The Issue Whether the Department of Management Services properly denied medical insurance reimbursement to Petitioner, a covered dependent of a state employee insured by the State Employees' Preferred Provider Organization health plan, for Genotropin recombinant growth hormone prescribed for the treatment of long- term growth failure associated with idiopathic short stature.
Findings Of Fact Based on the oral and documentary evidence adduced at the final hearing, and the entire record in this proceeding, the following findings of fact are made: The state group insurance program is a package of insurance plans offered to, among others, state employees and their dependents. § 110.123(2)(k), Fla. Stat.1/ Petitioner Arturo Puerto is insured as a dependent of a state employee, and is a participant in the state's group self- insured plan, known as the State Employees' Preferred Provider Organization health plan ("PPO plan" or "state plan"). The state plan includes a state employees' prescription drug program. § 110.12315, Fla. Stat. Pursuant to Section 110.123(3)(c), Florida Statutes, the Department is responsible for contract management and day- to-day management of the state employee health insurance program. Section 110.123(5)(c), Florida Statutes, authorizes the Department to contract with an insurance carrier or professional administrator to administer the state plan. The current contract provider of the state plan's pharmacy program is CareMark Inc. ("CareMark"). However, the Department makes all final decisions concerning the existence of coverage or covered benefits under the state plan. The Department's authority in this regard may not be delegated to a contract provider. § 110.123(5), Fla. Stat. Petitioner was born on February 12, 1992. On or about February 3, 2009, Petitioner's physician prescribed Genotropin, a recombinant growth hormone ("GH")2/ approved by the United States Food and Drug Administration ("FDA") as therapy for short stature, including idiopathic short stature ("ISS"). ISS is short stature that does not have a diagnostic explanation, in an otherwise healthy child. ISS is also called "non-GH-deficient short stature." The Group Health Insurance Plan Booklet and Benefits Document, effective January 1, 2007, as modified on January 1, 2009, includes the terms and conditions of participation in the PPO plan and the benefits provided by the PPO plan. The booklet and benefits document contains a section describing the prescription drug program. Participants in the PPO plan are automatically enrolled in the prescription drug program, which features a network of retail pharmacies and a mail order program. The participant makes a co-payment for covered prescriptions. The booklet and benefits document sets forth a list of drugs that are covered, and a list of drugs that are not covered under the prescription drug program. Under the heading "Important Information about the Prescription Drug Program," the document states the following concerning specialty medications:3/ 5. Certain medications, including most biotech drugs, are only available through Caremark Specialty Pharmacy Services. Generally, these drugs are for chronic or genetic disorders including, but not limited to, multiple sclerosis, growth deficiency and rheumatoid arthritis and may require special delivery options, (i.e. temperature control). Caremark Specialty Pharmacy provides 24/7 access and can be contacted at 1-800-237-2767. * * * 12. As part of the Caremark Specialty Services, Caremark will administer the Advanced Guideline Management program for the State Employees' PPO Plan. Advanced Guideline Management is intended to optimize outcomes and promote the safe, clinically appropriate and cost-effective use of specialty medications supported by evidence based medical guidelines. Failure to meet the criteria for Advanced Guideline Management during the respective use review will result in denial of medication coverage for the Plan participant and discontinuation of medication coverage for the Plan participant in the case of concurrent use review. The Advanced Guideline Management Program is a process by which authorization for a specialty medication is obtained based on the application of currently acceptable medical guidelines and consensus statements for appropriate use of the medication in a specific disease state. Therapies reviewed under the Specialty Guideline Management Program include, but are not limited to, the following: multiple sclerosis, oncology, allergic asthma, human growth hormone, hepatitis C, psoriasis, rheumatoid arthritis, and respiratory syncytial virus. Additional therapies may be added from time to time.... CareMark's current guideline covering Genotropin and similar GH medications is set forth in a 2008 CareMark document titled, "Specialty Pharmacy Program for Growth Hormone and Endocrine-Metabolic Disorders." The document contains flow charts describing the criteria employed by CareMark to determine coverage for specific conditions. Among the criteria set forth in the flow chart for prescribing GH to children with ISS is the following question: "Does pre-treatment growth velocity and height meet the AACE (American Association of Clinical Endocrinologists) criteria for short stature?" (See Appendix N). If the answer to the question is "no," then the criteria direct that coverage for the prescription of GH should be denied. Appendix N sets forth the following "AACE criteria for short stature": < -2.25 standard deviations below the mean for age and sex based on patient's growth rate, adult height prediction of less than 5'3" for boys and less than 4'11" for girls. Appendix N is based on the AACE's "Medical Guidelines for Clinical Practice for Growth Hormone Use in Adults and Children-- 2003 Update" and a December 2003 AACE Position Statement on growth hormone usage in short children.4/ The CareMark document is not explicit as to whether the quoted elements of the AACE criteria for short stature are to be considered in the disjunctive. However, the AACE Position Statement expressly states that GH use