Priority Med. Ctrs., LLC v. Allstate Ins. Co.

319 So.3d 724

PRIORITY MEDICAL CENTERS, LLC (a/a/o Susan Boggiardino), Appellant,

v.ALLSTATE INSURANCE COMPANY, Appellee.

No. 3D20-291

District Court of Appeal of Florida, Third District.

Opinion filed April 28, 2021

Phillips | Tadros, P.A., and Mac S. Phillips (Fort Lauderdale), for appellant.

Shutts & Bowen LLP, and Daniel E. Nordby (Tallahassee) and Garrett A. Tozier (Tampa), for appellee.

Before HENDON, LOBREE and BOKOR, JJ.

HENDON, J.

Priority Medical Centers, LLC ("Priority Medical") appeals from a final summary judgment in favor of Allstate Insurance Company ("Allstate") in which the trial court certified the following question as one of great public importance:

WHETHER "ALLOWABLE AMOUNT UNDER THE APPLICABLE SCHEDULE OF MEDICARE PART B FOR 2007 FOR MEDICAL SERVICES, SUPPLIES, AND CARE SUBJECT TO MEDICARE PART B[,]" REFERS TO THE NON-FACILITY PARTICIPATING PRICE OR THE NON-FACILITY LIMITING CHARGE.

We have jurisdiction. See Art. V, § 3(b)(4), Fla. Const. We answer the certified question by holding that the proper reimbursement rate for the MRI procedure at issue is the higher 2007 non-facility limiting charge, not the lower 2007 non-facility participating price.

Facts

There is no dispute as to the underling facts, to which the parties stipulated and which the trial court recited in the final judgment:

Specifically, the parties stipulated that Susan Boggiardino was insured under an automobile insurance policy issued by Allstate that was in full force and effect when she was injured in a car accident on or about May 18, 2016. Plaintiff treated Ms. Boggiardino for her accident-related injuries and, as part of that treatment, referred her to Stand Up MRI of Fort Lauderdale ("SUMRIFL") for magnetic resonance imaging of her lumbar spine. Both providers (Plaintiff and SUMRIFL) submitted their bills directly to Allstate under assignments of benefits. Allstate, having elected the schedule of maximum charges payment methodology, paid SUMRIFL the sum of $1,246.46. This amount represents two hundred percent of the non-facility limiting charge under Medicare Part B for CPT 72148 for calendar year 2007. Thereafter, Allstate exhausted benefits on or about August 9, 2016. After Allstate exhausted benefits, Plaintiff submitted additional bills for payment. Allstate denied those bills because benefits were exhausted. Plaintiff, claiming that Allstate should have paid SUMRIFL the sum of $1,141.92 based on the lower non-facility participating price as opposed to the higher non-facility limiting charge, commenced the instant case for declaratory relief and asserted that if Allstate paid SUMRIFL pursuant to the lower non-facility price, then additional benefits ($105.54) would have remained to satisfy a portion of Plaintiff's bills.

Priority Medical filed an action for declaratory relief to determine its rights and obligations pursuant to the Florida Motor Vehicle No-Fault Law (the "No-Fault Law"), sections 627.730 – 627.7405, Florida Statutes (2016), regarding the meaning of the phrase, "allowable amount under the applicable schedule of Medicare Part B for 2007 for medical services, supplies, and care subject to Medicare Part B" as it is used in section 627.736(5)(a) 2. In a lengthy opinion analyzing the relevant statutes, the trial court determined that Allstate's reimbursement calculation was correct and entered summary judgment in Allstate's favor on Priority Medical's declaratory action and certified to this court the question of great public importance noted above.

Standard of review

We review de novo a grant of summary judgment, Volusia Cnty. v. Aberdeen at Ormond Beach, L.P., 760 So. 2d 126 (Fla. 2000), as well as issues of statutory interpretation, Hardee Cnty. v. FINR II, Inc., 221 So. 3d 1162, 1165 (Fla. 2017).

Discussion

The Florida Supreme Court has explained that the no-fault statutes are to be liberally construed in order to implement the legislative purpose of providing broad PIP coverage for Florida motorists. Progressive Select Ins. Co. v. Florida Hosp. Med. Ctr., 236 So. 3d 1183, 1187 (Fla. 5th DCA 2018), aff'd Progressive Select Ins. Co. v. Florida Hosp. Med. Ctr., 260 So. 3d 219 (Fla. 2018) ; Nunez v. Geico Gen. Ins. Co., 117 So. 3d 388, 395 (Fla. 2013) (citing Fla. Med. & Injury Ctr., Inc. v. Progressive Express Ins. Co., 29 So. 3d 329, 341 (Fla. 5th DCA 2010) ); Blish v. Atlanta Cas. Co., 736 So. 2d 1151, 1155 (Fla. 1999). In matters of statutory construction, Florida courts have repeatedly recognized that legislative intent is the guiding polestar. Jimenez v. State, 246 So. 3d 219, 227 (Fla. 2018) ; Sch. Bd. of Palm Beach Cnty. v. Survivors Charter Schs., Inc., 3 So. 3d 1220, 1232 (Fla. 2009). "The plain meaning of the statute is always the starting point in statutory interpretation." GTC, Inc. v. Edgar, 967 So. 2d 781, 785 (Fla. 2007). "[I]f the meaning of the statute is clear then this Court's task goes no further than applying the plain language of the statute." Id. "However, if the language is unclear or ambiguous, then the Court applies rules of statutory construction to discern legislative intent." Polite v. State, 973 So. 2d 1107, 1111 (Fla. 2007). Thus, "examining the history of the legislation is a helpful tool in determining legislative intent." Raymond James Fin. Servs., Inc. v. Phillips, 126 So.3d 186, 192 (Fla. 2013).

Before 2012, the PIP statute expressly referenced the Medicare Part B for 2007 "participating physician" fee schedule. In 2012, the Florida Legislature amended the PIP statute to remove the phrase "participating physician" from section 627.736(5)(a) 2. and replaced it with "applicable schedule." The relevant statute now reads:

2. For purposes of subparagraph 1., the applicable fee schedule or payment limitation under Medicare is the fee schedule or payment limitation in effect on March 1 of the service year in which the services, supplies, or care is rendered and for the area in which such services, supplies, or care is rendered, and the applicable fee schedule or payment limitation applies to services, supplies, or care rendered during that service year, notwithstanding any subsequent change made to the fee schedule or payment limitation, except that it may not be less than the allowable amount under the applicable schedule of Medicare Part B for 2007 for medical services, supplies, and care subject to Medicare Part B. For purposes of this subparagraph, the term "service year" means the period from March 1 through the end of February of the following year.

Section 627.736(5)(a) 2., Florida Statutes (2016) (emphasis added). When the legislature amends a statute by omitting words, the general rule of construction is to presume that the legislature intended the statute to have a different meaning from that accorded it before the amendment. Aetna Cas. & Sur. Co. v. Buck, 594 So. 2d 280, 283 (Fla. 1992) (citing Capella v. City of Gainesville, 377 So. 2d 658 (Fla.1979) ).

With that in mind, there are two available Medicare Part B Fee Schedule reimbursement possibilities for the MRI procedure at issue: the non-facility participating price or the non-facility limiting charge. The record on appeal indicates that the Centers for Medicare & Medicaid Services...