13 Fla. L. Weekly Supp. 472b
Insurance — Personal injury protection — Uninsured motorist — Discovery — Pure bill — Where insurer has demonstrated that there are inconsistencies in medical findings made by medical provider relative to insureds who were allegedly involved in accident with phantom vehicle and in insureds’ accounts of how accident occurred, insurer has shown good cause to support request for pure bill of discovery requiring disclosure of facts and evidence regarding whether accident actually occurred, whether provider actually performed services for which it billed and received payment from insurer, identity of medical personnel performing services, whether services were up-coded, whether documented injuries actually exist, and whether services were reasonable, necessary and related to accident
STATE FARM FIRE AND CASUALTY AUTOMOBILE INSURANCE COMPANY, (in Re: Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, Petitioner/Movant, v. WEST COAST MEDICAL MANAGEMENT, INC., Respondent. Circuit Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 05-3685, Division I. January 2, 2006. Rex M. Barbas, Judge. Counsel: Gale L. Young, Gale L. Young, P.A., Tampa. Joseph R. Littman. Harley N. Kane.
REVISED ORDER ON PETITIONER/MOVANT’S VERIFIED COMPLAINT FOR PURE BILL OF DISCOVERY/MOTION FOR DISCOVERY PURSUANT TO FLORIDA STATUTES SECTION 627.736(6)(c) AND MOTION FOR GOOD CAUSE
THIS CAUSE, came before this Court on August 11, 2005, upon Petitioner/Movant’s Verified Complaint For Pure Bill Of Discovery/Motion For Discovery Pursuant To Florida Statutes Section 627.736(6)(c) and Motion For Good Cause. The Court entered an Order on November 23, 2005 granting the Petition, and the Respondent moved to vacate said Order and requesting additional time to review the proposed Order. The Court heard argument on Respondent’s objections on December 16, 2005. The Court hereby modifies its Order of November 23, 2005, vacates said Order, and replaces said Order with the Order contained herein. Based on the facts alleged by Petitioner, the Court finds sufficient evidence before it to find sufficient probable cause to proceed with discovery pursuant to its request for a Pure Bill of Discovery.
FACTS
The facts alleged by Petitioner are contained in Petitioner’s Verified Complaint, the Affidavit of Mary Beth Riebau, and excerpts from the Examination Under Oath (EUO) of Anderson Aguy including the following:
Petitioner, STATE FARM FIRE AND CASUALTY AUTOMOBILE INSURANCE COMPANY, hereinafter referred to as State Farm, issued a policy of insurance to Anderson Aguy and Rachelle Aguy. On or about March 6, 2004, Anderson Aguy was the driver of a motor vehicle in Hillsborough County, Florida when he was allegedly involved in an accident with a phantom vehicle. In addition to Anderson Aguy, four passengers occupied the motor vehicle at the time of the accident, to wit: Rashnide Aguy, Aguy Bethler Aguy (aka Bether Aguy), hereinafter referred to as Bethler Aguy, Pedro Jean, and Francois St. Clair. Anderson Aguy and all of his passengers allegedly sustained injuries as a result of said accident and treated at West Coast Medical Management, Inc., hereinafter referred to as WCMM. Anderson Aguy and Rashnide Aguy presented claims to State Farm for personal injury protection and medical payment benefits under the policy issued by State Farm. Francois St. Clair and Pedro Jean presented claims for personal injury protection benefits under the same policy issued by State Farm. Anderson Aguy, Rashnide Aguy, Francois St. Clair and Pedro Jean presented UM claims to State Farm. Bethler Aguy presented a PIP claim to Infinity Insurance and a UM claim to State Farm.
Dr. Raguso, of WCMM, allegedly performed five (5) evaluation and management services billed under CPT code 99204 on the same day, for each of the patients identified herein. WCMM presented to State Farm, an “Initial Chiropractic Evaluation” dated March 9, 2004 and signed by Richard P. Raguso, D.C., for each of the five patients, documenting alleged injuries and alleged complaints. Anderson Aguy testified during his EUO that his initial evaluation, that the initial evaluation of his daughter, Rashnide Aguy, were performed by Dr. Adam Willis, not Dr. Raguso who signed and submitted the Initial Chiropractic Evaluation reports to State Farm on both patients. Dr. Raguso also signed the Initial Chiropractic Evaluations pertaining to Francois St. Clair, Pedro Jean, and Bethler Aguy.
