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HomeMy WebLinkAbout11-6883!T, U.S. RENAL CARE, INC. f/k/a IN THE COURT OF COMMON PLEAS OF DIALYSIS CORPORATION OF AMERICA : CUMBERLAND COUNTY, PENNSYLVANIA d/b/a DCA OF CINCINNATI, Plaintiff 'L' V. Docket No.: 1 ',b 3 `' ??L It?rA PATRICIA MASON, 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. : 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 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. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 r 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 CINCINNATI, Plaintiff V. PATRICIA MASON, Defendant CIVIL COURT DIVISION 3 N ? c --+ zrn rv y - MF -u :Z:;u 4n r' c rn ?c? N - ._.) om , C:)-n =CD - Docket No.: ,. .. - ? Civil Action - Law COMPLAINT NOW COMES, U.S. Renal Care, Inc. f/k/a Dialysis Corporation of America d/b/a DCA of Cincinnati ("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 its principal a place of business at Camp Hill, Cumberland County, Pennsylvania. 2. Defendant Patricia Mason ("Patient" or "Defendant") is an adult individual with a last known address at 3820 Llewellyn Avenue, Cincinnati, Ohio 45223-2352. 3. The clinic formerly known as DCA of Cincinnati is an operating subsidiary of U.S. Renal Care with a dialysis clinic located at 7600 Affinity Drive, Mt. Healthy, Ohio 45231. 4. U.S. Renal Care provides dialysis treatments and services to its patients. 5. On or about May 14, 2008, Defendant executed a Consent for Hemodialysis Agreement ("Consent Agreement") to allow Defendant to receive regular dialysis treatments 2 from U.S. Renal Care as scheduled by her physician and U.S. Renal Care. A true and correct copy of the Consent Agreement is attached hereto and incorporated herein as Exhibit "A." 6. On or about May 14, 2008, Defendant executed a Patient Assignment and Authorization of Payment of Insurance Benefits Agreement ("Assignment and Authorization 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 and Authorization Agreement is attached hereto and incorporated herein as Exhibit "B." 7. Paragraph 5 of the Assignment and Authorization Agreement provides that Defendant "hereby acknowledges that, notwithstanding the foregoing assignment and authorization of benefit payments to U.S. Renal Care, the Patient shall be responsible for any and all charges and costs billed by U.S. Renal Care for dialysis treatments and related services ... and that U.S. Renal Care is authorized to bill the Patient directly for payment of such charges and costs." 8. U.S. Renal Care, at the special insistence and request of Defendant during the period May 2009 through July 2010 ("Dates of Service"), provided numerous separate dialysis treatments ("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." 9. On March 28 and April 26, 2011, U.S. Renal Care's counsel mailed to Defendant a demand letter, which provided information on how to pay the debt owed to U.S. Renal Care. A true and correct copy of the demand letter is attached hereto and incorporated herein as Exhibit «D 3 COUNT I - BREACH OF CONTRACT 10. Paragraphs 1 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, Medical Mutual of Ohio, Defendant received monthly checks from Medical Mutual of Ohio pursuant to the claims filed by U.S. Renal Care. 13. Defendant's insurance provider did not always pay 100% of U.S. Renal Care's claims, which resulted in Defendant owing a co-pay to U.S. Renal Care ("Co-pay"). 14. Pursuant to the Assignment and Authorization Agreement attached as Exhibit B, Defendant was required to transfer the payments she received from Medical Mutual of Ohio directly to U.S. Renal Care on a monthly basis. 15. The amounts that Defendant received from Medical Mutual of Ohio pursuant to the claims submitted by U.S. Renal Care are indicated in the "Amount Paid" column. 16. As provided from Medical Mutual of Ohio's records, Defendant received a total of $53,186.46 from Medical Mutual of Ohio for the Dialysis treatments during the Dates of Service. 