APR-G4-2888 14:68 Apr 4 2008 14:58 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO.: 2007-20980 FRANCIS J. FALOWSKI, D.C., RESPONDENT. ADMINISTRATIV MP T COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Chiropractic Medicine against Respondent, Francis J. Falowski, D.C., and in support thereof 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 Statutes; and Chapter 460, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed chiropractic physician within the state of Florida, having been issued license number CH 5108 on or about January 10, 1986. +-\PCLAMedical\Tobev\ «CASE 5\Falowski, Francis\200)7-20980\Falowski.ac.freud.drugs.doc 1 KO ie Apr 4 2008 14:58 APR-G4-2888 14:68 Pa? 3. | Respondent’s address of record is 4700 North State Road 7, Building A, Suite 102, Lauderdale Lakes, FL 33319. 4. During the month of June 2007, the Broward County Sheriff's Office received information from a confidential source indicating that Respondent was committing several criminal health care violations while operating his clinic, the “Broward Family Medical Center.” 5. Specifically, the confidential source observed Respondent sign and stamp physical forms with credentials of Dr. Joseph Deluca, D.O. (Dr. Deluca), an osteopathic physician, According to the confidential source, Respondent also hand wrote Dr. Deluca’s medical number on the forms. 6. Dr. Deluca was not employed by the Broward Family Medical Center at the time Respondent was stamping the forms with Dr. Deluca’s credentials nor was Dr. Deluca present at the clinic when this was being done. 7. According to the confidential source, Respondent instructed employees to stamp forms with Dr. Deluca’s information and tell the patients that it was reviewed by a medical doctor. }\PSU\Medical\Tobey\___C A 5 E S\Falowski, Francis\2007-20980\Falowski.ac.fraud.drugs.doc 2 Apr 4 200 : APR-G4-2888 14:08 IP i 14:59 8. The confidential source explained that chest x-rays were often taken without film in the machine, and that Respondent forged reports indicating that the x-rays were clear. 9. The confidential source indicated she observed Respondent use cocaine as well as Oxycodone and Xanax several times in the past while seeing patients. 10. Cocaine is a schedule II controlled substance listed in Chapter 893, Florida Statutes. It has a high potential for abuse and has a currently accepted, but severely restricted, medical use in treatment in the United States. Abuse of cocaine may lead to severe physical and psychological dependence. "LIT Oxycodone; a semi-synthetic narcotic “analgesic, is a Schedule II controlled substance under Chapter 893, Florida Statutes. Oxycodone is indicated for relief of moderate to moderately severe pain. It has a high potential for abuse and has a currently accepted, but limited, medical use in treatment in the United States, and abuse of the substance may lead to severe physical and psychological dependence. 12. Xanax, which contains alprazolam, is a Schedule IV controlled substance under Chapter 893, Florida Statutes. A substance in Schedule IV y\Pel WMedical\tahev\ CASE S\falowski, Francs\2007-209890\Falowskl.ac.fraud.drugs.doc 3 Apr 4 2008 14:59 APR-@4-2088 14:81 has a low potential for abuse, and a currently accepted medical use in treatment. Abuse of this substance may lead to limited physical or psychological dependence. 13. In order to substantiate the claims made by the confidential source, the Broward County Sheriff's Office conducted an undercover investigation of Respondent and his clinic. 14. AS part of the investigation, on or about July 31, 2007, the Broward County Sheriffs Office sent an undercover officer (UO1) to | Respondent's clinic. 15. Sometime upon entering the Falowski’s clinic, the confidential source introduced UO1 to Respondent’s wife, Christine Falowski (“Christine or Christine Falowski”). During the course of the conversation, Christine Falowski agreed to set up UO1 as a personal injury patient and explained that it would be billed to UO1's car insurance. Christine Falowski told UO1 that UO1 would have to sign some sheets so she could start billing his insurance company for treatments once he obtained a claim number. Christine then told the UO1 that he did not have to come in for treatment all the time but that UO1 would have to come in once in a while to sign some sheets in advance. At the end of the visit, Christine led UO1 to the J:\PSU\Medical\Tobey\__C ASE S\Falowski, Francis\2007- 20980\Falowskl.ac.fraud.drugs.doc 4 Apr 4 2008 14:59 APR-G4-28688 14:81 front desk and had him pre-sign several treatment forms. Christine instructed the UO1 not to date the forms. Christine continued to explain to UO1 that they were going to make a lot of money and that it would be easy to document his injuries for billing purposes. 