14 Fla. L. Weekly Supp. 45a
Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Licensure — Medical provider was precluded from seeking or obtaining payment of PIP or medical payment benefits from insurer or patients for care rendered when provider was not registered clinic or exempt from registration requirement — Insurer is entitled to reimbursement for all expenses paid for services rendered while provider was unregistered, even if investigation of charges did not commence within 30 days from submission of bill to insurer — Where insurer’s common law cause of action is founded on fact that provider was not licensed, reimbursement is required even after repeal of statute providing that insurer may assert claim that treatment was not reasonable, related or necessary after payment of claim
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Plaintiff, vs. AXCESS MRI JACKSONVILLE, L.L.C., Defendant. Circuit Court, 4th Judicial Circuit in and for Duval County. Case No. 2006-CA-000370, Division CVH. October 23, 2006. John H. Skinner, Judge. Counsel: David B. Kampf, Ramey & Kampf, P.A., Tampa, for Plaintiff. Vincent P. Gallagher, Gallagher Law Firm, Jacksonville, for Defendant.
FINAL JUDGMENT IN FAVOR OF STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY
THIS CAUSE came before the Court on the parties’ stipulation as to Final Judgment in favor of Plaintiff, State Farm Mutual Automobile Insurance Company, and the Court, having heard argument and being otherwise advised in the premises, makes the following findings:
1. State Farm filed this common law cause of action for reimbursement of monies paid by State Farm to Defendant, AXCESS MRI JACKSONVILLE, L.L.C., for health care services rendered by Defendant to numerous patients that were insured under State Farm policies of insurance.
2. Monies paid were from the patients’ PIP and medical payments coverage. Total benefits paid by State Farm from October 1, 2001 up to and including October 6, 2002, the date Defendant registered, were $54,074.51.
3. The parties agree that AXCESS MRI JACKSONVILLE, L.L.C., was a clinic as defined under Florida Statute 456.0375(1)(a), (October 1, 2001).
4. Florida law precludes a medical provider from receiving payment for any services rendered while the medical provider failed to comply with Florida registration requirements. Charges submitted by a clinic that is not registered are unlawful charges and are non-compensable pursuant to F.S. 456.0375(4)(a), which provides “All charges or reimbursement claims made by or on behalf of a clinic that is required to be registered under this section, but that is not so registered, are unlawful charges and therefore are non-compensable and unenforceable.”
5. Therefore, Defendant was precluded from seeking or obtaining compensation or payment of PIP/MPC benefits from State Farm or patients for any care, treatment or services rendered from October 1, 2001, up to October 6, 2002.
6. In addition, since the services were unlawfully rendered and billed, Defendant was not entitled to payment of benefits pursuant to F.S. 627.736(5)(a), which provides:
“Any physician. . . lawfully rendering treatment to an injured person for bodily injury covered by personal injury protection insurance may charge only a reasonable amount for the supplies, services and accommodation rendered, and the insurer providing such coverage may pay for such charges directly to such person or institution lawfully rendering such treatment . . . .” Emphasis added.
7. Neither the patients nor State Farm were required to pay the medical provider for the services rendered.
8. Based on the above, State Farm is entitled to reimbursement from the Defendant for all expenses paid by each patient’s PIP and medical payments coverage.
9. The no-fault statute permits the insurer to seek and obtain reimbursement at any time, including after payment of benefits and even if the investigation as to the charges did not commence within thirty days from the date the bill was submitted to the insurer. See F.S. 627.736(4)(b), which provides:
“This paragraph does not preclude or limit the ability of the insurer to assert that the claim was unrelated, was not medically necessary, or was unreasonable or that the amount of the charge was in excess of that permitted under, or in violation of, subsection (5). Such assertion by the insurer may be made at any time, including after payment of the claim or after the 30-day time period for payment set forth in this paragraph.”
10. Also see Kaminester v. State Farm Mut. Auto. Ins. Co., 775 So.2d 981, 985 (Fla. 4th DCA 2000), where the court stated that “surely it is entitled to recover the extent of any overpayment from a provider whom it has promptly paid in accordance with its statutory obligation. The fact that the statute was recently amended to extend the time of the payment obligation until after a claimant furnishes discovery does not alone generate an abandonment of the carrier’s right to recover an overpayment. Finally there is no collateral estoppel effect arising from State Farm having been denied court-ordered discovery in cases involving other insureds.”
11. As State Farm’s common law cause of action is founded on the fact Defendant was not licensed, reimbursement is required even after the repeal of F.S. 456.0375 and replacement by Florida Statutes 400.990-400.995. This is not a private cause of action on said statute although such a cause of action is appropriate due to the private party’s harm as a result of Defendant’s failure to comply with the law.
Based upon the above findings, it is hereby:
ORDERED AND ADJUDGED:
1. State Farm is hereby entitled to recover from AXCESS MRI JACKSONVILLE, L.L.C., the sum of $54,074.51 together with prejudgment interest from October 6, 2003. Yearly prejudgment interest is $3,785.22. Daily interest is $10.51. Pre-judgment interest up to September 6, 2006, totals $14,825.43. Thus, State Farm is entitled to $68,899.94.
2. State Farm shall be entitled to taxable costs which total $277.00.
3. Based on the above, State Farm is entitled to recover from Defendant the total sum of $69,176.64 and post-judgment interest at the rate of 9% per annum, for which sum let execution issue.
4. It is further ordered and adjudged that the judgment debtor, AXCESS MRI JACKSONVILLE, L.L.C., and its owners and directors, Stephen Miley, or any appropriate owner, shall complete under oath Florida Rule of Civil Procedure Form 1.977 (Fact Information Sheet), including all required attachments, and serve it on the judgment creditor’s attorney, Ramey & Kampf, P.A., within 45 days from the date of this Final Judgment, unless the final judgment is satisfied or post-judgment discovery is stayed.
5. Jurisdiction of this case is retained to enter further orders that are proper to compel the debtor, AXCESS MRI JACKSONVILLE, L.L.C., and its owners and directors, including Stephen Miley or any appropriate owner, to complete form 1.977, including all required attachments, and serve it on the Ramey & Kampf, P.A.