CopyCited 74 times | Published | District Court, S.D. Florida | 2000 U.S. Dist. LEXIS 6150, 2000 WL 290258
...Count II, also brought against Assetcare, Equifax, and Does 1 through N, alleges violation of the Florida Consumer Collection Practices Act, Fla. Stat. §§
559.55 to
559.785 ("FCCPA"). Count III seeks declaratory and other relief for violations of Section
641.315(3) of the Florida Insurance Code against Columbia Aventura Hospital and Medical Center ("Columbia Aventura"), Miami Beach Healthcare Group, Ltd....
...1998, and June 29, 1998 (¶ 50-54). Plaintiff also received a letter from Equifax attempting to collect the same alleged debt, dated September 25, 1998 (¶ 55). Plaintiff's alleges that defendants' attempts to collect money for the services violated Section 641.315(3) of the Florida Insurance Code, which states: No provider of services or any representative of such provider shall collect or attempt to collect from an HMO subscriber any money for services covered by an HMO and no provider or representative *1359 of such provider may maintain any action at law against a subscriber of an HMO to collect money owed to such provider by an HMO. Fla. Stat. § 641.315(3)....
...act prohibited by the FDCPA. a. Private cause of action Plaintiffs' claim in Count I for violations of the FDCPA is based on the alleged attempts by Assetcare and Equifax to collect a debt from a subscriber to an HMO in violation of Florida Statutes § 641.315(2) and (3). Section 641.315, entitled `Provider contacts,' states in paragraph 2 that "No subscriber of an HMO shall be liable to any provider of health care services for any services covered by the HMO," and states in paragraph 3 that "No provider of services o...
...collect from an HMO subscriber any money for services covered by an HMO and no provider or representative of such provider may maintain any action at law against any subscriber of an HMO to collect money owed to such provider by an HMO." Fla. Stat. § 641.315(2) and (3)....
...gal right when such person knows that the right does not exist. Fla. Stat. §
559.72(9). The plaintiffs allege that the defendants are prohibited from attempting to collect money for services covered by an HMO from an HMO subscriber under Fla. Stat. §
641.315(3), and that their actions therefore violated Fla. Stat. §
559.72(9). The defendants have made the same two arguments against the FCCPA claim in Count II as they made against the FDCPA claim in Count I: that Fla. Stat. §
641.315 does not create a private right of action, and that the plaintiff failed to allege knowledge or intent. At this stage of the proceedings, both arguments must fail. 1. Private right of action Defendants' attempt to attack plaintiffs' FCCPA claim by arguing that there is no private right of action under *1363 Section
641.315 of the Insurance Code is unpersuasive....
...Plaintiffs have argued that the required knowledge can be imputed to Assetcare and Equifax through agency theory. The complaint alleges that Defendants Assetcare, Equifax, Columbia Aventura, Miami, and Columbia/HCA were "acting jointly and in concert in circumvention of § 641.315" and that "each Defendant was the agent or employee of each of the other Defendants." Second Amended Class Action Complaint, ¶ 35-36....
...Reyes,
23 F.3d 345, 347 (11th Cir.1994). Therefore, defendants' motion to dismiss based on insufficient allegations of knowledge is denied. C. Count III Count III of plaintiff's complaint seeks declaratory and other relief for violations of the Florida Insurance Code, Fla. Stat. §
641.315(3), against Columbia Aventura, Miami, and Columbia/HCA. Specifically, the plaintiffs seek a declaration as to whether Columbia Aventura, Miami, and Columbia/HCA violated Florida's Insurance Code by attempting to collect sums from consumers they are prohibited from attempting to collect by Fla. Stat. §§
641.315(2) and (3), as well as actual damages and disgorgement of any money collected from consumers in violation of the Florida Insurance Code. The defendants have argued that the exercise of supplemental jurisdiction is improper in this case, that the plaintiff has no private cause of action under Section
641.315, that the plaintiff has not demonstrated an entitlement to declaratory relief, and that "Columbia Aventura Hospital" is a fictitious name for Miami Beach Healthcare Group, Ltd....
...Because of the novel and complex nature of the claims in Count III, this court agrees that it should decline to exercise jurisdiction in favor of permitting the state to interpret its own laws. Count III necessary involves a determination by the court as to whether Fla. Stat. § 641.315(3) implies a private right of action....
