# Brainbuilders, LLC v. Optum, Inc.

> New Jersey Superior Court Appellate Division · April 19, 2024

URL: https://www.frixlaw.com/law-library/cases/9961648

## Case

- **Court:** New Jersey Superior Court Appellate Division
- **Decided:** April 19, 2024
- **Precedential status:** Unpublished
- **Opinion:** Opinion
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/9961648

## How later opinions describe it (automated extraction)

- noting quantum meruit requires unjust enrichment
- holding "words which are absolutely privileged against an action for defamation are also absolutely privileged against an action for tortious interference with contract or economic advantage."

## Opinion text

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-0621-22

BRAINBUILDERS, LLC,

Plaintiff-Appellant,

v.

OPTUM, INC., OPTUM
SERVICES, INC.,
OPTUMHEALTH HOLDINGS,
LLC, OPTUMHEALTH
FINANCIAL SERVICES, INC.,
OPTUMHEALTH CARE
SOLUTIONS, LLC,
OPTUMHEALTH CARE
SOLUTIONS, INC., OXFORD
HEALTH INSURANCE, INC.,
OXFORD HEALTH PLANS (NY),
INC., OXFORD HEALTH PLANS
(NJ), INC., OXFORD HEALTH
PLANS LLC,
UNITEDHEALTHCARE
SERVICES, LLC,
UNITEDHEALTH GROUP, INC.,
UNITEDHEALTHCARE
SERVICES, INC., UHIC
HOLDINGS, INC., UNITED
BEHAVIORAL HEALTH, and
UNITEDHEALTHCARE
INSURANCE COMPANY,
Defendants-Respondents.
_______________________________

Argued April 9, 2024 – Decided April 19, 2024

Before Judges Mayer, Enright and Augostini.

On appeal from the Superior Court of New Jersey, Law
Division, Bergen County, Docket No. L-8088-17.

Vafa Sarmasti argued the cause for appellant (Sarmasti
PLLC, attorneys; Vafa Sarmasti, on the briefs).

Robert J. Norcia argued the cause for respondents
(Stradley Ronon Stevens & Young, LLP, attorneys;
Francis X. Manning, of counsel; Robert J. Norcia, on
the brief).

PER CURIAM

Plaintiff BrainBuilders, LLC appeals from a September 12, 2022 order

granting summary judgment in favor of defendants Optum, Inc., Optum

Services, Inc., OptumHealth Holdings, LLC, OptumHealth Financial Services,

Inc., OptumHealthcare Solutions, LLC, OptumHealth Care Solutions, Inc.

(Optum entities), Oxford Health Insurance, Inc., Oxford Health Plans (NY),

Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans LLC (Oxford entities),

UnitedHealthcare Services, LLC, UnitedHealth Group, Inc., UnitedHealthcare

Services, Inc., UHIC Holdings, Inc., United Behavioral Health, and

A-0621-22
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UnitedHealthcare Insurance Company (UHC entities) (collectively, defendants).

We affirm.

This matter concerns letters dated July 25, 2017 and August 2017 sent by

the Optum entities to BrainBuilders' patients following an investigation into

purported fraud by individuals associated with BrainBuilders.

BrainBuilders provides healthcare services to children on the autism

spectrum. As an out-of-network or non-participating healthcare provider,

BrainBuilders received reimbursement for claims only if a patient's health

insurance plan allowed "out-of-network benefits" or the insurer made a "single

case agreement" for the patient's care.

The Optum entities are the health claims administrator for health plans

issued or administered by the Oxford entities and UHC entities. The Optum

entities do not sell or issue health insurance policies. Rather, they provide

support for defendants who issued health insurance policies to individual

insureds.

The Optum entities also evaluate insurance claims submitted by providers

to its affiliated insurers, including BrainBuilders. The Optum entities often

investigate whether a provider has requested reimbursement beyond the

provider's entitlement, such as by misrepresenting or inflating the services

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3
provided. In January 2017 through approximately May 2017, the Optum entities

reviewed BrainBuilders' claims submitted for reimbursement, due to the

significant number of claims and the amounts charged in comparison to

BrainBuilders' peers.

In June 2017, four individuals related to the management of BrainBuilders

were arrested and charged with conspiracy to defraud Medicaid. A criminal

complaint, alleging misappropriation of funds, was filed against several

individuals affiliated with BrainBuilders. The arrests were reported in the news

media and the Optum entities learned of the arrests on July 14, 2017.

