Conclusions THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the Me™ sy of yp Encher_. 2013, in Tallahassee, Florida. ; Le . Ll. 4 lizabeth Dudek{Secret: Agency for Health Care Administration
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the Respondent pursuant to Chapter 408, Part IJ, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the Respondent the attached Administrative Complaint. (Ex. 1) 3. The parties have since entered into the attached Settlement Agreement. (Ex. 2) Based upon the foregoing, it is ORDERED: 4. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 5. The Respondent’s health care clinic license is voluntarily surrendered effective as of September 1, 2012. 6. The Administrative Complaint is withdrawn. 7. The Respondent is responsible for providing any refunds that may be due to any clients. 8. The Petitioner shall remain responsible for retaining and appropriately distributing client records as prescribed by Florida law. The Petitioner is advised of Section 408.810, Florida Statutes. The Petitioner should also consult the applicable authorizing statutes and administrative code provisions as well as any other statute that may apply to health care practitioners regarding client records. 9. The Respondent is given notice of Florida law regarding unlicensed activity. The Respondent is advised of Section 408.804 and Section 408.812, Florida Statutes. The Respondent should also consult the applicable authorizing statutes and administrative code provisions. The Respondent is notified that the cancellation of an Agency license may have ramifications potentially Filed June 11, 2013 8:37 AM Division of Administrative Hearings affecting accrediting, third party billing including but not limited to the Florida Medicaid program, and private contracts. ORDERED at Tallahassee, Florida, on this ££ day of pre , 2013. Elizabeth Dudek, Secretary Agency for Heath Care Administration
Other Judicial Opinions A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and come et this Final Orderwas served on the below-named persons by the method designated on this SO ay of Jn , 2013. Richard Shoop, Agency Cler Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Facilities Intake Unit Thomas Jones, Unit Manager (Electronic Mail) Licensure Unit Agency for Health Care Administration (Electronic Mail) Katrina Derico-Harris Arlene Mayo-Davis, Field Office Manager Medicaid Accounts Receivable Local Field Office Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Shawn McCauley David Glickman, D.O. Medicaid Contract Management 8159 South Savannah Circle Agency for Health Care Administration Davie, Florida 33328 (Electronic Mail) (U.S. Mail) Warren J. Bird, Assistant General Counsel Office of the General Counsel Agency for Health Care Administration (Electronic Mail) NOTICE OF FLORIDA LAW 408.804 License required; display.-- (1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. (2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued. 408.812 Unlicensed activity.-- (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency.
The Issue The issue to be addressed is whether Respondent violated section 1012.795(1)(d) and (j), Florida Statutes (2011), and/or Florida Administrative Code Rule 6A-10.081(5)(a), and if so, what penalty should be imposed.
Findings Of Fact Respondent holds Florida Educator Certificate number 972355, covering the area of elementary education. Respondent’s certificate was issued on July 1, 2008, renewed on March 5, 2013, and is valid through June 30, 2018. Respondent moved to the State of Florida in approximately March of 2011, from the State of Maine. She, her husband, and two small children moved into an apartment in Ocean Park Apartments at 801 First Street South, Jacksonville, Florida. Respondent’s apartment faced the beach and was within 100-200 yards from the beach. Shortly after moving there, Respondent obtained renters’ insurance through Geico. The renters’ insurance was issued on approximately March 23, 2011. On March 26, 2011, Respondent called the Jacksonville Beach Police Department to report a burglary at her residence. Respondent reported that she and her husband had taken their children to the beach for the day, and upon their return that afternoon, she and her husband placed the stroller, containing a beach bag and various other belongings they took to the beach, inside the front door to the apartment. Respondent and her husband then went upstairs to put the children down for a nap. When they returned downstairs approximately an hour later, the stroller and its contents were