64B8-30.015: Disciplinary Guidelines
PURPOSE AND EFFECT: The proposed rule amendments are intended to set forth additional disciplinary guidelines for specific violations.
SUMMARY: The proposed rule amendments set forth additional guidelines and penalties for various violations.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: A Statement of Estimated Regulatory Costs has been prepared. Essentially, the Statement estimates that physician assistants who are required to pay additional fines, attend courses and perform other duties as a result of violating laws and rules will be impacted by the rule. In addition, in instances where a license is revoked, the impact may negatively affect small business due to the loss of the licensee performing services. A positive impact in the community will result in instances where a physician assistant is required to perform community service at no charge to the public. Those entities providing continuing medical education will be positively impacted by the increased revenues derived from licensees who are required to complete designated CME as a result of certain violations of laws and rules.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 456.079, 458.309, 458.331(4) FS.
LAW IMPLEMENTED: 456.072, 456.079, 458.331(4), 458.347(4)(e)1., (7)(g) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Larry McPherson, Jr., Executive Director, Board of Medicine/MQA, 4052 Bald Cypress Way, Bin #C03, Tallahassee, Florida 32399-3253
THE FULL TEXT OF THE PROPOSED RULE IS:
64B8-30.015 Disciplinary Guidelines.
(1) Purpose. Pursuant to Section 456.072, F.S., the Boards provide within this rule disciplinary guidelines which shall be imposed upon physician assistant applicants or licensees whom it regulates under Chapters 458 and 459, F.S. The purpose of this rule is to notify such applicants and licensees of the ranges of penalties which will routinely be imposed unless the Boards find it necessary to deviate from the guidelines for the stated reasons given within this rule. The ranges of penalties provided below are based upon a single count violation of each provision listed; for multiple counts of the violated provisions or a combination of the violations the Boards shall consider a higher penalty than that for a single, isolated violation. Each range includes the lowest and highest penalty and all penalties falling between, including continuing medical education (CME). 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 rehabilitation, when appropriate; and to deter other applicants or licensees from violations.
(2) Violations and Range of Penalties. In imposing discipline upon physician assistant applicants and licensees, in proceedings pursuant to Sections 120.57(1) and (2), F.S., the Board 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 identification of offenses are descriptive only; the full language of each statutory provision cited must be consulted in order to determine the conduct included.
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VIOLATIONS |
RECOMMENDED PENALTIES |
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First Offense |
Subsequent Offenses |
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(a) Attempting to obtain a license or certificate by bribery, fraud or through an error of the Department or the Board. (Section 458.331(1)(a), F.S.) (Section 456.072(1)(h), F.S.) |
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1. Attempting to obtain an initial license by bribery or fraud. |
1. Denial of application and a $10,000.00 fine. |
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2. Attempting to renew a license by bribery or fraud. |
2. Revocation of the license and payment of a $5,000.00 fine to revocation and a $10,000 fine. |
2. Revocation and a $10,000.00 fine. |
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3. Obtaining or renewing a license by bribery or fraud. |
3. Revocation of the license and payment of a $5,000.00 fine to revocation and a $10,000 fine. |
3. Revocation and a $10,000.00 fine. |
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4. Obtaining or renewing a license through error of the Department of the Board. |
4. Revocation. |
4. Revocation. |
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(b) No change. |
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1. Action taken against license by another jurisdiction relating to healthcare fraud in dollar amounts in excess of $5,000.00. |
1. Revocation |
1. From |
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2. Action taken against license by another jurisdiction relating to healthcare fraud in dollar amounts of $5,000.00 or less. |
2. From an administrative fine ranging from $1,000.00 to $5,000.00, 100 hours of community service, and a reprimand through suspension of the license, or in case of application for licensure, denial of licensure. |
2. From an administrative fine ranging from $2,500.00 to $5,000.00, 200 hours of community service, and suspension of the license, followed by a period of probation to revocation, or in case of application for licensure, denial of licensure. |
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(c) Guilty of crime directly relating to practice or ability to practice. (Section 458.331(1)(c), F.S.) (Section 456.072(1)(c), F.S.) |
