throbber
Case 8:22-cv-00617-PWG Document 1-2 Filed 03/11/22 Page 1 of 32
`E-FILED; Montgomery Circuit Court
`Docket: 2/3/2022 3:46 PM; Submission: 2/3/2022 3:46 PM
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`CHARLES PUGH
`1443 Southern Avenue, Apt. 202
`Oxon Hill, Maryland 20745
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`and
`
`VERONICA STEWART
`3305 Mondawmin Avenue
`Baltimore, Maryland 21216
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`On Their Own Behalf and on Behalf
`of All Others Similarly Situated,
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`Plaintiffs,
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`V.
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`CIOX HEALTH, LLC
`120 Bluegrass Valley Parkway
`Alpharetta, Georgia 30005
`Serve On:
`CSC-Lawyers Incorporating Service Co.
`7 St. Paul Street, Ste. 820
`Baltimore, Maryland 21202
`
`and
`
`PETER McCABE
`In his capacity as Chief Executive Officer of
`CIOX Health, LLC
`c/o CIOX Health, LLC
`120 Bluegrass Valley Parkway
`Alpharetta, Georgia 30005,
`
`Defendants.
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`IN THE
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`CIRCUIT COURT
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`* MONTGOMERY-COUNTY, MD.
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`Case No.
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`Class Action Complaint and Demand for Jury Trial
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`Plaintiffs, Charles Pugh ("Mr. Pugh") and Veronica Stewart ("Ms. Stewart"), on their
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`own behalf and on behalf of a class of similarly situated persons, by and through their attorneys
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`Richard S. Gordon and Sara E. Assaid of GORDON, WOLF & CARNEY, CHTD. and
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`Charles A. Gilman and Lauren M. Geisser of GILMAN & BEDIGIAN, LLC, sue Defendants (1)
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`EXHIBIT 1
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`

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`CIOX Health, LLC ("CIOX" or "CIOX Health, LLC") and (2) Peter McCabe c/o CIOX
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`Health, LLC ("McCabe") and allege as follows:
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`Introduction
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`1.
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`This Class Action Complaint and Demand forJury Trial (the "Complaint")
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`challenges the predatory and illegal billing practices of CIOX, in violation of CIOX's statutory
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`and common law obligations, when billing their patients for Medical Records under Maryland's
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`Confidentiality of Medical Records Act, Md. Code, Health-Gen. §§ 4-301, et seq. ("Maryland's
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`Confidentiality of Medical Records Act" or "Md. CMRA").
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`2.
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`CIOX is a specialized Medical Records provider that contracts with health care
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`providers throughout the United States, including Maryland, to maintain, retrieve and prepare
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`individuals' personal health records, on the health care providers' behalf. Nationally, CIOX
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`fulfills over 50 million requests for health information annually.
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`3.
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`In Maryland, all costs associated with the retrieval and preparation of such
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`Medical Records, whether by a health care provider or through a health care provider's agent,
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`such as CIOX, are governed by Maryland's Confidentiality of Medical Records Act. The Md.
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`CMRA limits both the types of charges that may be imposed by health care providers and their
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`agents, as well as the amounts of those charges when imposed.
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`4.
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`The Md. CMRA, for example, limits the per-page charge by a health care
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`provider or its agent for the copying of Medical Records (currently set by the Maryland General
`
`Assembly at "76 cents for each page of the medical record"). Md. Code, Health-Gen.
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`§ 4-304(c)(3)(i). When the health care provider uses or maintains the requested medical records
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`in an electronic format, and further produces the medical records in an electronic format, this
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`per-page charge is limited to "75% of the per-page fee" (thus reducing the .76¢ to .57¢
`
`2
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`