On March 9, 2004, Dr. Adam Willis signed the Standard Disclosure and Acknowledgment Forms required by Florida Statutes §627.736(5)(e)(1)-(9), attesting that he was the licensed medical professional rendering treatment to Rashnide Aguy, Francoise St. Clair and Bethler Aguy, when the only reports submitted by WCMM for the March 9, 2004 treatment were the reports of Dr. Raguso.
Anderson Aguy, Rashnide Aguy, Bethler Aguy, and Pedro Jean allegedly told the doctor, and Dr. Raguso documented in each report, that their vehicle was struck on the driver’s side by a second vehicle. Francois St. Clair allegedly told the doctor, and Dr. Raguso documented in his report, that Mr. St. Clair was a passenger in a vehicle that was struck head on by a second vehicle. Anderson Aguy’s testimony about the seating of his passengers conflicts with the information documented in the police report.
Anderson Aguy’s left arm was amputated below the shoulder. Dr. Raguso’s report fails to mention the amputated left arm and Dr. Raguso allegedly performed muscle testing of the biceps, triceps and bracioradialis on Mr. Aguy’s left arm.
Each report submitted by Dr. Raguso, for each of the five patients, documents that prior history was “non-contributory for [his/her] current symptoms.” Evidence reviewed by State Farm revealed that Anderson Aguy was involved in prior motor vehicle accidents on June 11, 2001, December 24, 2002, July 12, 2003, January 15, 2004, and suffered from a worker’s compensation injury on December 20, 2001. Records also document that Anderson Aguy treated at another facility other than WCMM on March 22, 2004, just after the March 6, 2004 accident in question. On March 22, 2004, that chiropractor indicated that Mr. Aguy was at maximum medical improvement relating to his complaints from a January 15, 2004 motor vehicle accident, had made a full recovery, and suffered no disability. Anderson Aguy’s complaints relating to the January 15, 2004 motor vehicle accident were similar to those complaints relating to the March 6, 2004 motor vehicle accident.
Other records indicate that Anderson Aguy received a bodily injury settlement of $5,000.00 in 2004 relating to the July 12, 2003 accident, suggesting that Mr. Aguy suffered a permanent impairment significant enough to meet the threshold requirement for presentation of a bodily injury claim under Florida law. Anderson Aguy also received a settlement of future indemnity and medical payments in September, 2003, relating to the December 20, 2001 worker’s compensation claim.
Records indicate that Pedro Jean was involved in other motor vehicle accident on June 1, 2003. Pedro Jean received a bodily injury settlement of $2,000.00 relating to injuries allegedly suffered in the June 1, 2003 accident and was diagnosed with a 5% permanent impairment of his body as a whole. On April 1, 2004, Pedro Jean presented to a chiropractor at a facility other than WCMM, for a final examination relating to the June 1, 2003 motor vehicle accident. At that time, Pedro Jean allegedly stated that his symptoms relating to middle back pain had subsided, and he had continued complaints of low back pain. One (1) month earlier, on March 9, 2004, Pedro Jean allegedly presented to Dr. Raguso with alleged complaints of severe headaches, pain and stiffness in the neck, pain and stiffness in the upper back, and middle and lower back pain. On August 4, 2004, Dr. Raguso allegedly diagnosed Mr. Jean with “chronic, post-traumatic cervical and upper thoracic strains and sprains with soft tissue residuals and resultant cephalgia and radiculopathy (unresolved),” and “chronic, post-traumatic lower thoracic and lumbar strains and sprains with soft tissue residuals and resultant lumbago and radiculopathy (unresolved).” These findings appear inconsistent.
