18 Fla. L. Weekly Supp. 304a
Online Reference: FLWSUPP 1803TERE
Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Medical provider that is health care clinic, not massage establishment, and holds valid health care clinic license from Agency for Health Care Administration was not required to have massage establishment license in order to lawfully render massage services
TERESITA MEDICAL CENTER, INC., a/a/o YOLANDA ARENCIBIA, Plaintiff, vs. STATE FARM FIRE & CASUALTY COMPANY, Defendant. County Court, 11th Judcial Circuit in and for Miami-Dade County, Civil Division. Case No. 07-21497 SP 05 (08). November 29, 2010. Wendell M. Graham, Judge.
ORDER ON PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT REGARDING LAWFULNESS OF TREATMENT
This cause having come before the Court on September 20, 2010, the parties, STATE FARM FIRE & CASUALTY COMPANY’s., and TERESITA MEDICAL CENTER, INC.’s, a/a/o YOLANDA ARENCIBIA Cross-Motions for Partial Summary Judgment as to the Defendant’s Affirmative Defense re Massage Establishment, and the Court having heard argument of counsel and otherwise being fully advised in the premises herein it is hereby,STATEMENT OF FACTS
1. The present action involves Plaintiff’s claim for Personal Injury Protection (PIP) benefits against Defendant in connection with the medical services provided to Defendant’s insured.
2. On or about July 31, 2007, YOLANDA ARENCIBIA, was allegedly involved in an automobile accident which caused her to suffer personal injuries.
3. Plaintiff alleges that on or about August 6, 2007, YOLANDA ARENCIBIA executed an Assignment of Benefits to Plaintiff, transferring her rights and interests under this policy of insurance with the Defendant to Plaintiff who in exchange for said Assignment provided YOLANDA ARENCIBIA with medical services.
4. Plaintiff then timely submitted bills for said treatment to Defendant but Defendant did not render payment on said bills within 30 days as required by Fla. Stat. 627.736(4)(b).
5. On or about November 30, 2007 Plaintiff filed suit to compel Defendant to render the payment on the allegedly overdue bills.
6. On or about April 24, 2008 filed its Answer and Affirmative Defenses.
7. As its Fourth Affirmative Defense, Defendant alleges that it is not liable for payment of the medical bills at issue, in part, because the Plaintiff did not render lawful treatment, as it did not have a valid massage establishment license during the time period of September 1, 2007 through September 26, 2007.
8. The parties do not dispute that during the aforementioned time period that Plaintiff was in fact NOT licensed as a massage establishment.
9. The parties do not dispute that during the aforementioned time period, and in fact at all times material hereto, that Plaintiff was in fact a clinic licensed by the Agency for Health Care Administration (AHCA).
MEMORANDUM OF LAW
Question of Law
10. Whether Plaintiff required a massage establishment license in order for the services rendered to the Claimant to constitute lawful treatment pursuant to Fla. Stat. 627.736(5)(a).
Standard in a Motion for Summary Judgment
11. Pursuant to Fla. R. Civ. Proc. 1.510, where the pleadings, depositions, answers to interrogatories and admissions on file, together with affidavits, establish no genuine issues of material fact as to whether the Plaintiff provided lawful treatment to the Claimant pursuant to Fla. Stat. 627.736, then Plaintiff is entitled to judgment as a matter of law.