`

`per-page) and is capped at a specific dollar amount (currently $80) when a health care provider
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`that uses or maintains the requested Medical Records in an electronic format produces the
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`Medical Records in an electronic format. Md. Code, Health-Gen. § 4-304(c)(3)(iii)(2).
`
`5.
`
`In addition to these per-page fees, the Md. CMRA also limits any other fees that a
`
`health care provider or its agent may charge and only permits a"preparation fee" not to exceed
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`a capped amount (currently $22.88) for Medical Records or electronic format Medical Records
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`"retrieval and preparation." Md. Code, Health-Gen. § 4-304(c)(3)(ii)(1) and (iii)(1).
`
`6.
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`Other restrictions in the Md. CMRA further limit what can be charged for
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`preparation and production of Medical Records, which is dependent upon who is requesting the
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`Medical Records and their intended use. Effective October 1, 2021, for instance, the Maryland
`
`General Assembly expressly prohibits a health care provider or its agent from charging any fee
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`for providing copies of Medical Records requested by a"patient" or the patient's representative
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`when the Medical Records "will be used for the purpose of filing a claim regarding or appealing
`
`a denial of Social Security disability income or Social Security benefits under Title II or Title
`
`XVI of the Social Security Act." Md. Code, Health-Gen. § 4-304(c)(5).
`
`7.
`
`Despite the express limitations imposed by Maryland's General Assembly, CIOX
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`routinely and consistently charges fees well in excess of those permitted by Maryland's
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`Confidentiality of Medical Records Act and Maryland law including `Junk Fees" that are unfair,
`
`abusive and deceptive. For example, CIOX routinely charges a"Basic Fee" of up to $22.88 to
`
`individuals when CIOX searches for an individual's Medical Records but ultimately determines
`
`that the health care provider has no such records to retrieve or prepare. CIOX also frequently
`
`adds an "Electronic Data Archive Fee," a"Digital Archive Fee," a"Retrieval Fee," an "Instant
`
`

`

`Download Fee" and/or other `Junk Fees" even though those fees are not expressly permitted by
`
`Maryland law.
`
`8.
`
`In addition to these `Junk Fees," CIOX also charges patients and their
`
`representatives more than the legally permitted per-page fee for electronic copies (as provided for
`
`in Maryland's Confidentiality of Medical Records Act); and it refuses to cap its per-page fee for
`
`preparation of electronic format Medical Records, despite the clear requirements of the Md.
`
`CMRA.
`
`9.
`
`CIOX, as a large and sophisticated health care provider, which has operated in
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`the state of Maryland for more than twenty (20) years, at all times knew or should have known
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`that the fees that it charged to and collected from Named Plaintifls and members of the Class,
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`throughout the timeframe of this Complaint, were unlawful, excessive and impermissible.
`
`10.
`
`But CIOX's predatory and illegal billing practices go even further. Despite the
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`clear prohibition in the Md. CMRA, CIOX, as of the filing of this Complaint, knowingly and
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`intentionally charges copying fees for Medical Records requested by a"patient" and/or the
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`patient's representative when the Medical Records "will be used for the purpose of filing a claim
`
`regarding or appealing a denial of Social Security disability income or Social Security benefits
`
`under Title II or Title XVI of the Social Security Act." Md. Code, Health-Gen. § 4-304(c)(5).
`
`11.
`
`Complaints regarding CIOX's billing practices, either from patients or the
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`attorneys who represent them, have not slowed down CIOX's illegal activities. CIOX will not
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`stop its unfair, abusive and deceptive billing practices until it is compelled to stop them by a court
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`of law.
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`4
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`

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`12.
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`CIOX massively profits from victimizing the individuals who have been
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`improperly overcharged for the production of Medical Records, enjoying its financial windfall
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`and ill-gotten gains at the expense of vulnerable individuals.
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`13.
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`Accordingly, Named Plaintiffs bring this Complaint on behalf of all persons who,
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`during the timeframe of this Complaint sought copies of Medical Records from a Maryland
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`health care provider, or had the records requested by some other Person pursuant to their
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`authorization, and either: (1) were charged a fee by CIOX after it was determined that no such
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`records existed; or (2) were charged `Junk Fees" or excessive fees by CIOX in violation of
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`Maryland's Confidentiality of Medical Records Act.
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`Parties
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`14.
`
`Named Plaintiff Charles Pugh is a resident of Prince George's County, Maryland.
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`On or about December 23, 2021, Mr. Pugh's attorneys and personal representatives requested
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`Mr. Pugh's Medical Records from Medstar Southern Maryland Hospital in Clinton, Maryland
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`("Medstar") to be used for the purpose of filing a claim for Mr. Pugh regarding Social Security
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`disability income under Title II of the Social Security Act.
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`15.
`
`On or about December 31, 2021, CIOX, an agent of Medstar, produced the
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`requested Medical Records in an electronic format. CIOX's invoice for retrieving and
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`producing Mr. Pugh's Medical Records included per-page charges of .66¢, aggregate copy
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`charges of $86.54 and an "Electronic Data Archive Fee" of $4.99, all of which were collected
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`from Mr. Pugh.
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`16.
`
`17.
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`A copy of Mr. Pugh's CIOX Invoice is attached hereto as Exhibit A.
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`Named Plaintiff Veronica Stewart is a resident of Baltimore City, Maryland. On
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`or about February 19, 2020, Ms. Stewart's attorneys and personal representatives requested Ms.
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`

