Case 9:22-cv-81255-AMC Document 1 Entered on FLSD Docket 08/11/2022 Page 1 of 17
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`UNITED STATES DISTRICT COURT
`SOUTHERN DISTRICT OF FLORIDA
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`CASE NO.:
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`NEUROSURGICAL CONSULTANTS OF
`SOUTH FLORIDA, L.L.C., a Florida limited
`liability company,
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`
` Plaintiff,
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`vs.
`
`
`CIGNA HEALTH AND LIFE INSURANCE
`COMPANY, a foreign corporation,
`
` Defendant.
`_______________________________________/
`COMPLAINT
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`
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`Plaintiff, NEUROSURGICAL CONSULTANTS OF SOUTH FLORIDA, L.L.C.
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`(“Plaintiff”), a Florida limited liability company, sues Defendant, CIGNA HEALTH AND LIFE
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`INSURANCE COMPANY (“Defendant” or “Cigna”), a foreign corporation, and alleges as
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`follows:
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`Nature of Action
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`1.
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`This action arises out of Defendant’s failure to reimburse, or reimburse at an
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`unreasonably low rate, Plaintiff for medical services Plaintiff provided to a patients, L.M., Z.O.,
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`K.S., H.S. T.S., and G.S. (collectively, the “Patients”), covered under health insurance policies
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`issued, insured, operated, and/or administered by Defendant.
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`2.
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`Plaintiff provided medically necessary services to the Patient consisting of
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`emergency and non-emergency care and surgical management on a variety of neurological
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`Case 9:22-cv-81255-AMC Document 1 Entered on FLSD Docket 08/11/2022 Page 2 of 17
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`conditions of the brain and spine (the “Services”), as more specifically set forth in Exhibit “A”
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`attached and incorporated herein.
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`3.
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`Plaintiff performed the Services with the understanding and expectation that
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`Defendant would reimburse it at rates equal to the fair market or reasonable value of the Services
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`pursuant to the requirements of Florida law.
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`4.
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`For the claims at issue in this action, Plaintiff was a non-participating provider with
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`Defendant and, as a result, did not agree to accept discounted rates from Defendant for the Services
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`and did not agree to be bound by Defendant’s reimbursement policies or rate schedules.
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`5.
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`Nevertheless, Defendant has not paid Plaintiff the fair market or reasonable value
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`of its services.
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`6.
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`The impact of Defendant’s nonpayment on the claims at issue is considerable and
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`has left a balance due from Defendant exceeding the minimum jurisdictional limits of this Court.
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`Parties
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`7.
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`Plaintiff is a Florida professional limited liability company with its principal place
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`of business located in Palm Beach County, Florida.
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`8.
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`9.
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`Upon information and belief, the Patients are resident of the state of Florida.
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`Defendant is a foreign for-profit corporation registered to do business in the state
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`of Florida. At all material times, Defendant was a health insurer and/or health claims administrator
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`actively engaged in the transaction of health insurance servicing in the state of, including in Palm
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`Beach County, Florida.
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`Jurisdiction and Venue
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`10.
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`The amount in controversy exceeds the sum of $75,000.00, exclusive of interest,
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`costs, and attorneys’ fees.
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`11.
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`Defendant operates, conducts, engages in, and carries on business in the state of
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`Florida and has offices and agencies throughout the state of Florida.
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`12.
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`Venue is proper in Palm Beach County, Florida, because the Plaintiff provided the
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`medical services at issue to the Patients in Palm Beach County and because the payments to
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`Plaintiff for the Services were due in Palm Beach County, Florida.
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`Facts
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`13.
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`Plaintiff, through its physicians, provides medical services, including conservative
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`care and surgical management on a variety of neurological conditions of the brain and spine to
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`patients in Palm Beach County, Florida.
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`14.
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`15.
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`Plaintiff’s physicians are licensed medical doctors practicing in the State of Florida.
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`Plaintiff’s physicians specialize in newest techniques for the treatment of
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`neurological conditions of the brain and spine.
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`16.
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`Furthermore, Plaintiff’s physicians are bound by their professional ethics and the
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`medical standard of care to not only render emergency treatment, but also provide continuity of
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`care in the interest of the patient.
