Court Opinion

ID: 9391622
Source: CourtListenerOpinion
Date Created: 2023-05-02 19:04:57.430423+00
Date Added: 2024-06-11T17:18:41.829547
License: Public Domain

IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE

LPPAS REPRESENTATIVE, LLC, in its           )
capacity as authorized agent and            )
representative of Luis Perez, Gerardo       )
Necuze, and Manuel Enriquez,                )
                                            )
             Plaintiff,                     )
                                            )
       v.                                   )   C.A. No. 2020-0241-KSJM
                                            )
ATH HOLDING COMPANY, LLC, and               )
HIGHLAND ACQUISITION                        )
HOLDINGS, LLC,                              )
                                            )
             Defendants.                    )

SHAREHOLDER REPRESENTATIVE                  )
SERVICES LLC, solely in its capacity as     )
HealthSun Sellers’ Representative,          )
                                            )
             Plaintiff/Counterclaim         )
             Defendant,                     )
                                            )
       v.                                   )
                                            )   C.A. No. 2020-0443-KSJM
ATH HOLDING COMPANY, LLC and                )
HIGHLAND ACQUISITION                        )
HOLDINGS, LLC,                              )
                                            )
             Defendants/Counterclaim        )
             Plaintiffs.                    )
                                            )

                            MEMORANDUM OPINION

                           Date Submitted: January 4, 2023
                             Date Decided: May 2, 2023

Kelly L. Freund, Michelle Morgan, DLA PIPER LLP, Wilmington, Delaware; Counsel for
Plaintiff LPPAS Representative, LLC.
A. Thompson Bayliss, E. Wade Houston, Peter C. Cirka, ABRAMS & BAYLISS LLP,
Wilmington, Delaware; Counsel for Plaintiff and Counterclaim Defendant Shareholder
Representative Services LLC.

Kevin M. Coen, MORRIS, NICHOLS, ARSHT & TUNNELL LLP, Wilmington,
Delaware; Thomas Uebler, McCOLLOM D’EMILIO SMITH UEBLER LLC,
Wilmington, Delaware; Glenn M. Kurtz, Elizabeth Stainton, WHITE & CASE LLP, New
York, New York; Counsel for Defendants and Counterclaim Plaintiffs ATH Holding
Company, LLC and Highland Acquisition Holdings LLC.

McCORMICK, C.
       This is the latest installation in a dispute arising from an Equity Interests Purchase

Agreement (the “Purchase Agreement”) between health insurance providers and healthcare

companies. Under Section 10.6 of the Purchase Agreement, the sellers agreed to indemnify

the buyer and its parent company for losses arising from certain third-party claims. As to

third-party claims brought by government regulators, the Purchase Agreement granted the

indemnifying parties the right to participate in the defense strategy.

       In 2018, Anthem, the buyer, discovered what it believed to be fraudulent coding

practices that the sellers had perpetrated to receive excessive Medicare Advantage

reimbursement from the Center for Medicare and Medicaid Services (“CMS”). Anthem

reported the information to CMS and the United States Department of Justice (“DOJ”).

Anthem later had discussions concerning liability and executed tolling agreements with

both agencies. Anthem then noticed indemnification claims relating to the CMS and DOJ

investigations, but it did not contact the sellers to allow them to participate in the defense.

       The sellers’ representatives, who are the plaintiffs in these actions, have moved for

partial summary judgment. They argue that the buyer breached their participation rights

by unilaterally steering the defense of the DOJ and CMS claims. There are two plaintiffs—

the “HealthSun Plaintiff” and the “Pasteur Plaintiff.” Both seek a declaratory judgment

that Anthem breached their participation rights and request contractual fee-shifting under

the Purchase Agreement. The Pasteur Plaintiff seeks additional relief. The parties have a

complex escrow arrangement to fund the sellers’ indemnification obligations, which this

court has described in more detail in prior decisions. The Pasteur Plaintiff argues that
Anthem’s breach of the participation rights requires that Anthem release what funds remain

in escrow.

        This decision grants the plaintiffs’ motions for summary judgment in part, finding

that the buyer breached the plaintiffs’ participation rights and that the plaintiffs are entitled

to fee-shifting for that breach. This decision denies the Pasteur Plaintiff’s motion for

escrow relief in light of a potentially valid claim against the remaining escrow funds.

I.      FACTUAL BACKGROUND

        The background is drawn from the undisputed facts, which are stated in the

materials attached to the parties’ briefing on the motions for partial summary judgment.

        A.    The Purchase Agreement And Escrow Agreement

        Under the Purchase Agreement,1 Defendant Highland Acquisition Holdings, LLC

(the “Buyer” or “Highland”) acquired two groups of Florida-based entities (the “Pasteur

Entities” and the “HealthSun Entities,” and together, the “Entities”) from their respective

owners (the “Pasteur Sellers” and the “HealthSun Sellers,” and, together, the “Sellers”).

        The Entities operate as an integrated health plan, medical center network, and

pharmacy.2 The HealthSun Entities include a Medicare Advantage Organization (“MAO”)

that maintains networks of medical providers to service its Medicare-eligible enrollees.3

1
 C.A. No. 2020-0443-KSJM (the “HealthSun Action”), Docket (“Dkt.”) 172, Transmittal
Aff. of E. Wade Houston (“Houston Aff.”), Ex. 2 (“Purchase Agreement”); see also C.A.
No. 2020-0241-KSJM (the “Pasteur Action”), Dkt. 1 (“Pasteur Compl.”); HealthSun
Action, Dkt. 18 (“HealthSun Answer”) ¶ 9.
2
 Purchase Agreement at 2; see also Pasteur Action, Dkt. 28 (“Schlegel Decl.”) ¶ 3;
HealthSun Answer ¶¶ 25–30.
3
    HealthSun Answer ¶¶ 25–27.

                                               2
Highland’s acquisition of the Entities closed in November 2016.4              Anthem bought

Highland in 2017 and now owns the Entities.5

          The Purchase Agreement obligated the Sellers to indemnify the Buyer and its

successors for any “Losses” arising from breaches or inaccuracies in the Sellers’

representations or warranties.6 All of the representations and warranties at issue are

classified in the Purchase Agreement as “Specified Health Care Representations and

Warranties” (the “Specified Representations”), under which the Sellers represented that the

Entities had complied in all material respects with certain healthcare laws.7

          To secure the Sellers’ indemnification obligations under the Purchase Agreement,

Highland deposited $100 million of the purchase price into escrow.8 That amount provided

a cap on indemnification claims arising from breaches or inaccuracies in the Specified

Representations.9

4
 Schlegel Decl. ¶ 2; HealthSun Action, Dkt. 1 (“HealthSun Compl.”) ¶ 10; HealthSun
Answer ¶ 10.
5
    Schlegel Decl. ¶ 4; HealthSun Answer at 1 n.1.
6
    Purchase Agreement § 10.3(a).
7
 Id. § 10.2(a); see also id. §§ 2.13(e), (g), (h), (i), (l), (m). The Purchase Agreement defines
“Health Care Representations and Warranties” as the representations and warranties “set
forth in Sections 2.13(e) through 2.13(m).” Id. at A-8 (emphasis omitted). The Specified
Representations, as defined in § 10.2(a), are the representations and warranties “set forth
in Sections 2.13(e), 2.13(g), 2.13(h), 2.13(i), 2.13(l), 2.13(m) solely with respect to” certain
regulatory compliance claims. Id. § 10.2(a) (emphasis omitted).
8
    Id. § 1.3(d)(i).
9
    Id. § 10.2(c).

                                               3
           The parties agreed that the escrow funds would be released as governed by a

November 30, 2016 Escrow Agreement (the “Escrow Agreement”).10 The Purchase

Agreement required that the parties enter into the Escrow Agreement, attached the Escrow

Agreement as an exhibit, and incorporated it by reference.11 The Escrow Agreement

required that the escrow funds be released over four years.12 The releases were to be made

annually, beginning in 2017, in contractually specified amounts minus any indemnification

claims then “pending.”13

           The Purchase Agreement and the Escrow Agreement set out a complicated

contractual scheme discussed in greater detail in the legal analysis. The primary right

relevant to this decision is found in Section 10.6 of the Purchase Agreement, which governs

litigation practices relating to “Third[-]Party Claims” that “may give rise to a claim for

indemnification . . . under this Article 10[.]”14 Under Section 10.6(b), when one party

indemnifies the other, “[t]he Indemnifying Person shall . . . have the right to defend the

Indemnified Person against the Third[-]Party Claim” subject to certain conditions not

 Id. § 1.3(d); see also Pasteur Action, Dkt. 9 (“Freund Aff.”), Ex. B (Escrow Agreement);
10

HealthSun Compl. ¶ 10 & Ex. 2 (Escrow Agreement); HealthSun Answer ¶ 10.
11
   See Purchase Agreement at 3 (stating that the Purchase Agreement is contingent on the
parties entering into the Escrow Agreement); id. § 11.16 (incorporating the recitals as
material provisions); id. § 11.13 (incorporating all schedules and exhibits by reference); id.
at A-19 (adopting the Escrow Agreement as a related agreement).
12
     See Escrow Agreement §§ 6(a)–(d).
13
     Id.
14
     Purchase Agreement § 10.6(a) (underline in original).