12. Florida Law clearly supports the contention that Defendant cannot successfully preclude summary judgment in favor of the Plaintiff by merely asserting that an issue of fact does exist concerning whether the bills were timely submitted. See Hardcastle v. Mobley, 143 So.2d 715 (Fla. 3rd DCA 1962) (It is not sufficient in defense of a motion for summary judgment to rely on paper issues created by the pleadings, but it is incumbent upon the party moved against to submit evidence to rebut the motion for summary judgment and affidavits in support thereof or the court will presume that he had gone as far as he could and a summary judgment could be properly entered); Bird v. Leach, 226 So.2d 866 (Fla. 4th DCA 1969) (Although the burden does not shift to the party opposing a motion for summary judgment, he may not entirely assert that an issue does exist, but he must go forward with evidence sufficient to generate an issue on a material fact); Turner Produce Company, 217 So.2d 856 (Fla. 4th DCA 1969) (If the moving party presents evidence to support the claimed non-existence of a material issue, he will be entitled to summary judgment unless the opposing party comes forward with some evidence, which will change the result; that is, evidence to generate an issue of material fact. It is not sufficient for an opposing party merely to assert that an issue does not exist.); Bared v. Miami Professional Sports, Ltd, 363 So.2d 167 (Fla. 3rd DCA 1977) (Summary judgment affirmed where non moving party presented no evidence to oppose the moving party’s motion for summary judgment).Applicable Law
13. Fla. Stat. 400.903(3) defines “clinic” as “an entity at which health care services are provided to individuals and which tenders reimbursement for such services.”
14. Pursuant to Fla. Stat. 400.903(3)(a) exempt from the definition of a “clinic” are entities that are licensed under other licensing chapters, including chapter 460 & 480.
15. Fla. Stat. 400.905 provides that entities at which health care services are provided must be licensed and at all times maintain a valid license with the Agency for Health Care Administration (AHCA).
16. The purpose behind the licensure requirement is to ensure that the facilities providing health care services do so in a sanitary environment that is subject to inspection.
17. This purpose is delineated in Fla. Stat. 400.901(2) which calls for the regulation of health care clinics to prevent significant harm to consumers through the enforcement of basic standards for such clinics and the provision of an administrative oversight agency in AHCA.
18. Pursuant to Fla. Stat 480.033(3) “massage,” for the purposes of the massage establishment license requirement, constitutes the “manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device; or the application to the human body of a chemical or herbal preparation.” (Emphasis added).
19. Additionally, pursuant to Fla. Stat. 480.034(4), “An exemption granted is effective to the extent that an exempted person’s practice or profession overlaps with the practice of massage.”
Argument
20. In the instant case, Plaintiff is a health care clinic properly licensed by AHCA and therefore subject to the regulations under which it must operate in order to serve the purposes of Fla. Stat. 400.901(2).
21. At the time that treatments were rendered to YOLANDA ARENCIBIA, Plaintiff was licensed by AHCA, as were the massage therapist, chiropractic physician and the chiropractic physician’s assistant.
22. Moreover, any massage services rendered to YOLANDA ARENCIBIA were provided by TERESITA MEDICAL CENTER, INC. while holding a valid AHCA license at the time any such massage treatment was provided.
23. The holding of a valid clinic license from AHCA serves the purpose of ensuring that Plaintiff’s facility at which YOLANDA ARENCIBIA was treated, was subject to regulation, oversight and inspection and thus met all conditions necessary to allow Plaintiff to operate and provide lawful health care services.
24. Plaintiff is not required to have a massage establishment license because it is not a massage establishment but a health care clinic and it had the valid licenses to operate pursuant to its status.
25. Plaintiff employed medical and/or chiropractic physicians that ordered, prescribed and/or were responsible for the supervision of all treatment provided to Plaintiff’s assignor (i.e. the at-issue treatment). Said medical and/or chiropractic physician’s professions, practice and training and expertise allowed for them to order, prescribe and/or perform (directly and/or indirectly) massage services to Plaintiff’s assignor (the patient).
26. Although Plaintiff, may be described as “. . .a facility wherein a licensed massage therapist practices massage for compensation. . .,” Plaintiff nonetheless remains an AHCA licensed clinic, where the treating physician/medical director’s practice or profession overlaps with the practice of massage,” and therefore the Defendant’s contention that Plaintiff did not render lawful treatment remains without merit.
ORDERED and ADJUDGED, as follows: Defendant’s Motion for Summary Judgment re Plaintiff’s Failure to Lawfully Render Treatment due to the Alleged Failure of Plaintiff to Maintain a Massage Establishment License is hereby DENIED. Plaintiff’s Cross Motion for Partial Summary Judgment re Massage Establishment is hereby Granted.
