SURGERY CENTER VS UNITEDHEALTH

This is an action arising out of Defendants’ wrongful underpayment of the health

insurance benefits owed to the medical provider, SCV, of the patient / insured, C.G., relating to

medical services provided to C.G. by SCV on May 25, 2016.

Authority makes clear that a “rate of payment claim” (such as the instant case) is

not subject to the Employment Retirement Income Security Act of 1974, Title 29, United States

Code, Sections 1000-1461 (“ERISA”), versus a “right of payment claim” (not such as the instant

case) that would be subject to ERISA.

Filing 141750518 VS 05-2022-CA-011030-XXXX-XX3. At all material times, SCV was a medical provider and a Florida limited liability

company with its citizenship (i.e., principal place of business / “nerve center”) in Viera, Florida,

Brevard County. SCV is sui juris in all respects. SCV’s members are as follows: (a) Dr. Ara

Deukmedjian, domiciled in Brevard County, Florida, (b) Sun Deukmedjian, domiciled in Brevard

County, Florida, and (c) Dr. Bharat Patel, domiciled in Brevard County, Florida. At all material

times, SCV was the authorized representative of C.G. with an assignment of benefits as well.

At all material times, UHC was an insurance company with its principal place of

business / headquarters (i.e., “nerve center”) in the State of Connecticut and engaged in the

business of selling and / or administering health insurance and / or deciding health insurance

claims.

Atall material times, the Ocala Gran Prix Defendants maintained a principal place

of business / headquarters (i.e., “nerve center”) in the State of Florida. Upon information and belief,

the Ocala Gran Prix Defendants served as Plan administrator and / or Plan sponsor.'

This Court has jurisdiction over this matter pursuant to Sections 26.012 and 34.01

of the Florida Statutes, as the amount in controversy exceeds the sum of $30,000.00, exclusive of

attomeys’ fees, interest, and costs.

Venue is proper in this Court pursuant to Section 47.011 of the Florida Statutes

because, for examples, (a) a substantial part of the business transacted, events, or omissions giving

tise to this action occurred in (i.e., this “cause of action accrued” in) this jurisdiction, namely

underpayment of the subject insurance claim (and / or rejection of SCV’s pre-suit appeals) in

Brevard County where the authorized assignee medical provider (SCV) is situated and carried out

1 Tt is not clear from the insurance policy / SPD attached hereto as Exhibit A and fully incorporated herein by reference

whether the subject Plan was / is fully insured versus self-insured. Should it someday be learned that the subject Plan

was / is fully insured by UHC and that the Ocala Gran Prix Defendants played no role in claim and / or appeal decision-

making, the Ocala Gran Prix Defendants could be dismissed from this action without prejudice.

2

Filing 141750518 VS 05-2022-CA-011030-XXXX-XXthe subject medical procedures, and (b) the Ocala Gran Prix Defendants “reside” in Florida and

conduct business in this jurisdiction.”

All conditions precedent to the institution of this action (e.g., administrative pre-

suit appeals) have occurred, been performed, been waived, or were futile.

Causes of Action

tise to this action occurred in (i.e., this “cause of action accrued” in) this jurisdiction, namely underpayment of the subject insurance claim and / or rejection of SCV’s pre-suit appeals

COUNT I - BREACH OF PMCS RE-PRICING CONTRACT