HomeMy WebLinkAbout11-9411A. i".
T
F'IED-OFFICE
THE PROTHONOTARY
2011 DEC 21 PM 1:
U.S. RENAL CARE, INC7f MBERLANO COUN1N THE COURT OF COMMON PLEAS OF
DIALYSIS CORPORATION OffkWIMN1A CUMBERLAND COUNTY, PENNSYLVANIA
d/b/a DCA OF NORWOOID,
Plaintiff
V. Docket No.:
QUASI POWELL,
Civil Action - Law
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.
CUMBERLAND COUNTY BAR ASSOCIATION
32 SOUTH BEDFORD
STREET CARLISLE, PA 17013
1-800-990-9108
717-249-3166
AVISO
Le nan clemanaado a ustecl en la corte. Si usted
quiere defenderse de est?s 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
compazencia escrita o en pe sona o con un abogado
y entregar a la corte en f" Or escrita sus defensas o
sus objeciones a las dem das en contra de su
persona. Sea avisado que si usted no se defende, le
corte tomara medidas y pue a continuar la demanda
en contra suya sin previ aviso o notificacion.
Ademas, la corte puede decidir a favor del
demandante y requiere que usted cumpla con todas
]as provisioner de esta d manda. Usted puede
perder dinero o sus propie ades u ostros derechos
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
'V 0AJ
afxio';?' *
a# a WF7
IN THE COURT OF COMMON PLEAS
FOR UMBERLAND COUNTY, PENNSYLVANIA
U.S. RENAL CARE, INC?'?, f/k/a CIVIL COURT DIVISION
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF NORWOOD,
Plaintiff
V.
QUASI POWELL,
Defendant
. 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 Norwood ("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 Quasi Powell ("Patient" or "Defendant") is an adult individual with a last
known address at 1423 Corvallis Ave., Cincinnati, Ohio 45327.
3. The clinic formerly known as DCA of Norwood is an operating subsidiary of U.S.
Renal Care, Inc., with a dialysis clinic located at 1721 Tennessee Ave, Cincinnati, OH 45229.
4. U.S. Renal Care provides dialysis treatments and services to its patients.
5. On or abOt July 21, 2008, Defendant executed a Patient Agreement Regarding
Out-Of-Network Insuran?e Benefits ("Consent Agreement") wherein Defendant voluntarily
selected to receive dialys?s services from U.S. Renal Care, and wherein Defendant agreed to
2
promptly turn over to US. Renal Care any amounts received by Defendant from his insurance
company as payment for the services provided to him by 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 July 16, 2008, Defendant executed a Patient Assignment and
Authorization of Payment lof Insurance Benefits Agreement ("Assignment and Authorization
Agreement"), which required the Defendant to assign and transfer any insurance money or
benefits that he 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
of July 16, 2008 to February 4, 2011 ("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 July 12, 2011, and August 3, 2011, U.S. Renal Care's counsel mailed to
Defendant demand letters which provided information on how to pay the debt owed to U.S.
Renal Care. A true and correct copy of the demand letters are 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 ? rms of Defendant's policy with his insurance provider, Anthem
Benefit Administrators of Ohio, Defendant received monthly checks from Anthem Benefit
Administrators 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 he received from Anthem Benefit
Administrators of Ohio directly to U.S. Renal Care on a monthly basis.
15. The amounts that Defendant received from Anthem Benefit Administrators,
pursuant to the claims submitted by U.S. Renal Care, are indicated in the "Amount Paid"
column.
16. As provided from Anthem Benefit Administrators of Ohio's records, Defendant
received a total of $24,09$.65 from Anthem Benefit Administrators of Ohio for the Dialysis
treatments during the Dates of Service.
17. Defendant (failed to transfer the insurance checks that he received from Anthem
Benefit Administrators of, Ohio.
18. The total amount of principal that has become due and owing by Defendant to
U.S. Renal Care as a resu?t of his failure to transfer the insurance payments that he received and
his failure to pay the charges is $24,095.65.
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 pollicy agreement, Defendant had a duty to transfer $24,095.65.
21. Defendant's failure to pay his Co-pay, his failure to transfer the insurance
payments, and his failure to cure his default with U.S. Renal Care pursuant to the Assignment
and Authorization Agreement constitute a breach of contract.
I
22. U.S. Renal',Care has been financially damaged in the amount of $24,095.65, plus
interest and costs of collection.
