STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2010-16467 MARC ALAN RACHBIND, D.C., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Chiropractic Medicine against Respondent, Marc Alan Rachbind, D.C. 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 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 6704 on or about January 13, 1994, 3. Respondent's address of record is Past Office Box 7636, Fort DOH v. Marc Alan Rachbind, D.C. 1 Case No, 2010-16467 Lauderdale, Florida 33338. 4. On or about June 16, 2010, Patient M.A., a 48 year-old female, presented to the Respondent for treatment of injuries suffered during an ’ automobile accident on the same date. 5. Patient M.A. complained of neck, lower back, and right knee pain. 7 6 Respondent conducted an initial examination of Patient M.A. 7, Respondent recorded several orthopedic tests as positive without specifying what particular finding rendered the test positive. 8. Respondent recorded the following orthopedic tests as positive with respect to Patient M.A.’s right knee: Patella Grind, McMurray’s, Apley’s Compression, Apley’s Distraction, Abduction Stress, and Adduction Stress. . 9 In light of the patient’s subjective complaints and the positive orthopedic findings, Respondent should have ordered diagnostic testing of the patient's right knee. 10. Respondent recorded the following orthopedic test as positive with respect to Patient M.A.’s cervical spine: Foraminal Compression, Foraminal Distraction, Shoulder Depression, Soto-Hall, and Lindner’s. DOH v. Marc Aian Rachbind, D.C. 2 Case No. 2010-16467 11. In light of the patient’s subjective complaints and the positive orthopedic finding, Respondent should have ordered diagnostic testing of the patient’s cervical spine. 12. Patient M.A. returned to Respondent to receive treatment on or about the following dates: June 17, 18, 21, 22, 24, 25, 28, 29, July 2, 5, 6; August 2, 3, 4, 9, 10, 11, 16, 18, 19, 23, 26, 26, 31; and September 1, 3, 7, 8, 9, 2010. 13. Patient M.A. was generally provided with some combination of the following treatments on each date of service: chiropractic adjustment, extremity adjustment, electrical muscle stimulation, ultrasound, traction, manual therapy, and kinetic activities. 14. The daily treatment notes for Patient M.A. failed to adequately describe Patient M.A.’s objective symptoms or subjective complaints. 15. The daily treatment notes failed to adequately describe the treatment provided to Patient M.A. For instance, the treatments notes generally failed to indicate the anatomical areas treated, the length of time for each treatment, the settings used for electrical muscle stimulation and ultrasound, the type of chiropractic adjustment provided, or the type of manual therapy provided. DOH v. Marc Alan Rachbind, D.C. 3 Case No. 2010-16467 16. The daily treatment notes for Patient M.A. failed to justify the medical necessity of the treatment provided to Patient M.A. 17. The daily treatment notes failed to explain the almost one month gap in treatment involving Patient M.A. from approximately July 6, 2010, until approximately August 2, 2010. 18. Respondent billed for Patient M.A.’s initial evaluation using CPT Code 99204. 19. CPT is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and thereby serves as an effective means for reliable nationwide communication among physicians and other healthcare providers, patients, and third parties. CPT is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs, 20. In order to justify the use of the CPT Code 99204, a new patient visit must involve all of the three following items: a comprehensive history; a comprehensive examination, and medical decision making of moderate complexity. DOH v. Mare Alan Rachbind, D.C. 4 Case No, 2010-16467 21. The June 16, 2010, initial examination recorded by Respondent was insufficient to justify the use of CPT Code 99204, 22. Respondent’s license to practice chiropractic medicine was delinquent from April 1, 2010, until approximately August 27, 2010. 23. Respondent practiced chiropractic medicine on one or more patients, on one or more occasions without an active chiropractic license, including when he treated Patient M.A. between April 1, 2010 and August 27, 2010. Count One-Record Keeping Violations 24. