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F.S. 400.9935 on Google Scholar

F.S. 400.9935 on Casetext

Amendments to 400.9935


The 2022 Florida Statutes (including 2022 Special Session A and 2023 Special Session B)
Title XXIX
PUBLIC HEALTH
Chapter 400
NURSING HOMES AND RELATED HEALTH CARE FACILITIES
View Entire Chapter
F.S. 400.9935 Florida Statutes and Case Law
400.9935 Clinic responsibilities.—
(1) Each clinic shall appoint a medical director or clinic director who shall agree in writing to accept legal responsibility for the following activities on behalf of the clinic. The medical director or the clinic director shall:
(a) Have signs identifying the medical director or clinic director posted in a conspicuous location within the clinic readily visible to all patients.
(b) Ensure that all practitioners providing health care services or supplies to patients maintain a current active and unencumbered Florida license.
(c) Review any patient referral contracts or agreements executed by the clinic.
(d) Ensure that all health care practitioners at the clinic have active appropriate certification or licensure for the level of care being provided.
(e) Serve as the clinic records owner as defined in s. 456.057.
(f) Ensure compliance with the recordkeeping, office surgery, and adverse incident reporting requirements of chapter 456, the respective practice acts, and rules adopted under this part and part II of chapter 408.
(g) Conduct systematic reviews of clinic billings to ensure that the billings are not fraudulent or unlawful. Upon discovery of an unlawful charge, the medical director or clinic director shall take immediate corrective action. If the clinic performs only the technical component of magnetic resonance imaging, static radiographs, computed tomography, or positron emission tomography, and provides the professional interpretation of such services, in a fixed facility that is accredited by a national accrediting organization that is approved by the Centers for Medicare and Medicaid Services for magnetic resonance imaging and advanced diagnostic imaging services and if, in the preceding quarter, the percentage of scans performed by that clinic which was billed to all personal injury protection insurance carriers was less than 15 percent, the chief financial officer of the clinic may, in a written acknowledgment provided to the agency, assume the responsibility for the conduct of the systematic reviews of clinic billings to ensure that the billings are not fraudulent or unlawful.
(h) Not refer a patient to the clinic if the clinic performs magnetic resonance imaging, static radiographs, computed tomography, or positron emission tomography. The term “refer a patient” means the referral of one or more patients of the medical or clinical director or a member of the medical or clinical director’s group practice to the clinic for magnetic resonance imaging, static radiographs, computed tomography, or positron emission tomography. A medical director who is found to violate this paragraph commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
(i) Ensure that the clinic publishes a schedule of charges for the medical services offered to patients. The schedule must include the prices charged to an uninsured person paying for such services by cash, check, credit card, or debit card. The schedule may group services by price levels, listing services in each price level. The schedule must be posted in a conspicuous place in the reception area of any clinic that is considered an urgent care center as defined in s. 395.002(30)(b) and must include, but is not limited to, the 50 services most frequently provided by the clinic. The posting may be a sign that must be at least 15 square feet in size or through an electronic messaging board that is at least 3 square feet in size. The failure of a clinic, including a clinic that is considered an urgent care center, to publish and post a schedule of charges as required by this section shall result in a fine of not more than $1,000, per day, until the schedule is published and posted.
(2) Any contract to serve as a medical director or a clinic director entered into or renewed by a physician or a licensed health care practitioner in violation of this part is void as contrary to public policy. This subsection shall apply to contracts entered into or renewed on or after March 1, 2004.
(3) A charge or reimbursement claim made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed, or that is otherwise operating in violation of this part, regardless of whether a service is rendered or whether the charge or reimbursement claim is paid, is an unlawful charge and is noncompensable and unenforceable. A person who knowingly makes or causes to be made an unlawful charge commits theft within the meaning of and punishable as provided in s. 812.014.
(4)(a) Regardless of whether notification is provided by the agency under s. 408.812, a person commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, if the person knowingly:
1. Establishes, owns, operates, manages, or maintains an unlicensed clinic required to be licensed under this part or part II of chapter 408; or
2. Offers or advertises services that require licensure as a clinic under this part or part II of chapter 408 without a license.
(b) If the agency provides notification under s. 408.812 of, or if a person is arrested for, a violation of subparagraph (a)1. or subparagraph (a)2., each day during which a violation of subparagraph (a)1. or subparagraph (a)2. occurs constitutes a separate offense.
(c) A person convicted of a second or subsequent violation of subparagraph (a)1. or subparagraph (a)2. commits a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. If the agency provides notification of, or if a person is arrested for, a violation of this paragraph, each day that this paragraph is violated thereafter constitutes a separate offense. For purposes of this paragraph, the term “convicted” means a determination of guilt which is the result of a trial or the entry of a plea of guilty or nolo contendere, regardless of whether adjudication is withheld.