WHEREFORE, Plaintiff, U.S. Renal Care, Inc., f/k/a Dialysis Corporation of America
d/b/a DCA of Norwood demands judgment against Defendant in the sum of $24,095.65, 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 Defend, 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 reas0able 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 $24,095.65, 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, th? Defendant has not paid the total amount due.
WHEREFORE, Plaintiff, U.S. Renal Care, Inc., f(k/a Dialysis Corporation of America
d/b/a DCA of Norwood, demands judgment against Defendant in the sum of $24,095.65, plus
interest at the legal rate of 6% per annum from the date of judgment.
(COUNT III -CONVERSION OF MONEY
30. U.S. Reno Care incorporates Paragraphs 1 through 29 of this Complaint as if set
forth herein.
31. Defendant Illwas 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 Anthem Benefit Administrators 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 Anthem Benefit Administrators of Ohio made payable to Defendant to reimburse
U.S. Renal Care for the Dialysis it provided to her.
33. During th6 Dates of Service, Defendant's insurance provider paid to her
$24,095.65.
6
34. Defendant intentionally and permanently retained possession of the monies owed
to U.S. Renal Care by failing to transfer a total of $24,095.65 of the insurance benefits Anthem
Benefit Administrators of Ohio paid to him as required under the Assignment and Authorization
Agreement.
35. Defendant's intentional possession of and his failure to forward the Anthem
Benefit Administrators of (Ohio insurance monies to U.S. Renal Care for the Dialysis provided to
Defendant constitutes
36. U.S. Ren4Care has been financially damaged by Defendant's conversion in the
amount of at least $24,09.65.
WHEREFORE, Plaintiff, U.S. Renal Care, Inc., Ma Dialysis Corporation of America
d/b/a DCA of Norwood, demands judgment against Defendant for conversion in the sum of
$24,095.65, plus interest at the legal rate of 6% per annum from the date of judgment.
Respectfully submitted,
Dated: By:
CAPOZZI & ASSOCIATES, P.C.
Phifip C. W r oliC, Esquire
Attorney 1.1.186341
2933 North ront Street
Harrisburg, PA 17110
(717) 233-4101
Attorneys for Plaintiff
7
U.S. RENAL CARE, INC, fVa
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF NORWO D,
Pla?ntiff
V.
QUASI POWELL,
De endant
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
Docket No.:
Civil Action - Law
VERIFICATION
I, Joanne Zimmerman, Vice President of Clinical Services, of U.S. Renal Care, Inc., owner
and operator of DCA of Norwood, do hereby verify under penalties of perjury and upon
personal knowledge that the contents of the foregoing Complaint are true and correct.
Date:
anne Zimmerma ice President
f Clinical Services
U.S. Renal Care, Inc.
214 Senate Avenue, Suite 300
Camp Hill, PA 17011
8
JUL-11-2008 FRI 03,'46 !PM DIALSIS CORP FAX NO. 7177306223 P. 05
DC=ks,
DIALYSIS CORPORATION ov AMLiRICA
rAT E] T AGRIEEM)ENT RF'GA 1
OIIT,OF-NETWORK IN t7RANCE BENEFITS
I, Quasi po ell am a new patient who desires and needs to receive dialysis services now,
and I voluntarily N elect to receive such sen?ices from Dialysis Corporation of America ("DCA").
1 have private heath insurance, and i understand that DCA may not currently have a written
contract directly with my health insurance company, United Healthcare. I understand that my
insurance company has out-of network benefits for dialysis providers, and T may receive such
payments for dialy is by an out-of network provider such as DCA,
I understand that DCA will try to enter into a contract directly with my health insurance
company lbr paym m of the dialysis services DCA provides to me. In the meantime, I request
that DCA provide a with dialysis services now and ask that DCA submit claims for my dialysis
services at DCA td nay health insurance company. While DCA attempts to enter into a direct
contract with my health insurance company, DCA agrees to accept as full payment of claims
submitted by DCto my health insurance company the health insurance company's out-of-
network fee schedule for dialysis providers. I will promptly turn over to DCA any amounts
received by me from my insurance company as paymnnt for the services provided to me. by
D CA, In consideration of DCA accepting such out-of rietwork benefits as full payment for my
dialysis, and in consideration of DCA agreeing to begin my needed dialysis services now, DCA
and I each have voluntarily entered into this agreement regarding my dialysis services at DCA.
