12 Fla. L. Weekly Supp. 163a
Insurance — Personal injury protection — Claim forms — Physician signature — HCFA forms not containing physician’s signature are not deficient — Coverage — Unregistered clinic — Charges for services provided by licensed acupuncturist at unregistered medical clinic wholly owned by person who is not licensed medical provider are unlawful and noncompensable
OLD MASTERS MEDICAL, INC., (as assignee of Janice Guerrier), Plaintiff, v. PROGRESSIVE AUTO PRO INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 04-005511 COCE 52. September 22, 2004. Jay S. Spechler, Judge. Counsel: Matt Hellman, Matt Hellman, P.A., Plantation. Rita Baez.
FINAL JUDGMENT FOR DEFENDANT PROGRESSIVE AUTO PRO INSURANCE COMPANY
THIS CAUSE having come before the Court for hearing on August 19, 2004, on Defendant Progressive Auto Pro Insurance Company’s Motion for Final Summary Judgment, and the Court having reviewed the file, the depositions of record, including Defendant’s motion, heard argument of counsel, and being otherwise fully advised in the premises, it is hereby ADJUDGED:
Nature of the Case
1. Plaintiff, Old Masters, Inc., brought this action seeking recovery of personal injury protection (PIP) benefits under section 627.736, Florida Statutes. By its Complaint, Plaintiff alleged Defendant, Progressive Auto Pro Insurance Company, breached an insurance contract and therefore sought benefits for medical treatment rendered to Janice Guerrier (Insured) under an automobile policy issued by Defendant.
2. Defendant moved for summary judgment, asserting that Plaintiff was not entitled to any payment of PIP benefits because the undisputed evidence of record established that (1) Plaintiff did not submit a properly completed Health Insurance Claim Form (HCFA) so as to place Defendant on notice of a covered loss, as required under Florida Statutes section 627.736(5)(e) (2002); and (2) the location where the treatment was rendered was required to be registered with the Florida Department of Health, pursuant to Florida Statutes section 456.0375 (2002), but was not so registered on any of the dates of service at issue.
Findings of Fact
3. The facts material to Progressive’s motion for summary judgment are undisputed and established by the record. The material facts are set forth below.
4. Insured received acupuncture treatment from Nicholas Masters, A.P. from July 8, 2002 to September 25, 2002.
5. Plaintiff billed Defendant for the treatment rendered to Insured using HCFAs.
6. Box 31 of each HCFA contains the corresponding date of service along with the following type-written information: Nicholas Masters, AP Lic# 1078.
7. None of the HCFAs contain Nicholas Masters’ signature in Box 31.
8. Each HCFA indicates in Box 32 that the name and address of the facility where services were rendered is The Clinic, 8221 W. Atlantic Blvd., Coral Springs, FL 33071.
9. The Clinic is a Florida corporation that was owned by Shirley Butler on the dates of service at issue.
10. Shirley Butler is not a licensed medical provider.
11. Nicholas Masters did not own any interest in The Clinic Inc. at the time services were rendered to Insured.
12. Plaintiff’s only offices on the dates of service at issue were in Winter Springs, Seminole County, Florida.Conclusions of Law — Valid HCFAs
13. 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.
14. The Court concludes that Box 31 of each of the HCFAs at issue is not deficient. The fact that none of the HCFAs contain the treating provider’s signature in Box 31 does not render the HCFAs in violation of section 627.736(5)(d). Florida Statutes (2002).Conclusions of Law — Registration Requirement
15. 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.
16. Section 456.0375, Florida Statutes (2002) states in pertinent part:
(1)(a) As used in this section, the term “clinic” means a business operating in a single structure or facility, or in a group of adjacent structures or facilities operating under the same business name or management, at which health care services are provided to individuals and which tender charges for reimbursement for such services. . . . (2)(a) Every clinic . . . must register, and must at all times maintain a valid registration, with the Department of Health.
17. Section 456.0375(1)(b)3, Florida Statutes (2002), states that the registration requirements do not apply to sole proprietorships, group practices, partnerships, or corporations that provide health care services by licensed health care practitioners pursuant to chapter 457 (acupuncturists), which are wholly owned by licensed health care practitioners or the licensed health care practitioner and his spouse, parent, or child.
18. Lastly, section 456.0375(4)(a), Florida Statutes (2002), states, “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 noncompensable and unenforceable.”
19. The HCFAs submitted by Plaintiff indicate in Box 32 that all services rendered in this case were performed at The Clinic. The Clinic falls within the purview of section 456.0375 for the following reasons.
20. The Clinic is a business operating in a single structure located at 8221 W. Atlantic Blvd., Coral Springs, Florida 33071.
21. Health care services were provided at The Clinic to Insured.
22. Shirley Butler was the sole owner of The Clinic on the dates of service at issue.
23. Nicholas Masters, although a licensed acupuncturist, did not own any interest in The Clinic on the dates of service at issue.
24. The expenses incurred for the treatment of Insured were billed by Plaintiff, which at the time only had offices in Winter Springs, Seminole County, Florida.
25. Thus, The Clinic was required to register with the Department of Health.
26. Because the charges billed by Plaintiff involved treatment at an unregistered clinic that was required to be registered per statute, the charges and reimbursement claim are unlawful and therefore noncompensable and unenforceable.
Final Judgment
IT IS HEREBY ADJUDGED that Plaintiff, Old Masters Medical, Inc. (a/a/o Janice Guerrier), take nothing by this action and Defendant, Progressive Express Insurance Company, shall go hence without day and the Court retains jurisdiction for the purpose of determining any motion by Defendant to tax fees and costs.
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