Appellate Court Rules Against Massage Therapists in PIP Payment Case

A three-judge panel of the Third District Court of Appeal recently ruled that massage therapists are not entitled to receive personal injury protection (PIP) insurance benefits for treating patients injured in automobile accidents.

The case, originally filed in Miami-Dade County Circuit Court, centered on bills for physical therapy services sent by Beacon Healthcare Center Inc. on behalf of three patients under Florida’s PIP insurance system.

Case Details

Beacon’s treating physician and medical director prescribed physical therapy for auto accident patients which was performed by massage therapists and not physical therapists. The therapists were not directly supervised by either a licensed physician or licensed physical therapist. When billing, Beacon noted that the supervising physician, and not the massage therapists, provided treatment. The billing statements also indicated that the massage therapists performed physical therapy under the direct supervision of the medical director, whose only responsibility was to review patient files monthly.

Questions of Public Importance

Geico General Insurance Company denied payment, which led to Beacon filing litigation in Circuit Court. The judge granted summary judgment and final declaratory judgment to Beacon, concluding that a healthcare clinic can recover no-fault PIP insurance benefits for physical therapy services performed by unsupervised massage therapists. The court also certified two questions of public importance for the Third DCA to answer.

  1. Can a person who is licensed as a massage therapist, but not licensed as a physical therapist, lawfully render physical therapy modalities enumerated in § 486.021(11) where such therapy is part of or incidental to the lawful practice of massage therapy?
  2. Can a healthcare clinic licensed under Part X Chapter 400 receive PIP reimbursements for physical therapy services enumerated in § 486.021(11) by a licensed massage therapist employed by the clinic that is not “massage” as defined by § 480.033 (3), Fla. Stat?

Third DCA Ruling

The Third DCA overturned the circuit court ruling citing a January 2013 law excluding massage therapists from receiving PIP reimbursements.

The 2013 law states that medical benefits do not include massage as defined in s. 480.033 or acupuncture as defined in s. 457.102, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.

The appellate court ruled that while a licensed massage therapist can lawfully render physical therapy modalities pursuant to the exceptions set forth in the Physical Therapy Act section 486.021(11), a  healthcare clinic or provider licensed under Part X Chapter 400 may not receive PIP reimbursements for physical therapy services enumerated in section 486.021(11) rendered by a licensed massage therapist employed by the clinic that is not “massage” as defined by section 480.033(3), because the plain language of the PIP statute precludes those reimbursements.

The appellate court ruled that “while there is some overlap between the two licensed practices, they are different practices requiring different licensures.”

The panel stated that the trial court erred “when it appeared to rely on the ‘incidental to’ language in the Physical Therapy Act, section 486.161(1), to deem the Beacon Healthcare massage therapists’ services eligible for PIP reimbursement. The services were performed in these consolidated cases by unsupervised massage therapists, regardless of the modalities used. The plain language of the PIP statute, section 627.736(1)(a)(5), precludes reimbursement to the massage therapists – or to Beacon Healthcare – as these services were erroneously billed as having been directly supervised by a licensed physical therapist or medical doctor.”

The court vacated the trial court ruling and sent it back with instructions to enter judgement in favor of Geico.

The Health Law Offices of Anthony C. Vitale can advise affected providers on billing and operational compliance. If you have any questions or concerns, do not hesitate to contact us at 305-358-4500 or info@vitalehealthlaw.com

Posted in
The Health Law Offices of Anthony C. Vitale

The Health Law Offices of Anthony C. Vitale

Categories

Subscribe!