16. Also during the July 31, 2007, office visit, UO1 explained that he had a friend who was involved in the same accident as him who would | also be willing to “treat” with the Falowski’s clinic. UO1’s “friend” was actually a second undercover officer (UO2) who was assisting in the investigation of Respondent's clinic 17. On or about August 8, 2007, the Broward County Sheriff's Office received information in reference to fictitious insurance policies from “State-Farm™~ created for the two undercover officersto’ assist in the investigation. Policy number 546 3563-A11-59 was assigned to UOl1. Policy number 546 3563-F01-59 was assigned to UO2. Also a fictitious accident report was created with HSMV Crash Report #90495203. 18. On or about August 30, 2007, UO1 returned to Respondent's clinic and was greeted by Christine Falowski. After having a conversation with Christine, UOi met with Respondent. Respondent asked UO1 what type of symptoms he was having. The undercover officer responded, TAO MericattTaheyv, CAS F S\Ealowskl. Francis\2?007-20080\Falowski.ac.fraud.drugs.doc 5 Apr 4 2008 15:00 APR-G4-28688 14:81 “Whatever you tell me I have.” Respondent stated that UO1 had headaches at which point the undercover officer replied, “Sure.” 19. Respondent then took UO1 into an x-ray room and began taking x-rays in a very fast and unprofessional manner. Respondent took about eight or nine x-rays in a matter of few minutes; moving UOQ1 in a haphazard manner. 20. After completing the x-rays, Respondent told UO1 that he was going to complete a report and that UO1 would be good to go after that. Respondent told UO1, “If you’re smart, you'll get rich quick.” 21. On or about September 6, 2007, the undercover officers returned to Respondent's clinic. The purpose of the visit was to introduce UQ2 to the Falowskis and see if they would continue with the insurance scheme. 22. Christine talked to UO1 about his “kickback” and stated that she would give the undercover officers one thousand dollars each for any personal injury referrals. Christine began telling UO1 that for every $5000 she billed out through insurance, she would give each undercover officer $2000. Christine told UO1 that his initial bill was $2000 with $395 for each additional visit. Christine indicated to UO1 that she was billing his J:\PSU\Medical\Tobey\__C A'S E 5\Falowski, Francis\2007-20980\Falowski.ac. fraud .drugs.doc 6 Apr 4 2008 15:00 APR-@4-2088 14:81 insurance company for treatment to include: hot packs, massage, ultrasound, adjustment, and acupuncture. During the visit, Christine also instructed UO1 to sign six treatment forms but not to date them. 23. Respondent then met with UO1. Respondent told UO1 that he typed up several letters for him to use as a referral to a pain management doctor. The letters contained information on patient injuries, examinations, treatment plans, interim reports, thoracic spine exams, lumbar spine exams and “ECG” reports. The letters depicted several exams and treatments that UO1 never received. Respondent told UO1 that it was going to be fun doing this (referring to the insurance fraud.) Respondent then began to talk about his extensive cocaine use and told UO1 that he was a medical doctor anda ‘stirdéon. ~ Responderit “also offered’ to give UO1 blank prescription forms if needed so he could create fraudulent prescriptions for narcotics. 24. Respondent is not a licensed medical doctor or surgeon. 25. Respondent told UO1 that when he received the first payment from the insurance company he would call both the undercover officers in for a meeting (referring to payment of the undercover officers). J\PSU\Maedical\Tobey\ CAS E S\Falowski, Francis\2007-20980\Falowski.ac.fraud.drugs.doc ” 7 Apr 4 2008 15:00 APR-@4-2888 14:82 26. Thereafter, Respondent began discussing human growth hormone with UO1 and told him he could get it if he wanted some. 27. Human growth hormone (commonly known as hGH) is a legend drug available only by prescription. Pursuant to Section 460.403 (9)(a), Florida Statutes, chiropractic physicians are expressly prohibited from prescribing or dispensing to any person any legend drug other than topical analgesic solutions consisting of 25 percent ethylchloride and 75 percent dichlorodifluoromethane or any solution consisting of 15 percent dichlorodifluoromethane and 85 percent trichloromonofluoromethane. 