(d) In addition to the requirements of part II of chapter 408, a health care provider who is aware of the operation of an unlicensed clinic shall report the clinic to the agency. The agency shall report to the provider’s licensing board a failure to report a clinic that the provider knows or has reasonable cause to suspect is unlicensed.
(e) A person commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, if the person knowingly:
1. Files a false or misleading license application or license renewal application or files false or misleading information related to such application or agency rule; or
2. Fails to report information to the agency as required by s. 408.810(3).
(5) Any licensed health care provider who violates this part is subject to discipline in accordance with this chapter and his or her respective practice act.
(6) Any person or entity providing health care services which is not a clinic, as defined under s. 400.9905, may voluntarily apply for a certificate of exemption from licensure under its exempt status with the agency on a form that sets forth its name or names and addresses, a statement of the reasons why it cannot be defined as a clinic, and other information deemed necessary by the agency. An exemption may be valid for up to 2 years and is not transferable. The agency may charge an applicant for a certificate of exemption in an amount equal to $100 or the actual cost of processing the certificate, whichever is less. An entity seeking a certificate of exemption must publish and maintain a schedule of charges for the medical services offered to patients. The schedule must include the prices charged to an uninsured person paying for such services by cash, check, credit card, or debit card. The schedule must be posted in a conspicuous place in the reception area of the entity and must include, but is not limited to, the 50 services most frequently provided by the entity. The schedule may group services by three price levels, listing services in each price level. The posting must be at least 15 square feet in size. As a condition precedent to receiving a certificate of exemption, an applicant must provide to the agency documentation of compliance with these requirements.
(7)(a) Each clinic engaged in magnetic resonance imaging services must be accredited by a national accrediting organization that is approved by the Centers for Medicare and Medicaid Services for magnetic resonance imaging and advanced diagnostic imaging services within 1 year after licensure. A clinic that is accredited or that is within the original 1-year period after licensure and replaces its core magnetic resonance imaging equipment shall be given 1 year after the date on which the equipment is replaced to attain accreditation. However, a clinic may request a single, 6-month extension if it provides evidence to the agency establishing that, for good cause shown, such clinic cannot be accredited within 1 year after licensure, and that such accreditation will be completed within the 6-month extension. After obtaining accreditation as required by this subsection, each such clinic must maintain accreditation as a condition of renewal of its license. A clinic that files a change of ownership application must comply with the original accreditation timeframe requirements of the transferor. The agency shall deny a change of ownership application if the clinic is not in compliance with the accreditation requirements. When a clinic adds, replaces, or modifies magnetic resonance imaging equipment and the accrediting agency requires new accreditation, the clinic must be accredited within 1 year after the date of the addition, replacement, or modification but may request a single, 6-month extension if the clinic provides evidence of good cause to the agency.
(b) The agency may deny the application or revoke the license of any entity formed for the purpose of avoiding compliance with the accreditation provisions of this subsection and whose principals were previously principals of an entity that was unable to meet the accreditation requirements within the specified timeframes. The agency may adopt rules as to the accreditation of magnetic resonance imaging clinics.
(8) The agency shall give full faith and credit pertaining to any past variance and waiver granted to a magnetic resonance imaging clinic from rule 64-2002, Florida Administrative Code, by the Department of Health, until September 2004. After that date, such clinic must request a variance and waiver from the agency under s. 120.542.
(9) In addition to the requirements of part II of chapter 408, the clinic shall display a sign in a conspicuous location within the clinic readily visible to all patients indicating that, pursuant to s. 626.9892, the Department of Financial Services may pay rewards of up to $25,000 to persons providing information leading to the arrest and conviction of persons committing crimes investigated by the Division of Investigative and Forensic Services arising from violations of s. 440.105, s. 624.15, s. 626.9541, s. 626.989, or s. 817.234. An authorized employee of the Division of Investigative and Forensic Services may make unannounced inspections of a clinic licensed under this part as necessary to determine whether the clinic is in compliance with this subsection. A licensed clinic shall allow full and complete access to the premises to such authorized employee of the division who makes an inspection to determine compliance with this subsection.
History.—s. 4, ch. 2003-411; s. 17, ch. 2004-298; s. 29, ch. 2004-350; s. 4, ch. 2006-305; s. 128, ch. 2007-230; s. 45, ch. 2009-223; s. 4, ch. 2011-122; s. 3, ch. 2012-160; s. 6, ch. 2013-93; s. 2, ch. 2015-179; s. 8, ch. 2016-165; s. 59, ch. 2018-24; s. 100, ch. 2019-167; s. 19, ch. 2020-156; s. 9, ch. 2021-112.