I certify t
from Medicare,
understand that
or other Federal
whether my Medl
hill check wilk A
This
can terminal
It I have private health insurance, and that my primary benettt is not
edicaid or another Federal health care program (such as Tricare). I
is Patient Agreement will expire immediately if my Medicare, Medicaid
ealth care benefits become primary. I understand that #'I gin not sure
re, Medicalel, or other Federal health care benefits are currently primary, I
I be ore,rlgningthisAgreement.
will be governed by the laws of the Stale of Ohio and either party
ment by sending 30 days prior A ritten notice to the other.
j DIALYSIS COR
•i t Name and I
Signature
Date
214 Srnatr
Date
TION OF AMERICA
111,
Suitc 300 • Comp Hill, PA 17011 ?'reh ('71:') 730.6164 • Fax: (717) 730--9133
wwa-.d ialysiscorpmation.curil
Exhibit A
DIALYSIS CORPORATIOIN.OF AMERICA ,
PATI]
Facility; DCA
Patient Name.
1.
ASSIGNMENT, AND AUTHORIZATION ----
L'YM-F,NT- OF .E"4-SURANCE-PENEF TS _.---
6
rod Date;
TO Patient I[W A_
(Please Print)
>y assigns, transfers and sets over to DCA of Nonvood monies and/or benefits to
r may be) entitled from any insurance and/or health care provider or national, state,
imental agency, including the Medicare insurance program, as well as any others
y liable for the Patient's dialysis treatments and services and related medical care
Norwood, including health insurance. benefits, major medical benefits and other
rage or other policy coverage for which the Patient is entitled, to cover the costs of
services and any other medical care rendered to the Patient by and/or at DCA of
orvt o .
AUTHORISATION OF PAYMEl1'T OF INSURANCE BENEFITS
The undersigned he
which the Patient is
county or local gov
who may be financ
by and/or at DCA
medical payment cc
dialysis treatment a
N ro d
The undersigned hereby authorizes and directs that payment of all insurance benefits, including Medicare
benefits, if applicable relating to any charges and costs incurred as a result of dialysis treatments and
related services and medical care provided to the Patient by and/or at DCA of Norwood, be paid and
remitted directly to D CA of Norwood in accordance with instructions provided or to be provided by an
agent or representative of DCA of Norwood,
if the undersigned's i surance policy or program does not provide for payment of the monies or benefits
in the name of DCA of Norwood, the undersigned hereby further authorizes and instructs the insurance
provider or agency responsible for payment of the applicable insurance benefits to issue the payment in
the Patient's name an to deliver said payment to DCA of Norwood at its address as set forth in the
instructions provided or to be provided by an agent or representative of DCA of Norwood.
3. DELIVERY IOF BENEFIT PAYA'.IENTS RECEIVED FROM PROVIDER
The undersigned hereby acknowledges that the monies or benefits to be paid by the Patient's
insurance prodder or government agency for the charges, costs and fees incurred by DCA of
Norwood in its provision of dialysis treatments and related services and medical care to the Patient
is and shall at all times remain, the property of DCA of Nonvood, and in furtherance thereof the
undersigned hereby covenants and agrees that in the event that any payment of insurance benefits,
including Medicare benefits, which relate directly to the charges, costs and fees incurred by DCA of
Norwood as a result of its provision of dialysis treatments and related sen'ices and medical care to
the Patient is sent to the Patient or such Patient's guardian, attorney-in-fact or representative, as
the case may be, inadvertently or othenvise, that the undersigned will promptly and
unconditionally forward such payment directly to DCA of Norwood,
Page 1 of 2
Exhibit B
7" 7
4, :: RELEASE !OF INTFORMATION
-The ur<dersrgned her y authorizes and consents to the release by DCA of Norwood, or any of its agents. ?T,
- or representatives, of-all or part of any-information, records or reports, either medical or financial in._
nature, to or with person, corporafion or government agency, me u mg any thud -pay insurance
and/or health care p ovider, who is financially liable for the Patient's dialysis treatments and related
services as well as medical care, which information is necessary. for the substantiation, verification and/or
confirmation of payment of charges and costs to DCA of Norwood for the provision to the Patient of such
dialysis treatments an related services as well as medical care.
