v. CASE NO.: 2008-19925
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, Wendy L. Flynn, D.C., and in support thereof alleges:
practice of chiropractic medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 460, Florida Statutes.
At all times material to this Complaint, Respondent was a licensed chiropractic physician within the State of Florida, having been issued license number CH 5692 on or about August 6, 1987.
J:\PSU\Medical\TobeyL_C ASE S\Flynn, Wendy D.C\2008-19992\5Flynn.ac(m)(n)(j )(k).doc 1
Filed September 16, 2011 9:49 AM Division of Administrative Hearings
Respondent's address of record is 3810 S. Florida Avenue, Suite A, Lakeland, Florida 33813.
At all times relevant to this complaint, Respondent was the
owner of Flynn Clinic, Inc., and provided care directly to patients.
On or about February 1, 2006, patient JC presented to Respondent's clinic, with a chief complaint of pain in the middle of her left and right arm. Patient JC also reported the following symptoms: dizziness, neck pain, shoulder pain, numbness in her rights fingers, weakness in the arms, and loss of balance.
On or about February 8, 2006, patient JC was examined by Respondent who diagnosed her with the following conditions: multi-level intervertebral discopathy with myelopathy, cervicobrachial/cervicocranial syndrome, and multi-level myofascitiis.
Patient JC was provided with the following treatments: interferential therapy, massage, myofascial release, and heat therapy.
Respondent's diagnoses of multi-level intervertebral discopathy with myelopathy and cervicobrachialjcervicocranial syndrome are not supported by the examination records and/or fraudulently created by the Respondent for the purpose of justifying care.
Respondent failed to conduct an adequate examination of patient JC when she first presented for treatment.
Based on her examination, Respondent referred patient JC for an MRI/CT Scan of the lumbar spine.
The MRI/CT Scan of patient JC's lumbar spine is not justified by the medical records.
Respondent failed to rule out several differential diagnoses suggested by patient JC's symptoms and/or failed to properly diagnose patient JC prior to initiating treatment.
During the course of treatment, patient JC entered into an agreement wherein Respondent agreed to treat patient JC for the insurance reimbursement payments only.
The agreement further provided that any special financial or hardship agreement made, such as the one contained in patient JC's care agreement, would be voided if the first treatment plan recommended by her doctor was not followed as directed.
Patient JC returned to Respondent's clinic to receive treatment on the following dates: February 10, 13, 15, 22, 24, 27; March 1, 3, 6, 8, 10, 15, 20, 22, 2006.
Generally, patient JC was provided with the following combination of treatments on each date of service: a spinal adjustment (CPT Code 98941), an extremity adjustment (CPT Code 98943), interferential therapy (97032), myofascial release (CPT Code 97140), manual traction (CPT Code 97012), and heat therapy (CPT Code 97010).
Respondent billed patient JC's insurance company for the care rendered to patient JC.
The daily treatment notes for patient JC often times do not
identify the treating physician.
The daily treatment notes fail to adequately describe patient JC's objective symptoms.
The daily treatment notes fail to adequately describe the treatment provided to patient JC.
The medical records do not justify the types or amounts of care provided to patient JC.
Subsequent to patient JC discontinuing care, Respondent billed patient JC $5,980.00 for the treatment rendered which was inconsistent with and substantially higher than the terms the treatment arrangement reached with patient JC.
Count One
Petitioner re-alleges and incorporates paragraphs one (1) through twenty-two (22) as if fully set forth herein.
Section 460.413(1)(m), Florida Statutes (2005), 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.
Section 460.413(1)(ff), Florida Statutes (2005), provides that violating any provision of chapter 456 or chapter 460, or any rules adopted pursuant thereto is grounds for disciplinary action by the Board of Chiropractic Medicine.
Rule 6482-17.0065, Florida Administrative Code C'F.A.C."), sets forth the minimal recordkeeping standards as set forth below in pertinent part:
a. Rule 64B2-17.0065(3), F.A.C., states
that the medical record 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.
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 clearly and accurately noted as late entries and dated accurately when they are entered into the record.
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.
Patient JC's medical records failed to comply with Section 460.413(1)(m), Florida Statutes, 460.413(1)(ff), Florida Statutes, and/or Rule 64B2-17.0065, F.A.C., in one or more of the following ways:
By failing record an adequate examination of patient JC when she first presented for treatment;
By failing to justify her diagnoses of multi-level intervertebral discopathy with myelopathy and cervicobrachialfcervicocranial syndrome for patient JC in the medical records;
By failing to justify the referral of patient JC for a MRI/CT
Scan of her lumbar spine;
By failing to rule out several differential diagnoses suggested by patient JC's symptoms and/or failing to properly diagnose patient JC prior to initiating treatment;
By often times not identifying the treating physician by name or initials in the daily treatment notes;
By failing to adequately describe patient JC's objective symptoms in the daily treatment notes;
By failing to adequately describe the treatment provided to patient JC; or
(b) By failing to justify the medical necessity of the amounts
or types of care provided to patient JC.
Based on the foregoing, Respondent violated Section 460.413(1)(m), Florida Statute, 460.413(1)(ff), Florida Statutes, and/or Rule 64B2-17.0065, F.A.C. by failing to comply with minimal record keeping standards.
Count Two
Petitioner re-alleges and incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein.
Section 460.413(1)(n), Florida Statutes (2005), 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 promotion or sale of services, goods, or appliances, or drugs.
Rule 642B2-17.005(1), F.A.C., states that the 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.
Overutilization of chiropractic services or practice is defined as services or practices rendered, or goods or appliances sold by a chiropractic physician to a patient for financial gain of the chiropractic physician or a third party which are excessive in quality or quantity to the justified needs of the patient.
Rule 64B2-17.005(3)(a), F.A.C., 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.
Respondent violated Section 460.413(1)(n), Florida Statutes, through one or more of the following actions:
By utilizing contractual terms which required patient JC to complete all recommended care or face substantial higher bills;
By billing patient JC in amounts that were inconsistent with and higher than the terms of her agreement with Respondent; or,
By billing patient JC's insurance company for amounts and types of care that were not justified by the medical records.
Based on the foregoing, Respondent has violated Section 460.413(1)(n), Florida Statutes, by exploiting patient JC for financial gain.
Count Three
Petitioner re-alleges and incorporates paragraphs one (1) through twenty-two (22) as if fully set forth herein.
Section 460.413(1)(k), Florida Statutes (2005), subjects a chiropractic physician to discipline for making misleading, deceptive, untrue, or fraudulent representations in the practice of chiropractic medicine.
Respondent made misleading, deceptive, untrue or fraudulent representations in the practice of chiropractic medicine when she fraudulently diagnosed patient JC with intervertebral discopathy with myelopathy and cervicobrachialjcervicocranial syndrome in order to justify rendering care.
Based on the foregoing, Respondent has violated Section 460.413(1)(k), Florida Statutes, by making misleading, deceptive, untrue, or fraudulent representations in the practice of chiropractic medicine.
WHEREFORE, 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.
, 2009.
Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General
(850) 245-4640 ext. 8176
Respondent has the right to request a hearing to be conducted in accordance with Sections 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.
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.