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-three (23), as if fully stated herein. 25. Section 460.413(1)(m), Florida Statutes (2009-2010), provides that failing to keep legibly written chiropractic medical records that identify clearly by name and credentials the licensed chiropractic physician rendering, ordering, supervising, or billing for each examination or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories, examination results, X rays, and diagnosis of a disease, condition, or injury is grounds for disciplinary action by the Board of Chiropractic Medicine. DOH v. Marc Alan Rachbind, D.C. 5 Case No. 2010-16467. 26. Section 460.413(1)(ff}, Florida Statutes (2009-2010), subjects a chiropractor to discipline for violating any provision of this chapter, or chapter 456, or any rules adopted pursuant thereto. 27. Rule 64B2-17.0065, Florida Administrative Code (F.A.C.) (2009- 2010), sets forth the minimal recordkeeping standards as set forth below in pertinent part: a. Rule 64B2-17,0065(3), F.A.C. states that medical records shall be legibly maintained and shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs dispensed or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at ~ the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. Initial and follow-up services (daily records) shall consist of documentation to justify care. If abbreviations or symbols are used in the daily recordkeeping, a key must be provided. b. Rule 64B2-17.0065(4), F.A.C., states that all patient records shall include a patient history; symptomatology and/or wellness care; examination finding(s), including X-rays when medically or clinically indicated; a diagnosis; a prognosis; assessment(s); a treatment plan; and, treatments provided. C. Rule 64B2-17.0065(5), F.A.C., states all entries made into the medical records shall be accurately dated. The treating physician must be readily identifiable either by signature, initials, or printed name on the record. Late entries are permitted, but must be cleariy and accurately noted as late entries and dated accurately when they are entered into the record, DOH v. Marc Alan Rachbind, D.C. 6 Case No. 2010-16467 d. Rule 64B2-17.0065(6), F.A.C., states that once a treatment plan is established, daily records shall include: (a) Subjective complaint(s); (b) Objective finding(s); (c) Assessment(s); (d) Treatment(s) provided, and (e) Periodic reassessments as indicated. 28. Respondent violated Section 460.413(1)(m), Florida Statutes, Section 460.413(1)(ff), Florida Statutes, and/or Rule 64B2-17.0065, F.A.C., in the following ways: a) By failing to record and/or maintain documentation sufficient enough to justify using CPT Code 99204 for Patient M.A.’s_ initial examination; b) By failing to record and/or maintain daily treatment notes that adequately described Patient M.A.’s objective symptoms and subjective complaints; c) By failing to record and/or maintain daily treatment notes that adequately described the treatment provided to Patient M.A.; d) By failing to explain Patient M.A.’s almost one month treatment gap from July 6, 2010, until August 2, 2010; e) By failing to document the findings that rendered several orthopedic tests positive; DOH v. Marc Alan Rachbind, D.C. 7 Case No. 2010-16467 f) By failing to document providing or ordering diagnostic testing of Patient M.A.’s right knee; g) By failing to document providing or ordering diagnostic testing of Patient M.A.‘s cervical spine; h) By failing to record and/or maintain sufficient records that justified the care rendered to Patient M.A.; 29. Based on the foregoing, Respondent violated Section 460.413(1)(m), Florida Statutes , Section 460.413(1)(ff), Florida Statutes, and/or Rule 64B2-17.0065, F.A.C. by failing to sufficient medical records. Count Two- Financial Exploitation 30. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-three (23), as if fully set forth herein. 31. Section 460.413(1)(n), Florida Statutes (2009-2010), subjects a chiropractor to discipline for 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 -promation or sale of services, goods, or appliances, or drugs. 