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`Stewart's Medical Records from Rubin Institute for Advanced Orthopedics ("Rubin Institute") in
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`Baltimore, Maryland to be used in connection with Ms. Stewart's claims for personal injuries.
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`18. On or about February 28, 2020, CIOX, an agent of Rubin Institute, notified Ms.
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`Stewart's attorneys that it was "unable to comply with [the] request" noting that no Medical
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`Records were located for Ms. Stewart. Regardless, CIOX sent Ms. Stewart an invoice, charging
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`her a"Basic Fee" of $22.88, which was collected from Ms. Stewart.
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`19.
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`A copy of Ms. Stewart's CIOX Invoice is attached hereto as Exhibit B.
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`20.
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`Defendant CIOX is a Georgia limited liability company doing business
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`throughout the state of Maryland, including Montgomery County, as a foreign limited liability
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`company.
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`21.
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`As a foreign limited liability company, CIOX assents to the laws of this state. Md.
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`Code, Corp. and Assoc. § 4A-1010.
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`22.
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`On December 23, 2016, CIOX forfeited its right to conduct business in the state
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`of Maryland. It is not in good standing and is no longer authorized to do business in the state of
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`Maryland.
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`23.
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`CIOX Health, LLC was formerly known as HealthPort Incorporated and
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`changed its name to CIOX Health, LLC in March 2016. CIOX Health, LLC was created by
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`the merger of HealthPort, IOD, Inc., Care Communications, Inc., and ECS. The company was
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`founded in 1976 and began conducting business in Maryland in 2001.
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`24.
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`CIOX is a specialized Medical Records provider that contracts with health care
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`providers in all 50 states to retrieve and produce individuals' protected health information
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`("PHI") under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and
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`relevant state privacy laws.
`
`[II
`
`

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`25.
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`CIOX provides Medical Records retrieval services for three out of five hospitals in
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`the United States and more than 16,000 physician practices, handling more than 50 nullion
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`Medical Records requests annually.
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`26.
`
`During the timeframe of this Complaint, Defendant CIOX contracted with
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`certain health care providers in Maryland — including but not limited to Medstar and Rubin
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`Institute — to retrieve and prepare Medical Records pursuant to patients' requests.
`
`27.
`
`For purposes of Maryland's Confidentiality of Medical Records Act, CIOX, at all
`
`times, was an agent of these, and many other, health care providers in Maryland.
`
`28.
`
`Defendant McCabe is the Chief Executive Oflicer of CIOX and is sued in this
`
`matter in his official capacity because Defendant CIOX Health, LLC has forfeited its authority
`
`to conduct business in the state of Maryland. See Md. Code, Corp. and Assoc. § 4A-1013.
`
`Jurisdiction And Venue
`
`29.
`
`This Court has subject matter jurisdiction over this case pursuant to Md. Code,
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`Cts. &Jud. Proc. § 1-501.
`
`30.
`
`This Court has personal jurisdiction over Defendants under the long-arm statute
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`of the state of Maryland, Md. Code, Cts. &Jud. Proc. § 6-103, and the United States
`
`Constitution, because Defendants conduct substantial business within the state of Maryland.
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`Therefore, a substantial part of the events and/or omissions giving rise to the claims and
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`Plaintiffs tortious injuries occurred within the state of Maryland.
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`31.
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`Venue is proper in this Court pursuant to Md. Code, Cts. & Jud. Proc. § 6-201
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`because CIOX carries on a regular business and habitually engages in vocation in Montgomery
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`County, Maryland.
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`

