FOUNDATION HEALTH, A FLORIDA HEALTH PLAN, INC., ET AL., APPELLANTS,
v.
RICARDO GARCIA-RIVERA, M.D., ET AL., APPELLEES
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Foundation Health and other HMOs appealed a trial court's certification of a class action brought by contract providers alleging violations of Florida's "prompt pay" statute. The court affirmed the class certification, rejecting the HMOs' argument that arbitration clauses in some provider agreements precluded class proceedings.
The trial court properly certified a class action of contract providers. The HMOs' objection based on arbitration clauses was waived and lacks substantive merit. Class proceedings are appropriate and preferable to multiple individual arbitration proceedings.
[1] A class of contract providers may be certified in an action for alleged violation of "prompt pay" provisions of section 641.3155, Florida Statutes.
[2] The existence of arbitration clauses in some provider agreements does not preclude class certification when the issue has been waived or lacks substantive merit.
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Join FLexlaw to unlock all legal intelligence“the trial court properly certified a class of contract providers to the appellant HMOs in an action for the alleged violation of the "prompt pay" provisions of section 641.3155, Florida Statutes (1999)”
Establishes that class certification was appropriate for prompt pay claims
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Join FLexlaw to unlock all legal intelligenceContract providers sued HMOs for alleged violations of section 641.3155, Florida Statutes, which requires HMOs to pay undisputed claims within 35 days…
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SCHWARTZ, Chief Judge.
As in the meaningfully indistinguishable case of Colonial Penn Insurance Co. v. Magnetic Imaging Systems, I, Ltd., 694 So. 2d 862 (Fla. 3d DCA 1997), the trial court properly certified a class of contract providers to the appellant HMOs in an action for the alleged violation of the “prompt pay” provisions of section 641.3155, Florida Statutes (1999).1 The appellants’ claim that class proceedings are inappropriate because of the existence of arbitration clauses in some of the agreements between the defendants and the providers was both waived below, see Arvida/JMB Partners v. Council of Villages, Inc., 733 So. 2d 1026 (Fla. 4th DCA 1998), review denied, 732 So. 2d 325 (Fla.1999); Hansen v. Dean Witter Reynolds, Inc., 408 So. 2d 658 (Fla. 3d DCA 1981), review denied, 417 So. 2d 328 (Fla.1982), and is without substantive merit. See Burns v. Prudential Securities, Inc., 145 Ohio App.3d 424, 763 N.E. 2d 234 (2001) (proper exercise of discretion to conclude that class action preferable to multiple individual arbitration proceedings).
Affirmed.
. 641.3155 Provider contracts; payment of claims.
(l)(a) A health maintenance organization shall pay any claim or any portion of a claim made by a contract provider for services or goods provided under a contract with the health maintenance organization which the organization does not contest or deny within 35 days after receipt of the claim by the health maintenance organization which is mailed or electronically transferred by the provider. (b) A health maintenance organization that denies or contests a provider’s claim shall notify the contract provider, in writing, within 35 days after receipt of the claim by the health maintenance organization that the claim is contested or denied. The notice that the claim is denied or contested must identify the contested portion of the claim and the specific reason for contesting or denying the claim, and may include a request for additional information. If the health maintenance organization requests additional information, the provider shall, within 35 days after receipt of such request, mail or electronically transfer the information to the health maintenance organization. The health maintenance organization shall pay or deny the claim or portion of the claim within 45 days after receipt of the information.
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Westside EKG Assocs. v. Found. Health, 932 So. 2d 214 (Fla. 4th DCA 2005)…ervice providers of common law rights to civil remedies, including third party claims. Such a result would be to the detriment of subscribers, the protected class under the Act. See § 641.185, Fla. Stat. In Foundation Health v. Garcia-Rivera, M.D., 814 So. 2d 537 (Fla. 3d DCA 2002), a class action by contract providers for violation of the Act’s “prompt pay” provisions, issued prior to Villazon, the Third District recognized that service providers have a right to sue HMOs. The court reasoned that its decisio…
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Peter F. Merkle, M.D., P.A. v. Health Options, Inc., 940 So. 2d 1190 (Fla. 4th DCA 2006)…Instead, the AHCA directed the parties to bring this issue before a ‘court of competent jurisdiction or the provider dispute resolution program as outlined in section 408.7057.’ 934 So. 2d at 604 n. 2; see also Found. Health v. Garcia-Rivera, M.D., 814 So. 2d 537, 538 (Fla. 3d DCA 2002) (finding that class action proceedings may be appropriate despite arbitration provisions in agreements between providers and HMOs). Thus, while the dispute resolution process under section 408.7057 may provide an adequate rev…
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Found. Health v. Ricardo Garcia-Rivera MD., 847 So. 2d 581 (Fla. 3d DCA 2003)…PER CURIAM. This is an appeal of a post judgment order directing disbursement of certain class action settlement proceeds. See Foundation Health v. Garcia-Rivera, 814 So. 2d 537 (Fla. 3d DCA 2002) (affirming certification of class). We entirely agree with Judge Rothenberg that the class action settlement agreement is clear on its face, see Barakat v. Broward County Housing Authority, 771 So. 2d 1193, 1195 (Fla. 4th DCA 2000…
Authorities Cited
- Hansen v. Dean Witter Reynolds, Inc., 408 So. 2d 658 (Fla. 3d DCA 1981)
- Bowman v. State, 733 So. 2d 1026 (Fla. 1st DCA 1998)
- Arvida/JMB P'rs v. Council OF Villages, Inc., 733 So. 2d 1026 (Fla. 4th DCA 1998)