State Farm v. 24387
In State Farm v 24387 filed in 2014, State Farm claimed that a clinic was licensed with AHCA but it had a medical director that was “appointed in name only.”
For instance, State Farm claimed that a Basic Machine Operator (lowest level of license able to perform x-rays) was performing all the x-rays at the facility without direct supervision and control by a doctor on-site. State Farm claimed that a Certified Radiologic Technician was actually required since there was no doctor physically present when the x-rays were performed.
The medical director reported that he (1) didn’t know what type of equipment was used in the center; (2) how many x-ray machines were at the center; and (3) didn’t know the names of the staff that he was allegedly supervising.
Also, State Farm claimed that the clinic never collected copays or deductibles from patients and that the medical director should have discovered this during their “systematic review of billings.” I don’t think any medical directors are looking to see if copays and deductibles are collected and I think State Farm is digging deep in their interpretation of “systematic review of billings” for this.
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.