On July 25, 2017, the Optum entities sent letters to BrainBuilders' patients

insured by the Oxford and UHC entities (July 2017 letters). The July 2017

letters explained the Optum entities were suspending payment for services

provided by BrainBuilders "due to potential insurance fraud and other violations

of state and federal law." The letters, advising patients insured under healthcare

plans issued by the Oxford and UHC entities, stated:

Optum is responsible for making benefit coverage
determinations for mental health and substance abuse
services that are provided to Optum members. The
availability of benefit coverage for a service is
determined by the terms of your benefit plan.

This letter is to notify you that, effective [thirty] days
from [insert termination date], [insert provider name]

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will no longer be reimbursed for services provided to
you and/or your child/ren due to potential insurance
fraud and other violations of state and federal law.
Services provided by [insert provider name] after this
date may not be covered under your benefit plan.

If you are in active, ongoing treatment with this
practitioner, you may continue to receive services from
this practitioner until [thirty] days after [insert
termination date], subject to medical record review or
other benefit plan requirements.

Optum is able to assist you in making arrangements for
your continued treatment with a participating
practitioner. Please contact us at your earliest
convenience at 866-xxx-xxxx so we can assist you in
locating a new provider. Our goal is to make any
needed transition in your treatment as smooth as
possible.

Again, if you choose to continue to see your current
practitioner beyond [thirty] days after [insert
termination date], you may be financially responsible
for the cost of those services and have no coverage
available under your benefit plan.

In August 2017, the Optum entities sent letters to BrainBuilders' patients.

(August 2017 letters). The letters stated:

Dear [name redacted]:

United Behavioral Health (UBH) is responsible for
making benefit coverage determinations for mental
health and substance abuse services that are provided to
Oxford Health Insurance, Inc. NY-PPO members. The
availability of benefit coverage for a service is
determined by the terms of your benefit plan. To

A-0621-22
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review information about your specific plan coverage,
please refer to the benefit information provided by your
health plan.
I have reviewed your treatment plan that was submitted
by Brain[B]uilders[,] LLC, and I have determined that
coverage is not available under your benefit plan for the
requested services of Applied Behavior Analysis.

As described in the section of your Certificate of
Coverage: Based on current information available to
the plan, authorization is not available due to quality of
care or member safety concerns and is excluded under
your plan as Non-Professional Care which is an express
exclusion from coverage under your plan.

This determination does not mean that you do not
require additional health care, or that you need to be
discharged. Decisions about continuation of treatment
should be made by you and your provider. The purpose
of this letter is to inform you that coverage is not
available under your benefit plan for the requested
service. On 8/8/2017 1:23 PM CDT we notified your
provider of this determination by telephone.

Under federal law, you have a right to request the
diagnosis and diagnosis code provided to us by your
provider. Alternately, you may request this information
from your provider.

Please refer to the enclosed form(s) for information
about your available options to appeal or dispute this
determination.

Based on the July and August 2017 letters, BrainBuilders filed a lawsuit

against defendants. BrainBuilders asserted the following causes of action:

conspiracy; tortious interference with business relations; tortious interference

A-0621-22
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with prospective economic advantage; negligence, trade libel; defamation, libel,

and slander; and unjust enrichment and quantum meruit. BrainBuilders alleged

the statements in the July and August 2017 letters were false and defamatory.

Defendants moved for summary judgment and BrainBuilders opposed the

motion. In support of summary judgment, defendants argued the July and

August 2017 letters were subject to a qualified privilege because the Optum

entities had a legal obligation to inform members of the true reason for

suspending BrainBuilders' services and, eventually, denying authorizations.

Additionally, defendants asserted the July and August 2017 letters were not

reasonably susceptible of defamatory meaning, were true or expressions of

opinion, and BrainBuilders failed to demonstrate the statements in the letters

were actuated by malice or that it suffered damages.

On August 26, 2022, the motion judge heard the parties' arguments on

defendants' motion for summary judgment. In a September 12, 2022 order and

written statement of reasons, the judge granted defendants' motion and

dismissed BrainBuilders' claims with prejudice.

