IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF FLORIDA

CASE NO. 20-CV-61007-AHS

AMENDED CLASS ACTION COMPLAINT & DEMAND FOR JURY TRIAL

SOUTH BROWARD HOSPITAL

DISTRICT, D/B/A MEMORIAL 

HEALTHCARE SYSTEM, 

on its own behalf and on 

behalf of other similarly 

situated healthcare facilities, 

Plaintiff,

vs.

ELAP SERVICES, LLC, 

a Pennsylvania limited liability company, and

GROUP & PENSION ADMINISTRATORS, 

INC., a Texas corporation,

Defendants

____________________________________/

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TABLE OF CONTENTS

INTRODUCTION.........................................................................................................................1

PARTIES........................................................................................................................................4

JURISDICTION AND VENUE ...................................................................................................4

FACTUAL BACKGROUND .......................................................................................................5

I. The Genesis of ELAP’s Deceptive and Illegal Scheme ......................................................5

A. ELAP’s use of Reference Based Pricing results in lower payments to hospitals and 

greater patient financial responsibility. ...................................................................................6

B. ELAP’s use of Reference Based Pricing in its business model violates federal law. .....9

C. ELAP’s marketing ropes employers into ELAP’s web.................................................10

D. ELAP pays itself millions of dollars at the expense of providers, and leaves patients 

holding the bag. .....................................................................................................................13

II. ELAP’s Conduct Deceives Healthcare Providers like Plaintiff. .......................................15

A. ELAP fails to disclose its identity and Reference Based Pricing on insurance cards. ..17

1. The ID card fails to disclose ELAP’s name and role. ...............................................17

2. The ID card references a PPO network familiar to providers to trick them into 

expecting fair compensation..............................................................................................18

B. ELAP fails to disclose its role as “Designated Decision Maker.”.................................22

C. ELAP’s front man, GPA, lends legitimacy to ELAP’s scheme. ...................................23

D. ELAP deceives and misleads providers throughout the claim adjudication process. ...24

E. ELAP reveals itself as the decision maker during the appeal process, but refuses to 

meaningfully discuss resolution of the claims.......................................................................25

F. ELAP defends patients to obstruct and deter providers’ collection efforts...................26

G. ELAP directs plan members to ignore providers and breach their ...................................

Patient Agreements........................................................................................................27

III. Plaintiff and the Proposed Classes Have Been Damaged by ELAP and ..........................

GPA’s Scheme...............................................................................................................28

CLASS ALLEGATIONS............................................................................................................28

CLAIMS FOR RELIEF..............................................................................................................34

DEMAND FOR JURY TRIAL ..................................................................................................39

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Plaintiff South Broward Hospital District d/b/a Memorial Healthcare System (“Memorial”

or “Plaintiff”) sues ELAP Services, LLC (“ELAP”) and Group and Pension Administrators, Inc. 

(“GPA”) (collectively “Defendants”), and alleges as follows: 

INTRODUCTION

1. ELAP touts its service as a way for businesses to save money on healthcare by 

fighting expensive hospital bills. ELAP convinces its clients — employers with self-funded 

insurance plans — to let ELAP handle the administration of their employees’ healthcare claims, 

including the decisions on how, and in what amount, each employee’s healthcare claim will be 

paid.

2. ELAP refers to its service as a “fair” promotion of “responsible and sustainable 

management of healthcare costs.” 

3. There is nothing fair, responsible, or sustainable about ELAP’s service.

4. ELAP makes tens of millions of dollars off the backs of hospitals and healthcare 

facility providers while adding zero value to the provider – patient – health insurance relationship.1

5. The crux of the service — and the central, predominant issue at the heart of this 

case — is ELAP’s systematic method of underpaying healthcare providers, like Plaintiff, for the 

healthcare services provided to ELAP’s clients. ELAP refers to its underpayment scheme as a 

healthcare reimbursement model called “Reference Based Pricing.”

6. ELAP’s application of Reference Based Pricing is arbitrary, uniform, and 

unilateral. For emergency services, ELAP exploits state and federal laws that require hospitals to 

treat patients in emergency situations without inquiring about their ability to pay. So ELAP’s plan 

1 For clarity, Plaintiff and the putative classes of healthcare facility providers will generally be 

referred to simply as hospitals or providers. 

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members receive emergency services required by law, then ELAP underpays the hospital for the 

service it had no choice but to provide. Regardless of the service provided — emergent or not —

ELAP applies Reference Based Pricing to slash a provider’s charges to a fraction of the reasonable 

value of the services for each healthcare claim that ELAP reviews.

7. Remarkably, while ELAP holds itself out as responsibly managing healthcare costs 

by fighting excessive hospital bills, ELAP is actually compensated based on a percentage of the 

very hospital bills it claims are excessive. 

8. ELAP coordinates with two other ostensibly legitimate companies to further its 

objectives. First, it directs its clients to contract with Defendant GPA, a third-party claims 

administrator that is familiar to healthcare providers like Plaintiff. 

9. ELAP then creates insurance cards for its clients’ members that not only omit any 

reference to ELAP’s identity or application of Reference Based Pricing, but also include the logos

for both GPA and another established healthcare company, MultiPlan. MultiPlan operates a wellknown health insurance network with contracts and pre-negotiated rates with many healthcare 

providers, including Plaintiff.

10. The GPA and MultiPlan logos dupe healthcare providers like Plaintiff, which

contracts with MultiPlan and is in MultiPlan’s paid provider network, into providing treatment 

under the belief that they will be reimbursed at their contracted rates with MultiPlan.

11. But the hospitals will never receive payment at the MultiPlan rates, because ELAP 

directs its clients to honor the MultiPlan rates only for physician and healthcare professionals; for 

facility services provided by hospitals, ELAP directs its clients to pay a fraction of the MultiPlan

rates. This means that doctors are paid their MultiPlan rates, while hospitals are paid whatever 

ELAP decides using Reference Based Pricing. 

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12. ELAP’s involvement only becomes known to reasonable providers, including 

Plaintiff, once the healthcare services have already been provided and billed, and after ELAP has 

unilaterally and arbitrarily decided how much the provider will be paid — at a fraction of the 

reasonable value of the provider’s services.

13. While ELAP provides certain information about its identity and role to healthcare 

providers, that information is inconspicuous, insufficient, and fails to adequately disclose to 

providers the true nature of ELAP’s conduct. For example, at least some of the insurance cards 

created by ELAP provide a link, on the back of the card, to a website “For Additional Information.”

At the link, information about ELAP and Reference Based Pricing is available. But access to the 

website is not required, nor does the card describe what information is available on the site. And 

no reasonable provider would access the link before providing healthcare services, or discern from 

the face of the card that ELAP is involved or intends to arbitrarily and unilaterally apply Reference 

Based Pricing.

14. When a provider tries to combat ELAP’s deceit by appealing the arbitrary payment,

ELAP responds with uniform boilerplate denials, forcing the healthcare provider to seek full 

reimbursement from the patient.

15. But if the provider actually seeks reimbursement from a patient, ELAP sends 

intimidating and threatening attorney letters designed to deter the hospital from obtaining full 

payment for its services.

16. ELAP’s scheme funnels hard-earned revenues from healthcare providers like 

Plaintiff into ELAP’s pocket.

17. ELAP has made hundreds of millions of dollars as a result of this scheme.

18. This is a class action to expose ELAP’s deception. 

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19. This action is particularly suited for class treatment because the central, 

predominant issue at the heart of this case — ELAP’s arbitrary, uniform, and unilateral application 

of Reference Based Pricing — can be proven on a class-wide basis using the same evidence as 

would be used to prove the issue in individual actions alleging the same claims.

20. With respect to this central and overriding issue, each healthcare transaction at issue 

in this case is materially identical. ELAP reprices each claim it reviews in an arbitrary and 

unilateral manner, regardless of the circumstances. 