(c) From reprimand to revocation or denial of license, |
(c) From probation to revocation or denial of the license, |
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1. Involving a crime directly related to healthcare fraud in dollar amounts in excess of $5,000.00. |
1. Revocation |
1. From permanent revocation and an administrative fine ranging from $2,500.00 to $5,000.00, or in the case of application for licensure, denial of licensure. |
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2. Involving a crime directly related to healthcare fraud in dollar amounts of $5,000.00 or less. |
2. From an administrative fine ranging from $1,000.00 to $5,000.00, 100 hours of community service, and a reprimand through suspension of the license, or in case of application for licensure, denial of licensure. |
2. From an administrative fine ranging from $2,500.00 to $5,000.00, 200 hours of community service, and suspension of the license, followed by a period of probation to revocation, or in case of application for licensure, denial of licensure. |
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(d) False, deceptive, or misleading advertising. (Section 458.331(1)(d), F.S.) |
(d) From a letter of concern to reprimand, or denial of licensure, |
(d) From a letter of concern to reprimand, or denial of licensure, |
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(e) Failure to report another licensee in violation. (Section 458.331(1)(e), F.S.) (Section 456.072(1)(i), F.S.) |
(e) From a letter of concern to probation |
(e) From reprimand to suspension or denial of licensure, |
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(f) Aiding unlicensed practice. (Section 458.331(1)(f), F.S.) (Section 456.072(1)(j), F.S.) |
(f) From reprimand to suspension, followed by probation, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(f) From probation to revocation or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(g) Failure to perform legal obligation. (Section 458.331(1)(g), F.S.) (Section 456.072(1)(k), F.S.) |
(g) For any offense not specifically listed herein, based upon the severity of the offense and the potential for patient harm, from a reprimand to revocation or denial of licensure, 50 hours of community service and an administrative fine from $1,000.00 to $5,000.00. |
(g) For any offense not specifically listed herein, based upon the severity of the offense and the potential for patient harm, from a reprimand to revocation or denial, from 50 to 100 hours of community service and an administrative fine from $2,500.00 to $5,000.00. |
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1. through 2. No change. |
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3. Failing to disclose financial interest to patient. (Section 456.052, F.S.) |
3. A refund of fees paid by or on behalf of the patient and from an administrative fine of $1,000.00, 50 hours of community service to a reprimand, 100 hours of community service and an administrative fine of $2,500.00. |
3. A refund of fees paid by or on behalf of the patient and from a reprimand, 100 hours of community service and an administrative fine of $2,500.00 to a reprimand, 200 hours of community service and an administrative fine of $5,000.00. |
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(h) No change. |
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1. Involving healthcare fraud in dollar amounts in excess of $5,000.00. |
1. Revocation |
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2. Involving healthcare fraud in dollar amounts of $5,000.00 or less. |
2. From an administrative fine ranging from $1,000.00 to $5,000.00, 50 to 100 hours of community service and a reprimand through suspension of the license, or in case of application for licensure, denial of licensure. |
2. From an administrative fine ranging from $2,500.00 to $5,000.00, 100 to 200 hours of community service and suspension of the license, followed by a period of probation to revocation, or in case of application for licensure, denial of licensure. |
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(i) Kickbacks or split fee arrangements. (Section 458.331(1)(i), F.S.) |
(i) A refund of fees paid by or on behalf of the patient, 25 to 50 hours of community service and from a reprimand and an administrative fine of $1,000.00 to a reprimand and an administrative fine of $5,000.00, or denial of licensure. |
(i) A refund of fees paid by or on behalf of the patient, 50 to 100 hours of community service, and from suspension to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(j) Sexual Misconduct. (Section 458.331(1)(j), F.S.) (Section 458.329, F.S.) (Section 456.072(1)(u), F.S.) |
(j) From probation to revocation, or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(j) From suspension, to be followed by a period of probation to revocation, 100 to 200 hours of community service or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(k) Deceptive, untrue, or fraudulent representations in the practice of medicine. (Section 458.331(1)(k), F.S.) (Section 456.072(1)(a), (m), F.S.) |
(k) From a letter of concern, and 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(k) From probation or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00 to revocation. |
