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HomeMy WebLinkAbout12-5574 x t * R .s 1... ~ f"'1 STRADLEY RONON STEVENS & YOUNG, LLP ~ ~ ~ ~ ~ ~i ~ ; ~ °i t7 l ~i fi't' By: Brian P. Seaman (Atty. ID No. 91024) Benjamin E. Gordon (Atty. ID No. 311741) ' _ ~ ' ~ ~ 9 ~ ~ 2005 Market Street, Suite 2600 ~ ~ ~'``h ~ a,(`~ C J T Y Philadelphia, PA 19103-7098 ~ , , , ; y,~ ~ Phone: (215) 564-8000 Attorneys For Plaintiffs EASTERN REGIONAL MEDICAL CENTER, INC. and CANCER TREATMENT IN THE COURT OF COMMON PLEAS OF CENTERS OF AMERICA PROFESSIONAL 'CUMBERLAND COUNTY CORPORATION OF PENNSYLVANIA, :PENNSYLVANIA P.C., 1331 E. Wyoming Avenue, 'CIVIL ACTION Philadelphia, PA 19124 Plaintiffs, v. !Case No. J ~ , S s~y 1 ROGER FAILOR 441 Crossroad School Road Carsiile, PA 17015 Defendant. NOTICE 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 this 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 the 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 Bax Association 34 S. Bedford Street Carlisle, Pennsylvania Telephone No. (717) 249-3166 Uu~ ~ ~ (~3 ,7~~~ a a ~ ~ a~ ~k,~a ~~-a~c~~re(~ 1 ~ 1 AVISO Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene veinte (20) dias de plazo al partir de la fecha de la demanda y la notification. Hate 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, la corte tornara medidas y puede continuar la demanda en contra suya sin previo aviso o notification. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpla con todas las priviones de estda demanda. Usted puede perer dinero o sus propiedades u otros derechos importantes para usted. Lleva esta demanda a un abogado immediatamente. Si no tiene abogado o si no tiene el dinero suficiente de pagartal servicio. Vaya en persona o llame por telefono a la oficina cuya direction se encuentra escrita abajo para averiguar donde se puede conseguir asistencia legal. Condado de Cumberland Bar Asociacion 34 S. Bedford Street Carlisle, Pensilvania -2- STRADLEY RONON STEVENS & YOUNG, LLP By: Brian P. Seaman (Atty. ID No. 91024) Benjamin E. Gordon (Atty. ID No. 311741) 2005 Market Street, Suite 2600 Philadelphia, PA 19103-7098 Phone: (215) 564-8000 Attorneys for Plaintiffs EASTERN REGIONAL MEDICAL CENTER, INC. and CANCER TREATMENT IN THE COURT OF COMMON PLEAS OF CENTERS OF AMERICA PROFESSIONAL ;CUMBERLAND COUNTY CORPORATION OF PENNSYLVANIA, :PENNSYLVANIA P.C., 1331 E. Wyoming Avenue, ;CIVIL ACTION Philadelphia, PA 19124 Plaintiffs, v. Case No. ROGER FAILOR 441 Crossroad School Road Carslile, PA 17015 Defendant. COMPLAINT Plaintiffs, Eastern Regional Medical Center, Inc. ("ERMC" or "Hospital") and Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C. ("PCP") (collectively "Plaintiffs"), by and through their undersigned counsel, Stradley Ronon Stevens & Young, LLP, by way of Complaint against Defendant Roger Failor, aver as follows: THE PARTIES 1. ERMC is a corporation organized and incorporated pursuant to the laws of the Commonwealth of Pennsylvania, with its principal place of business at 1331 E. Wyoming Avenue, Philadelphia, Pennsylvania 19124. -3- 2. PCP is a corporation organized and incorporated pursuant to the taws of the Commonwealth of Pennsylvania, with its principal place of business at 1331 E. Wyoming Avenue, Philadelphia, Pennsylvania 19124. 3. Defendant is an adult citizen of the Commonwealth of Pennsylvania domiciled at 441 Crossroad School Road, Carlisle, PA 17015. JURISDICTION AND VENUE 4. This Court has personal jurisdiction over the Defendant pursuant to 42 Pa. C.S. § 5301(a)(1). 5. Venue is proper in this Court pursuant to Pa. R. Civ. P. 1006. FACTUAL BACKGROUND 6. In approximately October, 2011, Julie S. Phillips ("Phillips"), who is now deceased, sought medical treatment from Plaintiffs. 7. In connection with this treatment, Phillips entered into a Patient and Spouse Payment Agreement (the "Payment Agreement") with Plaintiffs. A true and correct copy of the Payment Agreement is attached hereto as Exhibit "A." 8. In connection with this treatment, Defendant also entered into the Payment Agreement with Plaintiffs, signing as the "Spouse." See Ex. "A". 9. Upon information and belief, Defendant was Phillips' spouse. 