State Farm Mutual Automobile Insurance v. B & A Diagnostic, Inc.

104 F. Supp. 3d 1366, 2015 U.S. Dist. LEXIS 64336, 2015 WL 2217312
CourtDistrict Court, S.D. Florida
DecidedApril 6, 2015
DocketCase No. 14-cv-24387-KMM
StatusPublished
Cited by4 cases

This text of 104 F. Supp. 3d 1366 (State Farm Mutual Automobile Insurance v. B & A Diagnostic, 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
State Farm Mutual Automobile Insurance v. B & A Diagnostic, Inc., 104 F. Supp. 3d 1366, 2015 U.S. Dist. LEXIS 64336, 2015 WL 2217312 (S.D. Fla. 2015).

Opinion

ORDER ON MOTIONS TO DISMISS

K. MICHAEL MOORE, Chief Judge.

THIS CAUSE came before the Court upon Defendants’ Motions to Dismiss (ECF Nos. 18, 19, 20, and 22), which are nearly identical.1 Plaintiffs State Farm Mutual Automobile Insurance Co. and State Farm Fire & Casualty Co. (collectively, “State Farm” or “Plaintiff’) filed a Response (ECF No. 30). The Motions are now ripe for review. UPON CONSIDERATION of the Motions, the Response, the pertinent portions of the record, and being otherwise fully advised in the premises, for the reasons set forth below, the Court now enters the following Order.

1. BACKGROUND

Florida law requires that Florida automobile insurance policy holders have Personal Injury Protection coverage (“PIP”) to provide victims of motor vehicle accidents benefits for reasonable, necessary, related and lawful treatment; irrespective of fault. Fla. Stat. § 627.30. Florida law also sets forth what benefits are covered under PIP, stating that “thé medical benefits shall provide reimbursement only for such services and care that are lawfully provided, supervised, ordered or prescribed. ...” Fla. Stat. § 627.736(l)(a).

State Farm’s Complaint alleges that Defendants submitted claims for auto insurance benefits for services that were unlawfully rendered to obtain insurance payments from State Farm in excess of $2,200,000. Compl., at ¶1 (ECF No. 1). Specifically, Defendant B & A Diagnostic, Inc. (“B & A”)2 failed to meet its obligations to employ a Medical Director that [1370]*1370complied with all applicable Florida law and failed to ensure that X-ray services performed on its patients were performed by technicians that were properly employed, supervised, and lawfully certified to perform those services in accordance with Florida law. Id. at ¶¶2-3. Additionally, Defendants ■ Esteban Genao (“Genao”) and Alex Alonso, M.D.. (“Alon-so”) failed to meet their obligations to perform the statutory duties required of Medical Directors. Id. at ¶ 4. Finally, Defendants Ernesto Alvarez Velasco (“Velas-co”) and Jose Angel Ortiz Maza (“Maza”) failed to meet their obligations to obtain the statutorily required certifications- relating to radiological services. Id. at ¶ 5.

Defendant B & A is a Florida corporation operating as a health- care clinic licensed by Florida’s Agency for Health Care Administration (“AHCA”) and doing business at 8150 S.W. 8th Street in Miami. Id. at ¶¶2, 10. Defendant Genao was designated as the Medical Director for B & A from March 21, 2008 through March 31, 2010. Id. at ¶ 14. Defendant Alonso was designated as the Medical Director for B & A from April 1, 2010 through November 16, 2011. Id. at ¶ 15. Defendant Ve-lasco was employed by B & A to perform X-ray scans on patients. Id. at ¶ 16. Defendant Maza was employed by B & A from roughly July 2009 through in or about November 2013 to perform X-ray services on patients. Id. at ¶ 17., All of the named Defendants are citizens of Florida who reside in. Miami-Dade County. Id. at ¶¶ 14-17.

State Farm makes numerous allegations in support of its claim that the services rendered were unlawful and therefore non-compensable. State Farm claims that in 2009 and 2010, Defendant Velasco. performed X-rays on patients, including State Farm insureds, without the certification required by the Radiological Personnel Certification Act (“RPCA”), Florida Statute § 468.3001. Id. at ¶¶ 73-76. State Farm asserts that Defendants B & A, Genao, Alonso, and Velasco knew or should have known that Velasco lacked certification from the Department of Health, as required under the RPCA. Id. at ¶ 83. Additionally, State Farm claims that Defendant B & A’s employment of Defendant Maza, who held a certification from the State of Florida as a Basic Machine Operator (“BMO”), was in violation of Florida law regulating the use of BMO’s, as it was a clinic owned by a layperson, and not the office of a licensed practitioner. See id. at ¶ 87; see also Fla. Stat. §§ 468.301(1) and 468.302(3)(a). State Farm also contends that B & A and its Medical Directors failed to make a good faith effort to collect deductibles and/or copays, in violation of Florida law. Id. at ¶¶ 61-70.

State Farm claims that Defendants B & A, Genao, and Alonso failed to comply with the requirements for a Medical Director set forth in the Health Care Clinic Act (“HCCA”). See Compl. at ¶¶ 105-122. Specifically, Defendant Genao did not enter into a written agreement with B & A agreeing to accept legal responsibility for his statutory Medical Director duties. Id. at ¶ 106. Defendant Alonso did not enter into an agreement with B & A until March 15, 2011, nearly one year after he was appointed B & A’s Medical Director on April 1, 2010. Id. Further, Defendants Genao and Alonso failed to ensure the technicians at B & A were lawfully employed, supervised, and certified, failed to conduct systematic reviews of B & A’s billings for unlawful conduct, failed to pro[1371]*1371vide day-to-day supervision of B & A, and faded to ensure the lawfulness of B & A’s billings. Id. at ¶¶ 105-122.

On this basis, State Farm seeks to recover the amounts it paid to Defendants based on a theory of unjust enrichment (Count I). State Farm further seeks a declaratory judgment confirming that State Farm is not obligated to pay any of Defendant B & A’s bills, to the extent they remain unpaid (Count II).

II. STANDARD OF REVIEW

On a motion to dismiss, the Court must accept the factual allegations as true and construe the complaint in the light most favorable to the plaintiff. SEC v. ESM Group, Inc., 835 F.2d 270, 272 (11th Cir.1988). “To survive a motion to" dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim for relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (quoting Bell Atl. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). “The plausibility standard is not akin to a ‘probability requirement,’ but it asks for more than a sheer possibility that a defendant has acted unlawfully.” Id. “But where the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged — but it has not ‘show[n]’ — ‘that the pleader is entitled to relief.’ ” Id. at 679, 129 S.Ct. 1937.

A complaint must also contain enough facts to indicate the presence of the required elements. Watts v. Fla. Int'l Univ.,

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104 F. Supp. 3d 1366, 2015 U.S. Dist. LEXIS 64336, 2015 WL 2217312, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-v-b-a-diagnostic-inc-flsd-2015.