Filing # 105930722 E-Filed 04/06/2020 06:39:57 PM
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`IN THE CIRCUIT COURT OF THE 11th JUDICIAL CIRCUIT
`IN AND FOR MIAMI-DADE COUNTY, FLORIDA
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`Case No. 2019-023456-01
`Section CA 43
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`KIDZ MEDICAL SERVICES, INC. d/b/a
`CRITICAL CARE NEWBORN SERVICES,
`a Florida corporation,
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`Plaintiff,
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`vs.
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`UNITEDHEALTHCARE OF FLORIDA, INC.,
`a Florida corporation, and UNITEDHEALTHCARE
`INSURANCE CO., a foreign corporation,
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`Defendants.
`__________________________________________/
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`JOINT INITIAL CASE MANAGEMENT REPORT
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`Plaintiff Kidz Medical Services, Inc., d/b/a Critical Care Newborn Services (“Plaintiff” or
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`“Kidz Medical”), and Defendants UnitedHealthcare of Florida, Inc. (“United HMO”) and
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`UnitedHealthcare Insurance Company (“United PPO”) (collectively, “United”), pursuant to the
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`Court Order Setting Initial Case Management Conference and the CBL Rule 5.1(1)(f), hereby
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`submit this Joint Initial Case Management Report and state as follows:1
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`A.
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`Brief Factual Statement of the Action and Status of Pleadings
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`Plaintiff Kidz Medical, a health care provider in pediatric and neonatal health care in South
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`Florida, brought this case alleging that Defendants United, national health insurers, have underpaid
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`Kidz Medical for medically necessary health care services rendered by Kidz Medical to patients
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`1 United jointly files the instant report pursuant to the Court’s orders and without waiver or
`prejudice to its pending Motion to Compel Arbitration and Stay Case discussed at Section A, p.3
`infra.
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`1
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`who are members of United. Kidz Medical sued United HMO for alleged violations of Fla. Stat.
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`Case No. 2019-023456-01
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`§ 641.513(5) concerning the reimbursement rates for emergency services provided by non-
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`participating providers, United PPO for alleged violations of Fla. Stat. § 627.64194 concerning the
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`reimbursement rates for non-emergency and emergency services provided by non-participating
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`providers, and both entities for breach of contract implied in fact, unjust enrichment, and quantum
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`meruit. Kidz Medical seeks monetary damages, pre-judgment and post-judgment interest, and
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`costs. Additionally, Kidz Medical seeks a declaratory judgment declaring the rates at which United
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`must reimburse Kidz Medical and mandatory injunction compelling such reimbursement. Kidz
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`Medical demanded a jury trial.
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`United anticipates filing a motion to dismiss if the Court denies its pending motion to
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`compel arbitration. Without waiver or prejudice of its right to arbitrate, United contends that Kidz
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`Medical’s claims fail as a matter of law for a number of reasons, including but not limited to
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`because Kidz Medical has failed to allege compliance with certain conditions precedent under the
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`insurance and HMO prompt payment statutes which it sues under and because such statutes do not
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`provide Kidz Medical with a private cause of action against United. Additionally, Kidz Medical’s
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`quasi-contractual claims fail as a matter of law because Kidz Medical’s services were provided, if
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`it all, not to United, but to United’s members, and any benefits conferred by Kidz Medical were
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`received not by United, but by its members.
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`The parties had an agreement since 2011 whereby Kidz Medical provided emergency and
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`other medical services to United members in exchange for reimbursement pursuant to a rate
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`schedule (“Agreement”). United contends it terminated the Agreement as of August 1, 2018. Since
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`then, United has reimbursed Kidz Medical as an out-of-network provider. Prior to the disputed
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`termination, Kidz Medical filed a demand for arbitration against United, alleging improper
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`termination, among other things. See Kidz Medical Services, Inc. v. UnitedHealthcare Insurance
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`Case No. 2019-023456-01
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`Co., AAA Case No. 01-18-0002-8305 (“Arbitration”). United contends it properly terminated the
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`agreement and that Kidz Medical was provided proper and actual notice of same. The Final
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`Hearing was last scheduled for April 28, 2020, but will be reset for a period to occur in the
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`following months, to accommodate for any contingencies and alternatives to an in-person hearing,
`due to the ongoing public health crisis.
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`If the Arbitration Panel finds that the agreement was not terminated as of July 31, 2018,
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`United will be required in the Arbitration to reprocess Kidz Medical’s claims from August 1, 2018
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`through July 31, 2019, and Kidz Medical’s out-of-network claims in this action would start August
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`1, 2019, subject to any defenses. If the Arbitration Panel finds that the agreement was terminated
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`as of July 31, 2018, then Kidz Medical’s out-of-network claims in this action will start August 1,
`2018, subject to any defenses.
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`United filed a Motion to Compel Arbitration and Stay Case on September 30, 2019. In
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`response, on October 31, 2019, Plaintiff filed a Memorandum in Opposition. On November 14,
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`2019, Defendants filed a Reply. The matter has been fully briefed and is set for hearing on May
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`21, 2020.