Statutes updated from Official Statutes on: March 07, 2023
F.S. 400.9935 on Google Scholar

F.S. 400.9935 on Casetext

Amendments to 400.9935


Arrestable Offenses / Crimes under Fla. Stat. 400.9935
Level: Degree
Misdemeanor/Felony: First/Second/Third

400.9935 1h - HEALTH-SAFETY - HEALTH CLINIC DIRECTOR MAKE ILLEGAL REFERRAL - F: T
400.9935 4 - HEALTH-SAFETY - FILE FALSE HEALTH CLINIC APP OR INFO - F: T

Civil Citations / Citable Offenses under S400.9935
R or S next to points is Mandatory Revocation or Suspension

Current data shows no reason a civil citation or a suspension or revocation of license should have been issued under Florida Statute 400.9935.

Annotations, Discussions, Cases:

  1. State Farm Fire & Cas. Co. v. Silver Star Health & Rehab

    739 F.3d 579 (11th Cir. 2013)   Cited 68 times
    State Farm's position is that it does not have to pay that $86,000 because the treatment was not “lawfully provided” since Silver Star did not comply with the licensing statute. Florida law provides that an insurer is not required to pay for medical treatment that is not “lawfully provided.” See id.§§ 400.9935(3), 627.736(1)(a) 1. State Farm filed a lawsuit against Silver Star, McKenzie, and Colin in federal district court seeking: (1) a declaratory judgment that it is not required to pay the outstanding bills from Silver Star; and (2) damages for unjust enrichment of more than $151,000, the amount that State Farm has already paid Silver Star. The unjust enrichment count was tried to a jury, which returned a verdict for State Farm. The district court entered judgment on the jury verdict, and the court also entered the declaratory judgment that State Farm sought. Silver Star has appealed the final judgment against it and State Farm has cross-appealed (on a discovery issue and a jury instruction issue) as a precautionary measure. We begin by addressing Silver Star's contentions because we will need to reach State Farm's cross-appeal only if Silver Star prevails.
    PAGE 582

  2. Allstate Ins. Co. v. Vizcay

    826 F.3d 1326 (11th Cir. 2016)   Cited 21 times   1 Legal Analyses
    Florida's Clinic Act requires clinics operating in and licensed by the State to “appoint a medical director or clinic director who shall agree in writing to accept legal responsibility for [certain enumerated] activities on behalf of the clinic.” Fla. Stat. § 400.9935(1) ; see also id. §§ 400.9905(4), 400.991. One of those activities is “[c]onduct[ing] systematic reviews of clinic billings to ensure that the billings are not fraudulent or unlawful.” Id. § 400.9935(1)(g). A clinic's failure to comply with the Clinic Act's licensing requirements carries significant consequences. In relevant part, the Act provides:
    PAGE 1328

