Only weeks after the Florida Senate passed an amended PIP law, businesses have begun to emerge offering “rent-an-M.D.” services to circumvent the 2012 Statute’s $2,500 cap on medical benefit reimbursement for chiropractic treatment.
The recently amended PIP law caps reimbursement to $2,500 for chiropractic treatment under ordinary circumstances. However, if an Insured both (1) receives treatment within 14 days in an ambulance or hospital, or with a physician, osteopathic physician, chiropractic physician or dentist and (2) has a physician, osteopathic physician, dentist, or a supervised physician’s assistant or advanced registered nurse practitioner determine that the insured has an “emergency medical condition,” then there are $10,000 in benefits available for chiropractic treatment.
Services are already beginning to emerge offering to send an MD or DO to chiropractic facilities to satisfy the “emergency medical condition” requirement of the new statute. One ad claims:
“Medical On Demand” can send a MD/DO to your facility to see your PIP patients. Our physician wil do assessments, fill out and sign forms that state the Insured has an emergency medical condition.
Follow FL PIP Guide for for additional updates on the changes and reactions to Florida’s recently amended PIP laws.
From the Palmetto Bay (Miami) News:
Each year, insurance fraud costs consumers an estimated $150 billion, an average of almost $1,000 per family in additional insurance premiums. Fraud specialists say well-organized criminal rings have set up phony clinics statewide and they have tracked how thieves stage accidents, and pay the so-called victims, hundreds of dollars.
The full article is available here.
Today Florida Chief Financial Officer Jeff Atwater announced rewards of $25,000 would be awarded to three Floridians who provided key information leading to arrests and convictions in five major insurance fraud cases. The information provided assisted the Florida Department of Financial Services Division of Insurance Fraud in uncovering almost $560,000 in fraudulent insurance billings leading to 10 arrests to date.
WTXL ABC in Tallahassee reported the rewards were:
- $10,000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner, recruiter and massage therapist all from the same clinic.
- $10,000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic. The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives.
- $5,000 was awarded to a citizen who provided detectives with assistance in uncovering a scheme to intentionally destroy a vehicle and making a fraudulent insurance claim.
The full article is available here.
Yesterday the United States 11th Circuit Court affirmed the lower court’s denial of class certification in DWFII Corporation v. State Farm. The Plaintiff, by way of a class action, filed suit against State Farm challenging State Farm’s use of the National Correct Coding Initiative (NCCI) edits. The 11th Circuit federal appellate court affirmed the Southern District’s ruling and found:
DWFII is unable to satisfy the typicality prerequisite of Rule 23(a).
Even if the class is able to show that NCCI edits are impermissible under FLA.
STAT. § 627.736 et seq., each individual medical service provider in the class must
still demonstrate that it is entitled to reimbursement for the disputed charges—i.e.,
the bill was properly completed pursuant to FLA. STAT. § 627.736(5)(b)(1)(d), the
benefits of the insurance plan were not exhausted at the time of the procedure, the
recipient of the medical services had valid insurance coverage with State Farm,
and the medical provider actually performed the services for which it billed.
Furthermore, State Farm is entitled to present any unbundling or set off defenses
that would allow it to properly reduce the amount of reimbursement due. FLA.
STAT. § 627.736(5)(b)(1)(e). Because each claim would require the establishment
of different facts and would be subject to different defenses, we conclude that the
district court did not abuse its discretion in finding that this prerequisite was not
met and class certification was therefore improper.
The entire order is available here: DWFII v. State Farm (11th Cir).
The March, 2012 Florida Diviision of Insurance Fraud “PIP Source” is now available.
This month’s topics include:
- Charges being filed against an Orlando chiropractor and 2 others in an attempt to create a “straw” ownership situation to skirt Florida’s licensing laws.
- Clinic owner and 5 others arrested for staged accidents, claims neared $200,000.00
- Miami police initiative to crackdown on falsified insurance cards
The complete PIP Source is available here: Florida “PIP Source” – March, 2012.
John Askins, the former head of the Florida Division of Insurance Fraud, spend the first 24 years of his career in Miami investigating staged accidents, falsified injury claims, and other auto insurance fraud. Here are his comments from a recent interview with the Broward-Palm Beach New Times:
Broward-Palm Beach New Times Interviews John Askins
Today Florida Chief Financial Officer Jeff Atwater announced that after a two year investigation, 15 arrests were made in an alleged $600,000 insurance fraud involving Miami food trucks used to stage accidents. The alleged fraud involved the owners of the lunch trucks recruiting participants to stage auto accidents. Officials report that more than a dozen accidents between 2008 and 2010 were a result of the Miami food truck fraud ring. Additional arrests are expected.
Those arrested include: Armando Alonso, Yordan Martin Mata, Yanet Soriano, Dunaikis Roche, April Caridad Sequinot, Alberto Paz Hernandez, Yoandris Benitez, Eduardo Alonso Castellanos, Lucia Amigot, Alicia Iris Laurenco Cuesta, Ivan Silva, Robert Jabani Hinklein, Abraham Alliegro, Evelyn Yero Noy and Jesus Iluminado Guerrero.
Yoandris Benitez surrendered today.