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`Facts Anplicable to All Counts
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`32.
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`This is an action against CIOX resulting from its predatory and unreasonable
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`billing practices, which are not only unlawful under Maryland's Confidentiality of Medical
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`Records Act, but also unfair, abusive and deceptive.
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`33.
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`All physicians, chiropractors, hospitals, dentists and other duly licensed
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`practitioners in the state of Maryland (collectively "health care providers") are required by
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`Maryland statute to furnish a copy of all Medical Records to the patient or the patient's
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`representative upon request. See Md. Code, Health-Gen. § 4-304(a).
`
`34.
`
`Under the Md. CMRA, "Health care provider" is broadly defined and includes
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`any "person who is licensed, certified, or otherwise authorized under the Health Occupations
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`Article or § 13-516 of the Education Article to provide health care in the ordinary course of
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`business or practice of a profession or in an approved education or training program," as well as
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`any facility — inpatient or outpatient — where health care is provided. Md. Code, Health-Gen.
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`§ 4-301(h)(1).
`
`35.
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`Health care provider also "includes the agents, employees, officers, and directors
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`of a facility and the agents and employees of a health care provider." Md. Code, Health-Gen.
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`§ 4-301(h)(2).
`
`36.
`
`Defendant CIOX is a Medical Records copying service which has contracts with
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`a number of health care providers in the state of Maryland to maintain, copy and distribute,
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`upon request, the Medical Records of patients and/or former patients of such health care
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`providers.
`
`E23
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`

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`37.
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`CIOX is required to comply with all provisions of the Md. CMRA because
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`through its role of fulfilling Medical Records requests, CIOX acts as an agent of health care
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`providers by processing the Medical Records requests on their behalf.
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`38.
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`Indeed, upon information and belief, all contracts between CIOX and health care
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`providers in Maryland provide that CIOX agrees that the fees and charges invoiced and
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`collected by CIOX in connection with the fulfillment of Medical Records requests shall be in
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`compliance with state laws.
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`39.
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`CIOX, under its business model, and as is typical of standard industry practice,
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`charges state-authorized rates, such as those delineated in Maryland's Confidentiality of Medical
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`Records Act, for all Medical Records requests from third parties, such as law firms seeking their
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`client's Medical Records for purposes of legal representation.
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`40.
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`"Medical record" is defined by the Md. CMRA to include "any oral, written, or
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`other transmission in any form or medium of information that:
`
`(i)
`(ii)
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`Is entered in the record of a patient or recipient;
`Identifies or can readily be associated with the identity of a patient or
`recipient; and
`(iii) Relates to the health care of the patient or recipient."
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`Md. Code, Health-Gen. § 4-301(j)(1).
`
`41.
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`"Medical record" also includes any documentation showing that a Medical
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`Record was disclosed to any person who is not an employee, agent; or consultant of the health
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`care provider. Md. Code, Health-Gen. § 4-301(j)(2)(i). It also includes any medical bills
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`requested by an individual. Md. Code, Health-Gen. § 4-304(c)(1)(i).
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`42.
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`Under the Md. CMRA, "Patient" is defined as "a person who receives health care
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`and on whom a medical record is maintained." Md. Code, Health-Gen. § 4-301(1).
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`~]
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`