is indicated for ISS only for children whose height is "< - 2.25 standard deviations below the mean and have an adult height prediction of less than 5'3" for boys and less than 4'11" for girls." (Emphasis added.) The height standard deviation criterion used by CareMark to determine the appropriateness of Genotropin therapy as a treatment for ISS was shown to be consistent with FDA criteria and the specifications established by Pfizer, the manufacturer of Genotropin. The medical records submitted on behalf of Petitioner show that at the time Genotropin therapy was prescribed in February 2009, Petitioner's height was 162.5 cm (5'4"). This was 1.66 standard deviations below the mean for his age and sex. Untreated, his predicted final height was 164 cm (5'4 1/2"). At the time Genotropin therapy was prescribed, Petitioner did not meet the height standard deviation requirement. His height standard deviation was 1.66 standard deviations below the mean. The deviation required by the CareMark criteria was greater than 2.25 standard deviations below the mean. At the time Genotropin therapy was prescribed, Petitioner did not meet the adult height prediction requirement. Petitioner was already 5'4" tall and was projected to reach a height of 5'4 1/2" without treatment. The CareMark criteria required a projected adult height without treatment of 5'3" or below. The PPO plan denied payment for the Genotropin therapy because Petitioner did not meet criteria established by CareMark through its Specialty Pharmacy Program guidelines. The booklet and benefits document makes no provision for exceptions to strict conformity to the CareMark criteria. At the hearing, Petitioner's representative acknowledged that Petitioner does not meet the criteria for Genotropin therapy, but requested that the Department order such coverage as an exception to the criteria.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law set forth herein, it is RECOMMENDED: That the Department of Management Services, Division of State Group Insurance enter a final order denying coverage for Petitioner's prescription for Genotropin therapy. DONE AND ENTERED this 10th day of March, 2010, in Tallahassee, Leon County, Florida. S LAWRENCE P. STEVENSON 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 10th day of March, 2010.
The Issue The issue in this case is whether disciplinary action should be taken against the Respondent on the basis of her failure to timely comply with continuing education requirements established by Section 626.2815, Florida Statutes.
Findings Of Fact The Respondent is currently licensed by the Florida Department of Insurance ("Department") as a General Lines (2-20) Agent. During the period from August 1, 1995, through July 31, 1997, the Respondent was licensed as a General Lines (2-20) Agent and as a Life, Health, and Variable Annuity (2-15) Agent. At all times material to this case, insurance agents licensed in Florida have been required to complete continuing education courses every two years. Licensed insurance agents can meet their continuing education requirements by attending seminars, taking classroom courses, or taking self-study courses. During the period from August 1, 1995, through July 31, 1997, the Respondent was required to complete 28 hours of continuing education courses. /3 The required courses could be taken and completed at any time during that two-year period. At all times material, the Respondent has been aware of the continuing education requirements applicable to licensed insurance agents. The Respondent resides in Key Largo, Florida, and has lived at the same address for at least 10 years. Miami, Florida, is about 60 miles from Key Largo. Key West is about 100 miles from Key Largo. During the period from August 1, 1995, through July 31, 1997, there were 11 continuing education courses offered in Key largo. During that same period there were 73 continuing education courses offered in Monroe County. During that same period there were approximately 3,000 continuing education courses offered in Dade County. The Respondent waited until July 16, 1997, which was 15 days before the end of her two-year continuing education deadline, before taking any action to comply with the continuing education requirements. On that day she ordered two self-study courses from a course provider named Noble. If an insurance agent chooses a self-study course to fulfill the continuing education requirements, the course is not considered to be completed until the agent has taken a monitored examination on the course material and has achieved a score of at least 70 percent. The Respondent finished her study of the course materials she bought from Noble by the end of July 1997, but she did not take and pass the examinations on those materials until the end of August 1997, which was three or four weeks past the end of her compliance deadline. In July of 1997, the Respondent was nursing an infant child. Although Noble had a testing site in Miami, the Respondent did not want to go to Miami to take the examinations for her self-study courses, because a trip to Miami would interfere with nursing her child. The Respondent waited until the end of August, because by that time Noble had opened a testing site in Key Largo. All insurance agents who failed to comply with the continuing education requirements for the period ending July 31, 1997, were sent a Preliminary Notice of Non-Compliance. All agents who did not respond to the Preliminary Notice of Non- Compliance were sent a Final Notice of Non-compliance. Both preliminary and final notices were sent to the Respondent. The Department initiated disciplinary action against all insurance agents who were found to have failed to comply with the continuing education requirements. The Department offered each of the non-compliant agents an opportunity to settle the disciplinary actions by payment of an administrative fine in the amount of $250.00. Numerous insurance agents settled on those terms. In one case, such a disciplinary action was resolved by a stipulated six-month license suspension.
