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HomeMy WebLinkAbout09-4286CAPOZZI & ASSOCIATES, P.C. By: Trudy A. Marietta Mintz, Esquire Attorney I.D. No. 208523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Dialysis Corporation of America IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DIALYSIS CORPORATION OF AMERICA 214 Senate Avenue Ste. 300 Camp Hill, Pennsylvania 17011 109 Plaintiff Action at Law V. THE LOOMIS COMPANY 850 N. Park Road PO BOX 7011 Wyomissing, Pennsylvania 19610-6011 * Defendant and LAUREL HEALTH SYSTEM, Inc. 22 Walnut Street Wellsboro, PA 16901 Defendant * * * * * * * * * * NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after the complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 1-800-990-9108 (717) 249-3166 AVISO e han demandado a usted en la corte. Si usted quiere defenderse de estas de estas demandas expuestas an las paginas signientes, usted tiene veinte (20) dias de plazo al partir de is fecha de la demanda y is notificacion. Hace falta asentar una comparencia escrita o en persona o con un abogado y entregar a la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, le corte tomara medidas y puede continuar la demanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpla con todas las provisiones de esta demanda. Usted puede perder dinero o sus propiedades u ostros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE, SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO. VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 Respectfully submitted, CAPOZZI &ASSOCIATES P.C. Date: (0 /S By: Trudy A. Marietta M' squire Attorney ID N 8523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff CAPOZZI & ASSOCIATES, P.C. By: Trudy A. Marietta Mintz, Esquire Attorney I.D. No. 208523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Dialysis Corporation of America IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DIALYSIS CORPORATION OF AMERICA 214 Senate Avenue Ste. 300 , Camp Hill, Pennsylvania 17011 Plaintiff Action at Law V. THE LOOMIS COMPANY 850 N. Park Road PO BOX 7011 Wyomissing, Pennsylvania 19610-6011 Defendant and LAUREL HEALTH SYSTEM, Inc. 22 Walnut Street Wellsboro, PA 16901 Defendant * * * * * * * * * * * * * * * COMPLAINT COMES NOW the Plaintiff, DIALYSIS CORPORATION OF AMERICA, by and through their counsel, CAPOZZI & ASSOCIATES and TRUDY A. MARIETTA MINTZ, and alleges as its Complaint as follows: PARTIES AND VENUE 1. Dialysis Corporation of America (hereinafter referred to as "DCA" or "Plaintiff') is a Florida corporation with its principal place of business located at 1302 Concourse Drive (Suite 204), Linthicum, Maryland 21090, which conducted business in Pennsylvania at all times relevant hereto with main offices located at 214 Senate Avenue (Suite 300), Camp Hill, Pennsylvania 17011 and dialysis facilities in Camp Hill, Bedford, Carlisle, Chambersburg, Huntingdon, Lemoyne, Mechanicsburg, Pottstown, Selinsgrove, Wellsboro, and York. 2. Defendant The Loomis Company (herein after referred to as "Loomis" or "Defendant") is a Pennsylvania corporation with its principal place of business located at 850 Park Road, Wyomissing, Pennsylvania, which conducted business with the Plaintiff in Pennsylvania at all times relevant hereto; and 3. Defendant Laurel Health System, Inc. (hereinafter referred to as "Laurel") is a Pennsylvania not-for-profit corporation who owns and operates an ERISA self-funded group health plan known as the Laurel Health System Health Plan, with its principle place of business located at 22 Walnut Street, Wellsboro, Pennsylvania, which conducted business with Plaintiff in Pennsylvania at all times relevant hereto. 4. Venue is proper in this Court pursuant to Pa. R. Civ. P. Rule 2179 because the cause of action arose in Cumberland County and because Defendants regularly conduct business in Cumberland County. FACTS 5. Plaintiff is in the business of providing dialysis and other renal care services. 6. Defendant Loomis is a third party administrator contracted to provide such services for Defendant Laurel's self-funded health plan (hereinafter, "the Plan"). 7. Defendant Laurel is operator of an ERISA self-funded group health plan ("the Plan") providing health care coverage, including that for a patient whose services are the subject of this matter and who is further identified in Plaintiff's March 12, 2008 demand for payment addressed to Defendant Loomis (hereinafter "Patient"). The name and other identification of the Patient are not specified herein to protect the Patient's privacy rights and because the parties have previously communicated about payment for the services for the Patient and therefore have knowledge of who the Patient is. 8. Defendant Loomis, at all relevant times, acted on behalf of Defendant Laurel by interpreting the health insurance coverage to be provided to members of the Plan, such as the Patient, including but not limited to, "in- network" status of providers and amounts of reimbursement to be made to such providers and entering into agreements with out-of-network providers, such as Plaintiff, with respect to services for Plan participants, such as Patient, for which there were no "in-network" providers. 9. Plaintiff is not a parry to the contract for insurance coverage between the Patient and Defendant Laurel. 10. Plaintiff is neither a participant, nor a beneficiary of the Plan. 11. Plaintiff is not a party to the contract for administrative services between Defendant Laurel and Defendant Loomis. 12. Plaintiff and Defendants do not have a written contract by which their business transactions are governed; however, they have an oral agreement with respect to payment for the services involved. 13. Patient's healthcare identification card, which was provided by Defendant Laurel to its covered members, such as Patient, states that claims for payment for services provided to Patient are to be submitted to The Loomis Company, Claims Dept., PO BOX 7011, Wyomissing, PA 19610-6011. 14. Defendant Loomis subsequently identified themselves to Plaintiff as having contracted with Defendant Laurel to administer Plaintiff's claims for services to the Patient. 15. Prior to Plaintiff providing services to the Patient, Defendants confirmed that the Patient was eligible and had coverage for Plaintiff s dialysis services under the Plan. 16. At all relevant times, the Plan did not have any dialysis services providers in their network of providers. 17. Prior to providing services to the Patient in April 2006, Plaintiff sought to determine how Plaintiff would be paid for such services, since Plaintiff was not a participating provider in the Plan's network of providers; and, inquired of Defendant Laurel about payment for such out-of-network services. 18. Defendants advised Plaintiff on or about April 27, 2006, prior to Plaintiff's providing any services for the Patient, that: (a) since the Plan had no in- network providers for dialysis services, such services were available to its beneficiaries on an "open access basis" under which beneficiaries could obtain services from any available provider, including Plaintiff; (b) the Plan agreed to pay Plaintiff for such services even though Plaintiff was not a participating provider in the Plan based on Plaintiff's usual and customary charges for such services; and, (c) the Plan had no written provisions concerning "open access basis" payments for out-of-network dialysis services and nothing in writing that they could provide to Plaintiff. 19. The Plan authorized referrals of the Patient to Plaintiff for all the dialysis services provided by Plaintiff at issue in this matter knowing that Plaintiff was not a participating in-network provider and had no written agreement with the Plan with respect to any limitations on payment for charges for dialysis services. 20. In reliance on Defendant's agreement to make payment to Plaintiff based on Plaintiff's usual and customary charges for dialysis services for Patient even though Plaintiff was not a participating provider in the Plan, Plaintiff provided the services involved in this matter to the Patient at Plaintiff's facilities in Wellsboro, Selinsgrove, and Mechanicsburg from April 27, 2006 through January 3, 2008. 21. Defendants contracted with Wellington Healthcare Group, LLC and with The National Care Network to obtain discounts from non-participating providers from the charges that such out-of-network providers were permitted to bill for services to Plan beneficiaries and which discounted amounts the out-of-network providers would agree not to bill to Plan beneficiaries. 