Tag Archives: Personal Injury Protection

Florida Supreme Court Allstate Fee Schedule Litigation: Shall We Read The Tea Leaves?

The Florida Supreme Court recently heard oral argument in Allstate Insurance Company v. Orthopedic Specialists, No. SC15-2298. At issue was an appeal of a ruling that it wrongfully limited its reimbursements under Medicare fee schedules for motorists’ personal injury protection (PIP) claims.

Allstate’s policy language has been found to be exceedingly clear and concise by the majority of appellate courts across the state. A ruling affirming the Fourth District Court of Appeals decision would only serve to blindside Florida’s citizens with additional bills for costly co-payments while also limiting the amount of coverage available to them.

While we wait for a final opinion, industry professionals have been closely watching the court for any and all clues. Politics of the high court aside, what “shall” we analyze to determine how the justices will rule?

One such clue seems to be overlooked, yet is hiding in plain sight. On the very day that the court heard oral argument in Allstate v. Orthopedic Specialists the court issued a Per Curiam Opinion amending the Florida Rules of Civil Procedure in which the word “shall” was stricken over 200 times. See In Re: Amendments to the Florida Rules of Civil Procedure No. SC16-155. Ironically and perhaps persuasively, the court writes unanimously that “[t]he amendments shall become effective January 1, 2017, at 12:01 a.m.” (emphasis mine.)

More recently, numerous Per Curiam Opinions amending various procedural and administrative rules have been issued. They have seen the court continue to favor “shall”. Amendments to the Rules of Criminal Procedure, Rules of Appellate Procedure, Code of Judicial Conduct and Small Claims Rules did not remove any “shall” provisions.

Pouring over minor amendments by the high court with no clear answer, perhaps we are left to channel Judge May’s epic dissent in the Fourth District Court of Appeals Opinion in which she found Allstate’s policy language to be unambiguous and compliant. While accusing the medical providers of leading the majority down the yellow brick road she writes frustratingly, “As the Pope once asked Michelangelo during the painting of the Sistine Chapel: “When will there be an end?”

We “shall” know soon.

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Filed under Legislation, Personal Injury Protection (PIP)

Sixth Person Found Guilty in Unlicensed Chiropractic Clinics Scam

According to Southwest Florida Online News, a federal jury found Nesly Loute guilty of fraud after a six day trial where he and five others testified that they had conspired to operate five unlicensed chiropractic clinics and fraudulently billing auto insurers for Personal Injury Protection benefits. This ruling was the culmination of a two-year law enforcement investigation dubbed Operation Fraudulent Pain.

Loute and five other individuals who have also pleaded guilty are facing a maximum penalty of 20 years each in federal prison and must make restitution to the insurance companies they have defrauded. The unlicensed chiropractic clinics had received more that $2 million in fraudulent PIP payments.

Click here to view the full story.

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Federal Appeals Court Reinstates PIP Claims Suit Against HCA

A federal appeals court has revived a lawsuit against HCA Holdings charging that HCA and three of its Florida hospitals violated Florida’s Deceptive and Unfair Practices Act.

The U.S. Court of Appeals for the Eleventh Circuit’s April 26 ruling overturned a February 2015 federal court decision in the Middle District of Florida that dismissed the class action. That suit accused three HCA hospitals—Memorial Hospital Jacksonville, North Florida Regional Medical Center of Gainesville and JFK Medical Center in Atlantis—of charging unreasonably high fees for emergency radiological services covered by Florida’s Personal Injury Protection (PIP) insurance.

The four Florida residents who filed the complaint received emergency radiological services after motor vehicle accidents. They said they were billed more than other patients who received the same services. “In fact, these fees are up to 65 times higher than the usual and customary fees charged to non-PIP patients for similar radiological services,” according to the complaint.

In one example, the court’s opinion said the hospitals charged between $5,900 and $6,965 for spinal CT scans on the plaintiffs. The ruling said Medicare rates for spinal CT scans are between $213 and $220, and rates for uninsured patients go up to $3,454.

