New Pain Law

The Board of Medicine announced July 7, 2011 that implementation of the new prescription law will be delayed until August 29.

As of August 29, all prescriptions for controlled substances must be on approved tamper-proof pads or electronically prescribed. Below is a copy of the law, as well as the link to the list of approved vendors of tamper-proof pads.

http://www.doh.state.fl.us/mqa/info_approved_vendors.pdf

(2)  A written prescription for a controlled substance

  244 listed in chapter 893 must have the quantity of the drug

  245 prescribed in both textual and numerical formats, must be dated

  246 with the abbreviated month written out on the face of the

  247 prescription, and must be either written on a standardized

  248 counterfeit-proof prescription pad produced by a vendor approved

  249 by the department or electronically prescribed as that term is

  250 used in s. 408.0611. As a condition of being an approved vendor,

  251 a prescription pad vendor must submit a monthly report to the

  252 department which, at a minimum, documents the number of

  253 prescription pads sold and identifies the purchasers. The

  254 department may, by rule, require the reporting of additional

  255 information. 

Direct Supervision

As part of the continuing efforts to rein in inappropriate dermatological care, the FSDDS in April 2010 led a coalition of health care providers opposing efforts to allow electrologists to perform laser hair removal without the benefit of an on-site physician. Backed by representatives from the Florida Academy of Phyiscian Assistants, the Florida Society of Plastic Surgeons, and the Florida Medical Association, FSDDS President Albert J. Nemeth, M.D. and General Counsel Chris Nuland convinced the Florida Board of Medicine to allow the current rule, which requires direct physician supervision of electrologists performing laser hair removal. to remain intact.

While this victory was important, it is but part of an ongoing struggle by the FSDDS to control what sees as the unlicensed practice of medicine in many medical spas. Whether it be laser hair removal by electrologists, dermal filler injection by nurses, or other medical procedures being performed by non-physicians, the FSDDS has consistently advocated that these paraprofessionals must operate under the direct supervision of a physician. Not only does direct supervision simply make sense from a patient safety perspective, but Florida explicitly states that medical assistants and electrologists performing laser hair removal work under the "direct supervision and responsibility" of the supervising physician. Moreover, nurses receive statutory protections from accusations of the improper practice of medicine only if they work under the direct supervision of a physician.

Although ARNPs and physician assistants are exempt from the direct supervision requirement, physicians are reminded why these professionals are called "physician extenders." They are meant to be part of a physician-led team, and the physician therefore bears the ultimate responsibility for their actions. FSDDS members should always ensure that those who work under their licenses work only within the scope of their training and professional licensure.

FSDDS Fraud Alert

As many are aware, state and federal investigators have increased their crackdown suspected fraudulent activity among physicians. Two of the targets of their attention are physicians paying for patients and physicians allowing extenders (Pas and ARNPs) to bill under the physician's name.

Patient Brokering

Florida State law makes it a felony to offer or receive any compensation in return for referring patients. For instance, were a company to offer physicians a supply of patients at a specified fee per patient, both the broker and physician would be subject to criminal penalties. It should be noted that the prohibition does not extend to flat fee marketing (e.g., paying for advertising space).

Billing in the Name of Another

Medicaid has learned that many physicians routinely allow extenders to bill in the physician's name, thereby reaping an additional 20% for such services. Unfortunately, not only is such conduct illegal, but Medicaid (and soon Medicare) regularly analyzes the number of services attributable to a single physician and will investigate when it feels that the number of services/physician exceeds the statistical norm.

For further information, please feel free to contact General Counsel Chris Nuland at nulandlaw@aol.com.