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`43.
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`In Maryland, a health care provider, including but not limited to CIOX, is
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`required to provide a copy of Medical Records "within a reasonable time" after a"Person in
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`interest" requests such records "in writing." Md. Code, Health-Gen. § 4-304(a)(1).
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`44.
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`A"Person in interest," under the Md. CMRA, is broadly defined to include,
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`among others, an adult or minor "on whom a health care provider maintains a medical record"
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`or their duly appointed representatives. "Person in interest" also includes any "attorney
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`appointed in writing." Md. Code, Health-Gen. § 4-301(m).
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`Maryland Law Expressly Limits the Fees that Can be
`Charged for Producing Medical Records
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`45. When a Person in Interest or any authorized person requests copies of Medical
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`Records, health care providers "may require a person in interest or any other authorized person
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`who requests a copy of a medical record to pay for the cost of copying." Md. Code, Health-Gen.
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`§ 4-304(c)(2).
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`46. Maryland's Confidentiality of Medical Records Act enumerates the specific fees
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`and charges that can be imposed upon a person who requests Medical Records from a health
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`care provider.
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`47.
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`In particular, under § 4-304(c)(3)(i) of the Md. CMRA, a health care provider such
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`as CIOX, "may charge a fee for copying and mailing not exceeding" a specific dollar amount
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`(currently "76 cents") for each page of the Medical Records.
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`48.
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`In addition to the per-page fee, a hospital or a health care provider may also charge:
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`Subject to the fee limitations that apply to persons in interest
`under 45 C.F.R. 164.524 and any guidance on those limitations
`issued by the U.S. Department of Health and Human Services, a
`preparation fee not to exceed $22.88 for medical record retrieval
`and preparation; and
`
`2.
`
`The actual cost for postage and handling of the medical record.
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`10
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`Md. Code, Health-Gen. § 4-304(c)(3)(ii).
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`49. When Medical Records are produced in an "electronic format," the health care
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`provider is also permitted to charge certain fees for the Medical Records, but the fees are
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`reduced and limited:
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`(iii)
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`Subject to the fee limitations that apply to persons in interest under 45
`C.F.R. 164.524 and any guidance on those limitations issued by the U.S.
`Department of Health and Human Services, a hospital or a health care
`provider that uses or maintains the requested medical records in an
`electronic format may charge for an electronic copy of a medical record
`in an electronic format requested by a person in interest or any other
`authorized person:
`
`1.
`
`2.
`
`3.
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`A preparation fee not to exceed $22.88 for electronic
`format medical records retrieval and preparation;
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`A per-page fee of 75% of the per-page fee charged by a
`health care provider under subparagraph (i) of this
`paragraph that may not exceed $80; and
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`The actual cost for postage and handling of the electronic
`format medical records.
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`Md. Code, Health-Gen. § 4-304(c)(3)(iii).
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`50.
`
`As of the date of the filing of this Complaint, the "per-page fee of 75% of the per-
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`page fee charged by a health care provider under" Md. Code, Health-Gen. § 4-304(c)(3)(i) is .57¢
`
`per-page.
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`51. Maryland's Confidentiality of Medical Records Act does not permit any fee to be
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`charged or collected when the health care provider or its agent searches for Medical Records but
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`determines that the health care provider has no such records to copy, retrieve or prepare.
`
`52.
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`In addition, the Md. CMRA as of October 1; 2021, prohibits a health care
`
`provider or its agent from charging any fee for providing copies of Medical Records requested by
`
`a"patient" or the patient's representative when the Medical Records "will be used for the
`
`purpose of filing a claim regarding or appealing a denial of Social Security disability income or
`
`

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`Social Security benefits under Title II or Title XVI of the Social Security Act." Md. Code,
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`Health-Gen. § 4-304(c)(5).
`
`CIOX Charges and Collects More than
`the Fees Permitted by Maryland Law
`
`53.
`
`Despite the express restrictions of Maryland law on the fees that CIOX and other
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`health care providers can charge and collect for the copying, retrieval and preparation of
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`Medical Records, CIOX routinely and consistently invoices and collects fees in excess of the
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`amounts permitted.
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`54.
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`For example, CIOX routinely and consistently charges to and collects from
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`Persons in Interest a"Basic Fee" of up to $22.88 when CIOX merely searches for requested
`
`Medical Records but determines that the health care provider has no such records to copy,
`
`retrieve or prepare.
`
`55.
`
`The "Basic Fee" of up to $22.88 charged and collected in such a circumstance
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`deceives or tends to deceive because no fee is authorized by Maryland law for merely searching
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`for Medical Records. Indeed, the charging of a"Basic Fee," or any fee at all, is unfair, abusive or
`
`deceptive in such a circumstance and has caused loss and damage to those who paid the fee to
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`CIOX in reliance upon the implicit suggestion that such a fee is legally permitted and authorized
`
`by the law.
`
`56.
`
`Even when CIOX locates Medical Records, and retrieves and prepares them for
`
`production, CIOX also frequently and consistently adds additional fees and charges to their
`
`invoices in an eflbrt to collect more from Persons in Interest than legally permitted. In this
`
`regard, during the timeframe of this Complaint, CIOX has invoiced Persons in Interest for a
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`variety of `Junk Fees" including but not limited to "Electronic Data Archive Fees," "Digital
`
`12
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`