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1. No change. |
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2. Deceptive, untrue, or fraudulent representations in the practice of medicine relating to healthcare fraud in dollar amounts of $5,000.00 or less. |
2. From an administrative fine ranging from $1,000.00 to $5,000.00, 50 to 100 hours of community service, and a reprimand through suspension of the license, or in the case of application for licensure, denial of licensure. |
2. From an administrative fine ranging from $2,500.00 to $5,000.00, and suspension of the license, followed by a period of probation to revocation, 100 to 200 hours of community service, or in case of application for licensure, denial of licensure. |
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(l) Improper solicitation of patients. (Section 458.331(1)(l), F.S.) |
(l) From an administrative fine ranging from $1,000.00 to $5,000.00, 25 to 50 hours of community service and a reprimand to probation, or denial of licensure. |
(l) From suspension, to be followed by a period of probation, 50 to 100 hours of community service, to revocation or denial of licensure, and an administrative fine from $2,500.00 to $5,000.00. |
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(m) Failure to keep legible written medical records. (Section 458.331(1)(m), F.S.) |
(m) From letter of concern, 25 to 50 hours of community service to a reprimand, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.000. |
(m) From a reprimand to suspension followed by probation, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00, or denial of licensure. |
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1. No change. |
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2. Failure to keep legible written medical records relating to healthcare fraud in dollar amounts of $5,000.00 or less. |
2. From an administrative fine ranging from $1,000.00 to $5,000.00, and a reprimand, 50 to 100 hours of community service to |
2. From an administrative fine ranging from $2,500.00 to $5,000.00, and suspension of the license, followed by a period of probation, 100 to 200 hours of community service to revocation, or in case of application for licensure, denial of licensure. |
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(n) Exercising influence on patient for financial gain. (Section 458.331(1)(n), F.S.) (Section 456.072(1)(n), F.S.) |
(n) Payment of fees paid by or on behalf of the patient and from a reprimand, 25 to 50 hours of community service to probation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
(n) Payment of fees paid by or on behalf of the patient and from probation, 50 to 100 hours of community service, to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(o) Improper advertising of pharmacy. (Section 458.331(1)(o), F.S.) |
(o) From a letter of concern to probation, or a denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $250.00 to $2,500.00. |
(o) From a reprimand, 50 to 100 hours of community service and an administrative fine of $2,500.00 to probation, and an administrative fine from $2,500.00 to $5,000.00, or denial of licensure. |
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(p) Performing professional services not authorized by patient. (Section 458.331(1)(p), F.S.) |
(p) From a letter of concern, 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(p) From a reprimand, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(q) Inappropriate or excessive prescribing. (Section 458.331(1)(q), F.S.) |
(q) From reprimand to probation, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00, or denial of licensure. |
(q) From probation, 50 to 100 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(r) Prescribing or dispensing of a scheduled drug by the physician assistant to himself or herself. (Section 458.331(1)(r), F.S.) |
(r) From probation to suspension or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $2,500.00. |
(r) From suspension to revocation or denial of licensure, 50 to 100 hours of community service and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(s) Inability to practice medicine with skill and safety. (Section 458.331(1)(s), F.S.) |
(s) From reprimand to suspension, which may be stayed to allow a period of probation with supervision, and a demonstration by the licensee of the ability to practice with reasonable skill and safety, or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $2,500.00. |
(s) From probation to revocation, until the licensee is able to demonstrate ability to practice with reasonable skill and safety, followed by probation, or denial of licensure, 50 to 100 hours of community service and an administrative fine from $2,500.00 to $5,000.00. |
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(t)1. Malpractice: practicing below acceptable standard of care. (Section 458.331(1)(t), F.S.) |
(t)1. From a letter of concern, 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(t)1. From reprimand, 50 to 100 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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2. Gross Malpractice. |
2. From probation, 25 to 50 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $1,000.00 to $2,500.00. |
