THE RISKS OF SERVING AS A MEDICAL DIRECTOR

In 2003, the State of Florida began aggressively seeking a mechanism to control practices at facilities offering health care services that were not directly owned by health care practitioners. In 2003, a structure for the registration of medical clinics was enacted by the Florida Legislature. Initially, this structure was placed under the Department of Health. By legislation enacted in 2004, clinic registration was transferred to the Agency for Health Care Administration, the same agency that licenses hospitals and ambulatory surgical centers.

The general intent of the legislature was to require all entities at which health care services are provided to individuals, and which tender charges for reimbursement for such services to be registered as a clinic. There are numerous exceptions to the registration requirement. Primarily, these exceptions are applicable if the health care entity is owned solely by health care practitioners, or if the ownership of the health care entity is directly related to another licensed facility, such as a hospital or ambulatory surgical center. There are also exemptions for health care entities that are exempt from taxation as charitable organizations. The hallmark of the legislation was to require supervision of certain aspects of the operation of the health care facility by a licensed health care practitioner. As such, the legislation requires that a medical director be employed or under contract with each clinic.

The Health Care Clinic Act is found in Part XIII of Chapter 400, Florida Statutes. It provides that each clinic have a medical director who is licensed with a full and unencumbered license as an allopathic, osteopathic, podiatric or chiropractic physician. It is important to note that the medical director must be authorized under law to supervise all services provided at the clinic. Thus a clinic providing general medical care cannot be supervised by a chiropractic or podiatric physician, due to the limited scope of practice of those practitioners.

Service as a medical director can be risky to professional licensees. Florida Statutes impose certain clinic responsibilities on the medical director. Section 400.9935, Florida Statutes, requires that the medical director accept, in writing, legal responsibility for certain activities of the clinic. The medical director shall:

(a) Have signs identifying the medical director or clinical director posted in a conspicuous location;

(b) Ensure that all practitioners providing health care services or supplies to patients maintain a current, active and unencumbered Florida license;

(c) Review any patient referral contracts or agreements executed by the clinic;

(d) insure that all health care practitioners at the clinic have active appropriate certification or licensure for the level of care being provided;

(e) Serve as the clinic records owner as required under Chapter 456, Florida Statutes;

(f) Ensure compliance with the recordkeeping, office surgery, and adverse incident reporting requirements of Florida Statutes and rules;

(g) Conduct systematic reviews of clinic billings to ensure that the billings are not fraudulent or unlawful, and upon discovery of any unlawful charge, take immediate corrective action.

Additional responsibilities are imposed on clinics providing radiology services. Chapter 400 further provides that any licensed health care provider who violates the Health Care Clinic Act is subject to discipline by that practitioner's respective licensing board and that the Agency for Health Care Administration may fine, suspend or revoke the license of a clinic.

Practitioners who choose to serve as a medical director of a clinic must understand the significant responsibility and liability that they are undertaking. We recommend that any contractual or employment relationship between a practitioner agreeing to serve as a medical director to a clinic include provisions that allow the practitioner to terminate the contract if they cannot affect compliance with those areas under their responsibility as set forth in the Health Care Clinic Act.