  3. State Farm Mut. Auto. Ins. Co. v. B&A Diagnostic, Inc.

    145 F. Supp. 3d 1154 (S.D. Fla. 2015)   Cited 17 times
    Florida's Health Care Clinic Act (“HCCA”) makes it unlawful for health care clinics to operate without a license from AHCA. Fla. Stat. § 400.991. The HCCA also requires that all clinics which are owned by non-licensed individuals must “appoint a [M]edical [D]irector who shall agree in writing to accept legal responsibility” for various activities identified in the HCCA. Fla. Stat. § 400.9935(1). One requirement is that the Medical Director must ensure that all practitioners have active, unencumbered, and appropriate licenses and certifications for the level of care being provided. Fla. Stat. § 400.9935(1)(b), (d). The Medical Director also has a statutory obligation to ensure that any billing for services rendered by the clinic do not contain charges that are fraudulent or unlawful, and the Medical Director must conduct “systematic reviews of clinic billings” to accomplish this task. Fla. Stat. § 400.9935(1)(g). Any charge submitted on behalf of a clinic whose Medical Director is in violation of the aforementioned statutory requirements “is an unlawful charge and is noncompensable and unenforceable.” Fla. Stat. § 400.9935(3).
    PAGE 1163

  4. Gov't Emps. Ins. Co. v. Quality Diagnostic Health Care, Inc.

    369 F. Supp. 3d 1292 (S.D. Fla. 2019)   Cited 2 times
    Fla. Stat. § 400.9935(3). The plain language of Fla. Stat. § 400.9935(3) makes clear that a claim for reimbursement made by a clinic that is not properly licensed or that is otherwise operating in violation of the Clinic Act, constitutes an unlawful charge that is "noncompensable and unenforceable." Stated another way, if a clinic is not currently licensed, any claim – whether for PIP benefits or not – made by that clinic constitutes an unlawful charge that is "noncompensable and unenforceable." See id. In fact, the catch-all provision appended to the exclusions from the definition of a "Clinic" reinforces this point and specifically makes clear that any entity that wishes to receive PIP reimbursements , even if generally excluded from the definition of a "Clinic," will be deemed a "Clinic," and therefore must be a licensed "Clinic" under the Clinic Act in order to receive PIP reimbursements. Fla. Stat. § 400.9905(4) ("[A]n 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).") (emphasis added).
    PAGE 1297

  5. Gov't Emps. Ins. Co. v. Merced

    8:20-cv-802-KKM-AAS (M.D. Fla. Sep. 10, 2021)
    GEICO asserts this information is necessary to establish its claim that Dr. Merced failed to conduct the “systematic review” of Right Spinal's billing required of a medical director under Fla. Stat. § 400.9935(1)(g). (Doc. 225, p. 6). While Dr. Merced testified he reviews “between 5-10 of Right Spinal's patient files during each such review, ” Dr. Merced could not give a precise estimate of how many patients Right Spinal treats every month. (Id.). GEICO argues the number of patients treated by Right Spinal each month is “critically relevant” to determining whether the 5-10 patient files Dr. Merced reviews each month constitute a large enough sample of total patient files to qualify as a “systematic review” under Fla. Stat. § 400.9935(1)(g). (Id. at 8). GEICO also alleges any objections by Right Spinal should be waived because Right Spinal responded to GEICO's second set of interrogatories 11 days after responses were due under Fed. R. Civ. Pro. 33(a)(b)(2). (Id. at 2).
    PAGE 3