21. Plaintiff, on behalf of itself and the putative class, accordingly seeks to recover the 

millions of dollars that ELAP and GPA have stolen from healthcare providers like Plaintiff, and 

to enjoin ELAP and GPA from their continued deceptive and unfair trade practices. 

PARTIES

22. Plaintiff is an independent special tax district and healthcare system in Broward 

County, Florida, consisting of various healthcare facilities and providers, including hospitals, 

physicians, and outpatient facilities. 

23. ELAP is a limited-liability company organized and existing under the laws of 

Pennsylvania, with its principal place of business in Chesterbrook, Pennsylvania. 

24. GPA is a corporation organized and existing under the laws of Texas, with its 

principal place of business in Dallas, Texas. 

JURISDICTION AND VENUE

25. This Court has original jurisdiction over this class action pursuant to the Class 

Action Fairness Act (“CAFA”) and 28 U.S.C. § 1332(d) because members of the proposed Class 

are citizens of states different from ELAP’s and GPA’s home states of Pennsylvania and Texas, 

and upon information and belief the total amount in controversy in this action exceeds $5,000,000 

exclusive of interest and costs. This Court has supplemental jurisdiction over Plaintiff’s state law 

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claims under 28 U.S.C. § 1367. 

26. This Court has personal jurisdiction over Defendants pursuant to Florida Statutes 

§§ 48.193(1)(a)(1) and (1)(a)(2) because (i) Defendants operate, conduct, engage in, or carry on 

business in this state; and (ii) Defendants have committed tortious acts within this state. This Court 

also has personal jurisdiction over Defendants pursuant to Florida Statutes § 48.193(2) because 

Defendants engage in substantial and not isolated activity within this state. 

27. Venue is proper in this Court under 28 U.S.C. § 1391 because Plaintiff is domiciled 

and resides in this judicial district and it is where a substantial part of the events giving rise to this 

action occurred.

28. All conditions precedent to this action have occurred, been performed, or have been 

waived. 

FACTUAL BACKGROUND

I. The Genesis of ELAP’s Deceptive and Illegal Scheme 

29. ELAP holds itself out as providing healthcare claims auditing, repricing, and legal 

support services to self-funded plans. 

30. A “self-funded” plan is a healthcare plan where an employer assumes the financial 

risk of providing healthcare benefits to its employees. Because employers lack the knowledge and 

resources to determine how to process and pay their employees’ health insurance claims, they often 

outsource claims handling functions to third-party administrators, such as GPA, who handle the 

administration of the plan. 

31. ELAP contracts with Defendant GPA to provide third-party administrator services 

for the ELAP-designed self-funded plans. GPA touts itself, together with ELAP, as “leaders and 

co-founders of metric based pricing.”

32. What ELAP and GPA refer to as “metric based pricing” is more commonly known 

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as Reference Based Pricing.

A. ELAP’s use of Reference Based Pricing results in lower payments to hospitals 

and greater patient financial responsibility.

33. Reference Based Pricing is a payment model that some health plans implement in 

lieu of traditional PPOs. 

34. In a Reference Based Pricing regime, the health plan sets an arbitrary amount it will 

pay healthcare providers. This arbitrary amount is referred to as the “allowed amount.” Plans that 

use Reference Based Pricing unilaterally determine the maximum amount they will pay, and the 

patient is financially responsible for paying the difference between the provider’s charges and the 

allowed amount.

35. Transparent and fair Reference Based Pricing is not inherently wrong, but requires

the plan to (1) set a reimbursement level that providers would actually accept; and (2) adequately 

disclose the reimbursement level before service to allow the member to either shop for a provider 

who will accept the reimbursement amount, or plan to pay the difference between the 

reimbursement amount and what the provider will accept. In fact, many plans that use Reference 

Based Pricing disclose on the member’s insurance identification card that the claim will be 

processed based on Reference Based Pricing, the reimbursement level, or both — allowing the 

provider to decide whether it will agree to perform the services in light of the Reference Based 

Pricing reimbursement methodology. 

36. Transparent and fair Reference Based Pricing also complies with applicable state 

and federal laws, rules, and regulations regarding reimbursement for emergency services, which 

are designed to prevent patients from being forced to pay excess amounts of money out of their 

own pocket. 

37. ELAP does not operate or apply a transparent and fair Reference Based Pricing 

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model. ELAP designed and operates a deceptive and unfair Reference Based Pricing model that

fails to comply with applicable laws, sets unreasonably low reimbursement levels, misleads 

providers and members, stonewalls providers that attempt to resolve billing disputes, and deceives

everyone involved in the process to enrich itself. ELAP does not disclose the reimbursement level 

or that the plan uses Referenced Based Pricing on the member’s insurance identification card.

38. Upon information and belief, ELAP’s Reference Based Pricing structure typically 

sets their allowed amount at the greater of 112% of ELAP’s estimated hospital cost for the service, 

or the Medicare allowed amount for the services in the geographic region plus an additional 20%. 

39. ELAP’s reliance on Medicare cannot serve as a reasonable foundation for fair 

reimbursement because those payment rates are set by federal law, rather than through an arm’slength negotiation process as with private insurers.2 

40. In a January 2019 fact sheet entitled “Underpayment by Medicare and Medicaid”

published by the American Hospital Association, Medicare and Medicaid payment rates are 

“currently set below the costs of providing care, resulting in underpayment.”3 In the aggregate, 

both Medicare and Medicaid payments fall below costs:

• Combined underpayments were $76.8 billion in 2017. This includes a shortfall 

of $53.9 billion for Medicare and $22.9 billion for Medicaid. 

• For Medicare, hospitals received payment of only 87 cents for every dollar 

spent by hospitals caring for Medicare patients in 2015. 

2 While hospital participation in Medicare is technically voluntary, Medicare and Medicaid 

account for more than 60 percent of all care provided by hospitals, so very few hospitals can elect 

not to participate in these programs. See UNDERPAYMENT BY MEDICARE AND MEDICAID, Am. 

Hosp. Ass’n (Jan. 2019), https://www.aha.org/system/files/2019-01/underpayment-by-medicaremedicaid-fact-sheet-jan-2019.pdf. 

3 See id. Underpayment means the difference between the expected reimbursement and the 

payment for delivering care to patients. Underpayment occurs when the payment received is less 

than the reasonable value of the healthcare services provided.

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• In 2017, 66 percent of hospitals received Medicare payments less than cost.4

41. Medicare-based pricing methodologies like Reference Based Pricing employed by

ELAP (1) have no bearing on commercial claims, (2) are far lower than what is usual and 

customary in the industry, and (3) are drastically below the reasonable value of the healthcare 

services that hospitals provide. 

42. Patients with ELAP’s Reference Based Pricing plans believe they have insurance 

that will cover their treatment and are often surprised by large medical bills after the services are 

rendered. These surprise medical bills create conflict between healthcare providers and their 

patients. The patient and healthcare provider do not discover this unilateral and arbitrary allowed 

amount until after the services are rendered.

43. Patients frequently cannot afford medical bills created by ELAP’s Reference Based 

Pricing, and the result is that healthcare providers are inadequately compensated for the care they 

furnish. 

44. Conversely, under the traditional PPO model, healthcare providers like Plaintiff

enter into participation agreements with PPOs that are composed of insurance companies, thirdparty administrators, and rental networks. 

45. These PPO participation agreements include discounted reimbursement rates that 

self-funded plans agree to pay healthcare providers, so payment of the pre-negotiated rate 

constitutes payment in full. And under these participation agreements, healthcare providers are 

not permitted to “balance bill” patients for the difference between the discounted rate and the 

healthcare provider’s full billed charges. 

