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Home My WebLink About05-0242 LAW OFFICES OF CHRISTOPHER S. LUCAS & ASSOCIATES By: Christopher S. Lucas, Esquire Attorney ID No. 77903 220 Cumberland Parkway, Ste. 4 Mechanicsburg, P A 17055 Phone: (717) 691-0203; Fax: (717) 691-3130 Email: cslucas@lucashealthlaw.com ATTORNEYFORPL~F JO ANN GRUBBS, Joint Account Holder and Wife of the Deceased A. Richard Grubbs 52 Oakwood Avenue Mechanicsburg, P A 17055 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA CIVIL ACTION - LAW CIVIL ACTION NO.DS" ~t.;~ (};u:L ~ Plaintiff v. ST.AGNESHEALTHCARE 900 Caton Avenue Baltimore, MD 21229-5299 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 claims or relief requested by the Plaintiffs. 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, P A 17013 (717) 249-3166 LAW OFFICES OF CHRISTOPHER S. LUCAS & ASSOCIATES By: Christopher S. Lucas, Esquire Attorney ID No. 77903 220 Cumberland Parkway, Ste. 4 Mechanicsburg, P A 17055 Phone: (717) 691-0203; Fax: (717) 691-3130 Email: cslucas@lucashealthlaw.com ATTORNEY FOR PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA CIVIL ACTION - LA W JO ANN GRUBBS, Joint Account Holder and Wife of the Deceased A. Richard Grubbs 52 Oakwood Avenue Mechanicsburg, P A 17055 CIVIL ACTION NO. Plaintiff v. ST.AGNESHEALTHCARE 900 Caton Avenue Baltimore, MD 21229-5299 Defendant COMPLAINT 1. Jurisdiction over the Defendant Hospital is proper in Cumberland County Pennsylvania because the Defendant Hospital negotiated the terms of an escrow agreement with husband and wife A. Richard Grubbs and Jo Ann Grubbs whereby Mr. and Mrs. Grubbs transferred $100,000.00 from their joint account at Members First Federal Credit Union located at 500 Louise Drive Mechanicsburg, Pennsylvania to Defendant Hospital and Defendant Hospital accepted those funds and acknowledged holding them in escrow by mailing a letter to Mr. and Mrs. Grubbs at their home address at 52 Oakwood Avenue Mechanicsburg, P A 17055. 2. Plaintiff, A. Richard Grubbs, is a deceased adult individual, who formerly resided at 52 Oakwood Avenue, Mechanicsburg, Pennsylvania, 17055. 3. A. Richard Grubbs was a life-long federal government employee and had, at all relevant times, medical insurance coverage through the Federal Employee Health Benefits Program (FEHBP). 4. Federal Employees Health Benefits Program, is administered by the Office of Personnel Management, 1900 E Street NW, Washington, DC 20415-1000. 5. A. Richard Grubbs FEHBP benefits were administered by HealthGuard until 1110104. 6. HealthGuard of Lancaster Inc., is a wholly owned subsidiary of Highmark, Inc., located at 280 Granite Run Drive, Lancaster, P A 17601-6801. 7. A. Richard Grubbs FEHBP benefits were administered by Federal Blue Cross and Blue Shield through (in this case) its affiliate CareFirst, Inc. (CareFirst) from 1/11/04, until his death on May 21, 2004. 8. The Federal Blue Cross and Blue Shield plan is a corporation with its principal place of business in Camp Hill, Pennsylvania and a mailing address at P.O. Box 890037 Camp Hill, Pennsylvania. 9. CareFirst, Inc. is the not-for-profit, non-stock, parent company of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., affiliates that do business as CareFirst Blue Cross Blue Shield, with its principal place of business located at 10455 Mill Run Circle Owings Mills, Maryland. 10. Plaintiff, Jo Ann Grubbs, is an adult individual, who resides at 52 Oakwood Avenue, Mechanicsburg, Pennsylvania. 11. Jo Anne Grubbs was the wife of A. Richard Grubbs and joint account holder of an account at Members First Federal Credit Union from which escrow payments were made to Defendant Hospital. 