Dr. Raguso also completed “Final Chiropractic Evaluations” on Francois St. Clair on June 7, 2004, on Bethler Aguy on July 21, 2004, on Pedro Jean on August 4, 2004, and on Rashnide Aguy on August 24, 2004.
Despite documenting that Rashnide Aguy had no subjective complaints, Dr. Raguso diagnosed Rashnide Aguy with:
a. “chronic, post-traumatic cervical and upper thoracic strains and sprains with soft tissue residuals and resultant cephalgia and radiculopathy (unresolved),”
and
b. “chronic, post-traumatic lower thoracic and lumbar strains and sprains with soft tissue residuals and resultant lumbago and radiculopathy (unresolved).”
Dr. Raguso’s final evaluation pertaining to Francois St. Clair, Bethler Aguy, and Pedro Jean, contain identical diagnoses. Dr. Raguso rendered his diagnoses as to Pedro Jean despite the fact that there was no reference to any radiation from the lower back into the left leg in the March 6, 2004 report, nor was there any diagnosis of thoracic strain or sprain in the March 6, 2004 report. Additionally, the Final Chiropractic Evaluation of Francois St. Clair identifies him as Francoise, and reports his age at 71 years, despite an Initial Evaluation report dated March 9, 2004, documenting his age at 47 years. The Final Chiropractic Evaluation of Pedro Jean reports his age at 25 years, despite an Initial Evaluation report dated March 9, 2004, documenting his age at 34 years. WCMM submitted bills to State Farm for CPT codes 99204, 97112, 97010, 97012, 97124, 97035 for each of the five patients. WCMM additionally billed 97014 and 99214 for some of the patients, but not others. Each of the CMS-1500 forms appeared to be signed by Dr. Adam Willis. State Farm paid WCMM $2,640.00 in personal injury protection and medical payment benefits on behalf of Anderson Aguy, $5,070.00 on behalf of Rashnide Aguy, $10,000.00 in personal injury protection benefits, and exhausting all available benefits, on behalf of Francois St. Clair, and $8,736.00 under the personal injury protection benefits coverage on behalf of Pedro Jean. Infinity Insurance paid $3,256.00 personal injury protection benefits, after applying a $1,000.00 deductible, on behalf of Bethler Aguy. WCMM has demanded payment for additional services allegedly rendered to Rashnide Aguy and Pedro Jean, which State Farm has not paid. WCMM billed CPT code 97124 twice, at different rates, on eight different dates, for services allegedly rendered to Anderson Aguy.
State Farm seeks its Complaint for Pure Bill of Discovery/Motion for Discovery Pursuant to Florida Statutes Section 627.736(6)(C) and Motion for Good Cause to secure the disclosure of certain facts and evidence, i.e. whether or not the accident actually occurred, whether WCMM actually performed the services for which it billed and received payment from State Farm, who performed those services, whether any services were up-coded, whether documented injuries actually existed, whether the services were reasonable and medically necessary, and whether the services were related to the accident in question.
Despite State Farm’s request for discovery pursuant to Florida Statutes, Section 627.736(6)(c), the Court treats this petition as a common law Pure Bill for Discovery. Based on the evidence presented, Petitioner/State Farm has shown good cause to support its request for discovery from Respondent/WCMM.
It is therefore ORDERED AND ADJUDGED as follows to each of Petitioner’s numbered requests:
1. The curriculum vitae/resume of any and all persons who allegedly administered services to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean at any time, for injuries alleged to have occurred as a result of the March 6, 2004 accident, or at any other time, for any other accident or injury.
RULING: Court reserves ruling. Petitioner/Movant must show additional evidence and specifically identify the names of persons whose curriculum vitae/resume are to be produced.
2. Any and all raw data, tracings, films, photos, waveforms, etc. associated with all services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
3. Copies of licenses of all persons who participated in the services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Court reserves ruling. Petitioner/Movant must show additional evidence that it cannot actually obtain the requested documents through public records and specifically identify the names of persons whose licenses are to be produced.