17. Defendant failed to transfer the insurance checks that she received from Medical Mutual of Ohio. 18. 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 $156,643.08. 4 19. To date, Defendant has failed and refused to pay the total due as provided under the Account Statement and the Assignment and Authorization Agreement. 20. Under the terms of the Authorization and Assignment Agreement and Defendant's insurance policy agreement, Defendant had a duty to transfer $53,186.46. 21. Defendant's failure to pay her Co-pay, her failure to transfer the insurance payments, and her failure to cure her default with U.S. Renal Care pursuant to the Assignment and Authorization Agreement constitute a breach of contract. 22. U.S. Renal Care has been financially damaged in the amount of $156,643.08, plus interest and costs of collection. WHEREFORE, Plaintiff, U.S. Renal Care, LLC d/b/a U.S. Renal Care, demands judgment against Defendant in the sum of $156,643.08, plus interest at the legal rate of 6% per annum from the date of the judgment. 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. 23. Plaintiff incorporates paragraphs 1 through 22 of this Complaint as if set forth at length herein. 24. 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. 25. The Defendant has been unjustly enriched by accepting the Dialysis. 26. The rates reflected in the Account Statement as Exhibit C are the just and reasonable rates for dialysis treatments and services. 27. The total value by which Defendant has become enriched on account of the Dialysis is $156,643.08, as is more specifically reflected in the Account Statement. 28. U.S. Renal Care has demanded Defendant pay this amount, but Defendant has failed to do so. 29. 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 $156,643.08, plus interest at the legal rate of 6% per annum from the date of judgment. COUNT III -CONVERSION OF MONEY 30. U.S. Renal Care incorporates Paragraphs 1 through 29 of this Complaint as if set forth herein. 31. Defendant was aware that due to the contractual relationship between Defendant and U.S. Renal Care pursuant to the Assignment and Authorization Agreement, the insurance payments Defendant received from Medical Mutual of Ohio properly belonged to U.S. Renal Care. 32. Defendant had a legal and contractual duty to safeguard and forward the insurance payments by Medical Mutual of Ohio made payable to Defendant to reimburse U.S. Renal Care for the Dialysis it provided to her. 33. During the Dates of Service, Defendant's insurance provider paid to her $53,186.46. 6 34. Defendant intentionally and permanently retained possession of the monies owed to U.S. Renal Care by failing to transfer a total of $53,186.46.of the insurance benefits Medical Mutual of Ohio paid to her as required under the Assignment and Authorization Agreement. 35. Defendant's intentional possession of and her failure to forward the Medical Mutual of Ohio insurance monies to U.S. Renal Care for the Dialysis provided to Defendant constitutes conversion. 36. U.S. Renal Care has been financially damaged by Defendant's conversion in the amount of at least $53,186.46. WHEREFORE, Plaintiff, U.S. Renal Care, demands judgment against Defendant for conversion in the sum of $53,186.46, plus interest at the legal rate of 6% per annum from the date of judgment. Dated: f (u C it By: Respectfully submitted, Capozzi & Associates, P.C. 7 Philip C. arholic, Esquire Attorney I .86341 2933 Nort Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Plaintiff 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 CINCINNATI, Plaintiff V. Docket No.: PATRICIA MASON, Civil Action - Law Defendant VERIFICATION 1, Joanne Zimmerman, Vice President of Clinical Services, of U.S. Renal Care, Inc., owner and operator of DCA of Cincinnati , do hereby verify under penalties of perjury and upon personal knowledge that the contents of the foregoing Complaint are true and correct. Date: anne Zimme n, Vice President of Clinical Services U.S. Renal Care, Inc. 214 Senate Avenue, Suite 300 Camp Hill, PA 17011 8 DIALY'5Is COOO. kTION O)' AAI)'C WCA D.CA O ' Cincintad Cols NT FOR HE MODIALYSIS 4 w~ z8 Patient: er:.. Date: ( } r, tl:c unden?si?'