Labor & Employment Law Daily Wrap Up, PENSION AND BENEFIT PLANS—M.D. Tenn.: Emergency medical provider fails to perfect association-in-fact enterprise pleading for RICO claims, (Jun 10, 2026)

By Justin Marcus Smith, J.D.

The Supreme Court has required than an association-in-fact “enterprise” must have a certain amount of organizational structure to eliminate simple conspiracies from the reach of the RICO Act.

A provider of emergency medical services could not proceed with Racketeering Influenced and Corrupt Organizations Act (RICO) claims against two United Healthcare (UHC) entities that administered employer health plans, held the federal district court in Nashville, Tennessee. A suggestion that each UHC entity did bad things contemporaneously and in parallel may have been consistent with alleging the existence of some association-in-fact “enterprise” comprised of all of them, but the conclusory nature of the allegations did not make that plausible. On its face, the pleading failed to exclude the possibility that each defendant was merely conducting its own affairs. Most of the provider’s other claims also failed to survive dismissal (Envision Healthcare Operating, Inc. v. United Healthcare Services, Inc., No. 3:22-cv-00693 (M.D. Tenn. Jun. 4, 2026)).

Background. Envision, one of the country’s largest providers of emergency medical services sued United Healthcare Services, Inc., a claim administrator for employer health plans, and its subsidiary, United Healthcare Insurance Company (collectively, UHC). Envision alleged UHC engaged in systematic and fraudulent practices to deny or reduce payment for emergency medical services provided to UHC insureds. Envision alleged the disputed conduct was part of a coercive campaign to force Envision to accept unfavorable contract terms and to suppress Envision’s business in favor of non-party UHC subsidiary Optum, Inc.

In December 2020, Envision became a UHC “out-of-network” provider after the parties’ long-standing “in-network” arrangement ended and most recent “in-network” agreement expired. Envision alleged that UHC launched an intentional campaign of withholding reimbursements to force Envision to accept dramatically lower reimbursement rates to regain in-network status while enriching UHC and Optum.

Envision asserted two RICO claims alleging that UHC conduct constituted predicate acts of mail and wire fraud that formed a pattern of racketeering. In the first RICO count, Envision brought a substantive RICO claim against each named UHC entity for alleged violation of 18 U.S.C. 1962(c). In the second RICO count, Envision alleged a conspiracy to violate 18 U.S.C. 1962(c). Envision also asserted a Tennessee Prompt Pay Act claim, Tenn. Code Ann. § 56-7-109, et seq.; and claims for fraud; civil conspiracy; unjust enrichment; breach of implied contract; and quantum meruit.

UHC moved to dismiss for deficient pleading, including purported failure to allege the existence of a distinct RICO enterprise, predicate acts of racketeering, or a direct causal connection between UHC actions and the plaintiff’s purported injuries.

RICO claims. The court determined that the two RICO counts failed to meet the applicable requirements for pleading a RICO enterprise. Envision alleged an “association-in-fact” enterprise within the meaning of “enterprise” found in 18 U.S.C. § 1961(4). Courts have construed the statutory definition of “enterprise” to include not only groups of individuals, but also groups of legal entities; however, Envision only pleaded conclusory allegations to show the existence of an association-in-fact enterprise consisting of exactly four entities, the two named UHC entities, and the two non-party entities UMR, Inc. and Optum.

The court distinguished between alleging an association-in-fact and alleging an association-in-fact RICO enterprise. The amended complaint sufficiently alleged the former, but did not satisfy the latter with respect to the definition of “enterprise” found in Boyle v. United States, 556 U.S. 938, 129 S. Ct. 2237, 173 L.Ed.2d 1265 (2009). Boyle requires at least three structural features to find an association-in-fact “enterprise”: a purpose; relationships; and longevity sufficient to permit associates to pursue enterprise purpose. In other words, an “enterprise” must have a certain amount of organizational structure to eliminate simple conspiracies from RICO Act reach. See Ouwinga v. Benistar 419 Plan Servs., Inc., 694 F.3d 783, 794 (6th Cir. 2012).

The court found the first amended complaint (FAC) set forth facts sufficient to suggest a plausible association-in-fact consisting of the four entities, but it did not satisfy Boyle with respect to a “continuing unit” organized for a common purpose. The alleged purposes of seeking windfall profits or committing a pattern of racketeering activity could have just as easily been company-specific or shared by some subset of the four entities. The allegation that the four companies operated as a continuing unit in purpose of common objectives was conclusory and unsupported by facts sufficient to advance the allegations of the complaint beyond the merely possible to the plausible.

Requiring facts about a “continuing unit” with a common purpose is essential to precluding litigants from alleging the existence of a particular association-in-fact enterprise, with particular membership, merely because a litigant finds it convenient or advantageous to do so. The court noted here that civil RICO claims, unlike most civil claims, necessarily assert underlying criminal conduct, “a public assertion that should never be made too casually.” RICO liability depended on showing that the UHC entities conducted or participated in the affairs of the RICO enterprise, not just their own affairs. The court dismissed the RICO counts because Envision did not allege the facial existence of a RICO enterprise.

Other claims. Among the non-RICO claims, only the breach of implied-in-fact contract survived dismissal. The court found Envision failed to plead fraud with the required particularity of Fed. R. Civ. P. 9(b) for failure to specify the who, what, when, and where of alleged false statements to third parties. The fraud pleading was also deficient on the elements of reliance and damages. Envision could not pursue the Tennessee Prompt Pay Act claim because there was no private right of action. Under Tennessee law, there was no cause of action for civil conspiracy, just a theory for extending tort liability from one co-conspirator to others; the claim failed as an independent cause of action. The court did not see a difference between the unjust enrichment and quantum meruit claims, and the sole “benefit” alleged in the FAC was not one Envision conferred.

The Case is No. 3:22-cv-00693.

Judge: Richardson, E.

Attorneys: Caldwell G. Collins (Caldwell & Berkowitz) for Envision Healthcare Operating, Inc. Jamie R. Kurtz (Robins Kaplan) for United HealthCare Insurance Co.

Companies: Envision Healthcare Operating, Inc.; United HealthCare Insurance Co.

Cases: PensionBenefitPlans CoverageLiability TortClaims TennesseeNews