Geico v. 24198
In Geico v. 24198 filed in 2018, Geico claimed that five unrelated clinics were licensed with AHCA and shared the same medical director who was “appointed in name only.”
In this case, the medical director oversaw five unrelated clinics in Dade County and also had his own traveling medical practice where he would visit multiple offices in Dade County performing initial, follow-up, and final examinations for patients involved in motor vehicle collisions.
The five clinics were placing the medical director’s name and signature in Box 31 as the “signature of physician or supplier” for the following timed CPT codes:
- mechanical traction- 97012
- electrical stimulation- 97014;
- paraffin bath therapy- 97018;
- attended electrical stimulation- 97032;
- contrast bath therapy- 97034;
- ultrasound therapy- 97035;
- therapeutic exercises- 97110;
- neuromuscular re-education- 97112;
- manual therapy- 97140;
- therapeutic activity- 97530; and
- low-level laser therapy- S8948.
On the back of the CMS 1500 form, Box 31 is explained in more detail that the services were “personally furnished by me or my employee under my personal direction.” The Medicare Claims Processing Manual states that the signing physician “performed or directly supervised” the services.
Geico “did the math” and said it was “improbable to the point of impossibility” that the doctor could conduct examinations of patients all over Dade County while “directly supervising” 12 to 36 hours per day of treatment from the five clinics where he was medical director.
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.