The judge found the statements in the July and August 2017 letters sent

by the Optum entities were subject to qualified immunity. The judge explained

the healthcare industry in New Jersey is heavily regulated and healthcare service

A-0621-22
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providers "are contractually required by health benefits plans to communicate

with members and, therefore, deal with them in good faith regarding all things

that implicate the availability of benefits under a plan." Thus, the judge

concluded, "[t]he statements communicated to [BrainBuilders] and its patients

in the July 2017 and August 2017 [l]etters [were] plainly subject to and protected

by a qualified privilege."

Additionally, the judge found the Optum entities commenced an

investigation into BrainBuilders' claims for reimbursement prior to the arrests

of individuals associated with the company. The judge stated the Optum entities

were suspicious of BrainBuilders' claims for reimbursement based on its recent

increase in patients treated and the volume of claims it submitted when

compared to similar service providers. The judge noted the Optum entities

commenced a formal fraud investigation into BrainBuilders' activities upon

learning of the arrests of individuals associated with BrainBuilders . As the

judge found, the results of the investigation led the Optum entities to suspect

BrainBuilders "potentially committed insurance fraud" and "raised questions as

to the legitimacy of the services rendered by [BrainBuilders] and the bills

submitted to [d]efendants."

A-0621-22
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The judge rejected BrainBuilders' defamation claim. He found "[a]

reasonable person would not interpret Optum's July 2017 and August 2017

[l]etters as defamatory." Because the July 2017 letters used the word "potential"

preceding the word "fraud," the judge found the "use of the word 'potential'

remove[d] any suggestion that BrainBuilders actually committed fraud and other

violations of state and federal law." The judge concluded "the July 2017 [l]etters

communicated the reason for the suspension and merely indicated that insurance

fraud by BrainBuilders was 'capable of coming into being; possible if the

necessary conditions exist.'" Regarding the August 2017 letters, the judge

determined those letters "merely communicated Optum's 'concerns' about

'quality of care or member safety' in making a decision regarding the availability

of coverage for BrainBuilders' services."

The judge specifically highlighted the context in which the Optum entities

sent the July and August 2017 letters. He explained that shortly before the letters

were sent to BrainBuilders' patients, "several individuals at the highest ranks of

BrainBuilders, as well as several other parents of BrainBuilders' patients, had

been arrested for conspiracy to commit Medicaid fraud (i.e., insurance fraud),

and news of their arrests was widespread in the media." Further, around the

same time period, the judge noted the Optum entities "separately uncovered

A-0621-22
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evidence suggesting BrainBuilders was engaged in fraud, waste, or abuse."

Thus, the judge concluded, "[w]hen read with context, no reasonable person"

could interpret the July or August 2017 letters "as fallacious or injurious."

The judge expressly rejected BrainBuilders' claim that the statements in

the July and August 2017 letters were defamatory. The judge explained truth

was an absolute defense to a defamation claim and found the statements in the

July and August 2017 letters "were true."

Even before the arrests of individuals associated with BrainBuilders, the

judge noted "Optum had already begun reviewing [BrainBuilders'] claims to

investigate its high utilization." After the arrests were reported in the news

media, the judge explained the Optum entities opened a formal fraud

investigation. Based on that formal fraud investigation, the judge stated forensic

accountants for the Optum entities "uncovered evidence suggesting the

existence of potential insurance fraud not only by [BrainBuilders]" but by

individuals "who had obtained health benefits plans from Oxford Health Plans

(NJ), Inc. and used those plans almost exclusively for reimbursement of

[BrainBuilders'] services." Thus, the judge determined the July 2017 letters

conveyed the Optum entities' true reason for suspending authorization for

BrainBuilders' services.

A-0621-22
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Similarly, the judge found the August 2017 letters conveyed the true

reason for the denial of authorizations for BrainBuilders' services. As the judge

noted, "[a]llegations of potential health insurance fraud necessarily implicate[d]

the value and quality of the services rendered." The judge concluded "the

statement[s] in the July 2017 and August 2017 letters [were] not defamatory"

because the statements were true.

Additionally, the judge found BrainBuilders failed to demonstrate it

suffered actual damages to prevail on its defamation claim. After months of

discovery, the judge concluded BrainBuilders failed to "suppl[y] any

documentation or other evidence of actual harm to its reputation, nor ha[d] it

provided proof that it lost any patients or otherwise suffered a general

diminution in business value that was the natural and direct result of Optum's

allegedly defamatory statements."