                                              4
directly relevant here.15 In other words, Section 10.6(b) gives the indemnifying party rights

to control the defense of third-party litigation (the “Control Rights”).

         Section 10.6(b) contained an exception for “Regulatory Claim[s]” that “involve[] a

Governmental Authority or Health Care Law[.]”16 In the case of Regulatory Claims, in

lieu of Control Rights, Section 10.6(c) grants the indemnifying party the right to participate

in the defense of the Third-Party Claim in various ways (the “Participation Rights”). The

Participation Rights are discussed in greater detail in the legal analysis.17

         B.      Regulators Begin Examining Anthem And Anthem Launches An
                 Internal Investigation.

         As early as March 2018, the DOJ began investigating Anthem in connection with

its submission of risk adjustment claims to CMS for Medicare reimbursement.18 As an

MAO, Anthem—and the Highland subsidiaries it acquired—may seek reimbursement

from CMS for coverage provided to Medicare-eligible beneficiaries.19

         In as simplified terms as possible, reimbursement under Medicare Advantage works

as follows: first, a beneficiary receives a diagnosis from a healthcare provider; second, the

15
     See id. § 10.6(b).
16
     See id.
17
     See id. § 10.6(c).
18
   See HealthSun Action, Dkt. 172 (“HealthSun Pl.’s Opening Br.”), Ex. 3 (United States
v. Anthem, Inc., 18-MC-379 (Nov. 13, 2018)) at 1 (Report and Recommendation of Kevin
Nathaniel Fox, United States Magistrate Judge recommending that the court grant the
DOJ’s petition to compel testimony in response to the DOJ’s Civil Investigative Demand
(“CID”)) [hereinafter “Report and Recommendation”].
19
   See HealthSun Pl.’s Opening Br., Ex. 10 at 1; see also Report and Recommendation at 1
(stating that Anthem participates in the applicable Medicare Advantage program).

                                              5
healthcare provider submits service information to the MAO; third, the MAO submits a

record of the service to CMS, including relevant data submissions; fourth, CMS reviews

the submission, checks the integrity of the data provided, and identifies “risk-adjustment-

eligible” diagnoses; and fifth, CMS pays the MAO a risk-adjusted payment.20 After

submitting reimbursement data in the form of code, MAOs may make corrections after the

fact to account for errors.21

           The structure of the Medicare Advantage program creates a financial incentive for

MAOs to portray their beneficiaries as sicker than they are, and the federal government

monitors MAOs for fraud of this nature. CMS adjusts its payment for the beneficiary’s

risk because sicker beneficiaries are likely to need greater amounts of care, thus generating

higher medical costs than healthier beneficiaries. CMS determines an MAO enrollee’s risk

score based on demographics and hierarchical condition categories (“HCCs”), which are

categories of clinically related diagnoses that bear on costs of treatment.22 And the total

risk-adjusted payment to an MAO for an enrolled beneficiary equals the risk score

multiplied by the Medical Advantage plan’s base payment rate.23 Therefore, to obtain

20
     See HealthSun Pl.’s Opening Br., Ex. 10 at 2 (chart explaining process).
21
  See 42 C.F.R. § 422.310(g)(2)(i) (“Prior to calculation of final risk factors for a payment
year, CMS allows a reconciliation process to account for risk adjustment data submitted
after the March deadline until the final risk adjustment data submission deadline in the year
following the payment year.”); id. § 422.310(g)(2)(ii) (“After the final risk adjustment data
submission deadline, which is a date announced by CMS that is no earlier than January 31
of the year following the payment year, an MA organization can submit data to correct
overpayments but cannot submit diagnoses for additional payment.”).
22
     HealthSun Pl.’s Opening Br., Ex. 10 at 3–4.
23
     Id.

                                               6
higher payments, MAOs are incentivized to make beneficiaries appear as sick as possible.24

Accordingly, the Office of the Inspector General of the U.S. Department of Health and

Human Services (“OIG”) monitors coding submissions from MAOs for potentially

fraudulent data that exaggerates the sickness of Medicare Advantage beneficiaries.25

          Before Anthem purchased the Entities, HealthSun had audited Pasteur in 2016

relating to its Medicare Advantage reimbursement practices (the “2016 Audit”). In the

2016 Audit, HealthSun found what it believed to be numerous instances of misconduct

relating to code submissions to CMS (the “Coding Misconduct”).26 By 2018, Anthem had

learned of the Coding Misconduct and came to believe that HealthSun and Pasteur had

failed to correct prior data submissions for the errors detected in the 2016 Audit.27

          C.     Anthem Asserts Three Indemnification Claims Prior To The 2019
                 Release.

          In the twelve months prior to the 2019 escrow release, Anthem provided the Sellers

with notice of three claims for indemnification as to losses for breaches or inaccuracies in

the Specified Representations.

24
     Id. at 1.
25
     See id.
26
     See, e.g., HealthSun Pl.’s Opening Br., Ex. 13 at 2.
27
     See HealthSun Pl.’s Opening Br., Ex. 17, Attach. 2, at 3.

                                               7
         Anthem made the first claim in the amount of $5 million on June 28, 2019, 28 and

the second claim in the amount of $800,000 on November 1, 2019.29 The third claim,

which was also provided on November 1, 2019,30 asserted losses in connection with Civil

Investigation Demands (the “CIDs”) that Anthem received from the DOJ regarding the

ongoing investigation. The notice stated that “the amount of Loss is currently unknown”

but concluded that the Loss “could well exceed the materiality standard ($14,675,000).”31

         Anthem noticed a claim against the escrow funds in connection with each of the

indemnification claims on November 25, 2019, instructing the Escrow Agent to withhold

the Disputed Funds.32 The Escrow Agent did.

         D.     Subsequent Events Eliminate The Basis For Anthem’s Third
                Indemnification Claim.

         On March 26, 2020, the DOJ filed a complaint in the United States District Court

for the Southern District of New York against Anthem for violations of the False Claims

Act.33 The complaint did not name the Entities as parties. This development eliminated

28
  Pasteur Action, Dkt. 28 (“Toscano Decl.”), Ex. 13 (“First Indemnification Notice”);
HealthSun Compl. ¶ 104 & Ex. 21 (First Indemnification Notice); HealthSun
Answer ¶ 104.
29
  Toscano Decl., Ex. 15 (“Second Indemnification Notice”); HealthSun Compl. ¶ 113 &
Ex. 24 (Second Indemnification Notice); HealthSun Answer ¶ 113.
30
  Toscano Decl., Ex. 19 (“Third Indemnification Notice”); HealthSun Compl. ¶ 120 & Ex.
25 (Third Indemnification Notice); HealthSun Answer ¶ 120.
31
     Third Indemnification Notice at 1.
 Toscano Decl., Ex. 20 (“Escrow Notice”); HealthSun Compl. ¶ 135 & Ex. 28 (Escrow
32

Notice); HealthSun Answer ¶ 135.
33
     Freund Aff., Ex. I; HealthSun Compl. ¶ 144; HealthSun Answer ¶ 144.

                                             8
the basis for Anthem’s third indemnification claim, and Anthem withdrew its request for

indemnification from the Sellers based on the third indemnification claim.34

          E.       The Pasteur Plaintiff Files Litigation.

          The Pasteur Plaintiff, as representative of the Pasteur Sellers, filed suit against

Defendants ATH Holding Company, LLC and Highland Acquisition Holdings, LLC

(together, “Defendants” or “Anthem”) on March 31, 2020, claiming that Defendants

breached the Purchase Agreement and Escrow Agreement by withholding the disputed

funds and seeking specific performance, declaratory relief, and attorneys’ fees.35

          F.       Anthem Asserts A New Indemnification Claim.

          On April 16, 2020, Anthem sent the Sellers notice of an additional indemnification

claim.36 It stated that, in February 2019, Anthem received a whistleblower report from a

terminated employee.37 The report alleged fraudulent and improper coding practices by

the Pasteur Entities, buttressing Anthem’s suspicions of wrongdoing following the 2016

Audit.38       The report prompted Anthem to conduct an internal investigation, which

supposedly unearthed wrongdoing in the Entities’ code reporting that predated Highland’s

34
     See Pasteur Action, Dkt. 27 at 26; HealthSun Action, Dkt. 43 at 21.
35
     See Pasteur Action, Dkt. 1.
36
  Toscano Decl., Ex. 12 (“Fourth Indemnification Claim”); Toscano Decl., Exs. 1, 9, 10,
22 (attachments to the Fourth Indemnification Claim); HealthSun Compl. ¶ 152 & Ex. 37
(Fourth Indemnification Claim); HealthSun Answer ¶ 152. Pincites to the attachments to
the Fourth Indemnification Claim are to the version of that document attached as Exhibit
37 to the HealthSun Complaint.
37
     Fourth Indemnification Claim at 2.
38
     Id. at 2–3.