missing. Officer Michael Abate of the Jacksonville Beach Police Department responded to Respondent’s call. He found no signs of forced entry or any other indications that there had been an intruder. However, the home was apparently unlocked at the time of the reported incident, which would negate the need of forced entry. Assuming for the sake of this Recommended Order that the burglary occurred,1/ it appears that the theft was a crime of opportunity, given the apartment’s proximity to the beach and the number of people in the area on a spring weekend. Respondent furnished to Officer Abate a list of approximately twelve items she claimed were stolen: the baby stroller; a beach bag; a canon digital camera; an Apple iPad; sunglasses; flip flops; a Coach® wallet; a Maine Driver’s License; a Bank of America credit card; $100 in cash; children’s shoes; and towels. On May 5, 2011, Respondent went to the police department and provided a more extensive list (supplemental list) of items she claimed were stolen. This list contained 47 items as opposed to the 12 originally described for Office Abate. In addition to the number of items described, there were a number of discrepancies between the first and second lists. For example, the original list identified $100 in cash. The supplemental list reported $160 in cash. The Coach® wallet was originally valued at $200, while the supplemental list valued the wallet at $248. The value of a pair of sunglasses changed from $150 to $199, and the digital camera’s value was amended from $799 to approximately $1,200. Other items added to the claim in the supplemental list included an iPhone 4, Otterbox Defender case, and Invisible SHIELD screen protector; an iPad case; a Kobo E-reader; make-up and name-brand cosmetics; monogrammed beach wraps; and a pair of Lacoste sunglasses in addition to the pair of sunglasses previously listed. On April 1, 2011, Respondent filed a written claim with Assurant Insurance Company, which provided her renter’s policy. The value of the claim submitted was $6,024.56. With the exception of her wallet and driver’s license, Respondent claimed that all of the missing items were purchased within a year of the alleged theft. No depreciation was acknowledged for any item. Assurant referred the claim to its special investigations unit for further review, which was conducted by Special Investigator Charles Beall. Mr. Beall interviewed Respondent by telephone on May 17, June 21, and August 3, 2011. During his investigation, Mr. Beall had discovered that some photographs submitted by Respondent of items supposedly taken in the burglary were actually taken two to three weeks after the burglary had been reported. Moreover, the photographs were taken with the camera that was listed as stolen. When Mr. Beall confronted Respondent in the telephone conference on June 21, with the times the pictures were taken, she could not provide an explanation. Respondent was hired at a Duval Charter School at Baymeadows on June 21, 2011. She continues to teach there. Mr. Beall also discovered during his investigation that a receipt from Amazon.com submitted by Respondent for the camera equipment was altered to reflect a higher purchase price by $639. The original receipt indicated that a single item, the camera, was purchased for $599. The receipt was altered to show the purchase of two items (a more expensive camera and a separately purchased lens) for $1198.95. When asked to confirm the information on the invoice she had provided to Assurant, Respondent initially confirmed the information as accurate. When confronted with the information received from Amazon regarding the purchase, Respondent admitted to altering the Amazon.com invoice in order to make up the monetary difference in her claims deductible. It is found that neither the camera, nor the items photographed with the camera after the date the theft was reported to the Jacksonville Beach Police Department, was actually stolen. Based upon its investigation, Assurant denied Respondent’s claim in full and notified Respondent of the denial by certified mail dated August 1, 2011. It also referred the case to the National Insurance Crime Bureau and to the Florida Department of Financial Services, Division of Insurance Fraud. Investigator Ed Johnson (now Lieutenant) from the Division of Insurance Fraud was assigned to the case, and during his investigation interviewed Respondent. During the interview, Respondent provided a sworn statement, which reads in part: In March of 2011 my family moved to the above listed address. Within two weeks of our arrival, we were the victims of a theft. I then filed a police report with the Jacksonville Beach Police Department, and filed a claim with my insurance company. While filing a report and claim, I purposely [sic] and untruthfully stated that a Canon T2i camera was stolen. Through the investigation of Mr. Charles Beall at Assurant Insurance it was determined that my claim for the camera was false, and my claim was denied. I falsified the camera being stolen in order to make up for the deductible on my claim. I also claimed that my ME (Maine) license was stolen. It has been determined that my ME license was actually used to acquire a Florida Drivers License on April 11, 2011.