5, RESPONSIBILITY FOR PAYMENTS
The undersigned hereby acknowledges that, notwithstanding the foregoing assignment and authorization
of benefit payments t DCA of Norwood, the Patient shall be responsible for any and all charges and
costs billed by DCA of Norwood for dialysis treatments and related services provided and not otherwise
covered or paid by such third-party payor or governmental agency, including, without limitation all
deductible, co-insurance and co-payment amounts, and that DCA of Norwood is authorized to bill the
Patient directly for pa went of such charges and costs.
6. RENO
The undersigned hereby acknowledges that this PATIENT ASSIGNNMN`T AND AUTHORIZATION
OF PAYMENT OF INSURANCE BENEFITS may not be revoked unless such revocation is
accompanied by the written consent to such revocation by DCA of Norwood.
7. PHOTOCOPIES
The undersigned h eby ees that a photocopy of this PATIENT ASSIGNMENT AND
AUTHORIZATION F PA NT OF INSURANCE BENEFITS shall be consi valid as an
original for purposes reof d may be used in place of the on ' I with resp ct to eac of items i
through 5 abov .
V'
Signature: Witn s:
Print Name
If you are signing as a attorney-in-fact or representative of a patient, please indicate by marking
the box and comp?ardian,
information below: D
CERTIFICATION
The undersigned
representative
behalf of st cf h dd
Print Nam
GUARDIAN/ATTORNEY-M-FA CT/REPRESENATIVE
that lie/she is the duly appointed
?ed patient, and that he/she has M
a rney- -fact and/or
to
xecute t 's form on
/ /
r 1A
Date:
Page 2 of 2
Exhibit B
O O O O O O Ln O
Ln Ln O O o o LD o
I- N 111 Ln Ll) Lf1 111 Ln
C .N M O N N N M 1-
111 00 M 00 00 00 00 M
C
3
O
E
Q vT v? v> v} v> v1 v} v}
ri r- N Ln N M M Ln
N ri it d• w r` r- m
d• -tt ICT d' It q* R* TT
m 0 0 0 0 0 0 0 0
D!
3
LLn ?D It* N LD 00 O
O
N lD M M M al m
V O N r4 M M
N N M M
0J 00 00 00 00 00 00 00
v o 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
o Ln 0 0 0 0 0 0 Ln a O
L11 N L1) Ur u i O Ln U1 r? Ln O
(N M N n N Ln N d' n 00 N
00 00 0 Ln d 0 w N Ln m r-
N M M N
V). V? V/ VL - V/ V/ - i1? i/? t/} i/? AA-
N V-1 d O O 00 al al e-I
Ln m mR* d Ln o Ln o Ln w
0 0 0 0 0 0 0 0 0 0 0
a, 01 G1
N N N O O O
O O O N VI N
rn r, a) Ln o ?^ vyi an "a 'a 'a
ri Ln ri M w 41 *-'
oN0 n ONO O n O O O=
Ln M Ln Ln LD Z Z Z 'a -o
It* 01 1t r-I r-I
00 r- 00 00 00 - - _ :3 m :3
O O O O o 3 3 3
r-I r-4 r-I r-4 -4 u
L
N I
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ri e-I e-I r-I
t r-I r-i r-'I e" I ri H rl ri H r••1 r•1 r-I rj r-1 r -I r'i ri ri ri
i+ O O O O O O O O O O O O O O O O O O O
C N N N N N N N N N N N N N N N N N N N
C 00 00 00 al a1 O O O ? ? Ln LD n N N e-I ri N r1
L 0 0 0 0 0 H e-I H ri O O O O c-1 ri O O O O
w
E
m
Z 0 0 0 0 0 0 0 0
3 3 3 3 3 3 3 3
m 00 LO o LO 0 0 0
L- Z Z Z Z Z Z Z Z
-0 •'a -a m -a m -a m 'a 'a -0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
3 3 3 3 3 3 3 3 3 3 3
L L L L L L L L L L L
0 0 0 0 0 0 0 0 0 0 0
Z z z Z Z Z Z Z Z Z Z
d
CO f0 fC fC f0 fp (0 f9
Z
°' 3 3 3 3 3 3 3 3
m 0 0 0 0 0 0 0 0
CL a a a a_ a s a. a
U
c
O
O
v
v
Q
N M M M M M M M M
M M M M M M M M
N N N N N N N N
C cl. C* tt d ? ? ICT cr
. N .N .N .N N .N .N .N •N •N •N
7 m :3 :3 m = :3 :3 m m m
N of 0) Gl OJ o! O) 01 0) 41 O1
3 3 3 3 3 3 3 3 3 3 3
0 0 0 0 0 0 0 0 0 0 0
a_ a a. a_ a. a a a. a a. a
M M M M M M M M M M M
M M M M M M M M M M M
N N N N N N N N N N N
lqr 14, qt q:*, R:zr It q* R* * R* ICT
V
X
W
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
Gwenn M. Keene, Paralegal
* (Licensed in PA, NJ and MD)
** (Licensed in PA and NJ)
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
