Preview
Filing # 135038888 E-Filed 09/21/2021 05:31:04 PM
IN THE CIRCUIT COURT OF THE
20' JUDICIAL COURT IN AND
FOR CHARLOTTE COUNTY,
FLORIDA
DEBORAH COOPER BURG, by and through GENERAL JURISDICTION DIVISION
her Court-appointed Guardian, RICKY
BURG; NICOLE BURG, her daughter; and CASE NO. 2020-000616 CA
RICKY BURG, her spouse,
Plaintiffs,
Vv.
WEST FLORIDA PHYSICIAN NETWORK, LLC;
DILENDRA WEERASINGHE; JOHN RIOUX;
FAWCETT MEMORIAL HOSPITAL, INC. d/b/a
FAWCETT MEMORIAL HOSPITAL; SUSAN
BRUNER; ABIGAIL UTECH; SOVI JOSEPH,
M.D., P.A.; SOVI JOSEPH; MILLENNIUM
PHYSICIAN GROUP, LLC d/b/a MILLENNIUM
PHYSICIAN GROUP; CATHY CRISS; LIFE
CARE CENTERS OF AMERICA, INC.; PUNTA
GORDA MEDICAL INVESTORS, LLC d/b/a
LIFE CARE CENTER OF PUNTA GORDA;
LIFE CARE PHYSICIAN SERVICES, LLC;
and VANCE MALONEY, III,
Defendants.
/
s 7
E
DD!
PHYSICIAN GROUP LLC d/b/a MILLENNIUM PHYSICIAN GROUP
COME NOW the Plaintiffs, DEBORAH COOPER BURG, by and through her Court-
appointed Guardian, RICKY BURG; NICOLE BURG, her daughter; and RICKY BURG, her
spouse, by and through their undersigned attorneys, and as their motion to compel as to
Plaintiffs July 28, 2021 supplemental request for production to Defendant MILLENNIUM
PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP, state:
¢ Ccballire,
PA,
NEW WORLD TOWER - 100 N, BISCAYNE BOULEVARD, GUITE 2802 - MIAMI, FLORIDA $132 + TEL (805) 368-6829 |
Burg v West Florida Physician Network, LLC, et al.
CASE NO. 2020-000616 CA
Page 2
Background
1. Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN
GROUP, at all times material hereto, is the employer of Defendant DR. CATHY
CRISS.
Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN
GROUP assumed the responsibility and duty of evaluating and assessing DEBORAH
COOPER BURG'S health and wellbeing as well as the appropriate location DEBORAH
COOPER BURG should be in for her care and treatment going forward.
That the assumption of Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a
MILLENNIUM PHYSICIAN GROUP'S duty of care occurred on or about August 19,
2021 as reflected in the correspondence forwarded to Defendant DR. CATHY CRISS
by DEBORAH COOPER BURG'S health insurance company, United Health Care. See
attached Exhibit A.
As part of the assumed duty of care by Defendants MILLENNIUM PHYSICIAN
GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS, a Plan
of Care was established by a related MILLENNIUM company called Millennium Home
Care on August 20, 2019 utilizing and identifying Defendant DR. CATHY CRISS as
DEBORAH COOPER BURG'S primary physician as well as her attending physician.
See attached Exhibit B. This Plan of Care was approved and billed for by
Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN
GROUP and DR. CATHY CRISS.
Daitich Blumberg
& Caballire,
PA,
‘NEW WORLD TOWER + 100 N. BISCAYNE BOULEVARD, SUITE 2802 + MIAMI, FLORIDA $3132 - TEL (308) 388-6929
Burg v West Florida Physician Network, LLC, et al.
CASE NO. 2020-000616 CA
Page 3
5. This August 20, 2019 Plan of Care consisted of the providing of home health care
with skilled nursing, physical therapy, occupational therapy, and social work visit
and was approved by Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a
MILLENNIUM PHYSICIAN GROUP, through its employee, Defendant DR. CATHY
CRISS. By information and belief, no one from Defendant MILLENNIUM PHYSICIAN
GROUP, LLC d/b/a MILLENNIUM PHYSICIAL GROUP including Defendant DR.
CATHY CRISS actually reviewed this Plan of Care on August 20, 2019.
In reality, had Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a
MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS actually fulfilled their
assumed duty of being DEBORAH COOPER BURG'S primary and attending physician,
DEBORAH COOPER BURG would have been promptly hospitalized in an acute care
setting for the medical emergency of the onset of Wernicke Encephalopathy.
The attached Home Health Certification and Plan of Care that Defendants DR.
CATHY CRISS and MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM
PHYSICIAN GROUP approved was falsely dated. The Plan of Care states there was
a face to face encounter on August 11, 2019 which is impossible as DEBORAH
COOPER BURG on August 11, 2019 was an inpatient at FAWCETT MEMORIAL
HOSPITAL and no MILLENNIUM entity including Defendant DR. CATHY CRISS was
involved with DEBORAH COOPER BURG at that point.
Defendant DR. CATHY CRISS falsely claimed in the Home Health Care Certification
and Plan of Care form that “I HAVE REVIEWED AND CONCUR WITH THESE
Deutsch Blumberg
@ Caballero,
PL,
NEW WORLD TOWER » 100 N. GISCAYNE BOULEVARD, SUITE 2002 - MIAMI, FLOFIDA 93192 - TEL (305) 369-6329
Burg v West Florida Physician Network, LLC, et al.
CASE NO. 2020-000616 CA
Page 4
FINDINGS AND THEY ARE CONSISTENT WITH MY OBSERVATIONS OF
HOMEBOUND STATUS AT THE TIME OF THE ENCOUNTER, AND ACCURATELY
REFLECT THE REASON FOR HOMECARE AS ABOVE.”
Further, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM
PHYSICIAN GROUP obtained money for its false Home Health Certification and Plan
of Care by, after the fact, submitting a bill under the name of Defendant DR. CATHY
CRISS on September 5, 2019. Further, Defendant DR. CATHY CRISS affirmed that
the implementation of the Plan of Care met DEBORAH COOPER BURG'S needs,
which was obviously not true because the home health evaluations, in reality,
recommended that DEBORAH COOPER BURG not receive home health care. See
attached Exhibit C. (In truth, on August 20, 2021, Millennium Home Care had not
yet done its evaluation and further recommended against home health care and
instead recommended inpatient care in a rehabilitation facility.)
10. Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN
GROUP submitted a bill under Defendant DR. CATHY CRISS’ name to DEBORAH
COOPER BURG’S health insurance company for an August 11, 2019 encounter that
never took place.
11.Discovery has revealed that Defendant DR. CATHY CRISS falsely claimed to have
evaluated and assessed her patient, DEBORAH COOPER BURG as her attending
physician, with money being paid for same and Defendant DR. CATHY CRISS and
her employer, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM
Deutsch Blumberg
4 Caballero, PA,
NEW WORLD TOWER » 100 5. BISCAYNE BOULEVARD, SUITE 2802 « MIAMI, FLORIDA $3132 - TEL (305) 358-6320
Burg v West Florida Physician Network, LLC, et al.
