Recovering PIP Payments Made to an Unlawfully Licensed Medical Provider

Roig Lawyers Partner Keith Hernandez recently secured a successful recovery for an insurer in an unjust enrichment action involving Personal Injury Protection (PIP) benefits paid to a medical provider that was operating without the required licensure.

The medical provider submitted bills for reimbursement under Florida’s PIP statute and received payment for services rendered. However, it was later determined that the provider was wholly owned by an Advanced Practice Registered Nurse (APRN) and was operating as a health care clinic without the license required under Florida’s Health Care Clinic Act.

Roig Lawyers filed an unjust enrichment action seeking reimbursement of the improperly paid benefits. The legal strategy focused on establishing that, under Sections 400.9905(n) and 627.736(5)(h), Florida Statutes, the provider qualified as a clinic that was required to obtain licensure from the Agency for Health Care Administration (AHCA) before it could lawfully receive PIP reimbursements.

Working closely with the client, the team identified all payments made to the provider during the applicable statute of limitations and pursued recovery of those funds. As a result, the provider agreed to reimburse the insurer for all payments it received while operating without the required license.

Key Takeaway

This matter reinforces an important principle under Florida law: payment of unlawful, non-compensable, or unenforceable charges does not waive an insurer’s right to seek reimbursement. Thorough investigation and a detailed understanding of Florida’s PIP and Health Care Clinic statutes can create meaningful opportunities to recover improperly paid benefits.

Lead Attorney: Keith Hernandez

Paralegal Support: Cindy Morales-Holmberg and Lori Spiller