`

`Archive Fees," "Retrieval Fees," "Instant Download Fees" and others even though those fees also
`
`are not expressly permitted by Maryland law.
`
`57.
`
`Upon information and belief, these `Junk Fees" are invoiced and collected as a
`
`matter of course, are unfair, abusive or deceptive and have caused loss and damage to those who
`
`have paid the fees to CIOX in reliance upon the implicit suggestion that such `Junk Fees" are
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`legally permitted and authorized by the law.
`
`58.
`
`-
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`In addition to the `Junk Fees," CIOX also refuses and/or fails to limit its fees,
`
`charged to and collected from patients and their representatives, to the legally permitted per-
`
`page rate for electronic copies (as provided for in the Maryland's Confidentiality of Medical
`
`Records Act); and it refuses and/or fails to cap its aggregate copying fee for preparation of
`
`electronic format Medical Records, despite the clear requirements of the Md. CMRA.
`
`59.
`
`In this regard, CIOX typically and routinely currently charges Persons in Interest
`
`.66¢ per-page or more, even though the Md. CMRA currently limits the per-page charge for
`
`Medical Records produced in an electronic format to .57¢ per-page — which is "75% of the per-
`
`page fee" allowable when the Medical Records are retrieved and prepared in a hard copy
`
`format. Md. Code, Health-Gen. § 4-304(c)(3)(iii).
`
`60.
`
`And CIOX also typically and routinely charges Persons in Interest more than the
`
`aggregate fee permitted when Medical Records are produced in an electronic format (currently
`
`$80). Md. Code, Health-Gen. § 4-304(c)(3)(iii). Indeed, CIOX often charges an aggregate fee for
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`electronic copies in excess of $85 or more.
`
`61.
`
`But CIOX's predatory and illegal billing practices go even further. Despite the
`
`clear prohibition in the Md. CMRA, CIOX, as of the filing of this Complaint, still charges
`
`copying fees for Medical Records requested by a"patient" and/or the patient's representative
`
`13
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`

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`when the Medical Records "will be used for the purpose of filing a claim regarding or appealing
`
`a denial of Social Security disability income or Social Security benefits under Title II or Title
`
`XVI of the Social Security Act." Md. Code, Health-Gen. § 4-304(c)(5).
`
`62.
`
`At all times relevant to this Complaint, CIOX, a company that has conducted
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`business and operations in the state of Maryland for more than twenty (20) years, was fully aware
`
`of the requirements, limitations and nuances of the Md. CMRA with respect to requiring a
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`Person in Interest or any other authorized person who-requests a copy of Medical Records to pay
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`the cost of copying the Medical Records and/or retrieval and preparation of the Medical
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`Records.
`
`63.
`
`For years, CIOX has charged and collected the fees challenged in this Complaint
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`from Named Plaintiffs and Class members when it knew or should have known that the fees were
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`unlawful, excessive and impermissible.
`
`64.
`
`In this regard, CIOX is fully aware that it may not: (a) charge and collect `Junk
`
`Fees" from the Named Plaintifls and Class members seeking copies of their Medical Records; (b)
`
`impose a per-page copy rate in excess of that permitted by Maryland law; and (b) levy a fee of
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`any type on the members of the Class (such as a"Basic Fee" of up to $22.88) when CIOX
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`searches for a person's Medical Records but determines that the health care provider has no such
`
`records to produce.
`
`65.
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`Likewise, CIOX also is fully aware that post-October 1, 2021, it is prohibited
`
`from charging and collecting a fee for copying Medical Records from anyone in Maryland
`
`seeking to pursue a claim for Social Security disability income or Social Security benefits under
`
`Title II or Title XVI of the Social Security Act.
`
`14
`
`