Recommendation On the basis of all of the foregoing, it is RECOMMENDED that the Department of Insurance issue a final order concluding that the Respondent is guilty of failing to comply with statutory and rule provisions regarding continuing education, and imposing a penalty consisting of a six-month suspension of the Respondent's license. DONE AND ENTERED this 8th day of October, 1999, in Tallahassee, Leon County, Florida. MICHAEL M. PARRISH 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 8th day of October, 1999.
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: Respondent Michael Quintana is currently licensed as a general lines agent in Florida. On or about January 18, 1983, respondent went to the home of Shirley W. McLaughlin for the purpose of soliciting insurance. Mrs. McLaughlin agreed to purchase a homeowners insurance policy and "mortgage" insurance was also discussed. She supplied the necessary information and signed the applications for both the homeowner insurance and the "mortgage" insurance. While she did not desire to purchase what she understood to be strictly "life" insurance, she did understand that what she "was getting at that particular time was protection for the house, period." (TR. 32) She further understood that she was applying for coverage that would pay something if either she or her husband died, and that such would be payable to the beneficiaries. While she was given the opportunity to review all the papers she signed on January 18, 1983, Mrs. McLaughlin apparently did not understand that the premium payments for the "mortgage" insurance would be automatically withdrawn from her bank account. Sometime after her application for homeowners insurance was refused because of a space heater in her home, Mrs. McLaughlin learned from her bank of the automatic withdrawal of premium payments for the "mortgage" insurance. She thereafter cancelled such insurance and all monies were refunded to her. The cover sheet for the "mortgage" insurance policy identifies the policy as a "joint reducing term life insurance policy." The inserted printout setting forth the costs and benefits describes the basic policy as "joint reducing term life (20-year mortgage term) with disability waiver benefit." Agents within the company with which respondent was employed on January 18, 1983, typically refer to such a policy as a "mortgage insurance policy" or a "mortgage cancellation policy," as opposed to a "life insurance policy." The term "mortgage" is used to delineate that a specific policy has been purchased for a specific loss. The beneficiary of such a policy has the option of either paying off the mortgage or using the money for any other purpose.
Recommendation Based upon the findings of fact and conclusions of law recited herein, it is RECOMMENDED that the Administrative Complaint filed on June 11, 1984, be DISMISSED. Respectfully submitted and entered this 25th day of January, 1985, in Tallahassee, Florida. DIANE D. TREMOR Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 28th day of January, 1985. COPIES FURNISHED: William W. Tharpe, Jr. 413-B Larson Building Tallahassee, Fla. 32301 Timothy G. Anderson 620 E. Twigg Street Tampa, Fla. 33602 Bill Gunter Insurance Commissioner The Capitol Tallahassee, Fla. 32301
The Issue Whether the Petitioner meets the pre-licensing qualifications for a general lines agent, pursuant to Sections 626.731 and 626.732, Florida Statutes.
