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Florida Fourth DCA rules that PIP insurer was not entitled to reduce payments to health care provider by 2% based on Medicare schedule intended to apply only to Medicare payments

On May 19, 2021, in Sunrise Chiropractic and Rehabilitation Center, Inc. v. Security National Insurance Company, No. 4D21-188, the Florida Fourth DCA ruled that the defendant insurer in a county court case filed by a medical provider for the recovery of Personal Injury Protection (PIP) benefits was not entitled to impose a 2% reduction in the amount to be paid to the health care provider. The insurer had arrived at the 2% deduction based on its use of the payment files of Medicare & Medicaid Services. Under Medicare, for the years 2010 through 2014, chiropractic fees were to be reduced for Medicare claims by two percent to recoup the cost of a study conducted regarding chiropractic fees. The Fourth DCA approvingly cited a federal district court decision, Coastal Wellness Ctrs., Inc. v. Progressive Am. Ins. Co., 309 F. Supp. 3d 1216, 1221 (S.D. Fla. 2018), in which the district court noted that the U.S. Department of Health and Human Services (“HHS”) had made clear that the 2% reduction was only to be applied to Medicare claims.

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