Frier Levitt recently secured a significant victory on behalf of a healthcare provider client, recovering the full amount of unpaid claims along with statutory interest pursuant to Florida’s prompt pay law, Fla. Stat. § 627.6131 (and its companion HMO provision, Fla. Stat. § 641.3155).
Florida’s Prompt Pay Law and Ongoing Reimbursement Challenges
Although Florida’s prompt pay law requires health insurers and HMOs to pay, deny, or contest electronic clean claims within 20 days (and paper claims within 40 days) of receipt, and to pay overdue claims with interest at 12% per annum, late and improperly denied payments are a chronic problem for physicians, medical groups, hospitals, ambulatory surgery centers, and ancillary providers. Florida’s prompt pay law is one of the strongest tools available to combat this conduct, but recovery requires a careful, claim-by-claim showing that each claim was “clean,” properly submitted, and not timely paid, denied, or contested.
Leveraging Expedited AAA Procedures to Recover Unpaid Claims
Providers, especially those with smaller dollar values at issue, tend to forgo pursuit of these claims (or their interest) because of the costly nature of litigation. Frier Levitt’s result restores the provider to the position it should have been in had the payor complied with its statutory obligations in the first instance and provides an avenue, through expedited procedures under the American Arbitration Association (AAA), to address the claims without facing the same expense and delay as ordinary litigation.
Under the expedited procedures of the AAA, a matter may be decided on documents only, with no discovery, no motion practice, no hearings, no depositions, and no delay in receiving a final award. The only downside is that the total claim amount must be $100,000 or less. However, for smaller claim totals, this type of expedited procedure may be beneficial in recovering unpaid amounts and applicable interest depending on the complexity and status of the claims themselves.
Through aggressive and strategic application of Florida’s HMO Act and pursuit of expedited procedures through AAA, Frier Levitt obtained a full recovery of the outstanding claim balances for its client, together with statutory interest, without engaging in a lengthy litigation process.
How Frier Levitt Can Help
Frier Levitt is a national law firm focused exclusively on healthcare and life sciences law. We have experience representing physicians, medical practices, pharmacies, providers, and other healthcare stakeholders in payor disputes, prompt pay litigation, network access matters, audits, and reimbursement recovery against commercial insurers, HMOs, Medicare Advantage plans, PBMs, and TPAs. If you are a healthcare provider experiencing delayed payments, improper denials, or recoupments from a Florida payor (or any payor nationwide), please contact Frier Levitt to discuss your options and potential recovery strategies.
Senior Associate
