Florida is Serious in Combating PIP Fraud: Don’t Land Yourself in Prison
Friday, February 5, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawAn Orlando health clinic owner and one other person were recently arrested on charges of defrauding multiple insurance companies and payers, according to the Florida Division of Insurance Fraud. Dr. Troy Godsey of Spine Health Solutions, P.A., allegedly provided treatments to”patients” involved in auto accidents. Three insurance companies received a $300,000 bill for reimbursements under the “patients'” personal injury protection (PIP) auto insurance. The companies reportedly paid out $100,000 before realizing it was a scam.
Godsey Operated Under the Pretense That He Was the Sole Owner of the Clinic.Although Godsey, a licensed chiropractor, was allegedly the sole owner of the clinic, it was employee Renata Berriel Deazevedo, a non-licensed individual, who carried out the daily operations of the business. According to the Florida Department of Financial Services, Godsey was previously granted an exemption from clinic licensing requirements with the Agency for Health Care Administration. This reportedly allowed him to run the PIP fraud scheme without having to obtain a separate health care clinic license that would make the practice subject to periodic inspections. This further violated Florida’s PIP insurance laws.It seems Godsey was attempting to create a “straw ownership” to avoid the proper licensing of his clinic. In accordance with Florida law requirements, it should have been licensed under the Florida Health Care Clinic Licensure Act (HCCLA). To operate a clinic in violation of the HCCLA is a felony. Furthermore, every day of operation is a different felony charge. In addition, all medical bills that an illegal clinic issues are void.
Facing Prison for Half a Century.Godsey’s and Deazevedo’s felony charges include operating an unlicensed health care clinic and filing false and fraudulent insurance claims. These charges carry with them penalties in excess of 50 years prison time. If convicted, the pair are faced with spending more than half a century behind bars. For most individuals, this would equate to a life sentence behind bars.
Who’s Your Boss?Physicians, especially dentists, chiropractors, and optometrists, should always be extremely wary about working for a clinic or medical group owned in any part by someone who is not a licensed health professional. If it is owned in any part, even one percent (1%) by a person or business entity that is not a Florida licenced health professional, it may be operating illegally. This includes someone licensed in another state or who has a suspended or revoked license in Florida. Dentists, optometrists and chiropractors have even more restrictions placed on their practices than other health professionals in Florida and most other states.Florida specifically prohibits the corporate practice of dentistry. The key provision in Florida law that establishes this is Section 466.028, Florida Statutes, but the Florida Board of Dentistry has adopted administrative rules on this topic as well.Physicians who are “partners,” “shareholders” or “co-owners” with unlicensed personnel need to ensure they are in full compliance with the HCCLA and all other applicable Florida laws and regulations. Consult with an experienced health lawyer before making an expensive mistake.
The Effect of the New Legislation: Know the Law and Be Sure to Follow It.Several health care clinics wholly owned by licensed practitioners, were once allowed exemptions from licensing requirements of their facilities per Section 400.9905 (4)(G) of Florida Statutes. However, if these clinics wish to collect on PIP benefits, they will no longer be eligible to maintain their exempt status. The new PIP legislation is still under fire and it is likely it will undergo additional revisions. Due to its’ ever-changing nature, a licensed dentist or other licensed practitioner needs to stay up-to-date on Florida law requirements to avoid becoming entangled in illegal activity. It’s not enough to assume your employer is following the law.What may have started off as blissful ignorance or an honest mistake, can quickly catapult into a significant consequence. Consulting with an experienced health attorney will keep your license safe and keep at bay unwanted prison time.
Comments?Have you ever been a victim or suspect of a PIP scam? Please leave any thoughtful comments below.
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.
Sources:Chief Financial Officer’s Press Office. “Orlando PIP Clinic Owner Arrested for Defrauding Insurance Companies of More Than $100,000.” (June 25, 2015). From http://www.myfloridacfo.com/sitePages/newsroom/pressRelease.aspx?id=4520Health News Florida Staff. “Chiropractor Caught In PIP Scam.” (June 29, 2015). Health News Florida. From http://health.wusf.usf.edu/post/chiropractor-caught-pip-clinic-scam
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. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: PIP fraud, PIP claims, licensed dentist, health care clinic owners, health fraud defense lawyer, Agency for Health Care Administration, Health Care Clinic Licensure Act, health care clinic attorney, litigation over ownership of clinic, corporate practice of medicine, health fraud defense attorney, false claims lawyer, insurance fraud, Florida Division of Insurance Fraud, health law firm, The Health Law Firm, fraudulent claims, false claims attorney, health care fraud, health care clinic attorney“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 © 1996-2016 The Health Law firm. All rights reserved.
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