12. Defendant, St. Agnes Healthcare, Inc, is a corporation duly organized under the laws of the state of Maryland, with its principal place of business at 900 Caton Avenue, Baltimore, Maryland, 21202. 13. On or about May 2003, A. Richard Grubbs was diagnosed with pseudomyxoma peritonei, a rare form of cancer. 14. On or about June 2004, A. Richard Grubbs, was admitted to the Holy Spirit Hospital Emergency Room due to a rapidly deteriorating condition. 15. Upon admission to Holy Spirit Hospital, A. Richard Grubbs, was eventually referred to Dr. Bieligk, a physician with hospital privileges at Defendant Hospital, for surgical treatment of his pseudomyoma peritonei. 16. During the consultation with Dr. Bieligk, A. Richard Grubbs, was given a CT scan, which revealed a bilateral pulmonary artery thrombi, which required immediate surgical intervention. 17. On or about July 1,2003, Dr. Bieligk scheduled A. Richard Grubbs for surgery at Defendant Hospital on July 14,2003. 18. Defendant Hospital required that A. Richard Grubbs place $100,000.00 in escrow with it before it would permit Dr. Bieligk to the perform surgery there. 19. The deposit was to be held in escrow in the even that HealthGuard did not pay for the hospital charges incurred at the Defendant Hospital. 20. A. Richard Grubbs borrowed $80,000.00 from his father and used $20,000.00 of his own funds to put together the funds necessary to allow Dr. Bieligk to perform the surgery at Defendant Hospital. 21. On or about July 9,2003, A. Richard Grubbs deposited, by wire transfer, from Members First Federal Credit Union at 5000 Louis Drive Mechanicsburg, Pennsylvania, $100,000.00 into the escrow fund maintained by Defendant Hospital. 22. On or about July 14,2003, Plaintiff, A. Richard Grubbs, was admitted to Defendant Hospital for surgical treatment with Dr. Bieligk. 23. On or about July 30,2003, A. Richard Grubbs was discharged from Defendant Hospital (Admission I). 24. On or about July 15,2003, A. Richard Grubbs, received a letter from Defendant, acknowledging receipt of $100,000.00 deposit. This letter further indicates that the money would be returned less any unpaid insurance claims. 25. HealthGuard subsequently reimbursed Defendant Hospital for all reasonable and necessary charges related to Admission I through July 23, 2003. 26. In August of 2003, Defendant Hospital refunded $50,000.00 of the escrow deposit. 27. At that time, Defendant Hospital failed to remit the balance of the $100,000.00 escrow payment. 28. On or about December 31,2003, A. Richard Grubbs was readmitted to Defendant for additional treatment. 29. No escrow agreement was reached for this second admission. 30. On or about January 29,2004, A. Richard Grubbs was discharged from Defendant Hospital for a second time (Admission II). 31. HealthGuard subsequently reimbursed Defendant Hospital for all reasonable and necessary charges related to Admission II through January 10, 2004. 32. In the interim between Admission I and Admission II, during "open enrollment," a period in which FEHB beneficiaries may choose their health plan option, A. Richard Grubbs elected to discontinue the HealthGuard plan and instead to switch to Federal Blue Cross and Blue Shield. 33. As of January 11,2004, HealthGuard ceased proving FEHB plan services to A. Richard Grubbs and Federal Blue Cross and Blue Shield began providing FEHB plan services. 34. On or about January 10, 2004, A. Richard Grubbs informed Defendant Hospital about the change in his FEHB from HealthGuard to Care First. 35. On or about January 10,2004, Defendant Hospital, through its agent, Accounts Receivable Supervisor Laura Hesselbein, requested pre- certification from Care First, an affiliate of Federal Blue Cross and Blue Shield. 