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UR Health Chiropractic Corp. v. Progressive Select Insurance Co.

United States District Court, S.D. Florida, Miami Division

January 18, 2018

UR HEALTH CHIROPRACTIC CORP., a/a/o Oxana Kouzmenko, on behalf of itself and all others similarly situated, Plaintiff,
v.
PROGRESSIVE SELECT INSURANCE COMPANY, Defendant.

          ORDER GRANTING DEFENDANT'S MOTION TO DISMISS

          FEDERICO A. MORENO UNITED STATES DISTRICT JUDGE

         Plaintiff UR Health Chiropractic Corporation brought this action against Defendant Progressive Select Insurance Company to challenge its reimbursement practices related to personal injury protection benefits. Progressive subsequently moved to dismiss the complaint for failure to state a claim upon which relief can be granted. For the reasons discussed below, it is ADJUDGED that Progressive's motion to dismiss is GRANTED.

         I. The Parties

         A. Relevant Non-Party

         1. Oxana Kouzmenko

         Oxana Kouzmenko is a Florida resident who sustained injuries during an automobile accident that occurred on August 6, 2016. At that time, Kouzemenko was covered under an insurance policy issued by Defendant Progressive Select Insurance Company. The Policy provided Kouzmenko with personal injury protection benefits in accordance with Florida's Motor Vehicle No-Fault Law.[1] Kouzmenko assigned the benefits under this Policy to UR Health and, in exchange, UR Health provided medical services to help treat Kouzmenko's injuries.

         B. The Parties

         2. Plaintiff- UR Health Chiropractic Corporation

         UR Health is a Florida corporation with its principal place of business in Broward County, Florida. It provides chiropractic services to help patients with a variety of injuries.

         3. Defendant - Progressive Select Insurance Company

         Progressive Select Insurance Company is a foreign corporation that provides, among other things, automobile insurance in Florida. Progressive sold an automobile insurance policy to Kouzmenko. This Policy was in effect at the time of Kouzmenko's automobile accident, which triggered Progessive's obligation to provide Kouzmenko with the personal injury protection benefits included in the policy.

         II. Background

         Following the 2016 automobile accident, Kouzmenko assigned the personal injury protection benefits from her Progressive automobile insurance policy to UR Health. In turn, UR Health provided chiropractic services to help Kouzmenko recover from the personal injuries she sustained during the accident. Progressive subsequently reimbursed UR Health for certain medical services covered by the policy.

         To calculate the reimbursement owed to UR Health under Kouzmenko's insurance policy, Progressive applied Medicare's Multiple Procedure Payment Reduction Rule to UR Health's bills for chiropractic services. The Multiple Procedure Payment Reduction Rule- which accounts for the savings and efficiencies achieved when a provider performs multiple medical procedures in a single day-reduces payment to a healthcare provider by a set percentage for second and subsequent procedures provided to the same patient on the same day. See 7 ...


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