The Issue Whether disciplinary action should be taken against Respondent's license to practice medicine for filing false and fraudulent insurance claims and failing to make records available to patients.
Findings Of Fact Respondent is, and has been at all times material hereto, a licensed physician in the State of Florida. He holds license number ME 0039675. Respondent repeatedly filed false and fraudulent insurance claim forms on patients C.J., his wife K.J. and their children which were paid. These included claims for removal of benign lesions, a proctosigmoidoscopy and related treatment, and surgery on a perianal abscess on C.J. who never saw Dr. Patel, or any physician, for such treatment or care. False claims for care for office visits, x-rays, blood work and stress tests for K.J. were submitted. False claims for care never provided to the children were also concocted. He received payment for services and procedures that were never performed or even attempted, and to support the fraudulent insurance claims, Dr. Patel even created false operative reports. Dr. Patel wrongfully fai1ed to release patient records to C.J. and his family, when required by law to do so. The continuing nature of the false billing leads to the inference that the records were withheld in an attempt to cover up Dr. Patel`s wrongdoing.
Recommendation It is RECOMMENDED that the Respondent be found guilty of violating Sections 458.331(1)(h)(i) and (1) , Florida Statutes (1985). Due to Dr. Patel's clear and repeated pattern of fraud and deceptive practices in his medical practice, his license to practice medicine should be revoked. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 28th day,of December, 1989. WILLIAM R. DORSEY, Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 28th day of December, 1989. COPIES FURNISHED: Joseph Harrison, Senior Attorney Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0750 Pravinkumar Patel, M.D. Post Office Box 9828 Coral Springs, Florida 33075 Kenneth D. Easley, General Counsel Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0750 Dorothy Faircloth, Executive Director Department of Professional Regulation Board of Medicine 1940 North Monroe Street Tallahassee, Florida 32399-0750
The Issue The issue is whether Petitioner’s request for hearing should be dismissed as untimely.
Findings Of Fact In a letter dated January 29, 2009,1/ DSGI informed Petitioner that his Level II appeal was denied. The appeal concerned Blue Cross and Blue Shield of Florida’s denial of coverage for a Magnetic Resonance Imaging Spectography procedure that Petitioner underwent in July 2008. The letter informed Petitioner of his right to request an administrative hearing on the denial of his appeal, and also informed Petitioner that the request must filed with DSGI within 21 days of his receipt of the letter. Copies of Florida Administrative Code Rules 28-106.201 and 28-106.301 were attached to the letter, as was an “informational page” that stated in pertinent part: Your request (petition) for a formal hearing must be in writing. We recommend you send your request by certified mail so you will have proof of the date the Department of Management Services (DMS) receives it. You lose your right to a hearing if we do not receive your request on time. (Bold in original and underlining added). * * * If you dispute the facts we used in our decision, state them in your written request for a hearing. Your request must meet the requirements of rule 28-106.201, Florida Administrative Code. Petitioner received the letter denying his appeal on February 9, 2009. The 21-day period for requesting a hearing on that decision expired on March 2, 2009. Petitioner requested a hearing on the denial of his appeal through a letter dated March 1, 2009. The letter stated in pertinent part: I am writing in protest of the decision rendered against a health insurance claim I submitted in July of 2008 by DSGI. I believe that the decision to DENY my health insurance is improper, the reasons for which actually encourage further health risks by limiting my health care options to only procedures that are inherently dangerous by promoting the spread of cancer. I am writing to request a formal hearing.... Petitioner mailed this letter to DSGI. The postmark date on the envelope in which the letter was mailed was March 5, 2009, which is after the applicable filing deadline. Petitioner’s request for hearing was received by DSGI on March 9, 2009 (seven days after the deadline), and was filed with the Clerk of the Department of Management Services on March 10, 2009 (eight days after the deadline). Petitioner’s request for hearing was untimely because it was filed more than 21 days after he received the letter denying his Level II appeal. The Order to Show Cause issued on April 23, 2009, gave Petitioner an opportunity to explain why his untimely petition should not be dismissed. The letter filed by Petitioner in response to the Order to Show Cause stated in pertinent part: I apologize for missing the 21 day deadline to file a request for hearing. I do not waive my rights. I cannot afford legal representation in this matter. I received the letter dated January 29 from the Department of Management Services [and] I was led to believe that a full and complete response -- one that was equal to the five-page letter I received -- was necessary. Because of the amount of information I felt that I was required to assemble, and demands on my life circumstances I [was] unable to file in a timely manner. The response to the Order to Show Cause also articulates what Petitioner believes to be the merit of his case,2/ which he argues “outweighs dismissal because of procedural technicalities.”