-,1?eG paileilt; ( ) I, the undersigned parent or guardian of the above patient who is under 18 years of age or otherwise incapable of consenting; hereby request and authorize Dr, . -_A and whomever he. or she may designate as his or her associate or assistan _t administer to rn.e (or to the above named patient) the procedure known as hc,modialysis, under such conditions as shall be detennine'd by the physician (s) in altendance. I agree to abide by the policies, rules, and regulations established by the above muned Dialysis Unit in earTr ug out its herhod.ialysis program. It has been explained to me that hmaodialysis is a procedure used in the case of patients with irnpairment of failure of kidney function by which certain components of the blood are separated by a semi-peianeable substance which permits (he passage of certain :molecrnl.es and hinders that of others when the blood is oirculat:ed fluongh an artificial kidney, called a dialyzes. I u:ridcrstaznd that there are different types of equiprnenl: employed for the dialysis treatrnmt and di:fCerent types of azt:ificial kidneys (dialysers) used in the process. I acknowledge that the possible risks and complications of hemodialysis such as but riot ed to leakage of the dialyzex, changes iii blood pressure, hemolysis, hypoxmmia, heart anythrnias, and malfunction of equipment have been explained to me by the px,ofessional personnel of the Dialysis twit and I accept, on behalf of myself and/or the above patient the dialysis fteatment with all potential rislcs and. cornplications. I also understand that any disorder, which afflicts me, oaxi have effects on my treatment and on myself during the time that I ann receiving a dialysis treatment but that this fact does riot mean that tkae dialysis treatment had anything to do with the development of the problern related to this condition. further consent to the adnninishxatian of'such drugs, transfusions of blood. or blood compornernts, or any otl ae treatment and testing, 'including 111•V testing, deemed necessary or desirable Yn the judgruent of the physician (s) in attendance. I am aware that the practice, of medicine is :aot an exact science, and I a.cletrowledge that -no guarantee, warranty of representation whatsoever has been.o:ffered or made -to Tne or anyone, onz nnay'belnrlll' aoncerxring the results of tare 'hennodialysis procedure. xrature: C? (! _ f? 1ti ??? or __ Natzer.?t Legal Guardian orr Parent Da __-- Vol DCA Fo m t l 049 Revised 10100, 8/02 iIBIT T . ;- ..? VIALy,$IS COItPORAI'ION OF A1VII!+RI 1 PATIENT .ASSIGNMEN'T' AN.U AUTHORIZATION O:c PAYM, NT OF INSURANCE DI N.1PITS• lDatoi c? ...1? . 4-?::6 patient IU#,t ?? .•t? Patient Mimi ?, -. (t?leaeo t>cini) j, ASSIGNMENT 'rho undorsi nod hereby flosigtis, trat,0098 And sots over to DCA of Clnoiunati monioe and/or benefits to. alco%p1Quo Provider 01, natiolial, otato, ogt mn , no Wo11 is Any oth rs which the Patient Is r(or nmo itnt be) ontiltIod a h£oludhiig die alidlor ooulhty or looAl govoln 6o1 oyY, T by and other hvaldi dialysis who l bo lannnolally ln©atli inoluding pattolit'D suranoo (iibomfits l mmoo modloal bouot o by and/or at DCA of Ci ic , rondored Paftit Is sis tro payment all(] sor o os allpoliother aedlool l' oaro whioll the 1 atltont by and/or at Coots dialysis DCA of dialysis hoaimon ont all(] servlaos Arad i? Cinatitiiati, 2, A V Tjj0juzA'I ON 01T rA'YM&.r Olt INSWUNCE' WENrL`FI`I'S - and 'rho uudersigl2od hereby authollto diroots that oosteoinc?ti?eall diIa ua result of ?li?a,tyrsis hbiaigi? modloaro paid banolits, if apl?lioable, rolating y oliarg? A , be aild rotated so otl and modioal d ill gooordanco with 1 stroottons lpo'vld%l or toibo provided by all ro,nlttvd dit irectly to DCA CA of Cinolml agont or reph'osontadve of DCA of Cnoinnati, If the Un iAo llt?