26 Fla. L. Weekly Supp. 30b
Online Reference: FLWSUPP 2601GANDInsurance — Personal injury protection — Discovery — Failure to comply — Sanctions — Where medical provider seeking reimbursement for non-prescription drug did not comply with multiple court orders compelling it to respond to discovery and provide drug cost invoice to insurer, sanctions are imposed, and insurer’s motion for summary judgment is granted
THORPE CHIROPRACTIC & REHAB CENTER (a/a/o Gussie Anderson), Plaintiff, v. FIRST ACCEPTANCE INSURANCE COMPANY, INC., Defendant. County Court, 6th Judicial Circuit in and for Pinellas County. Small Claims Division. Case No. 15-10717-SC SOUTH. February 20, 2018. Lorraine M. Kelly, Judge. Counsel: T. Roger White, White & Twombly, for Plaintiff. Steven T. Sock, Dutton Law Group, Tampa, for Defendant.
ORDER ON DEFENDANT’S THIRD RENEWED MOTIONTO DISMISS FOR CONTEMPT OF COURT AND/ORMOTION FOR SUMMARY JUDGMENT AND FOR SANCTIONS
THIS CAUSE having come before the Court upon Defendant’s Third Motion to Dismiss for Contempt of Court and/or Motion for Summary Judgment and for Sanctions, and argument having been heard by this Court on February 14, 2018, having been fully advised in the premises, it is ORDERED AND ADJUDGED that:
1. Plaintiff filed suit for payment of a medical bill submitted to the Defendant for payment under Personal Injury Protection (PIP) benefits. Plaintiffs service was coded on the bill as CPT A9150 for a non-prescription drug.
2. Defendant responded to the bill with an Explanation of Review (EOR) advising Plaintiff “Provide invoice showing cost for reimbursement.”
3. The Florida PIP Statute under §627.736 provides for reimbursement limited to 80 percent of 200 percent of the allowable amount under Medicare Part B fee schedule, or if not reimbursable under Medicare Part B, limited to 80 percent of the maximum reimbursable allowance under workers’ compensation. A9150 does not appear on the payment schedule charts of Medicare Part B or Workers’ Compensation, however the Workers’ Compensation Health Care Provider Reimbursement Manual provides for over-the-counter drugs that the dispensing practitioner shall submit an invoice to the insurer that includes the cost of the drugs and that reimbursement shall be made at the providers charge or an amount not to exceed 20 percent above the actual cost of each drug furnished.
4. Plaintiff at no time provided a copy of the cost invoice to the Defendant.
5. Defendant’s Motion for Summary Judgment is GRANTED.
6. Defendant’s Motion for Sanctions is GRANTED.
7. Plaintiff shall pay sanctions in the amount of $500.00 each for two of three Court Orders that went disregarded compelling Plaintiff to respond to discovery and provide a copy of the cost invoice for the non-prescription drug billed as A9150.
8. Plaintiff shall pay the sanction in the total amount of $1,000.00 to the Florida Bar Foundation for legal aid fund (https://thefloridabarfoundation.org/donate/).
9. The Court reserves jurisdiction to consider all matters ancillary hereto.
10. Defendant shall go hence without day. Plaintiff shall take nothing from this action. The Court reserves jurisdiction to determine the amount of taxable fees and costs to award the Defendant
