06-004767PL Department Of Health, Board Of Medicine vs. Isaac Nosovsky, M.D Status: Closed Recommended Order on Friday, March 23, 2007.

Summary: Respondent`s convictions of conspiracy to defraud the U.S. Department of Health and Human Services regarding Medicare and to commit health care fraud violated Section 458.331(1)(c), Florida Statutes.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD OF )

MEDICINE , )

)

Petitioner, )

)

vs. ) Case No. 06 - 4767PL

)

ISAAC NOSOVSKY, M.D., )

)

Respondent. )

_________________________________ __ )

RECOMME NDED ORDER

This case came before Larry J. Sartin, an Administrative

Law Judge of the Division of Administrative Hearings, on a

factual record stipulated to by the parties.

APPEARANCES

For Petitioner: April Dawn M. Skilling , Esquire

Office of General Cou nsel

Department of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, F lorida 32399 - 3265

For Respondent: J. David Bogenschutz, Esquire

Bogenschutz, Dutko & Kroll, P.A.

600 South Andrews Avenue, Suite 500

F ort Lauderdale , Florida 33301 - 2802

STATEMENT OF THE ISSUE S

The issue s in this case are whether Respondent, Isaac

Nosovsky, M.D., committed a violation of Chapter 458, Florida

Statutes (2005), as alleged in the Administrative Complaint

filed by Petitioner, the Department of Health, on July 1 8 , 2006,

in DOH Case Number 2006 - 07801, as amended; and, if so, what

disciplinary action should be taken against his license to

practice medicine in the State of Florida.

PRELIMINARY STATEMENT

On or about July 18 , 2006, the Department of Health filed

an Administrative Complaint against Isaac Nosovsky, M.D., an

individual licensed to practice medicine in Florida, before the

Board of Medicine, in which it alleged that Dr. Nosovsky had

committed a violation of Section 458.331(1)(c) , Florida Statutes

(2005). Dr. Nosovsky executed an Election of Rights form in

which he disputed the allegations of fact contained in the

Administrative Complaint and requested a formal administrative

hearing pursuant to Section 120.569 (2)(a), Florida Statutes

(2006 ).

On November 2 2, 2006, the matter was filed with the

Division of Administrative Hearings with a request that an

administrative law judge be assigned the case to conduct

proceedings pursuant to Section 120.57(1), Florida Stat utes

(2006 ). The matter was designated DOAH C ase Number 06 - 4767PL

and wa s assigned to the undersigned.

The final hearing was scheduled by a Notice of Telephonic

Final Hearing entered December 4, 2006, for January 24, 2007.

Although arrangements had been made to allow the incarcerated

Dr. Nosovsky to participate in the final hearing by telephone, a

letter was r eceived from counsel for Dr. Nosovsky indicating

that Dr. No sovsky would not be able to participate in the

hearing. In order to resolve this issue, a pre - hearing

conference was scheduled by tel ephone. During the pre - hearing

conference, the parties stipulated that no evidentiary hearing

was necessary if the following conditions were met: (1) An

amended administrative complaint was issued making it clear that

Petitioner did not allege that the f acts that underlie

Respondent's criminal convic tion were necessarily true;

(2) Petitioner was allowed to admit certified copies of the

indictment, verdict, and commitment relating to Respondent's

criminal conviction; (3) Petitioner was allowed to admit an

affidavit addressing the issue of whether Respondent's criminal

conviction relate to his practice of medicine or his ability to

practice medicine; and (4) the parties were given an opportunity

to file proposed recommended orders.

On January 16, 2007, an Or der Establishing Timelines was

entered memorializing the conditions agreed to by the parties

for cancellation of the final hearing. On January 17, 2007 , the

final hearing scheduled for January 24, 2007, was cancelled by

an O rder Cancel ing Hearing.

