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At a Glance:
Title:
453-01-2368-m5
Date:
January 2, 2002
Status:
Retrospective Medical Necessity

453-01-2368-m5

January 2, 2002

DECISION AND ORDER

I. Summary

“Vono d/b/a Plaza Pharmacy” sought reimbursement in the amount of $650.73 for medications dispensed to__________ for an injury to her back, but the Texas Education Entity Cooperative, Carroll Independent School District (the Cooperative) denied payment. Subsequently, the Medical Review Division (the Division) of the Texas Workers' Compensation Commission (the Commission) determined that Vono d/b/a Plaza Pharmacy was not entitled to reimbursement because it did not show the medical necessity of the medication. EZ Rx Pharmacy (EZ) requested a hearing to challenge the Division’s findings.

On November 12, 2001, Administrative Law Judge (ALJ) Cathleen Parsley convened the hearing at the Stephen F. Austin Building, 1700 North Congress Avenue, Austin, Texas. EZ appeared by telephone through Nicky Otts, one of its corporate officers and a pharmacist. The Cooperative was represented by its attorney, Laurie Gallagher. The staff of the Commission (the Staff) appeared through its counsel, Jacqueline Harrison. The parties did not contest notice, but the Cooperative re-urged its motion to dismiss for lack of jurisdiction, which will be discussed in the

next section.[1] Both EZ and the Cooperative presented evidence in support of their positions on the merits of the case. The ALJ closed the hearing on November 12, 2001.

This ALJ finds that the Cooperative’s re-urged motion to dismiss for lack of jurisdiction and standing should be granted and orders the appeal dismissed. The merits of the appeal will not be reached.

II. Motion to Dismiss for

Lack of Jurisdiction and Standing

At the hearing, the Cooperative moved again for dismissal of the proceeding on the grounds that EZ did not have standing to pursue the appeal because it was not the health care provider that provided the medications to__________. At the hearing, EZ pointed out (correctly) that the ALJ had already ruled on the Cooperative’s motion (see Footnote 1). It contended it did have standing, however, and that “EZ Rx Pharmacies” is an advertising slogan used to refer to all the pharmacies owned by Vono L.P., the latter being the true petitioner in the case, according to EZ.

Upon reconsideration of the written and oral motions, the written response to the motion from EZ, and the testimony elicited from Mr. Otts at the hearing, the ALJ has concluded that the appeal should be dismissed for lack of jurisdiction. As will be fully set out in the findings of fact and conclusions of law:

  • EZ was not the health care provider in this case;
  • EZ failed to demonstrate how it and the original requestor in this proceeding, Vono d/b/a Plaza Pharmacy, are related such that EZ became the party in interest in this proceeding;
  • The parent corporation of Plaza Pharmacy no longer exists;
  • The assumed name APlaza Pharmacy #6", which was the Plaza Pharmacy that made the original request for reimbursement, was abandoned as an assumed name in July 2000;
  • The entity now claimed by EZ to be the correct party in interest, Vono, L.P., is a completely different entity than the company that owned Plaza Pharmacy #6; and
  • Vono L.P. did not assume the name “Plaza Pharmacy” until almost a year after the dates of service.

III. Findings of Fact

  1. On July 7 and 20, 1999, Plaza Pharmacy #6 dispensed medications to__________ upon the prescription of her doctor, Dr. Bill Weldon.
  2. Plaza Pharmacy #6 was an assumed name of Vono, Inc., a Texas corporation (Vono Texas).
  3. Vono Texas d/b/a Plaza Pharmacy requested reimbursement from the Texas Education Entity Cooperative, Carroll Independent School District (the Cooperative) in the amount of $650.53 for the medications dispensed to_______ from the Cooperative and was denied.
  4. On November 17, 1999, Vono Texas d/b/a Plaza Pharmacy requested medical dispute resolution from the Medical Review Division (the Division) of the Texas Workers’ Compensation Commission (the Commission) of the denial of reimbursement by the Cooperative.
  5. On February 2, 2001, in MDR No. M5-00-0237-01, the Division denied reimbursement to Vono Texas d/b/a Plaza Pharmacy on the grounds that medical necessity had not been demonstrated.
  6. EZ Rx Pharmacies (EZ) appealed the Division’s decision to deny reimbursement on February 22, 2001.
  7. The staff of the Commission issued notice of a hearing on the appeal filed by EZ on March 27, 2001.
  8. A hearing was held on November 12, 2001. All parties appeared and participated in the hearing.
  9. At the hearing, the Cooperative re-urged its Motion to Dismiss for Lack of Jurisdiction and Standing.
  10. Vono Texas merged into Vono, Inc., a Nevada corporation (Vono Nevada), in July 2000.
  11. Vono Texas abandoned the name “Plaza Pharmacy #6” in July 2000.
  12. Vono Texas no longer exists.
  13. Vono Nevada is the limited partner of Vono L.P., a Texas limited partnership.
  14. Vono L.P. became an active limited partnership in May 2000.
  15. Vono L.P. began doing business as Plaza Pharmacy in July 2000, approximately one year after the dates of service.
  16. ”EZ Rx Pharmacies” is not an assumed name of Vono L.P.
  17. “EZ Rx Pharmacies” is an assumed name of Resource Medsupply, Inc., the general partner of Vono L.P., and Nuvono, Inc.
  18. Vono L.P. was not in existence on the dates of service to_________.
  19. EZ did not dispense medications to_________.
  20. Vono L.P. and Vono Texas are two separate entities.
  21. There is no evidence that Vono Texas sold, gave, or transferred its rights to reimbursement to Vono, L.P.
  22. There is no evidence that Vono Texas, Vono Nevada, or Vono L.P. sold, gave, or transferred any right to pursue reimbursement, if such existed, to EZ.

IV. Conclusions of Law

  1. The Texas Workers’ Compensation Commission (the Commission)has jurisdiction over the issue presented pursuant to the Texas Workers’ Compensation Act (the Act), Tex. Lab. Code Ann. §413.031.
  2. The State Office of Administrative Hearings has jurisdiction over all matters related to the hearing in this case, including the issuance of this decision and order, pursuant to Tex. Gov’t Code Ann.ch. 2003 and pursuant to §413.031(d) of the Act.
  3. Notice of the hearing was proper and timely, as required by the Administrative Procedure Act, Tex. Gov’t Code Ann. ch. 2001.
  4. EZ Rx Pharmacies does not have the jurisdiction and standing to pursue the claim for reimbursement for medications dispensed to_________ by Plaza Pharmacy on July 7 and 20, 1999.
  5. The appeal of EZ Rx Pharmacies should be dismissed for lack of jurisdiction and standing.

ORDER

IT IS, THEREFORE, ORDERED that the appeal of EZ Rx Pharmacies seeking reimbursement in the amount of $650.73 for medications dispensed to_____________ by Vono, Inc. d/b/a Plaza Pharmacy #6 is denied.

Signed this 2nd day of January, 2002.

CATHLEEN PARSLEY
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

  1. The Cooperative first raised its question of jurisdiction in a written Motion to Dismiss for Lack of Jurisdiction and Standing on October 17, 2001. The Petitioner responded to the motion on October 25, 2001. By order dated November 1, 2001, the ALJ denied the motion.
End of Document
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