CASE NO. 2020-000616 CA
Page 5
PHYSICIAN GROUP fell below the accepted standard of care for failing to actually
timely and properly review DEBORAH COOPER BURG’S physical condition and
presentation, which prevented DEBORAH COOPER BURG from obtaining the
emergency medical care that she needed.
12. Defendant DR. CATHY CRISS testified in her deposition that she signs approximately
80 Plans of Care a week which is a significant revenue stream flowing to her
employer, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM
PHYSICIAN GROUP.
The
Outstanding
Discovery in Question
13.0n July 28, 2021, Plaintiffs requested the following items be produced in their
supplemental request for production to Defendant MILLENNIUM PHYSICIAN
GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP. (See attached Exhibit D.)
1 All policies and procedures in effect in August 2019 concerning
Millennium (which includes Millennium Physician Group, LLC,
Millennium Health Care, and Millennium Home Care) as to the
process for a Millennium patient being identified as eligible for skilled
nursing facility admission and the process that Millennium follows to
have a patient admitted to a skilled nursing facility such as Life Care
Center of Punta Gorda.
2 All Beneficiary and/or Admission Protocols in effect in August
2019 concerning the evaluation and approval of a Millennium Health
Care patient to be admitted to a skilled nursing facility such as Life
Care Center of Punta Gorda.
3 All policies, procedures and protocols in effect in August 2019
which were followed by Millennium (which includes Millennium
Physician Group, LLC, Millennium Health Care, and Millennium Home
Deutsch Blumbog
& Caballero,
PA,
NEW WORLD TOWER « 100 N. BISCAYME BOULEVARD, SUITE 2802 - MIAMI, FLORIDA 33132 - TEL (305) 358-6329
Burg v West Florida Physician Network, LLC, et al.
CASE NO. 2020-000616 CA
Page 6
Care) as to the transfer of Plaintiff Deborah Cooper Burg from
Millennium Home Care to Life Care Center of Punta Gorda.
4. The Case Manager Audit from Millennium Physician Group as
to Plaintiff Deborah Cooper Burg.
5 Ail policies and procedures in effect in August 2019 relating to
the process whereby Defendant Dr. Cathy Criss executed the Home
Health Certification and Plan of Care conceming Plaintiff Deborah
Cooper Burg.
[It appears that an entity known as Millennium Health Care promulgates policies
and procedures that are utilized by entities known as MILLENNIUM PHYSICIAN
GROUP, LLC and MILLENNIUM HOME CARE, LLC.] (See attached Exhibit E.)
14. The items requested are specifically designed to obtain discovery as to the role and
methodology of Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a
MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS concerning the above
referenced Home Health Certification and Plan of Care, as well as the process
whereby DEBORAH COOPER BURG became a patient at LIFE CARE CENTER OF
PUNTA GORDA on August 21, 2019.
15.In response to Plaintiffs’ July 28, 2021 supplemental request for production,
Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN
GROUP filed the attached Motion for Protective Order. (Exhibit F)
16. The obtaining of discovery from Defendants MILLENNIUM PHYSICIAN GROUP, LLC
d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS has been
cumbersome dating back to their failure to timely comply with the Chapter 766
statutory presuit process.
Deutich Blumberg
& Caballive,
PA,
NEW WORLD TOWER - 100 N: BISCAYNE BOULEVARD, SUITE 2008 » MIAMI, FLORIDA $3132 - TEL (30S) 388-6329
Burg v West Florida Physician Network, LLC, et al.
CASE NO. 2020-000616 CA
Page 7
17.The undersigned certifies that the movant, in good faith, has conferred or will
attempt to confer with counsel for Defendant MILLENNIUM PHYSICIAN GROUP, LLC
d/b/a MILLENNIUM PHYSICIAN GROUP, who has failed to make the discovery, in an
effort to secure the information and materials without court action.
WHEREFORE, it is respectfully requested that the Court order Defendant
MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP to respond
to Plaintiffs’ July 28, 2021 supplemental request for production.
CERTIFICATE
OF SERVICE
WE HEREBY CERTIFY that a true and correct copy of the foregoing has been
furnished by e-service this 21 day of September, 2021 to: see attached service list.
DEUTSCH BLUMBERG & CABALLERO, P.A.
Attorneys for Plaintiffs
New World Tower, Suite 2802
100 North Biscayne Boulevard
Miami, Florida 33132
(305) 358-6329
(305) 358-9304 (facsimile)
Email ~ erb@deutschblumberg.com;
tmitchell@deutschblumberg.com
B
EDWARD R. BLUMBERG, ESQ.
Florida Bar No. 190870
Deutich Blumberg
& Caballere, PA.
NEW WORLD
TOWER + 100 N. BISCAYNE BOULEVARD, SUITE 2602 » MIAMI, FLORIDA 39132 « TEL (905) 358-6570
BURG v. WEST FLORIDA PHYSICIAN NETWORK, LLC, et al.
CASE NO, 2020-000616 CA
SERVICE LIST
Michael J. Swan, Esquire
Rossway Swan Tierney Barry & Oliver, P.L.
Co-Counsel for PLAINTIFFS
2101 Indian River Boulevard, Suite 200
Vero Beach, Florida 32960
Telephone: (772) 231-4440
E-Mails: mswan@rosswayswan.com; cdelo@rosswayswan.com
Richard K. Bowers, Esquire
Brandon R. Scheele, Esquire
Bankers Lopez Gassler, P.A.
Attorneys for DILENDRA WEERASINGHE
501 East Kennedy Boulevard, Suite 1700
Tampa, FL 33602
Telephone: 813-221-1500
Fax: 813-222-3066
rbowers@bankerlopez.com
Email: service-rbowers@bankerlopez.com ; service-bscheele@bankerlopez.com
Jay P. Chimpoulis, Esquire
Susanne E. Riedhammer, Esquire
Chimpoulis & Hunter, P.A.
Attorneys for Defendants PUNTA GORDA MEDICAL INVESTORS, LLC d/b/a LIFE CARE
CENTER OF PUNTA GORDA; LIFE CARE PHYSICIAN SERVICES, LLC; and VANCE MALONEY,
III
150 S. Pine Island Road, Suite 510
Plantation, FL 33324
Telephone: 954-463-0033
Fax: 954-463-9562
Email: JCHimpoulis@ChimpoulisHunter.com
Victoria N. Ferrentino, Esq.
Erin B. Reynolds, Esq.
Bush Graziano Rice & Platter, P.A.
Attorneys for Defendants WEST FLORIDA PHYSICIAN NETWORK, LLC and JOHN RIOUX
100 S. Ashley Drive, #1400
Tampa, FL 33602
Telephone: 813-228-7000
Fax: 813-273-0091
E malls: Vferrentino@bgrplaw.com
n law.com,eserve@barplaw.com; and dhensley@barplaw.com
ereynolds@bgrplaw.com
1|Page
Brett P. Gliosca, Esq
Jeffrey M. Goodis, Esq,
LA CAVA JACOBSON & GOODIS, P.A.