(1'H les ii, t io undo siigood hereby ill for paymont of tile monios or bonefito mo And lnstruow tho lnsulanoo in the nn?no o of WA of o£ Citi Cino nua sat > moat in provkior or 080noy lnsponislble for paymout of th0 apptlooblo iosuranoe bon0f'lts to isshis the pay the Patlont'e name slid to dollvor said paymont to DCA of Chiolunsitl. at Its- a(ldrooe as set forth in the instmoti011e provided or to be provido(t by an agont or roprosotativo of nCA of Cinoinnad. 3. X)i+] AVER Y OV DYNBIt r PAYMENTS RUCTUVROD FROM PROVXXDUR The undersigned licroby aelmowledges that the 3nontes or benefits to be paid by tlho Patient's DCA Cheri in prbvider or government e tre.tntentsoand retatcd fees and medical cure to the Cincinnati in 11 Its s p rovlsl011 oll of of dialysis Patient Is and slhall at till tinges reinaln, the property of ACA of ClsicInnoti, and In furtberanee (hereof the undersigned hereby covenants and agrees that lit the event that. tiny paytYhohat of insurame benefits, Including Medicare benefits, which relate.directly to tile, charges, costs and fees Incurred by ACA of Cincinnati as a result of Its provision of dialysis treatments and relitted services and medical cam to the Patient, Is sent to the Patient or such Patlent'ti gaardltm, attorney"iii"fact or rcprescittative, as tike case may be, Inadvertently or othorwise) that the undersigned will promptly And uncondltlonally forward such paymeu:t directly to DCA of Cincinnati, :gage 1 of 2 EXHIBIT 9 1 ' _c-u 'U61 a 4, It1aL11+A,5E 01? 1NYORMATION Tho, widorolglled 110y0by authorizos and 0011sents to Clio release by MA of Onoinnad, 01' any of Its agents or reprvsontatlvos, of, all of part of au?r infoilnatlon, rocords or reports, either modlool or BlIanolal ila ltawm -to or -with any poison, 001-polwon or govorlunout agalloy, lnoludilnat?. any tbird•pnrtg lnsuranoo; W/o 110a1t11 001-0 provider, w110 is Ofinnoially.liable'for thho ation4 substantiation, deon l4 *01 d rolote and/or sorvloog ne well as tnodioal oaro, v hioh information is Y for ooAlnation of paylnont of charges [old oosts to DOA of Cluoinnati for tiro provision to the Podont of such dialysis tlnatmonts and related servloos as well as modlool oars. The undorsiglled hereby aoh(nowleclgos that, notivitlwtandhlgg the foregoing asslgntllont and atltllorization of bonofit payments to DCA ofi Chlohwad, lira Ptttiout a11a11 be responsible for any and all 6100i3es and coots billed by DCA of Ciaolanati for dialygig i1-e4imonts and rolatod oervhoes pi'ovldod and.not.othvrtiviso oouoti or pai(1 by ouch o a and thataDON of C1n0 tuttatl is without t0 b ll the dedclotiblo, ca-lnsuialtoo fld opflynio 1t atops, Patient directly for payment of suoh ohorgos mid.oosti, RE'SVONS)<BILITY FOR PAYMi1' N'TS. Tho undorsignod lioroby aoknowledgdo t1+at this PATIENT ASSSSION revoked unless s Ur 10 ava Kon.U is oft PAYM13NT OF 1NSURAN(X 1)T?N13ljTS may not aooompnniod by the writion oomoJlt to suoh rovoootlon by DCA of Cinoinnag. G, RCVOCA,TtITal(`1'X' P110 TOCOVIRS The undet'sigaod hereby' &81008 Chat a photocopy of ihls PATA*NT ASSIONMENT AND AUTHORIZATION OF PAYMENT OF INSURANCE BBNBVrfS shall be 001101dore(1 as vall(l as at1 original for purposes hereof atld.nay be ..Sell It, place of the original with rospeot•to ea,011 of items l through S above 81gllattll®; 11t,10 Naino: Y) jmo: If you ace signing as a guardian, at(oitloy-ln.faot or reprosontfitivo of a pationt, pleases llulioatO by Marking the box and obnlploto die information below; 0 C% 11trIVICA'.CIoN Orr (,1,vAttj)XANtA,')<TO111N0'SIMXN-V A.G`T7MMINS)WA'1'ZVO The undorolglUxi hlabuvcrm 0rdfj onCtortvdtpa?vnt, and that 110/8110 11.118 X11 ?uthox'I y to exoouto t is forill on reprosolltative of the behalf of suoh dependent pationt. Witness; ..? M._ .._ ,, _ . _ .. -.., w hint Name: ? ?.?._ ._.... _ _ _. _ ?.? ... .Page 2 0 2 • Received: Mar 31 2011 07:46pm 03/31/2011 20:48 7177308596 BILLING PAGE 02/05 DIALYSIS ? CORPORATION of AM E81 CA Patient Accounting Department 214 Senate Avenue, Suite 300 Camp Hill, PA 17011 Tel: 866-390-0376 