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Dangers of Health Care Fraud Statute 456.0635

Dangers that every Florida health professional should be aware of.

Background

In 2009 the Florida legislature passed a bill creating Florida Statute (F.S.) section 456.0635 with the purpose of preventing heath care fraud and which establishes penalties for health professionals involved in such fraud. The current version of the statute, following significant amendments in 2012, describes acts which constitute violations and strict penalties for fraudulent activities occurring both within and outside of health care.

Licensed health care professionals and license applicants in Florida should familiarize themselves with F.S. 456.0635 and the implications that it has for their careers. The statute covers a broad realm of violations including those which evidence a propensity for one to commit health care fraud including non-health related fraud and drug-related convictions and pleas. The impact of the statute on license holders (including renewals) and license applicants is significant and should not be underestimated.

In general the statute prohibits Medicaid fraud in the practice of health care professions and requires the Department of Health to refuse to admit to exams and to deny licenses, permits, or certificates to persons who have engaged in the prohibited acts. The statute requires health care practitioners to report allegations of Medicaid fraud, and specifies that the relinquishment of a license in anticipation of charges relating to Medicaid fraud constitutes permanent revocation of a license.

The statute is complex and contains many complicated subsections. The important subsections that health care professionals and applicants must be aware of are discussed below. If you believe that your license is in jeopardy or if you have any questions about F.S. 456.0635 you should contact the Chapman Law Group and their professional licensing attorneys.

Disqualifying Convictions

Felony convictions, and pleas of guilty or nolo contendere, under certain Florida Statutes’ Chapters will result in the denial of license renewals and applications. The specific Chapters are 409 (Social and Economic Assistance), 817 (Fraudulent Practices), and 893 (Drug Abuse Prevention and Control).

A broad array of convictions/pleas outside health care could cause you to lose your license or prevent you from getting one. Some of the common violations in Chapter 817 include: making false statements, mortgage fraud, and fraudulent use of credit cards. Some of the common violations in Chapter 893 include: unlawful use, possession, manufacture, delivery, or transportation of controlled substances.

The statute prescribes post-conviction time periods during which a licensee, applicant or candidate for licensure, examination, certification or registration must complete prior to becoming eligible for licensure. The periods of probation range from five (5) to fifteen (15) years depending upon the seriousness of the conviction. This includes convictions for similar laws that occurred in states besides Florida.

You will also be refused license renewal or application approval if you were terminated for cause from the Florida Medicaid program and have not been in good standing with the program over the last five (5) years1 following the termination.

The statute also contains disqualifying federal convictions. Felony convictions and pleas of guilty or nolo contendere under the either the Federal Controlled Substances Act2 or the Medicaid and CHIP Payment laws3 will bar an applicant or candidate from licensure, examination, certification or registration for a period of fifteen (15) years.

This statute has broad impacts such that individuals applying for medical, nursing or other health related training or education should consider whether this law will prevent them from getting licensed and practicing following graduation. Health care providers charged with crimes identified above should contact the Chapman Law Group to discuss how their defense to the charges could affect their licenses.

Case Studies

In one notable case a physician received over two-hundred thousand dollars in Medicaid overpayments and was ordered to refund the money along with statutory interest4. She refused to make repayment and was terminated from the Florida Medicaid Program. Subsequently, she was notified by the Board of Medicine that her medical license renewal was refused on the ground that she was terminated for cause from the Florida Medicaid program. She challenged this refusal before an administrative law judge (ALJ), who ruled against her holding that the Dept. of Health “has no lawful option but to follow this clear legislative directive and refuse to renew physician’s medical license.”

In another case, a physical therapist was convicted of grand theft (felony) in accordance with Sections 409.913, Florida Statutes5. Felony violations of Chapter 409 are included in the list of disqualifying convictions in F.S. 456.0635. Accordingly, she was notified of the intent to deny the renewal of her physical therapy (PT) license. She challenged the Board of Physical Therapy’s non-renewal before an ALJ. The ALJ held that, “section 456.0635 triggers the mandatory prohibition” on license renewals and that she “would be statutorily barred, pursuant to the clear directive issued by the Legislature in section 456.0635.” Thus, the ALJ agreed with the Board of Physical Therapy and recommended a final order declining to deny the renewal of the physical therapist’s license.

Relinquishment of License

Health care licensees and applicants must be aware of the hazards of subsection five (5) of the statute. This subsection provides for the extreme sanction of permanent revocation of your license6. You should contact the Chapman Law Group prior to voluntarily relinquishing your license as you likely have other options available to you.

Often, prior to or when administrative charges are filed against you, the Dept. of Health will offer you the option of voluntarily relinquishing your license. Many practitioners think that they should comply because it will result in the charges “going away.” While in some case this might end the discipline against your license, you will still be saddled with investigative costs and fines, and left permanently without a license. It is often better for you to fight the charges rather than unnecessarily relinquish your license. Contact the Chapman Law Group to discuss the numerous alternatives that you have besides voluntarily relinquishing your license.

Mandatory notification

You are required by law to report allegations of health care fraud that occur against you7. Further, the law states that you must report allegations, “regardless of the practice setting in which the alleged health care fraud occurred8.” For example, whether the alleged fraud occurred at your primary job or at a location where you “moonlight,” you must report the allegation to the Dept. of Health.

Implications for Health Care Professionals

Although it is the district attorney (DA) that ultimately decides which criminal charges will be filed against you, your attorney may have the ability to work with the D.A. to get the charges into categories other that the three disqualifying ones (i.e. F.S. Chapter 409, Chapter 817, and Chapter 893). This can happen because there are often redundancies or overlaps in statutes, and your charge could fall into another similar statute. If so, the D.A. might be persuaded by your attorney to charge you under such other statute rather than the initial one that would have put your health care license at risk.

Chapman Law Group is dedicated to defending licenses and livelihood of all health care professionals: Doctors, Physician Assistants, Nurse Practitioners, Nurses, Medical Assistant.

References

1.Florida Statute sec. 456.0635(1)(c)(3)(c)
2. 21 U.S.C. ss. 801-970
3. 42 U.S.C. ss. 1395-1396
4. Rojas, M.D. v. Dept. of Health, Case No. 11-1089, (Fla. Div. Adm. Hear. 2011)
5. Cueto v. Dept. of Health Case, Board of Phys. Therapy Practice, No. 11-1728, (Fla. Div. Adm. Hear. 2011)
6. Florida Statute sec. 456.0635(5)
7. Florida Statute sec. 456.0635(4)
8. Id.