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United States District Court for the Southern District of Florida
September 25, 2017, Decided; September 25, 2017, Entered on Docket
Case No. 1:17-CV-20028-KMM
[*1311] ORDER GRANTING IN PART AND DENYING IN PART DEFENDANTS' MOTIONS TO DISMISS AMENDED COMPLAINT
THIS CAUSE came before the Court upon the following motions: Defendant Metropolitan Health Community Services Corporation's Motion to Dismiss (ECF No. 60), and Defendants Performance Orthopaedics & Neurosurgery, LLC, Physicians Central Business Office, LLC, Mark Cereceda, and Brian Mevorah's Motion to Dismiss (ECF No. 61), to which Defendants, Omni Neurological, Orthopedic & Spine Center, Inc. and Sergio Triana filed a Notice of Joinder (ECF No. 63).1 Both motions are fully briefed and now ripe for review. For the reasons that follow, both [*1312] motions to dismiss are GRANTED IN PART AND DENIED IN PART.
In its Amended Complaint, State Farm Mutual Automobile Insurance Company ("Plaintiff" or "State Farm") alleges a "scheme" involving Defendants Performance Orthopaedics & Neurosurgery, LLC d/b/a Calhoun Orthopaedics & Neurosurgery ("Calhoun"), Omni Neurological, Orthopedic & Spine Center, Inc. ("Omni"), Metropolitan Health Community [**3] Services Corporation d/b/a Metropolitan Hospital Of Miami ("Metropolitan"), Surgery Center Of Coral Gables, LLC d/b/a Coral Gables Surgery Center ("Coral Gables"), Physicians Central Business Office, LLC ("CBO"), Mark Cereceda, D.C. ("Cereceda"), Sergio Triana, D.C. ("Triana"), and Brian Mevorah, D.C. ("Mevorah") (collectively, "Defendants"). See Amended Complaint ("Am. Compl.") (ECF No. 56) ¶ 1.
This scheme consisted of two allegedly "unlawful referral arrangements," id. ¶ 121. The first such arrangement (the "Metropolitan Arrangement") took place from early 2012 through April 2014. Id. ¶ 6. During that time, Calhoun, a medical practice which specialized in orthopedic treatment and surgery, referred patients to Metropolitan, a surgical facility where Calhoun's physicians would perform surgery. Id. ¶ 6. Prior to treatment, Calhoun required each patient to execute a Letter of Promise (or "LOP"), which provided that Calhoun would be paid from any settlement, judgment, or verdict rendered in connection with the patient's personal injury claim. Id. ¶ 60; see also id. ¶¶ 39-40. For each referred surgical procedure performed on Calhoun's patients, Calhoun paid Metropolitan an all-inclusive [**4] pre-arranged price in full satisfaction of the patient's surgical facility charges. Id. ¶ 6. The amount Calhoun paid was typically pre-negotiated and based on a price list that assigned a specific dollar amount to particular procedures. Id.
Despite this pre-arranged price, however, Metropolitan prepared and sent invoices to Calhoun which reflected an amount for Metropolitan's services that "greatly exceeded" the amount Calhoun actually paid to Metropolitan. Id. These invoices purportedly reflected itemized charges for each of the supplies and services rendered. Id. ¶ 71. These invoices did not include any reference to, or deduction for, the amount that Calhoun actually paid Metropolitan. Id. ¶ 6. Rather, the "invoices" showed the total amount of Metropolitan's itemized charges as an unpaid "balance." Id. ¶ 71.
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278 F. Supp. 3d 1307 *; 2017 U.S. Dist. LEXIS 156284 **; 98 Fed. R. Serv. 3d (Callaghan) 1142; 2017 WL 4270620
State Farm Mutual Automobile Insurance Company, Plaintiff, v. Performance Orthopaedics & Neurosurgery, LLC, et al., Defendants.
Subsequent History: Motion granted by, in part, Motion denied by, in part, Dismissed by, in part, Without prejudice State Farm Mut. Auto. Ins. Co. v. Performance Orthopaedics & Neurosurgery, LLC, 2018 U.S. Dist. LEXIS 26841 (S.D. Fla., Feb. 16, 2018)
Summary judgment denied by, Partial summary judgment granted by, in part, Partial summary judgment denied by, in part State Farm Mut. Auto. Ins. Co. v. Performance Orthapaedics & Neurosurgery, LLC, 2018 U.S. Dist. LEXIS 148674 (S.D. Fla., May 9, 2018)
allegations, amended complaint, invoices, patients', charges, Surgical, motion to dismiss, settlement, packages, misrepresentation, medical practice, accident victim, commerce, unjust enrichment, joined, unfair, Facilities, reasons, practices, absent party, particularity, billing, parties, common law fraud, deceptive act, fraudulent, referral, necessary party, customary, deceptive
Civil Procedure, Defenses, Demurrers & Objections, Motions to Dismiss, Failure to State Claim, Pleadings, Complaints, Requirements for Complaint, Pleading & Practice, Complaints, Evidence, Types of Evidence, Documentary Evidence, Judicial Notice, Responses, Motions to Dismiss, Rule Application & Interpretation, Antitrust & Trade Law, Consumer Protection, Deceptive & Unfair Trade Practices, State Regulation, Deceptive & Unfair Trade Practices, Trials, Jury Trials, Province of Court & Jury, Torts, Business Torts, Fraud & Misrepresentation, Actual Fraud, Governments, Courts, Common Law, Actual Fraud, Elements, Heightened Pleading Requirements, Fraud Claims, Fraud & Misrepresentation, Legislation, Statutory Remedies & Rights, Contracts Law, Remedies, Equitable Relief, Quantum Meruit, Insurance Law, Declaratory Judgments, Joinder of Parties, Compulsory Joinder, Indispensable Parties, Burdens of Proof, Allocation, Parties, Joinder of Parties