Fax- (717) 730-8596 Patient Name, Patrica Mason 1930 Adams Road ^ - Apt 3 Cincinati, CH 45231 Notice of Account Outstanding Date of Bill Date of Previous Bill ID O Statement# 1/17/2011 12/9/2010 574 3 D.O.s insurance Co. Group # Policy 3/1-31/10, 5/10.7/10 Amount of Payment $ Piraae Make Checks Payable to Dialysis Comoratlon *FAniorico and Return This Portion with Your Psyrflent, Qty Service Description of Dialysis allied to Paid Patient Dates of Service Code Service Total Cho a Insurance Amount 5/1.31/10 1 90999 Hernodlalysls $ 42,025.81 $ - $ 97AS $ 41,927.96 6/1-30/10 1 90999 Hemodialysis $ 28,564.28 $ - $ 5 28,564.28 7/1.31/10 1 90999 Hemodialysis $ 86,150.84 $ - $ - $ 86,150.84 TOTALS $156,740.93 $0.00 $97.85 $156,664433,0088 PLEASE SEND EXPLANATION OF BENEFITS WITH YOUR PAYMENT. Questions? Please Ca11838-73"164 Monday through Friday SAM to 430 PM EST P8 This Amount ?156,643.08 Additional patient billing may be necessary fpr any ehargos not posted when this was prepared, or it any InAuranea earners do not pay arty part.of the amounts bi11Rd to Insummce.. EXHIBIT Received: 03/31/2011 20:48 7177308596 Mar 31 2011 07:46pm BILLING PAGE 03/05 DIALYSIS ? CORPORATION Of AMERICA Patient Accounting Department 214 Senate Avenue, Suite 300 Camp Hill, PA 17011 Tel: 866-390-0376 Fax: (717) 730-8596 Notice of Account outstanding Date of Bill Date of Previous Bill ID # Statement # 1219/2010 11/8/2010 574 3 Patient Name Patrica Mason 1930 Adams Road Apt 3 Cincinati, OH 45231 D.O.S insurance Co. Group iY Policy 3/1-31/10 5/1-31/10 6/1-30/10 Amount of Payment $ Pleale Make Checks Payable to Dlolysle corporation of America and Rctyrn Thiz Portion with Your Payment, { City Service Description of Dialysis Billed to Paid Patient Dates of Service Code Service Total Cha a Insurance Amount 3/1-31/10 1 90999 Hemodlalysis $ 46,926.20 $ - $ $ 35,926.20 5/1-31/10 1 90999 Hemodialysis $ 42,025.81 $ - $ - $ 42,025.81 6/1-30/10 1 90999 Hernodialysis $ 28,564.28 $ - $ - $ 28,564,28 TOTALS $117,516.29 $0.00 $0.00 $106,516.29 PLEASE SEND EXPLANATION OF BENEFITS WITH YOUR PAYMENT. Questions? Please call 866.730.6164 Monday through Friday SAM to 430 PM EST Pay This Amount $106,516.29 Additional patient billing may be necessary for any charges not posted when this was prepared, or If any insurance carriers do not pay any part of the amounts billed to Insurance. jillm" watt" 0 W 0 000& 4579 Mason, Patricia Medical Mutual of OH Transferred Out Cincinnab - 08/2010 4579 Mason, Patricia Medical Mutual of OH Transferred Out Cincinnati 09/2010 lam. pwida- T `t}t±t Ci .. s 4579 Mason, Patricia Medical Mutual of OH Transferred Out Cincinnati 10/2010 wow> 4579 Mason, Patricia Medical Mutual of OH Transferred Out Cincinnati 11/2010 4579 Mason, Patricia Medical Mutual of OH Transferred Out Cincinnati 06/2010 4,09 _ Mason, Patrkla... Medici IvluuaCz„ :... Transferred Oaf Cialrl tl 0712010 TJ ?,.iYFdr 3,04*A2 I A . Will Not Disclose 10/11/2010 $ 3,310.33 90106 " Will Not Disclose 10/11/2010 $ 2,819.79 98240 L x/Ztf a1 S 6,176,57 _ 4296271 10/25/2010 $ 2,738.58 106162 4001M-V:,'? 2, 64 10-AW Will Not Disclose 12/13/2010 $ 3,095.93 116459 ,.. 6/ $ 6, 7:0$ 16 Will Not Disclose 8/16/2010 $ 1,932.46 17 Wiii Nat Dim 10/15/2010 $ 11,107.11 18 4629674 1/10/2011 F ? F S K 4614 1/17/20€1 $ 2,529.98 127906 Louis J. Capozzi, Jr., Esquire* Daniel K. Natirboff, Esquire Donald R. Reavey, Esquire Craig 1. Adler. Esquire** Bruce G. Baron, Esquire Andrew R. Eisemann, Esquire Michael M. Jerominski, Esquire Dawn L. Richards. Esguire Timothy Ziegler, Reimb. Analyst Karen L. Fisher, Paralegal Keyoung J. Gill, Paralegal Michele A. Candy, Paralegal * (Licensed in PA, NJ and MD) ** (Licensed in PA and NJ) Patricia Mason 1930 Adams Road, Apt. 3 Cincinnati, OH 45231 2933 North Front Street Q Harrisburg, PA 17110 Ca O I.C.X. SsQC- * '? . Telephone: (717)2334101 turn`, y Facsimile: (717) 2331103 »: •- www.capozziassociates.com 40v Mid-Penn Abstract Company s Charter Settlement Company C Telephone: (717) 234-3289 