Consist ent with the agreement reached by the p arties and

the January 16, 2007 , Order Establishing Timelines, Petitioner

filed an Amended Administrative Complaint along with the agreed

upon exhibits: Respondent's Indictment in the United Sates

District Court Sout hern District o f Florida, Case No. 06 - 20178

CR ; the Verdict in that case, finding Respondent guilty on all

seven counts of the Indictment; the Judgment in a C riminal C ase

entered by the Honorable Paul C. Huck, United States District

Judge; and an Affidavit of John P. Mahoney, M.D. Petitioner

also filed the Final Order in Department of Business and

Professional Regulation v. Isaac Nosovsky, M.D. , DBPR Case

No. 92 - 00411, and the Florida Licensure Certification for

Respondent . These seven E xhibits are hereby admitted.

Respondent did not file any exhibits.

Also consistent with the agreement reached by the parties,

both parties filed proposed orders for consideration in entering

this Recommended Order. Those pleadings have been fully

considered.

FINDINGS OF F ACT

A. The Parties .

1. Petitioner, the Department of Health (hereinafter

referred to as the "Department"), is the agency of the State of

Florida charged with the responsibility for the investigation

and prosecution of complaints involving physicians lice nsed to

practice medicine in Florida. § 20.43 and Chs. 456 and 458,

Fla. Stat. (2006).

2. Respondent, Isaac Nosovsky, M.D., is, and was at all

times material to this matter, a physician licensed to practice

medicine in Florida pursuant to Chapter 458 , Fl orida Statutes,

having been issued license number ME 29814.

3. Dr. Nosovsky’s address of record is 1865 N orth

Corporate Lakes Blvd., Suite 2, Weston, Florida 33326.

B. The Indictment and Conviction .

4 . O n or about March 23, 2006, Respondent was indicted in

the United States District Court, Southern District of Florida,

Case No. 06 - 20178 CR, United States of America v. Isaac Nosovsky

and Faustina Adela Gonzalez , on seven counts (hereinafter

referred to as the "Indictment") :

a. In Count 1, Dr. Nosovsk y is charged with Conspiracy to

Defraud the United States and to Commit Health Care Fraud . In

particular, it is alleged that Dr. Nosov s k y committed conspiracy

against the United States Department of Health and Human

Services in its administration and oversigh t of Medicare and

against Medicare in connection with the delivery of any payment

for health care benefits, items, and services, in violation of

Title 18, U.S.C. Section 371 .

b. In Counts 2 through 7, Dr. Nosovsky is charged with

Health Care Fraud . In pa rticular, it is alleged that he

committed Health Care Fraud against a health care benefit

program affecting commerce, that is, Medicare, in violation of

Title 18 U.S.C. Sections 1347 and 2, in connection with the

delivery and payment for health care benefi ts, cost of

therapies, treatments, and related items and services allegedly

performed by the Nosovsky Clinic.

5 . Generally, t he Indictment was predicated upon the

allegation that , in or around August 2004, Dr. Nosovsky and his

co - conspir ator formed a clin ic, the Nosovsky Clinic, which it

then used to unlawfully enrichment themselves by "(a) submitting

and causing the submission of false and fraudulent claims to

Medicare; (b) paying kickbacks and bribes to Medicare

beneficiaries so that they would serve as patients at the

Nosovsky clinic, thereby furthering the billing fraud scheme;

and concealing the submission of false and fraudulent claims to

Medicare, the receipt and transfer of fraud proceeds, and the

payment of kickbacks and bribes."

6 . The Indictment alleges the following facts regarding

the Nosovsky Clinic:

1. The medical clinic of IS AAC NOSOVSKY

(hereinafter the "Nosovsky clinic") was

located at 2250 Southwest 3 rd Avenue, Suite

150, in Miami, Florida, and was in business

from in or around Novembe r 2004 through in

or aroun d April 2005, when it closed.

