13 Fla. L. Weekly Supp. 151a
Insurance — Personal injury protection — Coverage — Medical provider — Unregistered clinic — Where medical provider was clinic required to register under section 456.0375 but was not registered, insurer is entitled to reimbursement from provider for all expenses paid by each insured’s PIP and med pay coverage for treatment rendered while provider was not registered
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Plaintiff, vs. DIAGNOSTIC ACCESS IMAGING, INC., Defendant. Circuit Court, 20th Judicial Circuit in and for Lee County. Case No. 05-CA-003836. October 27, 2005. R. Thomas Corbin, Judge. Counsel: David B. Kampf, Ramey, Ramey & Kampf, P.A., Tampa, for State Farm.
FINAL JUDGMENT IN FAVOR OF STATE FARM
THIS CAUSE came before the Court on Plaintiff, State Farm Mutual Automobile Insurance Company’s Motion for Final Judgment, and the Court, having heard argument and being otherwise advised in the premise, makes the following findings:
1. State Farm filed suit seeking reimbursement of monies paid by State Farm to Defendant, DIAGNOSTIC ACCESS IMAGING, INC., 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 policies which may have included medical payments coverage for some of the patients. Total benefits paid by State Farm from October 1, 2001 through July 19, 2002 were $34,930.61.
3. The undisputed facts reveal Defendant, DIAGNOSTIC ACCESS IMAGING, INC., was a clinic as defined under Florida Statute 456.0375(1)(a), (October 1, 2001).
4. Therefore, Defendant was required to register as a clinic pursuant to 456.0375(2)(a).
5. The undisputed facts reveal Defendant was not a “registered clinic” pursuant to Florida Statute 456.0375 at any time since the effective date of the statute up to July 19, 2002. Defendant was not exempt from the registration requirements.
6. Florida law precludes a medical provider from receiving payment for any services rendered should the medical provider fail to comply with Florida registration requirements. Charges submitted by a clinic that is not registered are unlawful charges and are noncompensable 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 noncompensable and unenforceable.”
7. Therefore, Defendant was precluded from seeking or obtaining compensation, damages or payment of PIP benefits from State Farm or the patients for any care, treatment or services rendered to patients from October 1, 2001 to July 19, 2002. Reimbursement is required even with the repeal of F.S. 456.0137 and replacement of the statute by Florida Statutes 400.990-400.995.
8. 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.
9. Neither the patients nor State Farm were required to pay the medical provider for the services rendered.
10. Based on the above, State Farm is entitled to reimbursement from the Defendant for all expenses paid by each patient’s PIP coverage and medical payments coverage.
11. 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.”
12. 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.”
Based upon the above findings, it is hereby:
ORDERED AND ADJUDGED:
1. State Farm’s complaint against Defendant seeking reimbursement of paid PIP and medical payments coverage based on Defendant’s failure to register pursuant to F.S. 456.0375 states a cause of action of reimbursement for which relief may be granted.
2. State Farm is hereby entitled to recover from DIAGNOSTIC ACCESS IMAGING, INC., the sum of $34,930.61 together with pre-judgment interest at the rate of 7% per annum from date the suit was filed. Interest accrued since the date of filing up to October 24, 2005, totals $502.43. Thus, State Farm is entitled to a judgment of damages totaling $35,433.04.
3. State Farm shall be entitled to taxable costs which total $355.00.
4. Based on the above, State Farm is entitled to recover from Defendant the sum of $35,788.04, and post-judgment interest at the rate of 7% per annum, for which sum let execution issue.
5. This Court hereby reserves jurisdiction to hear argument and determine State Farm’s entitlement, if any, and reasonableness of attorney’s fees.
6. It is further ordered and adjudged that the judgment debtor, DIAGNOSTIC ACCESS IMAGING, INC., and its owners and directors, Mr. Gregory Edds and Ms. Martha Woodburn 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, 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.
7. Jurisdiction of this case is retained to enter further orders that are proper to compel the debtor, DIAGNOSTIC ACCESS IMAGING, INC., and its owners and directors, Mr. Gregory Edds and Ms. Martha Woodburn or any appropriate owner, to complete form 1.977, including all required attachments, and serve it on the Ramey, Ramey & Kampf, P.A.
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