19 Fla. L. Weekly Supp. 653b
Online Reference: FLWSUPP 1908HORNInsurance — Personal injury protection — Coverage — Summary judgment — Factual issues — Where there exist disputed issues of material fact as to whether insurer paid medical provider correct amount under Medicare Part B fee schedule as required by PIP statute, it would be inappropriate to grant insurer’s motion for summary judgment
FIRST COAST MEDICAL CENTER, INC., (as assignee of David Horne), Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, a foreign corporation, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2011-SC-00153, Division N. February 8, 2012. Gary P. Flower, Judge. Counsel: Vincent P. Gallagher, Jacksonville Beach, for Plaintiff. James Rinaman, Rinaman & Associates, P.A., Jacksonville, for Defendant.
ORDER DENYING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT
This cause having come to be heard before this Court on Defendant’s Motion for Summary Judgment, and this Court, having heard arguments of counsel, and having fully considered the record, and otherwise being fully advised in the premises, makes the following findings of fact and conclusions of law.
1. On April 25, 2011, Plaintiff filed a Complaint, alleging breach of an insurance contract and failure to pay for services rendered to Defendant’s insured.
2. On October 14, 2011, Defendant filed a Motion for Summary Judgment, arguing that Defendant properly paid for services performed by Plaintiff (nurse practitioner) pursuant to section 627.736(5)(a)(2)(f), Florida Statutes (2010) and 42 CFR §414.56(c).
3. In 2008, the Florida legislature amended subsection (5)(a)(2)(f) and (5)(a)(3) of Florida’s No-Fault Law to clarify that PIP reimbursement for medical services would be based on 200 percent of the allowable amount under the participating physicians’ schedule of Medicare Part B. All Family Clinic of Daytona Beach, Inc. v. State Farm, 685 F.Supp.2d 1297, 1298 (S.D. Fla. 2010) [22 Fla. L. Weekly Fed. D352a](denying State Farm’s motion for summary judgment and holding that it is undisputed that the participating physicians schedule for Medicare Part B is the proper schedule to use when calculating reimbursement payments for MRI services under Florida’s No-Fault Statute); First Coast Med. Ctr., Inc. v. Nationwide Ins. Co., 17 Fla. L. Weekly Supp. 819a (Fla. Duval Cty. Ct. 2010)(finding that Florida No-Fault statute clearly and unanimously requires that the participating physicians schedule of Medicare Part B is the appropriate schedule for determining reimbursements for reevaluations performed by nurse practitioners without resorting to any other schedules or limitations promulgated under the code of federal regulations); see also Central Magnetic Imaging Open MRI of Plantation, Ltd. v. State Farm, 789 F.Supp.2d 1311 (S.D. Fla. 2011) [23 Fla. L. Weekly Fed. D363a](denying in part State Farm’s motion to dismiss and holding that plaintiff’s claim regarding State Farm’s use of MMDIR to pay for services rendered instead of the Medicare Part B fee schedule was sufficiently pled); see generally Progressive Auto Pro Ins. Co. and State Farm v. One Stop Medical, Inc., 985 So. 2d 10, 15 (Fla. 4th DCA 2008) [33 Fla. L. Weekly D1052a](holding that since 2001, the Florida legislature enacted a fee schedule to regulate the amount that MRI healthcare providers could charge PIP insurers and their insureds).
4. This Court finds that there exist genuine issues of material fact as to whether Defendant failed to pay Plaintiff the correct amount according to the participating physicians schedule of Medicare Part B as required in section 627.736(5)(a)(2)(f), Florida Statutes (2010). As such, this Court finds it would be inappropriate to grant the Motion for Summary Judgment.
Therefore, in view of the above, it is:
ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment is DENIED.
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