22. Defendants, at all relevant times, did not require out-of-network providers, such as Plaintiff, to agree to discount their charges as a condition of obtaining payment for services provided to Plan beneficiaries. 23. Plaintiff expressly declined each and all of Defendants' requests that Plaintiff voluntarily agree to discount Plaintiff's charges for services, including those requests specifically addressed to the services to be provided to the Patient; and, did not agree to make any voluntary discounts to Plaintiff's usual and customary charges for any of the services Plaintiff provided to the Patient. 24. Plaintiff billed Defendants Plaintiff s usual and customary charges for the services provided to the Patient from April 27, 2006 through January 5, 2008. 25. Defendants paid Plaintiff in full Plaintiff s billed charges for services provided to the Patient for Dates of Services April 27, 2006; May 2, 2006; June 1-29, 2006; July 1-29, 2006; August 1-31, 2006; September 2, 2006; October 3, 2006; November 2, 2006; December 2-30, 2006; January 2-30, 2007; February 1-27, 2007; and, March 1-20, 2007, with no excluded charges and no discount claimed. 26. Defendants payment to Plaintiff for the dates of service identified in ¶25, above, are consistent with the terms and rates of payment agreed to by the parties in April 2006. 27. On information and belief, between April 27, 2006 and January 3, 2008, there were no changes to the Patient's eligibility and coverage under the Plan for Plaintiff s services. 28. Beginning with Plaintiff s invoice for services for the Patient for April 3-28, 2007 and continuing for the invoices for May 1, 2007; June 2, 2007; July 3- 31, 2007; August 2, 2007; September 1, 2007; October 4, 2007; November 1-29, 2007; December 1-31, 2007; and, January 3-5, 2008, Defendants did not pay Plaintiff s billed charges in full and deducted a "Discount Amount" which Defendants described on their Explanation of Benefits statements, sent to DCA and to the Patient, as follows: "The amount in the discount column represents a discount offered by the Provider of Care. You should not be billed for this amount. *** COMMENTS *** Paid according to DCC" 29. Plaintiff did not offer or agree to any discount with respect to Plaintiff's services to the Patient for the dates identified in ¶28 above. 30. Defendants did not advise Plaintiffs of any change to their previously agreed upon basis for billing and payment for services provided by Plaintiff to the Patient from April 3, 2006 through January 5, 2008; did not provide Plaintiff with any written notice of Defendants' intention or desire to change the payment rate or the basis for payment that Defendants applied to pay Plaintiff's billed services for the Patient from April 27, 2006 to March 20, 2007 for any period thereafter; and, did not provide Plaintiff with any provision of the Plan that required any change. 31. By correspondence of June 17, 2008 addressed to Plaintiff, Defendant Loomis conceded that the "Discount Amount" withheld by Defendants from each of the payments referred to in ¶28, above, was not, in fact, a "discount offered by the Provider of Care," but was, instead, a discount "taken through Dialysis Cost Containment" and "based on the Usual, Customary and Reasonable fees for the services provided." 32. The Explanation of Benefit statements identified in ¶28, above, contain no explanation or definition of the phrase "Paid according to DCC" and no information on how the amount of the alleged discount was calculated other than as the amount allegedly agreed to by the Provider of Care. 33. The total amount of the "discounts" withheld by Defendants and not paid to Plaintiff for Plaintiff's services to the Patient on the payment notices sent by Defendants to Plaintiff for the services identified in 128, above, is $53.675.40. COUNT I - BREACH OF CONTRACT [Both Defendants] 34. Plaintiff incorporates by reference the allegations in paragraphs 1-33 above as if fully set forth herein. 35. On March 12, 2008, Plaintiff demanded payment from Defendants in the amount of $53,675.40 with respect to services involved in this matter, which amount Defendants have refused to pay and have not paid to date. 36. All conditions precedent to Plaintiff's demand for payment have been performed and occurred. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. COUNT II - QUANTUM MERUIT [Both Defendants] 37. Plaintiff incorporates by reference the allegations in paragraphs 1 through 36 as if fully set forth herein. 38. Plaintiff provided dialysis services to the Patient and thereby conferred benefits on Defendant Laurel. 39. Plaintiff did not provide its services to the Patient gratuitously but rather provided them with an express expectation of compensation and notified Defendant Laurel of such by ascertaining benefits prior to treatment and submitting billing to its agent, Defendant Loomis. 40. Defendant Laurel accepted the services provided to its covered member and acknowledged the benefits and expectation of compensation thereof by full payment, through its agent Defendant Loomis, of bills sent by Plaintiff for the periods from April 27, 2006 through March 20, 2007, but did not make full payment for the dates of service from April 3, 2007 through January 5, 2008. 41. Defendant Laurel's acceptance of services without rendering payment in full is inequitable; and 42. The reasonable value of services received, which has not been paid to date, is $53,675.40. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. COUNT III - PROMISSORY ESTOPPEL [Both Defendants] 43. Plaintiff incorporates by reference the allegations in paragraphs 1 through 42 as if fully set forth herein. 44. Defendants made promises to Plaintiff with respect to the rate and basis for payment to Plaintiff for the services to be provided to the Patient for the purpose of inducing Plaintiff to provide dialysis services to the Patient. 45. Plaintiff reasonably relied on the promises made by Defendant to Plaintiff referred to in ¶44, above. 46. Defendants' promises to Plaintiff and Plaintiff's reasonable reliance thereon have resulted in detriment and damages suffered by Plaintiff in the amount of $53,675.40, for which damages Plaintiff is entitled to recover. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. COUNT IV - ACCOUNT STATED 47. Plaintiff incorporates by reference the allegations in paragraphs 1 through 46 as if fully set forth herein. 48. Pursuant to the parties' agreement with respect to payment for Plaintiff s services for the Patient, Defendants agreed to payment Plaintiff for those services. 49. Plaintiff provided the services for the Patient. 50. Defendants, without justification, excuse or dispute of Plaintiff's invoices for the services identified in ¶28, above, has not paid Plaintiff in full for the amount invoiced. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. JURY DEMAND 51. Plaintiff hereby demands a jury of twelve. Respectfully submitted, CAPOZZI & AS IATES, P_.C. Date: June 12, 2009 TRUDY A. MARI A M Z ID No. 208523 2933 North Front Street Harrisburg, PA 17110-1250 (717) 233-4101 Attorneys for Plaintiff VERIFICATION I, Edward J. Newett, Jr., in my capacity as the Senior Director of Reimbursement and Finance for Dialysis Corporation of America, hereby state that I am authorized to make this verification on their behalf and that the facts set forth in the attached Complaint filed in this matter are true and correct to the best of my knowledge, information, and belief, and that this verification is being made subject to 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Edward J. New , Jr. DATE: ! ?5?0 9 FP, "FH- ),ool - 14 Sheriffs Office of Cu? berland County R Thomas Kline FL ; Sheriff utr o ?Cu?b r/ hr Ronny R Anderson D Chi eputy ef Jody S Smit h `rJ 4 Civil Process Sergeant OFFICE OF TI'$ ` ERIFF CS`FYI __,_ Edward L Schorpp r i` %l' ' ' - Solicitor Dialysis Corporation of America vs. The Loomis Company Case Number 2009-4286 SHERIFF'S RETU 06/26/2009 R. Thomas Kline, Sheriff who being duly sworn acc inquiry for the within named defendant, to wit: The bailiwick. He therefore deputized the Sheriff of Bei according to law. OF SERVICE ling to law states that he made a diligent search and omis Company, but was unable to locate them in his County, PA to serve the within Complaint and Notice 06/26/2009 