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that DSGI issue a final order dismissing Petitioner’s request for hearing. DONE AND ENTERED this 5th day of May, 2009, in Tallahassee, Leon County, Florida. S T. KENT WETHERELL, II Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 5th day of May, 2009.
Findings Of Fact In January 1995, Petitioner, Dubois Farms, filed a complaint with the Department. The complaint alleged that Respondent, Mo-Bo, and Respondent, General Accident, was indebted to Petitioner in the amount of $800.00 for 100 cartons of eggplant purchased from Petitioner. The Department gave notice to the Respondents that the complaint had been filed. On or about February 24, 1995, Mo-Bo responded to the complaint, denied the allegations, and requested a hearing. At hearing, Petitioner offered and had admitted into evidence Exhibits numbered 1-5, subject to Respondent General Accident's hearsay objection. No other proof was offered. Since Petitioner's proof was hearsay, and not subject to any exceptions to the hearsay rule, it cannot support a finding of fact that Mo-Bo is indebted to Petitioner as claimed.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered dismissing the complaint filed by Dubois Farms, Inc., against Mo-Bo Enterprises, Inc., and its surety, General Accident Insurance Company of America. DONE and ORDERED this 30th day of August, 1995, in Tallahassee, Florida. CAROLYN S. HOLIFIELD Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 30th day of August, 1995. COPIES FURNISHED: Mike D. Bess, Qualified Representative Marketing Management Services Florida Fruit and Vegetable Association P.O. Box 140155 Orlando, Florida 32814-015 Zoe Krikorian, Esquire Brad A. Thomas, Esquire General Accident Insurance Company Brickell Centre - Suite 900 799 Brickell Avenue Miami, Florida 33131-2805 Don Bieda, Esquire Legal Department General Accident Insurance Company 436 Walnut Street Philadelphia, Pennsylvania 19105-1109 Richard Tritschler, Esquire Department of Agriculture and Consumer Services The Capitol, PL-10 Tallahassee, Florida 32399-0810 Mo-Bo Enterprises, Inc. P.O. Box 1899 Pompano Beach, Florida 33061 Charles Barnard, Esquire 200 SE 6th Street, Suite 205 Fort Lauderdale, Florida 33301 Brenda Hyatt, Chief Bureau of Licensing & Bond Department of Agriculture 508 Mayo Building Tallahassee, Florida 32399-0800 Honorable Bob Crawford Commissioner of Agriculture The Capitol, PL-10 Tallahassee, Florida 32399-0810
Findings Of Fact On October 9, 1992 Petitioner executed a sworn application for licensure as a life and variable annuity and health insurance agent. Such application was filed with the Department on October 13, 1992. At the Department's request, the Petitioner sent a second application by facsimile transmission on February 19, 1993. This second application was unexecuted, that is, unsworn but was on the same form as previously described in paragraph 1. On each copy of the application, Petitioner responded "yes" to the question: Has your application for a license ever been declined or denied by this or any other Insurance Department or has your License or eligibility to hold a license ever been declined, denied, suspended, revoked, placed on probation or an administrative fine or penalty levied? On each copy of the application, Petitioner responded "no" to the question: Does any insurer or general agency claim that you are indebted under any agency con- tract or otherwise? If yes, please attach a letter of explanation. When the Department requested additional information regarding Petitioner's answer to the question described in paragraph 3, the Petitioner gave a response that led to the review of a final order entered by the Department on October 30, 1990. As set forth in the final order and the recommended order attached thereto, the basis for the Petitioner's prior revocation, was a pattern of deceit evidenced by false statements on applications for insurance, by the forgery of names on applications for proposed insureds, and by forging names for requests for cancellation of coverage. As a result of the actions described in paragraph 6, the insurer for whom Petitioner worked at the time, Colonial Life and Accident Insurance Company (Colonial), took legal action against Petitioner for damages incurred or to be incurred by the company as a result of the deceit. That civil suit was settled by the entry of a settlement judgment in which Petitioner agreed to repay Colonial damages in the amount of $60,000. The amount was to be repaid pursuant to a payment schedule. At the times Petitioner filed applications with the Department (October and February), such monies had not been repaid and Petitioner was, in fact, in default on the payment schedule. Colonial is currently owed approximately $32,000 of the original settlement. Additionally, when Colonial sought to enforce its judgment against Petitioner, he filed for bankruptcy to protect his assets and to restructure his debt. Thus when Petitioner answered in the negative to the question outlined in paragraph 4, such answer was incorrect and misleading. On February 24, 1993, the Department notified Petitioner that his application for licensure had been denied. The actions complained of, and which gave rise to Petitioner's prior revocation, were fully established in the prior proceeding. Petitioner's misstatement on the current application gives concern as to whether misleading statements or misrepresentations may recur.
