STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, A CASE NO. 2004-22960 ARIEL DURAN MONDRAGON, M.D., RESPONDENT. ADMINISTRATIVE COM T COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against Respondent, Ariel Duran Mondragon, M.D. and in support thereof alleges: - 1, Petitioner is the state department charged with regulating the practice of Medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed physician within the state of Florida, having been issued license number ME 70040. pOd Getll é00¢ ¢ 78q S2:0T 400¢ fF Jal tae 10.kK7-01 3. Respondent's address of record is 10760 West Flagler Street, #11, Miami, Florida 33174. 4. On or about August 5, 2003, Patient H.R., a then thirty-one year old woman, was involved in a motor vehicle accident that left her with neck and back pain. 5. Onor about August 6, 2003, Patient H.R. presented to National — Rehab Center, 7200 NW 7th Street Suite 204, Miami, Florida 33126 (“National Rehab”). Upon her arrival at National Rehab, Patient H.R. was examined, x-rayed and received treatment for her sore back and neck. She also met with a woman who asked her to sign a significant number of documents, including thirty-one forms titled “Therapy Sheet,” in blank, which H.R. was told not to date. 6. After August 6, 2003, Patient H.R. never returned to or was treated at National Rehab again. 7. “Therapy Sheets” sheets were completed in Patient H.R.'s name and maintained in her medical record at National Rehab which indicated that she had received and was actively participating in treatment on the following dates, when in fact National Rehab did not treat her on these dates at all: August 7, 8, 11-15, 18-20, 22, 25, 27-28, 2003; September 3, 90d 9e*LL é00¢8 ¢ 78d Se:0T 400¢ PF Jaq 2, 8, 9, 11, 15, 17, 22, 24-25, and 30, 2003; and October 1, 7-8, and 14+ 15, 2003. 8. Respondent, who at all times material to this complaint was employed by National Rehab, completed and signed a progress report relating to an office visit allegedly made by Patient H.R. on August 20, 2003. In this report, Respondent documented that Patient H.R. “still complains of experiencing neck pain upper and lower back pain [sic] associated with radicular type symptoms in the back areas.” Respondent also documented Patient H.R’s progress in an allegedly ongoing course of treatment and instructions she was given relating to her continuing physical therapy, 9. Respondent's August 20, 2003 progress report was deceptive, untrue or fraudulent because Patient H.R. did not complain of pain to, was not seen by, and was not participating in any kind of treatment plan with Respondent or anyone else at National Rehab on August 20, 2003. She left National Rehab on August 6, 2003 and never returned. 10. ‘Respondent completed and signed a progress report relating to an office visit allegediy made by Patient H.R. on September 17, 2003. In this report, Respondent documented that Patient H.R. “still complains of experiencing neck pain upper and lower back pain [sic] associated with 90 ‘d Se*lL é008 38g Se:0T 400¢ PF Jaq radicular type symptoms in the back areas.” Respondent also documented Patient H.R.'$ progress in an allegedly ongoing course of treatment and instructions she was given relating to her continuing physical therapy. 11. Respondent’s September 17, 2003 progress report was deceptive, untrue or fraudulent because Patient H.R. did not complain of pain to, was not seen by, and was not participating in any kind of treatment plan with Respondent or anyone else at National Rehab on September 17, 2003. 12. On or about October 15, 2003, Respondent completed and signed a document titled “Final Examination Report” relating to Patient H.R. In this report, Respondent alleged that H.R. “came back today for a Final Examination report on her condition,” and that she “continues to experience pain tae .” He asserts that H.R. “has been cooperative in keeping with the treatment schedule” and concludes that H.R. has sustained “6% impairment of the body as a whole” as a result of her accident. 