26 Fla. L. Weekly Supp. 521c
Online Reference: FLWSUPP 2606LANNInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit and deposition filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant, whose statement that he always attempted to charge near or at 200% of Medicare fee schedule is rebutted by own charges, is not qualified to render opinion on reasonableness of charges
PETRIE CHIROPRACTIC LIFE CENTER a/a/o Allan Lanni, Plaintiff(s) / Petitioner(s), v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant(s) / Respondent(s). County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE15010573, Division 50. August 1, 2018. Mardi Levey Cohen, Judge. Counsel: Nathan J. Avrunin and Emilio R. Stillo, for Plaintiff. Ananta Rampersad and Jessica Martin, for Defendant.
ORDER ON PLAINTIFF’S MOTION FOR SUMMARYJUDGEMENT ON REASONABLENESS OF CHARGES
THIS CAUSE came before the Court on July 16, 2018 for hearing on Plaintiff’s Motion for Summary Judgment as to Reasonableness of Charges. The Court having reviewed the entire Court file; the relevant legal authorities; having heard argument of counsel; having made a thorough review of the matters filed of record including those filed by both the Defendant and the Plaintiff; and having been sufficiently advised in the premises, the Court finds as follows:
The Plaintiff is a chiropractic office that provided medical services to the claimant as a result of an automobile accident of December 9, 2011. The Plaintiff submitted bills from December 19, 2011 through March 22, 2012 totaling $2,875.00. At 80% the Plaintiff expected to be reimbursed $2,300.00. The Defendant reduced the Plaintiff’s bills to 200% of Medicare and reimbursed the Plaintiff $1,474.55. The Plaintiff maintains that the amount of the charges they submitted are reasonable and filed the instant lawsuit to recover the difference between the amount billed and the amount reimbursed. The Defendant has stipulated that the services rendered by the Plaintiff were necessary and related to the automobile accident and that the only issue that exists is whether the Plaintiff’s charges are reasonable in price. The parties in this matter also agree that the policy applicable to this claim did not specifically adopt the Fee Schedule as the payment methodology but rather based reimbursement on what is reasonable.
In support of its Motion for Summary Judgment the Plaintiff has attached the affidavit of Dr. Michael Petrie, D.C. who is a chiropractic physician for Plaintiff as well as the owner and corporate representative. Dr. Petrie testifies that he is the person responsible for determining the charges for the medical services in the instant case. He states that it is his responsibility to ensure that the charges submitted for he services at issue were reasonable and within the usual and customary range for the same geographical area. He states this was done in part by doing a market survey of various medical providers that are located in Broward County Florida that provide the same medical services in his geographical area. He states that he had been reimbursed without reduction to his billed amount from other PIP insurers whose policies did not adopt the permissive 200% of Medicare payment methodology. In fact, Dr. Petrie had been reimbursed at this same billed amount for these same CPT codes from this same Defendant during this same time period. He attaches to his affidavit Explanations of Review from this same Defendant wherein State Farm had reimbursed Plaintiff for the same CPT codes at the same billed amount as in this case, for treatment he rendered during the same time period, without reduction.
Florida Rule of Civil Procedure 1.510(b) provides that a party is entitled to summary judgment “if the pleadings, depositions, answers to interrogatories, and admissions on file together with affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of laws.” It is a well settled principle of law that a movant for summary judgment has the initial burden of demonstrating the nonexistence of a genuine issue of material fact. Ramos v. Write Superior Inc., 610 So.2d 46 (Fla. 3rd DCA 1992). In determining whether there are any genuine issues of material fact, all inferences are viewed in favor of the nonmoving party and the moving party must conclusively show that there are no genuine issues of material fact. Holl v. Talcott, 191 So.2d 40 (Fla. 1996). Once a moving party tenders competent evidence to support its motion for summary judgment, the opposing party must come forward with counter-evidence sufficient to reveal a genuine issue of material fact. Landers v. Milton, 370 So.2d 368 (Fla. 1979). It is not enough for the opposing party to merely assert that an issue does exist; the opposing party must present admissible evidence to support its claim. Page v. Staley, 266 So.2d 129, 130 (Fla. 4th DCA 1969); Magma Trading Corp. v. Lintz, 727 So.2d 377 (Fla. 5th DCA 1999) [24 Fla. L. Weekly D616a]. Kolnick v. Fountainview Ass’n, 737 So.2d 1192 (Fla. 3rd DCA 1999) [24 Fla. L. Weekly D1695b]; See also Martin Cnty. V. Edenfield, 609 So.2d, 29 (Fla. 1992); Harvey Building, Inc. 175 So.2d 780 (Fla. 1965); Farrey v. Betterndorf, 96 So.2d 889 (Fla. 1957); Soper v. Stine, 184 So.2d 892 (Fla. 2nd DCA 1966).