Attorneys for Defendants SOVI JOSEPH and SOVI JOSEPH, M.D., P.A.
200 Central Avenue, Suite 250
St. Petersburg, FL 33701
Office: 727-477-1013
Fax: 727-550-0811
Emails: stp-pleadings@liglegal.com; bgliosca@tiglegal.com; mmorgan@liglegal.com
Ronald E. Bush, Esq
Frances G. Prockop, Esq.
Alexandra S. Farren, Esq.
Bush Graziano Rice & Platter, P.A.
Attorneys for Defendant FAWCETT MEMORIAL HOSPITAL, INC. and ABIGAIL UTECH
100 S. Ashley Drive, Suite 1400
Tampa, FL 33602
Office: 813-228-7000
Fax: 813-229-6316
Emails: eserve@barplaw.com; Iplyushko@barplaw.com; bconde@barplaw.com
R. Ryan Rivas, Esq
Hall Booth Smith, P.C.
Attorneys for SUSAN BRUNER
2701 North Rocky Point Drive, Suite 400
Tampa, Florida 33607
Telephone~ 727-568-8435
Emails: rrivas@hallboothsmith.com; mhobbs@hallboothsmith.com
Barry A. Postman, Esq.
Ron M. Campbell, Esq
Daniel C. Calvert, Esq.
Cole, Scott & Kissane, P.A.
Attorneys for CATHY CRISS and MILLENNIUM PHYSICIAN GROUP, LLC d/b/a
MILLENNIUM PHYSICIAN GROUP
27300 Riverview Center Boulevard, Suite 200
Bonita Springs, FL 34134
Telephone: 239-690-7925
Facsimile: 239-738-7778
Emails: barry.postman@csklegal.com; ron.campbell@csklegal.com;
daniel.calvert@cskleqal.com; krystal.perez@csklegal.com; daniela.perez@cskleaal.com
2|Page
Walter H. Tache, Esq.
Gavrila A. Brotz, Esq.
Tache, Bronis, and Descalzo, P.A.
Co-Counsel for Defendant FAWCETT MEMORIAL HOSPITAL
150 S.E. 2nd Avenue, Suite 600
Miami, FL 33131
Telephone: 305-537-9565
Facsimile: 305-537-9567
Emails: wtache@tachebronis.com; service@tachebronis.com; gbrotz@tachebronis.com
3[Page
M i 4 L e n 5 i w m P h s i € i a n
BURG, DEBORAH A (id #237590, dob: i
‘292CEINRO00G001-1 1108-05
United HealthCare Services, Inc, on behalf of UnitedHeatthcare
BO Box 30555
Salt Lake City, UT 84130
@ Unitedticatthcare
a en
{Service
Ref # 079113965
sacemcen etm
a
August 19. 2019
CATHY CRISS
19531 COCHRAN BLYD
PORT CHARLOTTE FI. 33948,
{ Dear Cathy Criss:
t
: ‘You are receiving a copy of this letter to keep you informed about the
| status of this issue, The letter included in this envelope was sent to
| Deborah Burg. Please keep a copy of this letter for your records,
\ Sincerely,
} UnitedHealthcare
i
:
be eaten aes ap eternen nena cel
® Go Paperless! UHCprovider.com/paperiess
EXHIBIT
PA
Millennium Physician Group records 114
M i t L 2 n a
BURG, DEBORAH A (id #237590, dob:
United HeulthCare Services, Tac, on behalf Of UnitedHealtheare
PO Box 30555
Salt Lake City, UT 8413
G Unitedteaitneare
[rene etna tert ne
August 19, 2019 Service Ref; ADTSIII6S
Member(D: S28T3TSAA
Grosp Manse: APYLE INC.
DEBORAH BURG (Grew @
1802 LOS ALAMOS DRIVE [Letier renreneemeri CON_CCROO
PUNTA GORDA FL 33950 oes asnenen
Dear Deborah Burg:
We received a request to cover Outpatient services. Afier review of the informati
on submitted and
your plan documents, it was determined the following service is eligible for Outpatient coverage.
oe: me
Procedure description
code
$9123 Nursing care, in the home; by registered nurse, per hous (use for general nursing
care
jonly, not to be used when CPT codes 99500-! 99602
can be used
$9131 Physical therapy; in the home, per diem
$9129 (Occupational therapy, in the home, per diem
Remember:
e You're still responsible for your copayment, coinsurance, and deducti
ble (when applicable).
¢ Your plan may have limits on how many visits or services the plan covers. Please
check
your plan documents,
Before getting service, it's a good idea to check your provider's network status
and cost of service.
© ‘A network provider is a doctor, health care. professional, or facility (like a hospital)
that has
contract with us to provide services or supplies at an agreed upon
ratc, 80 you usually pay
less when you get services in network.
Some plans have a designated or a tiered network of providers. These doctors,
health care
professionals, facilities, and suppliers provide health care services at the highest
benefit
level. If you have this type of plan, you may pay less depending on which provider
you see.
Af required by your plan, your primary care provider must send an electronic referral before you see
a specialist, If you see a specialist without a referral, you might have to pay the full cost for
services.
Clinical Coverage Review
Revised: 6-2019
P fare
Miltennium Physician Group records 113
M i L @ A n i u m h x $ i & { 2 a
BURG, DEBORAH A (id #237590, dob:
233CEINR0008001-08977-01
United HealthCare Services, Inc, on behalfuf UnitedMenlthcare
PO Box 30885
Sak Lake City, UT 84130 @ unitedHeatheares
sevritontg
{Service Ref#; 079209598 _ ened
August 20, 2019
CATHY CRISS
19531 COCHRAN BLVD
PORT CHARLOTTE FL 33948
CRESS
Dear Cathy Criss:
You are Teceiving a copy of this letter to keep you informed about the
! status of this issuc. The letter included in this envelope was sent to
Deborah Burg. Please keep a copy of this letter for your records.
’ Sincerely,
_ UnitedHealthcare
= ~
@ Go Paperless} UHCprovider.com/paperless
Millennium Physician Group records 120
& i i t @ a n i u m P fh ¥. $s i €
BURG, DEBORAH A (id #237590, dob
‘United HealthCare Services, Inc. on behalfof UnitedHealthcare
PO Rox 30555,
Salt Lake City, UT 84130 @ Unitedticattheare
anna
Deborah Berg
August 20, 2019 Service Rett:
Member 1D: ‘S287ITSS
Groap Nase: APPLE INC.
DEBORAH BURG
Groupe:
1802 LOS ALAMOS DRIVE {Letter IDt CON_CCROO!
PUNTA GORDA FL 33950
Dear Deborah Burg:
We received a request to cover Outpatient services. After review of the information submitted and
your plan documents, it was determined the following service is eligible for Outpatient coverage.