Findings Of Fact Petitioner, Carmen Rosa Maldonado (Maldonado), has been employed by M & D Group, Inc. (M & D), an insurance agency, since 1992. M & D writes property and casualty lines of insurance. Maldonado is the bookkeeper for M & D. Her responsibilities include inputting data into the computer and translating for the Spanish-speaking customers. L & W Group (L & W) is a sister corporation of M & D. L & W writes life, health, and disability insurance policies and annuities. If M & D has a customer who desires a life, health, or disability policy, a representative of M & D will contact Mr. Weinberg at L & W and give him the customer information. Mr. Weinberg prepares the quote for the policy and either sends the quote to M & D for an agent at M & D to explain to the customer or comes himself to the M & D office to explain the quote and policy to the customer. If a Spanish-speaking client is involved, Maldonado is the translator. M & D provides three to seven quotes each month for health insurance through L & W. In September 1997, Maldonado participated in writing a surety bond, and on February 2, 1998, Maldonado assisted Erica Woodham, Vice President of M & D, in giving a quote on a surety bond. The evidence is not clear whether the quote and bond were provided through another insurance agency, because according to Ms. Woodham, M & D does not write surety bonds. On June 6, 1997, Maldonado filed an application for licensure as a general lines agent with the Department. She listed her insurance experience as "customer service" and indicated she wanted her experience to be the basis for meeting the pre-licensing qualifications. On June 13, 1997, the Department returned Maldonado's application and requested that she provide additional information concerning her experience. The letter stated: To qualify for this examination through experience you must have completed, within the past 4 years, at least 1 year of substantially full-time responsible duties as a bona fide employee. Your duties during this time must have been in all lines of Property, Casualty, Surety, Health and Marine Insurance. Please complete and return the enclosed certificates of employment. On or about June 18, 1997, Maldonado resubmitted her application with an addendum to the Department for the purpose of determining whether she was qualified to sit for the pre- licensing examination or to be licensed as a general lines insurance agent. Maldonado's addendum did not indicate that she was experienced in marine, health, or surety lines. By letter dated July 11, 1997, the Department advised Maldonado that her application for a general lines insurance agent was denied because she did not meet the pre-licensing educational requirements for a general lines agent. The denial letter was later amended to state that Maldonado lacked the one year of experience in health, flood, surety, and fire insurance. On August 1, 1997, Maldonado sent a letter to the Department, stating that she inadvertently failed to mark the appropriate boxes on the addendum form regarding her experience in health, surety, and marine insurance.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered denying Petitioner's application for a general lines agent. DONE AND ENTERED this 10th day of March, 1998, in Tallahassee, Leon County, Florida. SUSAN B. KIRKLAND 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 Filed with the Clerk of the Division of Administrative Hearings this 10th day of March, 1998. COPIES FURNISHED: Bill Nelson State Treasurer and Insurance Commissioner Department of Insurance The Capitol, Plaza Level 1 Tallahassee, Florida 32399-0300 Daniel Y. Sumner General Counsel Department of Insurance The Capitol, Lower Level 26 Tallahassee, Florida 32399-0300 Joe DeMember, Esquire Department of Insurance and Treasurer Division of Legal Services 200 East Gaines Street Tallahassee, Florida 32399-0333 Carmen Rosa Maldonado, pro se 2931 Southwest 11 Court Fort Lauderdale, Florida 33312-2805
The Issue The issue is whether Respondent should withdraw its approval of a continuing education course that Petitioner offers to life, health, and variable annuity insurance agents.
Findings Of Fact Respondent is the state agency responsible, in relevant part, for regulating continuing education courses for insurance licensees, pursuant to Chapters 626 and 627, Florida Statutes (2008).1 Petitioner provides a course entitled, Reverse Mortgages, identified in the record by course number I.D. 64231 (the course). On June 12, 2008, Respondent approved the course for two hours of continuing education credit for licensed life, health, or variable annuity insurance agents. The course content addresses reverse mortgages rather than insurance. A reverse mortgage is a financing device. It is a special type of home loan that converts a portion of the equity in a home into cash. Unlike a traditional home equity loan or second mortgage, no repayment is required until the borrowers no longer use the home as their principal residence. References to life insurance in the course pertain to the use of a reverse mortgage as a funding mechanism for life insurance. The course does not have significant intellectual or practical content to enhance and improve the insurance knowledge of licensees who participate in the course. The course is not a formal program of learning which contributes directly to the professionalism, ethics, or competence of a licensee acting under the scope of his or her license. Respondent has statutory authority to regulate continuing education courses for insurance licensees. Respondent does not have statutory authority to regulate lending and financing, including financing through reverse mortgages. Withdrawal of approval for continuing education credit does not prevent an insurance agent from taking the course in addition to the required continuing education. If an insurance agent conducts financial transactions in conjunction with an insurance transaction, the agent should be sufficiently educated to avoid a breach of the fiduciary duty owed to the insurance consumer. Petitioner presented evidence of courses that Respondent has approved for continuing education, and those courses do not address insurance topics. Respondent approved those courses pursuant to rules that provide partial credit for certain non-insurance topics, such as communication or time management.2 Respondent is currently seeking to amend the rule to remove the partial credit provision because that provision is not consistent with national standards.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Respondent enter a final order withdrawing approval of the course. DONE AND ENTERED this 16th day of April, 2009, in Tallahassee, Leon County, Florida. S DANIEL MANRY 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 16th day of April, 2009.