28. Prior to the undercover officers leaving the office, Christine had UO2 sign several treatment forms. Christine instructed UO2 not to date — the forms" 29. On or about October 25, 2007, UO1 placed a controlled telephone call to Christine Falowski. During the call UO1 asked Christine about what he could take to get drugs out of his system so he could pass a drug test. Christine put Respondent on the phone and Respondent told UO1 what to ingest in order to pass a urine drug test. 30. On or about November 6, 2007, both undercover officers presented to Respondent's clinic. Respondent requested that UO1 obtain J:\P5U\Medical\Tobey\__C.A 5 E S\Falowski, Francis\2007-20980\Falowskl.ac.fraud.drugs.doc i] Apr 4 2008 15:00 APR-G4-2888 14:82 the cocaine on his behalf. Respondent indicated that the cocaine was for Christine for treatment of pain. Thereafter, a receptionist requested that both undercover officers pre-sign more patient treatment forms to which both officers responded by signing ten forms each. 31. While in a separate area, UO2 asked Christine when the undercover officers would be getting paid. Christine told UO2 that she would be picking up the money that week and that both undercover officers should receive $4,000 each. 32. On or about November 9, 2007, UO1 placed a controlled phone call to Christine Falowski. During the conversation, Christine told the UO1 that she did not have the money yet but that she would deposit it on Tuesday and call UO2 when it was available. 33. On or about November 14, 2007, UO1 placed a controlled phone call to Christine Falowski. UO1 made contact with Respondent who indicated that State Farm wrote them a check but that it had a ten day hold because it was from out of state. 34. On November 17, 2007, UO1 received a message on his telephone from Respondent which indicated that he cracked a molar and was in a lot of pain. Respondent wanted UO1 to get him what he asked J:\PSU\Medical\Tobey\___C AS E S\Falowski, Frandis\2007-20980\Falowski.ac.fraud.drigs.doc 9 Apr 4 2008 15:01 APR-@4-2888 14:82 for in reference to Christine (referring to cocaine). Respondent also explained that Christine had a document that he was looking for (referring to the blank prescription). 35. Subsequently, State Farm Insurance Company received Health Insurance Claims Forms from Respondent's clinic requesting payment for treatment of UO1. The dates of service and the billed amounts for UO1 are as follows: 1. September 4, 2007 $395 not present 2. September 6, 2007 $395 present, treatment not ‘ rendered 3 September 7, 2007 $395 not present 4 September 10, 2007 $395 not present 5. September 12, 2007 $395 not present 6. September 13, 2007 $395 not present 7. September 14, 2007 $395 not present 8. September 17, 2007 $395 not present 9. September 19, 2007 $395 not present 10. September 21, 2007 $395 not present 11. September 24, 2007 $395 not present 12. September 25, 2007 $395 not present 13. September 28, 2007 $395 not present 14. September 29, 2007 $395 not present 15. October 1, 2007 $395 not present 16. October 3, 2007 $395 not present 17, October 12, 2007 $395 not present 18. October 15, 2007 $395 not present 19. October 17, 2007 $395 not present 20. October 19, 2007 $395 not present 21, October 22, 2007 $395 not present 22. October 26, 2007 $395 not present 23. October 30, 2007 $395 not present J:\PSU\Medical\Tobey\__C AS E 5\Falowskl, Franci¢\2007-20980\Falowskl.ac.fraud.dnugs.doc 10 APR-G4-2088 14°85 24. November 1, 2007 25. November 2, 2007 26. November 6, 2007 $395 $395 $395 Apr 4 2008 15:01 not present not present present, treatment not rendered 36. As shown above, State Farm Insurance Company was billed for 26 days of treatment when no such treatment was rendered and has paid approximately $10,270 for treatments not rendered. 37, State Farm Insurance Company received Health Insurance Claims Forms from Respondent's clinic requesting payment for treatment of UO2. The dates of service and the billed amounts are as follows: 1. September 6, 2007 2 September 7, 2007 3 September 10, 2007 4. September 17, 2007 5. September 24, 2007 6. September 26, 2007 7 September 28, 2007 8. October 1, 2007 9. October 3, 2007 10. October 5, 2007 11. October 12, 2007 12, October 15, 2007 13. October 17, 2007 14. October 19, 2007 15. October 22, 2007 16. October 26, 2007 17. October 30, 2007 18. November 1, 2007 19. November 2, 2007 $1,895 $695 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 $395 . present, treatment performed not present not present not present not present not present not present not present not present not present not present not present not present not present not present not present not present not present not present 7:\PSU\Medical\Tobey\, CAS E $\Falowski, Fran¢ls\2007-2D980\Falowskl.ac.fraud.drugs.doc 1 Apr 4 2008 : APR-G4-2088 14°85 is 15:01 20. November 6, 2007 $395 present, treatment not rendered 38. As shown above, State Farm Insurance Company was billed for 19 days of treatment when no such treatment was rendered and has paid approximately $7,805 for treatments not rendered. 