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Agency for Health Care Administration Health Care Clinic Licensure Unit Health Quality Assurance Gov. Rick Scott Liz Dudek Gov. Rick Scott Liz DudekSecretary.

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Presentation on theme: "Agency for Health Care Administration Health Care Clinic Licensure Unit Health Quality Assurance Gov. Rick Scott Liz Dudek Gov. Rick Scott Liz DudekSecretary."— Presentation transcript:

1 Agency for Health Care Administration Health Care Clinic Licensure Unit Health Quality Assurance Gov. Rick Scott Liz Dudek Gov. Rick Scott Liz DudekSecretary

2 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 (850) Manager OMC Mgr. 2

3 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,

4 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 4

5 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 5

6 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 6

7 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 , unless exempted under s (5)(h) s (4), Florida Statutes 7

8 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 8

9 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] 9

10 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 10

11 False or Misleading AHCA Application false, misleading, or fraudulent application or other documentIf the person knows that the payee knowingly submitted a false, misleading, or fraudulent application or other document licensurefor licensure as a health care clinic, or exemption from licensureseeking an exemption from licensure as a health care clinic, or demonstrating compliance with part X of chapter 400. = Fraudulent Insurance Act 11

12 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 youre not. --Col. Dan Anderson 12


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