STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTM ENT OF HEALTH, PETITIONER, Ve. CASE NO, 2007-10151 GUSTAVO ACOSTA, D.C, ~ RESPONDENT, / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through counsel, files this Administrative Complaint before the Board of Chiropractic Medicine against Respondent, Gustavo Acosta, D. C., and in support 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 order, Respondent was licensed to Practice chiropractic medicine in the State of Florida, having been issued license number CH 8885 on or about December 9, 2004. 3. Respondent's address of record is 14850 Sw 199 Avenue, J:\PsuU\Allied Health\Cecelia\Chiropractic Cases\Acosta, Gustavo\2007-10151\Acosta AC-460. 41301) (KMN)CX), doc Filed October 3, 2011 10:00 AM Division of Administrative Hearings its undersigned Q0-17-°G Miami, Florida 33196. nn. os ~~ Between on-or-about July-2006-and-on-or about September oo 2006, patients AR, AH, and DL were patients at Tapia Chiropractic Clinic. 5. During the course of treatment at Tapia Chiropractic Center, each patient usually received the following treatment modalities for treatment of injuries sustained in an automobile accident: Therapeutic Exercises; Hydrotherapy (Hydrobed); Ultrasound, Electric Stimulation, and Massage. 6. Medical bills and records submitted from Tapia Chiropractic Center to State Farm Insurance and signed for by Respondent for each of the patients indicate that Therapeutic Exercises, Hydrotherapy (Hydrobed), Ultrasound, Electric Stimulation, and Massage were all ‘performed on patients AR, AH, and DL on or about August 7, 8, and 9, 2006. 7. None of the services billed to State Farm were actually . performed on patients AR, AH, or DL on or about August 7, 8, and 9, 2006, Count One 8. Petitioner re-alleges and incorporates Paragraphs one (1) through seven (7) as if set forth fully herein, "J:APSU\Aliied Health \Cecela\Chiropractic Cases\Acosta, Gustavo\2007-10151\Acosta AC-460.413(1))(k)(n)(x).doc 9. Section 460.413(1)(j), Florida Statutes, (2006), subjects a = Chiropractic physician to discipline for making “or filing a report which the licensee knows to be false, intentionally or negligently failing to file a report or “record required by state or federal law, willfully impeding or obstructing . such filing or inducing another person to do so. _ 10. “Respondent has submitted billing and medical records to State "Farm and has been paid for services to patients AR, AH, and DL that they did not actually receive, 11. Based on the foregoing, the Respondent violated Section 460. 413(1)(j), Florida Statutes, (2006), for making or filing a report which the licensee knows to ‘be false, Count Two 12, Petitioner re-alleges and incorporates Paragraphs one (1) Hrouah seven (2) as if Seton fly herein chiropractic physician to discipline for making misleading, deceptive, untrue, or fraudulent representations in the. practice ‘of chiropractic medicine or employing a trick or scheme in the practice of chiropractic J:\PSU\Aliied Health\Cecelia\Chiropractic Cases\acosta, Gustavo\2007-10151 \Acosta AC-480.413(1)G)(K)(n)(x).doc medicine when such trick or scheme fails to conform to the generally prevailing standards Of treatinent ih the chiropractic Medical community. ~ 14, Respondent made a fraudulent representation when he submitted billing forms and received payment for services that were never actually rendered to patients AH, AR, or DL. , 15. Based on the foregoing, Respondent has violated Section 460.413(1) (k) Florida Statutes, (2006), Count Three 16. Petitioner re-alleges and incorporates paragraphs one (1) through seven (7) as if set forth fully herein. 17, Section 460.413(1)(x), Florida Statutes, (2006), subjects a chiropractor to disciplinary action for submitting to any third-party payor a claim for a service or treatment which was not actually provided to patient. 18. Respondent submitted billing forms and received payment from State Farm Insurance for services that were never actually rendered to patients AH, AR, or DL. 19. Based on the foregoing, Respondent has violated Section 460.413(1)(x), Florida Statutes (2006), J:\PSU\Allied Health\Cecelia\Chiropractic Cases\Acosta, Gustavo\2007-10151\Acosta AC-460,413(1)G)(k)(n)(x).doc WHEREFORE, the Petitioner respectfully requests that the Board of ~ Chiropractic Medicine enter an order imposinc 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, refun relief d of fees billed or collected, remedial education and/or any. other that the Board deems appropriate. , 2008. SIGNED this 90" day of Mow Ana M. Viamonte Ros M.D., M.P.H., State Surgeon General J Lb bg Cecelia D. Jeffe °e Assistant General Counsel etme, a DOH Prosecution Services Unit DEPARTMENT OF HEALTH 4052 Bald Cypress Way, Bin C-65 onc O ret Re PCP: J:\PSU\AI Tallahassee, FL 32399 DATE, 5-2 Florida Bar # 0007609 (850) 245-4640 ext, 8167 (850) 245-4684 FAX 5/13/08 Perman & LaRusso ied Health\Cecelia\Chiropractic Cases\Acosta, Gustavo\2007-10154 \Acosta AC-460.413(1)G)(k)(n)(x) doe : 5: Respondent has the right to request a hearing to be conducted in accordance 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. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation 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. J:\PSU\Allied Health\Cecelia\Chiropractic Cases\Acosta, Gustavo\2007-10151\Acosta AC-460.413(4)G)(k)(n)(x).doc 6

Docket for Case No: 11-005087PL