Geico v. 21183
In Geico v 21183 filed in 2019, Geico claimed that a clinic was licensed with AHCA but it had a medical director that was “appointed in name only.”
For instance, Geico claimed that there was a predetermined treatment protocol where the initial exam stated every patient needed “therapy five times a week for the first four weeks of treatment” and the follow-up exam stated every patient needed “therapy four times a week for the next four weeks” and second follow-up exam stated that every patient needed “therapy three times a week for the next four weeks.”
Also, Geico claimed that if the medical director performed systematic reviews of the files he would have noticed that massage therapists were performing physical therapy and without proper supervision. Specifically, the massage therapists were billing for:
- 97035 (ultrasound);
- 97140 (manual therapy);
- 97110 (therapeutic exercises);
- 97012 (mechanical traction therapy);
- 97018 (paraffin bath therapy);
- 97026 (infrared therapy);
- 97032 (electric stimulation);
- 97535 (self-care training).
Geico also “did the math” and found that some days the Clinic performed over 24 hours in one day of timed therapy codes.
Geico 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.