The judge also rejected BrainBuilders' claim that defendants' statements

in the July and August 2017 letters were made with actual malice to prevail on

its defamation claim. The judge found BrainBuilders was required "to present

'clear and convincing evidence' that could 'support a reasonable jury finding' that

Optum's statements in the July 2017 and August 2017 [l]etters were motivated

by 'actual malice'" by showing the statements were knowingly false or made

A-0621-22
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with reckless disregard for the truth. The judge concluded BrainBuilders was

"unable to make such a showing." Further, because the Optum entities

undertook a forensic analysis of BrainBuilders' activities, which revealed

"dubious billing and treatment issues," the judge determined "Optum's conduct

was not motivated by actual malice, but by a detailed investigation which

resulted in the discovery of concerning information."

Because the judge found the statements in the July and August 2017 letters

were "not defamatory," he dismissed BrainBuilders' conspiracy and tortious

interference claims, as those claims were predicated on the same conduct and

statements as the defamation claims.

The judge also dismissed BrainBuilders' negligence claim, finding such a

theory must be asserted as a claim for defamation or trade libel. Because the

judge rejected the defamation and trade libel claims against defendants, he

explained BrainBuilders' negligence claim necessarily failed.

Similarly, the judge dismissed BrainBuilders' quasi-contract claims for

unjust enrichment and quantum meruit "because an insurer derives no benefit

from the provision of services on an insured." Relying on a federal case, the

judge noted that the benefit, if any, "is not the provision of the healthcare

services per se, but rather the discharge of the obligation the insurer owes to the

A-0621-22
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insured." Plastic Surgery Ctr., P.A. v. Aetna Life Ins. Co., 967 F.3d 218, 240

(3d Cir. 2020). The judge determined BrainBuilders' quasi-contract claims

required demonstration that it conferred a benefit on defendants. Because

BrainBuilders failed to present evidence of any benefit it conferred on

defendants, the judge dismissed those claims.

On appeal, BrainBuilders argues the judge erred in granting summary

judgment to defendants. Specifically, BrainBuilders contends the Optum

entities were not entitled to a qualified privilege and the issue should have been

presented to a jury. BrainBuilders also asserts it presented evidence in support

of its defamation claim, including evidence that defendants' statements were

made with actual malice and it suffered specific damages. Additionally,

BrainBuilders argues the judge erred in dismissing its other tort claims and

quasi-contract claims.

We review a judge's decision on a motion for summary judgment de novo,

applying the same standard as the trial court. Samolyk v. Berthe, 251 N.J. 73,

78 (2022). We must consider "whether the competent evidential materials

presented, when viewed in the light most favorable to the non-moving party, are

sufficient to permit a rational factfinder to resolve the alleged disputed issue in

favor of the non-moving party." Ibid. (quoting Brill v. Guardian Life Ins. Co.

A-0621-22
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of Am., 142 N.J. 520, 540 (1995)). If there is no genuine issue of material fact,

we must then "decide whether the trial court correctly interpreted the law."

Massachi v. AHL Servs., Inc., 396 N.J. Super. 486, 494 (App. Div. 2007). We

accord no deference to a trial court's legal conclusions and review issues of law

de novo. Nicholas v. Mynster, 213 N.J. 463, 478 (2013).

We first consider whether the statements in the July and August 2017

letters were either true or constituted opinions to establish a defense to

BrainBuilders' defamation claim.

"Our law of defamation is grounded on the principle that people should be

free 'to enjoy their reputations unimpaired by false and defamatory attacks.'"

Fees v. Trow, 105 N.J. 330, 336 (1987) (quoting Swede v. Passaic Daily News,

30 N.J. 320, 331 (1959)). "A defamatory statement, generally, is one that

subjects an individual to contempt or ridicule, one that harms a person's

reputation by lowering the community's estimation of [them] or by deterring

others from wanting to associate or deal with [them.]" Petro-Lubricant Testing

Labs., Inc. v. Adelman, 233 N.J. 236, 253 (2018) (quoting Durando v. Nutley

Sun, 209 N.J. 235, 248-29 (2012)). To prevail on a defamation claim, a party

must demonstrate: "(1) the assertion of a false and defamatory statement

concerning another; (2) the unprivileged publication of that statement to a third

A-0621-22
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party; and (3) fault amounting at least to negligence by the publisher." Leang

v. Jersey City Bd. of Ed., 198 N.J. 557, 585 (2009).