4. Copies of any prescriptions and/or referrals for the services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
5. Any and all documents signed by Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted. If there are no such documents in the possession of, or under the control of, West Coast Medical Management, Inc., Respondent must state under oath that they do not have any such documents in their possession and/or that they cannot easily retrieve them.
6. Copies of all county and city occupational licenses in effect in 2003 and 2004.
RULING: Court reserves ruling. Petitioner/Movant must show additional evidence that it cannot actually obtain them through public records and specifically identify the names of persons whose licenses are to be produced.
7. Any and all documentation evidencing the name, credentials and licensure of WCMM’s medical/clinical director in 2004.
RULING: Granted only as they pertain to Adam Willis, D.C.
8. Any and all licenses of any persons who interpreted any testing allegedly performed on Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions and/or received West Coast Medical Management, Inc.’s answers to interrogatories and can specifically identify who rendered the testing and whether or not Petitioner/Movant can obtain the documents through a public records request.
9. The curriculum vitae/resume of any persons who interpreted any testing allegedly performed on Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions and/or received West Coast Medical Management, Inc.’s answers to interrogatories and can specifically identify the names of the persons whose curriculum vitae/resume are to be produced.
10. Any and all information or documentation evidencing what WCMM, or its personnel, accepted as payment, from Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carriers (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc.), private pay, or any other payor other than an automobile insurance carrier, for CPT code(s) 99204, 97112, 97010, 97012, 97124, 97012, 97014, 97035 and 99214 in calendar years 2003 and 2004.
RULING: Denied.
11. Any and all information or documentation evidencing what WCMM, or its personnel, billed Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carriers (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc.), private pay, or any other payor other than an automobile insurance carrier, for CPT code(s) 99204, 97112, 97010, 97012, 97124, 97012, 97014, 97035 and 99214 in calendar years 2003 and 2004.
RULING: Granted.
12. Any and all documentation WCMM or its personnel, have evidencing any recommendations by peer reviews, consultants, similar providers or other such personnel, including any hand written notes memorializing said recommendations.
RULING: Granted as to any complaints made to the Department of Professional Regulation for which there has been found cause to believe that charges were made for services not rendered.
13. Any and all documentation or information utilized by WCMM to determine the Usual, Customary and/or Reasonable amounts charged by WCMM for services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
14. Any and all schedules indicating what fee(s) WCMM considers to be within the “Usual and Customary” range and/or guidelines for CPT code(s) 99204, 97112, 97010, 97012, 97124, 97012, 97014, 97035 and 99214 or for any other service allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
15. A copy of WCMM’s or the medical provider(s)’ fee schedule for each of the specific services that the provider provides and/or which were allegedly provided to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, and the date WCMM’s fee schedule was last updated and how it was updated including, but not limited to CPT code(s) 99204, 97112, 97010, 97012, 97124, 97012, 97014, 97035 and 99214 or for any other service allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
16. The names, addresses and credentials of all individuals who participated in setting WCMM’s fee(s) schedule or pricing.
RULING: Granted.
17. Any and all evidence of the methods of determining the fee(s) and any ensuring that all fees comport with all state insurance equity laws, UCR guidelines and/or Relative Value Scales.
RULING: Granted.
18. Any and all computer profiles, fee schedules, reference sources or any other documentation used by WCMM to determine and/or support fees for services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: West Coast Medical Management, Inc. is to identify the computer program profile, fee schedule, reference sources or any other documentation it used to determine and/or support fees for services.
19. Any and all surveys relied upon by WCMM in setting the charges for services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: West Coast Medical Management, Inc. is to identify any surveys it relied upon in setting charges for services.
20. Any and all office manuals, policies, procedures and/or other documentation addressing any of WCMM’s office, service, treatment, or billing procedures.
RULING: West Coast Medical Management, Inc. is to identify any office manuals, policies and procedures that address its office, service, treatment or billing procedures.
21. All memos, guidelines, policies, procedures, and/or instructions to WCMM’s billing clerk or person responsible for billing, regarding the procedures the person must follow when billing an insurance carrier for services rendered by WCMM, the codes the person is to use, and the fees the person is to charge for each CPT code.