2. The Nosovsky c linic claimed to

specialize in the treatment of patients

diagnosed with Human Immunodeficiency Virus

( " HIV "). HIV is a viral infection that

attac ks the patient’s immune system. The

Nosovsky clinic purposed to provide

intravenous infusion treatments, i.e., the

insertion of a needle into a patient's vein,

in order to administer certain specialized

medications. The Nosovsky clinic also

purposed to provide injections, i.e., the

inse rtion of a syringe into the patient's

arm, in order to administer certain

specialized medications.

3 . ISAAC NOSOVSKY was a medical doctor

licensed to practice medicine in the State

of Florida pursuant to license number

ME29814. NOSOVSKY was employed b y the

Nosovsky clinic and purported to treat

patients there from in or around November

2004 through in or around April 2005.

4. FAUSTINA ADELA GONZALEZ was employed

as a medical assistant licensed to in the

State of Florida pursuant to license number

C NA121032. GONZALEZ WAS EMPLOYED BY THE

Nosovsky clinic as a medical assistant and

purported to treat patients there from in or

around November 2004 through in or around

April 2005.

7 . The Indictment alleges the following facts concerning

the Medicare Pr ogram :

5 . The Medicare Program (Medicare") was a

federal program that provided free or below -

cost health care benefits to certain

individuals, primarily the elderly, blind

and disabled. The benefits available under

Medicare are prescribed by statute an d by

federal regulations under auspices of the

United States Department of Health and Human

Services, through its agency, the Centers

for Medicare and Medicaid Services ("CMS") .

Individuals who receive benefits are

referred to as beneficiaries.

6 . Med icare was a "health care benefit

program," as defined by Title 18, United

States Code, Section 24(b).

7. Medicare Part B paid for a portion of

the cost of certain necessary medical

services and medications that were provided

and ordered by physicians, clinics, and

other qu alified health care providers.

Medicare Part B was administered in Florida

by First Coast Service Options ("FCSO"), a

company that contracted with CMS to receive,

adjudicate, process, and pay certain Part B

claims.

8. Physicians, clinics, and other

healthcare providers that provided services

to Medicare beneficiaries were able to apply

for and obtain a “provider number . ” A

health care provider who had been issued a

provider number was able to file claims with

M e dicare to obtain re imbursement for

services provided to beneficiaries. A

Medicare claim was required to set forth,

among other things, the beneficiary's name

and Medicare identification number, the

services that had been performed for the

beneficiary, the date the services were

provided, the cost of the services, and the

name and identification number of the

physician or other health care provider who

had ordered the services.

9. For Medicare billing purposes, medical

services and medications provided to

beneficiaries we re identified by a Current

Procedural Terminology ("CPT") code.

10. For services purportedly rendered

from in or around November 2004 through in

or around May 2005, the Nosovsky clinic

billed Medicare under a provider number

assigned to ISAAC NOSOVSKY , 96542O.

8 . The indictment alleges that, having formed the Nosovsky

Clinic and obtaining a Medicare provider number, Dr. Nosovsky

used the Medicare system in his clinic to defraud the United

States and commit Health Care Fraud in the following manner:

4. Co - conspirators established the

Nosovksy [sic] clinic, with ISAAC NOSOVSKY

agreeing to serve as its medical director.

5. ISAAC NOSOVSKY pre - signed numerous,

blank health care - related documents

including, but not limited to, "Infusion

Therapy" shee ts, progress notes, and

Medicare superbills.

6. FAUSTIN A ADELA GONZALEZ failed to

provide Medicare beneficiaries with

prescribed medications. In some cases,

GONZALEZ bandaged patients' arms to give the

appearance that a treatment or therapy had

been a dministered.

7. FAUSTINA ADELA GONZALEZ falsely stated

on the pre - signed "Infusion Therapy" sheets

that she had provided Medicare beneficiaries

with infusion therapy or treatments with

specific dosages of medications.

8. FAUSTINA ADELA GONZALEZ, am ong other

co - conspirators , fabricated therapy notes

and related documents stating that Medicare

beneficiaries had received specific

treatments, therapies, a nd dosages of

medications, when, in fact, the

beneficiaries had actually not received the

treatments , therapies, and medications

indicated on the therapy notes and

documents.

