HomeMy WebLinkAbout11-6881°1
I f s
U.S. RENAL CARE, INC. f/k/a
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF HYATTSVILLE,
Plaintiff
V.
DORIS WENDT,
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.
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Docket No.: 41-
Civil Action - Law
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.
CUMBERLAND COUNTY BAR ASSOCIATION
32 SOUTH BEDFORD
STREET CARLISLE, PA 17013
1-800-990-9108
717-249-3166
AVISO
Le han demandado a usted en la cone. 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 continuer 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 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.
CUMBERLAND COUNTY BAR ASSOCIATION
32 SOUTH BEDFORD
STREET CARLISLE, PA 17013
1-800-990-9108
717-249-3166
& d'
COP
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U.S. RENAL CARE, INC. f/k/a IN THE COURT OF COMMON PLEAS FOR
DIALYSIS CORPORATION OF AMERICA CUMBERLAND COUNTY, PENNSYLVANIA
d/b/a DCA OF HYATTSVILLE,
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Docket No.: um
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Civil Action - Law =: C:) r r,
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COMPLAINT
NOW COMES, U.S. Renal Care, Inc. f/k/a Dialysis Corporation of America d/b/a DCA
of Hyattsville ("U.S. Renal Care"), by and through its attorney, Capozzi & Associates, P.C., and
makes the following Complaint for a money judgment against Defendant, and in support thereof,
respectfully avers as follows:
1. Plaintiff, U.S. Renal Care is a registered Pennsylvania limited liability corporation
having a principal place of business address at 214 Senate Avenue, Camp Hill, Cumberland
County, Pennsylvania 17011.
2. Defendant Doris Wendt ("Patient" or "Defendant") is an adult individual with a last
known address at 12462 Dalton Trail, Lusby, Maryland 20657-3431.
3. The clinic formerly known as DCA of Hyattsville is an operating subsidiary of U.S.
Renal Care with a dialysis clinic located at 4920 Lasalle Road, Hyattsville, Maryland 20782.
4. U.S. Renal Care provides dialysis treatments and services to its patients.
5. On or about February 28, 2011, Defendant executed a Consent for Hemodialysis
Agreement ("Consent Agreement") to allow Defendant to receive regular dialysis treatments
from U.S. Renal Care as scheduled by her physician and U.S. Renal Care ("Dialysis"). A true
2
and correct copy of the Consent Agreement is attached hereto and incorporated herein as Exhibit
"A."
6. On or about February 28, 2011, Defendant also executed an Authorization for
Assignment of Medical Benefits and Payment Responsibility Agreement ("Assignment
Agreement"), which required the Defendant to assign and transfer any insurance money or
benefits that she received for the dialysis treatments from U.S. Renal Care. A true and correct
copy of the Assignment Agreement is attached hereto and incorporated herein as Exhibit "B."
7. Paragraph 5 of the Assignment Agreement provides that Defendant "hereby
authorize, request and direct any and all assigned insurance companies to pay direct to USRC,
Inc. the amount due me in my pending claims for benefits under the respective policies. I agree
that, should the amount be insufficient to cover the entire expense, I will be responsible for
payment of the difference, and that if the nature of the disability of such that it is not covered by
such policy, I will be responsible to USRC, Inc. for payment of the entire bill."
Paragraph 6 of the Assignment Agreement states that, "If any action or law inequity
is brought to enforce this agreement, USRC, Inc. shall be entitled to reasonable attorney's fees,
court costs, and any other costs of collection incurred. I understand that all bills are payable and
become due upon presentation."
9. U.S. Renal Care, at the special insistence and request of Defendant during the period
April 1 through April 29, 2011 ("Dates of Service"), provided Dialysis at the rates and on the
dates set forth in U.S. Renal Care's business records ("Account Statement"). A true and correct
copy of the Account Statement is attached hereto and incorporated herein as Exhibit "C."
COUNT I - BREACH OF CONTRACT
10. Paragraphs I through 9 are incorporated herein by reference.
11. The rates and total charges set forth in the Account Statement are just and
reasonable and are the rates that Defendant agreed to pay for the Dialysis.
12. Under the terms of Defendant's policy with her insurance provider, Carefirst,
Defendant received monthly checks from Carefirst pursuant to the claims filed by U.S. Renal
Care.
13. Pursuant to the Assignment Agreement attached as Exhibit B, Defendant was
required to transfer the payments she received from Carefirst directly to U.S. Renal Care upon
receipt.