R. Thomas Kline, Sheriff who being duly sworn accor ing to law states that he made a diligent search and inquiry for the within named defendant, to wit: Laurel Health Systems, Inc., but was unable to locate them in his bailiwick. He therefore deputized the Sheriff of Tioga County, PA to serve the within Complaint and Notice according to law. 07/01/2009 03:15 PM - Tioga County Return: And now July 1, 2 County, Pennsylvania, do herby certify and return the the within named defendant, to wit: Laurel Health S) Operations Coordinator at 22 Walnut Street Wellsboi handing to her personally the said true and correct o 07/02/2009 09:30 AM - Berks County Return: And now July 2, 2 Barks County, Pennsylvania, do herby certify and rel upon the within named defendant, to wit: The Loomi Human Resource Director at 850 N. Park Road Wyo handing to her personally the said true and correct o 9 at 1515 hours I, John L. Perry, Sheriff of Tioga I served a true copy of the within Complaint, upon ems, Inc. by making known unto Maria Smith, PA 16901 its contents and at the same time v of the same. )9 at 0930 hours I, Eric J. Weaknecht, Sheriff of rn that I served a true copy of the within Complaint, Company by making known unto Kathy Wolfe, issing, PA 19610 its contents and at the same time v of the same. SHERIFF COST: $62.00 July 15, 2009 SO ANSWERS, y 'j ° LujXr- r02-R THOMAS KLINE, SHERIFF COUNTY OF yvil" ? SHERIF w Courthouse- 3`d Floor d 633 Court Street Z Reading, PA 19601 Eric J. Weaknecht, Sheriff S. c AFFIDAVIT OF DOCKET NO. 09-4286 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF BERKS Personally appeared before me, JOHN PHILLIPS, De 633 Court Street, Reading, Pennsylvania, who being c JULY 2, 2009 at 9:30 AM, he served the annexed CC COMPANY, within named defendant, by handing a c at 850 N. PARK ROAD, WYOMISSING, PA 19610, contents thereof. Sworn and subscribed before me ,%s9 TH day of JULY, 2009 NOTARY LIC, ADING, BEIM - CO., PA ERKS, PENNSYLVANIA S DEPARTMENT Phone: 610.478.6240 Fax: 610.478.6222 Anthony Damore, Chief Deputy VICE r for Eric J. Weaknecht, Sheriff of Berks County, sworn according to law, deposes and says that on LAINT IN CIVIL ACTION upon THE LOOMIS thereof to KATHY WOLFE, H.R. DIRECTOR, •ks County, Pa., and made known to defendant the '?7L &9_7? ?U DEPU HERIFF OF BE RS CO., PA Service made as set forth above. NOTARIAL SEAL REBECCA OXENREIDER Notary Public READING CITY, BERKS COUNTY My Commission Expires Feb 22, 2012 Sheriffs Costs in Above Proceedings $ 100.00 DEPOSIT $ 29.50 ACTUAL COST OF CASE $ 70.50 AMOUNT OF REFUND So Answers, SHERIPFF OF BERK.S COUNTY, PA All Sheriff s Costs shall be due and payable when service demand and receive from the party instituting the proceec unpaid sheriffs fees on the same before he shall be oblig Sec. 2, Act of June 20, 191 s are performed, and it shall be lawful for him to lings, or any part liable for the costs thereof, all ited by law to make return thereof. ., P.L/ 1072 Dedicated to public service with integrity, virtue & excellence 1 0. In The Court of Common Pleas of Cumber Dialysis Corporation of America vs. The Loomis Company 850 North Park Road Wyomissing, PA 19610 d County, Pennsylvania Civil No. 2009-4286 Now, June 26, 2009, I, SHERIFF OF CUMBER Berks County to execute this Writ, this deputation being ) COUNTY, PA, do hereby deputize the Sheriff of at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service Now, , 20 , at o'clock M, served the within upon at by handing to. and made known to Sworn and subscribed before me this day of ,20 So answers, the contents thereof. COSTS SERVICE_ MILEAGE AFFIDAVIT County, PA copy of the Cori In The Court of Common Pleas of Cumb Dialysis Corporation of America VS. Laurel Health Systems, Inc. 22 Walnut Street Wellsboro, PA 16901 ?, Aft nsylvania 03AI333H 1009 JUN 2 9 P 1: 4 5 Civil No. 2009-4286 Now, June 26, 2009, I, SHERIFF OF CUMBER Tioga County to execute this Writ, this deputation being D COUNTY, PA, do hereby deputize the Sheriff of at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service Now, u / at- , 200q , at 3 ,1 o'clock h M, served the within ftjohe f- I ecrnn (a_ c n-? upon to-a tct 4atth JL13 at J, Wo-tn L.ct- Stm& by handing to l1/tQ1'' G t-5m1+fi a and made known to h e-r IV ( nc- ??c c.t??U rb T4 / b 9 b attorc C?DOrdlnQ-t?Y copy of the original So answers, Sheriff COSTS Sworn and subscribed before SERVICE me this day of (tLLJ ,20 09 MILEAGE- AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA NctsuW Seal A P. W44 Notary Pubk Wdeb=ft%TbW County My Cam *don E>gattea July 14,2W9 Member, Pennsylvania Aswgation. of No4o" the contents thereof. v? 71-0 co PA DIALYSIS CORPORATION OF AMERICA, Plaintiff VS. THE LOOMIS COMPANY, Defendant and LAUREL HEALTH SYSTEM, INC., Defendant IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PA : ACTION AT LAW : NO. 09-4286 CIVIL NOTICE TO PLEAD To: Dialysis Corporation of America, Plaintiff Capozzi & Associates, P.C. Trudy A. Marietta Mintz, Esquire 2933 North Front Street Harrisburg, PA 17110 You are hereby required to file a response to the within Preliminary Objections within twenty (20) days after the Preliminary Objections are served upon you. You are warned that if you fail to so do, the case may proceed without you, and judgment may be entered against you by the court without further notice. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Lawyer Referral Service Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 RIV047 Date OWLETT & LEWIS, P.C. By: '--J . Brian S. Duff, Esquire Attorney for Defendants PA ID # 85997 One Charles Street, P.O. Box 878 Wellsboro, PA 16901 (570) 723-1451 BSD@owlettlewis.com DIALYSIS CORPORATION OF AMERICA, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PA VS. THE LOOMIS COMPANY, Defendant and LAUREL HEALTH SYSTEM, INC., Defendant : ACTION AT LAW : NO. 09-4286 CIVIL PRELIMINARY OBJECTIONS And now, this _Oday of August, 2009, come Defendant Laurel Health System, Inc. ("Defendant LHS") and Defendant The Loomis Company ("Defendant Loomis"), by and through their attorney, Owlett & Lewis, P.C., for the purpose of filing Preliminary Objections to Plaintiff's Complaint as follows: Preliminary Objection #1: Insufficient Specificity of Pleading under Rule 1028(a)3 as to all Counts 1. Plaintiff, in each of its five (5) Counts against Defendants, asserts that the treatments allegedly provided by Plaintiff took place during a range of dates from April 3, 2007 through and including January 5, 2008 (see Complaint ¶ 28). 2. However, nowhere in Plaintiff's Complaint are the alleged treatments broken down by date, or by amount charged per treatment, or by actual services provided, or by location where the alleged services were provided. 3. In addition, there are no Exhibits attached to Plaintiff's Complaint that would guide Defendants regarding how much Plaintiff is seeking per alleged treatment, or when the alleged treatments took place, or what specific services were provided during each alleged treatment. 4. In addition, Plaintiff s Complaint refuses to identify the Patient, either by name or by Social Security Number, so it is impossible for Defendants to check their own records to either confirm or deny that the alleged treatments were given by Plaintiff to Page I of 5 OWLETT & LEWIS, P.C. * ATTORNEYS AT LAW * WELLSBORO, PA Patient, or to confirm or deny the amounts that were allegedly paid and/or allegedly withheld by Defendants. 5. It would be patently unfair and inequitable to force Defendants to respond to the Complaint as drafted, because the Complaint lacks the specificity required by the PA Rules of Civil Procedure, such as dates, amounts, services provided, and the identity of the Patient. WHEREFORE, Defendants pray Your Honorable Court dismiss Plaintiffs Complaint, or in the alternative, enter an Order directing Plaintiff to file an Amended Complaint to remedy the lack of specificity in all Counts of Plaintiff s Complaint. Preliminary Objection #2: Failure of Complaint to Conform to Law under Rule 1028(a)2 as to all Counts 6. Defendants hereby incorporate by reference all of Paragraphs 1 through 5 as if set forth in full herein. 7. In ¶ 31 of Plaintiffs Complaint, Plaintiff alleges that there was a written correspondence dated June 17, 2008 from one of the Defendants to Plaintiff, allegedly explaining the discounts that were taken; however, Plaintiff did not attach a copy of the alleged correspondence to its Complaint. 