"Whether the meaning of a statement is susceptible of a defamatory

meaning is a question of law for the court." Ward v. Zelikovsky, 136 N.J. 516,

529 (1994). Under the first element necessary to prevail on a defamation claim,

a plaintiff must demonstrate the publisher "made a false and defamatory

statement." G.D. v. Kenny, 205 N.J. 275, 292-93 (2011). "If a statement is not

legally defamatory, summary judgment is appropriate." G.D. v. Kenny, 411 N.J.

Super. 176, 188 (App. Div. 2009), aff'd, 205 N.J. 275 (2011).

True statements are "not actionable as defamation." Hart v. City of Jersey

City, 308 N.J. Super. 487, 492 (App. Div. 1998). Our courts have stated that

true statements are "absolutely protected under the First Amendment" from

liability for defamation. G.D., 205 N.J. at 293 (quoting Ward, 136 N.J. at 530).

True statements may provide a defense even when the statement contains "minor

inaccuracies." Id. at 294. The hallmark of the defense is "substantial truth."

Ibid. (quoting Masson v. New Yorker Magazine, Inc., 501 U.S. 496, 516

(1991)).

Here, the allegedly defamatory statements in the July and August 2017

letters related to BrainBuilders' "potential fraud," potential "violations of state

A-0621-22
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and federal law," and concerns for "quality of care or member safety." It is

uncontroverted that several of BrainBuilders' officers were arrested for

conspiracy to defraud Medicaid in association with "income they received from

BrainBuilders." These individuals were arrested because they potentially

committed fraud. Additionally, the arrests raised legitimate concerns regarding

the quality of care rendered by BrainBuilders.

While BrainBuilders disputed the Optum entities' motivation for

undertaking a formal investigation, it is undisputed that the Optum entities

investigated the claims submitted by BrainBuilders after the reported arrest of

several of BrainBuilders' officers. Given the fact that several of BrainBuilders'

officers were arrested for defrauding Medicaid in connection with

BrainBuilders' business operations, the Optum entities' statements in the July

and August 2017 letters were true and presented a complete defense to the

defamation claim.

We reject BrainBuilders' argument that the statements in the July and

August 2017 letters were false. Contrary to BrainBuilders' assertions, the

Optum entities never stated BrainBuilders committed insurance fraud or

violated criminal laws. Rather, the letters advised patients of "potential

insurance fraud and other violations of state and federal law." The judge relied

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on the dictionary definition of the word "potential" as "[c]apable of coming into

being; possible if the necessary conditions exist." See also Black's Law

Dictionary 1413 (11th ed. 2019). Applying this definition, the use of the term

"potential" is not an affirmative statement that BrainBuilders violated the law or

committed insurance fraud. The July 2017 letters never stated BrainBuilders

engaged in "widespread illegal conduct." Nothing about the Optum entities' use

of the word "potential" rendered the July 2017 letters misleading. Nor did the

July 21017 letters inform patients that BrainBuilders committed fraud or other

illegal acts to support its defamation claim.

Similarly, the fact that BrainBuilders was not charged with any crime,

separate from its officers who were charged with fraud, does not render the

statements in the July and August 2017 letters untruthful. We see no distinction

for purposes of a defamation claim between BrainBuilders as a company and the

individuals associated with BrainBuilders who were charged with a crime. The

veil of suspicion regarding potential fraud fell on BrainBuilders as well as its

officers, even if the company was not named in the criminal complaint.

We similarly reject BrainBuilders' argument that defendants bore the

burden of demonstrating substandard, unsafe, or unprofessional patient care. To

prevail on its defamation claims, BrainBuilders had to demonstrate the

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statements in the July and August 2017 letters were false. G.D., 205 N.J. at 292-

93. BrainBuilders failed to do so.

Further, BrainBuilders' reliance on the Optum entities' September 14,

2017 report to demonstrate the statements in the July and August 2017 letters

were defamatory is misplaced. The September 2017 report was issued after the

Optum entities sent the alleged defamatory letters to BrainBuilders' patients.

Because we are satisfied the July and August 2017 letters failed to satisfy

the first element to sustain a claim for defamation–that the letters contained a

false and defamatory statement–we need not address BrainBuilders' arguments

related to the judge's determinations regarding qualified privilege, actual malice,

and actual damages.