14. Under the terms of the Authorization and Assignment Agreement and
Defendant's insurance policy agreement, Defendant had a duty to transfer $87,435.05.
15. As provided from Carefirst's records, Defendant received a total of $87,435.05
from Carefirst for the Dialysis treatments during the Dates of Service.
16. Defendant failed to transfer the insurance checks that she received from Carefirst.
17. The total amount of principal that has become due and owing by Defendant to
U.S. Renal Care as a result of her failure to transfer the insurance payments that she received and
her failure to pay the charges is $115,637.13.
18. To date, Defendant has failed and refused to pay the total due as provided under
the Account Statement and the Assignment Agreement.
19. Defendant's failure to transfer the insurance checks she received from her
insurance carrier for Dialysis constitutes a breach of contract.
20. U.S. Renal Care has been financially damaged in the amount of $115,637.13, plus
interest and costs of collection.
4
WHEREFORE, Plaintiff, U.S. Renal Care, LLC d/b/a U.S. Renal Care, demands
judgment against Defendant in the sum of $115,637.13, plus attorney's fees and costs, which
sum does not exceed the local limit for arbitration.
COUNT II - QUANTUM MERUIT - UNJUST ENRICHMENT
If this Honorable Court should find that an express contract did not exist between U.S.
Renal Care and Defendant, which is denied, then, in that event, U.S. Renal Care pleads the
following alternative cause of action in quantum meruit against the Defendant.
21. Plaintiff incorporates paragraphs 1 through 20 of this Complaint as if set forth at
length herein.
22. Having requested U.S. Renal Care to provide the dialysis treatments and U.S.
Renal Care having done so to the benefit of Defendant, Defendant became liable to U.S. Renal
Care for the just and reasonable charges for the Dialysis.
23. The Defendant has been unjustly enriched by accepting the Dialysis.
24. The rates reflected in the Account Statement as Exhibit C are the just and
reasonable rates for dialysis treatments and services.
25. The total value by which Defendant has become enriched on account of the
Dialysis is $115,637.13, as is more specifically reflected in the Account Statement.
26. U.S. Renal Care has demanded Defendant pay this amount, but Defendant has
failed to do so.
27. To date, the Defendant has not paid the total amount due.
WHEREFORE, Plaintiff, U.S. Renal Care, LLC d/b/a U.S. Renal Care, demands
judgment against Defendant in the sum of $115,637.13, plus attorney's fees and costs, which
sum does not exceed the local limit for arbitration.
5
COUNT III -CONVERSION OF MONEY
28. U.S. Renal Care incorporates Paragraphs 1 through 27 of this Complaint as if set
forth herein.
29. Defendant was aware that due to the contractual relationship between Defendant
and U.S. Renal Care pursuant to the Assignment Agreement, the insurance payments Defendant
received from Carefirst properly belonged to U.S. Renal Care.
30. Defendant had a legal and contractual duty to safeguard and forward the insurance
payments by Carefirst made payable to Defendant to reimburse U.S. Renal Care for the Dialysis
it provided to her.
31. During the Dates of Service, Defendant's insurance provider paid to her
$87,435.05.
32. Defendant intentionally and permanently retained possession of the monies owed
to U.S. Renal Care by failing to transfer a total of $87,435.05 of the insurance benefits Carefirst
paid to her as required under the Assignment Agreement.
33. Defendant's intentional possession of and her failure to forward the Carefirst
insurance monies to U.S. Renal Care for the Dialysis provided to Defendant constitutes
conversion.
34. U.S. Renal Care has been financially damaged by Defendant's conversion in the
amount of at least $87,435.05.
WHEREFORE, Plaintiff, U.S. Renal Care, demands judgment against Defendant for
conversion in the sum of $87,435.05, plus attorney's fees and costs, which sum does not exceed
the local limit for arbitration.
6
t
Dated:
By:
7
Philip U. arholic, hsquire
Attorney .D. 86341
2933 North Front Street
Harrisburg, PA 17110
(717) 233-4101
Attorneys for Plaintiff
Respectfully submitted,
Fm:Capozzi and Associates, P.C. (717) 233-4103To:f-t Bonnie Newton: DCA v. Doris Wendt15:1 2 0811 811 1GMT-05 Pg 09-09
.