36. On that date, Care First denied precertification on the grounds that A. Richard Grubbs did not yet have plan benefits, which was true. 37. Defendant Hospital did not request pre-certification on the next day, January 11,2004, when A. Richard Grubbs' benefits with the Care First became effective, and indeed, never requested pre-certification. 38. Without pre-certification from Care First, Defendant Hospital may not bill Federal Blue Cross and Blue Shield. 39. Accordingly, Defendant Hospital never billed for Hospital services rendered to A. Richard Grubbs from January 11,2004 - January 29, 2004. 40. In November of 2004, at the request of Plaintiffs' attorney, Defendant Hospital made a second partial refund of the escrow deposit in the amount of $21,000.00. 41. Since that time, Defendant Hospital has refused to refund the remaining $29,000.00 and appears to have asserted a claim of right against the funds on the grounds that Care First has not paid for care and services provided to A. Richard Grubbs between January 11,2004 and January 17, 2004. COUNT I BREACH OF CONTRACT 42. Plaintiffs incorporate the foregoing paragraph as if fully set forth herein. 43. Defendant was obligated under the terms of the escrow agreement to use reasonable efforts to bill Federal Blue Cross and Blue Shield. 44. By failing to try to request pre-certification on or after the effective date for the Federal Blue Cross and Blue Shield benefits and failing to submit any request to it for payment, the Defendant Hospital acted unreasonably and violated its obligation to use reasonable efforts to obtain reimbursement from Care First. WHEREFORE, Plaintiffs request this Honorable Court enter judgment in its favor and against Defendant, S1. Agnes Healthcare, Inc. in the amount of $29,000.00. COUNT II BREACH OF FIDUCUARY DUTY 45. Plaintiffs incorporate the foregoing paragraph as if fully set forth herein. 46. Defendant had a fiduciary obligation, under the terms of the escrow to use reasonable efforts to bill Federal Blue Cross and Blue Shield. 47. By failing to try to request pre-certification on or after the effective date for the Federal Blue Cross and Blue Shield benefits, and failing to submit any request to it for payment, the Defendant Hospital breached its fiduciary duty to use reasonable efforts to secure reimbursement from Care First. WHEREFORE, Plaintiffs request this Honorable Court enter judgment in its favor and against Defendant, St. Agnes Healthcare, Inc. in the amount of $29,000.00. DATED: I/,) los Respectful!y suc:-..- itte~ .- ~1 BYC;- ~~) Christopher S. Lucas, Esquire ATTORNEY FOR PLAINTIFF Attorney ID No. 77903 LAW OFFICES OF CHRISTOPHER S. LUCAS & ASSOCIATES By: Christopher S. Lucas, Esquire Attorney ID No. 77903 220 Cumberland Parkway, Ste. 4 Mechanicsburg, P A 17055 Phone: (717) 691-0203; Fax: (717) 691-3130 Email: cslucas(a).lucashealthlaw.com ATIORNEYFORPLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW JO ANN GRUBBS, Joint Account Holder and wife of the deceased A. Richard Grubbs 52 Oakwood Avenue Mechanicsburg, PA 17055 : CIVIL ACTION NO. Plaintiff v. ST. AGNES HEALTHCARE 900 Caton A venue Baltimore, MD 21229-5299 Defendant VERIFICATION I, Jo Ann Grubbs, am the plaintiff in the above-titled action. I hereby state that the statements contained in the foregoing document are true and correct to the best of my personal knowledge, information and belief. I understand that the statements herein are made subject to the penalties of 18 Pa. C.S. S 4904 relating to unsworn falsification to authorities. JO~~ ()~A ~ p ~ It .~ ~ Lv 6 () .....", B C~ C":> 0 c-:; ~ - " ~., -0 ~ ' . <- :;:l ~ ::to.. a z Gl :TI ,.. "I:::.. -ern N :nCJ ~:<;, ) ~~ ~ 7:\. -0 -...., "'..::--::-= ( " ...1... '." '---~ ~ , - ;: r:~ -.-\ -.( 0.) ......... ::0 "--'-- W .