State Farm v. 20066
In State Farm v. 20066 filed in 2014, State Farm claimed that a clinic was licensed with AHCA but it had a medical director who was “appointed in name only.”
Specifically, the medical director testified at a deposition that (a) he did not know the address of the clinic; (b) he did not recall the name of a single person at the clinic; (c) he did not recall any of the licenses held by people working at the clinic; (d) he would review five charts per month that were pre-selected by the staff for 20-30 minutes. The medical director testified that his job was a “very simple job, you would show up once a month, you would go through a checklist, make sure that everything was in order and I’d be on my way.”
In this case, State Farm complained that every patient was billed a level 4 exam code regardless of the patient’s diagnoses, age, severity of accident, injuries, complaints, or medical history; every patient received exactly 35 visits even if they reported 1-2 level pain; and every patient got the same cookie-cutter treatment plan.
State Farm claimed that if the medical director did his job as required by Florida Statute 400.9935 then he would have taken immediate corrective action and stopped it from happening.
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company; therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.