AHCA Health Care Clinic Unit

Agency for Health Care Administration
Health Care Clinic Licensure Unit
Health Quality Assurance
Gov. Rick Scott
Liz Dudek
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
[email protected] Manager
[email protected] OMC Mgr.
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
Legislative Intent
• The purpose of the Health Care Clinic Act
• 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
What is a “Clinic?”
• "Clinic" means an entity where health care
services are provided to individuals and which
tenders charges for reimbursement for such
Exemption for “wholly owned”
• 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
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
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
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]
False or Misleading AHCA
• 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
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”
• 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

similar documents