                                                9
acquisition of the Entities.39 The notice provided both anecdotal evidence of improper

diagnosis coding and documentary evidence of the conduct to which it referred.40

           Anthem claimed that improper coding erroneously inflated the Entities’

2017 EBITDA, which was used to generate the purchase price under the Purchase

Agreement.41 Because it estimated that the identified practices inflated the Entities’ 2017

EBITDA by $10.01 million, and because the Entities’ 2017 EBITDA was multiplied by

14.5 to calculate the purchase price, Anthem’s notice claimed damages of

$145.145 million.42 Together with the damages it estimated to incur from correcting the

coding errors, Anthem’s notice asserted total losses up to $173.645 million arising out of

the breaches of the Specified Representations.43

           G.    Anthem Self-Reports The Misconduct To CMS And The DOJ.

           On April 2, 2020, around the same time that it asserted various claims against the

Sellers, Anthem self-reported its internal investigation to CMS.44 Anthem determined that

it would “need to submit data corrections for certain diagnosis codes to CMS” on a rolling

basis.45 Anthem sent a second letter to CMS on April 2, 2021, regarding the Coding

39
     Id. at 1.
40
     Id. at 3–4, 10–29.
41
     Id. at 7.
42
     Id.
43
     Id.
44
     HealthSun Pl.’s Opening Br., Ex. 12 (April 2, 2020 letter from Anthem to CMS).
45
     Id.

                                               10
Misconduct. The court refers to the interactions between Defendants and CMS as the

“CMS Investigation.”

         At some point before April 16, 2020, Anthem also discussed the Coding Misconduct

with the DOJ’s criminal division (“DOJ Criminal”).46 This decision refers to those

interactions as the “DOJ Criminal Investigation.” On August 26, 2021, Anthem, the DOJ’s

civil division (“DOJ Civil”), and the OIG entered into a tolling agreement as to the statute

of limitations on any civil liability (the “Tolling Agreement”).47 Anthem discussed the

Coding Misconduct with DOJ Civil on August 30, 2021.48 This decision refers to the

interactions between DOJ Civil and Defendants as the “DOJ Civil Investigation” and,

together with the DOJ Criminal Investigation, the “DOJ Investigations.” The court refers

to all three investigations together as the “Investigations.”

         H.     The HealthSun Plaintiff Files Litigation.

         The HealthSun Plaintiff, as representative for the HealthSun Sellers, filed a separate

action on June 5, 2020, alleging breach of contract for refusal to release the disputed funds

and seeking contractual fee-shifting.49

         I.     Subsequent Procedural History

         The Pasteur Plaintiff moved for partial summary judgment and the HealthSun

Plaintiff moved for judgment on the pleadings on May 11, and August 6, 2020,

46
     HealthSun Pl.’s Opening Br., Ex. 13 at 8.
47
     See HealthSun Pl.’s Opening Br., Ex. 19.
 See HealthSun Action, Dkt. 183 (“Defs.’ Answering Br.”) at 43 (representing that this
48

meeting occurred); see also Pasteur Action, Dkt. 102 at 43 (same).
49
     See HealthSun Compl.

                                                 11
respectively.50 The court issued a decision on December 29, 2020.51 The decision ruled in

Plaintiffs’ favor in part, holding that Anthem’s fourth indemnification notice did not “relate

back” to the first and that Anthem was required to reach a contractual materiality standard

in order to block the release of the disputed funds. The decision, therefore, ordered Anthem

to release the difference between the $13 million in disputed funds and the $5.8 million in

losses timely noticed in Anthem’s first two indemnification claims.52

           The decision also denied Plaintiffs’ motion in part, holding that the contractual

materiality standard was ambiguous as to whether Anthem’s first and second claim notices

totaling $5.8 million continued to meet the materiality standard.53

           The parties engaged in discovery on the unresolved issue. On April 30, 2021, after

the conclusion of document discovery, the HealthSun Plaintiff moved for summary

judgment, seeking a declaration that Plaintiffs’ interpretation of the materiality standard

was correct, an order compelling Anthem to release the remaining disputed funds, and an

award of attorneys’ fees.54 The Pasteur Plaintiff moved for summary judgment on June

17, 2021, seeking the same relief.55

50
     HealthSun Action, Dkt. 24; Pasteur Action, Dkt. 9.
51
  See LPPAS Rep., LLC v. ATH Hldg. Co., LLC, 2020 WL 7706937 (Del. Ch. Dec. 29,
2020).
52
     Id. at *15.
53
     Id.
54
     See HealthSun Action, Dkt. 70.
55
     See Pasteur Action, Dkt. 65.

                                               12
         On July 9, 2021, in lieu of responding to the summary judgment motions, Anthem

agreed to release the remaining $5.8 million at issue.56 To date, all disputed funds have

now been released.57 The parties have represented, however, that Anthem continues to

withhold the approximately $20 million that was scheduled for release on December 1,

2020 (the “2020 Release”).58 The parties also dispute Plaintiffs’ entitlement to fees.

Anthem has taken the position that “Plaintiffs have not proved that Anthem breached the

[Purchase Agreement] or any related agreement and are therefore not entitled to fees.”59

         The parties engaged in a brief but spirited letter-writing campaign to the court,

debating the effect of Anthem’s release of the disputed funds and Anthem’s failure to

respond to Plaintiffs’ summary judgment briefs on Plaintiffs’ fee-shifting claim.60 The

court sent a letter to the parties on September 3, 2021, canceling the hearing on the mooted

summary judgment motion and ordering the parties to brief Plaintiffs’ fee-shifting claim.61

On October 20, 2021, the court held oral argument on Plaintiffs’ fee-shifting claim.62

56
     HealthSun Action, Dkt. 97, Ex. D.
57
  See LPPAS Rep., LLC v. ATH Hldg. Co., LLC, 2022 WL 94610, at *4 (Del. Ch. Jan. 10,
2022) (“The history of these cases has placed the court in an awkward position. All the
Disputed Funds have now been released without the court ordering Anthem to do so.”).
58
  Compare Defs.’ Answering Br. at 1 (“The current amount that remains in escrow is
roughly $20 million (the ‘2020 Release’)”), with Pasteur Action, Dkt. 106 (Pasteur Pl.’s
Reply Br.) at 8.
59
     Defs.’ Answering Br., Ex. E.
60
     See Pasteur Action, Dkt. 75, 76, 77; HealthSun Action, Dkt. 97, 98, 99.
61
     HealthSun Action, Dkt. 100.
62
     Pasteur Action, Dkt. 87; HealthSun Action, Dkt. 111.

                                              13
Subsequently, the HealthSun Plaintiff and Anthem reached an agreement mooting the

HealthSun Plaintiff’s fee-shifting claim.63

         The court resolved the Pasteur Plaintiff’s fee-shifting claim in an order dated

January 10, 2022.64 The court held that the Pasteur Plaintiff was entitled to fee-shifting

under Section 10.4 of the Purchase Agreement, which requires the Buyer to indemnify the

Sellers from losses “incurred or suffered by them incident to, resulting from or in any way

arising out of or in connection with any breach . . . of any covenant or agreement applicable

to Buyer contained in or pursuant to this Agreement or any Related Agreement.” 65 The

court reasoned that Anthem had breached the Purchase Agreement and Escrow Agreement

by improperly blocking escrow distributions.66

         On February 4, 2022, the HealthSun Plaintiff filed a supplemental complaint for

specific performance (the “HealthSun Supplemental Complaint”).67 In it, the HealthSun

Plaintiff asserts three causes of action. In Count I, the HealthSun Plaintiff claims that

Defendants breached its Participation Rights by self-reporting and coordinating with the

DOJ and CMS.68 In Count II, the HealthSun Plaintiff claims that Defendants breached

Section 4 of the Escrow Agreement by instructing the Escrow Agent to withhold the 2020

63
     See HealthSun Action, Dkt. 112.
64
     See ATH, 2022 WL 94610.
65
     Purchase Agreement § 10.4.
66
     See ATH, 2022 WL 94610, at *6–8.
67
     HealthSun Action, Dkt. 120.
68
     Id. ¶¶ 88–91.

                                              14
Release.69 In Count III, the HealthSun Plaintiff seeks fee-shifting under Section 10.4 of

the Purchase Agreement.70

         On March 15, 2022, the United States moved to intervene and to stay the HealthSun

Action, citing confidentiality concerns relating to the DOJ Investigations.71 The court

granted a partial stay on April 26, 2022, which allowed Anthem to answer the HealthSun

Supplemental Complaint and instructed the United States to present an in camera affidavit

addressing answers to the HealthSun Plaintiff’s questions about the meritoriousness of

extending the stay.72 The court ordered the parties to complete the in camera affidavit by

August 2022, to aid in its decision whether to extend the stay past the six-month period the

United States requested.73

         On May 23, 2022, the Pasteur Plaintiff also filed a supplemental complaint (the

“Pasteur Supplemental Complaint”).74 The Pasteur Plaintiff asserts three causes of action

in the Pasteur Supplemental Complaint. In Count I, the Pasteur Plaintiff claims that

Defendants breached the Purchase Agreement and Escrow Agreement, for which it seeks

specific performance of the 2020 Release.75 In Count II, the Pasteur Plaintiff also claims

that Defendants breached its Participation Rights by self-reporting and coordinating with

69
     Id. ¶¶ 92–98.
70
     Id. ¶¶ 99–102.
71
     HealthSun Action, Dkts. 142–144.
72
     HealthSun Action, Dkt. 170 (“Apr. 26, 2022 Hr’g Tr.”) at 61:16–62:4.
73
     Id. at 62:5–15.
74
     Pasteur Action, Dkt. 93.
75
     Id. ¶¶ 39–44.