We next consider BrainBuilders' claim that the judge erred in dismissing

its claims for tortious interference with current business relations, tortious

interference with prospective economic advantage, and negligence. We

disagree.

"[I]f an intentional tort count . . . is predicated upon the same conduct on

which the defamation count is predicated, the defamation cause completely

comprehends" the intentional tort claims. LoBiondo v. Schwartz, 323 N.J.

Super. 391, 417 (App. Div. 1999); see also Binkewitz v. Allstate Ins. Co., 222

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N.J. Super. 501, 516 (App. Div. 1988) (holding "words which are absolutely

privileged against an action for defamation are also absolutely privileged against

an action for tortious interference with contract or economic advantage.") .

Additionally, "a party who claims that its reputation has been damaged by a false

statement cannot circumvent the strictures of the law of defamation . . . by

labeling its action as one for negligence." Dairy Stores, Inc. v. Sentinel Pub.

Co., Inc., 191 N.J. Super. 202, 217 (Law Div. 1983), aff'd, 104 N.J. 125 (1986).

Here, the judge found BrainBuilders' other tort claims were "predicated

on the same conduct and statements" as its defamation claim. Thus, the judge

properly dismissed BrainBuilders' other tort claims as duplicative of the

defamation claim.

We next consider BrainBuilders' argument that the judge erred in

dismissing its quasi-contract claims for unjust enrichment and quantum meruit.

Again, we disagree.

"To prove a claim for unjust enrichment, a party must demonstrate that

the opposing party 'received a benefit and that retention of that benefit without

payment would be unjust.'" Thieme v. Aucoin-Thieme, 227 N.J. 269, 288 (2016)

(quoting Iliadis v. Wal-Mart Stores, Inc., 191 N.J. 88, 110 (2007)). The party

must also "show that it expected remuneration from the defendant at the time it

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performed or conferred a benefit on [the] defendant and that the failure of

remuneration enriched [the] defendant beyond its contractual rights." Ibid.

(quoting Iliadis, 191 N.J. at 110).

"Quantum meruit is a form of quasi-contractual recovery and 'rests on the

equitable principle that a person shall not be allowed to enrich [themselves]

unjustly at the expense of another.'" Starkey, Kelly, Blaney & White v. Est. of

Nicolaysen, 172 N.J. 60, 68 (2002) (internal quotation marks omitted) (quoting

Weichert Co. Realtors v. Ryan, 128 N.J. 427, 437 (1992)). To prevail, the

plaintiff must establish "(1) the performance of services in good faith, (2) the

acceptance of the services by the person to whom they are rendered, (3) an

expectation of compensation therefor, and (4) the reasonable value of the

services." Ibid. (quoting Longo v. Shore & Reich, Ltd., 25 F.3d 94, 98 (2d Cir.

1994)); see also F. Bender, Inc. v. Jos. L. Muscarelle, Inc., 304 N.J. Super. 282,

285 (App. Div. 1997) (noting quantum meruit requires unjust enrichment).

Here, the record is devoid of evidence showing BrainBuilders conferred

any benefit on defendants to prevail on its unjust enrichment claim.

BrainBuilders alleged it conferred a benefit on defendants by way of "services

that were provided by BrainBuilders and for which there has been no

compensation or with respect to which there has been substantial

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underpayment." BrainBuilders further alleged it "expected to be paid for the

services it provided to patients that were or are insured by. . . [d]efendants."

To succeed on its quasi-contract claims, BrainBuilders was required to

demonstrate it performed or conferred a benefit upon defendants and expected

remuneration. In the July and August 2017 letters, the Optum entities advised

BrainBuilders it would no longer receive reimbursement for submitted claims.

In light of the statements in the July and August 2017 letters, BrainBuilders

failed to explain why it continued to expect compensation or identify services

provided to specific patients for which it expected to be paid. Moreover,

BrainBuilders conferred only benefits to the insured members and not

defendants. Under these circumstances, we are satisfied BrainBuilders failed to

proffer any support for its unjust enrichment and quantum meruit claims.

To the extent we have not addressed any remaining arguments, those

arguments lack sufficient merit to warrant discussion in a written opinion. R.

2:11-3(e)(1)(E).

Affirmed.

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/9961648. Public record. Not legal advice.