Conflict Alert: 2007 Limiting Charge v. Participating Price

On April 26, 2023, Florida's Fourth District Court of Appeal reversed its holding in Allstate Fire and Casualty Ins. Co. v. Jeffrey L. Katzell, M.D., P.A., 323 So. 3d 191 (Fla. 4th DCA 2021) and certified conflict with Priority Medical Centers, LLC v. Allstate Insurance Company, 319 So. 3d 724 (Fla. 3d DCA 2021). In an en banc decision issued in Progressive Select Ins. Co. v. In House Diagnostic Services, Inc. a/a/o Darryl Frazier, Case No. 4D21-2581 (Fla. 4th DCA 2023), the Fourth District Court of Appeal re-analyzed its prior analysis regarding which amount should be used when evaluating the 2007 Medicare Part B fee schedule.

In Progressive Select, the insurer argued, "[the] Third District in Priority Medical did not properly consider the nature of the limiting charge under the Medicare program, because such was never analyzed in the case, leading to incorrect decisions in both Priority Medical and Katzell." The Court explained the concept behind a provider's