                                             15
the DOJ and CMS.76 In Count III, the Pasteur Plaintiff seeks fee-shifting under Section

10.4 of the Purchase Agreement.77

         On June 6, 2022, the HealthSun Plaintiff moved for partial summary judgment on

Counts I and III of the HealthSun Supplemental Complaint.78 On June 29, 2022, the

Pasteur Plaintiff moved for partial summary judgment on Counts II and III of the Pasteur

Supplemental Complaint, seeking both the release of the remaining escrow funds due to

Defendants’ breach of their Participation Rights and fee-shifting.79

         The parties coordinated briefing in both actions given the substantial overlap in

issues presented. Defendants pressed affirmative defenses of repudiation and substantial

compliance. The court heard oral argument on the motions on January 4, 2023.80

II.      LEGAL ANALYSIS

         “A party is entitled to summary judgment under Court of Chancery Rule 56 when

that party can show there is no genuine issue of material fact and that it is entitled to

judgment as a matter of law.”81 In contract interpretation cases, a court will grant summary

judgment either “when the contract in question is unambiguous, or when the extrinsic

evidence in the record fails to create a triable issue of material fact and judgment as a matter

76
     Id. ¶¶ 45–47.
77
     Id. ¶¶ 48–50.
78
     HealthSun Action, Dkt. 172.
79
     Pasteur Action, Dkt. 97.
80
     See Pasteur Action, Dkt. 111; HealthSun Action, Dkt. 193 (“Jan. 4, 2023 Hr’g Tr.”).
81
  GRT, Inc. v. Marathon GTF Tech., Ltd., 2012 WL 2356489, at *4 (Del. Ch. June 21,
2012) (citing Court of Chancery Rule 56)).

                                              16
of law is appropriate.”82 “Summary judgment is the proper framework for enforcing

unambiguous contracts because there is no need to resolve material disputes of fact.”83

         Under Delaware law, a court “will interpret clear and unambiguous terms according

to their ordinary meaning.”84 A contract is unambiguous “if, by its plain terms, the

provisions in controversy are reasonably susceptible to only one meaning.”85 More

broadly, the “objective theory of contracts requires that a court ‘give priority to the parties’

intentions as reflected in the four corners of the agreement, construing the agreement as a

whole and giving effect to all its provisions.’”86 If contract language is facially ambiguous,

“a court must look to extrinsic evidence to determine the shared intent of both parties.”87

         Collectively, Plaintiffs’ motions raise five issues. The first four are implicated by

both Plaintiffs’ motions; the last is raised only by the Pasteur Plaintiff. First, did any of

the Investigations trigger Plaintiffs’ Participation Rights? Second, did Defendants breach

the Participation Rights? Third, do Defendants’ affirmative defenses of repudiation or

substantial compliance foreclose summary judgment in Plaintiffs’ favor? Fourth, are

Plaintiffs entitled to fee shifting? Fifth, are Plaintiffs entitled to a release of the escrow

funds?

82
     GRT, Inc., 2012 WL 2356489, at *4 (citations omitted).
83
     HIFN, Inc. v. Intel Corp., 2007 WL 1309376, at *9 (Del. Ch. May 2, 2008).
84
     GMG Cap. Invs., LLC v. Athenian Venture P’rs I, L.P., 36 A.3d 776, 780 (Del. 2012).
85
     GRT, Inc., 2012 WL 2356489, at *4.
86
  Neurvana Med., LLC v. Balt USA, LLC, 2020 WL 949917, at *15 (Del. Ch. Feb. 27,
2020) (quoting In re Viking Pump, Inc., 148 A.3d 633, 648 (Del. 2016) (citation omitted)).
87
     GRT, Inc., 2012 WL 2356489, at *4.

                                              17
         A.     The DOJ Investigations And CMS Investigation Triggered The
                Participation Rights.

         Plaintiffs argue that the Participation Rights unambiguously allowed it to participate

in the defense of the Investigations because each give rise to a “Regulatory” claim under

the Purchase Agreement.88

         The starting place in the contract analysis is with Section 10.6’s definition of

“Third[-]Party Claims” and “Control Rights.” As stated above, Section 10.6(a) provides:

“[i]f any third party shall notify an Indemnified Person with respect to any matter (a

‘Third[-]Party Claim’) which may give rise to a claim for indemnification against an

Indemnifying Person under this Article 10, then the Indemnified Person shall promptly

notify the Indemnifying Person thereof in writing[.]”89 Under Section 10.6(b), “[t]he

Indemnifying Person shall . . . have the right to defend the Indemnified Person against the

Third[-]Party Claim[.]”90 In other words, Section 10.6(b) gives the Sellers, as indemnifiers,

Control Rights over the defense of the Third-Party Claim.

         The Purchase Agreement, however, contains a list of exceptions for certain Third-

Party Claims that do not trigger the Control Rights. Section 10.6(b) provides:

                Notwithstanding anything contained herein to the contrary, the
                Indemnifying Person shall not have the right to direct the
                defense or settlement of any such Third[-]Party Claim (and
                shall pay the fees, costs, and expenses of counsel retained by
                the Indemnified Person with respect to), and the Indemnified
                Person shall be entitled to have sole control over the defense or

88
     See HealthSun Pl.’s Opening Br. at 34–38.
89
     Purchase Agreement § 10.6(a) (underline in original).
90
   Id. § 10.6(b). This provision is subject to additional conditions that are not directly
relevant here.

                                               18
                 settlement of, on behalf of and for the account and risk of
                 (subject to the limitations contained in this Article 10, to the
                 extent applicable), any Third-Party Claim if (A) such Third-
                 Party Claim seeks non-monetary relief (except where non-
                 monetary relief is merely incidental to a primary claim or
                 claims for monetary damages), (B) such Third-Party Claim
                 involves criminal or quasi-criminal allegations, (C) such
                 Third-Party Claim involves a Governmental Authority or
                 Health Care Laws, in each case that is material and adverse to
                 the Indemnified Person or its Affiliates (including, in the case
                 of a Buyer Indemnified Party, the Companies or their
                 respective businesses) (it being agreed that any RADV Claims
                 or CMS Program Audit Claims shall be deemed material and
                 adverse) (a “Regulatory Claim”), (D) such Third-Party Claim
                 involves a claim to which the Indemnified Person reasonably
                 believes an adverse determination would be materially
                 detrimental or injurious to the Indemnified Person, (E) upon
                 petition by the Indemnified Person, an appropriate court rules
                 that the Indemnifying Person failed or is failing to vigorously
                 prosecute or defend such Third[-]Party Claim or (F) it is
                 reasonably likely that the Losses arising from such Third[-
                 ]Party Claim and any other pending claims pending for
                 indemnification against the Indemnifying Person will exceed
                 the amount the Indemnified Person will be entitled to recover
                 under this Article 10 as a result of the limitations set forth
                 herein.91

         Summarized, this section creates six categories of excepted Third-Party Claims to

which no Control Rights apply. Relevant here are the two exceptions under Sections

10.6(b)(B) and (C) for “criminal or quasi-criminal allegations” or Third-Party Claims that

are “Regulatory Claims[,]” respectively.92 The Purchase Agreement does not define

“criminal or quasi-criminal allegations.”93 The Purchase Agreement defines “Regulatory

91
     Id. § 10.6(b).
92
     Id. § 10.6(b)(B)–(C).
93
     See generally id.

                                               19
Claims” as involving “Governmental Authority or Health Care Laws, in each case that is

material and adverse to the Indemnified Person or its Affiliates[.]”94

          Even though Sellers have no Control Rights regarding the defense of Regulatory

Claims, Sellers have Participation Rights under Section 10.6(c), which provides:

                 If a Third[-]Party Claim is a Regulatory Claim, then (i) the
                 Indemnified Person shall defend against the Regulatory Claim
                 with a nationally-recognized counsel of the Indemnified
                 Person’s choice . . . , (ii) the Indemnified Person shall (and shall
                 cause its counsel to) consult regularly (and not less than once
                 per week) with the designated representatives of the
                 Indemnifying Person regarding the status of such matter . . .
                 (iii) all filings or written submissions with the court or
                 Governmental Authority and correspondence with opposing
                 counsel and/or the applicable Governmental Authority shall be
                 subject to reasonable review and comment (not to be
                 unreasonably withheld, conditioned or delayed) of the
                 Indemnifying Person and their legal counsel, in each case
                 provided in not more than five (5) days (or such lesser period
                 as may be required by exigent circumstances, other than
                 resulting from the Indemnified Person’s delay) after any
                 written request, (iv) the Indemnified Person shall endeavor, to
                 the extent practicable, to permit active participation of the
                 designated representatives of the Indemnifying Person and its
                 counsel in all such matters, including, as mutually agreed by
                 the Indemnified Person and Indemnifying Person in light of
                 tactical considerations, providing an opportunity for
                 attendance at or in connection with any material scheduled
                 Proceedings, meetings (including telephonic), negotiations,
                 conferences or otherwise, and (v) the Indemnified Person and
                 the Indemnifying Person shall enter into a joint defense
                 agreement as mutually agreed by such parties.95

