Health Care Fraud Blog

We have previously written about the federal government’s HEAT, a task force dedicated to rooting out health care fraud in several cities very prominently including Miami. In the last legislative session, the Sate of Florida also got into the Act. The legislature designated Miami-Dade County as a “health care fraud area” requiring special scrutiny and presumably more funds for Medicaid / Medicare fraud enforcement. In addition, with Miami ’s immigrant community in mind, the legislature also now requires a $500,000 bond to be posted for any new or change of ownership for health care clinics, DME and home health providers. Those following the legislative process noted that the original intention was to eliminate non-citizen ownership altogether, citing to the amount of fraud coming from entities with immigrant owners being used as straw men for the actual operators. However, there were constitutional concerns that led to the bond requirement. To read more, click here.

Florida is among the few states that permit what is referred to as the “corporate practice of medicine.” In many other states, medical and other health care entities are required to be owned by medical professionals individually or through professional associations that include only medical professionals.

Florida still requires practitioner only practices for dentists and last year enacted restrictions on Chiropractic practices. In many states that have these laws, non-practitioners have to go through legal machinations to have an investment interest in a medical practice without actually owning the practice. In many instances in Florida and elsewhere, physicians act as “straw owners” of their own medical practices and are in fact employees or partners with other individuals who control the practice.

In 2004, following the recommendations of a Statewide Grand Jury that looked into abuses with respect to Medicaid and personal injury clinics, Florida passed legislation to specifically permit ownership of health care practices by non-medical professionals with the Health Care Clinic Act. Disturbingly, the Act, which was enacted to shed light on ownership of health care clinics and prevent abuses, has become increasing difficult for applicants. In addition, the surveys of facilities required under the act have also gotten tougher. Oddly, the result of the increasingly tougher regulation may now cause the opposite result, causing many non-practitioners to go back to less open methods of ownership.

Effective July 1, 2009, persons applying for clinic, home health agency or DME provider licensure or a change of ownership now must a host of new financial information. Previously the financials included only a pro-forma for the operation of the clinic. Now, detailed financials also include information about the owner and how the entity will be capitalized.

To read more, click here.

New Stark Law regulations posted on July 31, 2008 by the Centers for Medicare and Medicaid Services (CMS) revise and expand the prohibition on physician referrals for designated health services (DHS) to entities with which they have financial relationships. A recent Health Care Alert from Krieg DeVault LLP provides a more detailed analysis of these changes.

Effective July 1, 2008 there is a significant change in the law in Florida concerning the employment of chiropractic physicians, and the law carries felony level criminal penalties.

Under the statute, F.S. 760.4167, any entity, including licensed health care clinics, that employ chiropractic physician and is not owned entirely by licensed chiropractic physician(s) are statutorily prohibited from exercising control over the practice of chiropractic medicine. The scope of the statute extends to the hours a chiropractor works, pricing of chiropractic services, any equipment used by the chiropractor, and the advertising and selection of patients, among other requirements.

The statute makes any employment arrangement with a chiropractic physician entered into before July 1, 2008 that does not comply with its terms null and void.

Worse, any violation of these provisions is a third degree felony punishable by a maximum of five years in prison.