Quasi M. Powell
1423 Corvallis Avenue
Cincinnati, OH 45237-3101
Re: Account with U.S. Renal Care f/k/a Dialysis Corporation of America
Patient Name Quasi Powell
Account Balance: $209,163.21, as of 7/1/11, plus court costs if necessary
Our Matter No.: 922-11
Dear Mr. Powell:
Please be advised th t our law firm represents U.S. Renal Care formerly known as Dialysis
Corporation of America regarding your delinquent account. You received numerous treatments
from our client's facility in Norwood, OH, and your health insurance carrier provided checks to you
for the specific purpose of reimbursing the Dialysis Corporation of America. The Payment
Agreement with our client is currently in default because you intentionally failed to transfer
insurance proceeds to our client. If you fail to 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.
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 jud ent is obtained against you, you may be required to pay court costs,
attorney' fees, and interest in addition to the money you now owe.
3. If a judg ent 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: UNLES YOU DISPUTE THE VALIDITY OF THIS DEBT, OR ANY
PORTION THEREOF, WI THIN 30 DAYS AFTER RECEIVING THIS NOTICE, THE
DEBT WILL BE CONSID RED TO BE VALID. IF YOU NOTIFY OUR OFFICE IN
WRITING WITHIN 30 DA YS AFTER RECEIVING THIS NOTICE THAT THIS DEBT,
OR ANY PORTION THE REOF, IS DISPUTED, WE WILL OBTAIN VERIFICATION OF
THE DEBT AND WE WI L MAIL A COPY TO YOU. THE NAME OF THE ORIGINAL
CREDITOR OF THIS DE T IS IDENTIFIED ABOVE.
Exhibit D
THIS LETTER D 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.
Very truly y
III
ARE/kjg
CC., Bonnie Newton
2
Exhibit D
..
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
Dawn L, Richards, Esquire
Philip C. Warholic, Esquire
Matthew A. Thomsen. Esquire*
Timothy Ziegler, Reimb. Analyst
Karen L. Fisher, Paralegal
Keyoung J. Gill, Paralegal
Gwenn M, Keene, Paralegal
* (Licensed in PA, NJ and MD)
** (Licensed in PA and NJ)
Quasi M. Powell
1423 Corvallis Avenue
Cincinnati, OH 45237-:
Re: Account
Patient T
Account
Our Matt
Dear Mr. Powell:
2933 North Front Street
Harrisburg, PA 17110
Telephone: (717) 233-4101
Facsimile: (717) 233-4103
www.cMozziassociates.com
Mid-Penn Abstract Company
Charter Settlement Company
Telephone: (717) 234-3289
Facsimile: (717) 234-1670
tion of America
art costs if necessary
As you are aware, o law firm represents U.S. Renal Care f/k/a Dialysis Corporation of
America regarding the above-referenced delinquent account. You failed to respond to my letter to
you, dated July 12, 2011, attempting to amicably resolve this matter. 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 court costs.
Please call or write t me immediately if you would rather settle this matter in an amount
and installment payment arr gement that is reasonable to all parties. Otherwise, this will be my
final communication to you before we file the civil Complaint.
ARE/kj g
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.
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 NORWOOD,
Plaintiff
V. Docket No.: 11-9411
QUASI POWELL,
Civil Action - Law
Defendant
PRAECIPE TO ENTER RETURN OF SERVICE
TO THE CLERK OF CIRCUIT COURT:
3» Z -
z a
_0>
N
=
`Y9 7
as p
Kindly enter as a matter of record the attached Affidavit of Service form as proof of
personal service of the above-referenced Complaint upon Defendant Quasi Powell at 1423
Corvallis Avenue, Cincinnati, OH. A competent adult served the Complaint in accordance with
Rule 2-126(a).