94
     Id. § 10.6(b)(C).
95
     Id. § 10.6(c).

                                                 20
           Broken down, Regulatory Claims under Section 10.6(c) raise five obligations,

which collectively form the Participation Rights: first, the indemnified party must choose

counsel to defend the Third-Party Claim (the “Choice of Counsel Obligation”); second, the

indemnified party must consult regularly with the indemnifying party (the “Consultation

Right”); third, the indemnified party must give the indemnifier a chance to “review and

comment” on correspondences with “the applicable Government Authority” (the “Review

and Comment Right”); fourth, the indemnified party must allow the Sellers to “active[ly]

participat[e]” in relevant matters, which include the chance to attend “[p]roceedings,

meetings[,] . . . negotiations, [and] conferences” (the “Active Participation Right”); and

fifth, the parties must enter into a “mutually agreed” joint defense agreement (the “Joint

Defense Obligation”).96

           Defendants concede that the Participation Rights apply to Regulatory Claims and

that the DOJ Investigations are Regulatory Claims.97 The parties dispute whether the CMS

Investigation gives rise to a Third-Party Claim triggering Participation Rights.

           Defendants’ primary argument for why the CMS Investigation does not give rise to

a Third-Party Claim relies on the concept of notice. Defendants argue that losses incurred

from the CMS Investigation “will not ripen into a third[-]party claim” under Section

10.6(a) until CMS provides formal notice to Anthem that it is bringing a claim.98 In other

96
     Id.
97
     See Jan. 4, 2023 Hr’g Tr. at 44:9–45:3.
98
     Defs.’ Answering Br. at 39–40.

                                               21
words, Defendants read Section 10.6(a) to define Third-Party Claims as requiring third

party notice of a forthcoming claim.

         The language of Section 10.6(a) reads, in part, “[i]f any third party shall notify any

Indemnified Person with respect to any matter (a ‘Third[-]Party Claim’) which may give

rise to a claim for indemnification against an Indemnifying Person . . . , then the

Indemnified Person shall promptly notify the Indemnifying Person thereof in writing[.]”99

Effectively, Defendants argue that the first subordinate clause referring to notice is part of

the definition of Third-Party Claim.

         Although Section 10.6(a) mentions notice, it does not include notice in the definition

of Third-Party Claim. The parenthetical containing the defined term Third-Party Claim

follows the phrase “any matter,”100 and the phrase “any matter” exists independent of

notice. Put differently, a Third-Party Claim is the “matter”; it exists irrespective of whether

the third party has provided notice.

         Defendants raise a second argument for why the CMS Investigation does not give

rise to a ripe Third-Party Claim: there has been scant activity between Defendants and

CMS. Defendants state that they merely sent two letters to CMS regarding the Coding

Misconduct in April 2020 and April 2021.101

         Defendants’ description of the CMS Investigation, however, elides other activity

between Defendants and the relevant regulators. In August 2021, Defendants executed the

99
     Purchase Agreement § 10.6(a) (underline in original).
100
      See id.
101
      Defs.’ Answering Br. at 39.

                                               22
Tolling Agreement with DOJ Civil and OIG.102 OIG oversees CMS investigations, as CMS

is a DHHS operating division.103 That agreement waived statute of limitations, laches, or

“any other time-related defense” regarding the period between June 15, 2021 and

December 15, 2021.104 The fact that Defendants entered into such a tolling agreement

suggests that there is indeed a “matter” that “may give rise to a claim for indemnification”

resulting from the CMS Investigation.105

            The result is that the CMS Investigation gives rise to a Third-Party Claim. So, all

three Investigations trigger Participation Rights.

            B.    Defendants Breached Plaintiffs’ Participation Rights.

            The next issue is whether Defendants have breached their obligations to give

Plaintiffs Participation Rights with respect to each Investigation.

            To prevail on a claim for breach of contract, a plaintiff must prove: first, the

existence of a contract, whether express or implied; second, the breach of an obligation

imposed by that contract; and third, the resultant damage to the plaintiff.106 The breaching

party’s state of mind is not considered in an action for contractual breach—in that sense,

liability for failure to comply with a contract is strict.107 Liability for breach of contract

102
      Houston Aff., Ex. 19.
103
   About OIG, U.S. Department of Health & Human Services Office of Inspector General,
https://oig.hhs.gov/about-oig/ (last visited April 3, 2023).
104
      Houston Aff., Ex. 19.
105
      See Purchase Agreement § 10.6(a).
106
      See ATH, 2022 WL 94610, at *6 (cleaned up).
107
      Id.

                                                23
under common law turns on a concept of strict liability and parties are held to the standard

expressed in the words of the contract.108 If a party agrees to do something, he or she must

do it or be liable for resulting damages.109

            Plaintiffs argue that Defendants have breached its Participation Rights in connection

with the DOJ Criminal Investigation in three ways.

            First, Plaintiffs allege the Defendants have breached the Review and Comment

Right by unilaterally responding to at least 22 subpoenas from the DOJ.110 As evidence,

the HealthSun Plaintiff attaches a grand jury subpoena and cover letter from the DOJ dated

January 24, 2022, with “HealthSun20-022” in the title that was served on Anthem.111 The

subpoena offers Anthem the choice of either appearing before the grand jury or delivering

subpoenaed documents to the DOJ.112 Defendants do not deny the existence or accuracy

of this information, that they responded to the grand jury subpoenas, or in what volume

they received the subpoenas.113 Nor do Defendants argue that either Plaintiff had the

chance to review or comment on any responses.

108
      Id.
109
      Id.
110
   See HealthSun Action, Dkt. 187 (“HealthSun Pl.’s Reply Br.”) at 17 (citing Houston
Aff., Ex. 25)
111
      See Houston Aff., Ex. 25.
112
      Id. at 1.
113
      See generally Defs.’ Answering Br.; see also Jan. 4, 2023 Hr’g Tr.

                                                 24
         Because responses to subpoenas are “filings or written submissions with the court

or [applicable] Governmental Authority[,]”114 these subpoenas triggered the Review and

Comment Right. The Purchase Agreement required Plaintiffs be given the chance to

review and comment. Defendants breached by not giving them such a chance.

         Second, Plaintiffs alleges that Defendants have “discussed repeatedly Anthem’s

self-reporting, witnesses, and the direction of the DOJ Criminal Investigation[,]” which

constitutes a breach of the Active Participation Right by excluding the Sellers or their

representatives.115    The DOJ has appeared in this action and confirmed that these

discussions took place.116 Defendants excluded both Plaintiffs from these discussions.

That exclusion violates the Active Participation Right, which required Defendants to

“endeavor, to the extent practicable, to permit active participation of the designated

representatives of the Indemnifying Person and its counsel in all such matters” relating to

the Regulatory Claim.117

         Third, Plaintiffs allege that Defendants breached the Consultation Right by not

sharing information with Plaintiffs on the above-mentioned discussions.118 The court

agrees because the Consultation Right requires Buyer to “reasonably cooperate with and

inform the designated representatives of the Indemnifying Person with respect to the

114
      Purchase Agreement § 10.6(c)(iii).
115
      HealthSun Pl.’s Reply Br. at 17.
116
   Apr. 26, 2022 Hr’g Tr. at 44:3–18 (DOJ describing the communications with Anthem
as “a back and forth” that would signal “the direction of that criminal investigation.”).
117
      Purchase Agreement § 10.6(c)(iv).
118
      HealthSun Pl.’s Reply Br. at 17.

                                            25
conduct of the defense of [the] Regulatory Claim[.]”119          Defendants did not share

information with Plaintiffs.

         In sum, Defendants breached the Participation Rights provision in connection with

the DOJ Criminal Investigation.

         Plaintiffs next argue that Defendants have breached their Participation Rights in

connection with the DOJ Civil Investigation in three ways, all related to the execution of

the Tolling Agreement. Defendants do not deny the factual allegations.120 They instead

dispute that these allegations constitute a breach of the relevant provisions.

         First, Plaintiffs argue that Defendants breached the Review and Comment Right by

executing the Tolling Agreement and having surrounding discussions with DOJ Civil

without Plaintiffs’ input.121 Because the Tolling Agreement is a “correspondence with

opposing counsel and/or the applicable Governmental Authority[,]”122 signing the Tolling

Agreement triggered the Review and Comment Right. The Purchase Agreement required

that Plaintiffs be given the chance to review and comment. Defendants breached by not

giving them such a chance.