10. Pursuant to the Payment Agreement, Defendant agreed to the following: 1. Payment of Charges. Patient and Spouse each agree to be unconditionally and personally liable for payment for all services rendered Patient by Hospital and PCP. 2. "Out-of-Network" Acknowledgement; Assignment of Benefits.... Patient hereby agrees to assign to ERMC and PCP any and all benefits -4- payable under any health insurance plan, covering Patient 3. Pav Over of Checks Received. To the extent Patient or Spouse receives one or more checks or drafts from a third party payor (including an insurance company or health plan) relating to services provided by Hospital or PCP, Patient and Spouse hereby agree to immediately endorse such checks and drafts and deliver them to Hospital; Patient and Spouse hereby covenants that in no event will they ever negotiate, cash or deposit any such checks or drafts, except to and for the benefit of Hospital. After receipt of such endorsed checks and drafts, Hospital will credit Patient's account for the amount of such payment. See Exhibit "A" at 1-3. 11. Defendant further agreed that he would reimburse ERMC and PCP for the costs and expenses (including attorney's fees) of enforcing the Payment Agreement, and in the event he violated any provision of paragraph 3 of the Payment Agreement relating to checks or drafts from a third party payor, "that Hospital and PCP shall have, in addition to all other rights, the right to file suit against Patient and Spouse on the theory of conversion...." Id. at ¶ 4. 12. In reliance on the Payment Agreement signed both by Phillips and by Defendant, Plaintiffs provided medical services to Phillips between approximately October, 2011, and February, 2012, at ERMC's hospital located at 1331 E. Wyoming Avenue, Philadelphia, Pennsylvania. 13. Phillips accepted the medical services performed by Plaintiffs during that period and was benefited thereby. 14. In accordance with the terms of the Payment Agreement, Plaintiffs billed Phillips for the costs of the services provided, but Phillips failed to pay Plaintiffs in full for the oustanding amounts. -5- 15. Furthermore, despite demand for same, Defendant also has failed to pay Plaintiffs pursuant to the Payment Agreement for the services rendered to Phillips. 16. A demand letter was sent to Defendant on or about July 12, 2012 showing a balance due as of that date of $348,486 for services rendered to Phillips by Plaintiffs. Since that time, the balance has decreased to approximately $347,922, due to payments totaling $564.00 that were recently made directly to Plaintiffs by an insurance company. To the extent additional payments are made after the date this Complaint is filed, the balance may continue to decrease slightly. 17. Upon information and belief, Phillips' health insurer or health plan sent checks or drafts totaling approximately $118,296.18 to Phillips and/or Defendant as payment for the medical services provided by Plaintiffs. 18. Upon information and belief, Defendant received these checks or drafts. However, contrary to the terms of the Payment Agreement, Defendant has failed to endorse or deliver these checks or drafts to ERMC in order to pay the outstanding invoices. 19. Upon information and belief, in contravention of his contractual agreements with Plaintiffs, Defendant has negotiated these insurance checks or drafts a.nd converted the funds for his own use. 20. To date, Plaintiffs are owed a total of approximately $347,922 for medical services rendered to Phillips. True and correct copies of the outtanding invoices are attached hereto collectively as Exhibit "B." 21. Plaintiffs plead the following causes of action in the alternative. -6- COUNT I BREACH OF CONTRACT 22. Plaintiffs hereby incorporate by reference the preceeding paragraphs. 23. Defendant entered into the Payment Agreement with Plaintiffs pursuant to which he was obligated: (I) to make full payment for medical services provided by Plaintiffs; and (2) to endorse and deliver any checks and drafts received from such third party payor(s) to ERMC, and otherwise not to negotiate, cash or deposit any checks or drafts received from any healthcare insurance plans related to the services provided by Plaintiffs. See Ex. "A" at 1-3. 