by a date certain. Since the objections are withdrawn 

and these requests pertain to marketing materials that are easily accessible to Defendants, 

Memorial requested that Defendants prioritize the production of these documents. Please provide 

a date certain for Defendants’ production of marketing materials. If you cannot provide a date 

certain, please explain why.

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Request No. 16 — Memorial requested that Defendants provide “[a]ny and all marketing studies 

and profitability studies referring to ‘Reference-Based Pricing.’” Memorial agreed to define the 

term “profitability” in this request with the understanding that Defendants will produce responsive 

documents once Memorial provides a definition of “profitability study.” For purposes of Request 

No. 16, “profitability study” shall mean a study or similar analysis of an organization’s output to 

determine the organization’s production of profit or likelihood to produce profit.

Now that Memorial has provided the requested definition, please provide a date certain for

Defendants’ production of documents responsive to this request. If you cannot provide a date 

certain, please explain why.

Request Nos. 18, 19, & 20 — Memorial requested that Defendants produce copies of — and 

identify certain versions of — the Clients’ self-funded plan identification cards. Defendants agreed 

to provide Memorial with a sample of five self-funded plan identification cards responsive to these 

requests. Please provide a date certain for Defendants’ production of the self-funded plan 

identification cards. If you cannot provide a date certain, please explain why.

Request No. 21 — Memorial requested that Defendants produce documents sufficient to identify 

all websites listed on the Clients’ self-funded plan identification cards, including, but not limited 

to, when each website was added to the self-funded plan identification card. Defendants confirmed 

that, when they produce self-funded plan identification cards in response to Request Nos. 18 to 20, 

the produced cards will contain the relevant websites. This is not sufficient. Memorial is entitled 

to know whether these websites have changed over time. Defendants seek to defend their deceptive 

conduct by stating that the terms of their plans are disclosed on the websites listed on the cards. 

Defendants requested that Memorial provide an additional request. Memorial will serve a new 

request for production on Defendants.

Respectfully, 

/s/ Tal J. Lifshitz

Tal J. Lifshitz

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