8. PA Rule of Civil Procedure 1019(1) provides that "When any claim or defense is based upon a writing, the pleader shall attach a copy of the writing, or the material part thereof, but if the writing or copy is not accessible to the pleader, it is sufficient so to state, together with the reason, and to set forth the substance in writing. 9. Plaintiff s Complaint fails to attach a copy of the writing referred to in ¶ 31, and also fails to state that the writing is unavailable; therefore, Plaintiff s Complaint is deficient under both Rule 1028(a)2 and Rule 1019(i). 10. In ¶ 3 and ¶ 7of Plaintiff s Complaint, Plaintiff alleges the existence of a written health insurance plan ("Plan"), yet Plaintiff s Complaint fails to attach a copy of the Plan, or the material parts thereof, and fails to state that the Plan is not available; therefore, Plaintiffs Complaint is deficient under both Rule 1028(a)2 and Rule 1019(1). WHEREFORE, Defendants pray Your Honorable Court dismiss Plaintiff s Complaint, or in the alternative, enter an Order directing Plaintiff to file an Amended Complaint to remedy the failure to attach a copy of the writing relied upon by Plaintiff in ¶'s 3, 7 and 31 of its Complaint. Page 2 of 5 OWLETT & LEWIS, P.C. * ATTORNEYS AT LAW * WELLSBORO, PA Preliminary Objection #3: Improper Venue under Rule 1028(a) I 11. Defendants hereby incorporate by reference all of Paragraphs 1 through 10 as if set forth in full herein. 12. Plaintiff, in ¶ 4 of its Complaint, alleges that venue in the Cumberland County Court of Common Pleas is proper because "the cause of action arose in Cumberland County and because Defendants regularly conduct business in Cumberland County." 13. Defendant LHS is a Pennsylvania nonprofit corporation with a Wellsboro (Tioga County) address; Defendant LHS has health centers and regularly conducts business only in the following northern tier counties: Tioga, Bradford, Lycoming and Sullivan Counties; Defendant LHS does not regularly conduct business in Cumberland County. 14. Plaintiff, in ¶ 20 of its Complaint, alleges that services were provided by Plaintiff to Patient at three (3) different facilities: Wellsboro (Tioga County), Selinsgrove (Snyder County) and Mechanicsburg (Cumberland County); but again, because Plaintiff's Complaint fails to break down the alleged services by date and by location, it is unclear from the Pleadings where the cause of action "arose." It could have arisen in any one of the three (3) Counties referenced in 120 of Plaintiff s Complaint. 15. Because Defendant LHS does not regularly conduct business in Cumberland County, venue in Cumberland County can only be proper under Rule 2179(a)3, the "county where the cause of action arose," as opposed to Rule 2179(a)2, the "county where (Defendant) regularly conducts business." 16. It is logical to presume that Patient is a resident of the northern tier counties referenced in ¶ 12 of these Preliminary Objections, because Patient allegedly has health insurance coverage through Defendant LHS; therefore, it is more logical to presume that Patient had dialysis services performed at the Wellsboro (Tioga County) facility rather than at the Mechanicsburg (Cumberland County) facility. Therefore, the cause of action, if any, "arose" in Tioga County and not in Cumberland County. WHEREFORE, Defendants pray Your Honorable Court enter an Order dismissing Plaintiff's Complaint for improper venue under Rule 2179, together with any other relief deemed necessary or appropriate by Your Honorable Court. Page 3 of 5 OWLETT & LEWIS, P.C. * ATTORNEYS AT LAW * WELLSBORO, PA Preliminary Objection #4: Lack of Jurisdiction over the Subject Matter under Rule 1028(a)1 17. Defendants hereby incorporate by reference all of Paragraphs 1 through 16 as if set forth in full herein. 18. Even if Your Honorable Court would find that venue in Cumberland County (as opposed to Tioga County) is proper under the circumstances (which Defendants expressly deny), jurisdiction is still not proper in this Court, because the health insurance plan at issue is an ERISA plan, as admitted by Plaintiff in its Complaint (see 13 of Plaintiff s Complaint). 19. All state-law claims arising out of an ERISA plan (like those pled by Plaintiff in its Complaint) are specifically preempted by the Federal ERISA Statute. See 29 U.S.C. 1144. 20. Because said state-law claims such as breach of contract, promissory estoppel and quantum meruit are specifically preempted by a Federal Statute, this Court lacks subject matter jurisdiction to even hear the case as pled by Plaintiff in its Complaint. WHEREFORE, Defendants pray Your Honorable Court enter an Order dismissing Plaintiff's Complaint, with prejudice, for lack of subject matter jurisdiction, together with any other relief deemed necessary or appropriate by Your Honorable Court. Preliminary Objection #5: Failure to Exhaust Statutory Remedies under Rule 1028(a)7 21. Defendants hereby incorporate by reference all of Paragraphs 1 through 20 as if set forth in full herein. 22. The health insurance plan at issue is an ERISA plan, as admitted by Plaintiff in its Complaint (see ¶ 3 of Plaintiff s Complaint). 23. The Federal Statute governing ERISA plans sets forth in detail what administrative steps a Plaintiff must take prior to filing a civil action, none of which have been taken by Plaintiff in this case prior to filing the above-captioned civil action. See 29 U.S.C. § 1133. 24. Specifically, before an aggrieved party may file a civil action against a Plan or against the Administrator of a Plan, the aggrieved party must seek a "full and fair review by the appropriate named fiduciary of the decision denying the (aggrieved party's) claim." See 29 U.S.C. § 1133(2). Page 4 of 5 OWLETT & LEWIS, P.C. * ATTORNEYS AT LAW * WELLSBORO, PA 25. Plaintiff has not taken the appropriate steps as outlined above, and therefore Plaintiff has not exhausted its administrative or statutory remedies, and therefore Plaintiff s Complaint is deficient under Rule 1028(a)7. WHEREFORE, Defendants pray Your Honorable Court enter an Order dismissing Plaintiff s Complaint for failure to exhaust all of its administrative or statutory remedies, together with any other relief deemed necessary or appropriate by Your Honorable Court. Respectfully Submitted, OWLETT & LEWIS, P.C. '711-907 Date By: i/? A - Brian S. Duff, Esquire Attorney for Defendants PA ID # 85997 One Charles Street P.O. Box 878 Wellsboro, PA 16901 (570) 723-1451 BSDgowlettlewis.com Page 5 of 5 OWLETT & LEWIS, P.C. * ATTORNEYS AT LAW * WELLSBORO, PA DIALYSIS CORPORATION OF AMERICA, Plaintiff VS. THE LOOMIS COMPANY, Defendant and : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PA ACTION AT LAW : NO. 09-4286 CIVIL LAUREL HEALTH SYSTEM, INC., Defendant CERTIFICATE OF SERVICE I, BRIAN S. DUFF, Esquire, Attorney for Defendants, The Loomis Company and Laurel Health System, Inc., in the above captioned matter, do hereby certify that I served a true and correct copy of Defendants' Preliminary Objections by forwarding the same via US Mail, First Class, ostage prepaid by depositing same with the US Postmaster, Wellsboro, Tioga County, PA, on this L day of August, 2009, addressed as follows: Capozzi & Associates, P.C. Trudy A. Marietta Mintz, Esquire Attorney for Plaintiff 2933 North Front Street Harrisburg, PA 17110 OWLETT & LEWIS, P.C. FIX * By: 11f ?, -1? - & Date Brian S. Duff, Esquire Attorney for Defendants PA ID # 85997 One Charles Street P.O. Box 878 Wellsboro, PA 16901 (570) 723-1451 OWLETT & LEWIS, P.C. * ATTORNEYS AT LAW * WELLSBORO, PA 4f, rTA.TARY FN'S AUG 14 PM 2 56 A?,4D PB*S&V" PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: (List the within matter for the next Argument Court.) CAPTION OF CASE (entire caption must be stated in full) DIALYSIS CORPORATION OF AMERICA, Plaintiff vs. THE LOOMIS COMPANY, Defendant and LAUREL HEALTH SYSTEM, INC. No 09-4286 CIVIL Term Defendant 1. State matter to be argued (i.e., plaintiff's motion for new trial, defendant's demurrer to complaint, etc.): Defendants' Preliminary objections 2. Identify all counsel who will argue cases: (a) for plaintiffs: Trudy Mintz, Esquire, Capozzi & Associates, PC 2933 North Front St., Harrisburg, PA 17110 (Name and Address) (b) for defendants: Brian S. Duff, Esq., Owlett & Lewis, P.C. P.O. Box 878, Welslboro, PA 16901 (Name and Address) 3. 1 will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: Signature Brian S. Duff Print your name 9/x/09 Attorney for Defendants Date: INSTRUCTIONS: 1. Two copies of all briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) before argument. 