11 Fla. L. Weekly Supp. 152c
Insurance — Personal injury protection — Coverage — Referral and billing service — Where plaintiff picked up films of x-rays and CT scan from clinic and paid independent contractors to interpret films and transcribe interpretations, plaintiff’s activities constitute referral and billing services only, not medical services and/or treatment contemplated by Florida PIP statute, and plaintiff is not entitled to payment of PIP benefits — Summary judgment granted in favor of insurer
PHYSICIANS REFERRAL & MEDICAL SERVICES, INC. (a/a/f Manuel Louro), Plaintiff, v. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 02-013999 SP COCE 49. July 3, 2003. Kathleen D. Ireland, Judge. Counsel: Stephen E. Knoerr. Charles H. Bechert, III.
Affirmed. 11 Fla. L. Weekly Supp. 796b
ORDER GRANTING DEFENDANT’S MOTION FORSUMMARY JUDGMENT AND FINAL JUDGMENT
THIS CAUSE came before the Court on May 30, 2003, on Defendant’s MOTION FOR SUMMARY JUDGMENT. The Court, having considered the Motion, the record, argument of counsel, and being otherwise advised in the premises, makes the following findings of fact and conclusions of law as follows:
FINDINGS OF FACT
1. The patient, Manuel Louro, was insured by ALLSTATE INSURANCE COMPANY with personal injury protection coverage for reasonable and medically necessary services rendered to him as a result of a motor vehicle accident which occurred on September 25, 2001.
2. Manual Louro was receiving treatment for his injuries sustained from the accident at a clinic known as Ideal Health Network. Ideal Health Network performed x-rays to Mr. Louro’s left shoulder, cervical spine, thoracic spine, and left ribs. They also performed a CT of the cervical spine.
3. The Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., was contacted by Ideal Health Network to pick up the films to be interpreted by the appropriate medical physician.
4. Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., does not have a medical doctor on staff and did not interpret or review the x-ray films or CT scan at issue.
5. Two physicians, who are independent contractors, were contacted by Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., to come to their office to review the films and to prepare reports of their interpretation of the films.
6. The physician that interpreted the CT scan was Dr. Eric Godreau, who was paid $40.00 to interpret the CT scan of the cervical spine.
7. Dr. Silvia Peterson, a radiologist, interpreted the four x-ray films at $8.00 per view.
8. Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., paid another independent contractor to transcribe the interpretations dictated by the independent contracting medical doctors at the rate of $10.00 per transcription. Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., paid a courier to pick up and return the x-ray films and CT scans to Ideal Health Network.
9. Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., submitted bills to Defendant, ALLSTATE INSURANCE COMPANY, for the professional charge of interpretation of the four x-rays and the one CT scan, in the total amount of $1,200.00.
10. The Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., did not and does not have a medical physician on staff, did not interpret the films, did not examine the patient, and did not own any medical equipment other than an x-ray view box.
11. Prior to the filing of the within lawsuit, the Defendant, ALLSTATE INSURANCE COMPANY, paid the Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., a sum deemed to be reasonable for the services billed for.
12. Subsequent to the lawsuit being filed, the deposition of the owner and President of the Plaintiff, Delia Palacio, was taken by the Defendant.
13. The Defendant filed its Motion for Summary Judgment on the ground that discovery revealed that the Plaintiff did not render medical services or treatment to ALLSTATE’s insured, as contemplated and required by Florida Statute §627.736, whereby the Plaintiff is not entitled to recover PIP benefits under Florida law. The Defendant’s Motion for Summary Judgment did not allege or maintain that the Plaintiff’s activities are those of a broker, as defined by Florida Statute §627.736(1).CONCLUSIONS OF LAW
14. Florida Statute §627.736(1)(a) requires an insurance carrier, providing personal injury protection benefits, to pay 80% of all reasonable expenses for medically necessary medical, surgical, x-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services.
15. Florida Statute §627.736(5)(a) provides that any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance, may charge only a reasonable amount for the services and supplies rendered.
16. Florida Statute §627.736(5)(e) provides that no statement of medical services submitted to the insurer on a Health Care Finance Administration 1500 Form may include charges for medical services of a person or entity that performed such services without possessing the valid license as required to perform such services.
17. The Court agrees with the Fifth District Court of Appeal in Medical Management Group of Orlando v. State Farm Mutual Automobile Insurance Company, 811 So.2d 705 (Fla. 5th DCA 2002) that, providing referral and billing services, as the Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., did herein, does not constitute medical services or treatment as contemplated by the provisions of Florida Statute §627.736(1)(a), which provides that the insurer must pay 80% of the medically necessary medical services, thus, the Plaintiff is not entitled to recovery under Defendant’s policy with its insured.
18. The Court further agrees with the Third District Court of Appeal in Federated National Insurance Company v. Physicians Charter Services, 788 So.2d 403 (Fla. 3rd DCA 2001) that the Plaintiff herein, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., did not perform necessary medical services and was not a physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by PIP insurance and therefore, is not entitled to recovery under the Defendant’s policy with its insured.
19. This Court further agrees with the Third District Court of Appeals ruling in Federated National Insurance Company, supra, that there is no provision in Florida’s Personal Injury Protection Statutes for the payment of policy benefits to a third party who has not performed medical services.
20. The Plaintiff herein submitted a bill to the Defendant for CPT codes for the professional services of interpreting x-ray films and CT scans in the total amount of $1,200.00, notwithstanding that the Plaintiff did not render medical services or treatment to ALLSTATE’s insured, Manuel Louro, and therefore, pursuant to Florida Statute §627.736, the Plaintiff was not lawfully rendering treatment or medical services to ALLSTATE’s insured, Manuel Louro.
21. The Court concludes that the Plaintiff’s activities in the within action amount to referring and billing services, only, not medical treatment or services recoverable under PIP insurance. X-ray films were interpreted by independent contracting medical physicians. The dictation of the independent contracting physicians was referred to independent contracting transcriptionists and simply printed onto Plaintiff’s own letterhead. The reports and insurance forms were sent to Defendant, ALLSTATE INSURANCE COMPANY, for payment of the full professional component as if the Plaintiff had rendered the medical services and treatment billed for. The Plaintiff’s activities constitute referral and billing services only, and therefore do not constitute medical services and/or treatment as contemplated by the Florida PIP Statute, whereby the Plaintiff is not eligible to receive payment of PIP benefits, pursuant to Florida Statute §627.736.
ORDER AND FINAL JUDGMENT
IT IS ORDERED AND ADJUDGED that the Defendant, ALLSTATE INSURANCE COMPANY’s, Motion for Summary Judgment is GRANTED. Final Judgment is entered in favor of the Defendant, ALLSTATE INSURANCE COMPANY, and against the Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC. (a/a/f Manuel Louro). The Plaintiff, PHYSICIANS REFERRAL & MEDICAL SERVICES, INC., shall take nothing by this action and Defendant, ALLSTATE INSURANCE COMPANY, shall go hence without day. The Court retains jurisdiction to determine the amount of costs to be awarded to the Defendant, as prevailing party.
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