Agency for Health Care Admin. v. Wingo, 95-1971
| Decision Date | 27 June 1997 |
| Docket Number | No. 95-1971,95-1971 |
| Citation | 697 So.2d 1231 |
| Parties | 22 Fla. L. Weekly D1577 AGENCY FOR HEALTH CARE ADMINISTRATION, Appellant, v. Charles W. WINGO, M.D. and Tallahassee Orthopedic Clinic, P.A., Appellees. First District |
| Court | Florida District Court of Appeals |
Lisa S. Nelson, Deputy General Counsel, and Kathryn L. Kasprzak, Senior Attorney, Tallahassee, for Agency for Health Care Administration, for Appellant.
Thomas W. Lager, Tallahassee, for Appellees.
The Agency for Health Care Administration (AHCA) challenges an order of the Board of Medicine (Board) on a petition for declaratory statement regarding interpretation of the Patient Self-Referral Act. Because the Board's interpretation of the statute is clearly erroneous, we set aside the final order.
Notwithstanding opposition from AHCA, the Tallahassee Orthopedic Clinic, a group practice, and one of its physicians (together referred to hereinafter as TOC) sought and obtained a declaratory statement from the Board of Medicine (Board) that the use of TOC's recently purchased magnetic resonance imaging (MRI) system for the patients of its group practice, and at the same time for the patients of physicians outside the group practice who have no investment interest in TOC, is not prohibited under section 455.236, Florida Statutes. The statute seeks to avoid potential conflicts of interest with respect to referral of patients for health care services, while recognizing that it may be appropriate for health care providers to own entities providing health care services and to refer patients to those entities. Section 455.236(3)(c) defines "designated health services" to include diagnostic-imaging services like MRI. Section 455.236(4)(a) prohibits "referral" of a patient for provision of "designated health services" to an entity in which the referring health care provider has an investment interest. Section 455.236(3)(f) defines "group practice" and section 455.236(3)(k)3.f. defines "referral" as not including an order, recommendation, or plan of care "[b]y a ... member of a group practice for designated health services ... that are prescribed or provided solely for such. . . group practice's own patients, and that are provided or performed by or under the direct supervision of such ... group practice" (emphasis supplied).
There is no dispute that TOC meets the statutory definition of "group practice" and that it would also meet the requirements "exempting" its provision of MRI services to its own patients from the definition of "referral" and therefore from the prohibition of section 455.236(4)(a), so long as it does not provide MRI services to patients referred from physicians outside the group practice. There is no dispute that none of the physicians outside the group practice who would potentially refer patients to TOC for MRI services has any investment interest in TOC. The only issue is whether, by providing MRI services to patients referred by physicians outside the group practice, TOC would forfeit the...
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