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`17.
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`In exchange for premiums, fees, and/or other forms of compensation, Defendant
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`agrees to administer claims and provide reimbursement for healthcare services rendered to
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`members of its health insurance policies.
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`18.
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`At all material times, the Patients were each members of health insurance policies
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`issued, insured, and administered by Defendant, which policies provided coverage for services
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`received by Patient and provided in the State of Florida (the “Policies”).
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`Patient L.M.
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`19.
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`On or about August 31, 2020, Ronald L. Young, M.D., with the assistance of Martin
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`Greenberg, M.D., both employed by Plaintiff, performed medically necessary services on L.M.
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`20.
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`As such, Plaintiff submitted a Health Insurance Claim to Cigna for the charges
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`totaling eighty thousand dollars ($80,000.00) for Dr. Young’s services and eighty thousand dollars
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`($80,000.00) for Greenberg’s services, but Cigna denied coverage, claiming the services were
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`experimental.
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`Patient Z.O.
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`21.
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`On or about April 17, 2020, Z.O. was admitted to Delray Medical Center on an
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`emergency basis, and was seen by Dr. Young, who is employed by Plaintiff.
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`22.
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`A CT of the patient’s brain showed a large right temporal intracerebral hemorrhage
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`adjacent to the sylvian fissure. Accordingly, Dr. Young determined that the patient needed an
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`emergency surgery.
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`23.
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`On April 18, 2020, prior to the surgery, an MRI of the patient’s brain also showed
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`a possible aneurysm and cerebral angiogram.
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`24.
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`On the same day, Dr. Young performed the emergency surgery, including
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`craniectomy evacuation of the hematoma and stereotaxis procedures on the skull.
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`25.
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`Based on the foregoing, Plaintiff submitted a Health Insurance Claim to Cigna for
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`the charges totaling forty-five thousand dollars ($45,000.00). However, Cigna only paid Plaintiff
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`seven thousand six hundred nineteen dollars and ninety-five cents ($7,619.95) for the claim.
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`Patient K.S.
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`26.
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`On or about December 20, 2020, K.S. was admitted to Delray Medical center on an
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`emergency basis after sustaining a fall.
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`27.
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`A CT of K.S.’s brain showed a large right sided holohemispheric extra-axial
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`hemorrhage, probably subdural blood measuring maximal width of 2.8 cm, along with associated
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`mass effect upon the right parietal lobe near the vertex in the right frontal lobe and an effacement
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`of the frontal horn of the right lateral ventricle.
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`28.
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`On or about December 23, 2020, Lloyd Zucker, M.D., who is employed by Plaintiff,
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`performed a right craniotomy for subdural hematoma on K.S. on an emergency basis.
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`29.
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`Based on the foregoing, Plaintiff submitted a Health Insurance Claim to Cigna for
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`the charges thirty thousand dollars ($30,000.00). However, Cigna only paid Plaintiff six thousand
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`dollars ($6,000.00) for the claim.
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`Patient H.S.
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`30.
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`On or about December 23, 2020, Plaintiff performed medically necessary services
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`on H.S.
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`31.
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`Accordingly, Plaintiff submitted a Health Insurance Claim to Cigna for the charges
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`totaling fifty thousand dollars ($50,000.00). However, Cigna denied the claim and has failed or
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`refused to pay any portion thereof.
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`Patient T.S.
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`32.
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`On or about November 4, 2020, Plaintiff sought Cigna’s authorization to perform
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`posterior lumbar spinal fusion and laminectomy on T.S., along with related services.
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`33.
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`On November 12, 2020 Cigna denied Authorization No. IP0679713385, noting that
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`lumbar fusion was considered not medically necessary when performed for the treatment of spinal
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`stenosis in the absence of spinal instability.
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`34.
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`However, Cigna issued Authorization No. OP0685276798 for CPT 63047 (removal
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`of spinal lamina – lumbar) and advised Plaintiff that if, while in the operating room, the surgeon
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`found that the patient needed fusion, Plaintiff would need to contact Cigna to change the
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`authorization from outpatient to inpatient surgery.
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`35.
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`On November 16, 2020, Evan M. Packer, M.D, with the assistance of Lawrence C.
