April 5, 2011

Stephen Matrangalo, DC, PC v Allstate Ins. Co. (2011 NY Slip Op 50517(U))

Headnote

The relevant facts considered by the court were that a chiropractic practice was seeking to recover first-party no-fault benefits for services rendered to an assignor who was referred to the practice by a non-party practitioner. The insurance company moved for summary judgment dismissing the complaint, claiming that the referral violated Public Health Law § 238-a prohibiting referrals where the referring practitioner has a financial relationship with the healthcare provider. The main issue decided by the court was whether there was a "financial relationship" between the chiropractic practice and the referring practitioner, as defined by section 238(3) of the Public Health Law. The court determined that there was no evidence to establish a "compensation arrangement" or any payments for the rental or lease of office space between the parties. The holding of the case was that the evidence submitted by the insurance company failed to establish a "financial relationship" between the chiropractic practice and the referring practitioner as required by the Public Health Law. Therefore, the court reversed the order granting the insurance company's motion for summary judgment, denied the motion, and reinstated the complaint.

Reported in New York Official Reports at Stephen Matrangalo, DC, PC v Allstate Ins. Co. (2011 NY Slip Op 50517(U))

Stephen Matrangalo, DC, PC v Allstate Ins. Co. (2011 NY Slip Op 50517(U)) [*1]
Stephen Matrangalo, DC, PC v Allstate Ins. Co.
2011 NY Slip Op 50517(U) [31 Misc 3d 129(A)]
Decided on April 5, 2011
Appellate Term, First Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on April 5, 2011

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT


PRESENT: Schoenfeld, J.P., Hunter, Jr., J.
570684/10
Dr. Stephen Matrangalo, DC, PC, a/a/o Kevin Fogah, Plaintiff-Appellant,

against

Allstate Insurance Company, Defendant-Respondent.

Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Debra Rose Samuels, J.), dated June 10, 2010, which granted defendant’s motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Debra Rose Samuels, J.), dated June 10, 2010, reversed, without costs, motion denied and complaint reinstated.

Plaintiff, a chiropractic practice, commenced this action to recover assigned first-party no-fault benefits for services rendered to its assignor, who sustained injuries in a January 2009 automobile accident. The assignor was referred to plaintiff by a non-party practitioner. Defendant-insurer moved for summary judgment dismissing the complaint pursuant to Public Health Law § 238-a, claiming that plaintiff may not recover for the services rendered to the assignor because the referring practitioner had a “financial relationship” with plaintiff (see Public Health Law § 238-a[1][a], [b]). Civil Court granted the motion, and we now reverse.

Public Health Law § 238-a prohibits a practitioner from making a referral to a health care provider where the referring practitioner (or immediate family member of such practitioner) has a “financial relationship” with the health care provider (Public Health Law § 238-a[1][a]). A “financial relationship” is defined in section 238(3) of the Public Health Law as “an ownership interest, investment interest or compensation arrangement.” Critically, a “compensation arrangement” means “any arrangement involving any remuneration between a practitioner, or immediate family member, and a health care provider” (Public Health Law § 238-a[5][a]), but does not include “payments for the rental or lease of office space” if there is a lease that meets specific enumerated requirements, i.e., is in writing, for a term of at least one year, with a rent consistent with fair market value and not based upon the volume or value of any referrals, and would be commercially reasonable even if no referrals were made (Public Health Law § 238-a[5][b][i]).

The evidence submitted by defendant in support of its motion failed to establish, prima facie, that there was any “financial relationship” between plaintiff and the referring practitioner. No allegation is made that there was any “ownership interest” or “investment interest” between [*2]plaintiff and the referring practitioner. Although defendant submitted some unparticularized evidence indicating that plaintiff leased unspecified office space from various unnamed physicians in 2007 — two years prior to the underlying referral — defendant’s limited submission failed to establish that there was any “compensation arrangement” in general or any “payments for the rental or lease of office space” in particular, between plaintiff and the referring practitioner. Since defendant failed to meet its initial burden of establishing as a matter of law its defense pursuant to Public Health Law § 238-a, the motion for summary judgment should have been denied regardless of the sufficiency of plaintiff’s opposing papers (see Winegrad v New York Univ. Med. Center, 64 NY2d 851, 853 [1985]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: April 05, 2011