2. The moving party shall file and serve their brief 12 days prior to argument. 3. The responding party shall file their brief 5 days prior to argument. 4. If argument is continued new briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) after the case is relisted. CA /AL FLT( r1' " N RE 2009'S;E Fri fy' f CAPOZZI & ASSOCIATES, P.C. By: Michael M. Jerominski, Esquire Attorney I.D. No. 92977 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Dialysis Corporation of America IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DIALYSIS CORPORATION OF AMERICA 214 Senate Avenue Ste. 300 Camp Hill, Pennsylvania 17011 THE LOOMIS COMPANY 850 N. Park Road PO BOX 7011 Wyomissing, Pennsylvania 19610-6011 Defendant and LAUREL HEALTH SYSTEM, Inc. 22 Walnut Street Wellsboro, PA 16901 Defendant * * * RESPONSE TO PRELIMINARY OBJECTIONS OF DEFENDANTS THE LOOMIS COMPANY AND LAUREL HEALTH SYSTEM, INC. V. Plaintiff Action at Law * * No. 09-4286 * * * * * * * * * * * The Plaintiff, DIALYSIS CORPORATION OF AMERICA, by and through their counsel, CAPOZZI & ASSOCIATES and MICHAEL M. JEROMINSKI, hereby submits this response to the Preliminary Objections of the Defendants, The Loomis Company and Laurel Health Systems (hereinafter referred to as "Defendants") and alleges as follows: Procedural Background 1. Plaintiff Dialysis Corporation of America (hereinafter "DCA" or "Plaintiff") filed a Complaint on June 25, 2009, in which it alleged that Defendants failed to pay the Plaintiff for services performed and accepted by the Defendants. 2. On or about July 16, 2009, Defendants filed Preliminary Objections to the Complaint on the grounds that Plaintiffs failed to plead with specificity under Rule 1028(a)(3), the Complaint failed to conform to law under Rule 1028(a)(2), improper venue, lack of jurisdiction over subject matter under Rule 1028(a)(1), and failure to exhaust statutory remedies under Rule 1028(a)(7). The Plaintiff hereby incorporates by reference the facts and allegations contained in their Complaint as if set forth herein. A true and correct copy of the Complaint is attached hereto and made a part of this document with the designation of Exhibit A. 4. The Plaintiff files this Response to the Preliminary Objections to the Complaint filed by the Defendants The Loomis Company and Laurel Health Systems. Preliminary Obiection #1: Insufficient Specificity of Pleading under Rule 1028(a)(3) as to All Counts 5. The Plaintiff incorporates by reference Paragraphs 1-4 herein as if set forth in full. 6. Defendants correctly state that Plaintiffs set forth a range of treatment dates spanning April 3, 2007, to January 5, 2008, for the patient whose gave rise to the current litigation. 7. Defendants further allege that Plaintiff's Complaint fails to state with specificity locations of treatment, dates, amounts, services provided, and the identity of the patient. Defendants' Preliminary Objections at ¶ 2, 5. 8. Rule 1028(a)(3) is to be interpreted with an eye toward whether the complaint is sufficiently clear to enable the defendant to prepare his defense or whether the plaintiffs complaint informs the defendant with accuracy and completeness of the specific basis on which recovery is sought so that he may know without question upon what grounds to make his defense. McNeil v. Jordan, 814 A.2d 234, 237- 38, 2002 PA Super 400, ¶ 9 (2002). 9. As to location, Plaintiff's Complaint states that Plaintiff provided treatment at Plaintiff's facilities in Wellsboro, Selinsgrove, and Mechanicsburg. Plaintiff's Complaint at ¶ 20. 10. As to dates, Plaintiff provided dates of the services provided as set forth in Plaintiff's Complaint at T¶ 20, 24-25, and 28. 11. As to amounts, Plaintiff sets forth the amount in question in Plaintiff's Complaint at ¶T 33, 35, 42, and 46. 12. As to services provided, Plaintiff provided dialysis services. 13. As to the identity of the Patient, the Patient is Defendant Laurel Health Systems' insured, and such information is in their possession. 14. Plaintiff has provided sufficient information to meet the dictates of McNeil v. Jordan. WHEREFORE, the Plaintiff respectfully requests that the Court deny the Preliminary Objections of the Defendants regarding Insufficient Specificity of Pleading under Rule 1028(a)(3) as to All Counts, and order any other relief deemed equitable and just. Preliminary Obiection #2• Failure of Complaint to Conform to Law under Rule 1028(a)(2) as to All Counts 15. The Plaintiff incorporates by reference Paragraphs 1-14 herein as if set forth in full. 16. Defendants contend that Plaintiff's Complaint does not conform to law due to failing to attach the writing referenced in ¶ 31 of Plaintiff's Complaint. 17. PA Rule of Civil Procedure 1019(h) requires that when "any claim or defense is based upon an agreement, the pleading shall state specifically if the agreement is oral or written." Plaintiff specifically stated that the agreement that forms the basis of this matter is oral, not written. Plaintiff's Complaint at ¶ 12. 18. The writing referenced in ¶ 31 of Plaintiff's Complaint is evidentiary in nature, not the underlying agreement itself. Merely evidentiary writings do not need to 3 be attached to Complaints. Department of Transp. v. Bethlehem Steel Corp., 368 A.2d 888, 28 Pa.Cmwlth. 214, Cmwlth.1977. 19. The agreement is an oral one; therefore, PA Rule of Civil Procedure 1019(i) does not apply to the writing referenced in ¶ 31 of Plaintiff's Complaint. 20. Paragraphs 3 and 7 of Plaintiff's Complaint refer to a plan already in the possession of the Defendants. 21. Furthermore, the current action concerns representations made regarding payment outside of the plan. WHEREFORE, the Plaintiff respectfully requests that the Court deny the Preliminary Objections of the Defendants regarding Failure of Complaint to Conform to Law under Rule 1028(a)(2) as to All Counts, and order any other relief deemed equitable and just. Preliminary Obiection #3• Improper Venue under Rule 1028(a)(1) as to All Counts 22. The Plaintiff incorporates by reference Paragraphs 1-21 herein as if set forth in full. 23. Defendants assert that Defendant Laurel Health Systems regularly conducts business only in the Counties of Tioga, Bradford, Lycoming, and Sullivan, and fails to address the significance of PA Rule of Civil Procedure 1006(c), and its relation to Defendant The Loomis Company. 24. Defendant Laurel Health Systems regularly conducted business in Cumberland County by virtue of regularly conducting business with Plaintiff's main Pennsylvania office, located in Camp Hill, Cumberland County, and by having the Patient obtain services at, among other locations, Plaintiff's Mechanicsburg location. Plaintiff's Complaint at ¶¶ at 1, 20. 25. As Defendant Laurel Health Systems regularly conducted business in Cumberland County, venue is proper under Rule 2179(a)(2). 26. Defendant The Loomis Company regularly conducted business in Cumberland County by virtue of regularly conducting business with Plaintiff's main Pennsylvania office, located in Camp Hill, Cumberland County, and by having the Patient obtain services at, among other locations, Plaintiff's Mechanicsburg location. Plaintiff's Complaint at T¶ at 1, 20. 4 27. Defendant The Loomis Company also corresponded directly with regard to matters affecting the Patient through Plaintiff's main Pennsylvania office in Camp Hill, Cumberland County. Plaintiff's Complaint at T¶ 1, 31. 28. As Defendant The Loomis Company regularly conducted business in Cumberland County, venue is proper under Rule 2179(a)(2). 29. In reliance on Defendants' agreement to make payment to Plaintiff based on Plaintiff's usual and customary charges for dialysis services, Plaintiff provided said services to the Patient at their facilities, including their Mechanicsburg facility. 30. Defendants failed to make payment for said services. 31. As the failure to snake payment to an entity with a main Pennsylvania office situated in Camp Hill, Cumberland County, arose from services provided in, among other locations, Mechanicsburg, Cumberland County, venue is proper under Rule 2179(a)(3). 32. Defendants' Preliminary Objections do not state any objection to venue as it relates to Defendant The Loomis Company. 33. In actions alleging joint or joint and several liability against two or more defendants, venue is proper if it is proper to any one defendant. PA Rule of Civil Procedure 1006(c)(1). 