12 Fla. L. Weekly Supp. 153a
Insurance — Personal injury protection — Coverage — Magnetic resonance imaging — Medicare fee schedule adjustment — Prior to effective date of amendment to PIP statute, appropriate fee schedule to compensate medical provider for MRI was based on Medicare Part B schedule, not limiting charge — Where Consumer Price Index for Florida, named in statute prior to amendment as basis for determining amount to calculate adjustment for consumer price index for MRI does not exist, insurer properly paid for MRI services by paying 200% of Medicare Part B schedule without adjustment
OPEN MRI OF ORLANDO, INC., as assignee of ULYSSES FRANCIS, Plaintiff, vs. DIRECT GENERAL INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. SCO-032481, Division 71. November 12, 2004. C. Jeffery Arnold, Judge. Counsel: Andrea Kelemen, Orlando. Aaron E. Leviten, Orlando.
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court on October 5, 2004, before The Honorable Jeffery Arnold on Defendant’s Motion for Summary Judgment and Plaintiff’s Motion for Summary Judgment, and the Court having reviewed the file and being otherwise advised, this Court makes the following findings of facts and conclusions of law:
1. The undisputed facts reveal Plaintiff performed MRI services on Direct General Insurance Company’s insured, Ulysses Francis on or about November 4, 2002.
2. Plaintiff submitted medical bills in the form of HCFA forms for a total bill amount of $2,562.50.
3. Florida Statute §627.736(5)(b)(5) provides that the maximum amount that may be charged for MRI services is 200% of the Florida Medicare Part B Fee Schedule. The Florida Medicare Part B Fee Schedule for a participating provider in the area in which the treatment at issue was rendered indicates the appropriate charges to be $1,804.52, or 200% of the billed amount.
4. Direct General Insurance Company paid Plaintiff $1,443.62, which was 80% of the 200% of the participating fee schedule.
5. The amount paid by Direct General Insurance Company to Plaintiff was not adjusted to a medical consumer price index for Florida or any other region.
6. Plaintiff filed suit in this action for date of service November 4, 2002, seeking the amount of $515.69 plus statutory interest for the amount designated under the limiting charge as dictated by Medicare and an adjustment based upon the consumer price index adjustment identified by the Bureau of Labor Statistics and cited in the 2003 amendment to the no-fault statute.
7. This Court finds that prior to October 1, 2003, the effective date of the amendment to the no-fault statute, the appropriate fee schedule to compensate Plaintiff for the MRI services it provided on November 4, 2002, was based upon the Medicare Part B Schedule for participating physicians, not the limiting charge.
8. The Court upon review of recent case law on point namely Millennium Diagnostic Imaging Center, Inc. v. Security National Insurance Company, 2004 WL 1780923 (Fla. 3rd DCA) Aug. 11, 2004 [29 Fla. L. Weekly D1817b], that interpretation of the 2001 amendment to the Florida Motor Vehicle No-Fault law established that the fee schedule for personal injury protection benefits payable to magnetic resonance imaging providers was pursuant to the participating fee schedule. Based upon the above referenced case, as well as discussion of counsel, this Court finds that pursuant to F.S. §627.736(5)(b)(5), Defendant directly calculated the amount owed to Plaintiff basing its payment upon the participating fee schedule as described by Medicare Part B.
9. Moreover, this Court finds that prior to October 1, 2003, the effective date of the amendment to the no-fault statute there existed no criteria to determine or calculate the amount the MRI fee schedule may be adjusted pursuant to F.S. §627.736(5)(b)(5), as the consumer price index cited in the statute, the Medical Consumer Price Index for Florida does not exist. As noted by Plaintiff, the Bureau of Labor Statistics published a monthly for National CPI, as well as regional indices throughout the United States for various metropolitan areas, including the southeastern United States. The index cited by Plaintiff and identified in the October 1, 2003 amendment to the Florida No-Fault law was not specifically identified in the applicable 2001 statute. The Court recognizes that no Medical Consumer Price Index for Florida, specifically so entitled exists to provide the Defendant with a basis to determine the amount to calculate an adjustment for consumer price index for the MRI services provided by Plaintiff in this case.
10. Based on the above, this Court finds that F.S. §627.736(5)(b)(5) placed Defendant, Direct General Insurance Company, in an impossible position regarding a determination of the appropriate consumer price index adjustment to be applied to the services at issue. The Court holds that it is not the Court’s function to create law where none exists. The Court recognizes that the legislature specifically provided a consumer price index adjustment based on the Medical Consumer Price Index for Florida which does not specifically exist. Therefore, pursuant to the plain language of the applicable statute, there can be no means for specifically determining the amount of any CPI adjustment under the 2001 No-Fault Statute.
11. Based on the above findings and conclusions of law, it is ORDERED AND ADJUDGED as follows:
A. Defendant’s Motion for Summary Judgment shall hereby be GRANTED.
B. Plaintiff’s Motion for Summary Judgment is hereby DENIED.
C. The parties will determine whether Defendant has properly paid for MRI services, as based upon the findings of this Court paying 200% of the participating fee schedule under Medicare Part B, a Final Judgment will be entered in favor of Defendant if all payments have been properly made and the parties agree as such.
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