2. From suspension followed by probation to revocation or denial, 50 to 100 hours of community service and an administrative fine ranging from $2,500.00 to $5,000.00. |
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3. No change. |
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(u) Performing of experimental treatment without informed consent. (Section 458.331(1)(u), F.S.) |
(u) From a letter of concern to suspension, to be followed by a period of probation, or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00. |
(u) From suspension to be followed by a period of probation, 50 to 100 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(v) No change. |
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(w) Delegation of professional responsibilities to unqualified person. (Section 458.331(1)(w), F.S.) (Section 456.072(1)(p), F.S.) |
(w) From reprimand to suspension, followed by probation, 25 to 50 hours of community service or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(w) From probation, 50 to 100 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(x)1. Violation of law, rule, or failure to comply with subpoena. (Section 458.331(1)(x), F.S.); (Section 456.072(1)(b), (q), F.S.) |
(x)1. For any offense not specifically listed herein, based upon the severity of the offense and the potential for patient harm, from a reprimand to revocation, or denial of licensure, 25 to 100 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00. |
(x)1. From probation, 50 to 150 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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2. Violation of an order of the Board. |
2. From a reprimand, 25 to 50 hours of community service |
2. From a reprimand, 50 to 100 hours of community service and an administrative fine of $2,500.00 to a reprimand and an administrative fine of $5,000.00 and probation. |
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(y) Conspiring to restrict another from lawfully advertising services. (Section 458.331(1)(y), F.S.) |
(y) From a letter of concern to a reprimand, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $2,500.00 |
(y) From a reprimand, 50 to 100 hours of community service and an administrative fine of $2,500.00 to a reprimand and an administrative fine of $5,000.00. |
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(z) Aiding an unlawful abortion. (Section 458.331(1)(z), F.S.) |
(z) From probation, 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00. |
(z) From suspension, to be followed by a period of probation, 50 to 100 hours of community service, to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(aa) Presigning prescription forms. (Section 458.331(1)(aa), F.S.) |
(aa) From a letter of concern to a reprimand and an administrative fine of $1,000.00 to a letter of concern and an administrative fine of $2,500.00. |
(aa) From a reprimand to probation, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(bb) Failure to adequately supervise assisting personnel. (Section 458.331(1)(dd), F.S.) |
(bb) From a reprimand to probation, or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $2,500.00. |
(bb) From probation to suspension followed by probation, or denial of licensure, 50 to 100 hours of community service and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(cc) Improper use of substances for muscle building or enhancement of athletic performance. (Section 458.331(1)(ee), F.S.) |
(cc) From a reprimand to suspension, or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00. |
(cc) From suspension to be followed by a period of probation, to revocation or denial of licensure, 50 to 100 hours of community service and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(dd) Use of amygdaline (laetrile). (Section 458.331(1)(ff), F.S.) |
(dd) From a reprimand to probation, or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $2,500.00. |
(dd) From suspension to be followed by a period of probation to revocation or denial of licensure, 50 to 100 hours of community service and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(ee) Misrepresenting or concealing a material fact. (Section 458.331(1)(gg), F.S.) |
(ee) From a reprimand to probation, and an administrative fine ranging from $500.00 to $2,500.00, 25 to 50 hours of community service or the denial of licensure with the ability to reapply, upon payment of a $500.00 fine. |
(ee) From probation, 50 to 100 hours of community service to revocation or denial of licensure without the ability to reapply, and an administrative fine ranging from $500.00 to $5,000.00. |
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(ff) Improperly interfering with an investigation or a disciplinary proceeding. (Section 458.331(1)(hh), F.S.) (Section 456.072(1)(r), F.S.) |
(ff) From a reprimand to probation, 25 to 50 hours of community service or denial of licensure, and an administrative fine ranging from $1,000.00 to $2,500.00. |
(ff) From probation, 50 to 100 hours of community service to revocation or denial of licensure without ability to re-apply, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(gg) Failing to report any M.D., D.O. or PA, who is in violation of law. (Section 458.331(1)(ii), F.S.); (Section 456.072(1)(i), F.S.) |
(gg) From a letter of concern to probation, or denial of licensure, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $2,500.00 |
