Crooksville Family Clinic v. Quest Diagnostics Incorporated

CourtDistrict Court, S.D. Ohio
DecidedDecember 10, 2019
Docket2:16-cv-01145
StatusUnknown

This text of Crooksville Family Clinic v. Quest Diagnostics Incorporated (Crooksville Family Clinic v. Quest Diagnostics Incorporated) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Crooksville Family Clinic v. Quest Diagnostics Incorporated, (S.D. Ohio 2019).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO EASTERN DIVISION

CROOKSVILLE FAMILY CLINIC, INC.,

Plaintiff, : Case No. 2:16-cv-1145

-vs- Judge Sarah D. Morrison Magistrate Judge Kimberly A. Jolson QUEST DIAGNOSTICS, INC., et al., : Defendants.

OPINION AND ORDER This matter is before the Court upon Defendants Quest Diagnostics, Inc., MedPlus, Inc., and David Mills’ collective Motion for Summary Judgment (ECF No. 38), Plaintiff Crooksville Family Clinic, Inc.’s Brief in Opposition to Defendants’ Motion for Summary Judgment (ECF No. 42), and Defendants’ Reply Memorandum in Support of their Motion for Summary Judgment (ECF No. 43). For the reasons that follow, the Court GRANTS IN PART and DENIES IN PART Defendants’ Motion. I. FACTS From 1987 until 2012, Plaintiff Crooksville Family Clinic, Inc. (“Plaintiff” or “Clinic”) was a rural family clinic in Crooksville, Ohio. (Mumma Depo., 19, ECF No. 31). Dr. Paul Mumma, D.O., was Plaintiff’s president and primary practitioner during that time. (Id. at 19–21). Because Plaintiff was designated as a rural health clinic through the federal government, it received reimbursement based on an enhanced fee schedule from Medicare and Medicaid for treatment of patients. (Id. at 41). This required different billing processes and rules than the general Medicare and Medicaid programs. (Id.). In 2011, rural healthcare claims constituted 60 to 70 percent of Plaintiff’s primary care practice. (Id.). Defendant Quest Diagnostics, Inc. (“Quest”) marketed and sold two interfaced products under the “Care360” label: (1) the electronic health records (“EHR”) product, developed and supported by MedPlus, Inc.; and (2) the practice management system (“PMS”), developed and

supported by Kareo. (Mills Depo., 22, 26–27, ECF No. 36). At the time of the lawsuit, Defendant MedPlus, Inc. was a wholly-owned subsidiary of Quest. (Id. at 14). Quest was a reseller of Kareo’s PMS service. (Id. at 38). The EHR product maintained and imported patient data records, while the PMS service allowed for scheduling, billing, and sending claims to payors. (Id. at 16, 22, 27). For purposes of this Opinion, the Court will refer to both products collectively as the “Care360 Program” unless otherwise noted. In early 2011, David Mills, a technology account executive with Quest, met with Cheryl Crowder, Administrative Director for the Physicians Group of Southeast Ohio (“PGSEO”),1 to discuss the Care 360 Program. (Crowder Depo., 55, ECF No. 33). Upon learning that PGSEO was not interested in purchasing a billing system as a single entity, Mr. Mills inquired about

whether Plaintiff might be interested in the Care360 Program. (Id. at 57). Dr. Mumma was part of the PGSEO and Ms. Crowder had been handling the private insurance billing for Plaintiff since 2001. (Id. at 16). According to Ms. Crowder, “I told them that that was not the office that they wanted to start with. It’s not - - it’s not a very current office, as far as technology. . . . I know their office manager was older and didn’t have the technical knowledge that some of our younger office managers did, and I didn’t feel that that was a good place for them to start.” (Id. at 57–58).

1 PGSEO is a 34-physician primary care practice with locations in several rural Ohio counties. (Crowder Depo., 14, ECF No. 33). Nevertheless, shortly thereafter, Mr. Mills met with Barbara Anders, Plaintiff’s administrator and officer manager, to talk about the Care360 Program. (Anders Depo., 43, ECF No. 35). For nearly 25 years, Ms. Anders managed the cash flow, managed personnel, ordered supplies, and oversaw billing for Plaintiff. (Mumma Depo., 27–28; Anders Depo., 11). Dr.