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`Meiner, P.A., both employed by Plaintiff performed surgery on T.S.
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`36. While operating on T.S., Dr. Packer had to drill a significant portion of the patient’s
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`vertebral body due to the extensive calcification of the patient’s discs and the narrowing of the
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`spine, which caused the T.S.’s spine to become unstable.
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`37.
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`Accordingly, Plaintiff contacted Cigna to obtain authorization to convert the
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`surgery from outpatient to inpatient in order for Dr. Packer to proceed with lumbar fusion to
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`stabilize the patient’s spine. Cigna issued Authorization No. IP06926215295 and then Dr. Packer
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`performed a lumbar fusion of patient, with Mr. Meiner’s assistance.
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`38.
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`As such, Plaintiff submitted a Health Insurance Claim to Cigna for the charges
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`totaling one hundred thousand dollars ($100,000.00) for Dr. Packer’s service and ninety five
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`thousand dollars ($95,000.00) for Mr. Meiner’s services, but Cigna denied coverage, claiming the
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`serviced were not medically necessary.
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`39.
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`Ultimately, following a second appeal, Cigna approved coverage upon determining
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`that the services rendered to T.S. were covered under his benefit plan.
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`40.
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`However, Cigna only paid Plaintiff four thousand nine hundred and eight dollars
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`and eighty-four cents ($4,908.84) for the services rendered to T.S. by Dr. Packer.
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`Patient G.S.
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`41.
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`On or about December 11, 2019, G.S. was admitted to the emergency room at
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`Delray Medical Center due to a cervical spine cord injury.
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`42.
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`On or about December 18, 2019, Dr. Young, with the assistance of Dr. Greenberg,
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`performed a C3-4 anterior cervical diskectomy infusion on G.S. to treat the cervical spine cord
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`injury
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`43.
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`Based on the foregoing, Plaintiff submitted a Health Insurance Claim to Cigna for
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`the charges totaling ninety thousand dollars ($90,000.00) for Dr. Young’s services and eighty
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`thousand dollars ($80,000.00) for Dr. Greenberg’s services. However, Cigna only paid Plaintiff
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`ten thousand ($10,000.00) for the services rendered to G.S. by Dr. Young.
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`Non-Payments and Underpayments by Cigna
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`44.
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`Defendant issued the remittance notices of its foregoing underpayments on the
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`Claims to Plaintiff in Palm Beach County, Florida.
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`45.
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`Plaintiff did not and does not have applicable participation agreements with
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`Defendant, and thus the Claims are considered non-participating or out-of-network claims.
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`46.
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`Plaintiff never agreed to accept discounted rates from Defendant or to be bound by
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`Defendant’s reimbursement policies or rate schedules with respect to the Claims.
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`47.
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`The amounts Defendant paid to Plaintiff for the Services underlying the Claims do
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`not correspond with the statutory language mandated under Florida law and usual and customary
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`charges.
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`48.
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`Defendant was and is aware that Plaintiff provided the Services to the Patients and
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`billed Defendant for the medical services Plaintiff’s physicians provided to the Patients with the
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`expectation and understanding that its services had been approved by Defendant and that it
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`would be reimbursed by Defendant.
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`49.
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`Defendant’s refusal to pay Plaintiff the fair market value and/or the reasonable
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`value of the medical services Plaintiff provided to the Patients has caused Plaintiff to suffer
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`damages in an amount equal to the difference between the amounts Defendant paid on the Claims
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`and the fair market value and reasonable value of the services Plaintiff provided, plus Plaintiff’s
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`loss of use of that money.
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`50.
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`All necessary conditions precedent for Defendant to perform its obligations
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`occurred or were performed, excused, and/or waived.
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`Representations by Cigna.
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`51.
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`At the time that the Patients were provided the Services, each were covered by
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`policies of health insurance insured by and/or administered by Cigna.
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`52.
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`Prior to all non-emergent initial consultations with each new patient, Plaintiff
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`contacted Cigna to verify that each patient was covered by a health plan insured by and/or
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`administered by Defendant, and to obtain benefit information and pre-authorization for the services
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`to be provided.
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`53.