RULING: Granted. If no such items exist, West Coast Medical Management, Inc. must so state under oath.
22. Any and all documents verifying or indicating how much money WCMM paid for the equipment materials, devices and pads, etc., used to allegedly perform testing on, or allegedly provide any alleged treatment or alleged service to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Denied.
23. Any and all documentation including the name, model, serial or identification number, and description of any device, equipment, machine or material used by WCMM to allegedly provide any alleged treatment or alleged service to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Counsel for Petitioner/Movant is to address this request during a deposition.
24. Any and all documents verifying or indicating the lease terms of any equipment, machine or device used at WCMM for any treatment or service allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Denied.
25. Any and all applications submitted by WCMM to the Department of Health (relative to registering as a “clinic”) since 2003, including ALL applications submitted to the Department of Health or ACHA, or any other agency, by WCMM, whether accepted or rejected, pursuant to F.S. 456.0375 or Chapter 400, F.S.
RULING: Granted only as to applications submitted by West Coast Medical Management, Inc. specifically for medical and/or clinic director.
26. Any and all correspondence, letters, memoranda, memos, notes and/or other documentation received from the Department of Health, ACHA or any other agency, since 2003, pursuant to F.S. 456.0375 or Chapter 400, F.S.
RULING: Granted only with regard to documents that concern West Coast Medical Management, Inc.’s medical and/or clinic director.
27. Any and all documentation to support the medical necessity for any service or treatment allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, with identification of the person who prepared each piece of documentation.
RULING: Granted.
28. Any and all documentation showing the total number of patients who were allegedly treated on March 9, 2004, or allegedly received services on March 9, 2004, wherein WCMM billed a 99204 code for the alleged treatment or service, and indicate the name of the person who actually performed the alleged treatment or service.
RULING: Granted as an interrogatory, without identifying the names of the patient. West Coast Medical Management, Inc. is to identify the number of patients and who provided the treatment.
29. Any and all documentation showing the total number of patients who were allegedly treated on March 9, 2004, or allegedly received services on March 9, 2004, wherein WCMM billed an evaluation and management CPT code other than a 99204, for the alleged treatment or service, and indicate the name of the person who actually performed the alleged treatment or service.
RULING: Granted as an interrogatory, without identifying the names of the patient. West Coast Medical Management, Inc. is to identify the number of patients and who provided the treatment.
30. Any and all documentation of any patient allegedly treated or examined by either Richard P. Raguso or Adam C. Willis on March 9, 2004 for an evaluation and management service as defined by CPT codes 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, with the patient’s names redacted, unless the names are those individuals identified herein, and in such case identify said patient by the patient’s account number.
RULING: Granted. Any and all information contained on the documents that could in anyway reveal the patient’s identity, unless it is one of the individuals identified in this Petition, i.e., name, address, social security number, patient number, etc., is to be redacted.
31. Any and all documentation of any patient allegedly treated or examined by any WCMM personnel on March 9, 2004, June 7, 2004, July 21, 2004, August 4, 2004, and August 24, 2004 for an evaluation and management service as defined by CPT codes 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, with the patient’s names redacted, unless the names are those individuals identified herein, and in such case identify said patient by the patient’s account number.
RULING: Denied.
32. Any and all evidence of any payments made by WCMM, or any of its personnel, or anyone else with WCMM’s knowledge, or with the knowledge of any of WCMM’s personnel, or on WCMM’s behalf, or on behalf of anyone associated in any manner with WCMM, to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
33. All medical, surgical, x-ray, dental, rehabilitative, testing, ambulance, hospital, or nursing reports, records, or statements for alleged services concerning treatment, examination and/or evaluation of Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean at any time, both before and after the March 6, 2004 accident.
RULING: Granted.
34. All intake or sign in sheets, medical history forms, CMA-1500 forms, phone messages, notations on the chart jacket, and any other piece of paper contained within the chart or billing file, not included in any request above, pertaining to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
35. All correspondence that WCMM, its personnel, its attorney, or any agent, servant or employee of WCMM, or anyone on WCMM’s behalf, received from any agent, servant and/or employee of the Petitioner.