Recommendation Based on the foregoing, it is, hereby, RECOMMENDED: That the Department of Insurance and Treasurer enter a final order that denies Petitioner's application for licensure. DONE AND RECOMMENDED this 11th day of August, 1993, in Tallahassee, Leon County, Florida. JOYOUS D. PARRISH Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 11th day of August, 1993. APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-2587 The Petitioner submitted proposed findings in the form of a letter. Only the second and third paragraphs of that letter set forth findings of fact, the remainder of the letter is hereby rejected as argument, comment, or conclusions of law, not fact. Rulings on the proposed findings of fact submitted by Petitioner: With regard to the second paragraph, it is accepted that the Department was aware of the Petitioner's indebtedness to Colonial. That Petitioner, or his agent, wrote to Mr. O'Neil is rejected as irrelevant. Further, such letter is not accepted for the truthfulness of the matters asserted in it. When confronted, Petitioner has been truthful regarding the indebtedness to Colonial; such indebtedness, however, was not accurately depicted on the application for licensure. With regard to the third paragraph, it is accepted that Petitioner has repaid some of the indebtedness to Colonial; otherwise, the paragraph is rejected as not supported by the credible evidence presented in this case. Rulings on the proposed findings of fact submitted by Respondent: 1. Paragraphs 1 through 19 are accepted. COPIES FURNISHED: Lawrence Sherman Lowe, III, pro se 9150 South West 23rd Street, Apt. D Fort Lauderdale, Florida 33324 John R. Dunphy Department of Insurance and Treasurer Division of Legal Services 612 Larson Building Tallahassee, Florida 32399-0300 Tom Gallagher State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, Florida 32399-0300 Bill O'Neil General Counsel Department of Insurance The Capitol, PL-11 Tallahassee, Florida 32399-0300
The Issue As to DOAH Case No. 03-1447PL, whether the licensure as an insurance agent in Florida held by Respondent Jerrod Keith Zelanka (Jerrod Zelanka) should be disciplined based on the allegations of the Administrative Complaint filed against him and, if so, the extent of such discipline. As to DOAH Case No. 03-1448PL, whether the licensure as an insurance agent in Florida held by Respondent Fredric Stuart Zelanka (Fredric Zelanka) should be disciplined based on the allegations of the Administrative Complaint filed against him and, if so, the extent of such discipline.
