Example 8
I have handled several cases that I successfully negotiated before a lawsuit was filed where State Farm pointed out that PA’s and ARNP’s owned clinics and billed PIP without having an AHCA license.
The PA’s and ARNP’s owned a primary care/urgent care clinic where they primarily billed health insurance and cash patients. Occasionally they would bill PIP insurance if an existing patient was in an auto collision. They didn’t know about Florida Statute 627.736(5)(h), which limits clinics that bill PIP to be wholly owned by MD’s, DO’s, Dentists, DC’s, hospitals, and a few other groups (see above for specifics).
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company; therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.