Tag Archives: PIP insurance

Two More Join Class Action Suit Alleging Excessive Billing in PIP Claims at Florida Hospitals

In September, we reported on our FL-PIP Guide about two women injured in unrelated car accidents filing suit against a holding company that operates several hospitals in Florida. Marisela Herrera and Luz Sanchez alleged that HCA Holdings grossly overcharged for their emergency room radiological services.

Now two more Florida residents have joined the lawsuit in an amended class action that alleges Memorial Hospital Jacksonville, North Florida Regional Medical Center of Gainesville, JFK Medical Center, and parent company HCA have violated Florida’s Deceptive and Unfair Practices Act, according to a GlobeNewswire story.

Nicholas Acosta and Penny Wollmen, the new plaintiffs, also claim they were excessively billed and charged unreasonable fees for emergency radiological services covered in part by the plaintiffs’ Florida Personal Injury Protection (PIP) insurance. Florida’s PIP statute mandates that insurers pay 80 percent of all reasonable expenses.

However, Acosta was charged $6,965 for a CT scan of his spine and $6,277 for a CT scan of his brain after he was treated in the ER of Memorial Hospital in October 2013 following a car accident. After Wollmen’s accident in February 2014, she was billed $6,853 for the CT scan of her cervical spine, $6,140 for the CT scan of her brain, and $1,454 for a thoracic spine X-ray by North Florida Regional Medical Center.

Because of the allegedly inflated expenses, the complaint claims that each of the plaintiff’s $10,000 PIP coverage was prematurely depleted and that they were billed thousands of dollars for radiological services not paid for by their PIP insurers.

As a result, plaintiff Wollmen, for example, has been paying out-of-pocket expenses for additional chiropractic treatment that normally would have been at least partially covered by her PIP insurance if it had not been used up by hospital bills.

The complaint also charges breach of contract. All four plaintiffs technically entered into a “Condition of Admission” contract that stipulates patients must pay their accounts at the rates stated in the hospital’s price list.  None of the plaintiffs were given a price list at the time of their medical treatment.

The amended class action lawsuit was filed October 15, 2014, in U.S. District Court Middle District of Florida, Tampa Division.

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Filed under Insurance Fraud

JFK Medical Center Target of Lawsuit Alleging Excessive Billing in PIP Claims

Two women injured in unrelated 2013 car accidents have filed suit in Hillsborough County Circuit Court against a holding company that operates several hospitals in Florida, according to an article in The Tampa Tribune. The women allege that HCA Holdings grossly overcharged for emergency room radiological services.

The plaintiffs claim that the alleged overcharging harmed them in two ways:

  • First, because PIP covers only 80% of emergency medical care, they were left to pay 20% of the inflated charge.
  • Second, the excessively high rates prematurely sapped their $10,000 PIP benefits, leaving them each to pay the remainder of the costs.

One of the women, Marisela Herrera of West Palm Beach, underwent CT scans and x-rays at JFK Medical Center in Atlantis following her traffic accident. (JFK Medical Center is owned by HCA; it is the only HCA medical facility specifically named in the suit). The images done at JFK allegedly cost Herrera nearly $18,000. Plaintiffs say Medicare would typically pay only $465 for the same number and type of images.

Florida’s PIP statute mandates that insurers pay 80% of all reasonable expenses. Such exorbitant charges, plaintiffs allege, are well in excess of this reasonable amount. These charges form the basis of the plaintiffs’ claim that they were victims of “unreasonable, unconscionable and unlawful pricing and billing practices.”

The lawsuit seeks reimbursement for the plaintiffs of the out-of-pocket expenses due to the “excessive and artificially inflated medical bills.” Plaintiffs also request that the court prohibit HCA from charging those fees and order it to stop efforts to collect outstanding emergency radiological bills. The lawsuit seeks class-action certification.

The case brought by Ms. Herrera is Herrera, Marisela v. JFK Medical Center Limited Partnership, Case No. 14-CA-008372, filed on 8/18/14 in Hillsborough County Circuit Court.