Dated: alji?11;
Philio C. W olic, Esquire
Attorney L o.: 86341
Capozzi & A sociates, 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 NORWOOD
Plaintiff
vs.
QUASI POWERLL
Defendant
Person to be served (Name and Address):
QUASI M. POWELL
1423 CORVALLIS AVENUE
CINCINNATI OH 452##
By serving: QUASI M. POWELL
Attorney: PHILIP C. WARHOLIC, ESQ.
Papers Served: LETTER, NOTICE TO DEFEND, COMPLAINT, VERIFICATION.
EXHIBITS A-D
Service Data: Served Successfully [ ] No, SServvedd?
Date/Time'.?_J ' ''' -
[ ] Delivered a copy to him/her personally
r Left a copy with a competent household member over -14 years of age residing
therein (indicate name & relationship at right)
[ ] Left a copy with a person authorized to accept service, e.g. managing agent
registered agent, etc. (indicate name & official title at rights
Descriptlon of Person Accepting Service:
1111 M upplikkN11pplippli
?znX Q12?Ct/X?? Court Of C/?/- n ?[Ct`s
Venue
Docket Number: 11 9411 CV
AFFIDAVIT OF SERVICE
(For Use by Private Service)
Cost of Service pursuant to R. 4:4-3(c)
Attempts: DatelTime:
Date/Time:
Datw7ime:
Name of Person Served and relationshipRitle:
po??
?0,e.v 9-y- Ll
SEX: T AGE: L4 HEIGHT: WEIGHT: Cp SKIN: _ HAIR: %UCI OTHER:
Unsenred:
[ ] 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:
Served Data:
Subscribed and Swom to me this Arr
?i} was at It time of service a competent adult, over
19 day of -Ixe* 20 _12+ tttttltrtell the age of 18 and not having a direct interest in the
?- % IAL foregoing is declare under rrppenalty of perjury that the
Notary Signature: C 9 9 is tri
/20jt
Name of Notary Commission ExiR ti ?S' ature of Process Server Dat6
Jill
U.S. RENAL CARE, INC., f/k/a
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF NORWOOD,
Plaintiff
V.
QUASI POWELL,
Defendant
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
Docket No.: 11-9411
Civil Action - Law
PRAECIPE TO ENTER DEFAULT JUDGMENT
TO THE PROTHONOTARY/CLERK OF SAID COURT:
r -1
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, Quasi Powell, 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: $25,095.65
Attorney Fees: $ 1,204.00
Cost of Court: $ 227.99
TOTAL: $26,527.64
* 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:
a??
CIc ayaa1
pz# e97A J1 9- ?e
d
-1\ 16., h)ccl "
1. The last known address for Defendant is as follows:
Quasi M. Powell
1423 Corvallis Avenue
Cincinnati, OH 45237-3101
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: t' r
rill°
Philip C. arholic, Esquire
Attorney L.D. No.: 86341
Capozzi & Associates, P.C.
1200 Camp Hill Bypass, 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 NORWOOD
vs.
QUASI POWERLL
Person to be served (Name and Address):
QUASI M. POWELL
1423 CORVALLIS AVENUE
CINCINNATI OH 452##
By serving: QUASI M. POWELL
Attorney: PHILIP C. WARHOLIC, ESQ.
Plaintiff
Defendant
Papers Served: LETTER, NOTICE TO DEFEND, COMPLAINT, VERIFICATION,
EXHIBITS A-D
Service Data )'Served Successfully [ ] No, Served
ry?
Date/Time:?, ( _yf !!
[ ] Delivered a copy to him/her personally
Left a copy with a competent household member over '14 years of age residing
herein (indicate name & relationship at right)
[ ] Left a copy with a person authorized to accept service, e.g. managing agent
registered agent, etc. (indicate name & official title at right
IlIN?IHII I1I111II1I1111111f li III IIIIIII
?. ?.c 4, )LJ Court Of C "7 '?w?/"" rC=?;
?CCI)? ?l t (CU1a Venue
Docket Number; 11 9411 CV
AFFIDAVIT OF SERVICE
(For Use by Private Service)
Cost of Service pursuant to R. 4:4-3(c)
Attempts: Date/Time:
Date/Time:
Date/Time:
Name of Person Served and relationship/title:
h1k ?vi?-y' \4 .j1 e li
tY i "C V -C,Y"
Description of Person Accepting Service:
SEX: f_AGE: HEIGHT: PS "(r," WEIGHT: ??? SKIN: 2- HAIR [?lA OTHER
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:
Served Data:
Subscribed and Sworn to me this I, NG1LL??C
- was at t time of service a competent adult, over
day of 20 /? -??i413Stdlpll/! the age of 18 and not having a direct interest in the
litigation. I declare under penalty of perjury that the
Notary ( ?} ?