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`At the time of the verification of benefits or pre-authorization calls, Plaintiff did
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`not have access to any of the various health insurance plans that covered the Services for the
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`Patients.
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`54.
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`Therefore, Plaintiff had to rely upon the information provided by Cigna indicating
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`that the Services were covered services or covered benefits under each applicable insurance plan
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`for each patient.
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`55.
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`Thereafter, for each procedure performed or service otherwise provided, Plaintiff
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`sent a bill for its services to Cigna.
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`56.
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`Plaintiff continues to submit claims for reimbursement by Cigna, and the unpaid
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`and underpaid claims continue to accrue.
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`Cigna’s Erroneous Billing Practices Caused Harm on Plaintiff
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`57.
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`Plaintiff’s charges were in amounts that are usual and customary for providers
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`providing similar services in the areas in which the surgeries were performed and represent
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`reasonable values for services rendered.
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`58.
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`Notwithstanding, Defendant has either not made any payment for the Claims or
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`grossly underpaid the usual and customary rate for the medical services provided to the Patients,
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`as identified in Exhibit “A.”
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`59.
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`Plaintiff is a non-participating, out-of-network provider and is thereby not
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`subjected to any contracted rates or fee schedules with Cigna. Nor is Plaintiff subject to express
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`contractual obligations that in-network, participating providers would be subject to pursuant to
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`their contracts with Cigna.
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`60.
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`Cigna was aware that Plaintiff, at all material times, was an out-of-network
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`provider.
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`61.
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`Defendant has failed to pay usual and customary charges to Plaintiff for the
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`medically necessary procedures it provided to the Patients.
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`62.
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`For claims not subject to Section 641.513(5), Defendant is obligated to pay Plaintiff
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`under their implied contracts and the doctrine of quantum meruit the lesser of Plaintiff’s billed
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`charges or, if different, the reasonable value of the services Plaintiff's physicians rendered to
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`Defendant's members.
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`63.
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`Except for Patient H.S., Defendant has already adjudicated these claims and
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`determined that all of the claims at issue in this action were for covered services rendered to
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`Patient, and Defendant has already paid all of the claims at issue, albeit at amounts representing a
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`mere fraction of the applicable shared savings rates for the services, the "usual and customary
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`provider charges" for the services, and/or the reasonable value of the services. Thus, this action
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`Case 9:22-cv-81255-AMC Document 1 Entered on FLSD Docket 08/11/2022 Page 10 of 17
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`concerns only the rate of payment and not the right to payment. The claims brought on behalf of
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`K.S., G.S., T.S., and Z.O. do not include any claims in which benefits were denied, nor do they
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`challenge any coverage determinations under ERISA. Furthermore, Defendant, as an out-of-
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`network provider, does not seek payment under the plan.
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`COUNT I – Claim for Benefits Under ERISA § 502(a)(1)
`(Patients L.M. and H.S.)
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`Plaintiff re-alleges and re-incorporates by reference paragraphs 1 through 63 as if fully set
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`forth herein.
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`64.
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`Plaintiff files this action pursuant to ERISA §502(a)(1)(B), 28 U.S.C. §1132, to
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`recover benefits assigned to it by L.M. and H.S. under ERISA plans.
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`65.
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`Plaintiff has provided medically necessary services to L.M. and H.S., as reflected
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`on Exhibit A.
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`66.
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`Upon information and belief, benefit plans for L.M. and H.S. are each an
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`“employee welfare benefit plan” within the meaning of ERISA, 29 U.S.C. § 1002(1).
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`67.
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`L.M. and H.S. assigned their rights to receive health benefits under their respective
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`plans to Plaintiff.
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`68.
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`As assignee of the applicable plans, Plaintiff is entitled to recover benefits due to
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`L.M. and H.S., and enforce the rights of L.M. and H.S. under the terms of the plans.
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`69.
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`In particular, as assignee of the plans, Plaintiff is entitled to reimbursement under
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`the ERISA-governed plan for medical services provided to L.M. and H.S.
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`70.
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`Upon information and belief, the applicable plans did not prohibit L.M. and H.S.
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`from assigning theor rights to benefits under the plans to Plaintiff, including the right of direct
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`payment of benefits under the plans to Plaintiff.