Eure connie cea
Procedure
ee
Procedure description
eee eee
code
$9127 [Social work visit, in the home, per diem
Remember:
You're still responsible for your copayment, coinsurance, and deductible (when applicable).
« Your plan may have limitson how many visitsor services the plan covers. Please check
your plan documents.
Before getting service, it's a g00d idea to check your provider's network status and cost of service.
* A network provider is a doctor, health care professional, or facility (like a hospital) that has
a contract with us lo provide services or supplies at an agreed upon rate, so you usually pay
less when you get services in network.
Some plans have a designated or a tiered network of providers. These doctors, health care
professionals, facilities, and suppliers provide health care services at the highest benefit
level. If you have this type of plan, you may pay less depending on which provider you see.
If required by your plan, your primary care provider must send an electronic referral before you see
a specialist. If you seea specialist without a referral, you might have to pay the full cost for
services.
This is a benefit determination, not a medical decision. Only you and your doctor can decide what
medical
care you need.
This approval does not guarantee that the plan will pay for the service when, for example:
Clinical Coverage Review
Revised: 6-2019
fa
Millennium Physician Group records 119
athena 99/05/2019 07:43:35 AN EDT PAGE: 64/8
Se a eee £33048 -2084
From: MHC Adm fo: MPG ordera dept Fax: (299) 603-8024 Page: tof 0912012039 8:46 AM
Rome neatcn Gertificaen ana vian Grea uroer numoer wébeves/ZU or §
Patient Information
Pallent’s Hi Claim Ho. | Start of Care Date T cenitication Pertod Medical Record No,
j 084: 20/; 2019 From: 0820/2 1g To: 10/18/2019 88001
rib
a
Patient's Nome and Address Gender Date
of Birth Phone Number
Burg, Deborah A Female (941) 769-0133
1802 Los Alamos Dr
PUNTA GORDA, FL 33950
Email Primary Language
-- a
x ios eo
Patient Risk Profile
Risk Factors: currently taking 5 or more medications. Currently reports exhaustion. other risk(s)
mot listed in 1-8. Due to the following risk factors, this patient may be at a higher risk for
hospitalization: patient is at risk for falls (M1910) Discharged from hospital or SNF (M1000)
Patient is dyspneic (M1400) Patient requires help managing oral medications (M2020) Patient
experiences confusion (M1710)
patient will be discharged to che supervision of the mp or from each discipline when individual
goals are met or when patient no longer meets homebound requirements or upon
patient/caregiver/physician request. Instruct patient on the importance of follow up with physician.
Instruct patient to call 911 in an emergency Physician signature denotes acceptance of all pages. A
discharge summar: will be faxed to MD at end of care
I certify that this patient needs intermittent homecare services; is confined to the home; a plan of
care has been established and will be periodically reviewed by a physician; the services will be
furnished while the individual If was or is under the care of a physici a face-to-face
encounter occurred no more than 90 days prior to the home health start of care date or within 30
days of the start of the home health care, was related to the primary reason the patient requires
home health services, and was performed by a physician or allowed non physician practitioner. The
date of the face-to-face encounter was :08/11/201
By signing below I am affirming that I have reviewed the supplemental information, am incorporating
it into my records and adopting it in support of my certification
Clinical Data
Clinical Manager Branch Name and Address: PI
i Gervais, Sara Millennium Home Care LLC (855) 674-7500
4500 Kings Hi ghwai
Provider Number - Medicare Number Port Charlotte, FL 33980-9998 » Fax Number
1700058583 cas 5) 674 7502
- ~ . -- w . ne
Primary Phystcfan Address
; Criss, Cathy L. oo 19532 cochran B'vd on Bs: 3535
PORT CHARLOTTE, FL 33948
NPL “Fax Number
1346223229 (239) 603-8024
wees
Prit
code Description
248.815 Encntr for surgical aftcr following surgery on the dgstv sys 08/20/2019
0:
sy so ee %
Code Description
= --
iagn hs
Code Date
K22.10 ulcer of esophagus without bleeding (Co) 08/11/2019
298,84 Bariatric surgery status CO) 06/01/2019
R26.2 difficulty in waiking, not elsewhere classified Ce) 08/11/2019
K21L.9 Gastro-esophagea’ reflux disease without esophagitis (o) 01/01/2019
110 Essential (primary) hypertension (o} 01/01/2019
£03.9 Hypothyroidism, unspecified Co) 01/01/2019
EXHIBIT
Millennium Home Care 023
athena 89/05/2019 07:43:55 AH EDT PAGE: @5/8
BURG, DEBORAH A (id #237590, dob: ii FL.33948-208 1.
From: MHC A Fax. 1 Fo: MPO ordora dept Fax. (299) 909-8026 Page: 30f OB/28/2039 8:46 AM
HOME Healt CertiTication ana rian OF Cart
Burg, Deborah A
Sectieation Period From: 08/20/2019 70: 10/' 18/2019 Order Number weoeeee20 zo
~
{Conti yea
Code De Bats
£78.00 Pure hypercho‘esterolemia, unspecified (0) 01/01/2019
E55.9 | Vitamin D deFiciency, unspecified (0) 01/01/2019
£66.01 worbid (severe) obesity due to excess calories (0) 08/01/2019
Mentel Status
Forgetful . Disord ented -
‘Adaitioria Orders
--
Neurotopical Psychosocial
Oriented To: Person, Place WNL (within Normal Limit)
Oisoriented, Forgerful, PERRL
‘Tremor Lovationis)
ee
comune
-
a
omee Supplies
Tub/she er Bench. Exam Gloves. Grab Bars. walker
Prognozis
Good
. - «
Slow Position Change. Proper Position During Meals. Instructed on OME & electrical safety.
:
Instructed on sharps container. Fall Precautions. Instructed on mobility safety. rmstructed on safe
utilities management. Use of Assistive Devices. Safety in ADis. Emergency P™an Developed. Support
ouring transfer and ambulation. Instructed on disaster/emergency plan. instructed on safety
measures. Standard Pracautions/rafecti on Sontro}. + Tetage/Risk code: Be Disaster. Sode: 3
. oe
Nutritional Requirements
other: liquid soft.
Fundional Limitations
Bowel/Bladder Incontinence, Endurance, Ambulation
Other
--
.
Activities Peritied
Exercise prescribed, walker, Transfer bed-chair
i
Medications
Carafate Oral 1 GM 1 Tab(s) with meals and at bedtime
Pantoprazole Sodium Oral 40 MG 1 Tab(s) twice daily
Ondansetron HCl Oral 8 MG 1 Tab(s) twice daily
Tylenol 8 Hour oral 650 G1 tab(s) every 4 hours as needed for pain/fever
Millennium Home Care 024
athena 09/09/2019 7:43:56 AN EDT PAGE: 06/8
From: Fax: 18 ro: MPO orders dept
home Heattn certirication ana rian oT Cal
Fan: (239) 609-8024 Page: 4 of 6 08/20/2019 6:48 AM.
me
Burg, Deborah A
Sertiteation Period From: 08/20/2019 To: 10/18/: order Number eoneeer20 3 of 5
5 =
Reaction
latex allergy
Gabapenti a vivid d reams
&
Orders and Treatments,
Advance Directives? Yes.
