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Reversal of Summary Judgment and Holding that the Carrier Can Contest Reasonableness of Medical Charges and Services

Michael Clarke and Jennifer Emerson, of our Tampa office, obtained a reversal of a provider’s Final Summary Judgment ruling. The Court ruled that the carrier has the right to contest the reasonableness of a medical charge/service when the carrier relied exclusively on the Medicare Part B fee schedule amount in making its payment. The Court relied extensively on Progressive Select Ins. v. Emergency Physicians of Cent. Fla., 202 So. 3d 437 (Fla. 5th DCA 2016) to reach this holding. Further, the Court found not only that   our doctor’s  affidavit  was sufficient to create an issue of fact on reasonableness, but that the affidavit also met the Daubert standard. Note that our doctor relied on the reasonableness factors in  627.736(5)(a)1., Fla. Stat., including Medicare Part B rates to reach his opinion.

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