34. The relief requested for every count of Plaintiff's Complaint includes, inter alia, a request for judgment in favor of the Plaintiff and against the Defendants, jointly and severally. 35. Therefore, venue is proper as to both Defendants. WHEREFORE, the Plaintiff respectfully requests that the Court deny the Preliminary Objections of the Defendants regarding Improper Venue under Rule 1028(a)(1) as to All Counts, and order any other relief deemed equitable and just. Preliminary Obiection #4• Lack of Jurisdiction over the Subject Matter under Rule 1028(a)(1) 36. The Plaintiff incorporates by reference Paragraphs 1-35 herein as if set forth in full. 37. Defendants contend that all state law claims arising from an ERISA plan are specifically pre-empted by 29 U.S.C. § 1144. 38. Pre-emption under § 514(a) of ERISA, 29 U.S.C. § 1144(a), must be distinguished from complete pre-emption under § 502(a) of ERISA, 29 U.S.C. § I I32(a). Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 398 (3' Cir. 2004). 39. Only 29 U.S.C. § I I32(a) pen-nits removal of what would otherwise be a state law claim under the well-pleaded complaint rule. Under § 514(a), ERISA supersedes state laws that "relate to" an ERISA plan. 29 U.S.C. § 1 144(a). Unlike the scope of § 502(a), which is jurisdictional and creates a basis for removal to federal court, § 514(a) merely governs the law that will apply to state law claims, regardless of whether the case is brought in state or federal court. Lazorko v. Pa. Hosp., 237 F.3d 242, 248 (3d Cir.2000). Section 514(a), therefore, does not permit removal of an otherwise well-pleaded complaint asserting only state law claims. Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 398 (3rd Cir. 2004). 40. Plaintiff's Complaint relies upon Pennsylvania state law to allege breach of contract, quantum meruit, promissory estoppel, and account stated claims. 41. Plaintiff's state law claims do not relate to ERISA, but rather an oral agreement for payment separate from and outside of ERISA's framework. Plaintiff s Complaint at ¶T 12, 17-20. 42. Therefore, subject matter jurisdiction is proper in This Honorable Court. WHEREFORE, the Plaintiff respectfully requests that the Court deny the Preliminary Objections of the Defendants regarding Lack of Jurisdiction over the Subject Matter under Rule 1028(a)(1), and order any other relief deemed equitable and just. Preliminary Obiection #5• Failure to Exhaust Statutory Remedies under Rule 1028(a)(7) 43. The Plaintiff incorporates by reference Paragraphs 1-42 herein as if set forth in full. 44. Defendants contend that Plaintiff did not exhaust statutory remedies under ERISA. 45. Plaintiff had an agreement separate from and outside of any ERISA obligations. 6 46. Therefore, Plaintiff is not bound to take steps to exhaust ERISA statutory remedies. WHEREFORE, the Plaintiff respectfully requests that the Court deny the Preliminary Objections of the Defendants regarding Failure to Exhaust Statutory Remedies under Rule 1028(a)(7), and order any other relief deemed equitable and just. Respectfully submitted, Date: October 2, 2009 /&01/? "a'? . Michael M. Jerominski, Esquire Attorney I.D. No.: 92977 Capozzi & Associates, P.C. 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101 CAPOZZI & ASSOCIATES, P.C. By: Trudy A. Marietta Mintz, Esquire Attorney I.D. No. 208523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Dialysis Corporation of America IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DIALYSIS CORPORATION OF AMERICA 214 Senate Avenue Ste. 300 Camp Hill, Pennsylvania 17011 Plaintiff Action at Law V. THE LOOMIS COMPANY 850 N. Park Road PO BOX 7011 Wyomissing, Pennsylvania 19610-6011 * Defendant and LAUREL HEALTH SYSTEM, Inc. 22 Walnut Street Wellsboro, PA 16901 Defendant * * * * * * * * * * NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after the complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by Plaintiff. You may lose money or property or other rights important to you. EXHIBIT A YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 1-800-990-9108 (717) 249-3166 EXHIBIT A AVISO e han demandado a usted en la corte. Si usted quiere defenderse de estas de estas demandas expuestas an las paginas signientes, usted tiene veinte (20) dias de plazo al partir de is fecha de la demanda y is notificacion. Hace falta asentar una comparencia escrita o en persona o con un abogado y entregar a la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, le corte tomara medidas y puede continuar la demanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpla con todas las provisioner de esta demanda. Usted puede perder dinero o sus propiedades a ostros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE, S1 NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO. VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 Respectfully submitted, CAPOZZI & ASSOCIATES, P.C. Date: By: Trudy A. Marietta Mintz, Esquire Attorney ID No. 208523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff EXHIBIT A CAPOZZI & ASSOCIATES, P.C. By: Trudy A. Marietta Mintz, Esquire Attorney I.D. No. 208523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Dialysis Corporation of America IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DIALYSIS CORPORATION OF AMERICA 214 Senate Avenue Ste. 300 Camp Hill, Pennsylvania 17011 Plaintiff Action at Law V. THE LOOMIS COMPANY 850 N. Park Road PO BOX 7011 Wyomissing, Pennsylvania 19610-6011 Defendant and LAUREL HEALTH SYSTEM, Inc. 22 Walnut Street Wellsboro, PA 16901 Defendant * * * * * * * * * * * * * * * NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after the complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by Plaintiff. You may lose money or property or other rights important to you. Exhibit A YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 1-800-990-9108 (717) 249-3166 Exhibit A AVISO e han demandado a usted en la corte. Si usted quiere defenderse de estas de estas demandas expuestas an las paginas signientes, usted tiene veinte (20) dias de plazo al partir de is fecha de la demanda y is notificacion. Hace falta asentar una comparencia escrita o en persona o con un abogado y entregar a la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, le corte tomara medidas y puede continuar la demanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpla con todas las provisiones de esta demanda. Usted puede perder dinero o sus propiedades u ostros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE, SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO. VAYA EN PERSONA O LLAME POR TELEFONO ALA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 Date: /S Respectfully submitted, CAPOZZI & ASSOCIATES P.C. By: Trudy A. Marietta M' squire Attorney ID N 8523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff Exhibit A CAPOZZI & ASSOCIATES, P.C. By: Trudy A. Marietta Mintz, Esquire Attorney I.D. No. 208523 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Dialysis Corporation of America IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DIALYSIS CORPORATION OF AMERICA 214 Senate Avenue Ste. 300 Camp Hill, Pennsylvania 17011 Plaintiff Action at Law V. THE LOOMIS COMPANY 850 N. Park Road PO BOX 7011 Wyomissing, Pennsylvania 19610-6011 * Defendant and LAUREL HEALTH SYSTEM, Inc. 22 Walnut Street Wellsboro, PA 16901 Defendant * * * * * * * * * * COMPLAINT COMES NOW the Plaintiff, DIALYSIS CORPORATION OF AMERICA, by and through their counsel, CAPOZZI & ASSOCIATES and TRUDY A. MARIETTA MINTZ, and alleges as its Complaint as follows: Exhibit A PARTIES AND VENUE 1. Dialysis Corporation of America (hereinafter referred to as "DCA" or "Plaintiff") is a Florida corporation with its principal place of business located at 1302 Concourse Drive (Suite 204), Linthicum, Maryland 21090, which conducted business in Pennsylvania at all times relevant hereto with main offices located at 214 Senate Avenue (Suite 300), Camp Hill, Pennsylvania 17011 and dialysis facilities in Camp Hill, Bedford, Carlisle, Chambersburg, Huntingdon, Lemoyne, Mechanicsburg, Pottstown, Selinsgrove, Wellsboro, and York. 2. Defendant The Loomis Company (herein after referred to as "Loomis" or "Defendant") is a Pennsylvania corporation with its principal place of business located at 850 Park Road, Wyomissing, Pennsylvania, which conducted business with the Plaintiff in Pennsylvania at all times relevant hereto; and 3. Defendant Laurel Health System, Inc. (hereinafter referred to as "Laurel") is a Pennsylvania not-for-profit corporation who owns and operates an ERISA self-funded group health plan known as the Laurel Health System Health Plan, with its principle place of business located at 22 Walnut Street, Wellsboro, Pennsylvania, which conducted business with Plaintiff in Pennsylvania at all times relevant hereto. 