20 Fla. L. Weekly Supp. 1239b
Online Reference: FLWSUPP 2012ALCIInsurance — Personal injury protection — Fraud — False and misleading statement relating to claim or charges — Where medical provider knowingly submitted claim forms that included name and license number of physician who had stopped working for provider prior to claimed dates of service, provider’s entire claim is barred
NORTH BROWARD HEALTH & REHAB, INC., (a/a/o KERBEAU ALCIME), Plaintiff, vs. STATE FARM FIRE & CASUALTY COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 12-9922 CONO 71. August 12, 2013. Honorable Louis H. Schiff, Judge. Counsel: Cindy A. Goldstein and Sadie E. Naveo, Law Office of Cindy A. Goldstein, PA, Coral Gables, for Plaintiff. Matt Hellman and Brett Roth, Matt Hellman, PA, Plantation, for Defendant.
This case was consolidated with another appeal and REVERSED AND REMANDED by the appellate panel of the 17th Circuit. The case number for this appeal was CACE13020672. The date of the opinion reversing this order is 2/15/2017.
FINAL JUDGMENT IN FAVOR OF DEFENDANT
This case came before the Court on July 29, on Defendant’s Motion for Final Summary Judgment pursuant to Florida Statutes § 627.736(5)(b)(1)(c) and Plaintiff’s Cross Motion for Summary Judgment and the Court hereby makes the following factual and legal findings:
An insurer does not owe Personal Injury Protection benefits for any of the bills when a medical provider knowingly makes a false or misleading statement in relation to its claims for PIP benefits. See Chiropractic One, Inc. v. State Farm Mut. Auto. Ins. Co., 92 So.3d 871 (Fla. 5th DCA 2012) [37 Fla. L. Weekly D1565a]. It is undisputed that Plaintiff knew that Dr. Diblase’s employment relationship with the Plaintiff ceased prior to July 23, 2012. Plaintiff also knew that Dr. Diblase did not provide treatment to Kerbeau Alcime for dates of service July 25, 2012 -to- September 12, 2012, and that Dr. Diblase did not sign, approve, or give the Plaintiff permission to use his name and license number to bill for dates of service July 25, 2012 -to- September 12, 2012. Based on the forgoing the Plaintiff, North Broward Health & Rehab, Inc., knowingly made false and misleading statements relating to the claim and charges therefore may not recover any personal injury protection benefits. Specifically, Plaintiff knowingly submitted HCFA forms (medical bills) for dates of service July 25, 2012 -to- September 12, 2012 and a physical therapy note for date of service July 25, 2012 to the Defendant, and thereby falsely represented to the Defendant that (1) Dr. Diblase continued to work for the Plaintiff after July 23, 2012, and that (2) Dr. Diblase provided treatment to Kerbeau Alcime for dates of service July 25, 2012 -to- September 12, 2012, and that (3) Dr. Diblase had signed, approved, or given the Plaintiff permission to use his name and license number to bill for dates of service July 25, 2012 -to- September 12, 2012. The Court rejects Plaintiff’s explanation that the HCFA forms and notes were erroneously submitted due to a billing software error. The Court finds that Dr. Diblase name being placed in Box 31 of the HCFA Forms along with his license number is the equivalent of an electronic signature. Based on above findings all Plaintiffs’ entire claim is barred for all bills submitted by the Plaintiff to the Defendant. Accordingly, Plaintiff’s Motion for Summary Judgment is hereby Denied and Final Summary Judgment is hereby entered in favor of the Defendant.
IT IS ADJUDGED that Plaintiff, North Broward Health & Rehab, Inc. (A/A/O Kerbeau Alcime), take nothing by this action and that the Defendant, State Farm Fire & Casualty Company, shall go hence without day. The Court reserves jurisdiction to determine Defendant’s entitlement to and award of attorney’s fees and costs.
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