STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE

Transcription

1 DEPARTMENT OF HEALTH, Petitioner, STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE Final Order No. DOH MQA FILED DATE - DEC Departmerj ofj3ealth VS. Case Nos.: ; ; ; ; ; ; ; ; ; License No.: CH7840 TANYA RAE KAHL, D.C., Respondent. FINAL ORDER THESE MATTERS came before the Board of Chiropractic Medicine (hereinafter "Board") at a duly-noticed public meeting on October 31, 2014, in Orlando, Florida. Petitioner filed Administrative Complaints seeking disciplinary action against Respondent's license to practice as a chiropractic physician. A copy of each Administrative Complaint is attached to and incorporated as part of this Final Order. Petitioner was represented by Tan Rossitto-Van Winkle, Assistant General Counsel. Respondent was present with her counsel, Karen Barnet-Backer, Attorney at Law. Petitioner and Respondent have stipulated to a disposition of these cases. After considering the presentation of the parties and reviewing the record of each case, the Board voted to REJECT the Settlement Agreement as an appropriate settlement of these cases. The Board offered a counter Settlement Agreement which incorporates all of the terms of the original settlement with the following additional terms:

2 1. Ethics and Boundaries Examination. Within eighteen (18) months of the filing date of this Final Order, Respondent shall take and pass the Ethics and Boundaries examination by the National Board of Chiropractic Examiners and offered through Ethics and Boundaries Assessments Services LLC (or a successor examination or examination provider). 2. Community Service. The Board voted to require Respondent to provide twentyfive (25) hours of community service within eighteen (18) months of the filing date of this Final Order. The community service must be approved by the Disciplinary Compliance Chairperson prior to the start of the service. Payment of Costs. Pursuant to Section (4), Florida Statutes, the Department is authorized to collect costs for investigation and prosecution. The evidence presented to the Board was that the costs associated with these matters total thirty-two thousand two hundred fifty-six dollars and three cents ($32,256.03). The costs shall be paid in the manner set forth in the incorporated Settlement Agreement. Respondent accepted the terms of the counter settlement on the record at the hearing. IT IS THEREFORE ORDERED that the Board's proposed Counter Settlement Agreement is adopted and Respondent is hereby ordered to reimburse the Department costs in the amount of $32, This Final Order shall become effective upon filing with the Clerk of the Department of Health. DONE AND ORDERED this 7 day of /(_,I-et.4,LLAY, BOARD OF CHIROPRACTIC MEDICINE Adrienne Rodgers, J.D., Eicutive Director on behalf of Kevin Fogarty, D.C., Chair

3 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to Tanya Kahl D.C., by sending same via electronic mail to her counsel of record, Karen Barnet- Backer, kbacker@lawofficeslaley.com; and to: Tani Rossitto-Van Winkle, Assistant General Counsel, Department of Health, tari_rossitto-vanwinkle@doh.stateltus and Deborah B. Loucks, Assistant Attorney General, Office of the Attorney General, deborah.loucks@myfloridalegal.com,, Deputy Agency Clerk

4 Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. HEALTH Vision: To be the Healthiest State in the Nation Rick Scott Governor John H. Armstrong, MD, FACS State Surgeon General & Secretary is TO: FROM: Allison Dudley, Chief Bureau of Health Care Practitioner Regulation Adrienne Rodgers, Executive Director, Florida Boards of Chiropractic Medicine, Clinical Laboratory Personnel, Podiatric Medicine, Optometry, Nursing Home Administrators, Orthotists & Prothetisits, and The Advisory Council of Medical Physicists DATE: November 25, 2014 RE: Delegation of Authority During my absence November 26 through December 8, 2014, Sue Foster, Executive Director, will have delegated authority for the Board office. Thank you, Adrienne Rodgers, Executive Director Florida Department of Health Division of Medical Quality Assurance TWITTER:HealthyFLA 4052 Bald Cypress Way, Bin C-07 Tallahassee, FL FACEBOOK:FLDepartmentofHealth PHONE: FAX YOUTUBE: fldoh

5 DEPARTMENT OF HEALTH, STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE PETITIONER, v. CASE NOS , , , , , , , , , TANYA RAE KAHL, D.C., RESPONDENT, SETTLEMENT AGREEMENT Tanya Rae Kahl, D.C., referred to as the "Respondent," and the Department of Health, referred to as "Department" stipulate and agree to the following Settlement Agreement and to the entry of a Final Order of the Board of Chiropractic Medicine, referred to as "Board," incorporating the Stipulated Facts and Stipulated Disposition in this matter. Petitioner is a state agency charged with regulating the practice of chiropractic medicine pursuant to Section 20.43, Florida Statutes, and DOH v. Tanya Rae Kahl, D.C. 1 Case Nos , 20H-15255, , , , , , 201' , ,