-< LAW OFFICES OF CHRISTOPHER S. LUCAS & ASSOCIATES By: Christopher S. Lucas, Esquire Attorney ID No. 77903 220 Cumberland Parkway, Ste. 4 Mechanicsburg, P A 17055 Phone: (717) 691-0203; Fax: (717) 691-3130 Email: cslucas(Q)lucashealthlaw.com ATTORNEY FOR PLAINTWF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW CNIL ACTION NO. 05-242 Civil Term JO ANN GRUBBS, Joint Account Holder and Wife of the Deceased A. Richard Grubbs 52 Oakwood Avenue Mechanicsburg, P A 17055 Plaintiffs v. ST. AGNES HEALTHCARE 900 Caton Avenue Baltimore, MD 21229-5299 Defendant NOTICE OF DEFAULT YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS YOU ACT WITHIN TEN 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 South Bedford Street, Carlisle, PA 17013 (717)c-9~ BY: - Christopher S. Lucas, Esquire ATTORNEY FOR PLAINTIFF Attorney ID No. 77903 .' ~ CERTIFICATE OF SERVICE I, Christopher S. Lucas, hereby certify that I have served a copy of the forgoing document upon the defendant by facsimile and First Class U.S. Mail as follows: 410.368.2947 St. Agnes Medical Center 900 Caton Avenue Baltimore, MD 21229-5299 Date: :1.1410S cO Christopher S. Lucas, Esq. No. 77903 ---= CHRISTOPHER S. LUCAS & ASSOCIATES 220 Cumberland Pkwy. Ste, 4 Mechanicsburg, P A 17055 717.691.0203 voice 717.691.3130 facsimile cslucas(ajlucashealthlaw.com email (" 1"":; .:.., ;:7"1 -'- ',:"'1 (..""f..: . LAW OFFICES OF CHRISTOPHER S. LUCAS & ASSOCIATES By: Christopher S. Lucas, Esquire ATTORNEY FOR PLAINTIFF Attorney ID No. 77903 220 Cumberland Parkway, Ste. 4 Mechanicsburg, P A 17055 Phone: (717) 691-0203; Fax: (717) 691-3130 Email: cslucas(iV.lucashealthlaw.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 10 ANN GRUBBS, Joint Account Holder and Wife of the Deceased A. Richard Grubbs 52 Oakwood Avenue Mechanicsburg, P A 17055 CIVIL ACTION NO. 05-242 Plaintiff v. ST. AGNES HEALTHCARE 900 Caton Avenue Baltimore, MD 21229-5299 Defendant RETURN OF SERVICE I hereby certify that I caused a true and correct copy of Plaintiff's COMPLAINT in the above-captioned matter to be served upon Defendant by Certified Mail, Return Receipt requested, as governed by 42 Pa.C.S.A. 9 404, Service Outside the Commonwealth, on February 7, 2005. Proof of Service is attached. ----~- DATED: s / 5 / D~ ( I Chris op ucas, Esquire ATTORNEY FOR PLAINTIFF Attorney ID No. 77903 . . . .. ',ENDER COMPLETE THIS SECTION . Complete ttems 1, 2, and 3. Also complete ttem 4 W RestrIcted Delivery Is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: ~t-. r..T~~ \-\ea.~"- 900 Caron ~\Jenue ~~"rno(e, l"\~ Qllaaq ~5:lGq 2. ArtIcle Number /Ill1nsNfrom -label) PS Fonn 3811, August 2001 . D.18de1lvery<lddressdiffelentfromItem17 If YES, 8nler dsllv8ry address below: 3. Service 1YPO :BCet1IfIed Moll [J Exprass Moll [J Rsgl8lered [J Return ReceIpt for Maro_ [J Inswed Moll [J C.O.D. 4. R8Bldcl8d DsIIvery7 (Extra Fee) [J V.. 7004 1160 0004 2374 0074 102595-02-M-1540 Domestic Return Receipt (") c;. ..,...., _^~ i'"' 'I \~ i .' .'.'\ -"': "'( .( ~'.-~ c :') -- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNYSL VANIA JOANN GRUBBS, Joint Account Holder and Wife oftl1e Deceased, A. Richard Grubbs 52 Oakwood Avenue Mechanicsburg, P A 17055 Plaintiff v. Civil Action No. 05-242 Civil Team STAGNESHEALTHCARE 900 Caton Avenue Baltimore, MD 21229-5299 Defendant PRAECIPE TO SETTLE DISCONTINUE AND END TO: THE PROTHONOTARY Kindly mark the above-captioned action as settled, discontinued and ended. By: Christopher S. Lucas, Esquire 220 Cumberland Parkway, Suite 4 Mechanicsburg, PA 17055 717.691.0203 telephone 717.691.3130 facsimile cslucas@lucashealthlaw.com Attorney for Plaintiff 0 r--.'l = 0 C = "Tl -"1>' en L;r.E~ ". ~-n n-1rr, c: -~ ,,> nlp 6~~~'" -om N ::uv ;oS ... 0(- ~c '-J ,) -0 ;~::n Zr. ::E: \40 ~(= 251-n """'C: ~ -:;~. ..... :? N ~ , $:"" -<