State Farm Mutual Automobile Insurance v. Medical Service Center of Florida, Inc.

103 F. Supp. 3d 1343, 2015 U.S. Dist. LEXIS 60584, 2015 WL 2170396
CourtDistrict Court, S.D. Florida
DecidedMay 8, 2015
DocketCase No. 14-cv-20625-KMM
StatusPublished
Cited by10 cases

This text of 103 F. Supp. 3d 1343 (State Farm Mutual Automobile Insurance v. Medical Service Center of Florida, 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. Medical Service Center of Florida, Inc., 103 F. Supp. 3d 1343, 2015 U.S. Dist. LEXIS 60584, 2015 WL 2170396 (S.D. Fla. 2015).

Opinion

ORDER ON MOTIONS FOR SUMMARY JUDGMENT

K. MICHAEL MOORE, Chief Judge.

THIS CAUSE came before the Court upon Plaintiffs’ Motion for Summary Judg[1346]*1346ment (ECF No. 99). Defendants filed a Response (ECF No. 107), and Plaintiffs filed a Reply (ECF No. 116). THIS CAUSE also came before the Court upon Defendants’ Motion for Summary Judgment (ECF No. 102). Plaintiffs filed a Response (ECF No. 113), and Defendants filed a Reply (ECF No. 118). The Motions are now ripe for review. UPON CONSIDERATION of the Motions, the Responses, the Replies, 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.

I. BACKGROUND

Florida law requires that all health care clinics be licensed by the Agency for Health Care Administration (“AHCA”), unless they qualify for an exemption. Fla. Stat. § 400.991 (2009). One such exemption applies if the clinic is “wholly owned” by a licensed health care practitioner who supervises the business activities and is legally responsible for the entity’s compliance with all federal and state laws. See Fla. Stat. § 400.9905(4)(g). Florida law also provides that an insurer is required to provide reimbursement to health care clinics only for medical benefits that are “lawfully provided.” See Fla. Stat. § 627.736(l)(a)(l); see also Fla. Stat. § 627.736(5)(b)(l)(b) (“An insurer or insured is not required to pay a claim or charges ... for any service or treatment that was not lawful at the time rendered.”).

Plaintiffs State Farm Mutual Automobile Insurance Company and State Farm Fire & Casualty Company (collectively, “Plaintiffs” or “State Farm”) seek to recover the amounts paid to Defendants Medical Service Center of Florida, Inc., Medical Diagnostic Center of Florida, Inc., Lourdes Diaz, and Edel Perez Diaz (collectively, “Defendants”) based upon violations of the Florida Deceptive and Unfair Trade Practices Act (“FDUTPA”) and a claim of unjust enrichment (Count I and II). State Farm further seeks a declaratory judgment confirming that State Farm is not obligated to pay any of Defendants’ bills to the extent they remain unpaid (Count III).1

Defendant Medical Service Center of Florida, Inc. (“MSCF”) and Defendant Medical Diagnostic Center of Florida, Inc. (“MDCF”) are Florida corporations located in Miami. Compl. at ¶¶5-6. Defendant Lourdes Diaz (“Diaz”) is a citizen of Florida living in Miami-Dade County. Diaz is not a licensed medical professional in Florida. Id. at ¶7. Defendant Edel Perez Diaz (“Perez”) is a citizen of Florida . living in Miami-Dade County. Id. at ¶ 8. Perez was not a licensed medical professional in Florida until August 31, 2010, at which time he became a licensed massage therapist. Defs.’ Answer at ¶ 8.

MSCF was formed by Diaz in 2000, with Diaz designated as the owner and President. Id. at ¶ 30. Diaz represented to the AHCA that she was the 100% owner of MSCF from the date MSCF was formed until November 2009, at which point Miguel Hernandez (“Hernandez”), a licensed medical doctor who was hired by Diaz in 2008, allegedly became the owner of the clinic. Id. at ¶¶ 30-35. MDCF was formed in February 2009, with Hernandez designated as the President, Incorporator, and Registered Agent, and with Perez designated as the Vice President. Id. at ¶ 48.

[1347]*1347State Farm’s claims are based on two separate time periods during which State Farm asserts MSCF and MDCF were unlawfully operated: (1) the “exemption period,” between 2009 and 2010, during which time the clinics operated on an exemption from licensure based upon the representation that the clinics were wholly owned by Hernandez; and (2) the “licensure period,” between 2010 and 2011, during which time Defendants obtained healthcare clinic licenses based on false representations of ownership and sales of the clinics from Hernandez.to Perez.

a. Exemption Period2

In 2009, Diaz ran into legal trouble and could not renew MSCF’s license under her name.3 Defs.’ Reply at 3. Defendants subsequently obtained exemptions from clinic licensure from Florida’s AHCA for MSCF and MDCF by representing that Hernandez wholly owned both clinics. Id. at ¶¶ 9, 11, 35, 50. State Farm maintains that these representations were false, and therefore, the clinics unlawfully obtained payments from State Farm and other insurers throughout this period. Id. at ¶¶ 9, 84-86.

Defendants contend that Diaz had planned to close the MSCF clinic after she ran into legal trouble, but was convinced by Hernandez to transfer ownership of MSCF to him. Defs.’ Reply at 4. Defendants claim that after Hernandez made his offer, Diaz transferred her stock in MSCF to him so that he could apply for the exemption. Id. As everything was done quickly, Defendants decided other actions, “such as putting him on the bank accounts and figuring out a fair distribution of the profits,” would wait until the next tax year. Id. However, Hernandez testified at his deposition that, in fact, Diaz had asked him if he would mind being the owner of MSCF as a favor while Defendants opened a second clinic (MDCF). Hernandez Dep., at 70 (ECF No. 75-1). Hernandez testified that Diaz asked him to sign paperwork, including several forms that were given to him blank.4 Id. Hernandez further testified that he did not pay Defendants any money for the clinic. Id. at 72.

State Farm further maintains that Hernandez never wholly owned MDCF, the second clinic opened in February 2009. Defendants state that Hernandez started MDCF with money borrowed from Diaz, became its sole shareholder, and subsequently signed the AHCA- Application for Certificate of Exemption from Licensure as a Health Care Clinic. Defs.’ SOF, at 5-6. Hernandez testified, however, that he did not start the second clinic, that he did not believe his “favor” to Diaz extended to the new clinic, and that he was unaware [1348]*1348that his signature was on MDCF paperwork or that he had been named as the President of MDCF. Hernandez Dep. at 103-108.

b. Licensure Period5

On February 18, 2010, Hernandez voluntarily surrendered his medical license after an Administrative Complaint was filed by the Department of Health, Board of Medicine against him. See Voluntary Relinquishment of Medical License (ECF No. 95). Defendants subsequently submitted Applications for Health Care Clinic License to the AHCA on March 1, 2010 and March 11, 2010, for MSCF and MDCF, respectively. See Applications for Health Care Clinic License (ECF Nos. 95-4, 95-9). The AHCA rejected the Applications pending receipt of documentation reflecting transfer of ownership from Hernandez, whom AHCA believed to be the sole owner of the clinics. See Letter from ACHA to MDCF (ECF No. 95-10). Specifically, the letter stated:

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103 F. Supp. 3d 1343, 2015 U.S. Dist. LEXIS 60584, 2015 WL 2170396, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-v-medical-service-center-of-flsd-2015.