39. As of Friday, December 14, 2007, State Farm Insurance Company has issued nine (9) checks to Respondent's clinic concerning UO1. All nine (9) checks were picked up in person by Respondent at the State Farm Office where he produced his Florida drivers’ license to be copied and signed for the checks. 40. As of December 14, 2007, State Farm Insurance Company has issued five (5) checks to Respondent’s clinic concerning UO2. All five (5) checks were picked up in person by Respondent at the State Farm Office where he produced his Florida drivers’ license to be copied and signed for the checks. Count One 41, Petitioner re-alleges and incorporates paragraphs one (1) through forty¢46) as if-fully set forth herein. — 3:\PSU\Maedical\Tobey\___C. A 5 E S\Falowski, Francis\2007-20980\Falowski.ac.fraud, drugs.doc 12 APR-G4-2088 14°85 Apr 4 2008 15:02 42. Section 460.413(1)(j), Florida Statutes (2007), subjects a licensee to discipline, including suspension, for making or filing a report which the licensee knows to be false. 43. Respondent violated Section 460.413(1)(j), Florida Statutes (2007), through the following actions: a) Creating medical records using Dr. Joseph Deluca’s credentials; b) Forging x-ray reports for patients indicating they were clear when no x-rays were taken; ¢) Creating fraudulent patient records for patient UO1; and, d) Filing fraudulent Health Insurance Claims Forms for patients UO1 and UO2 seeking reimbursement for treatment that was not rendered. 44, Based on the foregoing, Respondent has violated Section 460.413(1)(j), Florida Statutes (2007), by making for filing report which he knew to be false. Count Two 45. Petitioner re-alleges and incorporates paragraphs one (1) through forty (40) as if fully set forth herein. 46. Section 460.413(1)(k), Florida Statutes (2007), subjects a licensee to discipline, including suspension, for making misleading, +V\Pol hMedical\Tahevi CA SE S\Batowskl. Francie\2007-20980\Falowskl.ac, fraud.drugs.doc 13 Apr 4 20 : APR-G4-2088 14:84 r OB 18702 deceptive, untrue, or fraudulent representations in the practice of chiropractic medicine. 47. Respondent violated Section 460.413(1)(k), Florida Statutes (2007), through the following actions: a) Creating medical records using Dr. Joseph Deluca’s credentials; b) Forging x-ray reports for patients indicating they were clear when no x-rays were taken; c) Creating fraudulent patient records for patient UO1; d) Filing fraudulent Health Insurance Claims Forms for patients UO1 and UO2 seeking reimbursement for treatment that was not rendered; and e) Telling patient UO1 that he was a medical doctor and surgeon. 48. Based on the foregoing, Respondent has violated Section 460.413(1)(k), Florida Statutes (2007), by making misleading, deceptive, untrue, or fraudulent representations in the practice of chiropractic medicine. Count Three 49. Petitioner re-alleges and incorporates paragraphs one (1) through forty (40) as if fully set forth herein. :\PSU\Medical\Tobey\___C A 5 & 5\Falowski, Francis\2007-20980\Falowski.ac,fraud.drugs.doc 14 APR-G4-28688 14:64 Apr 4 2008 15:02 50. Section 460.413(1)(t), Florida Statutes (2007), subjects a licensee to discipline, including suspension, for practicing or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities which the licensee knows or has reason to know that she or he is not competent to perform. 51. Respondent violated Section 460.413(1)(t), Florida Statutes (2007), when he offered to provide the undercover officers with human growth hormone, a legend drug. 52. Based on the foregoing, Respondent has violated Section 460.413(1)(t), Florida Statutes (2007), by practicing or offering to practice beyond he scope permitted by law or accepting™ and -performing professional responsibilities which the licensee knows or has reason to know that she or he is not competent to perform. Count Four 53. Petitioner re-alleges and incorporates paragraphs one (1) through forty (40) as if fully set forth herein. 54. Section 460.413(1)(q), Florida Statutes (2007), subjects a chiropractic physician to discipline for being unable to practice chiropractic _J:\PSU\Medical\Tobey\__€ A 5 E S\Falowski, Francis\2007-20980\Falowski.ac.fraud.drugs.doc ' 15 J:\PSU\Medical\Tobey\__C A S$ E S\Falowskl, Francis\2007-20980\Falowski.ac.fraud.drugs.doc 16 APR-B4-2008 14:04 Aer 4 2008 15:05 SIGNED this_|* day of __Sebrucex , 2008. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General & Tobey ame Assistant General Counsel DOH Prosecution Services Unit wenn RSE 4052 Bald Cypress Way, Bin C-65 Se Tallahassee, FL 32399-3265 : H 1 pEreqveN) OF Florida Bar No. 0542131 curexRac tire R27 (850) 245-4640 ext. 8176 pave 4 O% tobey_schultz@doh.state.fl.us ~ PEP: 1/31/08 Kirby & Wolfson" J:\PSU\Medical\Tobey\___C AS E S\Falowskl, Francis\2007-20980\Falowskl.ac, fraud.drugs.doc

Docket for Case No: 08-001638PL