The affidavit of Dr. Petrie establishes a prima facie case that the services rendered by Plaintiff to claimant were reasonable in price and were actually provided. The introduction of the medical bills into evidence, along with testimony that his services were actually rendered, satisfies the Plaintiff’s prima facie burden on the reasonableness of the charges. Pan Am Diagnostic Services, Inc. (a/a/o Fritz Telusma) vs. United Auto. Ins. Co., 21 Fla. L. Weekly Supp. 200a (Judge Robert W. Lee, 17th Cty. Ct. 2013); See A.J. v. State, 677 So.2d 935, 937 (Fla. 4th DCA 1996) [21 Fla. L. Weekly D1677e]; Iowa Mutual Nat’l Ins. Co. v. Worthy, 447 So.2d 998, 1000 n.5 (Fla. 5th DCA 1984); Polaco v. Smith, 376 So.2d 409, 409-10 (Fla. 1st DCA 1979). “A plaintiff, may, but is not required to, produce an expert witness to establish the reasonableness of its charges.” Pan Am Diagnostic Services, Inc. (a/a/o Fritz Telusma) vs. United Auto. Ins. Co., 21 Fla. L. Weekly Supp. 200a (Judge Robert W. Lee, 17th Cty. Ct. 2013) citing Sea World of Florida, Inc. v. Ace American Ins. Co., Inc., 28 So.3d 158, 160 (Fla. 5th DCA 2010) [35 Fla. L. Weekly D361a]; Canseco v. Cheeks, 939 So.2d 1122, 1123 (Fla. 3d DCA 2006) [31 Fla. L. Weekly D2485a]; A.J., 677 So.2d at 937-38; East West Karate Assn, Inc. v. Riquelme, 638 So.2d 605, 605 (Fla. 4th DCA 1994); State Farm Mutual Auto. Ins. Co. v. Multicare Medical Group, Inc., 12 Fla. L. Weekly Supp 33a, 33 (11th Circuit Ct. 2004, Appellate); Kompothrecas v. Progressive Consumers Ins. Co., 8 Fla. L. Weekly Supp. 505a, 506 (Sarasota Cty. Ct. 2001).
The Defendant filed an affidavit and an amended affidavit of Dr. Michael Mathesie, D.C. in opposition to Plaintiff’s motion. Both parties also filed the deposition of Dr. Mathesie taken in this case. In his affidavits, Dr. Mathesie opines that the Defendant’s reimbursements were reasonable. He states in his affidavits that he “always attempted to be near or at the 200% of Medicare Fee Schedule considering that amount would be the highest reasonable amount to charge. . . .” However, in reviewing what Dr. Mathesie charged in 2011-2012 with the amounts reimbursed by Defendant Dr. Mathesie’s charges for certain CPT codes are higher than Defendant’s reimbursements in this case.
Florida Rule of Civil Procedure 90.702 states that, “If scientific, technical, or other specialized knowledge will assist the trier of fact in understanding the evidence or determining a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training or education may testify it in the form of an opinion or otherwise, if: (1) The testimony is based upon sufficient facts or data; (2) The testimony is the product of reliable principles and methods; and (3) The witness has applied the principles and methods reliably to the facts of the case.”
Based on his credentials, it appears that Dr. Mathesie would qualify as an expert regarding whether chiropractic treatments and services would be appropriate and necessary for a person who has suffered injuries in an automobile accident. However, that is not at issue in the instant case as those issues have already been stipulated to. Rather, Dr. Mathesie has been tendered as an expert to render an opinion on the reasonableness of Plaintiff’s charges. Regarding pricing, the testimony of Dr. Mathesie through his affidavits and deposition do not demonstrate that they are based on sufficient facts or data, do not demonstrate that the testimony is the product of reliable principles and methods, and therefore the witness cannot show that he has applied the principles and methods reliably to the facts of the case.
The Court cannot consider Dr. Mathesie as an expert regarding pricing for PIP charges in 2011-2012 and therefore cannot consider his testimony as it relates to pricing which is the sole issue in this matter. Therefore, the Defendant has not put forth any testimony that creates a material issue of fact.
Based upon the foregoing, it is hereby ORDERED AND ADJUDGED that Plaintiff’s Motion for Partial Summary Judgment regarding reasonableness is GRANTED. The Court finds that the Plaintiff’s charges are reasonable in price.