Facsimile: (717) 234-1670 March 28, 2011 RE: DCA of Cincinnati Account Balance: $185,714.47 Our Matter No.: 706-03 Dear Ms. Mason: Please be advised that our law firm represents Dialysis Corporation of America regarding your delinquent account. Your Payment Agreement with our client is currently in default. If you fail to cure the default or contact me to make payment arrangements, we will prosecute a lawsuit, if necessary, against you to obtain asset information, force a settlement, or obtain a money judgment. You received 78 treatments from our client's facility in Cincinnati, Ohio from May 2009 through July 2010, and your health insurance carrier provided checks to you for the specific purpose of reimbursing the Dialysis Corporation of America. You have failed, however, to transfer the payments as required by the Provider Agreement, which may be prosecuted as insurance fraud. In addition, you have failed to fulfill your obligations pursuant to the Repayment Agreement. When suit is filed it may give rise to the following consequences: 1. To defend this suit, it may be necessary for you to appear in court. 2. If a judgment is obtained against you, you may be required to pay court costs, attorney's fees, and interest in addition to the money you now owe. 3. If a judgment is obtained against you, a writ of execution may be issued ordering the seizure and sale of your personal or real property. 4. A judgment is a matter of public record, and it will negatively affect your credit rating. NOTICE: UNLESS YOU DISPUTE THE VALIDITY OF THIS DEBT, OR ANY PORTION THEREOF, WITHIN 30 DAYS AFTER RECEIVING THIS NOTICE, THE DEBT WILL BE CONSIDERED TO BE VALID. IF YOU NOTIFY OUR OFFICE IN WRITING WITHIN 30 DAYS AFTER RECEIVING THIS NOTICE THAT THIS DEBT, OR ANY PORTION THEREOF, IS DISPUTED, WE WILL OBTAIN VERIFICATION OF EXHIBIT THE DEBT AND WE WILL MAIL A COPY TO YOU. THE NAME OF THE ORIGINAL CREDITOR OF THIS DEBT IS IDENTIFIED ABOVE. THIS LETTER AND ALL OTHER COMMUNICATIONS FROM US ARE ATTEMPTS TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. Please make arrangements to pay this debt in one or more installment payments, or you may call me if you have any other questions. You have the right to consult with an attorney for advice regarding this serious matter. I trust that you will give this Notice your immediate attention. lkjg cc: Bonnie Newton Louis J. Capozzi, Jr., Esquire* Daniel K. Natirboff, Esquire Donald R. Reavey, Esquire Craig I. Adler, Esquire** Andrew R. Eisemann. Esquire Bruce G. Baron, Esquire Michael M. Jerominski, Esquire Dawn L. Richards. Esquire Timothy Ziegler, Reimb. Analyst Karen L. Fisher, Paralegal Keyoung J. Gill, Paralegal Michele A. Candy, Paralegal * (Licensed in PA, NJ and MD) ** (Licensed in PA and NJ) Patricia Mason 1930 Adams Road, Apt. 3 Cincinnati, OH 45231 RE: DCA of Cincinnati Account Balance: $185,714.47 Our Matter No.: 756-11 Dear Ms. Mason: 2933 North Front Street Harrisburg, PA 17110 Telephone: (717) 233-4101 Facsimile: (717) 233-4103 www.capozziassociates.com Mid-Penn Abstract Company Charter Settlement Company Telephone: (717) 234-3289 Facsimile: (717) 234-1670 As you are aware, our law firm represents U.S. Renal Care f/k/a Dialysis Corporation of America regarding the above-referenced delinquent account. You have failed to respond to my letter, dated March 28, 2011, attempting to resolve this matter in an amicable manner. Accordingly, you have left me no choice but to advise our client to proceed with civil litigation to obtain a Money Judgment for the full amount owed, plus interest, attorney's fees, and costs of collection. Please call or write to me immediately if you would rather settle this matter and make flexible payment arrangements. Otherwise, this will be my final communication to you before we file the civil Complaint to obtain a money judgment for the full amount owed, plus costs of collection. /kjg cc: Bonnie Newton THIS LETTER AND ANY FUTURE LETTERS FROM OUR FIRM ARE AN ATTEMPT TO COLLECT A