Intent; Living wil)
copies on file with agency?
Sureogate: Yes (spouse)
Patient was provided written and verbal information on Advance Oirectives? Yes.
Advanced Directives (please check): __oWR x. Living wil] wealth Care surrogate___ourable
Power of attorney ._ None patient gest learns by ¢ Please check}: Reading _x Listening
—X_Demonstration video Pictures Patient Identified Strengths (Please check):
—x__Knowledgeable of longstanding disease process _x knowledgable of long standing medications
—xMotivated to learn _x Motivated and ready for change _x_strong support system ____stroni
interpersonal relationships .engaged in vocation incerest/hobbies patients identified Goal:
decreased pain, increased strength/mobility, rehab placement
SN: 4wl 2w3 iwS,
eT: Awl PT EVALUATION ONLY
oT: 2wi iwi,
! MSW: IML,
Assessment of patient with
Preview
Filing # 135038888 E-Filed 09/21/2021 05:31:04 PM IN THE CIRCUIT COURT OF THE 20' JUDICIAL COURT IN AND FOR CHARLOTTE COUNTY, FLORIDA DEBORAH COOPER BURG, by and through GENERAL JURISDICTION DIVISION her Court-appointed Guardian, RICKY BURG; NICOLE BURG, her daughter; and CASE NO. 2020-000616 CA RICKY BURG, her spouse, Plaintiffs, Vv. WEST FLORIDA PHYSICIAN NETWORK, LLC; DILENDRA WEERASINGHE; JOHN RIOUX; FAWCETT MEMORIAL HOSPITAL, INC. d/b/a FAWCETT MEMORIAL HOSPITAL; SUSAN BRUNER; ABIGAIL UTECH; SOVI JOSEPH, M.D., P.A.; SOVI JOSEPH; MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP; CATHY CRISS; LIFE CARE CENTERS OF AMERICA, INC.; PUNTA GORDA MEDICAL INVESTORS, LLC d/b/a LIFE CARE CENTER OF PUNTA GORDA; LIFE CARE PHYSICIAN SERVICES, LLC; and VANCE MALONEY, III, Defendants. / s 7 E DD! PHYSICIAN GROUP LLC d/b/a MILLENNIUM PHYSICIAN GROUP COME NOW the Plaintiffs, DEBORAH COOPER BURG, by and through her Court- appointed Guardian, RICKY BURG; NICOLE BURG, her daughter; and RICKY BURG, her spouse, by and through their undersigned attorneys, and as their motion to compel as to Plaintiffs July 28, 2021 supplemental request for production to Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP, state: ¢ Ccballire, PA, NEW WORLD TOWER - 100 N, BISCAYNE BOULEVARD, GUITE 2802 - MIAMI, FLORIDA $132 + TEL (805) 368-6829 | Burg v West Florida Physician Network, LLC, et al. CASE NO. 2020-000616 CA Page 2 Background 1. Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP, at all times material hereto, is the employer of Defendant DR. CATHY CRISS. Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP assumed the responsibility and duty of evaluating and assessing DEBORAH COOPER BURG'S health and wellbeing as well as the appropriate location DEBORAH COOPER BURG should be in for her care and treatment going forward. That the assumption of Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP'S duty of care occurred on or about August 19, 2021 as reflected in the correspondence forwarded to Defendant DR. CATHY CRISS by DEBORAH COOPER BURG'S health insurance company, United Health Care. See attached Exhibit A. As part of the assumed duty of care by Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS, a Plan of Care was established by a related MILLENNIUM company called Millennium Home Care on August 20, 2019 utilizing and identifying Defendant DR. CATHY CRISS as DEBORAH COOPER BURG'S primary physician as well as her attending physician. See attached Exhibit B. This Plan of Care was approved and billed for by Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS. Daitich Blumberg & Caballire, PA, ‘NEW WORLD TOWER + 100 N. BISCAYNE BOULEVARD, SUITE 2802 + MIAMI, FLORIDA $3132 - TEL (308) 388-6929 Burg v West Florida Physician Network, LLC, et al. CASE NO. 2020-000616 CA Page 3 5. This August 20, 2019 Plan of Care consisted of the providing of home health care with skilled nursing, physical therapy, occupational therapy, and social work visit and was approved by Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP, through its employee, Defendant DR. CATHY CRISS. By information and belief, no one from Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAL GROUP including Defendant DR. CATHY CRISS actually reviewed this Plan of Care on August 20, 2019. In reality, had Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS actually fulfilled their assumed duty of being DEBORAH COOPER BURG'S primary and attending physician, DEBORAH COOPER BURG would have been promptly hospitalized in an acute care setting for the medical emergency of the onset of Wernicke Encephalopathy. The attached Home Health Certification and Plan of Care that Defendants DR. CATHY CRISS and MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP approved was falsely dated. The Plan of Care states there was a face to face encounter on August 11, 2019 which is impossible as DEBORAH COOPER BURG on August 11, 2019 was an inpatient at FAWCETT MEMORIAL HOSPITAL and no MILLENNIUM entity including Defendant DR. CATHY CRISS was involved with DEBORAH COOPER BURG at that point. Defendant DR. CATHY CRISS falsely claimed in the Home Health Care Certification and Plan of Care form that “I HAVE REVIEWED AND CONCUR WITH THESE Deutsch Blumberg @ Caballero, PL, NEW WORLD TOWER » 100 N. GISCAYNE BOULEVARD, SUITE 2002 - MIAMI, FLOFIDA 93192 - TEL (305) 369-6329 Burg v West Florida Physician Network, LLC, et al. CASE NO. 2020-000616 CA Page 4 FINDINGS AND THEY ARE CONSISTENT WITH MY OBSERVATIONS OF HOMEBOUND STATUS AT THE TIME OF THE ENCOUNTER, AND ACCURATELY REFLECT THE REASON FOR HOMECARE AS ABOVE.” Further, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP obtained money for its false Home Health Certification and Plan of Care by, after the fact, submitting a bill under the name of Defendant DR. CATHY CRISS on September 5, 2019. Further, Defendant DR. CATHY CRISS affirmed that the implementation of the Plan of Care met DEBORAH COOPER BURG'S needs, which was obviously not true because the home health evaluations, in reality, recommended that DEBORAH COOPER BURG not receive home health care. See attached Exhibit C. (In truth, on August 20, 2021, Millennium Home Care had not yet done its evaluation and further recommended against home health care and instead recommended inpatient care in a rehabilitation facility.) 10. Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP submitted a bill under Defendant DR. CATHY CRISS’ name to DEBORAH COOPER BURG’S health insurance company for an August 11, 2019 encounter that never took place. 