9. To conceal the fact that the Medicare

beneficiaries were not receiving the

treatments, therapy, and medications that

were described in various documents and that

were being u tilized to bill Medicare,

various co - conspirators and FAUSTINA ADELA

GONZALEZ obtained fraudulent and/ or

falsified documents, including the pre -

signed documents from ISAAC NOSOVSKY, and

placed them in the patient files of the

beneficiaries.

10. To prom ote and further the billing

fraud scheme, co - conspirators paid kick backs

and bribes to Medicare beneficiaries so that

they would serve as patients.

11. Co - conspirators submitted and caused

the submission of numerous false and

fraudulent claims to Medic are on behalf of

the Nosovsky c linic, seeking reimbursement

for the cost of infusions, injections,

medications, and other items and services

that were not provided, not provided as

claime d, or not medically necessary. As a

result of the submission of thes e claims,

Medicare paid in excess of $1,300,000 into a

bank account in the name of ISAAC NOSOVSKY

and a co - c onspirator.

9 . The Indictment names six patients that were involved in

Dr. Nosovsky’s conspiracy to defraud Medicare; E.P., M.P, T.R.,

J.D., A.C., and J.M. The indictment alleges that Dr. Nosovsky

and his co - conspirators used the following means to perpetrate

the fraud with regard to Medicare Beneficiary E.P. These

alleged facts are, except for dates and the specifics as to

medication prescribed, the same for all the other five patients.

3. On or about November 1, 2004, ISAAC

NOSOVSKY sign ed a progress note falsely

indicating that he had examined Medicare

beneficiary E.P. and that the patient

required 80 units of the medication acthar

gel . . . .

4. On or about November 1, 2004, FAUSTINA

ADELA GONZALEZ prepared an "Infusion

Therapy" sheet falsely indicating that

GONZALEZ had administered 80 units of acthar

gel to Medicare beneficiary E.P.

5. On or about November 1, 2004, ISAAC

NOSOVSKY si gned a superbill falsely

indicating that Medicare beneficiary E.P.

had received 70 units of acthar gel.

6. On or about November 1, 2004, a co -

conspirator paid a cash kickback to Medicare

beneficiary E.P.

7. On or about December 8, 2004, a co -

conspi rator caused the submission of a false

claim to Medicare on behalf o f the Nosovsky

clinic, seeking reimbursement for a dosage

of acthar gel that supposedly had been

provided to Medicare beneficiary E.P. on or

about November 1, 2004.

10 . On or about March 30, 2006, Dr. Nosovsky was arraigned

in the United States District Court, Southern District of

Florida, on the I ndictment and entered a plea of not guilty.

11 . On or about May 31, 2006, Respondent was found guilty

by jury verdict of all seven counts of t he I ndictment .

12. On August 14, 2006, United States District Judge Paul

C. Huck adjudicated Dr. Nosovsky guilty of the criminal offense

charged in the Indictment. Judge Huck sentenced Dr. Nosovsky to

60 months ’ incarceration on Count 1, 65 months ’ incar ceration on

Counts 2 - 7, to run concurrently; participation in a drug/alcohol

treatment program while incarcerated; three years ’ supervised

probation; 200 hours of community service; and, restitution in

the amount of $1,305.066.

C. The Relationship of Dr. Nosovsky's Convictions to the

Practice of Medicine .

13. In light of the jury conviction on all counts of the

Indictment, it is concluded that Dr. Nosovsky engaged in the

activities alleged in the Indictment for purposes of this

proceeding. All of those activities related to the practice of

medicine.

14. But for Dr. Nosovsky's license to practice medicine in

Florida, Dr. Nosovsky would not have been able to commit the

crimes for which he was committed. It was his li cense to

practice medicine that facili tated his ability to open the

Nosovsky Clinic, to obtain a Medicare provider number, and to

fully participate in the Medicare program. All of the

activities he engaged in, such as signing necessary Medicare

documents and medical backup , were carried out i n his capacity

as a licensed Florida physician.

