People ex rel. Tonti v. Avee Laboratories CA2/1

CourtCalifornia Court of Appeal
DecidedSeptember 28, 2023
DocketB322999M
StatusUnpublished

This text of People ex rel. Tonti v. Avee Laboratories CA2/1 (People ex rel. Tonti v. Avee Laboratories CA2/1) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
People ex rel. Tonti v. Avee Laboratories CA2/1, (Cal. Ct. App. 2023).

Opinion

Filed 9/28/23 People ex rel. Tonti v. Avee Laboratories CA2/1 NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION ONE

THE PEOPLE ex rel. ALISON B322999 TONTI,

Plaintiff and Appellant, (Los Angeles County Super. Ct. No. BC674091) v. ORDER MODIFYING AVEE LABORATORIES, INC., OPINION (NO CHANGE et al., IN JUDGMENT) AND ORDER DENYING PETITION FOR REHEARING Defendants and Respondents.

THE COURT: The opinion in the above-entitled matter filed on August 29, 2023 is modified as follows:

1. On page 21, the entire paragraph that begins with “A defendant may also make this showing” is deleted.

2. On pages 23–24, the paragraph that begins with “Tonti argues that this evidence is insufficient to preclude a triable question” is deleted and replaced with the following paragraph: Tonti argues that this evidence is insufficient to preclude a triable question as to the laboratories’ intent for several reasons. First, she contends that neither laboratory offered any proof that it actually performed the confirmatory urine tests billed to Blue Shield, and that if the laboratories billed for tests they never performed, this is ample basis for inferring an intent to defraud an insurer. Assuming Tonti sufficiently alleged in the operative complaint that Millennium or Avee (as opposed to the rehabilitation centers) defrauded Blue Shield by billing for tests not performed (as opposed to by performing and charging for medically unnecessary and duplicative tests), and thus that this issue is within the scope of summary judgment (see AARTS, supra, 179 Cal.App.3d at p. 1064), Avee’s discovery responses and the declarations are evidence that the laboratories actually performed tests on what was presented to them as Tonti’s urine. Nothing in the record contradicts these documents, nor did Tonti seek discovery that might contradict them.

3. On pages 25–27, part B.3. of the Discussion (the heading and all text contained in that subsection, including footnote 4) is entirely deleted.

4. At the bottom of page 28, the following sentence is deleted: In addition, as to Avee’s motion, Avee provided Tonti’s factually devoid discovery responses to interrogatories requesting she identify “the basis of [her] allegation that ‘. . . [Living] Rebos

2 acted as a runner, capper, or steerer . . . to procure testing services’ for Avee.” 5. In the last paragraph on page 30, the first sentence of that paragraph is deleted and replaced with the following sentence: But the only evidence Tonti identifies to support her contention that Avee did not bill her for the copayments she would otherwise owe under the terms of her insurance contract with Blue Shield is her declaration stating that she never received bills from Avee, and evidence that the amounts Avee billed Blue Shield were more than the amounts Blue Shield paid Avee.

6. The paragraph on pages 31–32 that begins, “As to Millennium,” is entirely deleted (along with footnote 5) and replaced with the following paragraph and revised footnote:

As to Millennium, Tonti identifies similar evidence regarding Millennium’s billing to support her contention that Millennium did not bill her for the copayments she would otherwise owe. But the explanation of benefits documents prepared by Blue Shield reflect that, under the terms of the Blue Shield insurance contract applicable to Tonti, Tonti did not have any copayment or other financial obligations for the services that Millennium charged to the insurer on her behalf.1 Tonti has not

1 Millennium represents in its brief that all of these explanation of benefits documents generated by Blue Shield and attached to the Cartier declaration reflect a $0 patient

3 explained—let alone presented an evidentiary basis reflecting— how Millennium’s failure to bill Tonti for copayments Blue Shield concluded were not owed can support any inference regarding Millennium conferring a benefit to Sobertec.

7. On pages 36–37, the sentence at the bottom of page 36 that begins, “The declaration provides no facts,” is deleted and replaced with the following sentence:

responsibility amount, and Tonti does not dispute this characterization of the documents. Our own review of the documents reflects that 10 of these explanation of benefits documents show a $0 copayment obligation and a $0 amount for the portion of the services not covered by insurance. One of these explanations of benefits documents is for services dated August 5, 2014. There are also two exact copies of another explanation of benefits document itemizing services Millennium provided to Tonti on August 5, 2014; that document reflects that Tonti does have a copayment obligation, and that a portion of the charges for services Millennium provided to her are not covered. None of the Blue Shield explanation of benefits documents identifies services provided by name, but rather by billing code and using the term “office medical.” (Capitalization omitted.) Given that Tonti does not dispute the characterization of these documents as reflecting Tonti has no copayment or other financial obligations for the urine testing Millennium billed to Blue Shield, she has conceded the point. Nor is evidence that Blue Shield did not pay for the entire cost of the services Millennium provided to Tonti contrary to the $0 patient responsibility amount reflected in these explanation of benefits documents, because the amount of coverage and an insured’s financial obligation are distinct and unrelated issues. Tonti does not attempt to connect these two issues with evidence or argument.

4 The declaration provides no facts to establish counsel’s personal knowledge, based on which he is able to declare the documents are true and correct copies of what they purport to be.

8. Due to footnote 4 (on page 26) being deleted (see ante, p. 2), all footnotes after page 26 are renumbered.

These modifications do not constitute a change in the judgment.

The petition for rehearing filed on September 13, 2023 is denied.

____________________________________________________________

ROTHSCHILD, P. J. CHANEY, J. BENDIX, J.

5 Filed 8/29/23 People ex rel. Tonti v. Avee Laboratories CA2/1 (unmodified opinion) NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

THE PEOPLE ex rel. ALISON B322999 TONTI, (Los Angeles County Plaintiff and Appellant, Super. Ct. No. BC674091)

v.

AVEE LABORATORIES, INC., et al.,

Defendants and Respondents.

APPEAL from a judgment of the Superior Court of Los Angeles County, Michael P. Linfield, Judge. Affirmed. Medvei Law Group and Sebastian M. Medvei for Plaintiff and Appellant the People of the State of California ex rel. Alison Tonti. Polsinelli, Jonathan Buck and J. Alan Warfield for Defendant and Respondent Millennium Health, LLC. Kirkland & Ellis, Sierra Elizabeth and James R.P. Hileman for Defendant and Respondent Aveo Laboratories Inc.

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