11.Discovery has revealed that Defendant DR. CATHY CRISS falsely claimed to have evaluated and assessed her patient, DEBORAH COOPER BURG as her attending physician, with money being paid for same and Defendant DR. CATHY CRISS and her employer, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM Deutsch Blumberg 4 Caballero, PA, NEW WORLD TOWER » 100 5. BISCAYNE BOULEVARD, SUITE 2802 « MIAMI, FLORIDA $3132 - TEL (305) 358-6320 Burg v West Florida Physician Network, LLC, et al. CASE NO. 2020-000616 CA Page 5 PHYSICIAN GROUP fell below the accepted standard of care for failing to actually timely and properly review DEBORAH COOPER BURG’S physical condition and presentation, which prevented DEBORAH COOPER BURG from obtaining the emergency medical care that she needed. 12. Defendant DR. CATHY CRISS testified in her deposition that she signs approximately 80 Plans of Care a week which is a significant revenue stream flowing to her employer, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP. The Outstanding Discovery in Question 13.0n July 28, 2021, Plaintiffs requested the following items be produced in their supplemental request for production to Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP. (See attached Exhibit D.) 1 All policies and procedures in effect in August 2019 concerning Millennium (which includes Millennium Physician Group, LLC, Millennium Health Care, and Millennium Home Care) as to the process for a Millennium patient being identified as eligible for skilled nursing facility admission and the process that Millennium follows to have a patient admitted to a skilled nursing facility such as Life Care Center of Punta Gorda. 2 All Beneficiary and/or Admission Protocols in effect in August 2019 concerning the evaluation and approval of a Millennium Health Care patient to be admitted to a skilled nursing facility such as Life Care Center of Punta Gorda. 3 All policies, procedures and protocols in effect in August 2019 which were followed by Millennium (which includes Millennium Physician Group, LLC, Millennium Health Care, and Millennium Home Deutsch Blumbog & Caballero, PA, NEW WORLD TOWER « 100 N. BISCAYME BOULEVARD, SUITE 2802 - MIAMI, FLORIDA 33132 - TEL (305) 358-6329 Burg v West Florida Physician Network, LLC, et al. CASE NO. 2020-000616 CA Page 6 Care) as to the transfer of Plaintiff Deborah Cooper Burg from Millennium Home Care to Life Care Center of Punta Gorda. 4. The Case Manager Audit from Millennium Physician Group as to Plaintiff Deborah Cooper Burg. 5 Ail policies and procedures in effect in August 2019 relating to the process whereby Defendant Dr. Cathy Criss executed the Home Health Certification and Plan of Care conceming Plaintiff Deborah Cooper Burg. [It appears that an entity known as Millennium Health Care promulgates policies and procedures that are utilized by entities known as MILLENNIUM PHYSICIAN GROUP, LLC and MILLENNIUM HOME CARE, LLC.] (See attached Exhibit E.) 14. The items requested are specifically designed to obtain discovery as to the role and methodology of Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS concerning the above referenced Home Health Certification and Plan of Care, as well as the process whereby DEBORAH COOPER BURG became a patient at LIFE CARE CENTER OF PUNTA GORDA on August 21, 2019. 15.In response to Plaintiffs’ July 28, 2021 supplemental request for production, Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP filed the attached Motion for Protective Order. (Exhibit F) 16. The obtaining of discovery from Defendants MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP and DR. CATHY CRISS has been cumbersome dating back to their failure to timely comply with the Chapter 766 statutory presuit process. Deutich Blumberg & Caballive, PA, NEW WORLD TOWER - 100 N: BISCAYNE BOULEVARD, SUITE 2008 » MIAMI, FLORIDA $3132 - TEL (30S) 388-6329 Burg v West Florida Physician Network, LLC, et al. CASE NO. 2020-000616 CA Page 7 17.The undersigned certifies that the movant, in good faith, has conferred or will attempt to confer with counsel for Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP, who has failed to make the discovery, in an effort to secure the information and materials without court action. WHEREFORE, it is respectfully requested that the Court order Defendant MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP to respond to Plaintiffs’ July 28, 2021 supplemental request for production. CERTIFICATE OF SERVICE WE HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by e-service this 21 day of September, 2021 to: see attached service list. DEUTSCH BLUMBERG & CABALLERO, P.A. Attorneys for Plaintiffs New World Tower, Suite 2802 100 North Biscayne Boulevard Miami, Florida 33132 (305) 358-6329 (305) 358-9304 (facsimile) Email ~ erb@deutschblumberg.com; tmitchell@deutschblumberg.com B EDWARD R. BLUMBERG, ESQ. Florida Bar No. 190870 Deutich Blumberg & Caballere, PA. NEW WORLD TOWER + 100 N. BISCAYNE BOULEVARD, SUITE 2602 » MIAMI, FLORIDA 39132 « TEL (905) 358-6570 BURG v. WEST FLORIDA PHYSICIAN NETWORK, LLC, et al. CASE NO, 2020-000616 CA SERVICE LIST Michael J. Swan, Esquire Rossway Swan Tierney Barry & Oliver, P.L. Co-Counsel for PLAINTIFFS 2101 Indian River Boulevard, Suite 200 Vero Beach, Florida 32960 Telephone: (772) 231-4440 E-Mails: mswan@rosswayswan.com; cdelo@rosswayswan.com Richard K. Bowers, Esquire Brandon R. Scheele, Esquire Bankers Lopez Gassler, P.A. Attorneys for DILENDRA WEERASINGHE 501 East Kennedy Boulevard, Suite 1700 Tampa, FL 33602 Telephone: 813-221-1500 Fax: 813-222-3066 rbowers@bankerlopez.com Email: service-rbowers@bankerlopez.com ; service-bscheele@bankerlopez.com Jay P. Chimpoulis, Esquire Susanne E. Riedhammer, Esquire Chimpoulis & Hunter, P.A. Attorneys for Defendants PUNTA GORDA MEDICAL INVESTORS, LLC d/b/a LIFE CARE CENTER OF PUNTA GORDA; LIFE CARE PHYSICIAN SERVICES, LLC; and VANCE MALONEY, III 150 S. Pine Island Road, Suite 510 Plantation, FL 33324 Telephone: 954-463-0033 Fax: 954-463-9562 Email: JCHimpoulis@ChimpoulisHunter.com Victoria N. Ferrentino, Esq. Erin B. Reynolds, Esq. Bush Graziano Rice & Platter, P.A. Attorneys for Defendants WEST FLORIDA PHYSICIAN NETWORK, LLC and JOHN RIOUX 100 S. Ashley Drive, #1400 Tampa, FL 33602 Telephone: 813-228-7000 Fax: 813-273-0091 E malls: Vferrentino@bgrplaw.com n law.com,eserve@barplaw.com; and dhensley@barplaw.com ereynolds@bgrplaw.com 1|Page Brett P. Gliosca, Esq Jeffrey M. Goodis, Esq, LA CAVA JACOBSON & GOODIS, P.A. Attorneys for Defendants SOVI JOSEPH and SOVI JOSEPH, M.D., P.A. 200 Central