Court Rules for Progressive in Health Care Clinic Licensing Dispute
On July 29, 2014, the 13th Judicial Circuit Court for Hillsborough County granted final judgment in favor of Progressive Insurance in a case involving licensure violations by defendant health care clinic Best Medical. The defendant did not undertake a defense.
The following facts were undisputed:
- Best Medical listed licensed massage therapist Jorge Romero as its 100% owner;
- Romero did not actually own Best Medical, but was paid $2,000 a month for the right to use his credentials and claim that he was the owner;
- Best Medical obtained a certificate from the State of Florida exempting it from licensure as a health care clinic by utilizing Romero’s credentials; and,
- Progressive paid Best Medical PIP reimbursements in excess of $97,000 in response to bills submitted.
In his analysis of the case, Judge James Arnold noted that the Florida PIP statute requires that medical services be lawfully rendered and the corresponding bills be lawfully submitted to be valid. Additionally, the statute provides an insurer, such as Progressive, the right to challenge potential licensure violations, including the ownership of a clinic.
Florida’s Health Care Clinic Act requires that all medical clinics operating in Florida be licensed unless they are exempted. Relevant here is that a clinic “wholly owned by one or more licensed health care practitioners” is exempt from licensure.
The facts showed, however, that Romero was never the 100% owner of Best Medical. The clinic was therefore not entitled to the exemption for being wholly owned by a licensed health care practitioner.
Lacking a lawful exemption, Best Medical was required to possess valid licenses pursuant to the Health Care Clinic Act. Because it possessed no such licenses, Best Medical lacked the ability to lawfully render medical services and lawfully submit corresponding bills as required by Florida’s PIP statute.
Accordingly, Progressive was held not liable for payment of the bills rendered by Best Medical for reimbursement of purported medical services.
The case is Progressive v. Best Medical Healthcare Solution (f/k/a Tropical Healing Power), Case No. 14-CA-000327 Div. J (July 29, 2014). Click on the link to read the Final Judgment.