`

`66.
`
`As a result of CIOX's predatory and unlawful billing scheme, and the other acts,
`
`material omissions, aflirmative misrepresentations and unfair, abusive and deceptive practices
`
`described herein, Named Plaintiffs and Class members were charged and paid significantly more
`
`for the copying, retrieval and preparation of their Medical Records than the law permits.
`
`Facts APplicable to Named Plaintiffs
`
`CHAtu.Es PucH
`
`On or about December 23, 2021; Mr. Pugh's attorneys and personal
`
`A.
`
`67.
`
`representatives requested Mr. Pugh's Medical Records from Medstar to be used for the purpose
`
`of filing a claim for Mr. Pugh regarding Social Security disability income under Title II of the
`
`Social Security Act.
`
`68.
`
`The request for Mr. Pugh's Medical Records — which was submitted to Medstar
`
`at the request of the law firm representing Mr. Pugh via Mr. Pugh's authorized representative,
`
`ReleasePoint, a records retrieval service — included a written notice that Mr. Pugh's
`
`"MEDSTAR SOUTHERN MARYLAND HOSPITAL Records are needed for SSDI benefits
`
`hearing."
`
`69. Mr. Pugh's attorneys, as well as ReleasePoint, were appointed in writing by him.
`
`70.
`
`On or about December 30, 2021, CIOX, as an agent of Medstar, prepared an
`
`invoice in connection with the copying, retrieval and preparation of Mr. Pugh's Medstar Medical
`
`Records.
`
`71. Mr. Pugh's CIOX's Invoice — which was generated by CIOX's "Electronic
`
`Delivery Service" — also included the following preprinted communication in bold type:
`
`Please Note: Your medical record request
`has been delivered electronically to your
`Ciox eDelivery Account.
`
`15
`
`

`

`See Exhibit A.
`
`72.
`
`Despite the express notice from ReleasePoint that Mr. Pugh's Medical Records
`
`were requested for the purpose of pursuing a claim regarding Social Security disability income,
`
`CIOX's invoice included and demanded payment of $86.54 for the copying of Mr. Pugh's
`
`Medical Records.
`
`73.
`
`And notwithstanding the unambiguous communication from CIOX,
`
`acknowledging that Mr. Pugh's Medical Records were delivered in an electronic format, CIOX's
`
`Invoice for Mr. Pugh included charges of .66¢ per-page and aggregate copy charges of $86.54.
`
`Both of these charges are in excess of the maximum fees permitted under Maryland's
`
`Confidentiality of Medical Records Act.
`
`74. Moreover, and in addition to the other charges set forth on CIOX's Invoice for
`
`Mr. Pugh, CIOX included an "Electronic Data Archive Fee" — a`Junk Fee" — of $4.99 among
`
`the charges assessed to Mr. Pugh.
`
`75.
`
`Because of the unlawful and unauthorized charges that CIOX added to Mr.
`
`Pugh's invoice, CIOX demanded that Mr. Pugh and his authorized representatives pay CIOX a
`
`total of $114.41 for copying, retrieving and preparing Mr. Pugh's Medical Records. The actual
`
`charges permitted by Maryland law, however, for the copying, retrieval and preparation of Mr.
`
`Pugh's Medical Records are a fraction of that amount.
`
`76. Mr. Pugh and his authorized representatives paid the CIOX Invoice in full on or
`
`about December 30, 2021.
`
`77.
`
`On December 30, 2021, CIOX, as an agent of Medstar, produced the recluested
`
`Medical Records to Mr. Pugh and his authorized representatives, in, as noted, an electronic
`
`format.
`
`

