Gov't Emps. Ins. Co. v. Quality Diagnostic Health Care, Inc.

369 F. Supp. 3d 1292
CourtDistrict Court, S.D. Florida
DecidedFebruary 25, 2019
DocketCase Number: 18-20101-CIV-MARTINEZ-OTAZO-REYES
StatusPublished
Cited by2 cases

This text of 369 F. Supp. 3d 1292 (Gov't Emps. Ins. Co. v. Quality Diagnostic Health Care, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gov't Emps. Ins. Co. v. Quality Diagnostic Health Care, Inc., 369 F. Supp. 3d 1292 (S.D. Fla. 2019).

Opinion

JOSE E. MARTINEZ, UNITED STATES DISTRICT JUDGE

THIS MATTER is before the Court on Defendants', Quality Diagnostic Health Care, Inc. ("Quality"), Jorge Martinez ("Jorge"), Carlos Acebo Martinez ("Acebo"), Luis Anibal Queral, M.D. ("Dr. Queral"), Moulton Keane, M.D. ("Dr. Keane"), Ivelis Garcia ("Ivelis"), and Michel Viera, LMT ("Viera") (collectively, "Defendants"), Motion to Dismiss [ECF No. 39]. Plaintiffs filed a response in opposition [ECF No. 41], and Defendants filed a reply in further support [ECF No. 45]. For the reasons stated below, Defendants' Motion to Dismiss is granted in part and denied in part.

I. BACKGROUND

Plaintiffs bring this action seeking to recover money that Plaintiffs allege was unlawfully obtained by Defendants through the submission of fraudulent no-fault insurance ("personal injury protection" or "PIP") charges1 [ECF No. 33]. Plaintiffs also seek a declaration that they are not legally obligated to pay for the reimbursement of pending PIP charges by Defendants they contend are also fraudulent. Id. Specifically, Plaintiffs allege that Quality's billing records falsely represent that Quality was operating in compliance with Florida's Health Care Clinic Act, Fla Stat. §§ 400.900- 400.995 ("Clinic Act"), Florida's Patient Brokering Act, Fla Stat. § 817.505 ("Patient Brokering Act"), and Florida's Anti-Kickback Statute, Fla Stat. § 456.054 ("Anti-Kickback Statute") when, in fact, Quality was actually non-compliant with the Clinic Act, the Patient Brokering Act, and the Anti-Kickback Statute, and thus Quality was not eligible to receive PIP reimbursement, because: (1) Quality did not have a medical director who legitimately fulfilled the statutory duties required of a medical director, id. at ¶¶ 159-188; (2) Quality failed to disclose and acted to conceal Jorge's ownership interest in its clinic licensing applications, id. at ¶¶ 78-133; and (3) Defendants paid illegal cash kickbacks to patients who agreed to seek "treatment," id. at ¶¶ 134-158.

Additionally, Plaintiffs allege that Defendants' billing records misrepresent that the underlying services were lawfully provided and billed to Plaintiffs because: (1) most of the underlying services were unlawfully performed by an unsupervised massage therapist, Viera, id. at ¶¶ 201-261; (2) Viera was not licensed to provide pertinent services, id. ; (3) in an attempt to conceal the fact that the underlying services *1294were performed by Viera, Defendants misrepresent in billing records that Dr. Keane, a licensed physician, performed or directly supervised the underlying physical therapy services, id. ; (4) Dr. Keane and Viera were both independent contractors for whose services a healthcare clinic is not allowed to recover PIP benefits, id. at ¶¶ 65-69, 189-200; (5) the underlying services were not performed at all or were not medically necessary, id. at ¶¶ 29-38, 262-427; and (6) the underlying services were performed pursuant to kickbacks under which Defendants paid patients who agreed to seek "treatment," id. at ¶¶ 29-38, 134-158.

Based on these allegations, Plaintiffs assert the following counts: (1) Declaratory Judgment against Quality seeking a declaration that Plaintiffs do not have to pay the allegedly fraudulent, pending PIP claims; (2) violation of RICO, 18 U.S.C. § 1962(c) against Jorge, Acebo, and Ivelis; (3) violation of RICO, 18 U.S.C. § 1962(d) against Jorge, Acebo, Dr. Queral, Dr. Keane, Ivelis, and Viera; (4) violation of the Florida Deceptive and Unfair Trade Practices Act, Fla. Stat. §§ 501.201 - 501.213, against all Defendants; (5) violation of the Florida Civil Remedies for Criminal Practices Act, Fla. Stat. §§ 772.101 - 772.19, against Jorge, Acebo, Dr. Queral, Dr. Keane, Ivelis, and Viera; (6) common law fraud against all Defendants; and (7) unjust enrichment against all Defendants [ECF No. 33].

II. STANDARD

A motion to dismiss under Rule 12(b)(6) challenges the legal sufficiency of a complaint. See Fed. R. Civ. P. 12(b)(6). In assessing the legal sufficiency of a complaint's allegations, the Court is bound to apply the pleading standard articulated in Bell Atlantic Corp. v. Twombly , 550 U.S. 544, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) and Ashcroft v. Iqbal , 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). That is, the complaint "must ... contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face." Am. Dental Ass'n v. Cigna Corp. , 605 F.3d 1283, 1289 (11th Cir. 2010) (quoting Twombly , 550 U.S. at 570, 127 S.Ct. 1955 ). "Dismissal is therefore permitted when on the basis of a dispositive issue of law, no construction of the factual allegations will support the cause of action." Glover v. Liggett Grp., Inc. , 459 F.3d 1304, 1308 (11th Cir. 2006) (internal quotations omitted) (citing Marshall Cnty. Bd. of Educ. v. Marshall Cnty. Gas Dist. , 992 F.2d 1171

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
369 F. Supp. 3d 1292, Counsel Stack Legal Research, https://law.counselstack.com/opinion/govt-emps-ins-co-v-quality-diagnostic-health-care-inc-flsd-2019.