4. Venue is proper in this Court pursuant to Pa. R. Civ. P. Rule 2179 because the cause of action arose in Cumberland County and because Defendants regularly conduct business in Cumberland County. Exhibit A FACTS 5. Plaintiff is in the business of providing dialysis and other renal care services. 6. Defendant Loomis is a third party administrator contracted to provide such services for Defendant Laurel's self-funded health plan (hereinafter, "the Plan"). 7. Defendant Laurel is operator of an ERISA self-funded group health plan ("the Plan") providing health care coverage, including that for a patient whose services are the subject of this matter and who is further identified in Plaintiff s March 12, 2008 demand for payment addressed to Defendant Loomis (hereinafter "Patient"). The name and other identification of the Patient are not specified herein to protect the Patient's privacy rights and because the parties have previously communicated about payment for the services for the Patient and therefore have knowledge of who the Patient is. 8. Defendant Loomis, at all relevant times, acted on behalf of Defendant Laurel by interpreting the health insurance coverage to be provided to members of the Plan, such as the Patient, including but not limited to, "in- network" status of providers and amounts of reimbursement to be made to such providers and entering into agreements with out-of-network providers, such as Plaintiff, with respect to services for Plan participants, such as Patient, for which there were no "in-network" providers. 9. Plaintiff is not a party to the contract for insurance coverage between the Patient and Defendant Laurel. 10. Plaintiff is neither a participant, nor a beneficiary of the Plan. Exhibit A 11. Plaintiff is not a party to the contract for administrative services between Defendant Laurel and Defendant Loomis. 12. Plaintiff and Defendants do not have a written contract by which their business transactions are governed; however, they have an oral agreement with respect to payment for the services involved. 13. Patient's healthcare identification card, which was provided by Defendant Laurel to its covered members, such as Patient, states that claims for payment for services provided to Patient are to be submitted to The Loomis Company, Claims Dept., PO BOX 7011, Wyomissing, PA 19610-6011. 14. Defendant Loomis subsequently identified themselves to Plaintiff as having contracted with Defendant Laurel to administer Plaintiff's claims for services to the Patient. 15. Prior to Plaintiff providing services to the Patient, Defendants confirmed that the Patient was eligible and had coverage for Plaintiffs dialysis services under the Plan. 16. At all relevant times, the Plan did not have any dialysis services providers in their network of providers. 17. Prior to providing services to the Patient in April 2006, Plaintiff sought to determine how Plaintiff would be paid for such services, since Plaintiff was not a participating provider in the Plan's network of providers; and, inquired of Defendant Laurel about payment for such out-of-network services. Exhibit A 18. Defendants advised Plaintiff on or about April 27, 2006, prior to Plaintiff s providing any services for the Patient, that: (a) since the Plan had no in- network providers for dialysis services, such services were available to its beneficiaries on an "open access basis" under which beneficiaries could obtain services from any available provider, including Plaintiff; (b) the Plan agreed to pay Plaintiff for such services even though Plaintiff was not a participating provider in the Plan based on Plaintiff's usual and customary charges for such services; and, (c) the Plan had no written provisions concerning "open access basis" payments for out-of-network dialysis services and nothing in writing that they could provide to Plaintiff. 19. The Plan authorized referrals of the Patient to Plaintiff for all the dialysis services provided by Plaintiff at issue in this matter knowing that Plaintiff was not a participating in-network provider and had no written agreement with the Plan with respect to any limitations on payment for charges for dialysis services. 20. In reliance on Defendant's agreement to make payment to Plaintiff based on Plaintiff s usual and customary charges for dialysis services for Patient even though Plaintiff was not a participating provider in the Plan, Plaintiff provided the services involved in this matter to the Patient at Plaintiff's facilities in Wellsboro, Selinsgrove, and Mechanicsburg from April 27, 2006 through January 3, 2008. Exhibit A 21. Defendants contracted with Wellington Healthcare Group, LLC and with The National Care Network to obtain discounts from non-participating providers from the charges that such out-of-network providers were permitted to bill for services to Plan beneficiaries and which discounted amounts the out-of-network providers would agree not to bill to Plan beneficiaries. 22. Defendants, at all relevant times, did not require out-of-network providers, such as Plaintiff, to agree to discount their charges as a condition of obtaining payment for services provided to Plan beneficiaries. 23. Plaintiff expressly declined each and all of Defendants' requests that Plaintiff voluntarily agree to discount Plaintiff s charges for services, including those requests specifically addressed to the services to be provided to the Patient; and, did not agree to make any voluntary discounts to Plaintiff s usual and customary charges for any of the services Plaintiff provided to the Patient. 24. Plaintiff billed Defendants Plaintiff's usual and customary charges for the services provided to the Patient from April 27, 2006 through January 5, 2008. Exhibit A 25. Defendants paid Plaintiff in full Plaintiff's billed charges for services provided to the Patient for Dates of Services April 27, 2006; May 2, 2006; June 1-29, 2006; July 1-29, 2006; August 1-31, 2006; September 2, 2006; October 3, 2006; November 2, 2006; December 2-30, 2006; January 2-30, 2007; February 1-27, 2007; and, March 1-20, 2007, with no excluded charges and no discount claimed. 26. Defendants payment to Plaintiff for the dates of service identified in ¶25, above, are consistent with the terms and rates of payment agreed to by the parties in April 2006. 27. On information and belief, between April 27, 2006 and January 3, 2008, there were no changes to the Patient's eligibility and coverage under the Plan for Plaintiff's services. 28. Beginning with Plaintiff's invoice for services for the Patient for April 3-28, 2007 and continuing for the invoices for May 1, 2007; June 2, 2007; July 3- 31, 2007; August 2, 2007; September 1, 2007; October 4, 2007; November 1-29, 2007; December 1-31, 2007; and, January 3-5, 2008, Defendants did not pay Plaintiff's billed charges in full and deducted a "Discount Amount" which Defendants described on their Explanation of Benefits statements, sent to DCA and to the Patient, as follows: "The amount in the discount column represents a discount offered by the Provider of Care. You should not be billed for this amount. *** COMMENTS *** Paid according to DCC" Exhibit A 29. Plaintiff did not offer or agree to any discount with respect to Plaintiff's services to the Patient for the dates identified in ¶28 above. 30. Defendants did not advise Plaintiffs of any change to their previously agreed upon basis for billing and payment for services provided by Plaintiff to the Patient from April 3, 2006 through January 5, 2008; did not provide Plaintiff with any written notice of Defendants' intention or desire to change the payment rate or the basis for payment that Defendants applied to pay Plaintiff's billed services for the Patient from April 27, 2006 to March 20, 2007 for any period thereafter; and, did not provide Plaintiff with any provision of the Plan that required any change. 31. By correspondence of June 17, 2008 addressed to Plaintiff, Defendant Loomis conceded that the "Discount Amount" withheld by Defendants from each of the payments referred to in 128, above, was not, in fact, a "discount offered by the Provider of Care," but was, instead, a discount "taken through Dialysis Cost Containment" and "based on the Usual, Customary and Reasonable fees for the services provided." 