Multi Business Solutions sues Envolve Total Vision over contract dispute
Multi Healthcare Solutions seeks at least $250,000 in damages, alleging breach of contract and unjust enrichment.
San Juan-based Multi Business Solutions LLC, doing business as Multi Healthcare Solutions, has filed a lawsuit against Envolve Total Vision Inc., alleging breach of contract and unjust enrichment.
The lawsuit, filed on Jan. 29 in San Juan Superior Court and later moved to the U.S. District Court for the District of Puerto Rico, claims that Envolve unilaterally suspended a provider participation agreement (PPA), preventing Multi Business Solutions from delivering services as agreed.
Additionally, the plaintiff alleges that Envolve withheld payments for services rendered, including those provided under the Healthcare Effectiveness Data and Information Set (HEDIS) and Centers for Medicare & Medicaid Services (CMS) guidelines.
According to the complaint, Envolve raised concerns over billing practices related to Current Procedural Terminology (CPT) codes but did not provide documentation supporting its claims. Multi Business Solutions contends that it was not given an opportunity to address these concerns before its contract was suspended.
The lawsuit also states that Envolve failed to adhere to the dispute resolution process outlined in the PPA, which requires parties to make “reasonable, good faith efforts” to resolve disputes informally before resorting to arbitration. The plaintiff argues that Envolve acted unilaterally without following these steps.
The PPA requires that unresolved disputes be submitted to binding arbitration within 60 days of the last attempted resolution.
Multi Business Solutions claims that Envolve’s actions have led to significant financial losses, including unpaid services, operational disruptions and reputational damage. As a result, the company is seeking preliminary and permanent injunctive relief, a declaratory judgment and at least $250,000 in damages for breach of contract and unjust enrichment.