IN THE COURT OF COMMON PLEAS
FOR CUMBERLAND COUNTY, PENNSYLVANIA
U.S. RENAL CARE, INC. f/k/a DIALYSIS
CORPORATION OF AMERICA d/b/a
DCA OF HYATTSVILLE,
Plaintiff
V.
DORIS WENDT,
Docket No.:
Civil Action - Law
Defendant
VERIFICATION
I, Joanne Zimmerman, Vice President of Clinical Services, of U.S. Renal Care, Inc., owner
and operator of DCA of Hyattsville, do hereby verify under penalties of perjury and upon
personal knowledge that the contents of the foregoing Complaint are true and correct.
Date: FIA 3 A(11//
Joanne Zimmerman, Vice President
of Clinical Services
U.S. Renal Care, Inc.
214 Senate Avenue, Suite 300
Camp Hill, PA 17011
8
U. S. IRENAL AJU
M : INFORMED CONSENT FOR DIALYSIS EFFECTIVE DATE: 0112008
POLICY # C-FORMS-0160 1 PAGE 1 OF 11. 1 REVISION DATE:
DISCLOSURE OF INFORMED CONSENT FOR HEMODIALYSTS
bpi(
Patient Name:
1,W Date:
1. PATIENTS RIGHTS
As a patient, you have the right to be informed about your condition, and the recommended surgical,
medical, or'diagnostic procedure to be used so that you may make your own decision whether or not to
undergo the procedure, after knowing the risks and hazards involved. This disclosure is not meant to scare
or alarm you. It is an effort to make you better informed so you may give or withhold your consent to the
procedure.
11. Authorization for Procedure
Repetitive hemodialysis means that I will use the artificial kidney a minimum of 3 days per week, 3 - 6 hours
each session, depending on my medical problems and blood chemistries. The benefit of this procedure is
that it will clean excess toxins and fluid from the body which accumulate as a result of kidney failure. The
procedure is not without risks and these include; loss of blood, low blood pressure, blood clots, allergic
reactions, nausea and vomiting, cramping, heart arrhythmia, infection, and associated complications
including death.
I fully understand the above procedure and I voluntarily consent and authorize the hemadialysis procedure-
I understand that my physician may discover other or different conditions which require additional or
different procedures than those planned. I authorize my physicians and such associates, nurses,
technicians, and other heatthcare.pmviders to perform such other procedures which are advisable in their
professional judgment.
The benefit I expect to have from the procedure of dialysis is the maintenance of life, whereas without it, my
life would be considerably shorter. I would hope to have an improved state of health, although I do realize
that dialysis cannot take the place of normal functioning kidneys.
111. RIGHT To REFUSE TREATMENT
I understand that I have the right to refuse any procedure, withdraw from hemodialysis and ask questions
concerning the process. However, I do give the medical staff permission to render emergency care should
I not be able to give permission. awl r Patient Si r .
Date: OJT ,,6
Date: CT ??
US Rcnat Care, InC. proprietary and confidential information.
All Rights R03 :EXHIBIT
U.S.1RENAL CARE
AUTHORIZATION FOR ,ASSIG'NM ENT OF
jD17CALE1E1NEffF ANI3PAYI MNT RFIQPOIVgYBILITy
S Facility; HYATTSVILLE
As a condition of my treatment with U.S. Renal Care, Inc. and its subsidiaries ("USRC, AA,"), I agree to
the following;
Communications Authorization: USRC, Inc., its physicians, and nursing and billing staffs are authorized
to use telephone message systems to aid conunnnfeations with me, or my authorized representatives,
regarding my treatment, appointments, financial arrangements, and in response to any request I have
initiated.
Authorization to Release Information: I certify tbat the information given by me in applying for
payment under Title P7M and/or YIX of the Social Security Act is correct. I also authorize USRC, The, to
release to the Centers for Medicare dr Medicaid Services or its intermediaries or the insurance carrier(s)
liable for all or part of US12C, Inc.'s charges information necessary to determine benefits entitlement and to
process payments of claims for health care services provided to me. I consent to the review of
,patient/chent records including medical records by any Federal, State, or Accrediting Body or Agency as
required by the Regulatory. Licensing, or Accrediting body. This authorization shall be valid for the period
of time necessary to process claims pertaining to these services,
Denial ofPapment: USRC, Inc. will make every effort to obtain payment authoriziidon/pre-authorization
for all managed care contractual or Medicare supplemental agreements unless prohibited by contractual
agreemennk I realize, however, obtaining the authorization or referral is ultimately my responsibility and if
one is not obtained, any non-payment of claims will be my responsibility. I Agree, I shall be jointly 'and
severally financially responsible for any portion of USRC, Zuc.'s invoice that is not paid.