Findings Of Fact Respondent has been licensed by Petitioner as a physician in the State of Florida and has, at all times pertinent to this proceeding, held license number ME0030090. Andy Moya, a law enforcement investigator with the Division of Insurance Fraud of the Florida Department of Insurance, conducted an investigation of Respondent's billings to insurance companies. As a result of this investigation, Mr. Moya executed a probable cause affidavit that led to Respondent's arrest on multiple counts, including four counts of grand theft. Grand theft is a third degree felony. On June 12, 1991, Respondent was arrested pursuant to the arrest warrant that had been obtained by Mr. Moya. On October 8, 1991, Respondent freely and voluntarily entered a plea of nolo contendre to four counts of grand theft. The presiding circuit judge accepted Respondent's plea of nolo contendre, withheld adjudication of guilt, placed the Respondent on probation for a period of five years, and ordered Respondent to pay the Department of Insurance the sum of $1,000.00 and the State Attorney's office the sum of $750.00. A condition of Respondent's probation was that under no circumstances could he bill insurance companies for services he performed. All billings to insurance companies would have to be done by someone over whom Respondent had no control. A plea of nolo contendre to four counts of grand theft for billing insurance carriers for services not rendered is directly related to the practice of medicine. The following facts underlie the criminal charges to which Respondent entered a plea of nolo contendre. PATIENT #1 AND PATIENT #2 Patient #1 and #2 were in a car accident in Hialeah, Florida, and subsequently were referred to Respondent by attorney Richard H. Reynolds. Respondent billed U.S. Security Insurance Company, Inc., a total of $1,995.00 for treating Patient #1 on 41 different dates from January 17, 1990, through May 2, 1990. Patient #1 later testified that she had been treated by Respondent on no more than ten different dates. Respondent assigned to Patient #1 a disability rating of five to six percent permanent/partial impairment. Patient #1 later denied under oath that any disability resulted because of the accident. Respondent billed U.S. Security Insurance Company, Inc., a total of $2,195.00 for treating Patient #2 on 46 different dates from January 17, 1990, through May 7, 1990. Patient #2 later testified that she had been treated by Respondent on no more than ten different dates. Respondent assigned to Patient #2 a disability rating of five to six percent permanent/partial impairment. Patient #2 later denied under oath that any disability resulted because of the accident. On October 25, 1990, Respondent authenticated his medical records and billings on Patient #1 and Patient #2 and affirmed to Mr. Moya that these documents were correct. Respondent's medical records and billings for Patient #1 and Patient #2 were fraudulent. PATIENT #3 On July 13, 1990, Patient #3 was in a car accident. On July 27, 1990, an attorney referred Patient #3 to Respondent. Several days after July 27, 1990, Patient #3 visited Respondent (or any other doctor following the accident) for the first time. Respondent subsequently billed U.S. Security Insurance, Inc., for services rendered to Patient #3 on July 20, 23, 25, and 27, 1990. These billings, in the approximate amount of $300.00, were fraudulent in that they were for services purportedly rendered on dates before Respondent first saw this patient. PATIENT #4 Respondent billed Allstate Insurance Company for services that Respondent purportedly rendered to Patient #4 as follows: office visit on June 26, 1990, and physiotherapy treatments on June 26, 28, and 29, and July 3, 5, 6, and 9, 1990. These billings were fraudulent in that Patient #4 was hospitalized at Coral Gables Hospital from June 26, 1990, to July 11, 1990. Respondent did not provide the services for which he billed Allstate Insurance Company during June and July 1990. On February 6, 1991, Respondent signed an affidavit that provided, in pertinent part, as follows: I have read the attached medical report and bill for services rendered to [Patient #4]. I declare that the treatments indication on the attached medical report and bill for services were provided by me on the dates listed and that the treatment and services rendered were reasonable and necessary with respect to the bodily injury sustained. Respondent's billings for Patient #4, in the approximate amount of $300.00, were fraudulent and the affidavit he signed on February 6, 1991, was untrue. Respondent was born in Cuba and graduated from the University of Havana School of Medicine in 1962. Respondent testified at the formal hearing that he was born on May 26, 1919, but the application for licensure submitted by Respondent reflects that Respondent was born May 26, 1924. There was no explanation for this discrepancy. Respondent has been licensed as a physician in the State of Florida since 1977. There was no evidence that Respondent has been previously disciplined by Petitioner. At the time of the formal hearing, Respondent was practicing medicine with Dr. Antonio Ramirez, M.D. Dr. Ramirez is a physician licensed to practice medicine in the State of Florida. Dr. Ramirez was also educated in Cuba, and had known Respondent since the 1970s. Dr. Ramirez is of the opinion that the services rendered by Respondent have been satisfactory. Respondent has no responsibility for submitting bills to patients or to insurance companies.