24 Fla. L. Weekly Supp. 753a
Online Reference: FLWSUPP 2409BEADInsurance — Personal injury protection — Coverage — Where Centers for Medicare and Medicaid Services instructed Medicare contractors to reprocess Medicare claims retroactive to 2010 in manner that would result in increase in Medicare reimbursements under revised payment files, PIP insurer that has elected to reimburse claims in accordance with permissive statutory fee schedule cannot pay less than 200% of Medicare fee schedule, including revised payment files retroactive to 2010
FLORIDA WELLNESS & REHABILITATION CENTER, INC. a/a/o Frank Beades, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 14-10555 COCE 55. May 22, 2015. Daniel J. Kanner, Judge. Counsel: Matthew C. Barber, Landau & Associates, P.A., Hallandale Beach, for Plaintiff. Jody Tuttle, for Defendant.
ORDER ON PLAINTIFF’S MOTIONFOR SUMMARY JUDGMENT ASTO PRICING AND FEE SCHEDULE
THIS CAUSE having come on to be heard on Plaintiff’s Motion for Summary Judgment, the Court having been otherwise fully advised in the premises and by consideration of arguments on May 14, 2015, the Record, legal authorities and the file, it is hereby,
ORDERED AND ADJUDGED:
1. Plaintiff’s Motion for Summary Judgment is GRANTED IN PART.
2. This Court will not disturb the prior trial court’s ruling entered on April 24, 2014. Therefore, a portion of the Motion for Summary Judgment will be treated as Plaintiff’s Motion for Rehearing and/or Reconsideration, which is hereby DENIED.
3. This Court does find that Plaintiff is entitled to an additional $19.07, which is 80% of the minimum allowable under the No-Fault Law (i.e. Fla. Stat. 627.736(5)(a)2 (2010).
4. The record, memos, press releases, undisputed facts and arguments show that the Centers for Medicare and Medicaid Services (“CMS”) instructed Medicare contractors to reprocess Medicare Part B claims retroactive to January 1, 2010, which would result in an increase in Medicare Part B reimbursements under revised payment files. State Farm argues that the CMS instruction to retroactively increase the allowable amount under Medicare Part B applies only to Medicare contractors and Medicare claims. Plaintiff argues and this Court agrees that State Farm decided to pay the allowable amounts under Fla. Stat. 627.736(5)(a)2, which is 200% of Medicare. State Farm is bound to its payment of the claim to the minimum statutory allowable of 200% of Medicare Part B participating physicians fee schedule.
5. State Farm cannot pay less than 200% of Medicare Part B participating physicians fee schedule, including the revised payment files which applied retroactively to January 1, 2010.