15. Based upon the Affidavit of John P. Mahoney, M.D.,

which is found credible, the crimes for which Dr. Nosovsky was

committed evidenced a lack of honesty, integrity,

trustworthiness, good judgment, and sou nd morale character, all

attributes expected of physicians licensed in Florida. The

scope and severity of Dr. Nosovsky's conduct evidences a lack of

these qualities.

D. Prior Disciplinary Action .

16. Dr. Nosovsky was previously disciplined by the Board

of Medicine in Department of Business and Professional

Regulation v. Isaac Nosovsky, M.D. , DBPR Case No. 92 - 00411. In

particular, Dr. Nosovsky was found to have violated Section

458.311(1)(m), Florida Statutes (failure to maintain medical

records justify ing a course of treatment), and Section

458.311(1)(t), Florida Statutes (the standard of care expected

of physicians).

C ONCLUSIONS OF LAW

A. Jurisdiction .

17. The Division of Administrative Hearings has

jurisdiction over the subject matter of this procee ding and of

the parties thereto pursuant to Sections 120.569, 120.57(1), and

456.073(5), Florida Statutes (2006).

B. The Charges of the Administrative Complaint .

18. Section 458.331(1), Florida Statutes (2005) ,

authorizes the Board of Medicine (hereinaft er referred to as the

"Board"), to impose penalties ranging from the issuance of a

letter of concern to revocation of a physician's license to

practice medicine in Florida if a physician commits one or more

acts specified therein.

19. I n its Administrativ e Complaint, as amended, the

Department has alleged that Dr. Nosovsky has violated Section

45 8.331(1)(c), Florida Statutes (2005) .

C. The Burden and Standard of Proof .

20. The Department seeks to impose penalties against Dr.

Nosovsky through the Administ rative Complaint , as amended, that

include suspension or revocation of his license and/or the

imposition of an administrative fine. Therefore, the Department

has the burden of proving the specific allegations of fact that

support its charge that Dr. Nosov sky violated Section

458.331(1)(c), Florida Statutes (2005) , by clear and convincing

evidence. Department of Banking and Finance, Division of

Securities and Investor Protection v. Osborne Stern and Co. , 670

So. 2d 932 (Fla. 1996); Ferris v. Turlington , 51 0 So. 2d 292

(Fla. 1987); Pou v. Department of Insurance and Treasurer , 707

So. 2d 941 (Fla. 3d DCA 1998); and Section 120. 57(1)(j), Florida

Statutes (2006 )("Findings of fact shall be based on a

preponderance of the evidence, except in penal or licensure

d isciplinary proceedings or except as oth erwise provided by

statute.").

21. What constitutes "clear and convincing" evidence was

described by the court in Evans Packing Co. v. Department of

Agriculture and Consumer Services , 550 So. 2d 112, 116, n. 5

(Fla. 1st DCA 1989), as follows:

. . . [C]lear and convincing evidence

requires that the evidence must be found to

be credible; the facts to which the

witnesses testify must be distinctly

remembered; the evidence must be precise and

explicit and the witnesses m ust be lacking

in confusion as to the facts in issue. The

evidence must be of such weight that it

produces in the mind of the trier of fact

the firm belief or conviction, without

hesitancy, as to the truth of the

allegations sought to be established.

Slo mowitz v. Walker , 429 So. 2d 797, 800

(Fla. 4th DCA 1983).

See also In re Graziano , 696 So. 2d 744 (Fla. 1997); In re

Davey , 645 So. 2d 398 (Fla. 1994); and Walker v. Florida

Department of Business and Professional Regulation , 705 So. 2d

652 (Fla. 5th DCA 1998)(Sharp, J., dissenting).