         Second, Plaintiffs argue that Defendants breached the Active Participation Right by

entering into the Tolling Agreement without Plaintiffs.123 Because Defendants entered into

119
      Purchase Agreement § 10.6(c)(ii).
120
      See generally Defs.’ Answering Br.
121
      HealthSun Pl.’s Reply Br. at 15–16.
122
      Purchase Agreement § 10.6(c)(iii).
123
      HealthSun Pl.’s Reply Br. at 16.

                                             26
the Tolling Agreement without Plaintiffs, Plaintiffs could not participate in the defense of

the DOJ Civil Investigation. Defendants breached the Active Participation Right.

          Third, Plaintiffs argue that Defendants breached the Consultation Right by

concealing the Tolling Agreement until February 2022, and by withholding it from Sellers

until this court ordered the production of the Tolling Agreement in April 2022.124 By

concealing and/or not disclosing the existence of the Tolling Agreement, Defendants failed

to “consult regularly” with the Sellers on the DOJ Civil Investigation.125 This violated the

Consultation Right.

          In sum, Defendants breached Plaintiffs’ Participation Rights in connection with the

DOJ Civil Investigation.

          Plaintiffs argue that Defendants breached the Participation Rights in connection

with the CMS Investigation in four ways.

          First, Plaintiffs allege that Defendants breached the Review and Comment Right by

“exchanging written communications with CMS and OIG without giving the sellers notice

or opportunity to comment.”126 In particular, Plaintiffs take aim at Anthem’s reporting to

CMS in April 2020 about the companies’ “historical MRA practices” which ostensibly

involved “up-coding and warranted correction.”127 Plaintiffs also point to Defendants’

124
      Id. at 15.
125
      Purchase Agreement § 10.6(c)(ii).
126
      See id.
127
      HealthSun Pl.’s Reply Br. at 13.

                                              27
April 2021 report to CMS concerning the Coding Misconduct. 128 Because this reporting

constituted “correspondence with opposing counsel and/or the applicable Governmental

Authority[,]”129 it triggered the Review and Comment Right. Defendants breached by not

giving Plaintiffs a chance to review or comment on the written communications.

            Second, Plaintiffs allege that this same activity breached the Choice of Counsel

Obligation because Defendants failed to “defend the Sellers from anything.”130 Defendants

state that they retained “nationally [] recognized counsel[,]” the law firm O’Melveny &

Myers LLP (“O’Melveny”).131 The record, however, is not clear when Defendants retained

O’Melveny. If Defendants did so when they submitted the MRA practice information to

CMS in April 2020, then there might not be a breach of the Choice of Counsel Obligation.

The record is therefore not developed enough on this point for the court to find a breach.

            Third, Plaintiffs argue that Defendants breached their Consultation Right when

Defendants deleted the diagnosis codes after discovering the Coding Misconduct.

Plaintiffs say the deletion was a “significant decision[]” on which Defendants failed to

“reasonably cooperate with and inform the designated representatives of the Indemnifying

Person[.]”132 Defendants state that they complied with this provision by offering Plaintiffs

a “detailed explanation of the Coding Misconduct” and separately agreed to provide “the

128
      Id.
129
      Purchase Agreement § 10.6(c)(iii).
130
      HealthSun Pl.’s Reply Br. at 13.
131
      See Defs.’ Answering Br. at 14.
132
      Purchase Agreement § 10.6(c)(ii).

                                               28
full extent of [their] communications with CMS related to the Coding Misconduct . . . and

a spreadsheet identifying the data corrections” subject to a confidentiality agreement with

CMS and federal regulations.133

            Defendants’ deletions—without informing Plaintiffs beforehand—amount to a

breach of the Consultation Right. On the one hand, Defendants have subsequently offered

to “inform [Plaintiffs’] designated representatives” about the litigation and the coding

deletions at issue.134 On the other hand, however, the Consultation Right also requires

Defendants to “reasonably cooperate with” Plaintiffs throughout the process.135 That

Plaintiffs only found out about the deletions and submissions to CMS after the fact reflects

a failure to consult with Plaintiffs beforehand. Even if Defendants’ decision to provide

that information to CMS was legally or ethically correct,136 the Consultation Right imposes

additional consultation obligations.

            Fourth, Plaintiffs present an additional factual theory, arguing that Defendants

breached the Consultation Right failing to “reasonably cooperate with and inform”

Plaintiffs about the CMS Investigation.137 Plaintiffs state that, after submitting relevant

information to CMS, Defendants failed to provide useful information to Plaintiffs “beyond

133
      Defs.’ Answering Br. at 40.
134
      Purchase Agreement § 10.6(c)(ii).
135
      Id.
136
   See Defs.’ Answering Br. at 43 (describing Plaintiffs’ position to be that “Anthem
should have concealed the Coding Misconduct and not corrected erroneous diagnosis
coding data on file with CMS[,]” a “bad faith approach to the business, their contractual
obligations[,] and their dealings with the government.”).
137
      HealthSun Pl.’s Reply Br. at 14.

                                               29
high-level summaries for which Anthem has withheld the underlying data.”138 Plaintiffs

say the insufficiency of the corroborating evidence prevents it from “test[ing] whether

Anthem’s code deletions are warranted.”139 Further, Plaintiffs express skepticism that

Defendants only exchanged two letters over a 29-month period with CMS—i.e., Plaintiffs

believe Defendants have concealed additional communications.140 Plaintiffs also accuse

Defendants of weaponizing the DOJ’s motion to stay as a pretext for failing to live up to

their contractual obligations.141

            Defendants state they have agreed to provide a “detailed explanation of the Coding

Misconduct[,]” the two relevant letter communications with CMS, and a spreadsheet

reflecting the data corrections between January 1, 2015 and December 21, 2017, subject to

an applicable confidentiality agreement with CMS and federal regulations.142

            It is unclear whether the information offered by Defendants undermines Plaintiffs’

newly developed theory of breach, or whether the additional detail would moot the theory.

The motion as to this issue is denied, giving Defendants the opportunity to attempt to moot

the issue.

            In sum, Defendants have breached the Participation Rights with respect to the CMS

Investigation, though not in every way Plaintiffs allege.

138
      Id. at 13.
139
      Id.
140
      Id. at 15.
141
      Id. at 14.
142
      Defs.’ Answering Br. at 40.

                                                30
         C.     Defendants’ Affirmative Defenses Do Not Foreclose Granting
                Summary Judgment In Favor Of Plaintiffs.

         Defendants argue that two affirmative defenses foreclose summary judgment:

excusal through Plaintiffs’ repudiation of the Purchase Agreement, and substantial

compliance with Section 10.6(c).

                1.     Repudiation

         Defendants argue that Plaintiffs may not demand performance of the Participation

Rights because they repudiated the Purchase Agreement by failing to indemnify

Defendants.143 Plaintiffs counter that “the conditions to their performance have not

occurred.”144

         “A repudiation is a manifestation by one party to the other that the first cannot or

will not perform at least some of its obligations under the contract.”145 “Under Delaware

law, repudiation is an outright refusal by a party to perform a contract or its conditions

entitling the other party to treat the contract as rescinded.”146 “Repudiation of only one

part of a contract will, if serious, amount to a repudiation of the whole; accordingly, a

partial repudiator cannot insist on enforcing the balance of the contract.”147

143
   Defs.’ Answering Br. at 33 (“Having repudiated their contractual obligations, Plaintiffs
are not entitled to demand any corresponding performance.”).
144
      HealthSun Pl.’s Reply Br. at 23.
145
      E. Allan Farnsworth, 2 Farnsworth on Contracts § 8.24 at 8-195 (4th ed. 2019).
146
   CitiSteel USA, Inc. v. Connell Ltd. P’ship, 758 A.2d 928, 931 (Del. 2000) (internal
quotation marks omitted).
147
      Farnsworth, supra § 8.24 at 8-196.

                                              31
          “In order to constitute a repudiation, a party’s language must be sufficiently positive

to be reasonably interpreted to mean that the party will not or cannot perform.”148 When a

promisor repudiates a contract, the promisee may “treat the contract as terminated” either

by “suspend[ing] its own performance” or “treat[ing] repudiation as a breach presently

remediable by damages” and “manifest[ing] its decision to treat the contract as

terminated.”149

          Defendants argue that Plaintiffs’ responses to its indemnification notices, taken

together, amount to joint repudiation of the Purchase Agreement.

