STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF INSURANCE AND ) TREASURER, )

)

Petitioner, )

)

vs. ) CASE NO. 87-2931

)

INTERNATIONAL MEDICAL )

CLINIC, INC., )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, William J. Kendrick, held a public hearing in the above-styled case on December 21, 1987, in Tallahassee, Florida.

APPEARANCES

For Petitioner: Rainell Y. McDonald, Esquire

Office of Legal Services 413-B Larson Building

Tallahassee, Florida 32399-0300 For Respondent: No appearance

PRELIMINARY STATEMENT

At issue in this proceeding is whether Respondent committed the offenses set forth in the amended administrative complaint and, if so, whether its certificate of authority should be revoked.

At hearing, Petitioner presented the testimony of Frank Siemon, and its composite exhibit A was received into evidence. The transcript of hearing was filed January 12, 1988, and the parties were granted leave until January 22, 1988, to file proposed findings of fact. Petitioner elected to file such proposals, and they have been addressed in the appendix to this recommended order.

FINDINGS OF FACT

1. Respondent, International Medical Clinic, Inc. (IMC), is a health maintenance organization organized under the laws of the State of Florida. At all times material hereto, IMC held certificate of authority number 0087028000, issued by Petitioner, Department of Insurance and Treasurer (Department), pursuant to Chapter 641, Part II, Florida Statutes.

   
   

2. Pursuant to an agreement dated June 5, 1985, between IMC and International Medical Centers, Inc. (Medical Centers), Medical Centers agreed to

   provide all medical provider and management services for IMC. Consequently, whether IMC had the capability to provide comprehensive health care services to its subscribers was dependent upon the ability of Medical Centers to perform its obligation under its existent contract with IMC.

   
   

3. Pursuant to an order dated May 14, 1987, the Circuit Court of the Second Judicial Circuit, Leon County, Florida, the Department was appointed receiver of Medical Centers. Due to the insolvency of Medical Centers, it was no longer capable of providing medical provider and management services for IMC, and its contract was therefore cancelled. IMC offered no proof that, in light of such cancellation, it was currently capable of providing comprehensive health care services to its subscribers.

   
   

4. Mr. Miguel Recarey, Jr., is a member of the Board of Directors as well as the president of both IMC and Medical Centers. Pursuant to an indictment filed April 8, 1987, under Case No. 87-0217 CR - Nesbit, United States District Court, Southern District of Florida, Mr. Recarey was charged, inter alia, with bribing a union official to secure a contract between IMC and the union. Consequently, the Department asserts it has reason to believe that the control of IMC is under the direction of a person whose practices demonstrate conduct detrimental to the public. IMC was not present at hearing to address those concerns.

   
   

5. IMC has permitted its professional liability coverage under the IMC Self Insurance Trust Fund to expire as of February 24, 1987, and has allowed its general liability coverage through National Union and Fire Insurance/Hartford Insurance Company to expire on June 30, 1987. IMC has, therefore, failed to provide continuing evidence of adequate insurance coverage or an adequate plan for self insurance to respond to claims for injuries arising out of the furnishing of comprehensive health care.

   
   

6. IMC has permitted its insolvency protection coverage with State Mutual Insurance Company to expire on August 1, 1987. IMC has, therefore, failed to provide continuous insolvency protection.

   
   

7. In addition to the foregoing, IMC has failed to fulfill its continuing obligation to provide for periodic review of its medical facilities and services, to provide a grievance procedure that will facilitate the resolution of subscriber grievance that includes both formal and informal steps, to establish an internal risk management program, to maintain a current list of all hospitals which are routinely and regularly used by the organization along with all primary care physicians, and to provide inpatient hospital services.

   
   

   CONCLUSIONS OF LAW

   
   

8. The Division of Administrative Hearings has jurisdiction over the parties to, and the subject matter of, these proceedings.

   
   

9. The amended administrative complaint charges that IMC violated the provisions of Sections 641.19(6)(a); 641.22(1), (4), (7), (8), (9), and (12); 641.221; 641.285(5)(a); 641.3109; 641.395, Florida Statutes, and Rule 4- 31.07(8), Florida Administrative Code. The Department has sustained its burden of proof, and has demonstrated that IMC violated these statutory provisions.

RECOMMENDATION

Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the certificate of authority granted to Respondent,

International Medical Clinic, Inc., to operate a health maintenance organization in the State of Florida be revoked.

DONE AND ENTERED, in Tallahassee, Leon County, Florida, this 3rd day of February, 1988.

WILLIAM J. KENDRICK

Hearing Officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 3rd day of February, 1988.

APPENDIX

Petitioner's proposed findings of fact are addressed as follows:

1. Addressed in paragraphs 1-7.

COPIES FURNISHED:

Rainell Y. McDonald, Esquire Department of Insurance

and Treasurer

Office of Legal Services 413-B Larson Building

Tallahassee, Florida 32399-0300

International Medical Clinic, Inc. c/o Recarey Enterprises, Inc.

1505 N.W. 167th Street Miami, Florida 33169

Honorable William Gunter State Treasurer and

Insurance Commissioner The Capitol, Plaza Level

Tallahassee, Florida 32399-0300

Don Dowdell, Esquire General Counsel

The Capitol, Plaza Level Tallahassee, Florida 32399-0300

Docket for Case No: 87-002931

Orders for Case No: 87-002931