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`B.
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`Brief Statement on the Theory of Damages by Any Party Seeking Affirmative Relief
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`Kidz Medical seeks damages for United’s adjudication of the out-of-network claims at the
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`difference between the amounts required by Florida statutory and common law and the amounts
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`adjudicated and paid by United.
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`C.
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`The Likelihood of Settlement
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`Not at this time.
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`D.
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`The Likelihood of Additional Parties
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`Case No. 2019-023456-01
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`Kidz Medical does not anticipate additional parties and have no nonparties to whom the
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`parties will seek to allocate fault. United will examine whether nonparties should be joined to this
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`lawsuit after the claims at issue in this case are made known them.
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`E.
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`Proposed Limits on the Time:
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`The parties do not agree on the proposed deadlines for this case. Kidz Medical proposes
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`specific dates for the case deadlines, outlined below. United believes that the case deadlines should
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`begin to run once the Arbitration Panel renders its Interim Award on liability in the aforementioned
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`arbitration between Kidz Medical and United because the outcome of the arbitration will influence
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`the scope of this case and thus the scope of discovery. For example, if United prevails in the
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`arbitration and Kidz Medical is found to have been out-of-network as of August 1, 2018, then Kidz
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`Medical’s out-of-network claims would begin as of that date, increasing the out-of-network claims
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`at issue here by over 10,000 claims, which in turn, will increase the scope of discovery. United
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`bases its proposed schedule on the assumption that an Interim Award on liability will be rendered
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`by August, 31, 2020.
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`The parties’ respective proposals are directly below:
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`Task
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`Identify any nonparties
`whose identity is known
`Join other parties
`File and hear motions
`Dispositive motions
`Disclose expert witnesses
`Complete expert discovery
`Complete discovery
`Mediation
`Final Pretrial Conference
`Trial Period
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`Kidz Medical’s Proposed
`Deadline
`Oct. 23, 2020
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`Nov. 6, 2020
`March 23, 2021
`May 21, 2021
`April 23, 2021
`June 1, 2021
`April 23, 2021
`April 23, 2021
`August 23, 2021
`September 2021
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`Case No. 2019-023456-01
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`United’s Proposed Deadline
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`Sept. 25, 2021
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`March 15, 2021
`Nov. 1, 2021
`Nov. 1, 2021
`Aug. 2, 2021
`Oct. 1, 2021
`July 1, 2021
`Oct. 15, 2021
`January 31, 2022
`February 2022
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`F.
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`Attorneys Handling the Action
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`For Plaintiff Kidz Medical: Alan D. Lash, Justin C. Fineberg, Lorelei J. Van Wey, Matthew
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`G. Frias of Lash & Goldberg LLP.
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`For Defendants United: Brian A. Briz, and Jennifer A. Mansfield of Holland & Knight
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`LLP.
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`G.
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`The Necessity for a Protective Order to Facilitate Discovery
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`The parties will work cooperatively to present a joint protective order regarding
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`confidentiality to the Court. The parties expect this case to include protected health information,
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`personal information and trade secret and proprietary business information.
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`Proposals for the Formulation and Simplification of Issues, Including the Elimination
`of Frivolous Claims or Defenses, and the Number and Timing of Motions for
`Summary Judgment or Partial Summary Judgment
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`H.
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`Case No. 2019-023456-01
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`United’s Motion to Compel Arbitration is scheduled for hearing on May 21, 2020.
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`The parties expect to file a single motion for summary judgment, if any. Kidz Medical
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`proposes the deadline be May 21, 2021. United proposes the deadline be November 1, 2021.
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`I.
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`The Possibility of Obtaining Admissions of Fact and Voluntary Exchange of
`Documents and Electronically Stored Information, Stipulations Regarding
`Authenticity of Documents, Electronically Stored Information, and the Need for
`Advance Rulings from the Court on Admissibility of Evidence
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`The parties will work cooperatively regarding admissions, the exchange of documents, an
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`ESI stipulation and any advance rulings on the admissibility of evidence. At this time, the parties
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`do not have such stipulations.
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`J.
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`K.
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`The Possibility of Obtaining Agreements Among the Parties Regarding the Extent to
`Which Such Electronically Stored Information Should Be Preserved, the Form in
`Which Such Information Should be Produced, and Whether Discovery of Such
`Information Should be Conducted in Phases or Limited to Particular Individuals,
`Time Periods, or Sources
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`The parties will work cooperatively to prepare a joint stipulation for ESI.
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`Suggestions on the Advisability and Timing of Referring Matters to a Magistrate,
`Master, Other Neutral, or Mediation
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`The parties do not anticipate the use of a magistrate or neutral at this time. The parties are
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`open to setting a deadline for mediation before an agreed-to mediator or, in the event of no
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`agreement, a mediator selected by the Court. Kidz Medical proposes the deadline for mediation to
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`be April 23, 2021. United proposes the deadline for mediation to be October 15, 2021.
