Agency for Health Care Administration
Health Care Clinic Licensure Unit
Health Quality Assurance
Gov. Rick Scott
Liz Dudek
Secretary
Public Records
• Chapter 119, Florida Statutes
• Call direct
• On time and under budget
Agency for Health Care Administration
2727 Mahan Drive, Mail Stop #53
Tallahassee, FL 32308
(850) 412-4404
Tom.Jones@ahca.myflorida.com Manager
Dennis.LaRosa@ahca.myflorida.com OMC Mgr.
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Health Care Clinic Act
• Agency for Health Care Administration,
Division of Health Quality Assurance, Bureau
of Health Facility Regulation, Health Care
Clinic Unit
• One of the most consequential penalties of the
law is that all charges made by unlicensed
clinics will be unlawful and uncollectible after
March 1, 2004
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Legislative Intent
• The purpose of the Health Care Clinic Act
is:
• To provide for the licensure
• Establishment and enforcement of basic
standards for health care clinics
• To provide administrative oversight by the
Agency for Health Care Administration
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What is a “Clinic?”
• "Clinic" means an entity where health care
services are provided to individuals and which
tenders charges for reimbursement for such
services
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Exemption for “wholly owned”
Clinics
• Wholly owned by practitioner, and the spouse,
parent, child or sibling
• One of the owners is supervising business
activities services performed
• Legally responsible for compliance with state
and federal laws
• May not supervise services beyond the scope
of the practitioner's license
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Need a License to bill PIP in 2013?
• Notwithstanding this subsection, an entity shall
be deemed a clinic and must be licensed under
this part in order to receive reimbursement
under the Florida Motor Vehicle No-Fault Law,
ss. 627.730-627.7405, unless exempted under
s. 627.736(5)(h)
s. 400.9905(4), Florida Statutes
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PIP (5)(h) Licensing Exemptions
(5)(h) …However, this licensing requirement
does not apply to:
1. wholly owned by an MD or DO and spouse,
parent, child, or sibling of the physician
2. Dentist
3. Chiropractic physician
4. Hospital or ambulatory surgical center
6. Medical school
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Wholly Owned
• (17) "Entity wholly owned" means a [company] that provides health
care services …by licensed health care practitioners and in which
licensed health care practitioners are the business owners of:
• All aspects of the business entity
• Business owners on the title or lease of the physical facility
• Filing taxes as the business owners
• Account holders on the entity's bank account
• Listed as the principals on incorporation documents
• having ultimate authority over all personnel and compensation
decisions relating to the [company]
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False or Misleading AHCA
Application
• Knowingly presents, causes to be presented, or
prepares or makes with knowledge or belief
that [license or certificate of exemption]
• Will be presented to any insurer a claim for
personal injury protection insurance
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False or Misleading AHCA Application
• If the person knows that the payee knowingly
submitted a false, misleading, or fraudulent
application or other document
• for licensure as a health care clinic, or
• seeking an exemption from licensure as a
health care clinic, or demonstrating
compliance with part X of chapter 400. =
“Fraudulent Insurance Act”
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Challenges
• New law may not be investigated til late 2013,
so there is time to prepare
• Sharing information and with stakeholders
• Knock on doors! “I am with the Division of
Insurance Fraud and you’re not.”
--Col. Dan Anderson
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