46. Self-funded plans contract with PPOs to ensure their members have access to the 

4 See id.

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PPO’s network and quality healthcare at a more cost-effective price. Providers agree to discount 

their charges for PPOs for a variety of reasons, including prompt payment of their bills, payment 

certainty, and increased volume of patients that a PPO can supply. 

47. Patients whose plans do not have a participation agreement with a healthcare 

provider (i.e., they are out-of-network) do not receive discounts on healthcare goods and services. 

Rather, the patients’ payment obligations are governed by the patient agreements entered into 

between the providers and the patients prior to rendering services. 

B. ELAP’s use of Reference Based Pricing in its business model violates federal 

law.

48. ELAP’s business model uses Reference Based Pricing to shift financial 

responsibility for healthcare services from employer to employee/patient. But patient 

responsibility is regulated — and capped — under the Patient Protection and Affordable Care Act 

(“ACA”). ELAP nevertheless designs its benefit plans in a way that end runs clear prohibitions of 

the ACA. 

49. The ACA requires self-insured welfare plans like ELAP’s plans to limit their 

members’ cost-sharing obligations (i.e., out-of-pocket) to a certain maximum amount. See 42 

U.S.C. § 18022(c)(1). In 2019, this maximum amount was $7,900.00 for an individual and 

$15,800.00 for a family.

50. The United States Departments of Labor, Health and Human Services, and the 

Treasury anticipated that Reference Based Pricing might result in increased patient financial 

responsibility, so they only allowed the use of Reference Based Pricing if it “[d]oes not function

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as a subterfuge for otherwise prohibited limitations on coverage.”5 

51. Thus, according to the Departments, plans cannot use Reference Based Pricing for 

emergency services because doing so end runs the ACA’s cost-sharing maximum requirement. 

52. But ELAP’s plans do exactly what the Departments tried to prohibit: they end run 

the ACA’s cost-sharing maximum requirement. 

53. ELAP has developed a template benefit plan that uses Reference Based Pricing to 

come up with an arbitrary allowed amount. Under ELAP’s plans, plan members are financially 

responsible for any amounts in excess of the allowed amount. Because ELAP’s allowed amounts

are well below the reasonable value of the providers’ services, plan members are stuck with outof-pocket obligations exceeding what is permitted by the ACA. 

54. All of ELAP’s violations further its deceptive and unfair scheme to the detriment 

of healthcare providers like Plaintiff. 

C. ELAP’s marketing ropes employers into ELAP’s web. 

55. ELAP’s clients are employers with self-funded benefit plans that pay ELAP to 

administer and audit their healthcare claims. 

56. To further its scheme, ELAP regularly markets its Reference Based Pricing

strategy to prospective and current clients as a “fair” pricing methodology. ELAP markets itself as 

empowering “employers, employees, and their families to get the most value from their health 

spend — while bringing clarity, consistency, and fairness to the entire plan experience.”6

5 FAQ ABOUT AFFORDABLE CARE ACT IMPLEMENTATION (PART XXI) (Oct. 10, 2014), 

https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/acapart-xxi.pdf. 

6 A DECADE OF SUCCESS WITH REFERENCE BASED PRICING, ELAP, 

https://www.elapservices.com/10-year-trend-report/ (emphasis added).

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57. According to ELAP, “[t]he health plan documentation defines pricing limits upon 

which claims will be paid, ensuring that fair prices are paid for medical services,” and ELAP builds 

“meaningful connections with employers, members, and hospitals and health systems to ensure a 

fair price for quality healthcare.”7 ELAP’s marketing material include the following:

7 MANAGING HEALTHCARE COSTS, A TRANSFORMATIVE SOLUTION, ELAP,

https://www.elapservices.com/managing-healthcare-costs-a-transformative-solution/ (emphasis 

added).

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58. ELAP also tells prospective and current clients that they “can be confident that 

medical facilities will be compensated fairly and promptly.”8 Even ELAP’s mission statement 

touts alleged fairness: “To recognize a medical provider’s actual cost in delivering services and to 

allow a fair margin above that cost.”9

59. GPA markets itself as a third-party administrator that is “small enough to care, but 

large enough to deliver.” According to GPA, it “combines industry leading technology and tools 

with ‘high-touch’ patient care to deliver the healthiest employees and the ‘healthiest’ bottom line.” 

GPA also advertises that (a) employees will not be denied care by facilities; (b) employees’ credit 

will not be impaired due to non-payment of medical bills in excess of the allowed amount; and 

(c) the plan and plan members are protected. 

60. As part of ELAP’s marketing ploy, it promises plans and plan members that they 

will not be held responsible for any charges above what ELAP sets as the plan’s allowed amount. 

ELAP tells prospective and current clients that its services will reduce the risk of balance billing 

“because the solution is focused on fair payment to medical providers,” so providers will be 

unlikely to seek additional payment from the plan member.10 

61. ELAP knows there is no law that prohibits providers like Plaintiff from balance 

8 ELAP OVERVIEW WITH BLINDED SAVINGS DATA (July 6, 2015),

https://houstonbch.starchapter.com/images/downloads/Program_Presentations/hbch_june_24___

elap_presentation.pdf. 

9 Id. 

10 DEBUNKING THREE MYTHS ABOUT REFERENCE-BASED PRICING, ELAP,

https://www.elapservices.com/debunking-three-myths-about-reference-based-pricing/ (emphasis 

added).

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billing self-funded employer group plan members11; and there is no federal law that prohibits 

providers from balance billing plan members for emergent and non-emergent services.

62. ELAP goes a step further, however, and directs plan members not to enter any 

payment arrangements with providers like Plaintiff, or agree to make upfront payments. ELAP 

advises plan members to “NEVER sign a payment plan at a facility/hospital as this will take ELAP 

out of the process, due to the facility/hospital now having that YOU (the member) are taking 

responsibility for any outstanding balance. If you are asked to do such an act, please contact GPA 

immediately.”12 ELAP also advises subscribers that “[s]ince ELAP will often reduce the amount 

you owe after auditing a bill, you could overpay by paying up front and the facility will not 

reimburse you.”13

63. ELAP’s deceptive marketing practices mislead employers into believing that they 

can use ELAP’s plans to save millions of dollars, unaware that the Reference Based Pricing

methodology is unfair, deceptive, misleading, and in many cases, in violation of the ACA. 

D. ELAP pays itself millions of dollars at the expense of providers, and leaves

patients holding the bag.

64. ELAP’s scheme has caused irreparable harm to the provider-patient relationship, 

and left countless patients holding the bag while ELAP has made millions off the backs of 

providers like Plaintiff. 

11 There are certain state laws that prohibit balance billing, which typically do not apply because 

they are preempted by ERISA. 

12 U.S. Cotton, Your 2019 Benefits, http://www.explainmybenefits.com/wpcontent/uploads/2018/11/Final-US-Cotton-2019-OE-Guide-11.13.18v2.pdf. 

13 FREQUENTLY ASKED QUESTIONS, ELAP, https://www.explainmybenefits.com/wpcontent/uploads/2018/11/ELAP_EMPLOYEE_FAQs2_FINAL-NoCrops-10.26.17.pdf. 

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65. Ironically, ELAP claims that the amounts billed by providers are excessive and 

inflated despite the fact that ELAP is paid based on those amounts. That is to say, ELAP charges 

its clients 12% of the provider’s total billed charges for any claim. So, as providers’ billed charges

go up, the more ELAP gets paid by its clients.

66. GPA is paid in various ways, including a fixed fee based on the number of enrolled 

employees, access fees, a percentage of the plan’s savings, or a fee for administering the claims. 

Defendants accordingly profit exponentially as more members are enrolled and providers like 

Plaintiff are paid less. 

67. Defendants have no incentive to reduce the billed charges they claim are 

“unconscionable,” because that would hurt their bottom line. 