[2/] Lt. Johnson prepared and submitted an arrest warrant for Respondent’s arrest on September 29, 2011, and a warrant was issued that same day. Respondent was charged with filing false insurance claims, a third-degree felony. Respondent was arrested the following day. On December 14, 2011, Respondent entered a pre-trial intervention program. On October 2, 2012, based upon her completion of the program, the State Attorney’s Office declined to prosecute the charges. On April 29, 2013, Respondent submitted a letter to Pam Stewart as Commissioner of Education, in response to the preliminary investigation by DOE. The letter stated in pertinent part: In April, 2011, my home was robbed, while myself and my husband were settling our two young children upstairs for a nap. Our stroller was taken, along with all of the contents. The contents totaled less than $5,000, however the emotional toll was far more extensive. In the aftermath of such an event, our emotions were heightened, and we were in dismal spirits. Although we had renter’s insurance, we knew that we would struggle financially to replace all of the items that were stolen. At that time, I made a foolish decision to add an extra item to my insurance claim to make up for our deductible, so that we wouldn’t end up losing money. * * * They reported the case to local law enforcement, and I met with a Detective to explain how a law-abiding, well-respected community leader such as myself,[3/] had made such a decision. The Attorney General decided to pursue the case, and charge me of [sic] Insurance Fraud in the 3rd degree. I fully cooperated with law enforcement officers, and drove myself [to] the jail to accept my consequence. I bonded out of jail, hired a lawyer, and enrolled in a “Pre-Trial Diversion” program. . . . I completed several hours of community service, and paid a hefty fine during my “Pre-Trial Diversion” program. After a year, upon successful completion of the program, the charges were dropped, and I am left with an arrest record. I feel like I have paid the price for what I did, and learned several valuable lessons during the recovery process. My family has moved on financially from this crisis, but the emotional scars will remain. Educating children is my truest love. Giving back to my community and country by educating our future leaders, and enhancing the lives of people around me is really who I am. This situation has encouraged me to reflect deeply upon my character, and what I am passionate about. I appreciate your time and careful consideration regarding this situation. I made a poor decision, for which I have suffered immensely for [sic]. In both the letter submitted to the Commissioner of Education and during her appearance before a panel of the Education Practices Commission, Respondent consistently maintained that the residence was in fact robbed. Respondent’s admission that she inflated the amount of her insurance claim in order to cover the amount of her deductible is consistent with a burglary occurring. The fact that there was no evidence of forced entry into an unlocked home near the beach is not clear and convincing evidence that the theft did not occur.4/ Petitioner’s claim that Respondent was lying when she made statements that there was in fact a theft at her home is rejected.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Education Practices Commission enter a Final Order finding Respondent has violated section 1012.795(1)(d), Florida Statutes. It is further recommended that the Commission suspend her teaching certificate for a period of two years, followed by a period of probation for three years, and impose a fine of $1,000, payable within one year of the entry of the Final Order. DONE AND ENTERED this 22nd day of December, 2014, in Tallahassee, Leon County, Florida. S LISA SHEARER NELSON 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 22nd day of December, 2014.