ry Signature: is0 foregoing is, true and(correct.
r,llrw
Name of Notary Commission E):Irti =5' ature of Process Server Datt?
t4lpp ee??E? Exhibit A
U.S. RENAL CARE, INC., f/k/a
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF NORWOOD,
Plaintiff
V.
QUASI POWELL,
Defendant
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
Docket No.: 11-9411
Civil Action - Law
NOTICE OF INTENTION TO ENTER JUDGMENT BY DEFAULT
TO: Quasi M. Powell
1423 Corvallis Avenue
Cincinnati, OH 45237-3101
DATED: February 22, 2012
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
W
U.S. RENAL CARE, INC., f/k/a
DIALYSIS CORPORATION OF AMERICA
d/b/a DCA OF NORWOOD,
Plaintiff
V.
QUASI POWELL,
Defendant
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
Docket No.: 11-9411
Civil Action - Law
NOTICIA IMPORTANTE
TO: Quasi M. Powell
1423 Corvallis Avenue
Cincinnati, OH 45237-3101
DATED: February 22, 2012
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 0 OSTROS DERECHOS
IMPORTANTES. USTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN
SEGUIDA. SI USTED NO TIENE ABOGADO 0 NO TIENE CON QUE PAGAR LOS
SERVICIOS DE UN ABOGADO, VAYA 0 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
K A A4 P (? Jj), -
Philip C. War ic, Esquire
Attorney I.D. ]Vo.: 86341
Capozzi & Associates, P.C.
1200 Camp Hill By-Pass, Suite 205
Camp Hill, PA 17011
(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 NORWOOD,
Plaintiff
V. Docket No.: 11-9411
QUASI POWELL,
Defendant 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:
Quasi M. Powell
1423 Corvallis Avenue
Cincinnati, OH 45237-3101
Date:
?J'
Philip C. W olic, Esquire l?/
Attorney I.D. o.: 86341
Capozzi & Associates, P.C.
1200 Camp Hill Bypass, 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 NORWOOD,
Plaintiff
V.
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: Docket No.: 11-9411
QUASI POWELL,
Defendant
: Civil Action - Law
RULE 236 NOTICE OF ENTRY OF JUDGMENT BY DEFAULT
NOTICE OF DEBTOR'S RIGHTS
TO: Quasi Powell, Defendant
You are hereby notified that on , 2012, judgment was
entered against you in the sum of Twenty-Six Thousand, Five Hundred Twenty-Seven
Dollars and 64/100 ($26,527.64), plus Post iudsment interest at the legal rate of 6% per
annum and cost of collection, for failure to appear or file an A er to the Com Taint in the
above-referenced action despite Notice of Intent served on Febru 22,
Date: ? -- , 14-1 t o? r1
Protho
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 certificate?of
residence: Quasi M. Powell, 1423 Corvallis Avenue, Cinpipnati,r OH 4?237-3101.
Date: ?h
Attorney 1,I)/ No.: 86341
Capozzi & Associates, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
(717) 233-4101
Attorney for Plaintiff
U.S. RENAL CARE, INC., f/k/a IN THE COURT OF COMMON PLEAS OF
DIALYSIS CORPORATION OF AMERICA CUMBERLAND COUNTY,
d/b/a DCA OF NORWOOD, PENNSYLVANIA
Plaintiff
V. Docket No.: 11-9411
QUASI POWELL,
Defendant Civil Action - Law
ORDER
AND NOW, THIS day of 'Z ti-/ , 2012, upon motion of Plaintiff,
IT IS HEREBY ORDERED that Defendant Quasi Powell shall answer fully Plaintiff's Post-
Judgment Interrogatories within ten (10) days hereof, under penalty of further sanctions as
follows: /? fa Gti 1`e/ Is4n+4 2!??4
BY THE COURT:
4016 "C-se
f?JClL
r•g g PTe_ E...m - _
I r1