68. To the contrary, their scheme is designed to underpay providers, take high fees from 

their clients (e.g., 12% of billed charges), and stick patients with the remaining balance of billed 

charges, leaving patients exposed to collection efforts and lawsuits, and unable to access providers 

for non-emergent care. 

69. Defendants are aware that providers may refuse non-emergent services to plan 

members who have a balance with the provider because of Defendants’ actions. Yet Defendants 

do nothing to rectify the billing dispute because they have already made their money. Instead, they 

simply direct the plan member to another provider who similarly falls victim to Defendants’

systemic scam.14

14 In certain instances, instead of directing a plan member to another provider 

for nonemergent services, ELAP and the plan member agree to a “single case agreement” — a 

contract under which the provider and the plan member agree in advance to the amount of the 

provider’s reimbursement. For these case agreements, ELAP typically agrees to reimburse 

hospitals at substantially higher rates, which are more in line with the provider’s reimbursement 

expectations under their MultiPlan contract. See ¶¶ 87–107, infra.

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70. Ultimately, Defendants make millions of dollars in profits as a result of their 

scheme, expose plan members to balance billing, and, in some cases, leave members unable to get 

non-emergent services from a provider because of Defendants’ actions. 

71. The only entities that benefit from Defendants’ business model are Defendants 

themselves. Patients lose out on care and are exposed to balancing billing and legal action. The 

self-funded plans fail to provide comprehensive medical care for their members and fail to provide 

the quality of coverage they promise. And providers are forced into a Hobson’s choice of eating 

massive underpayments or balance billing unsuspecting patients, either eroding the overall quality 

of care they can provide or destroying the relationship they have with individual patients.

72. Upon information and belief, GPA’s revenue in 2018 was approximately $150 

million and ELAP’s revenue was approximately $180 million. 

II. ELAP’s Conduct Deceives Healthcare Providers like Plaintiff.

73. Once ELAP has duped plans into buying ELAP’s services, ELAP sets its sights on 

its true victims — healthcare providers like Plaintiff. 

74. When a self-funded plan member goes to a provider like Plaintiff, or any other class 

member, for medical treatment, he or she provides an identification card. The identification card 

is a representation to the provider that the patient is covered by insurance issued by his or her selffunded plan. The identification card identifies the self-funded plan’s third-party administrator, and 

usually instructs the provider to submit the patient’s claim for payment to that third-party 

administrator. 

75. The identification card also shows the provider whether the patient has access to 

PPO networks, and providers like Plaintiff rely on this information to determine whether the 

services are “in-network” and will be paid at a pre-negotiated contractual rate. 

76. Providers like Plaintiff are not required to seek authorization from a self-funded 

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plan for emergent services.

15 But for non-emergent claims, the provider contacts the plan’s thirdparty administrator to obtain prior authorization and to ensure the healthcare services are covered. 

The third-party administrator’s authorization indicates to the provider that it can provide nonemergent services to the patient, who could otherwise receive healthcare services at another 

location. 

77. When a self-funded plan member seeks services at a facility like Plaintiff’s, he or 

she enters into a contract with the hospital called the “Patient Agreement.” Under the Patient 

Agreement, the plan member agrees to pay the provider’s billed charges as a precondition to 

receiving services, and to be legally responsible for billed charges in the absence of a predetermined discount. 

78. After the provider provides its services, it submits a claim form to the third-party 

administrator for processing which describes the services it provided to the patient. The claim 

contains the provider’s standard billed charges. If the provider is in-network with the self-funded 

plan, the provider is entitled to payment at the pre-negotiated (discounted) contractual rate. But if 

the provider is out-of-network with the plan, the provider is entitled to payment at its full billed 

charges. 

79. Once the provider submits a claim, the third-party administrator must respond to 

the provider, explaining whether the plan denied or approved each billed procedure code and the 

reasons for any denial. If the self-funded plan is in-network, the process to appeal a denial or 

underpayment is controlled by the applicable participating provider agreement. 

15 For these emergency services, state and federal laws require providers like Plaintiff to treat 

patients in emergency situations without inquiring about their ability to pay. ELAP exploits these 

laws, resulting in its plan members receiving emergency healthcare services while ELAP 

underpays the hospital — for the service it had no choice but to provide — using ELAP’s arbitrary 

and unilateral application of Reference Based Pricing. 

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80. ELAP’s scheme deceives and frustrates providers like Plaintiff from the moment 

ELAP’s plan members walk through the facility doors until providers attempt to collect payment 

on their medical services. 

A. ELAP fails to disclose its identity and Reference Based Pricing on insurance 

cards. 

81. ELAP designs the insurance ID cards that plan members present to providers like 

Plaintiff. The cards deceive providers in a number of ways. 

1. The ID card fails to disclose ELAP’s name and role.

82. First, ELAP omits its name or any connection to Reference Based Pricing on the 

face of the identification card. 

83. If ELAP revealed itself or its application of Reference Based Pricing to providers 

on the face of the ID card, no reasonable provider would provide medical treatment — beyond 

treatment it is legally obliged to provide — to an ELAP plan member without securing payment 

up-front. 

84. So ELAP buries a purported disclosure on a website that no provider is required to, 

or would, visit before providing healthcare services to an ELAP plan member.

85. At least some of the insurance cards created by ELAP provide a link, on the back 

of the card, to a website “For Additional Information.” See ¶ 96, infra (image of representative 

insurance card). At the link, information about ELAP and Reference Based Pricing is available. 

Access to the website is not required, and the card does not describe what information is available 

on the site. 

86. No reasonable provider would access the link to this website before providing 

healthcare services, or discern from the face of the card that (1) ELAP reviews and audits the 

provider’s bills; and (2) ELAP intends to arbitrarily and unilaterally apply Reference Based 

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Pricing.

2. The ID card references a PPO network familiar to providers to trick 

them into expecting fair compensation.

87. Second, ELAP uses a third-party PPO network called Multiplan (also sometimes 

referred to as PHCS) to dupe providers like Plaintiff into expecting reimbursement for its services 

at agreed “in-network” contract rates. 

88. Multiplan is a PPO which enters into contracts with numerous health care providers

including Plaintiff. 

89. These providers agree to provide services to Multiplan clients at discounted rates.

The group of providers as a whole is referred to as the PPO network. 

90. Multiplan also enters into agreements with health insurance companies and 

administrators, including ELAP and GPA, which gives these companies and administrators access 

to the discounted rates of the PPO network. 

91. The insurance companies offer incentives to their members to use participating 

providers like Plaintiff in the form of lower co-pays and deductibles. 

92. In exchange for agreeing to a discounted rate, these providers receive an increase 

in the number of patients, as the majority of the patients will seek medical services from providers 

in the PPO network. 

93. When one of these providers renders services to a member of one of Multiplan's 

clients, Multiplan “reprices” the claim to reflect the discounted rate.

94. ELAP’s deception with MultiPlan works as follows: providers like Plaintiff

contract with MultiPlan to offer discounted healthcare goods and services to MultiPlan’s clients, 

which include self-funded plans like ELAP’s clients. GPA also contracts with MultiPlan and 

offers its clients access to MultiPlan’s network. As a result, these plans are permitted to access 

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discounted healthcare services from the provider through its contract with MultiPlan.

95. The relationship between the provider (here Plaintiff), MultiPlan, and ELAP’s selffunded plans is represented by the below diagram:

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96. MultiPlan’s clients place the MultiPlan/PHCS logo on their insurance identification 

cards. For example:

FRONT OF CARD

BACK OF CARD

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97. This represents to providers like Plaintiff that the plan is part of the MultiPlan 

network and the provider will be paid the contracted rate. That contracted rate applies to both 

(1) facility services, i.e., healthcare goods and services provided at a healthcare facility, such as a 

hospital; and (2) physician services, i.e., healthcare goods and services provided by a physician. 