24. In reliance on these agreements signed both by Defendant and Phillips, Plaintiffs provided medical services and treatment to Phillips. 25. Plaintiffs fully performed their obligations to Phillips, as requested. However, both Phillips and Defendant failed or refused to pay Plaintiffs in full for the services rendered. 26. In addition, Defendant has failed or refused to endorse and deliver to ERMC checks and drafts (or proceeds from such checks and drafts) received from insurance companies, health plans, and/or other third party payors relating to the services provided by Plaintiffs, which checks and drafts were required to be endorsed and delivered to ERMC pursuant to the Payment Agreement. 27. Defendant's foregoing conduct constitutes a material breach of t:he Payment Agreement. 28. To date, there is currently an amount due and owing by Defendant of approximately $347,922 to Plaintiffs for various medical services that Plaintiffs performed for Phillips. -7- 29. Defendant's foregoing material breach has directly and proximately caused the Plaintiffs damages of approximately $347,922. WHEREFORE, Plaintiffs Eastern Regional Medical Center, Inc. and Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C. demand judgment against Defendant Roger Failor in the amount of $347,922, together with post judgment interest, costs, reasonable attorneys' fees and such other relief as this Court deems appropriate. COUNT II QUANTUM MERUIT/UNJUST ENRICHMENT 30. Plaintiffs hereby incorporate by reference the preceeding paragraphs. 31. Plaintiffs provided medical care and services to Phillips with the expectation of compensation by either Phillips or Defendant. 32. Defendant knew and agreed that Plaintiffs expected to be paid the reasonable value of the medical services provided. 33. Defendant accepted the benefit of the medical services provided by Plaintiffs without making full payment for such services, despite repeated demands for payment. 34. In addition, upon information and belief, Defendant has received checks or drafts from Phillips' healthcare insurer(s) or other third party payor(s) specifically for the services provided by Plaintiffs, and which were to be endorsed and delivered to ERMC' pursuant to the Payment Agreement. Defendant, however, have failed or refused to remit such payments to ERMC. 35. Defendant was enriched by the receipt of the insurance proceeds,, at Plaintiff's expense. 36. It would be against equity and good conscience to permit Defendant to retain the insurance proceeds, as there is no justification for Defendant's refusal to pay over the -8- insurance proceeds to compensate Plaintiffs for the various medical services performed on Phillips' behalf. 37. If it is determined that there is no remedy at law for Plaintiffs, it would be inequitable to allow Defendant to receive the benefits of the insurance proceeds without requiring Defendant to pay the Plaintiffs the full value of the services rendered to Phillips. WHEREFORE, Plaintiffs Eastern Regional Medical Center, Inc. and Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C. demand judgment against Defendant Roger Failor, in the amount of $347,922, together with post judgment interest, costs, reasonable attorneys' fees and such other relief as this Court deems appropriate. COUNT III PROMISSORY ESTOPPEL 38. Plaintiffs hereby incorporate by reference the preceeding paragraphs. 39. In the alternative to recovery under breach of contract, Plaintiffs are entitled to recovery under the doctrine of promissory estoppel. 40. At all times material hereto, Defendant promised Plaintiffs that he would be personally and unconditionally liable for payment for all services rendered to Phillips. 41. Defendant made this promise with the reasonable expectation of inducing action on the part of Plaintiffs. 42. Plaintiffs performed various medical services for Phillips in reasonable reliance upon the foregoing promise. 43. There is an amount due and owing from Defendant to Plaintiffs for various medical services that Plaintiffs performed pursuant to Defendant's request. 