16 Fla. L. Weekly Supp. 956a
Online Reference: FLWSUPP 1610VASQ
Insurance — Personal injury protection — Answer and affirmative defenses — More definite statement is ordered as to which bills or services insurer alleges fail to follow CPT codes, which services it alleges were upcoded, and which bills it alleges were not timely submitted — Affirmative defenses alleging that medical provider has charged unreasonable and excessive fee and billed for services not rendered are denials of allegations of complaint, not affirmative defenses, and are stricken
ORLANDO TOTAL HELP & REHABILITATION CENTER, INC., a/a/o JANICE VASQUEZ, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 08-CC-5124-O. July 31, 2009. Antoinette Plogstedt, Judge. Counsel: Chad A. Barr, Eiffert & Associate, P.A., Orlando. Julia Pinnell, Cameron, Hodges, Coleman, LaPointe & Wright P.A., Orlando.
ORDER ON PLAINTIFF’S MOTION TO STRIKE AND/OR MOTION FOR MORE DEFINITE STATEMENT AS TO THE DEFENDANT’S AMENDED AFFIRMATIVE DEFENSES
THIS MATTER came before the Court on July 24, 2009, on Plaintiff’s Motion to Strike and/or Motion for More Definite Statement as to Defendant’s Affirmative Defenses enumerated below, and, being considered by the Court and otherwise being fully advised of the premises; it is hereby ORDERED AND ADJUDGED as follows:
1. Paragraph 27 of the Defendant’s Amended Answer and Affirmative Defenses states as follows:
Defendant affirmatively alleges that Plaintiff has failed to comply with Section 627.736(5)(d), Fla. Stat., in that it has violated the requirement that all bills submitted for payment must follow the Physician’s Procedural Coding System.
2. The Court hereby GRANTS the Plaintiff’s Motion for More Definite Statement as to Paragraph 27, and further Orders that on or before August 3, 2009, the Defendant file an Amended Paragraph 27 which identifies exactly which bill(s) and/or service(s) the Defendant alleges fails to follow the Physician’s Procedural Coding System.
3. Paragraph 28 of the Defendant’s Amended Answer and Affirmative Defenses states as follows:
Defendant affirmatively alleges that Plaintiff has failed to comply with Section 627.736(5)(b), Fla. Stat. in that it has upcoded services.
4. The Court hereby GRANTS the Plaintiff’s Motion for More Definite Statement as to Paragraph 28, and further Orders that on or before August 3, 2009, the Defendant file an Amended Paragraph 28 which identifies specifically what CPT codes or services the Defendant alleges were upcoded in violation of section 627.736(5)(d) of the Florida Statutes.
5. Paragraph 29 of the Defendant’s Amended Answer and Affirmative Defenses states as follows:
Defendant affirmatively alleges that Plaintiff has violated Section 627.736(5)(a), Fla. Stat. in that it has charged an unreasonable and excessive fee for the treatment and services allegedly rendered to the assignee.
6. The Court hereby GRANTS Plaintiff’s Motion to Strike Paragraph 29 of the Defendant’s Amended Answer and Affirmative Defenses. Paragraph 29 of the Defendant’s Answer and Affirmative Defenses is a mere denial of the allegations contained within the Plaintiff’s Complaint and is therefore not an affirmative defense.
7. Paragraph 30 of the Defendant’s Amended Answer and Affirmative Defenses states as follows:
Defendant affirmatively alleges that the Plaintiff has billed for services not rendered to the assignee.
8. The Court hereby GRANTS Plaintiff’s Motion to Strike Paragraph 30 of the Defendant’s Amended Answer and Affirmative Defenses. Paragraph 30 of the Defendant’s Answer and Affirmative Defenses is a mere denial of the allegations contained within the Plaintiff’s Complaint and is therefore not an affirmative defense.
9. Paragraph 32 of the Defendant’s Amended Answer and Affirmative Defenses states as follows:
Defendant affirmatively alleges that pursuant to Fla. Stat. 627.736(5)(c)(1) medical bills not submitted with 35 days of service are not reimbursable by the patient insurance or insurance carrier.
10. The Court hereby GRANTS the Plaintiff’s Motion for More Definite Statement as to Paragraph 32, and further Orders that on or before August 3, 2009, the Defendant file an Amended Paragraph 32 which identifies specifically what bills it alleges were not timely submitted by the Plaintiff pursuant to section 627.736(5)(c)(1) of the Florida Statutes.