98. ELAP’s and/or GPA’s relationship with MultiPlan tricks providers like Plaintiff

into expecting reimbursement at the MultiPlan rate for facility services through a two-step process.

99. First, ELAP requires its plans to only contract with MultiPlan for physician 

services — not facility services — resulting in the small, grayed out “Practitioner Only” reference 

under the much larger ALL CAPS “PHCS” logo at the top of the card. 

100. The location, font size, color, and wording of the “Practitioner Only” reference fails 

to adequately disclose to providers that ELAP is involved and that ELAP will arbitrarily, 

uniformly, and unilaterally reprice each of the provider’s claims at a fraction of the reasonable 

value of the services. 

101. Conversely, the prominent PHCS/MultiPlan logo gives providers like Plaintiff a 

reasonable business expectation — upon seeing the ID card with the MultiPlan logo — that they 

will be paid at the rates contained in their MultiPlan contract for any client listed on MultiPlan’s 

client list.

102. The reasonableness of the provider’s expectation is bolstered by the fact that 

healthcare providers like Plaintiff have contracts with MultiPlan that do not permit MultiPlan to 

carve out services for physicians.

103. ELAP and MultiPlan recognize that the MultiPlan contracts do not allow any partial 

leasing or carve outs of the MultiPlan network and, upon information and belief, MultiPlan has 

attempted to amend its contracts with various providers to carve out “physician only” networks. 

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104. ELAP’s tactics result in providers like Plaintiff receiving payments far below the

level consistent with the terms of their MultiPlan contract. 

105. As Step Two, ELAP directs its plans to refuse to honor the provider’s contract with 

MultiPlan for facility services, so that ELAP can pay these “facility” claims at its arbitrary 

Reference Based Pricing allowed amount.

106. The result is that a physician rendering services at the healthcare facility will be 

fully compensated for his work at the MultiPlan-contracted amount, but the provider — the facility 

— will be drastically underpaid. 

107. At the time of service, providers like Plaintiff reasonably expect their services will 

be paid in accordance with their contract with MultiPlan. 

B. ELAP fails to disclose its role as “Designated Decision Maker.”

108. Providers are also deceived as to ELAP’s role as the plan’s “Designated Decision 

Maker.”

109. When ELAP creates (or modifies) a benefit plan for one of its clients, it designates

itself as the decision maker. Through this alleged authority, ELAP purportedly audits the claims

line-by-line. Using Reference Based Pricing, ELAP reprices Plaintiff’s claims — and the claims 

of other providers like Plaintiff — unilaterally deciding the allowed amount, and directs the plan 

to pay Plaintiff in that amount. 

110. Because of ELAP’s deception, providers like Plaintiff are unable to make an 

informed decision as to whether to provide non-emergent services to ELAP plan members or 

whether to seek advance payment before providing care.16

16 Any references to ELAP serving as the Designated Decision Maker on the website linked on the 

back of ELAP insurance cards fails to adequately disclose ELAP’s role, for the reasons set forth 

above. See ¶¶ 82–86, supra.

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C. ELAP’s front man, GPA, lends legitimacy to ELAP’s scheme.

111. In addition to ELAP’s deceptive conduct vis-à-vis the insurance cards, ELAP uses 

GPA to misrepresent the plans’ benefits to providers for non-emergency claims.

112. Unlike emergency claims, where providers are required by law to provide services 

and there is no required pre-service interaction between a provider and GPA, for non-emergent 

claims plan members’ identification cards direct providers like Plaintiff to contact the plans’ thirdparty administrator to determine if prior authorization is required for the services. 

113. For these non-emergent claims, GPA, ELAP’s third-party administrator, fails to 

adequately disclose to Plaintiff — and other providers like Plaintiff — that healthcare services will 

be paid using Reference Based Pricing and that the rates in the provider’s contract with MultiPlan 

will not be applied to facility services (as opposed to physician services). 

114. Even where a provider’s representative seeks authorization from GPA before 

providing non-emergent services, and where GPA representatives have told hospital staff via 

telephone that ELAP audits and reprices hospital claims, GPA’s disclosure fails to adequately 

inform reasonable providers that their claims will be arbitrarily and unilaterally slashed regardless 

of the circumstances of the claim. 

115. Discovery, which is uniquely in Defendants’ possession, will reveal GPA’s policies 

and practices with respect to these non-emergent claims, including whether all such calls between 

GPA and providers are recorded, how long the calls have been recorded, whether Defendants have 

a policy or practice requiring that all such calls be recorded, whether GPA uses a uniform script, 

when GPA began reading this script, whether GPA made any revisions to the script, and whether 

Defendants have ever referenced such oral disclosures as justification for ELAP’s application of 

Reference Based Pricing in connection with any specific claims. 

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116. Regardless, the mere fact that a provider proceeds with providing healthcare 

services suggests that any such oral conversations between GPA and providers had a tendency or 

capacity to mislead; tended to create a false impression in healthcare facility providers; and were 

likely to, and did in fact, deceive reasonable healthcare facility providers like Plaintiff as to 

ELAP’s intent to arbitrarily and unilaterally apply Reference Based Pricing — because no 

reasonable provider would knowingly provide healthcare services only to be reimbursed at a 

fraction of the reasonable value of those services.

D. ELAP deceives and misleads providers throughout the claim adjudication 

process. 

117. Once ELAP has deceived providers into providing medical services, it continues

its deceptive practices during the claim adjudication and payment processes. 

118. After Plaintiff, or a similarly situated provider, submits a claim to GPA as the thirdparty administrator, as described in paragraph 78 above, GPA sends an underpayment and an

explanation of that payment to the provider’s lockbox account/address, rather than directly to the 

provider. Lockbox banking is a service provided by banks to companies for the receipt of payment 

from customers. Under the service, the payments made by customers are directed to a special post 

office box instead of going to the company. The bank goes to the box, retrieves the payments, 

processes them, and deposits the funds directly into the company’s bank account.

119. Accordingly, the provider does not see the explanation of payment until weeks later 

— after the underpayment has already been deposited by the bank. 

120. ELAP deceptively adds a sentence in the explanation of payment that the payment

— which has already been deposited in the provider’s lockbox account — amounts to an accord 

and satisfaction of the claim, even though the provider had no prior knowledge of the Reference 

Based Pricing rate and did not have the ability to decline payment. 

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121. ELAP also provides explanations of payment that are confusing, deceptive, and 

misleading to further delay the process. The explanation of payment does not identify ELAP or 

provide any reasons why a particular service was denied or reduced, and does not give providers 

like Plaintiff sufficient information to articulate an informed response in an initial appeal. 

122. The explanation of payment does disclose that the claim is being repriced based on 

Medicare rates. This, of course, ignores the fact that the billed rates are governed by contract, such 

as participation agreements like Plaintiff’s contract with MultiPlan or its Patient Agreement with 

members of ELAP’s self-funded plans. Even though the claims have nothing to do with Medicare, 

ELAP misleadingly uses Medicare as its illegitimate justification for underpaying providers. 

E. ELAP reveals itself as the decision maker during the appeal process, but refuses 

to meaningfully discuss resolution of the claims.

123. When a provider like Plaintiff appeals the plan’s underpayments, it receives a 

response from ELAP, at which point ELAP announces its involvement and reveals to the provider

that ELAP is the decision maker. 

124. ELAP uniformly replies to providers with the same generic template response that 

does not address the provider’s specific arguments in its appeal. 

125. For example, ELAP’s generic response includes language that the provider accepts 

ELAP’s determination and waives any right to recover expenses from the plan member if it 

participates in the appeal. 