6 Chapter 456, Florida Statutes, and Chapter 460, Florida Statutes. STIPULATED FACTS 1. At all times material hereto, Respondent was a licensed chiropractic physician within the State of Florida, having been issued license number CH 7840 on or about January 6, The Department charged Respondent with ten (10) Administrative Complaints that were filed and properly served upon Respondent with violations of Chapter 460, Florida Statutes, and the rules adopted pursuant thereto. True and correct copies of the ten (10) Administrative Complaints are attached hereto as Exhibits "A" through 3. Respondent neither admits nor denies the allegations of fact contained in the Administrative Complaints. STIPULATED CONCLUSIONS OF LAW 1. Respondent admits that in her capacity as a chiropractic physician, she is subject to the provisions of Chapters 456 and 460, Florida Statutes, and the jurisdiction of the Department and the Board. 2. Respondent admits that the facts alleged in the Administrative Complaints, if proven, would constitute violations of DOH v. Tanya Rae Kahl, D.C. Case Nos , , , , , , , , ,

7 Chapter 460, Florida Statutes, as alleged in the Administrative Complaints. 3. Respondent agrees that the Settlement Agreement in these ten (10) cases is fair, appropriate and acceptable to Respondent. STIPULATED DISPOSITION 1. Reprimand - The Board of Chiropractic Medicine shall reprimand the license of Respondent. 2. Fine - The Board of Chiropractic Medicine shall impose an administrative fine of ten thousand dollars and no cents ($10,000.00) against the license of Respondent, to be paid by Respondent to the Department of Health, Compliance Management Unit, Bin C76, Post Office Box 6320, Tallahassee, Florida , Attention: Board of Chiropractic Medicine Compliance Officer, within seven (7) years of the Final Order accepting this Settlement Agreement, with payments to be made by Respondent in eighty-four (84) equal monthly payments of one hundred, nineteen dollars and five cents ($119.05). Ali fines shall be paid by certified funds or money order. The Board office does not have the authority to change the terms of payment of any fine imposed by the Board. DOH v. Tanya Rae Kahl, D.C. 3 Case Nos , 2011-J 5255, , , , , , , ,

8 RESPONDENT ACKNOWLEDGES THAT THE TIMELY PAYMENT OF THE FINE IS HER LEGAL. OBLIGATION AND RESPONSIBILITY, AND RESPONDENT AGREES TO CEASE PRACTICING IF THE FINE IS NOT PAID AS AGREED TO IN THIS SETTLEMENT AGREEMENT, SPECIFICALLY: IF WITHIN FORTY-FIVE (45) DAYS OF THE DATE OF FILING OF THE FINAL ORDER, RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION THAT THE FULL AMOUNT OF HER FIRST FINE PAYMENT HAS BEEN RECEIVED, AND WITHIN FIFTEEN (15) DAYS OF EACH MONTHLY FINE PAYMENT THEREAFTER, RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION FROM THE BOARD OF CHIROPRACTIC MEDICINE COMPLIANCE OFFICER, RESPONDENT AGREES TO CEASE PRACTICING UNTIL SUCH TIME AS WRITTEN CONFIRMATION IS RECEIVED BY RESPONDENT FROM THE BOARD OF CHIROPRACTIC MEDICINE COMPLIANCE OFFICER. 3. Reimbursement Of Costs - Pursuant to Section , Florida Statutes, Respondent agrees to pay the Department for any and all costs incurred in the investigation and prosecution of these cases. Such costs exclude the costs of obtaining supervision or monitoring of Doff v. Tanya Rae KW, D.C. 4 Case Nos , , , , , , , , ,

9 the practice, the cost of quality assurance reviews, and the Board's administrative cost directly associated with Respondent's probation, if any. Those costs are the additional responsibility of the Respondent. The current estimate of the Department's costs in these ten (10) cases is thirty thousand, two hundred, eighty-five dollars and thirteen cents ($30,285,13) ( $2,551.84, $3,052.12, $2,641.69, $3,068.61, $4,348.46, $2,915.90, $3,227.46, $3,106.76, $2,798.25, $2,574.04], but this amount will increase prior to the Board meeting where this Settlement Agreement is presented. Ali costs shall be paid by certified funds or money order. Respondent will pay costs to the Department of Health, Compliance Management Unit, Bin C76, P.O. Box 6320, Tallahassee, Florida , Attention: Board of Chiropractic Medicine Compliance Officer, within seven (7) years of the issuance of the Final Order accepting this Settlement Agreement, with cost payments being made by the Respondent in eighty-four (84) equal monthly payments of 1184th the actual costs presented at the time of the Board meeting DOH y. Tanya Rae Kahl, D.C. 5 Case Nos , , , , , , , , ,