RULING: Granted. If West Coast Medical Management, Inc. is going to assert or claim anything to be protected under the work-product privilege, it must prepare a privilege log for the Court, identifying the document.
36. All notes concerning any oral conversations that WCMM, its personnel, its attorney, or anyone on WCMM’s behalf, has had with any agent, servant and/or employee of the Petitioner.
RULING: Granted. If West Coast Medical Management, Inc. is going to assert or claim anything to be protected under the work-product privilege, it must prepare a privilege log for the Court, identifying the document.
37. Copies of all promotional material used to advertise or otherwise solicit business for WCMM during the time period of one (1) year preceding the date that WCMM, or members of WCMM’s organization, first allegedly treated any patient named herein, and continuing through the date of your response, including but not limited to, copies of yellow page advertisements, promotional brochures, institutional advertisements, faxes, posters, or the like, or solicitation letters to public adjusters, medical providers, attorneys, individuals, and any other similar materials.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions.
38. Any and all documentation (including computerized data which has not been printed to hard copy) received by any owners, shareholders, officers, directors, employees, agents, or representatives of WCMM from any professional organizations and/or entities regarding recovery of No-Fault or Personal Injury Protection benefits where payment for testing and/or treatment has been denied or reduced.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions.
39. Any and all documentation relating to any disciplinary actions, censures, reprimands, suspensions, or terminations of any health care related professional licenses or certifications held by any of your employees, whether occurring in Florida or any other state or government under the jurisdiction of the United States.
RULING: Granted as to any complaints made to the Department of Professional Regulation for which cause has been found to believe that charges were made for services not rendered. Granted only with regard to documents that concern West Coast Medical Management, Inc.’s medical and/or clinic director.
40. Copies of any correspondence, including but not limited to invoices, bills, collection notices, reports, or any other correspondence, from WCMM, or WCMM’s agent, servant or employee, to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean or their agents or attorneys.
RULING: Granted.
41. Copies of any written agreements between WCMM, WCMM’s representatives, agents or employees and Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, for alleged services between WCMM and Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
42. Copies of any drafts or documents reflecting payment on Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean’s account for services allegedly rendered by WCMM or WCMM’s agents, representatives or employees, to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
43. Copies of all correspondence to or from Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean’s attorney that WCMM has in WCMM’s possession.
RULING: Granted.
44. Copies of any fee or compensation agreements between WCMM and any medical practitioners or service providers associated with WCMM, or who have received referrals from WCMM.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions.
45. All patient sign-in sheets used by WCMM or any other entity operating out of WCMM’s address for the dates of service billed for services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, redacting the names of the patients other than Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, to protect confidentiality.
RULING: Granted only as to patient sign-in sheets used by West Coast Medical Management, Inc.
46. Articles of Incorporation for WCMM.
RULING: Petitioner/Movant is to obtain from the Secretary of State.
47. Copies of any and all assignments of benefits, directions to pay, letters of protection, and any and all documents executed by or on behalf of Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean to WCMM or WCMM’s representatives, agents, employees, or personnel.
RULING: Granted.
48. Copies of any demand letters submitted to Petitioner by WCMM, or anyone on WCMM’s behalf, that you contend comply with the requirements of Florida Statutes, Section 627.736(11).
RULING: Granted only with regard to any demand letters concerning the five individuals identified in the Petition filed herein.
49. Copies of any publication, memorandum, article, or written document of any kind that supports the medical necessity of the service rendered.
RULING: Denied.
50. Copies of all documents showing that WCMM complied with Florida Statutes, Section 456.0375 and/or Chapter 400, Florida Statutes.
RULING: Denied.
51. Copy of the original registration form submitted to Department of Health pursuant to Florida Statutes, Section 456.0375(2) and/or Chapter 400, Florida Statutes.
RULING: Denied.
52. Copy of any registration renewal pursuant to Florida Statutes, Section 456.0375(2).
RULING: Denied, redundant of prior request.
