13 Fla. L. Weekly Supp. 176a

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. GEORGE M. GONZALEZ, D/B/A TAMPA MRI, and DIAGNOSTICS U.S.A., INC., D/B/A TAMPA MRI, Defendants. County Court, 13th Judicial Circuit in and for Hillsborough County. Case No. 03-6112 CI. November 15, 2005. Sam D. Pendino, Judge. Counsel: David B. Kampf, Ramey, Ramey & Kampf, P.A., Tampa, for Plaintiff. Michael Vincent Laurato, Austin & Laurato, Tampa, P.A., for Defendant.

ORDER GRANTING STATE FARM’S MOTION FOR SUMMARY JUDGMENT

THIS CAUSE having come before the Court on November 1, 2005, on Plaintiff, State Farm Mutual Automobile Insurance Company’s Motion for Summary 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 Tampa MRI for healthcare services rendered to numerous patients that were insured under State Farm policies of insurance. That the complaint consisted of three (3) counts and causes of action to seek reimbursement of paid No-Fault benefits.

2. Monies paid were from patients’ PIP policies which may have included medical payments coverage. Total benefits paid by State Farm and at issue in the current matter are $39,179.35. The services at issue are from December 1, 2001, up to an including September 9, 2002.

3. That the undisputed facts reveal that Tampa MRI was owned by George Gonzales and Diagnostics USA, Inc.

4. The undisputed facts reveals Tampa MRI was a clinic defined in the Florida Statute 456.0375(1)(a), (October 1, 2001).

5. Therefore, Defendant was required to register as a clinic pursuant to F.S. §456.0375(2)(a). The undisputed facts reveal Tampa MRI was not a “Registered Clinic” pursuant to F.S. §456.0375 at anytime since the effective date of the statute up to and including September 9, 2002.

6. The undisputed facts reveals Defendant was not exempt from the registration requirements identified in the statute.

7. This Court finds that Florida Law precludes a medical provider from receiving payment for any services rendered should the medical provider fail to comply with the Florida Registration Requirements. Charges submitted by a clinic such as Tampa MRI that is not registered are unlawful charges and are not compensable pursuant to F.S. §456.0375(4)(a), which provides “All charges for reimbursement claims made by or on behalf of the 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”.

8. Therefore, Defendant was precluded from seeking or obtaining compensation, damages or payment of PIP benefits from State Farm for any care, treatment or services, including MRI services, rendered to patients from October 1, 2001, up to and including September 9, 2002.

9. In addition, Defendant was not entitled to payment of benefits pursuant to Sect. 627.736(5)(a), Florida Statutes, 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.

10. Neither the patients nor State Farm were required to pay the medical provider for the services rendered.

11. Based on the above, State Farm is entitled to seek reimbursement from the Defendant for all expenses paid by each patient’s PIP coverage and medical payments coverage.

12. The no-fault statute permits the insurer to seek and obtain reimbursement at any time, including after payment and even if the investigation as to registration 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.”

13. This Court further finds that Plaintiff’s cause of action seeking reimbursement of benefits under F.S. §456.0375 is a valid cause of action at this time. State Farm is entitled and may continue to rely upon statutes in effect in 2001 and 2002 since the services at issue were not lawful services at the time that services were rendered.

14. 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 Defendants seeking reimbursement of paid PIP and medical payments coverage based on Defendants’ failure to register pursuant to F.S. 456.0375 states a cause of action in reimbursement for which relief may be granted. This Court finds that Plaintiff’s cause of action for unjust enrichment is appropriate and proper and, therefore awards Plaintiff summary judgment under its cause of action for “unjust enrichment”.

2. However, Defendant shall have until November 10, 2005, at 5:00 p.m., in which to produce a copy of a license verifying that Tampa MRI was registered pursuant to F.S. §456.0375. Should Tampa MRI produce such a license, this Court shall withdraw this Order of Summary Judgment.

3. State Farm shall hereby be entitled to recover from Defendants, George M. Gonzales, d/b/a Tampa MRI, and Diagnostics USA, Inc., d/b/a Tampa MRI, jointly and severely, the sum of $39,179.35. Plaintiff shall be entitled to recover pre-judgment interest at a rate of 7% per annum from the date suit was filed. Annual interest totals $2,742.55. Monthly interest totals $228.55. Interest through October 31, 2005, totals $6,399.28.

4. This Court shall reserve jurisdiction to address entitlement, if any, and reasonableness of attorneys’ fees and costs to State Farm.

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