  6. Gov't Emps. Ins. Co. v. The Right Spinal Clinic, Inc.

    8:20-cv-0802-KKM-AAS (M.D. Fla. Jul. 6, 2022)   Cited 1 times
    Florida's Clinic Act requires that clinics like Right Spinal “appoint a medical director” to “accept legal responsibility” for the clinic. § 400.9935(1), Fla. Stat. The medical director must perform “systematic reviews of clinic billing to ensure that the billings are not fraudulent or unlawful.” § 400.9935(1)(g), Fla. Stat. He must also “take immediate corrective action” if he discovers an unlawful charge. Id.
    PAGE 11

  7. State Farm Mut. Auto. Ins. Co. v. B&A Diagnostic, Inc.

    Case No. 14-cv-24387-KMM (S.D. Fla. Nov. 9, 2015)
    Florida's Health Care Clinic Act ("HCCA") makes it unlawful for health care clinics to operate without a license from AHCA. Fla. Stat. § 400.991. The HCCA also requires that all clinics which are owned by non-licensed individuals must "appoint a [M]edical [D]irector who shall agree in writing to accept legal responsibility" for various activities identified in the HCCA. Fla. Stat. § 400.9935(1). One requirement is that the Medical Director must ensure that all practitioners have active, unencumbered, and appropriate licenses and certifications for the level of care being provided. Fla. Stat. § 400.9935(1)(b), (d). The Medical Director also has a statutory obligation to ensure that any billing for services rendered by the clinic do not contain charges that are fraudulent or unlawful, and the Medical Director must conduct "systematic reviews of clinic billings" to accomplish this task. Fla. Stat. § 400.9935(1)(g). Any charge submitted on behalf of a clinic whose Medical Director is in violation of the aforementioned statutory requirements "is an unlawful charge and is noncompensable and unenforceable." Fla. Stat. § 400.9935(3).
    PAGE 12

  8. Allstate Ins. Co. v. Vizcay

    CASE NO. 8:11-cv-804-T-17TBM (M.D. Fla. Sep. 30, 2013)
    "All charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part, but that is not so licensed, or that is otherwise operating in violation of this part, are unlawful charges, and therefore are noncompensable and unenforceable." Fla. Stat. § 400.9935(3). Furthermore, Florida's no fault PIP statute states "[a]n insurer . . . is not required to pay a claim or charges . . . [f]or any service or treatment that was not lawful at the time rendered . . .," id. § 627.736(5)(b)l.b., and it defines "lawful" as "in substantial compliance with all relevant applicable criminal, civil, and administrative requirements of state and federal law related to the provision of medical services and treatment," id. § 627.732(11) (emphasis added).
    PAGE 8

  9. Allstate Ins. Co. v. Vizcay

    Case No. 8:11-CV-804-EAK-EAJ (M.D. Fla. Apr. 23, 2014)
    1. Can the Medical Director Clinics be Held Liable for Sara C. Vizcay's Alleged Failure to Comply with Florida Statute § 400.9935(1)(G)?
    PAGE 2

  10. State Farm Mut. Auto. Ins. Co. v. Med. Serv. Ctr. of Fla., Inc.

    103 F. Supp. 3d 1343 (S.D. Fla. 2015)   Cited 17 times
    In their Response to Plaintiffs' Motion for Summary Judgment, Defendants contend that State Farm's interpretation of the term “lawfully provided,” as used in Florida's No–Fault Law, contravenes generally accepted standards of statutory interpretation and the intent of the legislature. The Court finds this argument to be without merit. Florida law defines the term “lawful” to mean in substantial compliance with all relevant applicable criminal, civil, and administrative requirements of state and federal law related to the provision of medical services or treatment. See Fla. Stat. § 627.732(11). Further, the HCCA clearly states that “all charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part, but that is not so licensed ... are unlawful charges, and therefore are noncompensable and unenforceable.” Fla. Stat. § 400.9935( 3). Additionally, the Eleventh Circuit has affirmed State Farm's interpretation of the terms “wholly owned” and “lawfully provided,” finding that a clinic that does not qualify for the “wholly owned” exemption, and does not otherwise have a license, is operating unlawfully under Florida law. Silver…
    PAGE 1355