126. These letters are designed to create a catch-22 for providers — they can either 

exhaust administrative remedies by appealing the plan determination, which could potentially 

waive their right to collect from the patient, or they can forego their right to take legal action 

against the plans and pursue the balance due from the patient. Unbeknownst to the providers,

ELAP never changes its arbitrary determination — and the appeals process is a sham. 

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127. The generic response letters also claim there is no contract between the facility and 

plan, even though the plans are subject to PPO participation agreements, and the plan members 

are subject to the Patient Agreements. 

128. ELAP’s template responses are designed to wear down providers like Plaintiff, and 

drive up providers’ administrative costs. 

F. ELAP defends patients to obstruct and deter providers’ collection efforts.

129. ELAP knows there is no law that prohibits providers like Plaintiff from balance 

billing self-funded employer plan members, but nevertheless deceptively advises plans and plan 

members that they will not be financially responsible for amounts beyond the allowed amount.

130. If the provider does balance bill the patient, ELAP pays for a legal defense to deter 

further collection activity. ELAP’s attorneys, purporting to act on behalf of the plan members (but 

being paid by and taking direction from ELAP), send the same template demand letter to providers, 

without addressing any of the issues the provider raised in its appeals. The template letter asserts 

the provider cannot balance bill the plan member because the provider’s billed charges are 

purportedly “unconscionable, deceptive, and discriminatory.” 

131. ELAP’s business model is built around the expectation that providers, like Plaintiff, 

will give up and accept ELAP’s insufficient payment because the cost to collect exceeds the 

outstanding balance.

132. For example, GPA boasts that from July 2008 to April 2016, there were only 171 

lawsuits filed against GPA’s plan customers who used the Reference Based Pricing model, and 

claims that all lawsuits were successfully defended. 

133. For ELAP, providing the legal defense for plans and plan members relating to the 

Reference Based Pricing scheme is a small cost of doing business because they are making millions 

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in return. 

G. ELAP directs plan members to ignore providers and breach their Patient 

Agreements. 

134. Pursuant to the Patient Agreement that all patients receiving treatment sign, 

members of self-funded plans (both ELAP and non-ELAP plans) agree to pay Plaintiff’s billed 

charges for healthcare goods and services received at Plaintiff’s facilities.

135. ELAP encourages its plan members to obtain healthcare services at providers’

facilities, knowing they will not pay in full for the services rendered. 

136. ELAP advises plan members that they can obtain care wherever they like regardless 

of cost. ELAP tells plan members that they are not responsible for costs in excess of their co-pay, 

coinsurance, or deductible, and directs them not to pay any upfront money to providers like 

Plaintiff other than these amounts.

137. ELAP knows its plan members have entered into the Patient Agreement with 

providers like Plaintiff. ELAP still encourages its plan members to disregard the terms of their 

Patient Agreements by misrepresenting that they are not required to pay the balance of the bill, 

directing plan members to ignore provider collections requests, and promising to pay for legal 

counsel to defeat the provider’s efforts to collect. 

138. ELAP thus interferes with the provider’s ability to enforce the Patient Agreements 

and collect anything beyond ELAP’s unilaterally established allowed amount. ELAP knows that 

once valuable care has been received, the entirety of the benefit of the health care transaction has 

been bestowed on the plan member, leaving the provider with the burden of trying to collect the 

amount the plan member already agreed to pay.

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III. Plaintiff and the Proposed Classes Have Been Damaged by ELAP and GPA’s Scheme.

139. Plaintiff and the proposed Class members provided emergent and nonemergent 

healthcare services to Defendants’ plan members. 

140. Plaintiff and the proposed Class members provided these services trusting that they

would be reimbursed for the reasonable value of their services — not the allowed amount 

arbitrarily and unilaterally imposed by ELAP.

141. As a result of Defendants’ conduct, Plaintiff and the proposed Class members were 

harmed and have suffered actual damages in the form of the difference between the reasonable 

value of the medical services, and the allowed amount arbitrarily and unilaterally imposed by 

ELAP. 

142. Plaintiff and the proposed Class members were deprived of the benefit of their 

bargain. They did not receive the actual and reasonable value of the healthcare services they 

provided to ELAP plan members, as a direct result of ELAP’s deceptive and unfair conduct. 

143. ELAP and GPA have each unjustly benefited from their scheme, and Plaintiff and 

the proposed Class members were deprived of the actual and reasonable value of the healthcare 

services they provided to ELAP plan members, as a direct result of ELAP and GPA’s deceptive 

and unfair conduct.

144. Plaintiff brings this action on behalf of itself and the putative Class members to 

recover their actual damages and their lost benefit of the bargain, and to enjoin ELAP and GPA 

from their continued deceptive and unfair trade practices.

CLASS ALLEGATIONS

Class Definitions:

145. Plaintiff brings this action on its own behalf, and on behalf of all healthcare 

providers similarly situated, pursuant to Rules 23(a) and (b)(2) or (b)(3) of the Federal Rules of 

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Civil Procedure. This action satisfies the numerosity, commonality, typicality, adequacy, 

predominance, and superiority requirements of those provisions. 

146. Plaintiff brings this class action and seeks to certify and maintain it as a class action 

under Rules 23(a) and (b)(2) or (b)(3) of the Federal Rules of Civil Procedure on behalf of itself 

and the following proposed Nationwide classes, and Florida state subclasses.

The Nationwide Emergent Class:

147. Plaintiff alleges a nationwide class on behalf of:

All healthcare facility providers in the United States with underpaid 

emergent claims for healthcare services provided to ELAP plan 

members. 

 

The Nationwide Nonemergent Class:

148. Plaintiff alleges a nationwide class on behalf of:

All healthcare facility providers in the United States with underpaid 

non-emergent claims for healthcare services provided to ELAP plan 

members. 

The Florida Emergent Subclass:

149. Plaintiff alleges a Florida statewide class action claim on behalf of:

All healthcare facility providers in Florida with underpaid emergent 

claims for healthcare services provided to ELAP plan members.

The Florida Nonemergent Subclass:

150. Plaintiff alleges a Florida statewide class action claim on behalf of:

All healthcare facility providers in Florida with underpaid nonemergent claims for healthcare services provided to ELAP plan 

members.

151. Excluded from each class are Defendants, their employees, officers, directors, legal 

representatives, heirs, successors, and wholly or partly owned subsidiaries or affiliated companies; 

Class Counsel and their employees; and the judicial officers and their immediate family members 

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and associated court staff assigned to this case. 

152. Plaintiff reserves the right to modify, expand, or amend the definitions of the 

proposed classes following the discovery period and before the Court determines whether class 

certification is appropriate, including as to particular issues or subclasses pursuant to Rule 

23(c)(4)–(5). 

153. Certification of Plaintiff’s claims for class-wide treatment is appropriate because 

Plaintiff can prove the elements of its claims on a class-wide basis using the same evidence as 

would be used to prove those elements in individual actions alleging the same claims.

Numerosity 

154. This action satisfies the requirements of Fed. R. Civ. P. 23(a)(1). There are 

thousands of healthcare facility providers nationwide who have been deceived by Defendants, 

including hundreds in Florida. Individual joinder of all Class members is impracticable. 

155. The identity of Class members is ascertainable, as the names and addresses of all 

Class members can be identified in Defendants’ or their agents’ books and records. Plaintiff 

anticipates providing appropriate notice to each certified class in compliance with Fed. R. Civ. P. 

23(c)(2)(A) and/or (B), to be approved by the Court after class certification, or pursuant to court 

order under Fed. R. Civ. P. 23(d).

