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What's Hot in Workers' Comp

Prescription Disputes Remain under the Exclusive Jurisdiction of the Florida Dept. of Financial Services

What’s Hot in Workers’ Comp – Special FL Alert – October 11, 2024

October 11, 2024

by Linda Wagner Farrell

Rite Rx Pharmacy Corp. v. Packard Claims Administration, Inc., 17th Judicial Circuit, Broward County, Florida, Case No. CACE21000476

Rite Rx filed suit against Packard Claims Administration, seeking to collect for prescription medication dispensed improperly and without prior authorization. Packard filed a motion to dismiss the complaint, and the court held that the Department of Financial Services has exclusive subject matter jurisdiction under 440.13(11), Florida Statutes, and granted the motion to dismiss with prejudice.

Rite Rx is known for providing prescription pads or forms to doctors, when then check off a medication. Rite Rx sends the medication to the claimant without obtaining authorization from the carrier or third party administration (TPA). The medications provided are significantly more costly than normal or the script will have a slightly higher dose of an ingredient that is a cost driver. The injured worker is provided the prescription medications via mail, and bills are sent to the carrier or TPA for payment. 

In some cases, carriers and TPAs are receiving bills via certified mail with a cover letter that states, if they do not receive approval within three days per 440.13(3)(d), then it is deemed authorized. Rite Rx is incorrectly relying on section 440.13(3)(d) of the statute because it relates only to a referral by a medical provider, not a prescription medication. If the bill is denied, some carriers are receiving correspondence from an attorney retained by Rite Rx, which threatens a lawsuit if not paid. Various causes of action are mentioned, such as illegal conversion of funds, Florida Deceptive and Unfair Trade Practices Act (FDUPTA), and tortious interference. 

We recommend that you contact us to assist with these matters. The Department of Financial Services has exclusive jurisdiction over any medical billing disputes, and the pharmacy should file a petition rather than engaging in threatening behavior or filing a lawsuit in Circuit Court.  

 

What’s Hot in Workers’ Comp – Special FL Alert – October 11, 2024, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2024 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.

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