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Petitioner enter a final order which finds that Respondent committed the acts alleged in the Administrative Complaint and which revokes Respondent's license to practice medicine in the State of Florida. DONE AND ORDERED this 7th day of February, 1994, in Tallahassee, Leon County, Florida. CLAUDE B. ARRINGTON 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 7th day of February, 1994. COPIES FURNISHED: Carlos J. Ramos, Esquire Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Manuel F. Fente, Esquire 1835 West Flagler Street, Suite 201 Miami, Florida 33135 Dr. Marm Harris, Executive Director Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0770 Jack McRay, General Counsel Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0792
The Issue The issues in this case are whether Respondent, Matthew Brillis ("Brillis"), and Respondent, Insurance School of Continuing Education (the "Insurance School"), violated Sections 626.611(7), (9), and (13), Sections 626.621(2), (3), (6), and (12), and Sections 626.9521(1) and 626.9541(1)(e)1, Florida Statutes (1997), and Florida Administrative Code Rules 4- 228.040(2)(d) and (3)(b), 4.228-090(5), 4-228.100(2), 4- 228.160(1) and (6), and 4-228.170 by submitting invoice and roster forms to the state for a cancelled class of continuing education, and, if so, what, if any, penalty should be imposed. (All references to chapters and sections are to Florida Statutes (1997) unless otherwise stated. Unless otherwise stated, all references to rules are to rules promulgated in the Florida Administrative Code in effect as of the date of this Order.)
Findings Of Fact Petitioner is the state agency responsible for regulating life and health insurance agents. Brillis is licensed as a life and health insurance agent and teaches continuing education courses under the name of the Insurance School. Section 626.2815 establishes requirements and standards for continuing education courses for persons licensed to sell insurance in Florida. Each licensee must complete 28 hours of continuing education every two years. Petitioner interprets Section 626.2815 as authorizing Petitioner to regulate providers of continuing education courses. Petitioner claims that Section 626.2815 authorizes Petitioner to approve the instructors and school officials employed by such providers. Petitioner requires providers to apply for approval for each course before the provider can offer the course. If Petitioner approves the course, Petitioner requires the provider to file with Petitioner a "schedule of classes." The schedule of classes contains a variety of information including the signature of the school official, the name of the course, the location of the class, and the number of credit hours requested. After the course is completed, Petitioner requires a provider to file an "invoice and roster." The invoice and roster contains the name of the course, its location, the names of the persons who attended the course for credit, and the number of credit hours received by each person. Petitioner requires the provider to include a payment of $1.00 per person with each invoice and roster. Petitioner enters the information from the invoice and roster into Petitioner's computer system. The computer assigns credit to each licensee listed in the invoice and roster. In May 1995, the Insurance School filed three schedule of classes with Petitioner. The schedules notified Petitioner that the Insurance School would teach classes on Life Insurance Policies and Rules and Regulations on September 18, 1995, and a class on Government/Retirement Programs on September 19, 1995, at a Holiday Inn in West Palm Beach. Each of the schedules were stamped with a replica of the signature of Brillis. The signature was stamped on the line requiring a signature of the school official. Employees of the Insurance School routinely used a stamp with a replica or facsimile of Brillis' signature to complete the forms required by Petitioner. Brillis travels extensively while teaching continuing education courses. His signature stamp is reasonably necessary to comply with the filing requirements imposed by Petitioner. The Insurance School has been in operation and approved by Petitioner since 1991. Employees at the