10 Fla. L. Weekly Supp. 1020c
Insurance — Personal injury protection — Claim for magnetic resonance imaging services by plaintiff which performed technical component of MRI and paid radiologist to perform professional component of MRI — Plaintiff would have been entitled to compensation for technical component if it had designated its bill to only seek compensation for that component — Plaintiff did not render and is not allowed to recover PIP benefits for professional component of MRI — Fee-splitting — Relationship between plaintiff and radiologist is not unlawful fee-splitting — Question certified whether medical provider can render medical service under section 627.736(5)(a) when medical service was provided through use of independent contractor
REGIONAL MRI OF ORLANDO, INC., as assignee of Wesley Odell, Plaintiff, vs. NATIONWIDE MUTUAL FIRE INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. SCO-02-5818. September 12, 2003. C. Jeffery Arnold, Judge. Counsel: Mark A. Cornelius, Bogin, Munns & Munns, Orlando, for Plaintiff. Katherine E. McKinley, Zimmerman, Kiser & Sutcliffe, P.A., Orlando, for Defendant.
[Reversed; Certified question answered in the affirmative at 29 Fla. L. Weekly D2355b.]
SUMMARY FINAL JUDGMENT IN FAVOR OF DEFENDANT
THIS CAUSE having come before the court for consideration upon the parties’ Cross Motions for Summary Judgment, and the court having reviewed the Motions and otherwise being fully advised in the premises, the Court finds as follows:
FINDINGS OF FACTS
The Court makes the following findings of fact:
1. Plaintiff’s assignee, Wesley Odell, presented at Regional MRI of Orlando, Inc., hereinafter “Regional MRI” for an MRI of the spine without contrast.
2. Regional MRI performed the technical component of the MRI by creating MRI films of Plaintiff’s spine.
3. Regional MRI then sent these films to Dr. Henry Floyd for interpretation and reporting.
4. Following the interpretation of these films, Regional MRI submitted a global bill to Nationwide for CPT code 72148, which constituted the bill for both the technical and professional components of the MRI. Said bill was in the amount of $1,250.00.
5. Defendant Nationwide Mutual Fire Insurance Company (hereinafter “Nationwide”) responded with an Explanation of Benefits form, refusing to pay Regional MRI for the global bill and, instead, inviting Regional MRI to either bill for the technical component of services, or to produce documentation demonstrating Dr. Floyd’s employment with Regional MRI. Plaintiff then filed suit against Nationwide for breach of its contract of insurance with Plaintiff’s assignee.
6. Dr. Henry B. Floyd was the radiologist who interpreted the MRI films taken of Wesley Odell at Regional MRI and thus provided the professional component of the services at issue.
7. Checks from Regional MRI are payable to Dr. Floyd personally. Dr. Floyd conducts his business of reading MRIs at 51 West Haley, Orlando, Florida and at his home in Heathrow.
8. Regional MRI pays Dr. Floyd’s compensation of $75.00 per read to Dr. Floyd personally.
9. Dr. Floyd is provided a 1099 at the end of each year.
10. Dr. Floyd is paid on a monthly basis, regardless of whether Regional MRI is paid for the reads Dr. Floyd performed.
11. Dr. Floyd is permitted to and does work for approximately 2 other diagnostic clinics, including competitors of Regional MRI.
12. Plaintiff requires that all reads provided to Dr. Floyd by 9:00 A.M. weekdays be completed and given to Regional MRI by noon that day, but he has flexibility as to how to accomplish the reads within those constraints.
13. Regional MRI does not exert authority and control over the manner in which Dr. Floyd performs his services, except as stated above.
14. Regional MRI does not provide Dr. Floyd with fringe benefits, such as health insurance or vacation pay.
15. Regional MRI provides Dr. Floyd only with the films and patient history. Dr. Floyd provides all other materials necessary to perform the reads.
16. Dr. Floyd, the interpreting physician, is an independent contractor and not an employee of Regional MRI of Orlando, Inc.
CONCLUSIONS OF LAW
17. The Court hereby adopts the foregoing findings of fact to the extent they encompass conclusions of law or mixed findings of fact and conclusions of law.
18. Florida Statute §627.736(5)(a) requires a provider to “lawfully render” a medical service in order to be entitled to remuneration for that service. This Court finds as a matter of law that the use of the word “render” in Florida Statutes, §627.736 is clear and unambiguous. The plain meaning of the word “render” as used in Florida Statutes, §627.736(5)(a) means to “perform” the medical services for which recovery is sought. “Render” does not mean to hire another corporation or independent contractor to perform the medical services on Plaintiff’s behalf. To conclude otherwise would be inconsistent with the use of the word “render” and would be contrary to the intent of the Florida Motor Vehicle Act.
19. Based on the this Court’s findings of fact as outlined above, this Court finds that Regional MRI did render the technical component of the MRI at issue in this matter and would have been entitled to compensation for the technical component of the service, had Regional MRI properly designated its bill to only seek compensation for the technical component of the MRI at issue.
20. Regional MRI did not, however, render the professional component of the MRI service according to Section 627.736(5)(a). Therefore, Regional MRI has sought recovery for a medical service which it did not render. This Court finds that it would be in violation of Section 627.736(5)(a) to allow Plaintiff to recover insurance proceeds from Nationwide for medical services which it did not render to Nationwide’s insured.
21. This Court finds that the determination of which fee schedule or consumer price index is properly applicable to these charges is beyond the scope of these motions and, therefore, this Court makes no determination as to what fee schedule and/or consumer price index may apply to the service at issue.
22. Aside from this Court’s finding that Regional MRI is not entitled to bill for the professional component of the service at issue, this Court does not find that the business relationship between Regional MRI of Orlando, Inc. and Dr. Henry Floyd constitutes an unlawful fee split.
THEREFORE, it is hereby ORDERED AND ADJUDGED that:
1. Plaintiff’s Motion for Partial Summary Judgment is DENIED.
2. Defendant’s Motion for Summary Judgment on the basis of fee splitting is DENIED.
3. Defendant’s Motion for Summary Judgment on the basis of global billing/lawful rendering is hereby GRANTED. Final judgment is hereby entered in favor of Defendant, Nationwide Mutual Fire Insurance Company. Plaintiff shall take nothing by this action and Defendant shall go hence without day.
4. This Court certifies as a question of great public importance: “can a medical provider render a medical service under Section 627.736(5)(a) when the medical service was provided through the use of an independent contractor.
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