DEBT, AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. April 26, 2011 V It U.S. RENAL CARE, INC. f/k/a IN THE COURT OF COMMON PLEAS OF DIALYSIS CORPORATION OF AMERICA CUMBERLAND COUNTY, PENNSYLVANIA d/b/a DCA OF CINCINNATI, Plaintiff V. PATRICIA MASON, Defendant Docket No.: 2011-6883 Civil Action - Law PRAECIPE TO ENTER RETURN OF SERVICE TO THE PROTHONOTARY/CLERK OF SAID COURT: C o ° r < ca A pc z 77 a t o -< rv Kindly enter as a matter of record the attached Affidavit of Service form as proof of personal service of the above-referenced Complaint upon the Defendant at 1930 Adams Road, Apt. 3, Cincinnati, Ohio. A competent adult served the Complaint in accordance with Pa.R.C.P. No. 402(a) on December 8, 2011. Dated: i Ph'Plip C. arholic, Esquire Attorne aD. No.: 86341 Capozzi Associates, P.C. 1200 Camp Hill By-Pass, Suite 205 Camp Hill, PA 17011 (717) 233-4101 Attorney for Plaintiff U.S. RENAL'CARE, INC., F/K/A DIALYSIS CORPORATION OF AMERICA, D/B/A DCA OF CINCINNATI Plaintiff VS. PATRICIA MASON Defendant Person to be served (Name and Address): PATRICIA MASON 1930 ADAMS ROAD APT. 3 CINCINNATI OH 452## By serving: PATRICIA MASON Attorney: PHILIP C. WARHOLIC, ESQ. Papers Served: NOTICE TO DEFEND, COMPLAINT, VERIFICATION, EXHIBITS A-D Service Data: [A Served Successfully [ ] Not Served Date/rime: -(= 46 o rn ] Delivered a copy to him/her personally 111 Left a copy with a competent household member over 14 years of age residing erein (indicate name S relationship at right) SKIN: f- HAIR: ?_ OTHER: ] Left a copy with a person authorized to accept service, e.g. managing agent, app registered agent, etc. (indicate name & official title at right) Oescrlption of Person Accepting Service: SEX: a AGE:. HEIGHT: 6' I 1 WEIGHT: 24-) Unserved: ] Defendant is unknown at the address furnished by the attorney ] All reasonable inquiries suggest defendant moved to an undetermined address ] No such street in municipality ] Defendant Is evading service ] No response on: Date/Time: Date/Time: Date/Time: Other: 0111A? f1Rif Served Data: Subscribed and Sworn to me this ` '/ day of "LP -c 20 w l m NotarySignature: Name of Notary Commission Expirafio'n `am Court Of (60-0) $ CttmNo Venue Docket Number: 11 6883 CIVIL TERM AFFIDAVIT OF SERVICE (For Use by Private Service) Cost of Service pursuant to R. 4:4-3(c) Attempts: Date/Tlme: Date/Time: Date/Time: Name of Person Served and relationship/title: was at the time of service a competent adult, over the age of 18 and not having a direct interest in the litigation. I declare under penalty of perjury that the foregoing is tru and correct. N' ?- I201f Si ture of Process Server D e J,q, t4 U.S. RENAL CARE, INC. f/k/a DIALYSIS CORPORATION OF AMERICA d/b/a DCA OF CINCINNATI, V. PATRICIA MASON, Plaintiff Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Docket No.: 2011-6883 Civil Action - Law c -O:x MW Z? cn r rz c? v c-) ZO D? x --i N N N ?c iV tT Q rn -urn ?:0p C) -4 C} own ocs __4 M p? PRAECIPE TO ENTER DEFAULT JUDGMENT TO THE PROTHONOTARY/CLERK OF SAID COURT: Pursuant to Pa.R.Civ.P. No. 1037(b), enter judgment in favor of Plaintiff, U.S. Renal Care, Inc. f/k/a Dialysis Corporation of America d/b/a DCA of Cincinnati, and against Defendant, Patricia Mason, for failing to file an Answer to Plaintiff's Complaint within twenty (20) days from the date of service of said Complaint and assess Plaintiff's damages certified to be calculable as a sum certain from the Complaint. I hereby certify that: Principal Amount Due: $156,643.08 Attorney Fees: $ 2,146.00 Cost of Court: $ 245.55 TOTAL: $159,034.63 * Plus post-judgment interest at the legal rate of 6% per annum, and costs of collection. I understand that any false statements therein are subject to the penalties contained in Title 18 of the Pennsylvania Consolidated Statutes §4904, relating to unsworn falsification to authorities. I verify that: aMt I(o. So pd afi ek ayDs 9 J e- *_ CA U N'01,Ce "led 1. The last known address for Defendant is as follows: Patricia Mason 1930 Adams Road, Apt. 3 Cincinnati, OH 45231-3164 2. It is certified that a written Notice of Intention to Enter Judgment by Default was mailed to Defendant, against whom this judgment is to be entered, after the default occurred, and at least 10 days prior to the date of the filing of this Praecipe. A copy of the Affidavit of Service is attached as Exhibit "A." A copy of the Notice of Intent to Enter Default Judgment is attached as Exhibit "B." Date: ?