Avenue, Suite 250 St. Petersburg, FL 33701 Office: 727-477-1013 Fax: 727-550-0811 Emails: stp-pleadings@liglegal.com; bgliosca@tiglegal.com; mmorgan@liglegal.com Ronald E. Bush, Esq Frances G. Prockop, Esq. Alexandra S. Farren, Esq. Bush Graziano Rice & Platter, P.A. Attorneys for Defendant FAWCETT MEMORIAL HOSPITAL, INC. and ABIGAIL UTECH 100 S. Ashley Drive, Suite 1400 Tampa, FL 33602 Office: 813-228-7000 Fax: 813-229-6316 Emails: eserve@barplaw.com; Iplyushko@barplaw.com; bconde@barplaw.com R. Ryan Rivas, Esq Hall Booth Smith, P.C. Attorneys for SUSAN BRUNER 2701 North Rocky Point Drive, Suite 400 Tampa, Florida 33607 Telephone~ 727-568-8435 Emails: rrivas@hallboothsmith.com; mhobbs@hallboothsmith.com Barry A. Postman, Esq. Ron M. Campbell, Esq Daniel C. Calvert, Esq. Cole, Scott & Kissane, P.A. Attorneys for CATHY CRISS and MILLENNIUM PHYSICIAN GROUP, LLC d/b/a MILLENNIUM PHYSICIAN GROUP 27300 Riverview Center Boulevard, Suite 200 Bonita Springs, FL 34134 Telephone: 239-690-7925 Facsimile: 239-738-7778 Emails: barry.postman@csklegal.com; ron.campbell@csklegal.com; daniel.calvert@cskleqal.com; krystal.perez@csklegal.com; daniela.perez@cskleaal.com 2|Page Walter H. Tache, Esq. Gavrila A. Brotz, Esq. Tache, Bronis, and Descalzo, P.A. Co-Counsel for Defendant FAWCETT MEMORIAL HOSPITAL 150 S.E. 2nd Avenue, Suite 600 Miami, FL 33131 Telephone: 305-537-9565 Facsimile: 305-537-9567 Emails: wtache@tachebronis.com; service@tachebronis.com; gbrotz@tachebronis.com 3[Page M i 4 L e n 5 i w m P h s i € i a n BURG, DEBORAH A (id #237590, dob: i ‘292CEINRO00G001-1 1108-05 United HealthCare Services, Inc, on behalf of UnitedHeatthcare BO Box 30555 Salt Lake City, UT 84130 @ Unitedticatthcare a en {Service Ref # 079113965 sacemcen etm a August 19. 2019 CATHY CRISS 19531 COCHRAN BLYD PORT CHARLOTTE FI. 33948, { Dear Cathy Criss: t : ‘You are receiving a copy of this letter to keep you informed about the | status of this issue, The letter included in this envelope was sent to | Deborah Burg. Please keep a copy of this letter for your records, \ Sincerely, } UnitedHealthcare i : be eaten aes ap eternen nena cel ® Go Paperless! UHCprovider.com/paperiess EXHIBIT PA Millennium Physician Group records 114 M i t L 2 n a BURG, DEBORAH A (id #237590, dob: United HeulthCare Services, Tac, on behalf Of UnitedHealtheare PO Box 30555 Salt Lake City, UT 8413 G Unitedteaitneare [rene etna tert ne August 19, 2019 Service Ref; ADTSIII6S Member(D: S28T3TSAA Grosp Manse: APYLE INC. DEBORAH BURG (Grew @ 1802 LOS ALAMOS DRIVE [Letier renreneemeri CON_CCROO PUNTA GORDA FL 33950 oes asnenen Dear Deborah Burg: We received a request to cover Outpatient services. Afier review of the informati on submitted and your plan documents, it was determined the following service is eligible for Outpatient coverage. oe: me Procedure description code $9123 Nursing care, in the home; by registered nurse, per hous (use for general nursing care jonly, not to be used when CPT codes 99500-! 99602 can be used $9131 Physical therapy; in the home, per diem $9129 (Occupational therapy, in the home, per diem Remember: e You're still responsible for your copayment, coinsurance, and deducti ble (when applicable). ¢ Your plan may have limits on how many visits or services the plan covers. Please check your plan documents, Before getting service, it's a good idea to check your provider's network status and cost of service. © ‘A network provider is a doctor, health care. professional, or facility (like a hospital) that has contract with us to provide services or supplies at an agreed upon ratc, 80 you usually pay less when you get services in network. Some plans have a designated or a tiered network of providers. These doctors, health care professionals, facilities, and suppliers provide health care services at the highest benefit level. If you have this type of plan, you may pay less depending on which provider you see. Af required by your plan, your primary care provider must send an electronic referral before you see a specialist, If you see a specialist without a referral, you might have to pay the full cost for services. Clinical Coverage Review Revised: 6-2019 P fare Miltennium Physician Group records 113 M i L @ A n i u m h x $ i & { 2 a BURG, DEBORAH A (id #237590, dob: 233CEINR0008001-08977-01 United HealthCare Services, Inc, on behalfuf UnitedMenlthcare PO Box 30885 Sak Lake City, UT 84130 @ unitedHeatheares sevritontg {Service Ref#; 079209598 _ ened August 20, 2019 CATHY CRISS 19531 COCHRAN BLVD PORT CHARLOTTE FL 33948 CRESS Dear Cathy Criss: You are Teceiving a copy of this letter to keep you informed about the ! status of this issuc. The letter included in this envelope was sent to Deborah Burg. Please keep a copy of this letter for your records. ’ Sincerely, _ UnitedHealthcare = ~ @ Go Paperless} UHCprovider.com/paperless Millennium Physician Group records 120 & i i t @ a n i u m P fh ¥. $s i € BURG, DEBORAH A (id #237590, dob ‘United HealthCare Services, Inc. on behalfof UnitedHealthcare PO Rox 30555, Salt Lake City, UT 84130 @ Unitedticattheare anna Deborah Berg August 20, 2019 Service Rett: Member 1D: ‘S287ITSS Groap Nase: APPLE INC. DEBORAH BURG Groupe: 1802 LOS ALAMOS DRIVE {Letter IDt CON_CCROO! PUNTA GORDA FL 33950 Dear Deborah Burg: We received a request to cover Outpatient services. After review of the information submitted and your plan documents, it was determined the following service is eligible for Outpatient coverage. Eure connie cea Procedure ee Procedure description eee eee code $9127 [Social work visit, in the home, per diem Remember: You're still responsible for your copayment, coinsurance, and deductible (when applicable). « Your plan may have limitson how many visitsor services the plan covers. Please check your plan documents. Before getting service, it's a g00d idea to check your provider's network status and cost of service. * A network provider is a doctor, health care professional, or facility (like a hospital) that has a contract with us lo provide services or supplies at an agreed upon rate, so you usually pay less when you get services in network. Some plans have a designated or a tiered network of providers. These doctors, health care professionals, facilities, and suppliers provide health care services at the highest benefit level. If you have this type of plan, you may pay less depending on which provider you see. If required by your plan, your primary care provider must send an electronic