Reg. Mri of Orlando v. Nationwide Mut. Fire

884 So. 2d 1102, 2004 Fla. App. LEXIS 15574, 2004 WL 2363589
CourtDistrict Court of Appeal of Florida
DecidedOctober 22, 2004
Docket5D03-3442
StatusPublished
Cited by4 cases

This text of 884 So. 2d 1102 (Reg. Mri of Orlando v. Nationwide Mut. Fire) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Reg. Mri of Orlando v. Nationwide Mut. Fire, 884 So. 2d 1102, 2004 Fla. App. LEXIS 15574, 2004 WL 2363589 (Fla. Ct. App. 2004).

Opinion

884 So.2d 1102 (2004)

REGIONAL MRI OF ORLANDO, INC., etc., Appellant,
v.
NATIONWIDE MUTUAL FIRE INSURANCE COMPANY, Appellee.

No. 5D03-3442.

District Court of Appeal of Florida, Fifth District.

October 22, 2004.

*1103 Mark A. Cornelius, of Bogin, Munns & Munns, Orlando, for Appellant.

Katherine E. McKinley and Andrea Caro, of Zimmerman, Kiser & Sutcliffe, P.A., Orlando, for Appellee.

GRIFFIN, J.

We have a question certified by the Orange County Court as an issue of great public importance, which we have agreed to accept: "Can a medical provider render a medical service under Section 627.736(5)(a), when the medical service was provided through the use of an independent contractor." We answer the question in the affirmative and reverse the appealed judgment.

On January 18, 2002, Wesley Odell ["Odell"] sustained injuries in an automobile accident. Odell was insured by defendant below, Nationwide Mutual Fire Insurance Co. ["Nationwide"], under a policy that provided personal injury protection benefits in compliance with the Florida Motor Vehicle No-Fault Law.[1] On April 8, 2002, plaintiff below, Regional MRI of Orlando, Inc. ["Regional MRI"], performed an MRI scan on Odell's spine.[2] Regional MRI then sent the MRI scan to a radiologist — Dr. Henry B. Floyd — to interpret. The scan is referred to as the "technical component" of the MRI; the reading of the scan is called the "professional component" of the MRI. After the services were completed, Regional MRI billed Nationwide $1,250 under a "global" code which included both the technical and professional components of the MRI. Nationwide refused payment, stating in an "Explanation of Benefits" letter:

You have presented a HCFA [Health Care Finance Administration] claim form and have billed the global service for this CPT [Physician's Current Procedural Terminology] code. Under the PIP statutes, you must provide a medical service to be considered for payment. The radiologist reading this film or the provider reading the nerve testing should be billing this service himself with a 26 modifier (professional reading) as he is actually providing the medical service and is usually reading the tests at multiple facilities or for multiple providers. Billing globally and paying the provider part of the proceeds or per scan or test would be considered a fee split. (1099 subcontractor, which is not a W2 employee). Since you are only performing the technical service (TC), please rebill under the correct CPT code and modifier (TC) if you wish reimbursement.... *1104 If the person reading this service for you is a true employee, please provide a copy of the W4 form they filled out for the [IRS] and provide a copy of an employment contract or a letter from the provider confirming he will file a W2 form with the IRS.

When Nationwide refused payment, Regional MRI, as assignee of Odell, filed a complaint for damages against Nationwide.

The parties entered into a joint stipulation of factual issues as follows:

1. Dr. Henry B. Floyd ["Dr. Floyd"][3] was the radiologist who interpreted the MRI films taken of Wesley Odell at Regional MRI and thus provided the professional component of the services at issue.
2. Checks from Regional MRI are payable to Dr. Floyd personally. Dr. Floyd conducts his business of reading MRIs at 51 West Haley, Orlando, Florida and at his home in Heathrow.
3. Regional MRI pays Dr. Floyd's compensation of $75.00 per read to Dr. Floyd personally.
4. Dr. Floyd is provided a 1099 at the end of each year.
5. Dr. Floyd is paid on a monthly basis, regardless of whether Regional MRI is paid for the reads Dr. Floyd performed.
6. Dr. Floyd is permitted to and does work for approximately 2 other diagnostic clinics, including competitors of Regional MRI.
7. Regional MRI requires that all reads provided to Dr. Floyd by 9:00 A.M. weekdays be completed and given to Regional MRI by noon that day, but he has flexibility as to how to accomplish the reads within those constraints.
8. Regional MRI does not exert authority and control over the manner in which Dr. Floyd performs his services, except as stated above.
9. Regional MRI does not provide Dr. Floyd with fringe benefits, such as health insurance or vacation pay.
10. Regional MRI provides Dr. Floyd only with the films and patient history. Dr. Floyd provides all other materials necessary to perform the reads.

Regional MRI filed a motion for partial summary judgment on the issue of fee splitting. Regional MRI asserted that since Dr. Floyd was paid a flat fee per read regardless of whether Regional MRI was paid by anyone for the MRI, there was no illegal fee split.

Nationwide also filed a motion for summary judgment. Nationwide contended that it was entitled to judgment as a matter of law because Regional MRI could not bill for services provided by Dr. Floyd since he was not their employee. As a secondary argument, Nationwide asserted that Regional's billing practice resulted in an illegal fee split or brokering arrangement in violation of sections 456.054 and 817.505(1), Florida Statutes.[4]

*1105 A hearing on the competing motions for summary judgment was held before the presiding county judge. Both parties agreed that there was no dispute of fact and that the only issue was which party was entitled to judgment as a matter of law. After hearing argument, the court decided that Regional MRI improperly billed for services that it did not render.

The court entered summary final judgment in favor of Nationwide. The court made the following conclusions of law:

18. Florida Statute § 627.736(5)(a)[5] requires a provider to "lawfully render" a medical service in order to be entitled to remuneration for that service. This Court finds as a matter of law that the use of the word "render" in Florida Statutes § 627.736 is clear and unambiguous. The plain meaning of the word "render" as used in Florida Statutes § 627.736(5)(a) means to "perform" the medical services for which recovery is sought. "Render" does not mean to hire another corporation or independent contractor to perform the medical services on Plaintiff's behalf. To conclude otherwise would be inconsistent with the use of the word "render" and would be contrary to the intent of the Florida Motor Vehicle Act.
19. Based on this Court's findings of facts as outlined above, this Court finds that Regional MRI did render the technical component of the MRI at issue in this matter and would have been entitled to compensation for the technical component of the service, had Regional MRI properly designated its bill to only seek compensation for the technical component the MRI at issue.
20. Regional MRI did not, however, render the professional component of the MRI service according to Section 627.736(5)(a). Therefore, Regional MRI has sought recovery for a medical service which it did not render. This Court finds that it would be in violation of Section 627.736(5)(a) to allow Plaintiff to recover insurance proceeds from Nationwide for medical services which it did not render to Nationwide's insured.
*1106 21.

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Cite This Page — Counsel Stack

Bluebook (online)
884 So. 2d 1102, 2004 Fla. App. LEXIS 15574, 2004 WL 2363589, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reg-mri-of-orlando-v-nationwide-mut-fire-fladistctapp-2004.