Mumma described Ms. Anders as handling “the business side of things” for the Clinic. (Mumma Depo., 65). According to Ms. Anders, she stressed several times in her initial discussions with Mr. Mills that Plaintiff was a rural health clinic, so any billing program they used had to be able to bill for rural healthcare claims. (Anders Depo., 44, 55). When asked by Ms. Anders if the Care360 Program’s billing tool could handle rural healthcare billing, Mr. Mills reached out to Kareo via e-mail. (Mills Depo., 50– 51). Matt Kelly, an account executive with Kareo, responded to Mr. Mills on June 6, 2011 as follows: We do have many different types of clients submitting UB042 claims today but I am not away [sic] of any Rural health clinics that are doing this today. I checked with our support team and they have sent me the following response.

***

If Kareo is not yet supporting your specialty, there are 2 options for you:

1. If you’re willing to partner with us as we develop support for your type or specialty of institutional billing, please contact our support team . . . . They will work with you to help you submit institutional claims. Please note that as a BETA customer, there may be additional fields the Kareo engineering department has to design to assist you, thus the process could take some time. Each specialty is different in terms of timelines, thus we don’t have a definitive ETA, but these types of features usually take between 4-8 weeks to develop. The first step is to talk to customer service; they will assist you with next steps.

(Pl. Ex. 2, ECF No. 36).

2 “UB” stands for universal billing and refers to the format of the claim. (Mills Depo., 104–105). After receiving this e-mail from Kareo, Mr. Mills relayed to Ms. Anders that rural healthcare billing “wouldn’t be an issue, that they could support that.” (Mills Depo., 52–53). Mr. Mills did not disclose the specific contents of the e-mail to anyone at the Clinic. (Id. at 121). According to Mr. Mills, Ms. Anders participated in a Kareo webinar shortly thereafter and Kareo

responded similarly regarding her question about Care360’s rural healthcare billing capability. (Id. at 52, 64–65). While Ms. Anders acknowledged in her deposition that she probably asked about rural healthcare billing during a Kareo webinar, she recalled that being after the contract was signed. (Anders Depo., 108–13). Sometime in the summer of 2011, Mr. Mills presented the Care360 Program to Plaintiff’s staff. (Pease Depo., 23, ECF No. 32). According to Ms. Anders, she again explained to Mr. Mills during this presentation “at least four or five times” that Plaintiff was a rural health clinic and the Care360 Program would have to be able to perform rural healthcare billing, that “was the main factor [they] had to have with [the] product.” (Anders Depo., 47–48). Mr. Mills responded each time that “there would be no problem.” (Anders Depo., 48; Mills Depo., 52). Ginger Pease,

Plaintiff’s assistant office manager, reiterated the same question during the demonstration and Mr. Mills’ response was the same. (Pease Depo., 18–19). Mr. Mills had no experience with rural healthcare billing up to that point. (Mills Depo., 57). Reflectively, Dr. Mumma believed Mr. Mills’ affirmations about the Care360 Program’s billing capabilities were false due to Mr. Mills being “possibly misinformed.” (Mumma Depo., 73). However, he did note that Mr. Mills “expressed no reservation.” (Id.). Similarly, Ms. Anders testified that she did not think Mr. Mills believed his assurances to be false. (Anders Depo., 93). Rather, she thought “David believed it could handle it.” (Id. at 93, 131). Ms. Pease also did not think Mr. Mills made any intentionally false statements, she just thought he did not know much about rural healthcare billing. (Pease Depo., 75–76). On August 31, 2011, Plaintiff executed the Care360 License and Services Agreement (“Care360 Agreement”). Ms. Anders signed the Care360 Agreement as the representative of Plaintiff after both herself and Dr. Mumma had an opportunity to review it. (Mumma Depo., 99;

Anders Depo., 88, 92). Ms. Anders and Dr. Mumma testified that they did not recall Mr.

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