          As to the HealthSun Sellers, Defendants rely on the following communications:

          •       On May 13, 2020, the HealthSun Plaintiff responded to Defendants’ April
                  16, 2020 claim notice, characterizing the claim as “improper” and stating that
                  it “objects to the [notice of claim] in its entirety[.]” 150 The same letter also
                  stated the HealthSun Plaintiff’s position that Defendants had violated their
                  “notice, consultation, review, comment, and participation rights.”151

          •       On December 3, 2020, the HealthSun Plaintiff sent a dispute notice to the
                  Escrow Agent regarding the claims Anthem had asserted in its November 27,
                  2020 claim notice. The dispute notice stated that “any and all amounts
                  referenced” in Defendants’ “Claim Notice or related to the purported Claims
                  included therein is a Disputed Amount and, therefore, no amounts should be
                  released from the Escrow Account to Buyer or anyone else unless and until
                  the parties instruct otherwise through a duly executed letter agreement.”152

148
      Rest. (Second) of Contracts § 250 cmt. b (Am. L. Inst. 1981).
149
  W. Willow-Bay Ct., LLC v. Robino-Bay Ct. Plaza, LLC, 2009 WL 458779, at *5 (Del.
Ch. Feb. 23, 2009).
150
      Houston Aff., Ex. 14 at 1, 6.
151
      Id. at 3.
152
      Defs.’ Answering Br., Ex. C.

                                                 32
          Neither of these communications evidence repudiation. In the May 13, 2020 letter,

the HealthSun Plaintiff invoked its Participation Rights under the Purchase Agreement,

which Defendants had breached. The May 13 letter is therefore not an “outright refusal”

to perform153—rather, it was an attempt to vindicate the HealthSun Plaintiff’s contract

rights.       Nor does the HealthSun Plaintiff’s December 3 letter to the Escrow Agent

constitute a repudiation. That letter put the Escrow Agent on notice that the parties disputed

the amount stated in Defendants’ claim. It did not unilaterally signal that the HealthSun

Plaintiff “will not or cannot perform.”154

          As to the Pasteur Sellers, Defendants rely on the following communications:

          •     On April 23, 2020, the Pasteur Sellers responded to Defendants’ April 16,
                2020 claim notice. In their objection letter, the Pasteur Sellers and their
                representative stated that they “do not agree that Anthem has properly
                asserted a claim or that the factual basis exists for it to do so.”155

          •     On December 4, 2020, the Pasteur Plaintiff sent a separate dispute notice to
                Anthem and the Escrow Agent.156

          •     On December 15, 2020, the Pasteur Sellers and their representative reiterated
                their position in a letter to Defendants.157

          None of these communications evidence repudiation. In the April 23, 2020 letter,

the Pasteur Sellers and their representative both challenged whether Anthem had properly

asserted a claim and stated “because Anthem appears to be alleging the existence of a

153
      CitiSteel USA, Inc., 758 A.2d at 931.
154
      Rest. (Second) of Contracts § 250 cmt. b.
155
      See Dkt. 97 (“Pasteur Pl.’s Opening Br.”), Ex. 3.
156
      Defs.’ Answering Br., Ex. D.
157
      Defs.’ Answering Br., Ex. E.

                                              33
Regulatory Claim . . . , Anthem has an obligation to comply with all provisions of Section

10.6(c)[.]”158 The Pasteur Plaintiff’s December 4, 2020 dispute notice letter informed the

Escrow Agent of the parties’ dispute and told it to withhold any releases “until the parties

instructed otherwise[.]”159 So, like the HealthSun Plaintiff’s December 3, 2020 letter to

the Escrow Agent, the Pasteur Plaintiff’s December 4, 2020 letter does not constitute a

repudiation.       Finally, the Pasteur Plaintiff’s December 15, 2020 letter “once again

remind[s] Anthem of its obligation under Section 10.6(c) of the parties’ Equity Interests

Purchase Agreement.”160 Much like the HealthSun Plaintiff’s communications, the Pasteur

Sellers’ communications constitute effort to vindicate contract rights, not to repudiate.

            In sum, Defendants’ defense of excusal through repudiation fails because neither

the HealthSun Plaintiff nor the Pasteur Plaintiff repudiated the Purchase Agreement.

                  2.     Substantial Compliance

            Defendants next argue that they have substantially complied with the Purchase

Agreement in all material respects. Although this argument is primarily directed at the

Pasteur Plaintiff, in their briefing, Defendants seem to raise it more generally as to both

Plaintiffs.161 Plaintiffs counter that the appropriate standard is strict rather than substantial

158
      Id.
159
      Defs.’ Answering Br., Ex. C at 1.
160
      Defs.’ Answering Br., Ex. E.
161
      Defs.’ Answering Br. at 35–39.

                                               34
compliance—so the court need not assess the materiality of any breach to enter declaratory

judgment on Count I.162

         The parties did not meaningfully brief the question of which standard of breach

applies—substantial compliance or strict. The limited authorities cited by the parties do

not fully support their respective positions.163

         To streamline this decision, the court assumes that the standard is substantial

compliance. Under that standard, Defendants still lose. Delaware follows the Restatement

162
      HealthSun Pl.’s Reply Br. at 19–20.
163
    Defendants cite to a number of authorities in support of their substantial compliance
argument. See Defs.’ Answering Br. at 37 (citing In re Eagle-Picher Indus., Inc., 285 F.3d
522 (6th Cir. 2002), In re Mobilactive Media, 2013 WL 297950, at *14 (Del. Ch. Jan. 25,
2013)). For instance, Defendants rely on In re Mobilactive Media, LLC, where the court
observed that “[a] party is excused from performance under a contract if the other party is
in material breach thereof[.]” 2013 WL 297950, at *13 (internal quotation marks omitted).
It is unclear whether those authorities are relevant where, as here, the plaintiff does not
seek to suspend its own performance because of Defendants’ breach. Defendants also
analogize to a pair of cases in which courts permitted persons to substantially and not
literally comply with contractual notice requirements and federal statute, respectively. See
Defs.’ Answering Br. at 37 (citing Gildor v. Optical Sols., Inc., 2006 WL 4782348, at *8
(Del. Ch. June 5, 2006), City of Phila. v. Sessions, 280 F. Supp. 3d 579, 651–652 (E.D. Pa.
2017)). Both cases are distinguishable. In Gildor, the court chided the defendants for
failing to take “reasonable steps” to provide “actual notice” to the stockholder where
“literal compliance” with the contractual notice provision was impossible. In Sessions, the
court reasoned that a substantial compliance concept rooted in contract law motivated the
design of a statutory scheme. Neither case supports Defendants’ argument in these
circumstances. Plaintiffs’ cited authority is similarly unpersuasive. Plaintiffs cite to a
decision of this court stating that “liability for failure to comply with a contract is strict.”
See ATH, 2022 WL 94610, at *6 (quoting Lacey v. Mota-Velasco, 2021 WL 508982, at *8
(Del. Ch. Feb. 11, 2021)); see also HealthSun Pl.’s Opening Br. at 41 (quoting same). But
that statement is taken out of context. The court used the phrase “strict liability” to
distinguish contractual liability from negligence or other standards that require peering into
a party’s state of mind. The court did not address the remedies available for a non-
breaching party when faced with a breach of questionable materiality.

                                              35
(Second) of Contracts for determining materiality in the substantial compliance context.164

Under the Restatement (Second),

                 In determining whether a failure to render or to offer
                 performance is material, the following circumstances are
                 significant: (a) the extent to which the injured party will be
                 deprived of the benefit which he reasonably expected; (b) the
                 extent to which the injured party can be adequately
                 compensated for the part of that benefit of which he will be
                 deprived; (c) the extent to which the party failing to perform or
                 to offer to perform will suffer forfeiture; (d) the likelihood that
                 the party failing to perform or to offer to perform will cure his
                 failure, taking account of all the circumstances including any
                 reasonable assurances; (e) the extent to which the behavior of
                 the party failing to perform or to offer to perform comports
                 with standards of good faith and fair dealing.165

         This standard is “necessarily imprecise and flexible” and must be “applied in the

light of the facts of each case in such a way as to further the purpose of securing for each

party his expectation of an exchange of performances.”166

         Here, the HealthSun Plaintiff has been “deprived of the benefit which [it] reasonably

expected”167—namely, the ability to participate in the defense of the Investigations. And

because this benefit is intangible, it is hard to imagine how to “adequately compensate[]”

164
  See, e.g., In re Mobilactive Media, LLC, 2013 WL 297950, at *13; BioLife Sols., Inc. v.
Endocare, Inc., 838 A.2d 268, 278 (Del. Ch. 2003) (citing Restatement (Second) of
Contracts § 241 (Am. L. Inst. 1981)).
165
      Restatement (Second) of Contracts §§ 241, 241(a)–(e).
166
      Id. § 241 cmt. a.
167
      Id. §§ 241, 241(a).

                                                 36
the HealthSun Plaintiff for the breach.168 Under the circumstances, these factors weigh in

favor of a finding of materiality.

            Defendants advance five arguments in favor of a finding of immateriality. First,

Defendants argue that “any consultation right would be limited to offering views” and that,

even if participating in the litigation, “Plaintiffs have no right to dictate strategy.”169 But

this framing reduces the Participation Rights—which include a Review and Comment

Right process and an Active Participation Right170—to consultation exclusively. Although

Plaintiffs do not have the autocratic authority to dictate strategy per se over Regulatory

claims, to exercise Participation Rights, one need not do so. Plaintiffs were entitled to a

seat at the table, which they did not receive.

