Florida PIP: Changes in Medicare Fee Schedules Affect Insurance Payments

Since January 1, 2008, insurance companies providing personal injury protection benefits (PIP) have been able to utilize a permission fee schedule to reduce payments to medical providers. The fee schedule is largely based on 200% of the Medicare Part B Participating Physicians Fee Schedule.

The Medicare Fee Schedule is typically updated at least annually. This year, however, there were several anomalies that affected both insurers and medical providers. The fee schedule was not updated in January of 2010. Instead, a retroactive update was issued in May, and applied to all services provided from January 1, 2010 to May 31, 2010. Another retroactive update was passed in June, effective for dates of service June 1, 2010 through November 31, 2010.

This created payment problems for the PIP insurers who based reimbursement on Medicare. Most did not update their payment files quickly, and refused to reprocess prior claims. As a result, many medical providers have not been paid the proper amount on PIP claims. While the individual amounts may be small, they do add up over the course of a claim – and certainly with numerous claims. Medical providers are encouraged to review their PIP payments to ensure that their services were properly compensated.

http://www.thelawlerfirm.com

Bucs Wide Receiver Charges with DUI Despite Breath Test Under the Legal Limit

As reported at http://www.tampabay.com/news/publicsafety/tampa-bay-buccaneers-receiver-mike-williams-accused-of-dui/1135235, the Buccaneers star wide receiver Mike Williams was recently arrested for DUI. According to the report, he was stopped by police for speeding and weaving in traffic at 2:48 a.m. in Brandon. He apparently failed field sobriety tests and was arrested. He then gave breath samples of of .065 and .061, both under the legal limit of .08. This news has given rise to many questions of how he could be charged with DUI if his breath alcohol content was below the legal limit.

In Florida, there are two ways to prove a DUI. The first is where the driver has a blood or breath alcohol content above the legal limit of .08. This is also known as DUBAL – driving with an unlawful blood/breath alcohol content. The second is driving while under the influence of alcohol or drugs to the extent the person’s normal faculties (vision, balance, reactions) are impaired. Whether someone is impaired is different in each circumstance. One person may be impaired with a lower alcohol level than another.

In impairment cases, the officer’s observations of the driver and the performance on field sobriety exercises are critical. Of course, the field sobriety exercises are simply a means for the officer to collect evidence against the driver for use at trial later. The observations are highly subjective in many cases, and made by an officer that is specifically looking for signs of DUI.

So while the star receiver may have been under the legal limit, he still may be convicted of DUI based on his level of impairment.

Http://www.thelawlerfirm.com