STATE OF FLORIDA | BOARD OF CHIROPRACTIC MEDICINE DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2014-02800 CRAIG SAMUEL ADERHOLDT, D.C. RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health (‘Department’), by and through its undersigned counsel, files this/ Administrative Complaint before the Board of Chiropractic Medicine (‘Board’) against Respondent, Craig Samuel Aderholdt, D.C. (‘Respondent’), In support, Petitioner alleges: 1. Petitioner is the state department charged with regulating the practice of Chiropractic Medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida $tatutes; and Chapter 460, Florida Statutes. 2. At all times material to this Complaint, Respondent was licensed to practice chiropractic medicine in the State of Florida, having been issued License Number CH 7814. 3. Respondent's address of record is 5221 26th Street West, Bradenton, Florida 34207. July 2013, through on or about February 4. From on or about 2014 (treatment period”), Respondent treated Patient A.M., a then sixty- six-year-old female, for lower back pain. During Respondent's treatment period of Patient A.M., 5. M. that his office would file the necessary Respondent assured Patient A, claims for reimbursement with Medicare. 6. For treatment to be commenced, Respondent requested that Patient A.M. pay for services upfront which he would later reimburse to Patient A.M. when his office received payment from Medicare. 7. During the treatment period, Patient A.M. paid Respondent approximately seven thousand, seven hundred. and twenty-six dollars ($7,726.00) consisting of approximately sixty-four treatments. 8. Respondent did not submit Medicare claims for Patient A.M.'s treatment on one or more occasion. 9. Upon Patient A.M. |discovering that Medicare claims had not Patient A.M. requested from Respondent been filed by the Respondent, copies of all billing and claim information submitted on one or more occasion. 10. Respondent failed to furnish billing and claim information to Patient A.M. 11. Patient A.M. has |not received any reimbursements from Medicare by the Respondent. 12. On or about August 6, 2013, and December 11, 2013, Respondent utilized billing code 98941 which indicated that three or four areas/regions of adjustment |were conducted; however, Respondent's Subjective, Objective, Assessment, and Plan (“SOAP note”) notes under Plan consisted of spinal manipulation of L3, L4, and L5 which indicated that only one area of the spine was adjusted, not three or four. COUNT I 13. Petitioner re-alleges and incorporates paragraphs one (1) through four (4), and thirteen (113) as if fully set forth herein. 14.° Section 460.413(1)(x), Florida Statutes (2013), provides that submitting to any third-party payor a claim for a service or treatment which was not actually provided to a patient shall be grounds for discipline. 15. Respondent violated section 460.413(1)(x), Florida Statutes, when on one or more occasion] he submitted a claim to a third-party payor for an adjustment of three or fur areas/regions of the spine when he only conducted an adjustment of one area/region. 16. Based on the fpregoing, Respondent violated Section 460.413(1)(x), Florida Statutes, by submitting a claim to a third-party payor that was not actually provided. COUNT II 17. Petitioner re-allegés and incorporates paragraphs one (1) through thirteen (13) as if fully Set forth herein. 18. Section 460.413(1)(n), Florida Statutes (2013), provides that exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party which shall include, but not be limited to, the promotion or sale of services, goods or appliances, or drugs shall be grounds for discipline. 19. Respondent violated section 460.413(1)(n), Florida Statutes in the following ways: a. by telling Patient ALM. that he would file claims with Medicare which he did not on one or more occasion; b. by failing to provide Patient A.M. with any form of reimbursement of Medicare; c. by billing Patient A.M. for an adjustment of three or four areas/regions when he only comducted an adjustment of one area/region; and/or, d. by exercising influence on Patient A.M. by having her pay for services to De rendered up front with the promise of a refund. 20. Based on the foregoing, Respondent violated section 460.413(1)(n), Florida Statutes} by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee. COUNT IT 21. Petitioner re-alleges and incorporates paragraphs one (1) through nine (9) as if fully set forth herein. 22. Section 460.413(1)(aa), Florida Statutes (2013), provides that failing to provide, upon request of the insured, a copy of a claim submitted to any third-party payor for service or treatment of the insured shall be grounds for discipline. | 23. Respondent violated section 460.413(1)(aa), Florida Statutes when Patient A.M., the insured, requested copies of her billing and claim information and Respondent failed to furnish it to her. 24, Based on the foregoing, Respondent violated section 460.413(1)(aa), Florida Statutes, by failing to provide, upon request of the insured, a copy of a claim submitted to any third-party payor for service or treatment of the insured. COUNT IV 25. Petitioner re-alleges and incorporates paragraphs one (1) through thirteen (13) as if fully set forth herein. 26. Section 460.413(1)(k), Florida Statutes (2013), provides that making misleading, deceptive, untrue, or fraudulent representations in the practice of chiropractic medicine or employing a trick or scheme in the practice of chiropractic medicine when such trick or scheme fails to conform to the generally prevailing standards of treatment in the chiropractic medical community] sha!l be grounds for discipline. 27. Respondent violated section 460.413(1)(k), Florida Statutes in the following ways: a. by telling Patient ALM. that he would file claims with Medicare which he did not on one or more occasion; b. by failing to provide Patient A.M. with any form of reimbursement from Medicare; c. by billing Patient A.M. for an adjustment of three or four areas/regions when he only conducted an adjustment of one area/region; and/or, d. by exercising influence on Patient A.M. by having her pay for services to be rendered up front with the promise of a refund. 28. Based. on the foregoing, Respondent violated section 460.413(1)(k), Florida Statutes, when he made a misleading, deceptive, untrue, or fraudulent representation to Patient A.M. in the practice of chiropractic which failed to conform to the prevailing standard of care in the chiropractic medical community. WHEREFORE, the Petitioner respectfully requests that the Board of Chiropractic Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or colleqted, remedial education and/or any other relief that the Board of Chiropractic Medicine deems appropriate. {Signature Page on Next Page} SIGNED this Kx ) day of we 2018. Celeste Philip, M.D., M.P.H. Surgeon General and Secretary, Derrick J. McBurrows Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar #1002311 Phone 850-558-9906 FAX 850-245-4684 derrick. mcburrows@flhealth.gov PCP Date: 6-19-18 PCP Panel Members: Fox and Vogel FILED DEP. any MENT OF HEALTH cL CLERK Angel Sandem DAT. a _JUN 2 0 2018 NOTICE OF RIGHTS Respondent has the conducted in accordance right to request a hearing to be with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. Please send your request to: If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or| contest the material facts or charges contained in the Administrative Complaint must conform to Rule © 28-106.2015(5), Florida Administrative Code. Please be advised that mediation under Section 120.573, Florida Statutes, is not available for administrative disputes involving this agency action. NOTICE REGARDING ASSESSMENT OF COSTS on notice that Petitioner has incurred ation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. Respondent is placed costs related to the investi

Docket for Case No: 18-004484PL

Orders for Case No: 18-004484PL