Findings Of Fact Jerrod Zelanka is currently eligible for licensure and licensed in Florida as a general lines insurance agent. Fredric Zelanka is currently eligible for licensure and licensed in Florida as a general lines insurance agent. American Insurance Management, Inc. (AIM) was incorporated as a Florida corporation on December 16, 1994. AIM was dissolved as a corporation on August 23, 1996. At all times pertinent to this proceeding, Accredited Insurance Group, Inc. (AIG) was an active Florida corporation and Fredric Zelanka was a director and officer of that corporation. At all times pertinent to this proceeding, American Professional Insurance Services, Inc. (APIS) was an active Florida corporation and Jerrod Zelanka was a director and officer of that corporation. There was no evidence as to any formal relationship between AIG (Fredric Zelanka's corporation) and APIS (Jerrod Zelanka's corporation), although the two corporations shared the same offices. At all times pertinent to this proceeding, Explorer was an insurance company doing business in Florida. On May 13, 1999, Explorer, as insurer, entered into an agency agreement with "Accreditted (sic) Insurance Group, Inc.: DBA American Insurance Management," as agent (the Agency Agreement).2 Fredric Zelanka signed the Agency Agreement on behalf of the agent. At all times pertinent to this proceeding, Fredric Zelanka was the agent of record with Explorer. The Agency Agreement authorized the agent to bind policies of insurance on behalf of Explorer. Paragraph 4 of the Agency Agreement was as follows: 4. The Company (Explorer) authorizes the Agent to collect, receive and receipt for premiums on insurance submitted by the Agent to, and accepted by, the Company. All premiums and return premiums received by the Agent either before or after the termination of this Agreement shall be held by the Agent in a fiduciary capacity as trustee for the Company until delivered to the Company, or in the case of return premiums, to the insured. Paragraph 5.B.(2) of the Agency Agreement required the agent to send to Explorer the required premium down payment or payment in full for the policy within five days of binding an insurance policy. Explorer received nine checks drawn on an account held by APIS at the MetroBank branch office located in Lighthouse Point, Florida. The first of these nine checks was dated August 9, 2001, and the last was dated September 14, 2001. Jerrod Zelanka signed eight of these checks. Each check represented the total or partial payment of premium for a policy of insurance bound pursuant to the Agency Agreement. MetroBank dishonored each of these checks because the check was not properly signed (one check), the account did not have sufficient funds to pay the check (three checks), the funds were uncollected3 (one check), or the account was closed when the checks were presented for payment (four checks). Explorer received ten checks drawn on an account held by APIS at the BankAtlantic branch office located in Deerfield Beach, Florida. The first of these ten checks was dated September 24, 2001, and the last was dated October 28, 2001. Jerrod Zelanka signed each check. Each check represented the total or partial payment of premium for a policy of insurance bound pursuant to the Agency Agreement. BankAtlantic dishonored each check because the account did not have sufficient funds to pay the check when it was presented. The 19 dishonored checks totaled $5,597.00. Fredric Zelanka was not a signatory on the account at MetroBank or on the account at BankAtlantic. Although the checks remitted by APIS to Explorer were dishonored, Explorer issued the policies of insurance that had been bound pursuant to the Agency Agreement. After the checks were dishonored, Explorer demanded payment of the premiums from Respondents. Explorer thereafter terminated the Agency Agreement because Respondents failed to remit the premiums to Explorer. After the termination of the Agency Agreement, Explorer withheld from Respondents commissions that had been earned pursuant to the Agency Agreement, which reduced the debt Respondents owed Explorer. On April 17, 2003, Jerrod Zelanka, on behalf of American Insurance Management, agreed that it owed Explorer the sum of $1,699.11 and agreed to a payment schedule. At the time of the final hearing, Respondents owed Explorer approximately $1,600.00. Fredric Zelanka was hospitalized with health problems and unable to work when the checks at issue in this proceeding were written by Jerrod Zelanka.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Petitioner enter a final order finding Jerrod Zelanka guilty of violating the provisions of Sections 626.561(1) and 626.611(7), (9), and (10), Florida Statutes. As penalty for these violations, it is RECOMMENDED that Petitioner suspend Jerrod Zelanka's insurance licenses and eligibility for licensure for a period of nine months. It is FURTHER RECOMMENDED that Petitioner enter a final order finding Fredric Zelanka guilty of violating the provisions of Sections 626.561(1), 626.611(10), and 626.621(4), Florida Statutes. As penalty for these violations, it is recommended that Petitioner suspend Fredric Zelanka's insurance licenses and eligibility for licensure for a period of three months. DONE AND ENTERED this 15th day of August, 2003, in Tallahassee, Leon County, Florida. S CLAUDE B. ARRINGTON Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 15th day of August, 2003.