            Second, Defendants state that Plaintiffs have retained separate criminal counsel and

have been communicating directly with DOJ Criminal—i.e., that they have received the

opportunity to participate in that Third-Party Claim.171 Defendants state that Plaintiffs have

not consulted with Defendants about their own interactions with DOJ Criminal or

otherwise “disclosed any information about that participation[.]”172

            This argument does not address the materiality of any breach on Defendants’ part.

Section 10.6(c) imposes an obligation on Defendants, as the “Indemnified Person[s],” to

168
      Id. §§ 241, 241(b).
169
      Defs.’ Answering Br. at 49.
170
      Purchase Agreement §§ 10.6(c)(iii), (iv).
171
      Defs.’ Answering Br. at 50.
172
      Id.

                                                 37
let the Sellers or their representatives participate in the defense of Regulatory Third-Party

Claims.173 That obligation did not flow both ways—i.e., Section 10.6(c) does not impose

any such obligation on the Indemnifying Person to consult with the Indemnified on their

own, separate defense. Although perhaps that result creates lopsided obligations, it is what

the parties agreed.

            Third, Defendants state that they have complied with obligations to defend the

Third-Party Claims with nationally recognized counsel, specifically, O’Melveny & Myers

LLP, in compliance with the Choice of Counsel Obligation.174 This point fails because

Defendants’ compliance with this provision does not address potential breaches elsewhere

or the materiality of those breaches.

            Fourth, Defendants argue that Plaintiffs’ failure to contact them to ask for a joint

defense agreement under the Joint Defense Obligation fails to trigger the remaining

Participation Rights.175 The Joint Defense Obligation provides that “the Indemnified

Person and the Indemnifying Person shall enter into a joint defense agreement as mutually

agreed by such parties.”176

            This argument fails for several reasons. For one, the Joint Defense Obligation does

not impose an affirmative duty on the indemnifying persons to contact the indemnified

persons to put a joint defense agreement in place. The Joint Defense Obligation says the

173
      See Purchase Agreement § 10.6(c).
174
      Defs.’ Answering Br. at 51.
175
      Id.
176
      Purchase Agreement § 10.6(c)(v).

                                                 38
parties shall “mutually agree[]” on a joint defense agreement—suggesting that neither party

alone bears the burden of first contact. So, Plaintiffs’ failure to propose a joint defense

agreement proactively does not necessarily absolve Defendants of their own obligation to

work with the HealthSun Plaintiff to get one in place.

         For another, the structure of Section 10.6(c) indicates that the Joint Defense

Obligation is not a trigger condition for the rest of the Participation Rights. Generally,

Section 10.6(c) creates a set of five parallel obligations, which are iterated in subsections

(i) through (v). Had the parties wanted the Joint Defense Obligation to be a threshold to

other Participation Rights iterated in Section 10.6(c), they could have used much clearer

language to that effect. Instead, Section 10.6(c) ascribes free-standing significance to each

Participation Right. It is therefore not apparent how a joint defense agreement’s failure to

materialize makes up for Defendants denying Plaintiffs other Participation Rights.

         Fifth, Defendants argue that “many of the events for which consultation rights

would be triggered . . . have not occurred,” including defenses, motions, offers of

settlement, or the like.177 Although many situations in which the Participation Rights apply

are not applicable here, this point does not address why Defendants’ breach should be

considered immaterial.

         In sum, even if the court analyzed the issue of breach using a substantial compliance

framework, the undisputed facts still demonstrate a material breach of the Participation

Rights provision.

177
      Defs.’ Answering Br. at 51–52.

                                              39
         D.     Plaintiffs Are Entitled To Fee-Shifting.

         Plaintiffs seek attorneys’ fees based on Section 10.4 of the Purchase Agreement,

which this court previously held “permits the sellers to recover fees on a claim-by-claim

basis.”178

         Section 10.4 of the Purchase Agreement states that the Buyer agrees to “indemnify

[Plaintiffs] . . . against, and agrees to hold each of them harmless from, any and all Losses

incurred or suffered by them incident to, resulting from or in any way arising out of or in

connection with any breach or inaccuracy of a representation or warranty[.]”179 The

Purchase Agreement defines “Losses” to include “all assessments, losses, penalties, fines,

damages, Liabilities, deficiencies, Taxes, debts, charges, costs or expenses, including

interest, and court costs and reasonable attorneys’ fees, costs, and expenses incurred . . .

with respect to asserting or enforcing its rights under this Agreement[.]”180

         Because the court has already determined that Defendants are in breach, the critical

issue is whether legal fees from bringing the action for declaratory judgment count as

“Losses” under the Purchase Agreement. In the January 10, 2022 decision, this court

determined that legal fees under the Purchase Agreement do count as such, to the extent

they were incurred to enforce Plaintiffs’ rights regarding the release of escrow funds.

Similarly, here, both Plaintiffs has incurred legal expenses in connection with their motions

  HealthSun Pl.’s Opening Br. at 43 (quoting ATH, 2020 WL 7706937, at *15); see also
178

ATH, 2022 WL 94610, at 4 (stating same).
179
      Purchase Agreement § 10.4.
180
      Id., Ex. A at A–13 (emphasis added).

                                              40
to enforce their Participation Rights. Those legal expenses therefore also count as Losses

to which Section 10.4 applies.

          Defendants do not meaningfully dispute that Plaintiffs are entitled to fee-shifting if

Defendants are found to have breached the Purchase Agreement. They half-heartedly

argue that Plaintiffs should not receive fees on an interim basis. The court disagrees.

Plaintiffs are entitled to fees in connection with the portions of their claims on which they

prevailed.

          E.     Plaintiffs Are Not Entitled To Escrow Relief.

          The Pasteur Plaintiff argues that Defendants’ contractual breaches nullify

Defendants’ instruction to the Escrow Agent in November 2020 to withhold the release of

the approximately $20 million remaining in escrow. Therefore, the Pasteur Plaintiff asks

the court to grant the release of the remaining funds and shift fees in its favor.181Defendants

assert a variety of arguments in response, but the court need only address one—that the

escrow funds should not be released because Defendants’ outstanding first-party claims

against the escrowed funds exceed the escrow amount.182

          Section 10.3(a) of the Purchase Agreement requires Plaintiffs to indemnify

Defendants for

                 any and all Losses sustained, incurred or suffered by any of
                 them incident to, resulting from or in any way arising out of or
                 in connection with . . . [a]ny breach or inaccuracy . . . of any
                 representation or warranty applicable to the Companies . . . or

181
      See id. at 1–5.
182
      Defs.’ Answering Br. at 4–5.

                                                41
                any breach of any covenant or agreement applicable to the
                Companies[.]183

         Defendants assert that Plaintiffs have breached representations in the Purchase

Agreement relating to their compliance with relevant healthcare laws and requirements

imposed by government authorities.184 Defendants have also asserted a first-party claim

against the escrow funds in addition to the Third-Party Claims addressed in this decision,

and they estimate that the amount of damages will exceed the total amount of the funds in

escrow.185

         The court has not yet resolved the validity of Defendants’ first-party claim or

assessed the damages Defendants might recover for that claim. Therefore, release of the

remaining escrow funds would be premature.

         The Pasteur Plaintiff reads this court’s December 2020 decision to foreclose

Defendants from laying claim to escrow funds unless in compliance with the entirety of

Article 10 of the Purchase Agreement.186 In particular, the Pasteur Plaintiff quotes a

portion of the court’s analysis stating that Section 10.3—which creates the indemnity

obligations at issue—is “[s]ubject to the provisions set forth in this Article 10[.]”187

Extending this statement beyond the context in which it was made, the HealthSun Plaintiff

183
      Purchase Agreement §§ 10.3, 10.3(a).
184
      See Defs.’ Answering Br. at 29 (citing Purchase Agreement §§ 2.13(e), (g), (l), (m)).
185
      See Defs.’ Answering Br. at 29–30.
186
      Pasteur Pl.’s Reply Br. at 11–12.
187
   See id. at 11–12 (citing ATH, 2020 WL 7706937, at *11) (quoting Purchase Agreement
§ 10.3).

                                              42
argues that a breach of the Participation Rights (also contained in Article 10) effects a

breach of Article 10 more generally, cancels the Sellers’ indemnification obligation, and

requires the release of the escrow funds.

       Although it is true that Section 10.3 is subject to the rest of Article 10, a breach of

obligations relating to Third-Party Claims does not necessarily do away with the pending

first-party claim. The court has not yet assessed the merits of that first-party claim and

cannot do so today on the limited record before it.

       The Pasteur Plaintiff’s request for the release of the escrow funds is therefore

denied.

III.   CONCLUSION

       Plaintiffs’ motions for summary judgment are granted, except as to the Pasteur

Plaintiff’s request for escrow relief. Plaintiffs shall prepare a revised form of order

implementing this decision within ten days, providing Defendants at least five days to

review the form.

       As a separate matter, the court notes that the passage of time may have mooted the

need for guidance to the parties regarding the in camera inspection or this court’s ultimate

decision on a discovery stay extension. The parties and the United States shall confer and

advise the court on whether they need additional guidance on this point.

                                             43