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Filed under Insurance Fraud

Court Rules for Progressive in Health Care Clinic Licensing Dispute

On July 29, 2014, the 13th Judicial Circuit Court for Hillsborough County granted final judgment in favor of Progressive Insurance in a case involving licensure violations by defendant health care clinic Best Medical. The defendant did not undertake a defense.

The following facts were undisputed:

  • Best Medical listed licensed massage therapist Jorge Romero as its 100% owner;
  • Romero did not actually own Best Medical, but was paid $2,000 a month for the right to use his credentials and claim that he was the owner;
  • Best Medical obtained a certificate from the State of Florida exempting it from licensure as a health care clinic by utilizing Romero’s credentials; and,
  • Progressive paid Best Medical PIP reimbursements in excess of $97,000 in response to bills submitted.

In his analysis of the case, Judge James Arnold noted that the Florida PIP statute requires that medical services be lawfully rendered and the corresponding bills be lawfully submitted to be valid. Additionally, the statute provides an insurer, such as Progressive, the right to challenge potential licensure violations, including the ownership of a clinic.

Florida’s Health Care Clinic Act requires that all medical clinics operating in Florida be licensed unless they are exempted. Relevant here is that a clinic “wholly owned by one or more licensed health care practitioners” is exempt from licensure.

The facts showed, however, that Romero was never the 100% owner of Best Medical. The clinic was therefore not entitled to the exemption for being wholly owned by a licensed health care practitioner.

Lacking a lawful exemption, Best Medical was required to possess valid licenses pursuant to the Health Care Clinic Act. Because it possessed no such licenses, Best Medical lacked the ability to lawfully render medical services and lawfully submit corresponding bills as required by Florida’s PIP statute.

Accordingly, Progressive was held not liable for payment of the bills rendered by Best Medical for reimbursement of purported medical services.

The case is Progressive v. Best Medical Healthcare Solution (f/k/a Tropical Healing Power), Case No. 14-CA-000327 Div. J (July 29, 2014). Click on the link to read the Final Judgment.

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Filed under Case Law

Uninsured Motorists Declining but Still a Concern in Florida, New Study Finds

A new study released by the Insurance Research Council (IRC) found that the estimated percentage of uninsured motorists has been in decline since 2010. According to the organization’s latest report, “Uninsured Motorists, 2014 Edition,” 14.9 percent of drivers were uninsured in 2003, but that figure dropped to 12.6 percent in 2012. That’s about one in eight drivers on the road who are uninsured, according to the study’s most recent data.

The study’s numbers were figured based on a ratio of insurance claims made by individuals who were injured by uninsured drivers to claims made by those who were injured by drivers who had insurance.

Although there is an overall downward trend nationwide, the IRC has broken the percentages down by numbers for each state and discovered great variation. Nationally, the number of uninsured drivers peaked at 29.9 million in 2009 and moderately declined to 29.7 million in 2012.

In terms of states, Florida ranked second in the highest total number of uninsured drivers with 3.2 million. California ranked highest with 4.1 million, while Texas followed Florida with 1.6 million, the report found.

The study also revealed that Florida ranked high in terms of the estimated percentage of uninsured motorists per state. That number is highest in Oklahoma at 26%, followed by Florida (24%) and then, Mississippi (23%).

The “Uninsured Motorists” study also analyzed the total number of uninsured motorist claim payments and found that amount has climbed drastically in spite of an overall drop in the number of uninsured drivers.

Not counting fatalities and total permanent disability claims, the IRC estimates that $2.6 billion was paid in the U.S. on 2012 uninsured motorists’ claims. This is a 75 percent increase over the past 10 years, translating to $14 per insured individual in 2012.

According to Elizabeth A. Sprinkel, CPCU, senior vice president of the IRC, these numbers show that “responsible drivers who pay for insurance end up also paying for injuries caused by uninsured drivers.”

“The declining trend in the percentage of uninsured motorists is a positive development for consumers; however, the heightened levels of uninsured motorists and the rising claim payments involved still remain a concern for insured drivers, insurers and policymakers,” she said.

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Filed under Insurance Fraud

Texting Laws Appear to Reduce Traffic Fatalities

States with primary enforcement laws against texting while driving appear to be having an impact on reducing traffic deaths, a new study released by the University of Alabama at Birmingham (UAB) – School of Public Health has found.

