Roig Partner Keith Hernandez Wins Summary Judgment on Brokering and Fraud for Liberty Mutual

Keith Hernandez, a partner in the Deerfield Beach office of Roig Lawyers, succeeded in getting a Motion for Summary Judgment granted in favor of Liberty Mutual.

Keith successfully argued that the medical provider was a broker as defined by § 627.732(1), Fla. Stat. (2012) because it was not the true owner or the 100-percent long-term lessee of the X-ray machine used to perform X-rays on the patient, which were billed by the medical provider to Liberty Mutual. Keith also successfully argued that the medical provider committed fraud by knowingly submitting false and misleading billing statements to Liberty Mutual regarding the rendering of the X-rays, specifically statements contained in items 20 and 32 of the health insurance claim form.

Prior to suit, Liberty Mutual received bills for X-rays allegedly performed by the medical provider on their premises. Liberty Mutual denied all claims of the provider after determining that the medical provider did not own any X-ray machines and did not have an X-ray machine on the premises. During discovery, the provider disclosed that the X-rays were performed at a different location on machines owned by a different medical provider. Both the medical provider that owned the X-ray machine and the medical provider that submitted the charges were owned by the same chiropractic physician.

With this newly obtained information, Keith moved to amend the affirmative defenses to add that the medical provider was a broker as defined in Fla. Stat. § 627.732(1) and that pursuant to Fla. Stat. § 627.736(5)(b)1.a., “An insurer or insured is not required to pay a claim or charges: Made by a broker or by a person making a claim on behalf of a broker.”

Keith successfully argued at the summary judgment hearing that the medical provider was acting as a broker in violation of Fla. Stat. § 627.732(1) and Fla. Stat. § 627.736(5)(b)1.a. and that by submitting charges for those services the medical provider was not entitled to reimbursement for any charges pursuant to Fla. Stat. § 627.736(5)(b)1.c., which states that “An insurer or insured is not required to pay a claim or charges: To any person who knowingly submits a false and misleading statement relating to the claim or charges.”