13. Respondent's October 15, 2003 progress report was deceptive, untrue or fraudulent because Patient H.R. did not complain of pain to, was not seen by, and was not participating in any kind of treatment plan with © Respondent or anyone else at National Rehab on October 15, 2003. é0‘d 9e*LL é00¢8 ¢ 78d 92:07 400¢ F Jaq 14. National Rehab submitted claim forms signed by Respondent and in Respondent’s name to Direct Insurance of Tampa, Florida billing Direct Insurance for treatment provided to Patient H.R. on ail of the dates listed in paragraph 7, above, as well as September 19, 2003. These were personal injury protection claims as required by Section 627.736, Florida Statutes (2003). . i 15. All of the billed charges described in paragraph 14, above, were deceptive, untrue or fraudulent because Patient H.R. was not seen or treated by Respondent or anyone else at National Rehab on the dates therein described and were for services not rendered. The total amount of the fraudulent charges was $9,610.00. Count One 16. Petitioner incorporates and realleges paragraphs 1 through 15 as if fully set forth herein. . 17. Section 458.331(1}(k), Florida Statutes (2003), provides that making deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employing a trick or scheme in the practice of medicine is grounds for discipline by the Board of Medicine. 18. Respondent made deceptive, untrue, or fraudulent representations in or related to the practice of medicine and/or employed a - 5 80 ‘d 9e*LL é00¢8 ¢ 78d 92:07 400¢ F Jaq trick or scheme in the practice of medicine in one or more of the following ways: a). by creating and/or signing deceptive, untrue or fraudulent examination reports for Patient H.R. on August 20, September 17 and October 15, 2003, as described in paragraphs 8-13, above, b). by submitting deceptive, untrue or fraudulent claims supported by deceptive, untrue or fraudulent documentation to Direct Insurance on August 7, 8, 11-15, 18-20, 22, 25, 27-28, 2003; September 3, 5, 8,9, 11, 15, 17, 19, 22, 24-25, and 30, 2003; and October 1, 7-8, and 14-15, 2003, as described in paragraphs 7-15, above. 19. Based on the foregoing, Respondent has violated Section 458.331(1)(k), Florida Statutes (2003). Count Two 20. Petitioner incorporates and realleges paragraphs 1 through 15 as if fully set forth herein. 21. Section 456.072(1)(ee), Florida Statutes (2003), provides that with respect to making a personal injury protection claim as required by 60d éetltl é008 ¢ 78d 92:07 400¢ F Jaq ~ os Section 627.736, Florida Statutes (2003), intentionally submitting a claim, statement, or bill for payment of services that were not rendered is grounds for discipline by the Board of Medicine. 22. On August 7, 8, 11-15, 18-20, 22, 25, 27-28, 2003; September 3, 5, 8, 9, 11, 15, 17, 19, 22, 24-25, and 30, 2003; and October 1, 7-8, — and 14-15, 2003, Respondent intentionally submitted a Claim, statement, or bill for payment of services that were not rendered to Direct Insurance of Tampa, Florida and did so with respect to making a personal injury protection claim as required by Section 627.736, Florida Statutes (2003). 23. Based on the foregoing, Respondent has violated Section 456.072(1)(ee), Florida Statutes (2003). WHEREFORE, Petitioner respectfully requests that the Board of 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 Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. Ol‘d éetltl é008 ¢ 78d 92:07 400¢ F Jaq ln SIGNED this 26" ~ day of ete be 2007. Ana M. Viamonte Ros, M.D., M.PH. State Surgeon General 10 ia Don Freeman Assistant General Counsel DOH-Prosecution Services Unit hig LS 4052 Bald Cypress Way-Bin C-65 DEPARTMENT OF HEALTH Tallahassee, Florida 32399-3265 CUBR een Florida Bar # 736171 DATE = eral (850) 245-4640 (850) 245-4681 fax PCP: October 26, 2007 PCP Members: El-Bahri, Thomas, & Long Lk *d éetltl é008 ¢ 78d 92:07 400¢ F Jaq 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. él‘d éetlh é00¢8 ¢ 789 2:07 400¢ fF Jal

Docket for Case No: 07-005479PL