Findings Of Fact Respondent graduated from the University of Havana Medical School in 1951 and practiced medicine in Cuba from that time until he immigrated to the United States in 1960. In Cuba his practice was primarily in the fields of obstetrics and gynecology. In his application dated 9 February 1975 to take the Florida Medical Examination, Respondent listed work at Hudson County Hospital for Mental Diseases (New Jersey) in 1960, work for the American Plasma Company (Miami) from 1965 to 1968, work at the Opa Locka General Hospital from 1967 to 1970, and that he was presently working as assistant doctor at 620 Southwest 1st Street, Miami. Prior to commencing this work at the Southwest Medical Clinic he contacted Physicians's Association of Clinics, Hospitals and Annex (PACHA), an organization which helps Cuban doctors obtain Florida licenses, and was told he could work at the clinic under Dr. Tomas and should register with the Board of Medical Examiners. Respondent registered with the Florida State Board of Medical Examiners as an unlicensed physician in two undated registrations, copies of which were admitted into evidence as Exhibit 5. In the earlier registration he states he is not a naturalized citizen and in the later application he states he is a naturalized citizen, although the year of naturalization is not shown. Anne West, who was apparently running an abortion referral service, called the State's Attorneys office in Miami on behalf of Respondent and was told Respondent could work at the clinic under a licensed doctor. She subsequently became Mrs. Bulas. Respondent testified he commenced doing medical work in the Miami area in 1975 when he became associated with and worked under the supervision of Kamel Tomas, M.D. in a clinic located at 620 Southwest 1st Street, Miami. He subsequently worked at this clinic under the supervision of two other licensed doctors whose names are Hernandez and Martin. In 1976 Respondent successfully passed the Florida Medical Examination and was licensed in July 1976. While working at the clinic on Southwest 1st Street Respondent performed several abortions. In an 18-count Information filed 23 March 1978 (Exhibit 1) for the period 1 May 1975 through 5 March 1976 Respondent was charged with 11 counts of unlawful practice of medicine, 6 counts of larceny and one count of unlawful termination of pregnancy. At his trial and upon the advice of counsel he pleaded nolo contendere, was found guilty of 10 counts of unlawful practice of medicine, six counts of grand larceny and one count of unlawful termination of pregnancy, and Adjudication of Guilt was withheld (Exhibit 2). Most of these charges alleged felonies. In Exhibit 3 the court stayed imposition of sentence and placed Respondent on probation for 5 years with a condition of probation that he be confined in the Dade County Jail for a term of one year. From reading the counts of the Information, as well as from the testimony of Respondent, it is clear that the larcenies alleged resulted from the fees charged by the clinic to those patients treated by Respondent, which formed the bases for the unlawful practice of medicine counts. The information alleging unlawful termination of pregnancy was based upon the performance of an abortion by Respondent while not licensed in Florida. The testimony was unrebutted that numerous clinics in Miami employ Cuban doctors who are unlicensed in Florida. In a class conducted at Jackson Memorial Hospital to prepare former Cuban doctors for the Florida examination there were about 460 in the class attended by Respondent, most of whom worked in clinics in Miami. At the time Respondent worked at the clinic he believed that so long as he was under a licensed doctor the medical work he performed was lawful. However, Respondent was not under the direct supervision of the licensed doctor as each was working on a different patient in separate examining rooms at the same time. No evidence was presented to indicate Respondent was not fully qualified by training and experience to perform the medical practices that he performed prior to receipt of his Florida license.
