insurance fraud
An Ohio jury has awarded Medical Mutual of Ohio more than $50 million in damages in its lawsuit against FrontPath Health Coalition and HealthScope Benefits, a subsidiary of UnitedHealthcare. FrontPath offers employee benefits solutions, and HealthScope is a third-party administrator.
Medical Mutual accused the two companies of conspiring to form an enterprise that consisted of their executives and engaging in fraudulent practices that manipulated the bidding process for a health benefits contract with the city of Toledo in 2015 and 2018. Medical Mutual claimed that the two companies gained unauthorized access to its confidential financial data, which they then used to artificially lower bids.
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The defendants were found to have committed federal wire fraud and telecommunications fraud; tampered with records; and obstructed justice by submitting false bid information. The jury found that the conspiracy resulted in significant damages to Medical Mutual and ultimately caused taxpayers to pay higher health care costs than necessary.
“For us, this case has always been about the integrity of the bidding process and maintaining a level playing field for everyone,” said Tony Helton, Medical Mutual’s president and CEO. “In its decision, the jury championed the values of transparency and fairness, and emphasized the unwavering importance of good stewardship of taxpayer dollars. The judgment reflects that.”
The lawsuit originally was filed against FrontPath in 2017, and Medical Mutual prevailed. The case then was consolidated with a lawsuit filed in 2022 against HealthScope.
The jury awarded Medical Mutual $23 million in compensatory damages, along with an additional $1.3 million in punitive damages. The court also granted $3.75 million for tortious interference with prospective business relations, as well as prejudgment interest and legal fees, increasing the total award to more than $50 million.
“We’re thrilled with the decision, because we know it’s a victory for public employees and taxpayers, as well as Medical Mutual,” Helton said. “Our mission has always been to advocate for our communities, and a financial judgment will continue to allow us to make meaningful investments to benefit the citizens of Northwest Ohio.”
Medical Mutual has more than 1.2 million members across ACA, Medicare Advantage and commercial employer plans.
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