Assignment of Insura"ce Benefits: Thereby authorize, request and direct any and all assigned insurance
companies to pay direct to VsRC, Inc. the amount due rue in my pending claims for benefits under the
respecdV0 policies. I agree that, should the -amount be insufficient to cover the entire expense, I will be,
responsible for payment of the difference, and that if the nature, of the disability be such that it is not
covered by such policy. I will be responsible to USRC, Inc, for payment of the entire bill.
If any action or law inequity is brought to enforce this agreement, USRC, .Inc. shall be entitled to
reasonable attorney's fees, court cost, and any other costs of collection incurred, I understand that all bills
are payable and become due upon presentation.
I and/or patient agree to execute any documents and perform any acts that USRC, Inc, may reasonably
request The undersigned warrant and represent that attached are originals or certified copies of any
legal applica guarbledian power of Of Patient. attorney, health care surrogate forms, or court orders appoim[ing the undersigned Of
the
I have read this contract and I understand it I will receive a copy upon request.
EXHIBIT
B
A, copy of any Or all above. signatures is as valid as the original.
DCA OF HYATTSVILLE LLC
P O BOX 713158
CINCINATTI, OH 45271--3158
(214) 736-2700
Statement Date: 08/17/11
Service Period: 04/01/11 to 06/17/11
ACCT: 9886
Name: WENDT, DORIS 1
12462 DALTON TRAIL
LUSBY, MD 20657
If you have questions call 214-736-2781.
Balance Due: 5115,637.1 MEMO:
( Send above portion with your payment )
------- -- - - --------------- ---- ---- - ------------- -- - ----
( Please retain this portion for your records )
ACCT: 9886
Name: WENDT, DORIS I
Insurer: - Secondary
Service Service
Claim# Rendered By Date Description
184870 158 04/01/11-04/29/11 HEMODIALYSIS TREATMENT
215400 158 06/01/11-06/17/11 HEMODIALYSIS TREATMENT
TOTAL:
Statement Date: 08/17/11
Service Period: 04/01/11 to 06/17/11
Balance
Charges Payments Adjustments Due
$63,318.98 $20,000.00 $0.00 $44,476.39
$71,160.74 $0.00 $0.00 $71,160.74
$134,479.72 $20,000.00 $0.00 $115,637.1
Please pay this amount
August July June May Before May Total
$0.00 $0.00 $71,160.74 $0.00 $44,476.39 $115,637.13
EXHIBIT
U.S. RENAL CARE, INC. f/k/a
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF HYATTSVILLE,
Plaintiff
V.
DORIS WENDT,
Defendant
C=
S CD
? ..f!
IN THE COURT OF COMMON
AS" ®F
CUMBERLAND COUNTY, PEr L AN
C:) _n
Docket No.: 2011-06881 F-C) o
Civil Action - Law
PRAECIPE TO SETTLE AND DISCONTINUE
TO: THE PROTHONOTARY OF CUMBERLAND COUNTY, PENNSYLVANIA
Kindly mark the above-referenced action as SETTLED and DISCONTINUED.
Respectfully submitted,
Date: By:
CAPOZZI & ASSOCIATES, P.C.
Philip C. ho?lic, Esquire C
Attorney I t # 86341
1200 Camp ill By-Pass, Suite 205
Camp Hill, PA 17011
(717) 233-4101
Attorney for Plaintiff
/J
U.S. RENAL CARE, INC. f/k/a
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF HYATTSVILLE,
Plaintiff
V.
DORIS WENDT,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Docket No.: 2011-06881
Civil Action - Law
CERTIFICATE OF SERVICE
I, hereby certify that I have, this date, served a true and correct copy of the foregoing
Praecipe to Settle and Discontinue by causing a copy of same to be deposited in the U.S. Mail,
first class, postage prepaid, addressed as follows:
Richard D. Lloyd, Esquire
Suite 209 A
135 West Dares Beach Road
Prince Frederick, MD 20678
r
Date: / 3 L By: n 0
Philip C. arholic, Esquire
Attorney # 86341
1200 C Hill By-Pass, Suite 205
Camp Hill, PA 17011
(717) 233-4101
Attorney for Plaintiff
r-