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`71.
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`Upon information and belief, the plans require reimbursement of medical expenses
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`incurred by L.M. and H.S. at usual, customary, and reasonable rates.
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`72.
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`Defendant is obligated to pay for medically necessary services, covered services,
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`or covered benefits as defined under the plan.
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`73.
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`Defendant has breached the terms of the plan by refusing to make out-of network
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`reimbursements for charges covered by the plan, in violation of ERISA § 502(a)(1)(B), 29 U.S.C.
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`§ 1132(a)(1)(B). These breaches include, among other things, refusing to pay the usual, customary,
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`and/or reasonable charges, or the prevailing fees or recognized charges, for the medically
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`necessary services performed provided by Plaintiff to L.M. and H.S.
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`74.
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`Pursuant to ERISA § 502(g), Plaintiff is entitled to recover its reasonable attorneys’
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`fees incurred in pursuing this claim.
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`WHEREFORE, Plaintiff demands judgment against the Defendant for the benefits due
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`under the ERISA plans for L.M. and H.S., together with interest, costs, reasonable attorneys’ fees,
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`and such other relief as the Court deems proper.
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`COUNT II - Violation of Sections 627.64194(4) – Emergency Services
`(Patients K.S., G.S., T.S., and Z.O.)
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`Plaintiff re-alleges and re-incorporates by reference paragraphs 1 through 63 as if fully set
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`forth herein.
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`75.
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`Section 627.64194(4) of the Florida Statutes imposes a duty on Defendant, as an
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`insurer to reimburse Plaintiff, a nonparticipating provider, for the Claims performed on an
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`emergency basis pursuant to Section 627.64194(2).
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`76.
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`Plaintiff has a private right of action under Sections 627.64194(4) to enforce the
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`statutes’ provisions against Defendant.
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`77.
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`At all material times, Plaintiff was a non-participating emergency medical provider
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`that provided services to patients insured by Cigna.
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`78.
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`Plaintiff provided covered emergency medical services to Patients K.S., G.S., T.S.,
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`and Z.O.
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`79.
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`Patients K.S., G.S., T.S., and Z.O. did not have the ability or opportunity to choose
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`a participating provider who was available to treat them at the time Plaintiff provided the covered
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`medical services to them because.
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`80.
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`Plaintiff and Defendant did not mutually agree on a specific charge for any of the
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`claims submitted for emergency services. Plaintiff did not agree to accept discounted rates from
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`Defendant for the claims, nor did it agree to be bound by Defendant’s reimbursement policies or
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`rate schedules with respect to the claims.
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`81.
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`Defendant violated Sections 627.64194(4) by failing to pay Plaintiff the “usual and
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`customary provider charges for similar services in the community where the services were
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`provided” for the Claims for Patients K.S., G.S., T.S., and Z.O.
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`82.
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`As a result of Defendant’s failure to fulfill its legal obligations to reimburse Plaintiff
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`in accordance with Sections 627.64194(4), Plaintiff has suffered injury and is entitled to monetary
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`damages from Defendant.
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`83.
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`Plaintiff seeks compensatory damages, as permitted by applicable law, in an
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`amount equal to the difference between the amounts Defendant paid to Plaintiff for the Claims for
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`Patients K.S., G.S., T.S., and Z.O. and the fair market value of the medical services underlying
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`those Claims, plus interest.
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`WHEREFORE, Plaintiff prays that this Court enter a judgment against Defendant and in
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`favor of Plaintiff in an amount representing the difference between the amounts Defendant paid to
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`Plaintiff for the Claims for Patients K.S., G.S., T.S., and Z.O., and the fair market value of the
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`medical services underlying those Claims, as determined by the finder of fact, together with an
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`award of prejudgment interest, costs, and such other and further relief as the Court may deem just
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`and proper.
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`COUNT III – UNJUST ENRICHMENT
`(In the Alternative)
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`Plaintiff re-alleges and re-incorporates by reference paragraphs 1 through 63 as if fully set
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`forth herein.
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`84.
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`Plaintiff conferred a direct benefit on Defendant by providing valuable medical
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`services to the Patients, with the knowledge and/or approval of Defendant.
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`85.