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`L.
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`A Preliminary Estimate of the Time Required for Trial
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`7-10 days.
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`Requested Date or Dates for Conferences Before Trial, a Final Pretrial Conference,
`and Trial
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`Kidz Medical’s Proposed Dates:
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`M.
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`N.
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`Case No. 2019-023456-01
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`(i) Final Pretrial Conference –August 23, 2021
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`(ii) Trial Period –September 2021.
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`United’s Proposed Dates:
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`(i) Final Pretrial Conference – January 31, 2022.
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`(ii) Trial Period – February 2022.
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`A Description of Pertinent Documents and a List of Fact Witnesses the Parties Believe
`to be Relevant
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`Documents:2
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`Parties’ Medical Group Participation Agreement and documents related thereto.
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`All claims for medical services provided by Kidz Medical to United members from August
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`1, 2018 forward, and all documents related thereto.3
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`All claims for medical services provided by Kidz Medical to non-United members during
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`the relevant time period.
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`Kidz Medical’s records related to all amounts received and accepted for payment of claims
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`for the CPT (Current Procedural Terminology) codes at issue in the case.
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`United’s records related to all amounts paid and accepted and disputed from other providers
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`regarding the CPT codes at issue in the case.
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`Communications between the parties regarding the Agreement and termination thereof.
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`Internal communication regarding the Agreement and termination thereof.
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`Fact Witnesses:
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`George MacConnell
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`2 By listing these documents the parties are not agreeing to the relevance or materiality of any
`documents.
`3 As set forth above, United contends that the damages period may be dictated by the Interim
`Award on liability entered in the related arbitration.
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`Case No. 2019-023456-01
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`Jorge Perez, M.D.
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`Albert Tano, M.D.
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`Ralph Quattrocchi
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`Wayne Brackin
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`David Lubowitz
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`Casandra Nunez
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`Saleem Alinur
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`O.
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`Number of Experts and Fields of Expertise
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`Kidz Medical anticipates expert testimony with regard to the fair market valuation of the
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`medical services provided by Kidz Medical on an out-of-network basis, and possibly the need for
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`statistical sampling of claims and respective experts for same.
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`United anticipates expert testimony with regard to the usual and customary charges for the
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`CPT codes at issue in the case, which United contents under Florida law is the amount actually
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`accepted for payment by providers for those CPT codes. United does not agree to statistical
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`sampling of claims, but to the extent sampling is done then United also anticipates expert testimony
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`regarding how sampling would be conducted.
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`P.
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`Any Other Information That Might be Helpful to the Court in Setting Further
`Conferences and the Trial Date
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`The parties have a status conference with the Arbitration Panel on April 28, 2020 and
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`respectfully suggest that they file a status report with this Court within 10 days thereafter to advise
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`as to the rescheduled Final Hearing date and anticipated rendition of the Interim Award.
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`Dated: April 6, 2020
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`Case No. 2019-023456-01
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`HOLLAND & KNIGHT LLP
`701 Brickell Avenue, Suite 3300
`Miami, Florida 33131
`Tel: (305) 374-8500
`Attorneys for UnitedHealthcare of Florida,
`Inc. and UnitedHealthcare Insurance
`Company
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`By:
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`s/ Brian A. Briz
`BRIAN A. BRIZ
`brian.briz@hklaw.com
`anabel.pargas@hklaw.com
`JENNIFER A. MANSFIELD
`jennifer.mansfield@hklaw.com
`camille.winn@hklaw.com
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`CERTIFICATE OF SERVICE
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`Respectfully submitted,
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`LASH & GOLDBERG LLP
`100 SE 2nd Street, Ste. 1200
`Miami, Florida 33131-2131
`Tel: (305) 347-4040
`Attorneys for Kidz Medical Services, Inc.
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`By:
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`s/ Justin C. Fineberg
`ALAN D. LASH
`Florida Bar No. 510904
`alash@lashgoldberg.com
`LORELEI J. VAN WEY
`Florida Bar No. 98279
`Lvanwey@lashgoldberg.com
`JUSTIN C. FINEBERG
`Florida Bar No. 0053716
`jfineberg@lashgoldberg.com
`MATTHEW G. FRIAS
`Florida Bar No. 117725
`mfrias@lashgoldberg.com
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`I hereby certify that on April 6, 2020, I electronically filed a true and correct copy of the
`foregoing with the Florida Courts E-Filing Portal, which will serve it via electronic mail to counsel
`of record listed:
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`Brian A. Briz, Esq.
`brian.briz@hklaw.com
`anabel.pargas@hklaw.com
`Jennifer A. Mansfield, Esq.
`jennifer.mansfield@hklaw.com
`camille.winn@hklaw.com
`HOLLAND & KNIGHT LLP
`701 Brickell Avenue, Suite 3300
`Miami, Florida 33131
`Tel: (305) 374-8500
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`/s/ Justin C. Fineberg _
` Justin C. Fineberg
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