Commonality

156. This action satisfies the requirements of Fed. R. Civ. P. 23(a)(2) and 23(b)(3) 

because there are questions of law and fact that are common to each of the classes. These common 

questions predominate over any questions affecting only individual Class members. The 

predominating common or Class-wide fact questions include, without limitation:

a. Whether Defendants’ unilateral, arbitrary, and uniform application of 

Reference Based Pricing is likely to deceive or mislead reasonable 

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healthcare facility providers;

b. Whether Defendants’ unilateral, arbitrary, and uniform application of 

Reference Based Pricing constitutes an unfair, deceptive, and/or unlawful 

act or practice;

c. Whether Defendants’ insurance ID cards adequately disclose ELAP’s 

identity and application of Reference Based Pricing and/or are likely to 

deceive or mislead reasonable healthcare facility providers;

d. Whether Defendants’ conduct with respect to their insurance ID cards 

constitutes an unfair, deceptive, and/or unlawful act or practice;

e. Whether ELAP’s conduct throughout the claims adjudication process 

constitutes an unfair, deceptive, and/or unlawful act or practice;

f. Whether ELAP’s legal defense of patients to obstruct and exhaust collection 

efforts constitutes an unfair, deceptive, and/or unlawful act or practice;

g. Whether ELAP’s direction to plan members to not respond to facility 

providers and violate patient agreements constitutes an unfair, deceptive, 

and/or unlawful act or practice;

h. Whether a reasonable healthcare facility provider likely would be misled by 

Defendants’ conduct; and

i. Whether Plaintiff and the facility provider classes suffered damages as a 

result of Defendants’ unfair, deceptive, and/or unlawful acts or practices.

Typicality

157. This action satisfies the requirements of Fed. R. Civ. P. 23(a)(3) because Plaintiff’s 

claims are typical of the claims of each of the Class members, as all Class members were and are 

similarly affected and their claims arise from the same wrongful conduct of Defendants. Each 

Class member provided healthcare services to ELAP plan members and as a result has sustained, 

and will continue to sustain, damages in the same manner as Plaintiff in the form of underpayment 

of those claims. The relief Plaintiff seeks in this action is typical of the relief sought for the absent 

Class members. 

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Adequacy of Representation

158. Plaintiff will fairly and adequately protect the interests of the Class members. 

Plaintiff is committed to the vigorous prosecution of this action and there is no hostility or conflict 

between or among Plaintiff and the unnamed Class members. Plaintiff anticipates no difficulty in 

the management of this litigation as a class action. 

159. To prosecute this case, Plaintiff has chosen the undersigned law firms, who have 

substantial experience in the prosecution of large and complex class action litigation and have the 

financial resources to meet the costs associated with the vigorous prosecution of this type of 

litigation. Plaintiff and their counsel will fairly and adequately protect the interest of all Class 

members.

Superiority

160. This action satisfies the requirements of Fed. R. Civ. P. 23(b)(3). A class action is 

superior to other available methods for the fair and efficient adjudication of the rights of the Class 

members. The joinder of individual Class members is impracticable because of the vast number 

of healthcare facility providers who have been deceived by Defendants’ conduct.

161. Because the monetary damages suffered by each individual Class member may be 

relatively small, the expense and burden of individual litigation would make it difficult or 

impossible for individual Class members to redress the wrongs done to each of them individually, 

such that most or all Class members would have no rational economic interest in individually 

controlling the prosecution of specific actions. The burden imposed on the judicial system by 

individual litigation, and to Defendants, by even a small fraction of the Class members, would be 

enormous. 

162. In comparison to piecemeal litigation, class action litigation presents far fewer 

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management difficulties, far better conserves the resources of both the judiciary and the parties, 

and far more effectively protects the rights of each Class member. The benefits to the legitimate 

interests of the parties, the court, and the public resulting from class action litigation substantially 

outweigh the expenses, burdens, inconsistencies, economic infeasibility, and inefficiencies of 

individualized litigation. Class adjudication is simply superior to other alternatives under Fed. R. 

Civ. P. 23(b)(3)(D). 

163. Plaintiff is unaware of any obstacles likely to be encountered in the management of 

this action that would preclude its maintenance as a class action. Rule 23 provides the Court with 

the authority and flexibility to maximize the efficiencies and benefits of the class mechanism and 

reduce management challenges. The Court may, on motion of Plaintiff or on its own determination, 

certify nationwide and statewide classes for claims sharing common legal questions; use the 

provisions of Fed. R. Civ. P. 23(c)(4) to certify particular claims, issues, or common questions of 

law or of fact for class-wide adjudication; certify and adjudicate bellwether class claims; and use 

Fed. R. Civ. P. 23(c)(5) to divide any Class into subclasses.

Requirements of Fed. R. Civ. P. 23(b)(2)

164. Defendants have acted or failed to act in a manner generally applicable to the Class 

members in the Nationwide Classes and the Florida Subclasses, thereby making appropriate final 

injunctive relief or corresponding declaratory relief with respect to any or all of the classes.

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CLAIMS FOR RELIEF

COUNT I 

VIOLATION OF FLORIDA DECEPTIVE AND UNFAIR TRADE PRACTICES ACT

(“FDUTPA”), Fla. Stat. § 501.201 et seq.

against Defendants on behalf of Plaintiff and the Florida Subclasses

165. Plaintiff incorporates by reference paragraphs 1 – 164 as though fully set forth

herein.

166. Plaintiff and the members of the Florida subclasses are “consumer[s]” engaged in 

“trade or commerce” within the meaning of FDUTPA. Fla. Stat. § 501.203 (7), (8).

167. Defendants engage in “trade or commerce” within the meaning of FDUTPA. Fla. 

Stat. § 501.203(8).

168. FDUTPA prohibits “[u]nfair methods of competition, unconscionable acts or 

practices, and unfair or deceptive acts or practices in the conduct of any trade or commerce.” Fla. 

Stat. § 501.204(1).

169. Each Plaintiff and Class member is an “aggrieved” person under § 501.211, Fla. 

Stat., and so has standing to pursue this claim. 

170. Defendants engaged in unfair and deceptive trade practices that violated FDUTPA, 

including but not limited to the following:

a. ELAP arbitrarily and unilaterally applied Reference Based Pricing to healthcare 

services, including emergency services regardless of the fact that state and federal 

laws require providers like Plaintiff to treat patients in emergency situations without 

inquiring about their ability to pay;

b. ELAP and GPA failed to adequately disclose ELAP’s identity and the application 

of Reference Based Pricing throughout the patient admission process;

c. ELAP failed to disclose its identity and the application of Reference Based Pricing

on insurance ID cards;

d. ELAP and GPA failed to adequately disclose the fact that facility services, such as 

the healthcare services provided by hospitals like Plaintiff, will not be reimbursed 

in accordance with the terms of the facility provider’s contract with MultiPlan;

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e. ELAP deceived and misled facility providers throughout the claim adjudication 

process;

f. ELAP provided a legal defense for patients to obstruct facility providers’ collection 

efforts; and

g. ELAP directed plan members to not respond to facility providers and violate patient 

agreements.

171. ELAP and GPA’s unfair or deceptive acts or practices, including its failure to 

disclose material facts about its involvement in the patient-provider relationship and its boilerplate 

application of Reference Based Pricing, had a tendency or capacity to mislead; tended to create a 

false impression in healthcare facility providers; and were likely to, and did in fact, deceive 

reasonable healthcare facility providers, including Plaintiff and the members of the Florida 

subclasses, about GPA and ELAP’s role in the patient-provider relationship; ELAP’s application 

of Reference Based Pricing; and ELAP’s efforts to obstruct and exhaust collection efforts from 

patients. 

172. ELAP and GPA knew or should have known that its conduct violated FDUTPA.

173. Plaintiff and the members of the Florida subclasses were and are injured as a result 

of GPA and ELAP’s conduct because Plaintiff and the members of the Florida subclasses provided 

healthcare services anticipating reimbursement at contractually agreed upon rates and instead 

received underpayments resulting from ELAP’s arbitrary and uniform application of Reference 

Based Pricing. 