10 accepting this Settlement Agreement. Any post-board costs, such as the costs associated with probation, are not included in this Settlement Agreement, and are the separate responsibility of the Respondent. RESPONDENT ACKNOWLEDGES THAT THE TIMELY PAYMENT OF THE COSTS IS HER LEGAL OBLIGATION AND RESPONSIBILITY, AND RESPONDENT AGREES TO CEASE PRACTICING IF THE COSTS ARE NOT PAID AS AGREED TO IN THIS SETTLEMENT AGREEMENT, SPECIFICALLY: IF WITHIN FORTY-FIVE (45) DAYS OF THE DATE OF FILING OF THE FINAL ORDER, RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION THAT THE FULL AMOUNT OF HER FIRST COST PAYMENT HAS BEEN RECEIVED, AND WITHIN FIFTEEN (15) DAYS OF EACH MONTHLY COST PAYMENT THEREAFTER, RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION FROM THE BOARD OF CHIROPRACTIC MEDICINE COMPLIANCE OFFICER, RESPONDENT AGREES TO CEASE PRACTICING UNTIL SUCH TIME AS WRITTEN CONFIRMATION IS RECEIVED BY RESPONDENT FROM THE BOARD OF CHIROPRACTIC MEDICINE COMPLIANCE OFFICER. DOH v. Tanya Rae Kahl, D.C. 6 Case Nos , , , , , , 2O , ,

11 4. Continuing Education ing, Documentation and Coding - Respondent shall complete six (6) hours of Board approved continuing education courses in the area of record keeping, documentation and coding within eighteen (18) months of the date of filing of the Final Order of the Board. Respondent shall submit documentation in the form of certified copies of the receipts, vouchers, certificates, or other papers, documenting completion of this course. All such documentation shall be sent to the Department of Health Compliance Unit, Bin C76, P. O. Box 6320, Tallahassee, FL , Attention: Board of Chiropractic Medicine Compliance Officer, within nineteen (19) months from the date of filing of the Final Order in this cause regardless of whether some or any of such documentation was provided previously during the course of any audit or discussion with counsel for the Department. These hours shall be in addition to all those hours required for renewal of licensure; and unless otherwise approved by the Board, said continuing education course(s) shall consist of the formal, live lecture format. 5. Continuing Education - Risk Management - Within eighteen (18) months of the date of the filing of a Final Order in this DO!! v. Tanya Rae Kalil, D.C. 7 Case Nos , , , , , , , ,

12 cause, Respondent shall attend three (3) hours of Board approved Continuing Education in Risk Management, two (2) of which must be laws and rules, Respondent shall submit documentation in the form of certified copies of the receipts, vouchers, certificates, or other papers, documenting completion of this course. All such documentation shall be sent to the Department of Health Compliance Unit, Bin C76, P. 0. Box 6320, Tallahassee, FL , Attention: Board of Chiropractic Medicine Compliance Officer, within nineteen (19) months from the date of filing of the Final Order in this cause regardless of whether some or any of such documentation was provided previously during the course of any audit or discussion with counsel for the Department. These hours shall be in addition to all those hours required for renewal of licensure; and unless otherwise approved by the Board, said continuing education course(s) shall consist of the formal, live lecture format. 6. Probation C Practice Restrictions: Effective on the date of the filing of the Final Order incorporating the terms of this Settlement Agreement, Respondents license to practice chiropractic medicine shall be placed on probation for a period of two (2) years, with the Board reserving 0011 v. Tanya Rae Kahl, D.C. 8 Case Nos , , , , , , , , ,

13 jurisdiction to extend Respondent's probation for additional two (2) years, if its sole discretion it determines that the Respondent's practice during the probationary period was insufficient in quantity of patients actually treated, to adequately meet the spirit and purpose of probation set forth below, or such an extension is necessary to adequately protect the health, safety and welfare of the people of the state of Florida. The. purpose of probation is not to prevent Respondent from practicing chiropractic medicine. Rather, probation is a supervised educational experience designed by the Board to make Respondent aware of certain obligations to Respondent's patients and the profession; and to ensure Respondent's continued compliance with the high standards of the profession through interaction with another chiropractic physician with appropriate expertise. To this end, during the period of probation, Respondent shall comply with the following obligations and requirements: A) Restrictions During Probation- During the period of Probation, Respondent shall: 1. Supervision - Respondent shall be responsible to provide full access for a Board-approved chiropractic monitoring physician, hereinafter referred to as the "Monitor", whose responsibilities are set by the Board. DOH v. Tanya Rae Kahl, D.C. 9 Case Nos , , , , , , 201i-15323, 201I , ,