53. Copies of all patient referral contracts or agreements executed by WCMM or any entity associated with WCMM.
RULING: Granted as to any contracts or agreements concerning the five individuals identified in the Petition filed herein.
54. Copies of any contract between WCMM, any employee of WCMM, and/or anyone serving as medical director or clinic director.
RULING: Denied, redundant of prior request.
55. Copies of all occupational licenses in effect on March 6, 2004 or any date after March 6, 2004 where WCMM, or anyone on WCMM’s behalf, allegedly rendered services to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Denied, redundant of prior request.
56. Copies of all licenses for any medical personnel and/or practitioners who allegedly treated Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean at any time for services allegedly rendered at WCMM’s location(s) regarding for the date of loss at issue in this case.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions and/or attempts to retrieve the documents through a public records request. Thereafter, Petitioner/Movant must show additional evidence that it cannot actually obtain the requested documents through public records and specifically identify the names of persons whose licenses are to be produced.
57. Copies of any agreements between WCMM and any medical facility or provider where WCMM, and/or anyone on WCMM’s behalf, has agreed to accept an amount equal to or less than the amount paid by Petitioner.
RULING: Denied.
58. A payment and/or account ledger, or similar document(s), reflecting all payments made to WCMM, by or on behalf of Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, from any/all source(s), for services allegedly rendered by WCMM to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted.
59. Any and all documents, including, but not limited to correspondence, copies of checks or drafts, or any other documentation, evidencing payments that were made to you by, or on behalf of Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, by Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, any third-party insurance carrier, any attorney, or any other collateral source, in payment of any of the WCMM’s bills for services allegedly rendered to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean.
RULING: Granted, redundant of #58.
60. Any documents evidencing a third party settlement or agreement between you and Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean for accepting any payment from any collateral source as a result of a third party liability settlement.
RULING: Granted.
61. Payroll records that reflect the names, addresses and telephone numbers of any person in the employ of WCMM or who acted as a sub-contractor of WCMM or was hired as casual labor by WCMM from March 6, 2003 until the present.
RULING: Granted only that Petitioner/Movant may inquire as to the name, address and telephone number of any person who rendered treatment as either an employee or subcontractor of West Coast Medical Management, Inc.
The Court grants State Farm’s request for depositions of Anthony Cirruzzo, Richard P. Raguso, D.C., Adam C. Willis, D.C., and Jean Joel Emile. As to the remaining requests for depositions, the Court rules as follows:
a. David Ortiz
RULING: Court reserves ruling until such time as Petitioner/Movant has verified that he in fact provided physical therapy services of some kind.
b. Any person designated by WCMM to serve as a Medical or Clinic Director pursuant to Chapter 400, Florida Statutes, or Section 456.0375, Florida Statutes.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions as granted above and/or can specifically identify a person to be deposed, with more particularity.
c. Any other person employed by, or associated with WCMM, who allegedly rendered any treatment or service to Anderson Aguy, Rashnide Aguy, Francois St. Clair, Aguy Bethler Aguy (aka Bether Aguy), and Pedro Jean, for injuries allegedly incurred as a result of the March 6, 2004 motor vehicle accident.
RULING: Court reserves ruling until such time as Petitioner/Movant has taken depositions as granted above and/or can specifically identify a person to be deposed, with more particularity.
WCMM is entitled to payment of any reasonable costs it incurs in complying with State Farm’s request for the production of documents. When producing documents to State Farm, Respondent shall redact the names of those patients not identified herein to protect the confidentiality of patients not relevant to this Petition. State Farm’s individual discovery requests shall encompass the calendar years of 2003 and 2004, unless supported otherwise by individual rulings on issues addressed above. Unless otherwise specifically stated within the Courts rulings on the individual requests above, WCMM must comply with the so ordered discovery requests within 45 days of being served with a Request To Produce and/or Interrogatories. State Farm may exceed the number of 30 Interrogatories it propounds on Respondent, provided that the Interrogatories conform to the Order above.
The Court treats this Petition as a pure bill in equity and therefore State Farm’s request for attorneys fees is denied.
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