The complaint said the exorbitant rates caused the residents’ $10,000 PIP coverage to be exhausted prematurely. The complaint also accuses HCA of breach of contract as the four Floridians entered into a Condition of Admission contract that required their accounts to be paid at the hospitals’ price lists. All four plaintiffs said they weren’t provided such a price list at the time of their treatments.

Only one of the four plaintiffs was allowed to go forward with a suit against a single hospital in the 2015 ruling by U.S. District Judge James Moody in the Middle District of Florida. Moody’s ruling was overturned by a unanimous Eleventh Circuit panel consisting of Judges Beverly B. Martin, Julie E. Carnes and Senior Judge R. Lanier Anderson III. The suit was originally filed July 2014 in the Southern District of Florida.

 

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Filed under Uncategorized

Central Florida Personal Injury Protection Fraud Investigation Comes to an End

On August 13, 2015, The Florida Department of Financial Services Division of Insurance Fraud (DIF) announced multiple arrests related to a large scale personal injury protection fraud scheme across the Central Florida region.

According to the Orlando Business Journal, DIF and the Federal Bureau of Investigation (FBI) partnered to investigate two clinics, First Medical Rehab of Bradenton and Kirkman Family Chiropractic Care in Orlando. Their investigation led to the arrest of five people, arrest warrants issued for three additional people, and three related arrests in the Fort Myers area. Insurance carriers and former patients raised allegations of possible illegal activity happening at these two personal injury clinics.

The Kirkman Family Chiropractic investigation disclosed their plot of bypassing clinic licensure requirements set by the Agency for Health Care Administration. Co-conspirators solicited licensed chiropractors to serve as straw owners, or owners on paper only because licensed health care professionals can operate clinics without the necessity of an additional clinic license. To date, more than $100,000 in fraudulent claims have been paid by multiple insurance carriers.

The charges varied depending on each individual’s alleged role which included: patient brokering, conspiracy to commit patient brokering, false and fraudulent insurance claims, solicitation, grand theft, organized scheme to defraud and conspiracy to commit insurance fraud. All individuals arrested, if convicted can face anywhere from five to 30 years in prison as well as face fines as large as $10,000.

Click here for the full story.

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Filed under Personal Injury Protection (PIP)

Roig Lawyers Tampa Attorney to Present “Emerging Trends in PIP SIU”

Roig Lawyers attorney Miguel R. Roura will present “Emerging Trends in PIP SIU” to a national insurance carrier in Tampa on August 5, 2015.

The presentation will educate adjusters on recent SIU trends, help identify fraud, and discuss various investigative tools used to fight fraud. Also, the presentation will review caselaw which will aid adjusters in determining what issues and facts create a solid or weak defense.

Miguel concentrates his practice in the areas of Personal Injury Protection (PIP)/No-Fault litigation and fraud (SIU) investigations. He also defends clients in cases involving bodily injury, uninsured motorist, property damage, and general liability litigation. The identification and investigation of fraudulent claims represents a significant portion of Miguel’s practice.

Miguel is a graduate of Stetson University College of Law (J.D., 2008) and the University of Florida (B.A., 2004).

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, corporate law, real estate, banking and finance, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit www.roiglawyers.com.

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Filed under Personal Injury Protection (PIP)

U.S. Court of Appeals Agrees to Hear Florida PIP Case

The U.S Court of Appeals for the 11th Circuit in Atlanta has agreed to consider an appeal of a lower-court decision in Florida on whether drivers in Palm Beach County and across Florida should be granted class-action status in their claim against Hospital Corporation of America (HCA) Hospitals who are allegedly grossly overcharging for services under the state’s PIP/No-Fault insurance system.

According to a recent blog post on PalmBeachPost.com, the lower court decision in Florida stated the drivers could pursue cases individually against HCA Hospitals but not as a group. The plaintiffs in the case allege that the hospitals are draining Personal Injury Protection (PIP) benefits by charging up to 65 times what Medicare pays.

Click here to read the blog post.

www.roiglawyers.com

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Filed under Personal Injury Protection (PIP)