26 Fla. L. Weekly Supp. 238b
Online Reference: FLWSUPP 2603JLUMInsurance — Personal injury protection — Coverage — Medical expenses — Licensed massage therapist services provided on behalf of a non-LMT owned and duly licensed healthcare clinic are compensable and reimbursable as PIP benefits under section 627.736(1)(a)(5)
NORTH MIAMI THERAPY CENTER, INC. (a/a/o Jacques Lumas), Plaintiff, v. GEICO GENERAL INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 14-014129 COCE (54). April 4, 2018. John D. Fry, Judge. Counsel: Susan Guller, The Law Office of Justin G. Morgan, P.A., Weston, for Plaintiff. George Gomez, Herssein Law Group, North Miami, for Defendant.
ORDER ON GEICO’S MOTION FOR SUMMARY JUDGMENTON LMT SERVICES BEING NON-REIMBURSABLE AND ONPLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENTON LMT BILLED SERVICES AS REIMBURSABLE,MEDICAL NECESSITY AND RELATEDNESS
THIS CAUSE came before this Honorable Court on February 26, 2018 for hearing on Plaintiff’s Motion for Final Summary Judgment on LMT Billed Services as Reimbursable, Medical Necessity and Relatedness, and Defendant’s Motion for Summary Judgment on LMT Services Being Non-Reimbursable. The Court, having reviewed the pleading, and relevant legal authorities, and having heard argument of counsel, finds as follows:
FACTS AND PROCEDURAL HISTORY
1. On or about July 25, 2014, Plaintiff, North Miami Therapy Center, Inc. (a/a/o Jacques Lumas), filed this PIP lawsuit, alleging that Plaintiff was owed further reimbursement for treatment allegedly rendered to the insured for dates of service October 22, 2013 through February 27, 2014.
2. On October 6, 2014, GEICO filed its Answer and Affirmative Defenses to Plaintiff’s Complaint, raising an Affirmative Defense alleging that the services at issue were rendered by a Licensed Massage Therapist and that pursuant to Fla. Stat. § 627.736 (1)(a)(5), medical benefits do not include services provided by a Licensed Massage Therapist, and that resultantly Plaintiff was not entitled to the payment of benefits under the Policy at issue.
3. Plaintiff’s reply, responses to discovery, and deposition testimony reflect Plaintiff’s assertions that 1) Fla. Stat. § 627.736 (1)(a)(5) only precludes Licensed Massage Therapists from being reimbursed for massage, which was withdrawn in this matter and 2) that the entity seeking payment in this matter is not a Licensed Massage Therapist but an incorporated health clinic, separate and distinct from the persons comprising it. It is undisputed that the services for which Plaintiff was not reimbursed were those rendered by a Licensed Massage Therapist.
ISSUE BEFORE THE COURT
4. The issue before this Court is whether the Defendant insurer properly denied the Plaintiff provider’s bills on the basis of Florida Statute §627.736(1)(a)(5) and the subject insurance policy, which incorporates said statute. Florida Statute §627.736(1)(a)(5) reads in pertinent part Medical benefits do not include massage. . .regardless of the person, entity, or licensee providing massage. . .and a licensed massage therapist may not be reimbursed for medical benefits under this section.” [emphasis added]
RATIONALE AND AUTHORITIES IN SUPPORT OF RULING
5. Summary judgment is granted in favor of Plaintiff as there are no genuine issues of material fact in dispute, and Plaintiff is entitled to a judgment as a matter of law. Based on the evidence presented through the deposition testimony and affidavits on file, the Court finds that the Licensed Massage Therapist (LMT) services billed by Plaintiff are compensable and reimbursable as PIP benefits pursuant to §627.736(1)(a)(5), Fla.Stat.
6. Plaintiff established its prima facie case on the bills being related and medically necessary through filing the Affidavits of its Billing Clerk and Records Custodian, Claude Jules, attaching the Assignment of Benefits and bills at issue, and by filing the Affidavit of the treating Chiropractor, Dr. Robert Gordon, who attested to the treatment being both medically necessary and related to the accident at issue. Moreover, Defendant stipulated to medical necessity and relatedness at the hearing.
7. The remaining issue regarding LMT billed services is a matter of first impression for this Court as to whether LMT services provided on behalf of a non-LMT owned, and duly licensed healthcare clinic, are reimbursable under §627.736(1)(a)(5), Fla.Stat.
8. The legal issue, as framed by this Court, is whether a LMT can perform medical services under the direction of a doctor or other medical provider and subsequently seek compensation on behalf of a corporate business entity that employs the LMT, even though the statute states that LMT’s may not be reimbursed for medical benefit under the statute.
9. The Court finds that these services, performed by a LMT, and billed by Plaintiff are compensable and reimbursable as PIP benefits pursuant to §627.736(1)(a)(5), Fla.Stat.
10. The Court finds that if the Defendant’s position were extended to its logical conclusion, even a medical doctor could not bill for the services Defendant alleges that a LMT could not be reimbursed for. Moreover, in this case, the LMT was acting under the authority of a medical professional, and the services performed by the LMT are reimbursable.
11. Moreover, the fact that an LMT performed the therapies at issue does not change the fact that the services provided and billed by Plaintiff, found to be medically necessary and related, are reimbursable under the Statute’s plain meaning.
12. Plaintiff had previously withdrawn from consideration CPT Code 97124 for massage therapy, so this service was not at issue.
13. Plaintiff set forth, through Dr. Gordon’s Affidavit, that the remaining CPT Codes at issue provided by the LMT, were not massage therapy. Defendant filed nothing to oppose this. Defendant filed nothing in opposition to any of the treatment falling into the statutory definition of massage, and even conceded in its pleadings that it was not raising massage as an issue for purposes of summary judgment. See page 4 of Defendant’s 12/20/17 Response in Opposition to Plaintiffs Motion for Final Summary Judgment on LMT Billed Services as Reimbursable, Medical Necessity, and Relatedness.
14. Defendant’s Motion for Summary Judgment Based on LMT Services a Non-Reimbursable is hereby DENIED.
15. Plaintiff stipulated to reasonableness based upon the Medicare Fee Schedule/Workers Compensation Fee Schedule.
16. Plaintiff is owed PIP benefits for all bills at issue reduced pursuant to said schedules, plus reasonable attorney’s fees and costs.