44. Defendant has materially breached their foregoing promises to pay Plaintiffs all billed amounts. -9- 45. The foregoing material breach has directly and proximately cause-d Plaintiffs damages of approximately $347,922. 46. The Court can only avoid injustice by finding that Defendant's promises to the Plaintiffs is binding. WHEREFORE, Plaintiffs Eastern Regional Medical Center, Inc. and Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C. demand judgment against Defendant Roger Failor in the amount of $347,922, together with post judgment interest, costs, reasonable attorneys' fees and such other relief as this Court deems appropriate. COUNT IV CONVERSION 47. Plaintiffs hereby incorporate by reference the preceeding paragraphs. 48. Defendant agreed in the Payment Agreement, if they violated any provision of paragraph 3 relating to checks or drafts from a third party payor, "Hospital and PCP shall have, in addition to all other rights, the right to file suit against Patient and Spouse on the theory of conversion...." Ex. "A" at ¶ 4. 49. Upon information and belief, Defendant received insurance checks or drafts totaling approximately $118,296.18 from Phillips' healthcare insurer(s) or third party payor(s) specifically for the medical services rendered to her by Plaintiffs. 50. Defendant agreed pursuant to the Payment Agreement to endorse and deliver these checks to ERMC. See Ex. "A" at 2-3. 51. Defendant further agreed that he would not negotiate, cash, or deposit any checks or drafts received from any healthcare insurance plans related to the services provided by Plaintiffs, except for the benefit of ERMC. See Ex. "A" at ¶ 3. -10- 52. Plaintiffs had a possessory interest in these checks and drafts that Defendant received from Phillips' insurance company, health plan or other third party payor. 53. In spite of his promises, Defendant has failed to endorse and deliver such checks and drafts to ERMC. 54. Instead, upon information and belief, Defendant knowingly, unlawfully and without Plaintiffs' consent, negotiated these insurance checks and converted the funds to their own use, notwithstanding that the monies were assigned and owed to Plaintiffs. 55. Defendant's retention of the proceeds from the insurance checks, without paying the full amount due and owing for services provided by Plaintiffs, constitutes an improper conversion of such insurance payments that were intended to benefit Plaintiffs. 56. Defendant's actions were taken with the intent to deprive Plaintiffs of insurance payments that should have been used to pay amounts due and owing to Plaintiffs. -11- WHEREFORE, Plaintiffs Eastern Regional Medical Center, Inc. and Cancer Treatment Centers of America Professional Corporation of Pennsylvania, P.C. demand judgment against Defendant Roger Failor in the amount of $118,296.18, together with post judgment interest, costs, reasonable attorneys' fees and such other relief as this Court deems appropriate. STRADLEY ONON STEVEN YOUNG, LLP ian P. Seaman (A moo: 91024) Benjamin. E. Gordon (Atty. ID No. 311741) STRADLEY RONON STEVENS & YOUNG, LLP 2005 Market Street, Suite 2600 Philadelphia, PA 19103-7018 P: (215) 564-8000 F: (215) 565-8120 E: BGordon@Stradley.com Attorneys for Plaintiffs Dated: September 7, 2012 -12- VERIFICATION T, Shecna Kauppinen, Patient Accounts) Recovery Service Supervisor, of Canner Treatment Centers of America, verifythat I am authorized to make-this Verification on behaifof Plaintiffs and that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. i understai?d.thz~t this Verification is made subject to the penalties of 1$ Pa. C.S.A. ~ 4904 relating to unswon~ falsification to authorities. J ~t Sh~ena Kauppinen Dated: September S , 2012 -13- y <s ~ ~°------'''ter ' 1 '~I~': ~ - r PAT`lEi'JT AND ~PUUBE PA'4'~bIEAtT' AGt~EEPvfEh'I` - t.,e;~~ L}ocisrm~ent t r hia f*atiitxet and S{snuse Payment .~,gire~t.