- By: rump %., Wd111ulll;, r'bLIuilc Attorne .D. No.: 86341 P. O. Box 5866 Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff 2 Capozzi & Associates, P.C. U.S. RENAL CARE, INC. f/k/a IN THE COURT OF COMMON PLEAS OF DIALYSIS CORPORATION OF AMERICA : CUMBERLAND COUNTY, PENNSYLVANIA d/b/a DCA OF CINCINNATI, Plaintiff V. Docket No.: 2011-6883 PATRICIA MASON, Civil Action - Law Defendant NOTICE OF INTENTION TO ENTER JUDGMENT BY DEFAULT TO: Patricia Mason 1930 Adams Road, Apt. 3 Cincinnati, OH 45231-3164 DATED: December 29, 2011 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 Exhibit B U.S, RENAL CARE, INC. f/k/a : IN THE COURT OF COMMON PLEAS OF DIALYSIS CORPORATION OF AMERICA CUMBERLAND COUNTY, PENNSYLVANIA d/b/a DCA OF CINCINNATI, Plaintiff V. PATRICIA MASON, : Docket No,: 2011-6883 : Civil Action - Law Defendant NOTICIA IMPORTANTE TO: Patricia Mason 1930 Adams Road, Apt. 3 Cincinnati, OH 45231-3164 DATED: December 29, 2011 USTED HA NO COMPLIDO CON EL AVISO ANTERIOR PORQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI USTED NO ACTUA DENTRO DE DIEZ (10) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA USTED SIN UNA AUDIENCIA Y USTED PODRIA PERDER SU PROPIEDAD O OSTROS DERECHOS IMPORTANTES. USTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEGUIDA. SI USTED NO TIENE ABOGADO O NO TIENE CON QUE PAGAR LOS SERVICIOS DE UN ABOGADO, VAYA O LLAME A LA OFICINA ESCRITA ABAJO PARA AVERIGUAR A DONDE USTED PUEDE OBTENER LA AYUDA LEGAL. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 n Philip C. Nytholic, Esquirii" Attorney I. V, No.: 86341 Capozzi & Associates, P.C. 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101 Exhibit B U.S. RENAL CARE, INC. f/k/a IN THE COURT OF COMMON PLEAS OF DIALYSIS CORPORATION OF AMERICA : CUMBERLAND COUNTY, PENNSYLVANIA d/b/a DCA OF CINCINNATI, Plaintiff V. PATRICIA MASON, Defendant Docket No.: 2011-6883 : Civil Action - Law CERTIFICATE OF SERVICE I hereby certify that I have this date caused a copy of the foregoing Praecipe to Enter Default Judgment to be served by regular first class U.S. Mail, postage prepaid, addressed to the following: Date: i // 0/ /.?' F-V Patricia Mason 1930 Adams Road, Apt. 3 Cincinnati, OH 45231-3164 t Philip qI Warholic, Esquire AttornI.D. No.: 86341 Capozzi & Associates, P.C. P. O. Box 5866 Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff U.S. RENAL CARE, INC. f/k/a DIALYSIS CORPORATION OF AMERICA d/b/a DCA OF CINCINNATI, Plaintiff V. PATRICIA MASON, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Docket No.: 2011-6883 Civil Action - Law RULE 236 NOTICE OF ENTRY OF JUDGMENT BY DEFAULT NOTICE OF DEBTOR'S RIGHTS TO: Patricia Mason, Defendant You are hereby notified that on 6L 2012, judgment was entered against you in the sum of One Hundred Fifty-Nine Thousand, Thirty-Four Dollars and 63/100 ($159.034.63), plus cost iudement interest at the legal rate of 6% per annum and cost of collection, for failure to appear or file an Answer t"qhe C lai ' the above-, referenced action despite Notice of Intent served on December 2011 Date: ! o? Protho ary YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OF 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 S. BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 I hereby certify that the following is the address of the Defendant stated in the a residence: Patricia Mason, 1930 Adams Road, Apt. 3,,§jnci#nati,,QH X45231-3 Date: AqU Philip G1 Warholib, Esquire Attorne I.D. No.: 86341 Capozzi & Associates, P.C. P. O. Box 5866 Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff 3