22 Fla. L. Weekly Supp. 837a
Online Reference: FLWSUPP 2207FERRInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Medicare and TriCare fee schedules filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges — Medical provider is not required to provide expert testimony regarding reasonableness of medical bills; prima facie showing of reasonableness can be established by presenting bills along with testimony that services were provided to insured
FLORIDA WELLNESS & REHABILITATION CENTER, INC., (a/a/o Jose Ferrer), Plaintiff(s), vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant(s).County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 12-23462 SP 25 (03). August 7, 2014. Patricia Marino Pedraza, Judge. Counsel: Martin I. Berger, Berger & Hicks, P.A., Miami, for Plaintiff. Andrea Mack, Goldstein Law Group, Ft. Lauderdale, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORSUMMARY JUDGMENT AND FINAL JUDGMENT
This cause came before the Court on July 29, 2014, on Plaintiff’s Motion for Summary Judgment. The Court, having reviewed the motions and entire Court file, heard argument of counsel, reviewed relevant legal authority, and been otherwise advised in the premises, makes the following findings of fact and conclusions of law:Findings of Facts
The material facts in this case are not in dispute. Jose Ferrer was involved in a motor vehicle accident on January 26, 2010, while in a vehicle insured by Defendant, State Farm Mutual Automobile Insurance Company. The policy in effect provided for personal injury protection (“PIP”) coverage under the Florida No Fault Statute. It is undisputed that Mr. Ferrer received services from Plaintiff. The subject policy of insurance required Defendant to pay 80% of all reasonable expenses. Defendant issued payment to Plaintiff for its services at 80% of 200% of participating physician’s fee schedule of Medicare Part B and, where applicable, the maximum reimbursable allowance under workers’ compensation. The amount in controversy is the difference between 80% of the billed amount and the paid amount. The parties previously stipulated to relation and medical necessity, therefore Plaintiff’s motion is moot as to those issues.Conclusions of Law
There is only one issue for the Court’s determination; namely, whether summary judgment should be granted regarding the reasonableness of Plaintiff’s charges. The Court answers in the affirmative and grants Plaintiff’s Motion for Summary Judgment as to reasonableness.
In support of its Motion for Summary Judgment, Plaintiff filed the Affidavit of Roy Canizares, D.C., Plaintiff’s medical director. Plaintiff stipulated that Dr. Canizares is not being presented as an expert regarding reasonableness for the purposes of the summary judgment. Dr. Canizares testifies Mr. Ferrer received services from Plaintiff and that Plaintiff’s charges are reasonable because they are within the range of usual and customary charges for the community in which Plaintiff operates, and are indicative of previous amounts Plaintiff has accepted from other insurers. The Court finds that the Affidavit of Roy Canizares, D.C. satisfies Plaintiff’s burden of production as to the reasonableness of its charges. It is not necessary for a plaintiff to provide expert testimony regarding the reasonableness of its medical bills. See State Farm Mutual Auto. Ins. Co. v. Multicare Medical Ctr. Inc. et. al., 12 Fla. L. Weekly Supp. 33a (Fla. 11th Cir. App. 2004); see also Pan Am Diagnostic Services, Inc. a/a/o Fritz Telusma v. United Auto. Ins. Co., 21 Fla. L. Weekly Supp. 200a (Broward Cty. Ct. Oct. 1, 2013). Reasonableness can be established through lay witness testimony. Additionally, a prima facie showing of reasonableness can also be established by merely presenting the bills for the services at issue along with testimony that those services were provided to the patient. See id.
The Court must now consider any evidence filed by Defendant in opposition to Plaintiff’s Motion. Defendant did not file any Affidavits or other record evidence that disputed the reasonableness of Plaintiff’s charges. The only items filed by Defendant were the Medicare Part B fee schedule and the TriCare fee schedule. The filing of fee schedules alone does not create a dispute of fact with regard to the reasonableness of Plaintiff’s bill. See generally Atkins v. Allstate Ins. Co., 382 So. 2d 1276 (Fla. 3d DCA 1980) (holding that Medicare is a social insurance to aid the general welfare and cannot be analogized to any type of medical insurance program or medical reimbursement plan); State Farm Mutual Auto. Ins. Co. v. Imaging Center of Pensacola, Inc. a/a/o Anthony Perkins, Case No. 2012-AP-000052 (Fla. 1st Cir.App. 2014) [21 Fla. L. Weekly Supp. 979a] (holding that fee schedules cannot be the sole basis for the “reasonable amount” determination). Therefore, Defendant has not come forward with any evidence demonstrating that Plaintiff’s charge is not reasonable.
Accordingly, it is ORDERED and ADJUDGED, that Plaintiff’s Motion for Summary Judgment is hereby GRANTED.
In accordance with this Order Granting Plaintiff’s Motion for Summary Judgment, Defendant, State Farm Mutual Automobile Insurance Company, shall pay Plaintiff, Florida Wellness & Rehabilitation Center, Inc., the sum of $3,190.53 in benefits and $743.31 in interest for a total recovery of $3,933.84, that shall bear interest at the rate of 4.75% per year, for which let execution issue. Additionally, this Court holds that Plaintiff, as the prevailing party to Count I of its Complaint is entitled to its reasonable attorney’s fees under Florida Statute § 627.428 and Florida Statute § 627.736(8) and costs pursuant to Fla. Stat. § 92.231 and Fla. Stat. § 57.041. This Court retains jurisdiction over this matter to determine the amount of attorney’s fees owed to the Plaintiff by the Defendant.