14 The Respondent shall allow the Monitor access to Respondent's medical records, financial records, billing records, trust account records, calendar, patient logs or other documents necessary for the Monitor to supervise Respondent as detailed below. It is expressly understood that Respondent will implement any changes to his practice suggested by Respondent's Monitor, and the failure to do so constitutes a violation of this Settlement Agreement that may result in disciplinary action. At any time after the Respondent has successfully completed the first one and one-half (11/2) years of probation the Respondent, with the advice, consent and support of her Monitor, may petition the Board for the early termination of the Respondent's Probation, B),Resnonibifities of the Monitor- During the first month of probation, the Monitor shall review a minimum of. ten (10) files, or one hundred percent (100%), whichever is less, of Respondent's active patient records for the purpose of ascertaining whether proper care and treatment is being provided, whether there are any signs of over-utilization, upcoding, and to determine if the Respondent is maintaining proper patient and billing records. Thereafter, for the next five (5) months of Respondent's probation, the Monitor shall go to Respondent's office once DOH v. Tanya Rae Kahl, D.C. 10 Case Nos , 201 I-15255, , , , , , , ,

15 every month, shall review Respondent's calendar and patient log, and shall select the records to be reviewed. if Respondent successfully completes the first six (6) months of probation, the Monitor shall only be required to review a minimum of five (5) patient files, or one hundred percent (100%), whichever is less, every quarter for the duration of probation. C) Monitoring Reports - The Monitor shall also submit Quarterly Reports, in affidavit form, which shall include: A brief statement of why Respondent is on a Monitoring Agreement; 2. A description of Respondent's practice (type and composition); 3. A statement addressing Respondent's compliance with the terms of Monitoring Agreement; 4. A brief description of the Monitor's relationship with Respondent; 5. A statement advising the Board of any problems which have arisen; and 6. A summary of the dates the Monitor went to Respondent's office, the number of records reviewed, the overall quality of the records DOI I v. Tanya Rae Kalil, D,C, 11 Case Nos , , , , , , , , ,

16 reviewed, and the dates Respondent contacted the Monitor as referenced above. More detailed information regarding the required content of the Monitoring Report will be provided to the Monitor by the Board's Disciplinary Compliance Chair or the Department's Compliance Unit. The Monitor will be expected to utilize the forms and comply with the guidelines contained in the materials provided by the Board's Disciplinary Compliance Chair or the Department's Compliance Unit. D) Obligation to Report Violations - The Monitor is required to immediately report to the Board any violations by Respondent of Chapters 456 or Chapter 460, Florida Statutes, and the rules promulgated thereto. The Monitor shall further be required to file a formal complaint against the Respondent with the Department of Health if, during the course of the probation the Monitor becomes aware of any potential additional violations of Chapters 456 or 460, Florida Statutes, or the Rules of the Florida Administrative Code promulgated pursuant thereto, not covered by the Administrative Complaints attached as Exhibits "A" through "3". DO11 v. Tanya Rae Kalil, D.C. 12 Case Nos ,20i , i5257, g, ,2011-t5323,201!- i5356, ,

17 E) Appearances- Respondent shall appear before the Board at the last regularly scheduled Board meeting preceding the anticipated date of termination of his probation. Respondent's Monitor shall appear before the Board at such times as directed by the Board. It shall be Respondent's responsibility to give adequate notice to the Monitor to appear as requested or directed, If the approved Monitor inexcusably fails to appear as requested or directed by the Board due to lack of notice by the Respondent, Respondent shall immediately cease practicing Chiropractic Medicine until such time as the approved Monitor, or alternate Monitor, appears before the Board, unless such failure is beyond the control of the Monitor or the Respondent. F) Other Obiiigationsl ieguirements of Monitoring Agreement - During the term of the Monitoring Agreement, Respondent shall comply with the following obligations and requirements: 1. During the period of probation Respondent agrees that, upon notification to Respondent to appear at the next Board of Chiropractic Medicine meeting and be heard, and upon a finding by the Board that Respondent failed to comply with any of the terms of this Settlement Agreement the Board may SUSPEND Respondent's license to practice v. Tanya Rae Kahl, D.C. 13 Case Nos, , , , , , , , , ,