32. The Explanation of Benefit statements identified in ¶28, above, contain no explanation or definition of the phrase "Paid according to DCC" and no information on how the amount of the alleged discount was calculated other than as the amount allegedly agreed to by the Provider of Care. Exhibit A 33. The total amount of the "discounts" withheld by Defendants and not paid to Plaintiff for Plaintiffs services to the Patient on the payment notices sent by Defendants to Plaintiff for the services identified in 128, above, is 53 675.40. COUNT I - BREACH OF CONTRACT [Both Defendants] 34. Plaintiff incorporates by reference the allegations in paragraphs 1-33 above as if fully set forth herein. 35. On March 12, 2008, Plaintiff demanded payment from Defendants in the amount of $53,675.40 with respect to services involved in this matter, which amount Defendants have refused to pay and have not paid to date. 36. All conditions precedent to Plaintiff's demand for payment have been performed and occurred. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. COUNT II - QUANTUM MERUIT [Both Defendants] 37. Plaintiff incorporates by reference the allegations in paragraphs 1 through 36 as if fully set forth herein. 38. Plaintiff provided dialysis services to the Patient and thereby conferred benefits on Defendant Laurel. Exhibit A 39. Plaintiff did not provide its services to the Patient gratuitously but rather provided them with an express expectation of compensation and notified Defendant Laurel of such by ascertaining benefits prior to treatment and submitting billing to its agent, Defendant Loomis. 40. Defendant Laurel accepted the services provided to its covered member and acknowledged the benefits and expectation of compensation thereof by full payment, through its agent Defendant Loomis, of bills sent by Plaintiff for the periods from April 27, 2006 through March 20, 2007, but did not make full payment for the dates of service from April 3, 2007 through January 5, 2008. 41. Defendant Laurel's acceptance of services without rendering payment in full is inequitable; and 42. The reasonable value of services received, which has not been paid to date, is $53,675.40. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. COUNT III - PROMISSORY ESTOPPEL [Both Defendants] 43. Plaintiff incorporates by reference the allegations in paragraphs 1 through 42 as if fully set forth herein. Exhibit A 44. Defendants made promises to Plaintiff with respect to the rate and basis for payment to Plaintiff for the services to be provided to the Patient for the purpose of inducing Plaintiff to provide dialysis services to the Patient. 45. Plaintiff reasonably relied on the promises made by Defendant to Plaintiff referred to in ¶44, above. 46. Defendants' promises to Plaintiff and Plaintiff's reasonable reliance thereon have resulted in detriment and damages suffered by Plaintiff in the amount of $53,675.40, for which damages Plaintiff is entitled to recover. WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. COUNT IV - ACCOUNT STATED 47. Plaintiff incorporates by reference the allegations in paragraphs I through 46 as if fully set forth herein. 48. Pursuant to the parties' agreement with respect to payment for Plaintiff's services for the Patient, Defendants agreed to payment Plaintiff for those services. 49. Plaintiff provided the services for the Patient. 50. Defendants, without justification, excuse or dispute of Plaintiff's invoices for the services identified in ¶28, above, has not paid Plaintiff in full for the amount invoiced. Exhibit A WHEREFORE, Plaintiff requests this Court to award judgment in favor of Plaintiff and against Defendants, jointly and severally, in the amount of $53,675.40, plus the costs of this action and such other relief as this Court shall deem just. JURY DEMAND 51. Plaintiff hereby demands a jury of twelve. Respectfully submitted, CAPOZZI & AS IATES, P_ Date: June 12, 2009 TRUDY A. MARI A M Z ID No. 208523. 2933 North Front Street Harrisburg, PA 17110-1250 (717) 233-4101 Attorneys for Plaintiff Exhibit A L L ? DIALYSIS CORPORATION OF AMERICA, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. THE LOOMIS COMPANY and LAUREL HEALTH SYSTEM, Defendants Docket No.: 09-4286 Civil Action - Law CERTIFICATE OF SERVICE I hereby certify that I have this day caused a copy of the foregoing Plaintiff's Response to Preliminary Objections of Defendants to be served by first class United States Mail, postage prepaid, addressed to the following: Date: October 2, 2009 Brian S. Duff, Esquire Owlett & Lewis, P.C. One Charles Street P. O. Box 878 Wellsboro,PA 16901 Michael M. Jerominski, Esquire Attorney I.D. No.: 92977 Capozzi & Associates, P.C. 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101 FILED Vii: "E OF TEE 2009 OCT -2 f'? 2: 10 CUIMI 4,L ha t [ ?y tt DIALYSIS CORPORATION OF AMERICA, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. THE LOOMIS COMPANY, Defendant : NO. 2009 - 4286 CIVIL TERM V. LAUREL HEALTH SYSTEM, Defendant : CIVIL ACTION LAW IN RE: DEFENDANTS' PRELIMINARY OBJECTIONS BEFORE HESS, OLER, JR., GUIDO, JJ. ORDER OF COURT AND NOW, this 19TH day of OCTOBER, 2009, an evidentiary hearing is scheduled for FRIDAY, DECEMBER 4, 2009, at 9:30 a.m. in Courtroom # 3 of the Cumberland County Courthouse, Carlisle, Pa. to resolve factual issues in connection with Defendants' preliminary objection to venue. B e Court, Edward E. Guido, J. ? Trudy Mintz, Esquire rian S. Duff, Esquire Court Administrator - Pba-a?,,J) L ??? 12 ? x ID 71 _ 2009 OCT 20 All ' H: : 01 I *r DIALYSIS CORPORATION OF AMERICA, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. THE LOOMIS COMPANY and LAUREL HEALTH SYSTEM, Defendants Docket No.: 09-4286 : Civil Action -Law JOINT MOTION FOR CONTINUANCE AND NOW, comes Plaintiff, Dialysis Corporation of America, by and through its attorneys, Capozzi & Associates, P.C., and files this Joint Motion for Continuance and avers as follows: 1. On or about June 12, 2009, Plaintiff filed its Complaint in the instant action averring breach of contract against the Defendants. 2. On or about August 12, 2009, Defendants filed Preliminary Objections alleging improper venue under Rule 1028(a)1. 3. On October 2, 2009, Plaintiff filed its response to Defendants' Preliminary Objections. 4. An evidentiary hearing has been scheduled for December 4, 2009 to resolve the factual issues in connections with Defendants' Preliminary Objections. 5. Settlement between the parties is highly likely and the parties would like some time to negotiate an amicable resolution to this matter. ' t 'I WHEREFORE, the parties, through their respective counsel, respectfully request a continuance of sixty (60) days of the hearing currently scheduled for December 4, 2009, and request this Honorable Court to set a new date on the pending matters. Respectfully submitted, Date: I Z 1' /01 By: Asw /;P?I . . Michael M. Jeromins i, Esquire Attorney I.D. No.: 92977 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17101 (717) 233-4101 • of Y DIALYSIS CORPORATION OF AMERICA, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. Docket No.: 09-4286 THE LOOMIS COMPANY and LAUREL HEALTH SYSTEM, : Civil Action -Law Defendants CERTIFICATE OF CONCURRENCE The undersigned hereby certifies that on December 1, 2009, he contacted counsel for Defendants, Brian S. Duff, Esquire, for concurrence or non-concurrence in the foregoing Motion. Brian S. Duff, Esquire concurs with this Motion. Date: I-0/01 Michael M. Jerominsl , Esquire Attorney I.D. No.: 92977 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17101 (717) 233-4101 A -Y DIALYSIS CORPORATION OF AMERICA, Plaintiff V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Docket No.: 09-4286 THE LOOMIS COMPANY and LAUREL HEALTH SYSTEM, Civil Action -Law Defendants ; CERTIFICATE OF SERVICE I hereby certify that I have this day caused a copy of the foregoing Joint Motion for Continuance to be served by first class United States Mail, postage prepaid, addressed to the following: Brian S. Duff, Esquire Owlett & Lewis, P.C. One Charles Street P. O. Box 878 Wellsboro, PA 16901 Date: December 1, 2009 A4?? /k Michael M. Jerominsk', Esquire Attorney I.D. No.: 92977 Capozzi & Associates, P.C. 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101