State Farm Mut. Auto. v. Greater Chiropractic Cen.

393 F. Supp. 2d 1317
CourtDistrict Court, M.D. Florida
DecidedJune 30, 2005
Docket604CV01784GAPKRS
StatusPublished

This text of 393 F. Supp. 2d 1317 (State Farm Mut. Auto. v. Greater Chiropractic Cen.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Mut. Auto. v. Greater Chiropractic Cen., 393 F. Supp. 2d 1317 (M.D. Fla. 2005).

Opinion

393 F.Supp.2d 1317 (2005)

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY and State Farm Fire & Casualty Company, Plaintiffs,
v.
GREATER CHIROPRACTIC CENTER CORP., Massage for Life Corp., Superior Massage Corp., and Florida Total Healthcare Corp., Defendants.

No. 604CV01784GAPKRS.

United States District Court, M.D. Florida, Orlando Division.

June 30, 2005.

*1318 *1319 Guy Scott DiMartino, Karen Marie Walker, Rissman, Weisberg, Barrett, Hurt, Donahue & McLain, P.A., Orlando, FL, for Plaintiffs.

Michael David Crosbie, Foley & Lardner, Piercy Joseph Stakelum, IV, Law Office of Piercy J. Stakelum, Orlando, FL, for Defendants.

ORDER

PRESNELL, District Judge.

This case is before the Court on Defendants Greater Chiropractic Center Corp.'s ("GCC"), Massage for Life Corp.'s ("MFL"), Florida Total Healthcare Corp.'s ("FTH"), and Superior Massage Corp.'s ("SM") Motion to Dismiss (Doc. 29) and Plaintiffs State Farm Mutual Automobile Insurance Company's ("State Farm Auto") and State Farm Fire & Casualty Company's ("State Farm Fire") Opposition (Doc. 30) thereto.

I. Background

State Farm Auto and State Farm Fire (collectively, the "Insurers") filed the Complaint (Doc. 1) in this case on allegations that GCC, MFL, FTH, and SM (collectively, the "Providers") each submitted unlawful, or unlawfully submitted, medical treatment claims for reimbursement under person-injury-protection ("PIP") policies the Insurers issued. The Insurers allege that each of the Providers is a corporation organized by Michael and Yesenia Ortiz, and that those individuals are not licensed health care providers. According to the Insurers, Michael Ortiz operated the Providers in pairs and in concert so as to submit two separate HCFAs[1] for each insured patient they claim to have treated. The Insurers allege that the method used to generate separate HCFAs for each insured patient violates patient disclosure requirements, does not comport with industry guidelines, and circumvents billing terminology guidelines; and further that the Providers failed to keep records sufficient to substantiate the treatment allegedly provided and billed for services that were not rendered or were rendered by a different Provider. According to the Insurers, Michael Ortiz operated GCC and MFL in the foregoing manner between 2001 and 2003, and he later operated FTH and SM in that manner between 2003 and 2004. The Insurers seek a declaratory judgment that, in essence, the Providers' billings are unlawful and such billings need not be paid in the future. The Insurers also seek reimbursement for past billings they paid.

The legal mechanism on which the Insurers base their claims is the interplay between Florida statutory provisions governing the submission and payment of medical bills. The Insurers' theory is that, under Florida statutory law, medical bills must be compiled and submitted in a certain manner to be "lawful," "unlawful" medical bills need not be paid, the Providers' billings were and will continue to be "unlawful," and so the Insurers should receive a declaration to that effect and reimbursement of past billings paid. The Insurers have not joined Michael Ortiz as a *1320 defendant, have not claimed that the Providers should be treated as Michael Ortiz's alter egos, nor have the Insurers sought to pierce any of the Providers' corporate veils.

As it stands, this case involves two separate corporate plaintiffs suing four separate corporate defendants for separate billings. The following graphs give a party-based representation of disputed billings:[2]

                        Billings the Providers Submitted to State Farm Fire
Anonymous     Billing        Billing        Total GCC      Total MFL      Total FTH      Total SM
Patient       Number         Date           Billed         Billed         Billed         Billed
1             59V939756      11/1/01        $ 7,599.00     $ 2,665.00     $     0.00     $     0.00
2             59V948868      11/26/01       $ 7,781.00     $ 2,560.00     $     0.00     $     0.00
3             59Y033944      2/4/02         $ 5,728.00     $ 1,255.00     $     0.00     $     0.00
4             59Y137567      7/7/02         $ 1,383.00     $   840.00     $     0.00     $     0.00
5             59Y249161      11/3/02        $ 6,477.89     $ 2,900.00     $     0.00     $     0.00
6             59Y278489      12/5/02        $ 8,264.89     $ 4,350.00     $     0.00     $     0.00
7             59Y336954      2/10/02        $ 3,939.89     $ 3,080.00     $ 2,370.00     $   140.00
8             59Y372712      3/23/03        $ 6,781.89     $ 3,935.00     $     0.00     $     0.00
9             59Y720003      4/26/04        $     0.00     $     0.00     $ 5,842.89     $ 3,330.00
10            59Y720003      4/26/04        $     0.00     $     0.00     $ 3,429.99     $ 2,080.00
11            59Y754273      6/6/04         $     0.00     $     0.00     $ 6,252.89     $ 3,235.00
12            59Y907635      11/27/04       $     0.00     $     0.00     $   382.89     $   110.00
13            59Y907635      11/27/04       $     0.00     $     0.00     $   382.89     $   110.00
14            59Y848049      9/22/04        $     0.00     $     0.00     $ 6,122.89     $ 3,225.00
15            59Y992525      3/4/05         $     0.00     $     0.00     $ 3,360.78     $ 1,960.00
Subtotal of Billings                        $47,955.56     $21,585.00     $28,145.22     $14,190.00
                     Billings the Providers Submitted to State Farm Automobile
Anonymous     Billing        Billing        Total GCC      Total MFL      Total FTH      Total SM
Patient       Number         Date           Billed         Billed         Billed         Billed
1             35W896581      5/21/02        $  2,572.00    $   740.00     $     0.00     $     0.00
2             59V754217      4/7/01         $  8,571.00    $ 2,380.00     $     0.00     $     0.00
3             59V926134      10/31/01       $  3,650.00    $   855.00     $     0.00     $     0.00
4             59V926856      11/1/01        $  5,363.00    $ 1,360.00     $     0.00     $     0.00
5             59V931652      11/6/01        $  2,555.00    $   765.00     $     0.00     $     0.00

*1321

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Cite This Page — Counsel Stack

Bluebook (online)
393 F. Supp. 2d 1317, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mut-auto-v-greater-chiropractic-cen-flmd-2005.