Conclusions Having reviewed the Administrative Complaint, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency has jurisdiction over the above-named Respondent pursuant to Chapter 408, Part I], and Chapter 400, Part X, Florida Statutes, and the applicable authorizing statutes and administrative code provisions. 2. The Agency issued the attached Administrative Complaint and Election of Rights form to the Respondent. (Ex. 1) The parties have since entered into the attached Settlement Agreement, (Ex. 2). Based upon the foregoing, it is ORDERED: 1. The Settlement Agreement is adopted and incorporated by reference into this Final Order. The parties shall comply with the terms of the Settlement Agreement. 2. The facility’s Certificate of Exemption is deemed surrendered and is cancelled and of no further effect. 3. Each party shall bear its own costs and attorney’s fees. Any requests for administrative hearings are dismissed and the above-styled case is closed. 4. In accordance with Florida law, the Respondent is responsible for retaining and appropriately distributing all client records within the timeframes prescribed in the authorizing statutes and applicable administrative code provisions. The Respondent is advised of Section 408.810, Florida Statutes. 5. In accordance with Florida law, the Respondent is responsible for any refunds that may have to be made to the clients. Filed December 24, 2014 3:13 PM Division of Administrative Hearings 6. The Respondent is given notice of Florida law regarding unlicensed activity. The Respondent is advised of Section 408.804 and Section 408.812, Florida Statutes. The Respondent should also consult the applicable authorizing statutes and administrative code provisions. The Respondent is notified that the cancellation of an Agency license may have ramifications potentially affecting accrediting, third party billing including but not limited to the Florida Medicaid program, and private contracts. ORDERED at Tallahassee, Florida, on this 75 day of bam ee , 2014. NOTICE OF RIGHT TO JUDICIAL REVIEW. A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct of this Final Ogder was served on the below-named persons by the method designated on this ebrtay of en Lia , 2014. Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone: (850) 412-3630 Jan Mills Thomas Jones, Unit Manager Facilities Intake Unit Licensure Unit Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Katrina Derico-Harris Arlene Mayo—Davis, Field Office Manager Medicaid Accounts Receivable Local Field Office Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Shawn McCauley Daniel A. Johnson, Senior Attorney Medicaid Contract Management Office of the General Counsel Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) Division of Administrative Hearings Dagmar Llaudy, Esquire (Electronic Mail) Law Office of Dagmar Llaudy, P.A. 814 Ponce De Leon Blvd, Suite 513 Coral Gables, Florida 33134 (U.S. Mail) NOTICE OF FLORIDA LAW 408.804 License required; display.-- (1) It is unlawful to provide services that require licensure, or operate or maintain a provider that offers or provides services that require licensure, without first obtaining from the agency a license authorizing the provision of such services or the operation or maintenance of such provider. (2) A license must be displayed in a conspicuous place readily visible to clients who enter at the address that appears on the license and is valid only in the hands of the licensee to whom it is issued and may not be sold, assigned, or otherwise transferred, voluntarily or involuntarily. The license is valid only for the licensee, provider, and location for which the license is issued. 408.812 Unlicensed activity. -- (1) A person or entity may not offer or advertise services that require licensure as defined by this part, authorizing statutes, or applicable rules to the public without obtaining a valid license from the agency. A licenseholder may not advertise or hold out to the public that he or she holds a license for other than that for which he or she actually holds the license. (2) The operation or maintenance of an unlicensed provider or the performance of any services that require licensure without proper licensure is a violation of this part and authorizing statutes. Unlicensed activity constitutes harm that materially affects the health, safety, and welfare of clients. The agency or any state attorney may, in addition to other remedies provided in this part, bring an action for an injunction to restrain such violation, or to enjoin the future operation or maintenance of the unlicensed provider or the performance of any services in violation of this part and authorizing statutes, until compliance with this part, authorizing statutes, and agency rules has been demonstrated to the satisfaction of the agency. (3) It is unlawful for any person or entity to own, operate, or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation and apply for a license under this part and authorizing statutes, the person or entity shall be subject to penalties as prescribed by authorizing statutes and applicable rules. Each day of continued operation is a separate offense. (4) Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance. , (5) When a controlling interest or licensee has an interest in more than one provider and fails to license a provider rendering services that require licensure, the agency may revoke all licenses and impose actions under s. 408.814 and a fine of $1,000 per day, unless otherwise specified by authorizing statutes, against each licensee until such time as the appropriate license is obtained for the unlicensed operation. (6) In addition to granting injunctive relief pursuant to subsection (2), if the agency determines that a person or entity is operating or maintaining a provider without obtaining a license and determines that a condition exists that poses a threat to the health, safety, or welfare of a client of the provider, the person or entity is subject to the same actions and fines imposed against a licensee as specified in this part, authorizing statutes, and agency rules. (7) Any person aware of the operation of an unlicensed provider must report that provider to the agency.
