Tag Archives: Health Care Clinic Act

Some Providers Billing PIP Claims No Longer Exempt From Health Care Clinic Act

MS_smBy Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

Some health care providers that were previously exempt from the requirements of the Health Care Clinic Act are now required to obtain a Health Care Clinic license in order to bill for care provided to their patients injured in car accidents.

The original purpose of the Health Care Clinic Act was to regulate health care entities that were not owned by licensed health care providers. Entities that were owned by licensed health care providers were exempt from the Health Care Clinic license requirements because those health care providers were already regulated by the Department of Health (DOH).

Effective January 1, 2013, the law changed so that every health care provider that bills personal injury protection (PIP) insurance carriers is now required to obtain a Health Care Clinic license unless the provider is exempt from that requirement under the PIP statute. The only health care providers that are still exempt under the PIP statute are medial doctors, osteopathic doctors, chiropractic doctors, and dentists. Physical therapists, nurse practitioners and doctors of podiatry must be licensed as Health Care Clinics in order to bill PIP insurance carriers. Acupuncture doctors and massage therapists are now completely prohibited from billing PIP insurance carriers.

Additional Requirements on Health Care Clinics.

The PIP statute also imposes additional requirements on Health Care Clinics before those clinics can bill PIP insurance carriers. In order to bill PIP, a Health Care Clinic must be:

A health care clinic licensed under Part X of Chapter 400, Florida Statutes, and is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state, or

1. Has a medical director licensed under chapter 458, chapter 459, or chapter 460;
2. Has been continuously licensed for more than three years or is a publicly traded corporation that issues securities traded on an exchange registered with the United States Securities and Exchange Commission as a national securities exchange; and
3. Provides at least four of the following medical specialties:

a. General medicine
b. Radiography
c. Orthopedic medicine
d. Physical medicine
e. Physical therapy
f. Physical rehabilitation
g. Prescribing or dispensing outpatient prescription medication
h. Laboratory services.

Click here to read 627.736(1)(a)2e, Florida Statutes.

PIP Insurance Carriers Might Deny Claims.

The Florida PIP statute also provides that a physical therapist can provide follow-up care upon the referral by a physician, which conflicts with the new Health Care Clinic license requirements in other parts of the statute. Several PIP insurance carriers are denying provider claims and demanding refunds based upon their own interpretations of these changes. A health care provider that receives denials, or demands for refunds should immediately contact an attorney experienced in these matters.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, denials and demands for repayment from insurance companies, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Were you aware for the changes to the Health Care Clinic Act? Were you previously exempt and now required to obtain a Health Care Clinic license? Please leave any thoughtful comments below.

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

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Chiropractors Not Allowed to Work for Clinics Owned by Non-Chiropractors in Florida, with Limited Exceptions

00011_RT8By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Apparently there are many chiropractic physicians and other medical business owners who are unaware of the prohibition provided in Florida law against a chiropractor providing services for a business owned by non-chiropractors. By non-chiropractor, this means anyone who does not have a current, active Florida chiropractic physician’s license.

The prohibition for chiropractors was passed into law in Florida originally in 2007. The law was amended in 2012. There had previously been similar prohibitions that applied to dentists and optometrists. To read the article I wrote on these issues, click here.

What’s the Purpose of This Law?

Found in Section 460.4167, Florida Statutes, the law states that a person (which includes a corporation or limited liability company), may not engage the services of a chiropractor as either an employee or an independent contractor to provide chiropractic services, except under a limited set of circumstances. To see the complete text of Section 460.4167, Florida Statutes, click here.

The purpose of the Florida Legislature in passing this law is set forth within the law itself. Subsection 4 of the law states:

The purpose of this section is to prevent a person other than the licensed chiropractic physician from influencing or otherwise interfering with the exercise of the chiropractic physician’s independent professional judgment. In addition to the acts specified [elsewhere in the statute], . . . a person or entity other than [the ones excepted] . . . may not employ or engage a chiropractic physician licensed under this chapter.

Exceptions to the Law.

There are, of course, exceptions stated in this law for organizations that are allowed to employ or contract with chiropractors. These include:

1. Business entities owned solely by chiropractors (licensed in Florida) and their immediate family members.

2. Business entities owned by medical, osteopathic or podiatric physicians licensed in Florida.

3. Business entities owned by hospitals.

4. A clinic that trains chiropractic students that is affiliated with an accredited chiropractic college.

5. A public or private college or university.

6. A business entity that is owned by a corporation that is tax exempt under certain Internal Revenue Service regulations (not-for-profit corporation).

7. A publicly traded corporation.

8. An insurance company licensed in Florida.

9. An HMO or prepaid health clinic (as set forth in chapter 641, Florida Statutes).

10. A clinic licensed as a Health Care Clinic under Florida Statutes, which provides chiropractic services by a licensed Florida chiropractor and also provides other health care services by medical doctors or osteopathic physicians, the medical director of which is licensed under chapter 458 (medical doctors) or chapter 459 (osteopathic physicians), Florida Statutes.

Special Exception for Clinics Licensed Under Florida’s Health Care Clinic Licensure Act.

This last exception, one for clinics licensed under Florida’s Health Care Clinic Licensure Act (Section 400.990, Florida Statutes), provides perhaps the broadest exception. A clinic that is properly licensed by the Florida Agency for Health Care Administration (AHCA), and meets the other requirements of the law, can be legally owned by non-chiropractors or non-physicians, and chiropractors may legally contract with or be employed by them. The safeguard is that the licensing requirements in Section 400.990 must be met, and physician services other than just chiropractic services must be performed at the clinic.

However, even under the exception provided by the Health Care Clinic Act, any agreement or other arrangement with the chiropractic physician whereby the other person (or an entity) provides the chiropractor with chiropractic equipment or chiropractic materials must contain a provision whereby the chiropractic physician expressly maintains complete care, custody and control of the equipment or practice.

To see the complete text of the Florida Health Care Clinic Act, click here.

Violating the Law Puts Your Professional License in Jeopardy.

If the business entity, clinic or group does not fall squarely within one of the exceptions listed above, the chiropractor may not legally be employed by or provide chiropractic services for it. The penalties for violating this law include:

1. Prosecution for a felony in the third degree.

2. Any contracts associated with the services are void.

3. Disciplinary action against health care licensees pursuant to chapter 456 or chapter 460, Florida Statutes.

4. By implication, since any contracts in violation are void, then any fees or bills for services in violation of the act are also void.

Don’t jeopardize your professional license, your reputation, your assets or your liberty by risking a violation of this act. Consult with an experienced health lawyer on any such business venture or proposal.

Contact a Health Care Attorney Experienced in Negotiating and Evaluating Physician and Health Professional’s Business Transactions.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, chiropractors, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider.

The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Were you aware of this law and its exceptions? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.