referral before you see a specialist. If you seea specialist without a referral, you might have to pay the full cost for services. This is a benefit determination, not a medical decision. Only you and your doctor can decide what medical care you need. This approval does not guarantee that the plan will pay for the service when, for example: Clinical Coverage Review Revised: 6-2019 fa Millennium Physician Group records 119 athena 99/05/2019 07:43:35 AN EDT PAGE: 64/8 Se a eee £33048 -2084 From: MHC Adm fo: MPG ordera dept Fax: (299) 603-8024 Page: tof 0912012039 8:46 AM Rome neatcn Gertificaen ana vian Grea uroer numoer wébeves/ZU or § Patient Information Pallent’s Hi Claim Ho. | Start of Care Date T cenitication Pertod Medical Record No, j 084: 20/; 2019 From: 0820/2 1g To: 10/18/2019 88001 rib a Patient's Nome and Address Gender Date of Birth Phone Number Burg, Deborah A Female (941) 769-0133 1802 Los Alamos Dr PUNTA GORDA, FL 33950 Email Primary Language -- a x ios eo Patient Risk Profile Risk Factors: currently taking 5 or more medications. Currently reports exhaustion. other risk(s) mot listed in 1-8. Due to the following risk factors, this patient may be at a higher risk for hospitalization: patient is at risk for falls (M1910) Discharged from hospital or SNF (M1000) Patient is dyspneic (M1400) Patient requires help managing oral medications (M2020) Patient experiences confusion (M1710) patient will be discharged to che supervision of the mp or from each discipline when individual goals are met or when patient no longer meets homebound requirements or upon patient/caregiver/physician request. Instruct patient on the importance of follow up with physician. Instruct patient to call 911 in an emergency Physician signature denotes acceptance of all pages. A discharge summar: will be faxed to MD at end of care I certify that this patient needs intermittent homecare services; is confined to the home; a plan of care has been established and will be periodically reviewed by a physician; the services will be furnished while the individual If was or is under the care of a physici a face-to-face encounter occurred no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care, was related to the primary reason the patient requires home health services, and was performed by a physician or allowed non physician practitioner. The date of the face-to-face encounter was :08/11/201 By signing below I am affirming that I have reviewed the supplemental information, am incorporating it into my records and adopting it in support of my certification Clinical Data Clinical Manager Branch Name and Address: PI i Gervais, Sara Millennium Home Care LLC (855) 674-7500 4500 Kings Hi ghwai Provider Number - Medicare Number Port Charlotte, FL 33980-9998 » Fax Number 1700058583 cas 5) 674 7502 - ~ . -- w . ne Primary Phystcfan Address ; Criss, Cathy L. oo 19532 cochran B'vd on Bs: 3535 PORT CHARLOTTE, FL 33948 NPL “Fax Number 1346223229 (239) 603-8024 wees Prit code Description 248.815 Encntr for surgical aftcr following surgery on the dgstv sys 08/20/2019 0: sy so ee % Code Description = -- iagn hs Code Date K22.10 ulcer of esophagus without bleeding (Co) 08/11/2019 298,84 Bariatric surgery status CO) 06/01/2019 R26.2 difficulty in waiking, not elsewhere classified Ce) 08/11/2019 K21L.9 Gastro-esophagea’ reflux disease without esophagitis (o) 01/01/2019 110 Essential (primary) hypertension (o} 01/01/2019 £03.9 Hypothyroidism, unspecified Co) 01/01/2019 EXHIBIT Millennium Home Care 023 athena 89/05/2019 07:43:55 AH EDT PAGE: @5/8 BURG, DEBORAH A (id #237590, dob: ii FL.33948-208 1. From: MHC A Fax. 1 Fo: MPO ordora dept Fax. (299) 909-8026 Page: 30f OB/28/2039 8:46 AM HOME Healt CertiTication ana rian OF Cart Burg, Deborah A Sectieation Period From: 08/20/2019 70: 10/' 18/2019 Order Number weoeeee20 zo ~ {Conti yea Code De Bats £78.00 Pure hypercho‘esterolemia, unspecified (0) 01/01/2019 E55.9 | Vitamin D deFiciency, unspecified (0) 01/01/2019 £66.01 worbid (severe) obesity due to excess calories (0) 08/01/2019 Mentel Status Forgetful . Disord ented - ‘Adaitioria Orders -- Neurotopical Psychosocial Oriented To: Person, Place WNL (within Normal Limit) Oisoriented, Forgerful, PERRL ‘Tremor Lovationis) ee comune - a omee Supplies Tub/she er Bench. Exam Gloves. Grab Bars. walker Prognozis Good . - « Slow Position Change. Proper Position During Meals. Instructed on OME & electrical safety. : Instructed on sharps container. Fall Precautions. Instructed on mobility safety. rmstructed on safe utilities management. Use of Assistive Devices. Safety in ADis. Emergency P™an Developed. Support ouring transfer and ambulation. Instructed on disaster/emergency plan. instructed on safety measures. Standard Pracautions/rafecti on Sontro}. + Tetage/Risk code: Be Disaster. Sode: 3 . oe Nutritional Requirements other: liquid soft. Fundional Limitations Bowel/Bladder Incontinence, Endurance, Ambulation Other -- . Activities Peritied Exercise prescribed, walker, Transfer bed-chair i Medications Carafate Oral 1 GM 1 Tab(s) with meals and at bedtime Pantoprazole Sodium Oral 40 MG 1 Tab(s) twice daily Ondansetron HCl Oral 8 MG 1 Tab(s) twice daily Tylenol 8 Hour oral 650 G1 tab(s) every 4 hours as needed for pain/fever Millennium Home Care 024 athena 09/09/2019 7:43:56 AN EDT PAGE: 06/8 From: Fax: 18 ro: MPO orders dept home Heattn certirication ana rian oT Cal Fan: (239) 609-8024 Page: 4 of 6 08/20/2019 6:48 AM. me Burg, Deborah A Sertiteation Period From: 08/20/2019 To: 10/18/: order Number eoneeer20 3 of 5 5 = Reaction latex allergy Gabapenti a vivid d reams & Orders and Treatments, Advance Directives? Yes. Intent; Living wil) copies on file with agency? Sureogate: Yes (spouse) Patient was provided written and verbal information on Advance Oirectives? Yes. Advanced Directives (please check): __oWR x. Living wil] wealth Care surrogate___ourable Power of attorney ._ None patient gest learns by ¢ Please check}: Reading _x Listening —X_Demonstration video Pictures Patient Identified Strengths (Please check): —x__Knowledgeable of longstanding disease process _x knowledgable of long standing medications —xMotivated to learn _x Motivated and ready for change _x_strong support system ____stroni interpersonal relationships .engaged in vocation incerest/hobbies patients identified Goal: decreased pain, increased strength/mobility, rehab placement SN: 4wl 2w3 iwS, eT: Awl PT EVALUATION ONLY oT: 2wi iwi, ! MSW: IML, Assessment of patient with