16 Fla. L. Weekly Supp. 687a
Online Reference: FLWSUPP 167DOR
Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Patient Self Referral Act — Medical provider who referred insured to pain management clinic of which provider is sole shareholder violated Patient Self Referral Act, and pain clinic is barred from claiming entitlement to PIP benefits — No merit to argument that only insured has standing to assert that services are not payable due to fact that they were not lawfully rendered
PHYSICIANS PAIN & REHAB CENTER, INC., (Charles Dor), et al., Plaintiff(s), v. NATIONAL SPECIALTY INSURANCE COMPANY, Defendant(s). County Court, 17th Judicial Circuit in and for Broward County. Case No. 05-018698 COCE (56). March 9, 2009. Linda R. Pratt, Judge. Counsel: Sisy Mukerjee, for Plaintiff, Physician’s Pain & Pain Management. Cris Boyar, for Plaintiff Wide Open MRI. Jose P. Font, for Defendant.
Editor’s note: See FLWSUPP 2001DOR
ORDER ON DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT AGAINST THE PLAINTIFFS, PHYSICIANS PAIN & REHAB CENTER AND PAIN MANAGEMENT GROUP OF S. FLORIDA
THIS CAUSE having come for hearing on the Defendant’s Motion for Final Summary Judgment Against the Plaintiffs, Physicians Pain & Rehab Center and Pain Management Group of S. Florida, and the Court having heard argument of counsel, and otherwise being fully advised in the premises, it is, hereby,
ORDERED AND ADJUDGED:
Findings of Facts
1. This is action for personal injury protection (“PIP”) benefits.
2. The Plaintiffs, Physicians Pain & Rehab Center (“Physicians Pain”) and Pain Management Group of S. Florida (“Pain Management”), are Florida Corporations with offices at the same location. Dr. Dennis Bonneau is the sole shareholder for both corporations.
3. Dr. Bonneau is a chiropractic physician who works as an employee of Physicians Pain and Rehab Center.
4. In relation to injuries said to have been sustained in a motor vehicle accident that occurred on June 18, 2005, Physicians Pain and Pain Management claims to have provided a course of treatment to Charles Dor.
5. As part of Mr. Dor’s treatment, Dr. Bonneau referred Mr. Dor to Dr. Eddie Sassoon, an employee of Pain Management. Dr. Bonneau disclosed his interest in Pain Management to Mr. Dor.
6. Dr. Sassoon is a medical doctor who possesses a specialty in physiatry. He is the sole medical provider employed by Pain Management. After performing his evaluation on Mr. Dor, Dr. Sassoon recommended that Mr. Dor continue with the chiropractic treatment plan of Dr. Bonneau. While the alleged chiropractic care of Mr. Dor continued at Physicians Pain, Mr. Dor would periodically return to Pain Management for diagnostic testing and follow up evaluations.
Conclusions of Law
7. As the sole shareholder of Pain Management and Physicians Pain, Dr. Bonneau possesses an investment interest in those entities as defined by the Patient Self Referral Act. Fla. Stat. § 456.053(3)(k).
8. Possessing an investment interest and control over Pain Management and Physicians Pain, Dr. Bonneau individually, and as an authorized representative of his corporations, violated the Patient Self Referral Act. Specifically, Dr. Bonneau violated the following sections of the statute:
5(b) A health care provider may not refer a patient for the provision of any other health care item or service to an entity in which the health care provider is an investor. . . .
5(f) Any health care provider or other entity that enters into an arrangement or scheme, such as a cross-referral arrangement, which the physician or entity knows or should know has a principal purpose of assuring referrals by the physician to a particular entity which, if the physician directly made referrals to such entity, would be in violation of this section . . . .
9. Dr. Bonneau does not fall within the exceptions described in sec. 5(b), or 5(i), therefore his disclosure under 5(j) does not cure the violation.
10. Because the course of treatment put into place by Dr. Bonneau, Physicians Pain, and Pain Management was not lawful pursuant to Florida Statute § 627.736(5)(b)(1)b, Physicians Pain and Pain Management are barred as a matter of law from claiming entitlement to PIP benefits.
11. This Court is unpersuaded by the Plaintiffs’ argument that only the insured has standing to assert that services at issue are not payable due to the fact that they were not lawfully rendered. To the contrary it is specifically stated in Florida Statute § 627.736(5)(b)(1)(b) that an “insurer or insured is not required to pay a claim or charges for any service or treatment that was not lawful at the time rendered.” Lawfully is defined under Florida Statute § 627.732(11) as “substantial compliance with all relevant applicable criminal, civil, and administrative requirements of state and federal law related to the provision of medical services or treatment.” The natural requirement that a medical care provider lawfully render services before claiming entitlement to PIP benefits is supported by a legion of cases throughout this State. Medical Management Group of Orlando, Inc. v. State Farm Mutual Automobile Insurance Company, 811 So.2d 705 (Fla. 5 DCA 2002) (The Court held that medical care provider that violated Fla. Stat. §817.505 could not claim entitlement to PIP benefits); See Vero Diagnostics, Inc., (a/a/o Patricia Ducap) v. Allstate Insurance Company, 11 Fla. L. Weekly Supp. 476b (Fla. Broward Cty. Ct. March 1, 2004) (Insurer was not obliged to pay PIP benefits for medical services that were rendered in violation of Fla. Stat. §§ 817.505 and 455.657); Motion X-Ray, Inc. d/b/a Nu-Best Diagnostics Labs, Inc. a/a/o Joel Packard v. State Farm Mutual Automobile Insurance Company, 10 Fla. L. Weekly Supp. 346a (Fla. Orange Cty. Ct. September 3, 2002) (Insurer absolved of liability for payment of PIP benefits for services unlawfully rendered in violation of Fla. Stat. §§ 817.505(1)(a)-(c) and 456.054); Radiology B & Services, Inc., (a/a/o Nabila Raza) v. Progressive Express Insurance Company, 11 Fla. L. Weekly Supp. 251c (Fla. Broward Cty. Ct. October 17, 2003) (Services rendered in violation of Fla. Stat. §817.505 were not payable under Fla. Stat. § 627.736); Radiology & Neurology Consultants, Inc., (a/a/o Sinodas Joseph) v. Progressive Consumers Insurance Company, 12 Fla. L. Weekly Supp. 754b (Fla. Broward Cty. Ct. February 9, 2005) (defendant absolved of liability for payment of PIP benefits for services unlawfully rendered in violation of Fla. Stat. § 817.505); Southeast Diagnostics, Inc. (a/a/o Paula Welch) v. Allstate Indemnity Company, 11 Fla. L. Weekly Supp. 745b (Fla. Broward Cty. Ct. June 10, 2004) (Medical care provider was barred from seeking payment of PIP benefits for services rendered in violation of Fla. Stat. §§ 817.505 and 455.657).
12. This Court finds that the cross-referral arrangement put into place by Dr. Bonneau, Physicians Pain, and Pain Management does not fall under any of the exclusions set forth in the Patient Self Referral Act.
13. Based on the above findings, final summary judgment is hereby entered if favor of the Defendant and against the Plaintiff Physicians Pain and Pain Management.