Primary enforcement means that there doesn’t have to be another reason for a police officer to stop a vehicle.

A recent Claims Journal article summarized some of the UAB findings, one of the most notable being a three percent decrease in fatalities among all age groups associated with states supporting primary texting bans. This translates to an average of 19 deaths prevented per year in states with such bans.

However, researchers revealed that states with secondary enforcement of texting bans (an officer must have another reason to stop a vehicle) didn’t see any real decrease in fatalities. Researchers also found bans on texting are most effective with young drivers, while bans on handheld cell phones are most effective with older adult drivers.

According to 2011 data from the Centers for Disease Control and Prevention, 31 percent of U.S. drivers, aged 18-64 years, said that they had read or sent text or email messages while driving at least once in the 30 days prior. That year saw 3,331 fatalities and 387,000 injuries involving distracted drivers.

Using roadway fatality data captured in the Fatality Analysis Reporting System between 2000 and 2010, Alva O. Ferdinand, Dr.P.H., J.D., led the longitudinal panel study. She wanted to examine what impact texting laws have had on roadway crash-related fatalities and how variations in states’ laws affect those results to ultimately determine which laws are most beneficial in improving roadway safety.

Researchers’ results indicated that states with primary texting bans:

  • Were “significantly associated” with reduced traffic fatalities in all age groups
  • In all age groups, a 3 percent reduction in traffic deaths equates to 19 deaths prevented each year
  • Reduced fatalities 11 percent among 15- to 21-year olds when targeted to young drivers.

States with secondary enforced restrictions also saw no significant reduction in traffic fatalities. In addition, states that prohibit use of cell phones without hands-free technology saw significant reductions in fatalities among the 21- to 64-year old age group.

Ferdinand hopes the findings help policymakers implement laws that are most effective in reducing traffic deaths. Her results are published in the August issue of the American Journal of Public Health.

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Filed under Fla. Stat. 627.736 (2008)

Eleventh Circuit Dismisses PIP Case Involving EMC and Massage Therapy

A class action suit filed by plaintiff Accumed Chiropractic against Progressive Select Insurance was dismissed on July 31, 2014 by Circuit Court Judge Antonio Arzola. Judge Arzola concluded that the action was inappropriate for class action treatment.

The suit was brought on behalf of plaintiff itself and two putative classes. The first class was to be anyone who was denied payment by Progressive under PIP or MedPay insurance coverage where Progressive’s denial was based on an assertion that an Emergency Medical Condition for the insured was not established.

The second class was to be defined as anyone whose PIP or MedPay claim was denied because the health care service was for massage therapy or acupuncture. Plaintiff sought both declaratory relief and damages for breach of contract.

Plaintiff stipulated at the hearing that it did not have standing to sue for MedPay benefits. As for the PIP claims, Judge Arzola found that the “necessary and individualized questions associated with the underlying PIP claims of the class will predominate in this Action.” As a matter of law, therefore, plaintiff’s case could not proceed as a class action, and the complaint was dismissed without prejudice.

The case is Accumed Chiropractic & Wellness Center, Inc. v. Progressive Select Insurance Company, Case No. 13-CA-029396 (Fla. 11th Cir. Ct., July 31, 2014). Click on the link to view the court order.

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Filed under Case Law

FL PIP Guide Readers: Vote Now for the 100 Best Legal Blawgs

Readers of the FL PIP Guide are invited to show their support for the blog by voting in the ABA Journal’s annual competition for the 100 Best Legal Blawgs.

Please nominate Roig Lawyers’ FL PIP Guide blog by clicking here to provide a brief explanation on why you like the blog!

In addition to your name and affiliation, you will be asked to provide the URL to the FL PIP Guide (www.flpipguide.com).

You also have the chance to identify a specific blog post that you consider to be representative of the quality of coverage provided by the FL PIP Guide.

Click on the link below to get started.
http://www.abajournal.com/blawgs/blawg100_submit/

Friend-of-the-blawg briefs are due no later than 5 p.m. ET on Friday, August 8, 2014.

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