°t~t l"Agreenrem"~ is made fnis day of 2A1 i betwtett ~as#ar~t Iiegtooal ~oa]leat tl~fcr ij$ft3NCj~„ 1uc., s P y#.v~ettire ottrpdretion which olx~aai~s u ha~ita] (c?catetl In Fhilrndclphia, EY,~. (°HcespitaT'), Caa~tr TreatmrraE CBtrt~s ad Aaeerlra Professltru9t ~Carltar>i~en of PctitnsutwnLa, lae. #"PG''P"}. rrrd ..P ~ ,("i'utienf'~. a resident. ot'tEse Stets of _ and t C`'SPo~e`"},. a t~sidora of iheySt of A Patient desires iu obtain stnc~logy scrvie;r,~ frarn liospira! arrel catair #'C`F' Ph3~ ~ca]iexxi~roty; the "S~er~icezt'~ and ~pausa desrrr~s far P-aticnt co obtain such Sc~wi+ees. tiospittt! atxl PGP ore unwilling to ptc7vide~ such Serui~cces unlr~; P"atien€ and Spcfuse are Rvi]lipg to gissorta! rtspc>trg>'lrility far tine pay~rre~ri ai a!i cbar~ relating to such. Services prior to admission of Aatient, In arderm induce Hospital amd PCP to provide Serrices W Patient. )~,aticra and Spausc each hexeby agrees as foibws: ,~+~t uttCiaraes. Parrivent drri Sparrac 6~y eact? egre:e tr, be uneondrtiortalty anti #aersatesliy liable far paymemt far all sen~ices rardered Pffi by Haa~pfrn! m~L i Patient irttiliais Spouse Irritia.]s 2. ~~1~.#~ Aeltlt~a'Yteiareedt: at'.ReweStr. Ihofiertt asd tgpowpoe erreA a~rastwkdgre tlratt aeitlher Horplrat aMr PGT hrtra o e~tratetai r~efatia~lrFp wine ~U' moral Pa~Y palror (irttetnding aaty in>foeagrae aartrpaay as Ines~ptb porn} tMKSt c~av~rs Patient. srttd nr srte6 Ha~rltd ~ JPCP are'iout-a~tte~rotdt" ~xrrrviier'i'sf tlro SerV~r. Pittiz`nf iu~[iy a~reea Oty aerie=n to EttMC and PCP nay awd all besreftta ~ urtaer` airy ttaehh i~tti~nav pion, rbrgring Pa~iiernt, irrttuditrg irrrurance company Pat~t?t and SQause further trgrae bo exaattc end deliver any ¦ttr! dl tlocrtnretlfe • ItMC cletearrnints t'y to give. effect to this assigrutrctrt of beeecfrts % Patient fern g'pauae Inir.isis 3. Pav Uvar. of C6erka rte~ixai. To the extent Patient or ~pc?t~ee re~ivcs a 4lutclc nr draft fr+trrrr a third party pey~o-r {inakxlr»p; an iiasuranac eompertiy or ltmNh pieit# rctatirrg to sert+iras prUVidcd by lit~ragital rn PCP', l~ati,nttt and Sporrae bm~eby agree to imarrecliately endorsre catch c~Feerks and dross sttd deliver thesttY to Hospital: Pai•ieet ~d Spc+urc hereby ct3ucttant that in nor evc»t Brill they ever rtetio[i*te, C~h ar d,~pc,~sit any Such ctlitscleS or tlrtl~5, txee~t t€r and fat' the bcnefu of l~aspittrl. ,l4ites receipt of ouch endorsed checks and dross, Httrpit~ e~:ill Credit. PRtietif's aecount foe the amotmt of xuch paymeutt. , Patient Initiol$ $~,?irtt3e Initials 4. R Putic~rt and Spu`JS~ i~ee~, ;t.~!r~ to rr;~eb~ue7ae Iiosplini and PCI' &rr the vosts.arrd expernses ~iinchrdi~ aitvrneya' feesY of errtarr irtg this Agreement.., .pati~etrt Bard Spouse fixtttesa~ei#utt in the ee.t. Pat'ierx and Spousevialates any pnovisian nfparagr~h 3 alrt+e~t rclatirtgta ahedcs ordrxfts, that Hospital and PC'#' shall' ham, art pdklitian to trll atleer rights, the right: to file suit stgr.~tisest: I'atie~nt aexi Spoerse orr tlee ttterr?: ot'rarrversioar acrd neither ttte F[aspaai os PCP nor anyphy+siaian ztciat,.d Chzrcrxfith she#! itmvc an}• ablig~~n fo cnt~niucta ts~x: the. t r Prrtiernt, Pt~ertt and Spouse here!>ar sgrtx that Patient's ~sbti~atioa~ set its pa~aph 3 t~bnv+e rr~attr~. to duets ttr dr~&s are aonditiao precedents to Hnrsp~ai'a ~ F~CP`s titQUittg obli~ioa tc~ praviae trt:atatent to Pati~tt: as sttelt, ~ the att that Patient artc~tes ~ provision of paragraph 3 sba~ rc}ating ic? checks got drafts, t~C?sisit~a7 and PAP s}ta1! hava no furtftcr obligatia~ to p ard'dititki~l titi8tmtnf tc~ Patient, .ln .svr~s cue. i~at shall be deerrtad to have refusrd adclitiana! tzt. a~i neither Ht~.ritai, PGP tt~ cider cif the6~ wive phvsipitlt~ OT ptd&~saicmtals riaa.[1 be de~ntcd to have "ahatxtoated" Aa#ie~. ~ rf Pfltie»t Inia~als ~pc~use initials S, In sf At~~+eetr~~ P~ and Spc?t~e :ooh thatt tits; Agraer4~ent modifies the termst~the: tiospilat's pa~ictt# intake ag<'eertaerrt t4`AdtiN9sipt~5 Ag~~ll7eitt"~ re~tir~; it} Fatietnt: the Admissiauz5 Agrr~srt remains in effect e~ctapt to the extemt terms thtxeti~`dfffea trorn tcrsrs aonsairtc6 h~tein. 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Cradics i 111118111 ! 51199233 ! 1 1 336.00 1 i I ~3alanas: ! 938.00 l • ~ 'q~~£ (~~tr3r.:r Trc~~trraettl. l`~~r~(rr5 ~~rf An~r~ric~ Cancer Treatment Centers of America® Q Professional Corporation of Pennsylvania 2610 SHERIDAN StD ZION, IL 60099 Guarantor: P6~ILLiPS JtfLIE S Patient: PHILLIPS JULiE S Visit i Dates I Svc Code t Description i Unitsl D~bita I Credits i 141J0&l12 ! 51199233 I ! I I 33b.00 i t ~ Balance: ! 335.09 1