174. ELAP and GPA’s unfair or deceptive acts or practices were material to Plaintiff 

and the members of the Florida subclasses. Healthcare services provided to plan members that are 

reimbursed at contractually agreed upon rates are reimbursed at higher rates than those decided by

ELAP using its arbitrary application of Reference Based Pricing.

175. Plaintiff and the members of the Florida subclasses have suffered ascertainable 

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losses as a result of GPA and ELAP’s misrepresentations and failure to disclose information about 

their role in the patient-provider relationship and their use of Reference Based Pricing. Had they 

been aware of ELAP’s role and application of Reference Based Pricing, Plaintiff and the members 

of the Florida subclasses would not have provided the healthcare services to ELAP plan members

(other than legally required emergency services) without seeking prepayment. Plaintiff and the 

members of the Florida subclasses did not receive the benefit of their bargain due to GPA and 

ELAP’s misconduct. 

176. As a direct and proximate result of GPA and ELAP’s violations of FDUTPA, 

Plaintiff and the members of the Florida subclasses have suffered injury-in-fact and actual 

damages. 

177. Plaintiff and the members of the Florida subclasses are entitled to recover their 

actual damages under Fla. Stat. § 501.211(2) and attorneys’ fees under Fla. Stat. § 501.2105(1).

178. Moreover, Defendants’ deceptive and unfair conduct is continuing, and continues 

to harm consumers in Florida and throughout the United States.

179. Section 501.211(1), Florida Statutes, states:

Without regard to any other remedy or relief to which a person is entitled, anyone 

aggrieved by a violation of this part may bring an action to obtain a declaratory 

judgment that an act or practice violates this part and to enjoin a person who has 

violated, is violating, or is otherwise likely to violate this part. 

180. Plaintiff is entitled to declaratory and injunctive relief pursuant to Section 

501.211(1), Florida Statutes, declaring that Defendants’ deceptive and unfair conduct violates 

FDUTPA and harms the consuming public of Florida and the United States, and enjoining 

Defendants from further such violations. 

181. Plaintiff, on behalf of itself and the members of the Florida subclasses, accordingly 

requests that the Court award them actual damages and issue an order enjoining Defendants’ 

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conduct and requiring ELAP to notify the members of the Florida subclasses of its role in the 

patient-provider relationship and its arbitrary application of Reference Based Pricing, awarding 

Plaintiff and the members of the Florida subclasses’ attorneys’ fees, and any other just and proper 

relief available under FDUTPA. 

COUNT II

UNJUST ENRICHMENT

against Defendants on behalf of Plaintiff and the Nationwide Classes

182. Plaintiff re-alleges and incorporates by reference paragraphs 1 – 164 as though fully

set forth herein.

183. Plaintiff brings this claim on behalf of itself and all Nationwide Class members 

under the common law of unjust enrichment, as there are no true conflicts (case-dispositive 

differences) among various states’ laws of unjust enrichment. In the alternative, Plaintiff brings 

this claim under the laws of Florida where Plaintiff and the members of the Florida Subclasses

were damaged by Defendants. To the extent this claim is brought on behalf of the Florida 

Subclasses, it is pled in the alternative to Count I.

184. Defendants have received and retained a benefit from Plaintiff and the Nationwide 

Class members and inequity has resulted. 

185. Plaintiff and the Nationwide Class members directly conferred benefits on 

Defendants by providing plan members with medical services at a discounted rate pursuant to PPO 

agreements such as Plaintiff's agreement with MultiPlan.

186. Plaintiff and the Nationwide Class members also conferred benefits on Defendants 

by rendering services to plan members, which Defendants and their plans are legally and 

contractually obligated to provide and pay for. 

187. Plaintiff and the Nationwide Class members provided healthcare services to 

Case 0:20-cv-61007-AHS Document 24 Entered on FLSD Docket 07/21/2020 Page 39 of 42
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Defendants’ plan members in reliance on Defendants’ representations and omissions. Plaintiff and 

the Nationwide Class members would not have provided their healthcare services as they did, if 

not for these representations. 

188. Defendants benefitted through their unjust conduct by receiving, inter alia, 12% of 

the facilities’ total billed charges, a percentage of the plans’ savings (i.e., the amount the facility 

is underpaid), and valuable medical services rendered to plan members. 

189. It is inequitable for Defendants to retain these benefits. Defendants will be unjustly 

enriched if they are allowed to retain the aforementioned benefits, and each Nationwide Class 

member is entitled to recover the amount by which Defendants were unjustly enriched at their 

expense.

190. Plaintiff does not have an adequate remedy at law.

191. The amount of Defendants’ unjust enrichment should be disgorged, in an amount 

to be proven at trial.

192. Plaintiff, on behalf of itself and all similarly situated Nationwide Class members, 

seeks an award against Defendants in the amount by which it has been unjustly enriched at 

Plaintiff’s and the Nationwide Class members’ expense, and such other relief as this Court deems 

just and proper.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff, on behalf of itself and all other similarly situated Class 

members, requests that the Court enter judgment against Defendants as follows:

1) Declare this action to be a proper class action maintainable under Rule 23(b)(2) and 

Rule 23(b)(3) of the Federal Rules of Civil Procedure and designate and appoint Plaintiff as class 

and subclass representative and Plaintiff’s chosen counsel as Class Counsel;

Case 0:20-cv-61007-AHS Document 24 Entered on FLSD Docket 07/21/2020 Page 40 of 42
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2) Declare that Defendants’ conduct as alleged herein is unlawful, deceptive, or unfair 

and issue an order temporarily and permanently enjoining Defendants from continuing the 

unlawful, deceptive, and unfair business practices alleged in this action;

3) Declare that Defendants must disgorge, for the benefit of Plaintiff and the Class 

members, all or part of the ill-gotten gains they received from their misconduct, or make full 

restitution to Plaintiff and Class members;

4) Award Plaintiff and Class members actual and compensatory remedies and 

damages and statutory penalties, including interest, in an amount to be proven at trial under the 

applicable claims;

5) Award Plaintiff and Class members their reasonable attorneys’ fees and costs, as 

allowed by law; 

6) Award Plaintiff and Class members pre-judgment and post-judgment interest as 

provided by law; and

7) Award Plaintiff and Class members any further and different relief as this case may 

require or as determined by this Court to be just, equitable, and proper under the circumstances.

DEMAND FOR JURY TRIAL

Pursuant to Fed. R. Civ. P. 38(b), Plaintiff demands a jury trial for any and all issues triable 

by a jury.

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Respectfully submitted: July 21, 2020. 

/s/Gail McQuilkin

Gail McQuilkin, Esq.

gam@kttlaw.com

Fla. Bar No. 969338

Benjamin Widlanski., Esq.

bwidlanski@kttlaw.com

Florida Bar No. 1010644

Tal J. Lifshitz, Esq. 

tjl@kttlaw.com

Fla. Bar No. 99519

Eric S. Kay, Esq.

ekay@kttlaw.com

Fla. Bar No. 1011803

KOZYAK TROPIN &

THROCKMORTON LLP

2525 Ponce de Leon Blvd., 9th Floor

Coral Gables, FL 33134

Telephone: (305) 372-1800 

Counsel for Plaintiff

/s/ Douglas A. Wolfe

Douglas A. Wolfe, Esq.

doug@wolfepincavage.com

Fla. Bar No. 28671

Danya J. Pincavage, Esq.

danya@wolfepincavage.com

Fla. Bar No. 14616

Omar Ali-Shamaa, Esq.

omar@wolfepincavage.com

Fla. Bar No. 121461

WOLFE | PINCAVAGE

2937 SW 27th Ave., Suite 302

Miami, FL 33133

Telephone: (786) 409-0800

Counsel for Plaintiff

Case 0:20-cv-61007-AHS Document 24 Entered on FLSD Docket 07/21/2020 Page 42 of 42