`

`78.
`
`Upon information and belief, had Mr. Pugh and his authorized representatives
`
`refused to pay CIOX's Invoice in full, Defendant CIOX would have refused to produce Mr.
`
`Pugh's Medical Records.
`
`79.
`
`As a result of CIOX's unlawful and predatory actions in this case, Mr. Pugh has
`
`paid more for copies of his Medical Records than permitted by Maryland law and suflffered actual
`
`damages.
`
`B.
`
`80.
`
`VERONICA STEWART
`
`On or about February 19, 2020, Ms. Stewart's attorneys and personal
`
`representatives requested Ms. Stewart's Medical Records from Rubin Institute, to be used in
`
`connection with Ms. Stewart's claims for personal injuries.
`
`81. Ms. Stewart's attorneys were appointed in writing by her.
`
`82.
`
`On February 28, 2020, Rubin Institute, by and through its agent CIOX, notified
`
`Ms. Stewart's attorneys, via a notice titled "Request Exception Notification," that it was "unable
`
`to comply with [the] request" noting that no Medical Records were located for Ms. Stewart.
`
`83.
`
`In particular, the Request Exception Notification advised Ms. Stewart and her
`
`attorneys that a search for Ms. Stewart in Rubin Institute's records, yielded no results:
`
`Patient Not Found
`We have been unable to locate a record for the above-named patient. We
`will gladly recheck our records if you can provide and verify the following
`information: date of birth, treatment types and dates, attending physicians,
`the specific outpatient department in which the patient was seen, or other
`names under which the patient might have been admitted. Please re-submit
`your request with the necessary information and will process your request
`upon receipt.
`
`84.
`
`Even though Defendant CIOX did not copy any Medical Records in response to
`
`Ms. Stewart's request for Medical Records, and neither retrieved nor prepared any records for
`
`17
`
`

`

`production (either electronically or otherwise), on or about February 28, 2020, CIOX sent Ms.
`
`Stewart an invoice, charging her a"Basic Fee" of $22.88. See Exhibit B.
`
`85.
`
`The $22.88 "Basic Fee" charged by CIOX to Ms. Stewart is a"Junk Fee" that
`
`has no permissible legal basis.
`
`86.
`
`Because of the unlawful and unauthorized charge that CIOX added to Ms.
`
`Stewart's invoice, CIOX demanded that Ms. Stewart and her attorney's pay CIOX a total of
`
`$22.88 "Net 30 days."
`
`87. Ms. Stewart and her attorneys paid the CIOX invoice in full on or aboutJune 1,
`
`2021.
`
`88.
`
`As a result of CIOX's unlawful and predatory actions in this case, Ms. Stewart
`
`paid CIOX a fee for searching for her Medical Records that is unlawful and impermissible under
`
`Maryland law. As a result, she has sufl'ered actual damages.
`
`C.
`
`CIOX HEALTH, LLC'S UNI.AWFUL AND PREDATORY FEES ARE NOT LIMITED
`TO THE NAMED PLAINTIFFS
`
`89.
`
`The facts and circumstances of Named Plaintifls Charles Pugh and Veronica
`
`Stewart against Defcndant CIOX are neither unique nor isolated. Upon information and belief,
`
`during the time frame of this Complaint, CIOX on its own behalf and on behalf of hundreds of
`
`health care providers throughout Maryland, has overcharged tens of thousands of individuals,
`
`and forced them to pay CIOX `Junk Fees" and unlawfully inflated fees similar to those
`
`challenged by this Complaint.
`
`Class Act.ion Allegations
`
`90.
`
`Named Plaintifls bring this action individually and as a class action pursuant to
`
`Maryland Rule of Civil Procedure Rule 2-231(b), (c)(1), (c)(2), and (c)(3) on behalf of a class (the
`
`"Class") defined as follows:
`
`W.
`
`

`

`All persons who, between February 3, 2010 and the present, sought copies of
`Medical Records from a Maryland health care provider, or had their Medical
`Records requested by some other person pursuant to their authorization, and
`either: (1) were charged a fee of any type by CIOX Health, LLC after it was
`determined that no such Medical Records existed; (2) were charged other `Junk
`Fees" — such as, by way of example, an "Electronic Data Archive Fee," a"Digital
`Archive Fee," a"Retrieval Fee" or an "Instant Download Fee" — or otherwise
`charged more
`than
`the maximum amounts permitted by Maryland's
`Confidentiality of Medical Records Act, Md. Code, Health-Gen. § 4-304; or (3)
`were charged a fee by CIOX Health, LLC, after October 1, 2021, for providing
`copies of Medical Records when the Medical Records will be used for the purpose
`of filing a claim regarding or appealing a denial of Social Security disability income
`or Social Security benefits und

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