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Home :: FAQ :: Personal Injury

How do courts limit these recoveries from physicians in Florida?

The Second District Court of Appeal addressed the admissibility of charges exceeding Medicare amounts in Cooperative Leasing Inc. and Domer v. Johnson, 872 So.2d 956, (Flat 2d DCA 2004).  The facts in Cooperative were that a motorist was injured in an automobile accident and the trial court allowed into evidence bills for all medical expenses.  The bills were in excess of benefits paid by Medicare.  The Second DCA ruled that the excessive billing was inadmissible because the plaintiff was not liable for the excessive billing pursuant to Title 42 U.S.C. §1395 and precedent.  In citing the U.S.C., the Second District determined that the plaintiff’s medical bills were paid by Medicare at the Medicare-approved amounts and that the physician could not recover from the plaintiff personally.  The Second District goes on to provide precedent that the plaintiff is entitled to compensation for reasonably valued medical care and found that the Medicare amounts paid to the physicians were customary and reasonable.  This is also the basis for approved amounts under 42 U.S.C. §1395w-4.  Therefore, any amounts in excess of the Medicare-approved amounts would allow the plaintiff to receive a windfall by recovering “phantom damages”. Id, at 959.  In its ruling, the Second District goes on to provide that the difference between what the physicians charged and the Medicare-Approved Amounts are not a collateral source that would be deducted as a set-off post verdict.  Id. At 960.

Moreover, all billing of the above physicians that do not meet the requirements for contracting with a Medicare Beneficiary and/or that are in excess of the Medicare-Approved Amounts are null, void, and of no merit as a matter of law pursuant to Florida Statute §456.056  It is of the utmost importance, therefore that if you are involved in any accident that you let your treating physician know you are disabled and on Medicare, so that you do not create any outstanding bills or bad-will by failing to tell your physician up front to bill Medicare, especially if you are involved in an accident other than one involving a car or other passenger vehicle