Tag Archives: Massage therapy

The 11th Judicial Circuit Court Issues Key Ruling in Health Care Clinic Licensure Case

On March 10, 2015, the Eleventh Judicial Circuit in and for Miami-Dade County issued a ruling in favor of Imperial Fire & Casualty Insurance in a mandatory licensing (House Bill 119) case. The Court found that the charges submitted for Personal Injury Protection (PIP) benefits to Imperial Fire & Casualty, to be unlawful and thus, noncompensable pursuant to Florida’s Motor Vehicle No-Fault Law.

Imperial Fire & Casualty issued a policy of automobile insurance to the Insured under which the Defendant, Magic Hands Solutions Inc. sought payment. Magic Hands Solutions operated as a medical clinic and allegedly rendered medical treatment to the Insured who was injured in an automobile accident. Subsequently, Magic Hands Solutions submitted charges for payment of PIP benefits to Imperial Fire & Casualty. Magic Hands Solutions was advised that the claim submitted for PIP benefits was not payable because the clinic was not properly licensed pursuant to Section 627.736, Florida Statutes (2013).

In 2012, the Legislature required mandatory licensing for all clinics holding an exempt status, whether by issuance of Certificate of Exemption or self-determined, in order for clinics to receive reimbursement pursuant to the “PIP Statute.” Hence, a clinic must be licensed under Part X, Chapter 400 to receive reimbursement for PIP benefits, unless it qualifies for an exception listed in Section 627.736(5)(h).

The Court found that the Magic Hands Solutions being wholly owned by a license massage therapist does not qualify for any of the exceptions delineated in §627.736(5)(h)(1)-(6) and was required to obtain a Health Care Clinic license as a condition precedent to receiving reimbursement of PIP benefits.

As a result of Magic Hands Solutions’ failure to obtain a Health Care Clinic License, the Court found that the charges submitted were unlawful and thus, noncompensable pursuant to Florida’s Motor Vehicle No-Fault Law and that Imperial Fire & Casualty.

Imperial Fire & Casualty Insurance Company vs. Magic Hands Solution Inc., Case No. 2014-2211 CC 24 (01) (Fla. 11th Circuit March 10, 2015).

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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

Riviera Beach Woman Fraudulently Billing Insurance Companies, Allege Detectives

Two undercover agents, covertly acting as patients who were injured in a car crash, uncovered alleged fraudulent insurance billing practices by Nadine Laurent at Optimum Medical Care in West Palm Beach.

In April, the patients were ordered to have a month of treatments in which they were given electrical stimulation, hot packs and massages, but their insurance was billed for additional services never provided, including manual therapy and ultrasound, according to an article in The Palm Beach Post on October 22.

Florida’s Division of Insurance Fraud found that between the two undercover detectives, Laurent fraudulently billed Security National Insurance Company $1,335 for therapies they had not received.

Laurent was charged with false and fraudulent insurance claim and grand theft. She was booked into the Palm Beach County Jail and released the next day after posting $3,000 bond.

Detectives began looking into the situation after some insurance companies and the National Insurance Crime Bureau flagged Laurent as a person who was potentially committing insurance fraud. A confidential source helped the agents connect with Laurent.

According to the affidavit, the detectives believed their operation was busted in May when employees were acting nervous and “operating by the book.”

Detectives also looked into a $500 compensation Laurent had been known to give to patients after their 10th visit to the clinic. When they asked her about the payment, Laurent denied it existed.

Laurent also refuted all allegations against her. She claims the $500 payment in which detectives were referring was for money she loaned to someone.

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Filed under Insurance Fraud

Interview With Dan Anderson, Head of Florida Division of Insurance Fraud

Appointed this February, Dan Anderson began his career as a Florida law enforcement officer.  As a 25-year veteran of the Drug Enforcement Agency, Anderson now heads the Florida Department of Financial Services, Division of Insurance Fraud.  In an interview with the Coalition Against Insurance Fraud, Anderson explains the effect of stricter clinic licensing requirements in Hillsborough County and the Miami-Dade County PIP ordinance we mentioned in a previous post.  Anderson also had this to say about the expected effects of the yet to be signed amended PIP law:

I think one of the potential game changers is the prohibition on billings. One of the bigger problems over the last few years was the explosion of clinics owned by massage therapists, many of whom we have proven to be straw owners and obtaining false exemptions from the AHCA license requirements. If the massage therapists can no longer bill, it could dramatically affect a large percentage of the PIP fraud that exists. This is not to say that all massage therapists are bad or committing fraud, but it is clear from our investigations and information collected by the Insurance Consumer Advocate at CFO Atwater’s direction that many have played a substantial role.

The other game changer is the limit of PIP benefits to $2,500 unless declared an emergency medical condition. It cuts down on the profit margin of the accident clinics, which have been paying large sums to recruit patients. This takes a big bite out of their ability to pay for patients, as their pool from which that money is drawn from dwindles.

We are also looking forward to the formation of the PIP Fraud Strike Force. This Strike Force, along with DIF, will look for ways to reduce fraud in the system. This group of dedicated professionals will be an additional tool in our fight against PIP fraud and will be able to accept donations for additional on-the-ground resources for law enforcement and state attorneys in the ongoing fight against PIP fraud.

The full interview is available here.

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Filed under Fla. Stat. 627.736 (2008), Insurance Fraud, The Statutory "Fee Schedules"

14 Arrested In Miami Massage Clinic Bust, Nearly $250,000 In Fraudulent Insurance Claims

Florida CFO Jeff Atwater announced the arrest of a licensed massage therapist, a physician’s assistant, and 14 massage clinic patients on charges of insurance fraud and grand theft.   From the Chief Financial Officer’s office:

Judith Gonzalez, 39, owner of Flamingo Health Corporation in Miami, allegedly billed insurance companies nearly $250,000 in fraudulent insurance claims and coached patients on how to commit personal injury protection (PIP) fraud.  CFO Atwater’s Division of Insurance Fraud (DIF) and the Miami-Dade Police Department Public Corruption Investigations Bureau conducted the undercover investigation that revealed the fraud scheme. Additionally, DIF was assisted by the U.S. Secret Service during the execution of a search warrant at Flamingo Health Corp.

Gonzalez is reported to have formerly owned and operated other Miami clinics including Fontainebleau Center, Theramed Service and Westchester Service Corporations.

The full press release from CFO Jeff Atwater’s office is available here.

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Filed under Insurance Fraud

Florida State Massage Therapy Association Asks Governor Rick Scott to Veto New PIP Law

This week the Florida State Massage Therapy Association sent a request to Governor Rick Scott to veto the recently amended Florida PIP law. In their letter the FSMTA addresses some of their concerns including:

Patients in Emergency Rooms – with the new mandate, Emergency Rooms will see an unnecessary increase at their facilities – potentially preventing those with “real” emergencies due to the influx of automobile accident patients.

Type of care – massage therapy is a non-pharmaceutical approach to health and healing. Based on the mandate, this option does not appear to be considered.

The full letter is available here.

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Filed under Fla. Stat. 627.736 (2012), Independent Medical Examinations (IME), Insurance Fraud