CopyPublished | Florida 5th District Court of Appeal | 2010 Fla. App. LEXIS 556, 2010 WL 322156
...s of a health maintenance organization plan may balance bill the subscribers for the unpaid portion of its statements for medical services that have not been paid by the health maintenance organization. We agree with the trial court that in light of section 641.3154, Florida Statutes (2007), the provider *142 may not balance bill the subscriber, and affirm....
...JLR received and retained each payment, but denied that the payments fully satisfied its statements, and then sent bills to the subscribers for the balance not paid by Florida Health Care. JLR refers to this as "balance billing." The patients brought suit seeking a declaratory judgment that JLR's balance billing violated section 641.3154, Florida Statutes (2007), and that balance billing violated Florida's Unfair Trade and Deceptive Practices Act under Chapter 501, Florida Statutes....
...The trial court noted that JLR billed Florida Health Care using the assigned authorization number for each subscriber, and that because Florida Hospital had a contract with Florida Health Care, it was empowered to authorize or direct the provision of JLR's anesthesia services to Florida Health Care members pursuant to section 641.3156(1). When the trial court reviewed section 641.3156(1), it found that under that statute a health maintenance organization was liable for services to a subscriber/patient by a provider, regardless of whether a contract existed between the health maintenance organization and the provider....
...ct exists between the HMO and the provider. The statute is quite specific in providing that a health maintenance organization is liable for payment of fees to the provider, and that a subscriber is not liable for payment of fees to the provider. See § 641.3154, Fla. Stat. More specifically, section 641.3154(4) reads as follows: A provider or any representative of a provider, regardless of whether the provider is under contract with the health maintenance organization, may not collect or attempt to collect money from, maintain any action...
...ber; JLR submitted its bill for each patient/subscriber to Florida Health Care using *144 the appropriate authorization number; Florida Health Care paid some part of the bill directly to JLR; and JLR retained the payments. Thus, JLR was forbidden by section 641.3154(4) to balance bill the patient/subscribers. JLR argues, however, that the second sentence of section 641.3154(4) modifies the first, so that the prohibition against balance billing only applies "during the pendency of any claim made by the provider to the organization for payment of the services and any legal proceedings or dispute resolution process" resulting from the claim....
...urely have begun this critical sentence by saying, "This prohibition only applies during the pendency of any claim...." Accordingly the plain reading of the statute convinces us of this interpretation. Second, we have previously held with respect to section 641.315, a precursor to section 641.3154, that the statute provides that only the HMO is liable for services rendered, not the subscriber or insured....
...Physicians Union, Inc. v. United Healthcare of Fla., Inc.,
837 So.2d 1133, 1135 (Fla. 5th DCA 2003); see also Shands Teaching Hosp. & Clinics, Inc. v. Humana Med. Plan, Inc.,
727 So.2d 341, 346 (Fla. 1st DCA 1999). In the same case we also commented that section
641.315, Florida Statutes (1997), was designed to protect and safeguard subscribers, and that while providers are viewed as essential to the overall plan of prepaid medical service, "they are not focused on as parties needing protection." Fla....
...tory and other relief in an effort to recover additional payments for the disputed services. The court noted during the course of its opinion that: As a "non-participating provider" of these services, [pathology group] was nonetheless prohibited (by section 641.3154(4), Florida Statutes (2007)) from directly billing [health maintenance organization] members if [pathology group] knew or should have known that [the organization] was liable for payment....
...Palmetto Pathology Servs., P.A.,
983 So.2d 608, 612 (Fla. 3d DCA), review denied,
994 So.2d 1104 (Fla.2008). JLR contends, however, that because it did not specifically seek or obtain Florida Health Care's authorization prior to performing its medical services, its rights are governed not by section
641.3154(4), but by section
641.3156(1)....
...contract with Florida Health Care to render services. Thus, according to JLR, because it did not follow the authorization procedures articulated by Florida Health Care, JLR was not in a contract position with the health maintenance organization, and section 641.3156 required Florida Health Care to pay whatever bill JLR sent them without diminishment....
...TORPY, J., and LAMBERT, B., Associate Judge, concur. NOTES [1] The trial court consolidated the 52 cases brought by the subscriber appellees. [2] This subsection would not, of course, prohibit collection by the provider of co-payments, co-insurance or deductible amounts due the provider. See § 641.3155(8), Fla....
