Progressive Select Insurance Company v. In House Diagnostic Services, Inc., a/a/o Darryl Frazier

Summary

The Florida Fourth District Court of Appeal held that reimbursement for the imaging services at issue under Florida's personal injury protection statute should be calculated using the lower 2007 Medicare Part B non-facility participating price rather than the higher limiting charge. The court receded from its prior decision in Allstate Fire & Casualty Insurance Co. v. Jeffrey L. Katzell, M.D., P.A., and certified conflict with the Third District's decision in Priority Medical Centers, LLC v. Allstate Insurance Co. The court reversed the provider's summary judgment and remanded with instructions to enter summary judgment for the insurer.

Holdings

1. Under section 627.736(5)(a), Florida Statutes (2013), the reimbursement rate for the imaging services was properly calculated using the lower 2007 Medicare Part B non-facility participating price, not the higher non-facility limiting charge.
2. A Medicare Part B limiting charge is not a fee schedule for purposes of calculating reimbursement under Florida's PIP statute; it is the maximum amount a nonparticipating provider may directly charge a Medicare beneficiary in specified circumstances.
3. The en banc court receded from Katzell because it was wrongly decided and certified conflict with Priority Medical.

Questions Presented

1. Whether section 627.736(5)(a), Florida Statutes (2013), permits a PIP insurer calculating reimbursement for imaging services to use the higher 2007 Medicare Part B non-facility limiting charge rather than the lower participating price.
2. Whether the Fourth District should recede from Allstate Fire & Casualty Insurance Co. v. Jeffrey L. Katzell, M.D., P.A., which adopted the contrary reasoning of Priority Medical Centers, LLC v. Allstate Insurance Co.
3. Whether the county court's summary judgment for the provider should be reversed and the matter remanded for entry of judgment for the insurer.

Disposition

reversed_and_remanded