Insurance School made arrangements with the Holiday Inn in West Palm Beach for a class room and lodging for the instructor for September 18 and 19, 1995. Prior to September 11, 1995, the Insurance School cancelled the classes due to an error in the flyers mailed out to promote the classes and consequent low attendance. On September 11, 1995, employees of the Insurance School cancelled the class room and the lodging for the instructor at the Holiday Inn in West Palm Beach. Brillis instructed employees of the Insurance School, in a written memorandum, to call each person enrolled in the cancelled classes and notify him or her of the cancellation. Brillis also instructed his employees to offer each person the choice of a refund or a credit toward a future class and to notify the state that the classes had been cancelled. Employees of the Insurance school carried out the instructions from Brillis. Attached to the written instructions left by Brillis, is a copy of the schedule of classes with a large "X" in the box next to the word "cancellation." In the upper right corner of the schedule is a notation written by an employee other than Brillis stating that the notice to the state was "sent 9/11." Petitioner does not have any record that it ever received the notice of cancellation. Petitioner does have a request for course credit for the cancelled classes that was filed with Petitioner in error. In May 1997, Petitioner notified Brillis that an invoice and roster had been sent to Petitioner for the cancelled classes. The invoice and roster requested course credit for the cancelled classes. Petitioner told Brillis that Petitioner had issued certificates of completion to the persons registered and listed on the invoice and roster. A computer error at the Insurance School caused the invoice and roster to be sent to Petitioner. After a class is cancelled and the licensee is notified, standard procedure requires the appropriate employee at the Insurance School to input the word "cancelled" in the computer file for each person in the cancelled class. This procedure was not followed for the cancelled classes. When the employee responsible for running the invoice and roster form for the Insurance School keyed the computer to collate the licensees that had attended the classes originally scheduled for September 18 and 19, 1995, the computer did not show that the classes had been cancelled. An employee would have no way of knowing that the classes had been cancelled unless the note of cancellation had been input into the computer file. The invoice and roster form was erroneously generated, stamped with Brillis' signature, and sent to Petitioner. Although some portions of the invoice and roster contain handwritten information, none of the handwriting is the handwriting of Brillis. The handwriting remains unidentified. The erroneous request for course credit for the cancelled classes is a single isolated incident caused by a computer error. The computer error was the result of an honest mistake committed by one or more employees of the Insurance School. Brillis did not cause the computer error and did not instruct his employees to take action that resulted in the erroneous request for course credit. Rather, Brillis instructed his employees to take action that would have prevented the mistake by notifying Petitioner that the classes had been cancelled. If those instructions had been followed, there would have been no erroneous request for course credit. Brillis has been licensed to sell insurance in Florida since 1964. In 34 years, Petitioner has never taken any disciplinary action against Brillis' license. Brillis began teaching continuing education courses for insurance agents before 1991. Since 1991, there has never been any disciplinary action taken against Brillis' license. The Insurance School was formed as a Florida corporation on May 31, 1991. It was dissolved on August 26, 1994. Since its dissolution, the Insurance School has not been a Florida corporation.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Petitioner enter a Final Order finding Respondents not guilty of all of the allegations in the separate administrative complaints filed against them. DONE AND ENTERED this 8th day of June, 1998, in Tallahassee, Florida. DANIEL MANRY Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 8th day of June, 1998. COPIES FURNISHED: Bill Nelson State Treasurer and Insurance Commissioner The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Daniel Y. Summer General Counsel Department of Insurance and Treasurer The Capitol, Lower Level 26 Tallahassee, Florida 32399-0300 John R. Dunphy, Esquire Joseph A. Robles, Esquire Department of Insurance Division of Legal Services 612 Larson Building Tallahassee, Florida 32399-0300 Cynthia S. Tunnicliff Pennington, Moore, Wilkinson, Bell and Dunbar, P.A. 215 South Monroe Street, Suite 200 Tallahassee, Florida 32302-2095
