18 Fla. L. Weekly Supp. 612c
Online Reference: FLWSUPP 1807LLAN
Insurance — Personal injury protection — Attorney’s fees — Justiciable issues — Attorney’s fees are awarded to prevailing insurer where medical provider knew or should have known that claim for inappropriately unbundled service was not supported by then existing law
SENPRI MEDICAL CENTER, INC., a/a/o CARLOS LLANOS, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 09-CC-032088, Division J. April 26, 2011. Honorable Gaston J. Fernandez, Judge. Counsel: Joseph Gleason, Gonzalez & Associates, Brandon, for Plaintiff. Joseph G. Sapp, Oxendine & Oxendine, P.A., Tampa, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION TO TAX ATTORNEY’S FEES AND COSTS PURSUANT TO§57.105, FLORIDA STATUTES
[Editor’s note: Final judgment published at 17 Fla. L. Weekly Supp. 1116b]
THIS CAUSE, having come before the Court on March 29, 2011, on Defendant’s Motion to Tax Attorney’s Fees and Costs pursuant to Florida Statute §57.105, and after hearing argument of counsel, and being otherwise fully appraised in the premises, it is hereby:
ORDERED AND ADJUDGED:
1. That Defendant’s Motion to Tax Attorney’s Fees and Costs pursuant to Florida Statute §57.105 is GRANTED.
2. That Plaintiff SENPRI MEDICAL CENTER, INC. a/a/o CARLOS LLANOS, knew or should have known that its personal injury protection (PIP) breach of contract claim for CPT code 97124 which was billed with CPT code 97140 on multiple occasions for the same patient for the same date of service, in violation of the National Correct Coding Initiative (“NCCI”) comprehensive edits database, was not supported by then existing law. Pursuant to Tran Chiropractic & Wellness Center, Inc. a/a/o Leadbetter v. State Farm, 16 Fla. L. Weekly Supp. 396a (13th Cir. App. 2009), one would anticipate that when services are inappropriately unbundled the insurer would do exactly as they did in this case, which is to deny the lesser code in favor of a bundled service code that includes the other services. In this case, the lesser component CPT code 97124 was denied in favor of comprehensive CPT code 97140. See also: Cega Stress & Esthetic Center, Inc. a/a/o Nataly Velez, v. State Farm, 17 Fla. L. Weekly Supp. 471b (Fla. Hillsborough Cty. Ct. March 30, 2010).
3. That this Court reserves jurisdiction as to the determination of the reasonable amount of attorney’s fees and costs to which Defendant is entitled.