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`In exchange for premiums, Defendant owes its members, including Patients, an
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`obligation to pay for the covered medical services the members receive.
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`86.
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`Under Florida and federal law, Defendant is obligated to provide coverage for
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`emergency and non-emergency services provided by out-of-network providers like Plaintiff.
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`87.
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`Defendant derives a direct benefit from Plaintiff’s provision of medical services to
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`its members because it is through Plaintiff’s provision of those services that Defendant fulfills its
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`legal obligations to its members.
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`88.
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`The medical services Plaintiff provided to the Patients were undisputedly covered
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`because Defendant adjudicated and paid for those services, albeit at an amount less than the
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`reasonable value of the services in the marketplace.
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`89. When Plaintiff provided covered medical services to the Patients, Defendant
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`received the benefit of having its legal obligations to the Patients discharged.1
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`1 See Reva, Inc. v. Humana Health Ben. Plan of La., Inc., 2018 U.S. Dist. LEXIS 45560, at *8 (S.D. Fla. Mar. 19,
`2018) finding on a motion to dismiss that “it would be inequitable for Defendants to be allowed to collect premiums
`from their members and subscribers in return for agreeing to properly reimburse providers like Plaintiff that render
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`90.
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`Defendant was aware of and implicitly approved Plaintiff’s provision of covered
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`medical services to the Patient because Defendant preauthorized Plaintiff’s provision of services
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`to the Patients.
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`91.
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`Defendant’s liability as the party responsible for payment to Plaintiff for the
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`Services it provided to the Patients is established by Defendant’s determination that the services
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`were covered and its payment for the Services, albeit at rates far below that to which Plaintiff is
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`entitled.
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`92.
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`Defendant voluntarily accepted, retained, and enjoyed, and continues to accept,
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`retain, and enjoy, the benefits conferred upon it by Plaintiff, knowing that Plaintiff expected to be
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`paid the reasonable value of the Services in the marketplace.
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`93.
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`Defendant has failed to pay the reasonable value of the benefit conferred upon it by
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`Plaintiff, in this case, the reasonable value of the Services provided to the Patients. As a result,
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`Defendant has withheld for itself monies that should have been paid to Plaintiff for Plaintiff’s
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`services and has received an unjustified windfall.
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`94.
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`95.
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`By refusing to pay Plaintiff, Defendant has been unjustly enriched.
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`Under the circumstances set forth above, it is unjust and inequitable for Defendant
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`to retain the benefit it received without paying the value of that benefit, i.e., by paying Plaintiff the
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`reasonable value in the marketplace of the medical services Plaintiff provided to the Patients.
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`covered medical services without paying the value thereof to Plaintiff.”; Surgery Ctr. of Viera, LLC v.
`Unitedhealthcare, Inc., 465 F. Supp. 3d 1211, 1224 (M.D. Fla. 2020) finding that the plaintiff provider had “conferred
`a direct benefit upon United by providing Patient C.R. with medical services such that United's failure to pay the 80%
`balance would unjustly enrich United.”; S. Baptist Hosp. of Fla., Inc. v. Celtic Ins. Co., 2018 U.S. Dist. LEXIS 112671,
`at *7, 10 n.3 (M.D. Fla. June 1, 2018) (“Plaintiff alleges that it conferred a benefit upon Defendant by supplying
`‘Covered Services to Subscribers which was the obligation of’ Defendant. . .the undersigned recommends that
`Plaintiff's allegations are sufficient to proceed past the pleading stage.”).
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`Case 9:22-cv-81255-AMC Document 1 Entered on FLSD Docket 08/11/2022 Page 15 of 17
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`96.
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`Plaintiff seeks compensatory damages, as permitted by applicable law, in an amount
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`equal to the difference between the amounts Defendant paid to Plaintiff for the Claims and the
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`reasonable value of the medical services underlying the Claims, plus interest.
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`WHEREFORE, Plaintiff prays that this Court enter a judgment against Defendant and in
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`favor of Plaintiff in an amount representing the difference between the amounts Defendant paid to
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`Plaintiff for the claims at issue and the reasonable value in the marketplace of the medical services
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`underlying those claims, as determined by the finder of fact, together with an award of prejudgment
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`interest, costs, and such other and further relief as the Court may deem just and proper.
