Geico v. 22206
In Geico v 22206 filed in 2019, Geico claimed that a PTP was taking place. Geico claimed that:
The provider owned an MRI center under a separate corporation name and tax identification number. He referred his chiropractic patients from all of his chiropractor offices (under different tax identifications numbers and different corporation names that were similar) to the MRI center.
FS 456.053(5)(a) states “a health care provider may not refer a patient for the provision of designated health services to an entity in which the health care provider is an investor or has an investment interest.” Diagnostic Imaging is defined in 456.053(3)(c) as a “designated health service.”
If the MRI center was owned under the same corporation’s name and billed under the same tax identification number and all of the chiropractic offices were under the exact corporation’s name and the same tax identification number then the MRI referrals would have been allowed under a different section of 456.053 which applies to “group owned” MRI centers known as (4) REQUIREMENTS FOR ACCEPTING OUTSIDE REFERRALS FOR DIAGNOSTIC IMAGING.
FS 456.052 states:
(1) A health care provider shall not refer a patient to an entity in which such provider is an investor unless, prior to the referral, the provider furnishes the patient with a written disclosure form, informing the patient of:
- (a) The existence of the investment interest.
- (b) The name and address of each applicable entity in which the referring health care provider is an investor.
- (c) The patient’s right to obtain the items or services for which the patient has been referred at the location or from the provider or supplier of the patient’s choice, including the entity in which the referring provider is an investor.
- (d) The names and addresses of at least two alternative sources of such items or services available to the patient.
(2) The physician or health care provider shall post a copy of the disclosure forms in a conspicuous public place in his or her office.
(3) A violation of this section shall constitute a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083. In addition to any other penalties or remedies provided, a violation of this section shall be grounds for disciplinary action by the respective board.
In other words, according to 456.052, if this medical provider would have just gotten the right paperwork and notified the patients properly, there would have been no problem with referring his chiropractic patients to his MRI center.
*Important note, the law does not require that the patient sign a form, but I advise that you have every patient sign the same form that is posted on the wall and save it in the patient chart. The insurance carriers can easily say “how do I know that the form was properly posted in a conspicuous public place two years ago when we started investigating your office.”
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.