(gg) From probation to revocation or denial of licensure, 50 to 100 hours of community service and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(hh) No change. |
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(ii) Violating Chapters 458, 456, F.S., or any rules adopted pursuant thereto. |
(ii) From a reprimand, 25 to 100 hours of community service, to revocation or denial and an administrative fine from $1,000.00 to $5,000.00. |
(ii) From probation, 100 to 200 hours of community service; to revocation or denial and an administrative fine from $5,000.00 to $10,000.00. |
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(jj) (Section 456.018, F.S.) |
(jj)(ii) Revocation |
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(kk) Performing or attempting to perform health care services on the wrong patient, a wrong site procedure, a wrong procedure, or an unauthorized procedure or a procedure that is medically unnecessary or otherwise unrelated to the patients diagnosis or medical condition. |
(kk) From a $1,000.00 fine, a letter of concern, a minimum of five (5) hours of risk management education, and one (1) hour lecture on wrong-site surgery in the State of Florida to a $5,000.00 fine, a letter of concern, a minimum of five (5) hours of risk management education, 50 to 100 hours of community service, undergo a risk management assessment, a one (1) hour lecture on wrong-site surgery, and suspension to be followed by a term of probation. |
(kk) From a $7,500.00 fine, a reprimand, 100 to 200 hours of community service, and probation or denial to a $10,000.00 fine and revocation. |
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(ll) Leaving a foreign body in a patient, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures. |
(ll) From a $1,000.00 to a $5,000.00 fine, a letter of concern, a minimum of five (5) hours of risk management education, 50 to 100 hours of community service, and a one hour lecture to the staff of a Florida licensed healthcare facility on retained foreign body objects to revocation. |
(ll) From a $7,500.00 fine, a reprimand and probation, 100 to 200 hours of community service, or denial to revocation. |
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(mm) Engaging in a pattern of practice when prescribing medicinal drugs or controlled substances which demonstrates a lack of reasonable skill or safety to patients. |
(mm) From reprimand to probation, 25 to 50 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00, or denial of licensure. |
(mm) From probation, 50 to 100 hours of community service to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00. |
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(nn) Being terminated from a treatment program for impaired practitioners, for failure to comply with the terms of the monitoring or treatment contract or for not successfully completing any drug-treatment or alcohol-treatment program. |
(nn) From suspension until licensee demonstrates compliance with all terms of the monitoring or treatment contract, and is able to demonstrate to the Board the ability to practice with reasonable skill and safety to be followed by a term of probation; and a fine of $1,000 to $2,500, to revocation. |
(nn) From suspension until licensee demonstrates compliance with all terms of the monitoring or treatment contract and is able to demonstrate to the Board the ability to practice with reasonable skill and safety to be followed by a term of probation; and a fine of $2,500 to $5,000, to revocation. |
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(oo) Being convicted of, or entering a plea of guilty or nolo contendere to any misdemeanor or felony, regardless of adjudication, under 18 USC s. 669, ss. 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s. 1349, or s. 1518, or 42 USC ss. 1320a-7b, relating to the Medicaid program. |
(oo) Revocation and a fine of $10,000, or in the case of application for licensure, denial of license. |
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(pp) Failing to remit the sum owed to the state for overpayment from the Medicaid program pursuant to a final order, judgment, or settlement. |
(pp) From a letter of concern to probation, and a fine of $500 to $5,000. |
(pp) From a reprimand to revocation, and a fine of $2,500 to $5,000. |
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(qq) Being terminated from the state Medicaid program, or any other state Medicaid program, or the federal Medicare program. |
(qq) From a letter of concern to suspension, and a fine of $1,000 to $5,000. |
(qq) From a reprimand to revocation, and a fine of $5,000 to $10,000. |
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(rr) Being convicted of, or entering into a plea of guilty or nolo contendere to any misdemeanor or felony, regardless of adjudication, which relates to health care fraud. |
(rr) Revocation and a fine of $10,000, or in the case of application for licensure, denial of license. |
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(3) through (4) No change.
Rulemaking Specific Authority 456.079, 458.309, 458.331(4) FS. Law Implemented 456.072, 456.079, 458.331(4), 458.347(4)(e)1., (7)(g) FS. HistoryNew 3-13-89, Formerly 21M-17.015, 61F6-17.015, 59R-30.015, Amended 6-7-98, 4-9-01,_________.