D. Section 458.331(1)(c), Florida Statutes (2005) .

22. Section 458.331(1)( c ), Florida Statutes (2005) ,

defines the following disciplinable offense:

(c) Being convicted or found guilty of,

or entering a plea of nolo conte ndere to,

regardless of adjudication, a crime in any

jurisdiction which directly relates to the

practice of medicine or to the ability to

practice medicine.

23. In p aragraph s 9 and 10 of the Administrative

Complaint , as amended, it is alleged that Dr. No sovsky’s felony

convictions relate to his practice of medicine and his ability

to practice medicine for the following reasons:

a. Dr. Nosovsky was only able to engage in the actions

resulting in this convictions through the use of his medical

license.

b. The crimes for which Dr. Nosovsky was convicted are

crimes that relate to the ability to practice medicine. " The

qualities essential to the practice of medicine include

reliability, honesty, and good moral character. The crimes for

which Respondent was convicted demonstrate that Respondent lacks

these essential qualities. "

24. The evidence has clearly and convincingly proven that

Dr. Nosovsky has been convicted of crimes that relate to his

practice of medicine as alleged in the Administrative Complaint

and described in the Findings of Fact. Dr. Nosovsky’s

convictions for Conspiracy to Defraud the United States and for

Health Care Fraud both involved Dr. Nosovsky’s manipulation of

the Medicare system. His status as a physician al lowed him to

open the No sovsky C linic and apply for and obtain his Medicare

provider number, and it was his signature as a licensed

physician on the false superbills and false Infusion Therapy

sheets that allowed the false claim s for Medicare reimbursement

to be submitted . These were the facts that were the basis for

the jury finding Dr. Nosovsky guilty, and they clearly relate d

to his practice of medicine.

25. As to the Department's second basis for finding that

Dr. Nosovsky has violated Section 458.311(1)(c), while it is

true that Dr. Nosovsky crimes indicate he lacks honesty,

integrity, trustworthiness, good judgment, and sound moral

character, all characteristics which a physician should possess,

it is concluded that many crimes demonstrate the lack of such

character. Lack o f those characteristics alone is not, however,

sufficient to support a conclusion that the commission of a

crime necessarily relates to a person's ability to practice

medicine. Had the legislature intended to punish physicians for

any crime demonstrating a lack of certain characteristics such

as honesty and good judgment , it could have done so without

requiring that the crime directly relate to the ability to

practice medicine.

E. The Appropriate Penalty .

26 . In determining the appropriate punitive action to

recommend to the Board in this case, it is necessary to consult

the Board's "disciplinary guidelines," which impose restrictions

and limitations on the exercise of the Board's disciplinary

authority under Section 458.331, Florida Statutes. See Parrot

Heads, Inc. v. Department of Business and Professional

Regulation , 741 So. 2d 1231 (Fla. 5th DCA 1999).

2 7 . The Board's guidelines are set out in Florida

Administrative Code Rule 64B8 - 8.001, which provides the

following "purpose" and instruction on the ap plication of the

penalty ranges provided in the Rule:

(1) Purpose. Pursuant to Section 456.079,

F.S., the Board provides within this rule

disciplinary guidelines which shall be

imposed upon applicants or

licensees whom it regulates under Chapter

458, F. S. The purpose of this rule is to

notify applicants and licensees of the

ranges of penalties which will routinely be

imposed unless the Board finds it necessary

to deviate from the guidelines for the

stated reasons given within this rule. The

ranges of p enalties provided below are based

upon a single count violation of each

provision listed; multiple counts of the

violated provisions or a combination of the

violations may result in a higher penalty

than that for a single, isolated violation.

Each range i ncludes the lowest and highest

penalty and all penalties falling between.

The purposes of the imposition of discipline

are to punish the applicants or licensees

for violations and to deter them from future

violations; to offer opportunities for

rehabilita tion, when appropriate; and to

deter other applicants or licensees from

violations.

(2) Violations and Range of Penalties.