32. Rule 642B2-17.005(1), F.A.C. (2009-2010), states that the DOH v. Marc Alan Rachbind, D.C. 8 Case No. 2010-16467 overutilization of chiropractic services or practice by exercising influence on a patient in such a manner as to exploit the patient for financial gain of a licensee or a third party is prohibited by Section 460.413(1)(n), Florida Statutes. 33. Rule 64B2-17.005(3)(a), F.A.C. (2009-2010), states that overutilization occurs when the written chiropractic records, required to be kept by subsection 460.413(1)(m), Florida Statutes, do not justify or substantiate the quantity or number of chiropractic services, practices rendered, or goods or appliances sold by a chiropractic physician to a patient. 34. Respondent violated Section 460.413(1)(n), Florida Statutes, through one or more of the following: a) When he billed Patient M.A.’s insurance company for the initial examination using CPT Code 99204: or, b) By billing for care provided to Patient M.A. that was. not justified by the medical records. 35. Based on the foregoing, Respondent violated Section 460.413(1)(n), Florida Statutes (2009-2010). DOH v. Marc Alan Rachbind, D.C, 9 Case No, 2010-16467 Count. Three- Practicing with a Delinquent License 36. Petitioner re-alleges paragraphs one (1) through twenty-three (23), as if fully set forth within this paragraph. 37. Section 460.413(1)(fP), Florida Statutes (2009-2010), subjects a chiropractic physician to discipline for violating any provisions of Chapter 460. 38. Section 460.411(1)(a), Florida Statutes (2009-2010), provides practicing or attempting to practice chiropractic medicine without an active license or with a license fraudulently obtained constitutes a violation of Chapter 460. | 39. Respondent practiced or attempted to practice chiropractic medicine without an active license when he practiced chiropractic medicine on one or more patients, on one or more occasions between April 1, 2010, and August 27, 2010, including when he treated Patient M.A. between April 1, 2010, and August 27, 2010. 40. Based on the foregoing, Respondent violation Section 460.413(1)(fA), Florida Statutes (2009-2010), by violating any provision of Chapter 460, specifically Section 460.411(1)(a), Florida Statutes (2009- 2010). DOH v. Marc Alan Rachbind, D.C. 10 Case No. 2010-16467 Count Four- Violation of the Standard of Care 41. Petitioner re-alleges paragraphs one (1) through twenty-three (23), as if fully set forth within this paragraph. 42. Section 460.413(1)(r), Florida Statutes (2009-2010), subjects a chiropractic physician to discipline for gross or repeated malpractice or the failure to practice chiropractic medicine at a level of care, skill, and treatment which is recognized by a reasonably prudent chiropractic physician as being acceptable under similar conditions and circumstances. 43. Respondent failed to practice chiropractic medicine at the level of care, skill and treatment which is recognized by a reasonably prudent chiropractic physician as being acceptable under similar conditions and circumstances through one or more of the following: a) By failing to order diagnostic testing of Patient M.A.’s right knee; or, b) By failing to order diagnostic testing of Patient M.A.’s cervical spine. 44. Based on the foregoing, Respondent violated Section 460.413(1)(r), Florida Statutes (2009-2010). DOH v. Mare Alan Rachbind, D.C. tt Case No. 2010-16467 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 collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this _ [= dayof___ J. , 2012. John H. Armstrong, MD Surgeon General and Secretary of Health EA OK Tobe Assistant Genéral Counsel Fla. Bar No. 0542131 Florida Department of Health DEPART or HEALTH Office of the General Counsel DEPUTY CLERK 4052 Bald Cypress Way, Bin C-65 CLERK Angel Sanders Tallahassee, Florida 32399-3265 DATE jayne @ 2.2002 Telephone: (850) 245-4640 x. 8176 Facsimile: (850) 245-4683 Email: tobey_schultz@doh.state.fl.us PCP: 5/31/12 PCP Members: Dr. Hoffman & Dr. Harding DOH v, Marc Alan Rachbind, D.C. 12 Case No. 2010-16467 NOTICE OF RIGHTS 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. DOH v, Marc Alan Rachbind, D.C. 13 Case No. 2010-16467

Docket for Case No: 13-003259PL