17 Fla. L. Weekly Supp. 122b
Online Reference: FLWSUPP 1702FLOR
Insurance — Personal injury protection — Fraud — Medical provider that submitted bill to insurer for x-ray that it did not perform as well as bills for treatment that it did provide is barred from any recovery of PIP benefits
FLORIDA LIFE REWARD HEALTH CARE INC., Plaintiff, vs. STATE FARM FIRE & CASUALTY COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 08-016422-CC-25 (02). September 24, 2009. Lawrence D. King, Judge. Counsel: E. Dennis Brod, Coral Gables. Maury Udell, Miami.
ORDER GRANTING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE came before the Court on September 9, 2009 for hearing on Defendant, State Farm Fire & Casualty Company’s Motion for Summary Final Judgment, and the Court having reviewed the Clerk’s file, considered Defendant’s Motion for Final Summary Judgment and supporting memorandum of law and Plaintiff’s Supplemental Response to Defendant’s Motion for Summary Judgment, and being otherwise apprised in the premises, hereby enters the following ruling.
IT IS ORDERED AND ADJUDGED that the Defendant, State Farm Fire & Casualty Company’s Motion for Summary Final Judgment is GRANTED.
The Court finds that pursuant to Fla. R. Civ. P. 1.510 there exists no genuine issue of material fact with respect to the x-ray diagnostic testing performed by Plaintiff, Florida Life Reward Health Care, Inc. Defendant has presented competent evidence that Plaintiff did not perform the services rendered to the insured, Ubaldo J. Soroa. This evidence remains unrebutted by Plaintiff. (See deposition of Maylin Espinoza – 4/17/09 Page 19-21). As Plaintiff has sought payment for services it did not provide, the claims presented in this case as more specifically set forth in the Complaint filed November 17, 2008 are without merit.
Defendant contends that Plaintiff has committed insurance fraud in violation of Fla. Stat. § 627.736(5)(b)(1)(c), having knowingly submitted a false or misleading statement to State Farm Fire & Casualty Company, which was admittedly not performed by Plaintiff.
Plaintiff, Florida Life Reward Health Care Inc., posits that only a portion of the x-ray bills were wrongfully submitted, and that other treatments performed should be paid pursuant to the policy provisions. Further, Plaintiff argues that the facts in evidence before the Court do not constitute violations of the provisions of Fla. Stat. § 627.736(4)(h), and do not amount to fraud sufficient to vitiate the entire medical bills in dispute.
The Court finds that coverage cannot be afforded in favor of Plaintiff. The alleged healthcare provider submitted for payment a false (x-ray services) HCFA claim form, and therefore is barred from any recovery for PIP insurance benefits.
The Court hereby reserves jurisdiction to award reasonable attorney’s fees and costs if appropriate in favor of Defendant, State Farm Fire and Casualty Company as the prevailing party.