In imposing discipline upon applicants and

licensees, in proceedings pursuant to

Section 120.57(1) and 120.57(2), F.S., the

Bo ard shall act in accordance with the

following disciplinary guidelines and shall

impose a penalty within the range

corresponding to the violations set forth

below. The verbal i dentification of

offenses are descriptive only; the full

language of each statu tory provision cited

must be consulted in order to determine the

conduct included.

28 . Florida Administrative Code Rule 64B8 - 8.001(2) goes on

to provide, in pertinent part, t hat the penalty guideline for a

violation of Section 458.331(1)( c ), Florida Stat utes, where the

crime involves healthcare fraud in dollar amounts in excess of

$5,000 , is revocation of the license and a n administrative fine

of $10,000.

2 9 . Florida Administrative Code Rule 64B8 - 8.001(3)

provides that, in applying the penalty guidelines , the following

aggravating and mitigating circumstances are to be taken into

account:

(3) Aggravating and Mitigating

Circumstances. Based upon consideration of

aggravating and mitigating factors present

in an individual case, the Board may deviate

from the penalties recommended above. The

Board shall consider as aggravating or

mitigating factors the following:

(a) Exposure of patient or public to

injury or potential injury, physical or

otherwise: none, slight, severe, or death;

(b) Legal status a t the time of the

offense: no restraints, or legal

constraints;

(c) The number of counts or separate

offenses established;

(d) The number of times the same offense

or offenses have previously been committed

by the licensee or applicant;

(e) The di sciplinary history of the

applicant or licensee in any jurisdiction

and the length of practice;

(f) Pecuniary benefit or self - gain

inuring to the applicant or licensee;

(g) The involvement in any violation of

Section 458.331, F.S., of the provision o f

controlled substances for trade, barter or

sale, by a licensee. In such cases, the

Board will deviate from the penalties

recommended above and impose suspension or

revocation of licensure.

(h) Where a licensee has been charged

with violating the stand ard of care pursuant

to Section 458.331(1)(t), F.S., but the

licensee, who is also the records owner

pursuant to Section 456.057(1), F.S., fails

to keep and/or produce the medical records.

(i) Any other relevant mitigating

factors.

30 . No mitigating c ircumstances have been presented by

Dr. Nosovsky . On the other hand, t he Department present ed the

Final Order in DBPR Case No. 92 - 00411 , which reflects a prior

disciplinary acti on against the Respondent.

31. In Petitioner's Proposed Recommended Order, th e

Department has suggested that Dr. Nosovsky's license to practice

medicine be revoked. This recommendation is well within the

guidelines and is appropriate in this case.

RE CO M MENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it i s

RECOMMENDED that the a final order be entered by the Board

of Medicine finding that Isaac Nosovsky, M.D., has violated

Section 458.331(1)(c), Florida Statutes, as described in this

Recommended Order; and revoking his license to practice medicine

in the State of Florida.

DONE AND ENTERED this 23rd day of March, 2007 , in

Tallahassee, Leon County, Florida.

S

___________________________________

LARRY J. SARTIN

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 Administrat ive Hearings

t his 23rd day of March, 2007 .

COPIES FURNISHED:

J. David Bogenschutz, Esquire

Bogenschutz, Dutko & Kroll, P.A.

600 South Andrews Avenue, Suite 500

Fort Lauderdale, Florida 33301 - 2802

April Dawn M. Skilling, Esquir e

Office of the General Counsel

Department of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399 - 3265

Larry McPherson, Executive Director

Department of Health

4052 Bald Cypress Way

Tallahassee, Florida 32399 - 3265

Dr. Ana M. Viamonte Ros, Secretary

Department of Health

4052 Bald Cypress Way, Bin A00

Tallahassee, Florida 32399 - 1701

Josefina M. Tamayo, General Counsel

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1701

R. S. Power, Agency Clerk

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahas see, Florida 32399 - 1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this recommended order. Any exceptions

to this recomm ended order should be filed with the agency that

will issue the final order in these cases.