News

FIRST DCA SCHEDULES ORAL ARGUMENT FOR JANUARY 16, 2024 REGARDING PROVIDER BILLING AND CARRIER AUTHORIZATION:

On December 4, 2023, the First DCA issued a Notice of Oral Argument in Case No.: 1D2023-0941. In the underlying case, a group of Florida Workers’ Compensation  employers and carriers challenged certain newly proposed administrative rules governing Provider Billing and Carrier Authorization of treatment, including medication dispensed directly to injured workers by doctors and nurses in the office. In a practice known as “physician dispensing” or “practitioner dispensing”, doctors and nurses who are “registered” to dispense, bypass the pharmacy and traditional pharmacist review of medication for complications, and typically have medical staff provide drugs and topical products directly to patients. Citing both patient safety and systemic abuse concerns, carriers objected to many but not all instances of this practice. Also citing efficiency concerns, and in an effort to effectively resolve a large backlog of perhaps thousands of workers’ compensation reimbursement disputes, the Department of Financial Services’ new rules interpret the workers’ compensation proviso that a claimant has absolute choice of “pharmacy or pharmacist” to also include “dispensing practitioners.” While employers and carriers agree with certain portions of the Department’s efforts to notify parties of statutory requirements, they challenge the rule’s new requirement that carriers must authorize in office practitioner dispensing. 

The underlying rule formulation and rule challenge proceedings were spearheaded by Ralph Douglas and Dave Terry with McConnaughhay, Coonrod, et al. The appeal by the employers and carriers includes Publix Super Markets, Inc., Normandy Insurance Company, Zenith Insurance Company, Bridgefield Employers Insurance Company, Bridgefield Casualty Insurance Company, BusinessFirst Insurance Company and RetailFirst Insurance Company, as Appellants. Ralph Douglas of McConnaughhay, Coonrod, and Bill Rogner with HR Law are representing the Appellants, with Bill Rogner to present the Oral Argument on behalf of the Appellants.