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`COUNT IV – QUANTUM MERUIT
`(In the Alternative)
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`Plaintiff re-alleges and re-incorporates by reference paragraphs 1 through 63 as if fully set
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`forth herein.
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`97.
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`In addition, and/or in the alternative, at all times material, the Plaintiff has conferred
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`a direct benefit upon Defendant by providing valuable continuity of care and/or inadvertent and/or
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`services to the Patients, who are Defendant’s members. In exchange for premiums, Defendant
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`owes its members, like the Patients, an obligation to pay for the covered medical services they
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`receive.
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`98.
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`Defendant derives a direct benefit from Plaintiff’s provision of covered services to
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`Defendant’s embers because it is through Plaintiff’s provision of those services that Defendant
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`fulfills its obligations to its members.
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`99.
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`There is no dispute that the Services at issue that the Plaintiff provided to the
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`Patients were covered services, because Defendant adjudicated them, determined they were
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`covered services, and paid Plaintiff for them, except at an amount less than the fair value of the
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`services.
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`Case 9:22-cv-81255-AMC Document 1 Entered on FLSD Docket 08/11/2022 Page 16 of 17
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`100. When Plaintiff provide covered services to Defendant’s members, including the
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`Patient, Cigna receives the benefit of having its contractual obligations to its members are
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`discharged.
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`101. Defendant has knowledge of the benefits the Plaintiff conferred on Defendant
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`because, inter alia, Defendant adjudicated the Claims for such services and determined that they
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`were covered services under the Policies
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`102. Defendant has voluntarily accepted and retained the benefits Plaintiff conferred on
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`Defendant by providing covered services to the Patients because, inter alia, Defendant adjudicated
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`the Claims for such services and determined that they were covered services under the Policies.
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`103. Defendant voluntarily accepted, retained, and enjoyed, and continues to accept,
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`retain, and enjoy, the benefits conferred upon it by Plaintiff, knowing that Plaintiff expected and
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`expects to be paid the fair value for its services. However, Defendant has failed to reimburse the
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`Plaintiff the fair value of the Services the Plaintiff has rendered to the Patients at all times material
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`hereto.
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`104. Under the present circumstances, it would be inequitable for Defendant to fail to
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`reimburse the Plaintiff the fair value of the Services they rendered to the Patients, while
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`retaining the benefits the Plaintiff conferred upon Defendant.
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`105. Defendant is therefore liable in quantum meruit to the Plaintiff for failing to
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`reimburse the Plaintiff the fair value of the Services the Plaintiff rendered to the Patients with
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`respect to each of the Claims.
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`106. Defendant owes Plaintiff as damages the difference between the fair value of the
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`services the Plaintiff rendered to the Patients and the amounts Defendant paid for those services.
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`Case 9:22-cv-81255-AMC Document 1 Entered on FLSD Docket 08/11/2022 Page 17 of 17
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`WHEREFORE, Plaintiff prays that this Court enter a judgment against Defendant and in
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`favor of Plaintiff in an amount representing the difference between the amounts Defendant paid to
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`Plaintiff for the claims at issue and the reasonable value in the marketplace of the medical services
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`underlying those claims, as determined by the finder of fact, together with an award of prejudgment
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`interest, costs, and such other and further relief as the Court may deem just and proper.
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`DEMAND FOR JURY TRIAL
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`Plaintiff demands a trial by jury of all issues so triable.
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`DATED this August 11, 2022.
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`Respectfully submitted,
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`DI PIETRO PARTNERS, PLLC
`901 East Las Olas Blvd, Suite 202
`Fort Lauderdale, FL 33301
`Primary Email Address:
`service@ddpalaw.com
`Secondary Email Address:
`nicole@ddpalaw.com
`Telephone: (954) 712-3070
`Facsimile: (954) 337-3824
`
`
`/s/ Nicole Martell
`NICOLE MARTELL, ESQ.
`Florida Bar No.: 100172
`nicole@ddpalaw.com
`LISANDRA ESTEVEZ, ESQ.
`Florida Bar No.: 111475
`lisandra@ddpalaw.com
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