18 Chiropractic Medicine until Respondent demonstrates to the Board that Respondent is in compliance with the terms of Monitoring Agreement. Notwithstanding the foregoing, Respondent shall have the opportunity to provide evidence to the Board to rebut any allegation of non-compliance and the Board shall provide reasonable notice of its concerns in advances of any meeting to allow the Respondent an opportunity to respond. 2. Respondent shall appear before the Board of Chiropractic Medicine at the last meeting of the Board preceding the scheduled termination of Respondent's probation, and at such other times as requested by the Board. The Board staff shall notify Respondent of the date, time and place of the Board meeting at which Respondent's appearance is required. Inexcusable failure of Respondent to appear as requested or directed by the Board shall be considered a violation of the terms of this Settlement Agreement, and shall subject Respondent to disciplinary action, unless Respondent's appearance is excused in advance by the Board or the failure to appear is beyond Respondent's control. 3. In the event that the Board or the Disciplinary Compliance Chair determines that that Respondent's or his Monitor's reports are unacceptable, the Board shall have the authority to extend Respondent's DO11 v. Tanya Rae Kahl, D.C. 14 Case Nos, , , , , , , , , ,

19 probationary term indefinitely. This authority is in addition to the Board's authority to suspend Respondent's license or file new charges based on the Respondent's non-compliance with this Settlement Agreement. G) Change in Monitor: In the event that Respondent's Monitor is unable, or unwilling, to fulfill the responsibilities of a Monitor, Respondent shall immediately notify the Board office. Respondent shall obtain another Board-appointed Monitor as expeditiously as possible to fulfill the obligations. Failure to notify the Board office and obtain a new Monitor within two (2) weeks shall be considered a violation of this Settlement Agreement. H) Continuity of Practice: 1. Tolling Provisions - In the event Respondent leaves the State of Florida for a period of thirty (30) days or more, or otherwise does not treat patients or engage in the active practice of Chiropractic Medicine in the State of Florida, then certain provisions of Respondent's Monitoring Agreement (and only those provisions of the Monitoring Agreement) shall be tolled as enumerated below and shall remain in a tolled status until Respondent returns to active practice in the State of Florida: a. The time period of the Monitoring Agreement shall be tolled; Doll v. Tanya Rae Kahl, D.C, 15 Case Nos , , , , , , , :56, ,

20 b. The provisions regarding supervision, whether direct or indirect, by another chiropractic physician, and required reports from the Monitor shall be toiled; and c. The provisions regarding preparation of investigative reports detailing compliance with this Settlement Agreement shall be tolled. 2. Active Practice - In the event that Respondent leaves the active practice of Chiropractic Medicine for a period of one (1) year or more, the Board may require Respondent to appear before the Board and demonstrate her ability to practice Chiropractic Medicine with skill and safety to patients prior to resuming the practice of Chiropractic Medicine in the State of Florida. STANDARD PROVISIONS 1. Appearance - Respondent is required to appear before the Board at the meeting of the Board where this Settlement Agreement is considered. 2. No Force or Effect Until Final Order - It is expressly understood that this Settlement Agreement is subject to the approval of the Board and the Department. In this regard, the foregoing paragraphs {and only the foregoing paragraphs) shall have no force and DOH v. Tanya Rae Kahl, D.C. 16 Case Nos , , , , , , , , ,

21 effect unless the Board enters a Final Order incorporating the terms of this Settlement Agreement. 3. Addresses - Respondent must keep current residence and practice addresses on file with the Board. Respondent shall notify the Board within ten (10) days of any changes of said addresses. 4. Future Conduct - In the future, Respondent shall not violate Chapter 456 or 460, Florida Statutes, or the rules promulgated pursuant thereto, or any other state or federal law, rule, or regulation relating to the practice or the ability to practice chiropractic medicine. Prior to signing this Settlement Agreement, the Respondent shall read Chapters 456 and 460, Florida, Statutes, and the Rules of the Board of Chiropractic Medicine, at Chapter 6482, Florida Administrative Code. 5. Violation of Terms of Settlement Agreement Considered Violation of Final Order - It is expressly understood that a violation of the terms of this Settlement Agreement shall be considered a violation of a Final Order Of the Board, for which disciplinary action may be initiated pursuant to Chapters 456 and 460, Florida Statutes. DOH v. Tanya Rae Kalil, D.C. 17 Case Nos , , , , , , , , ,

22 6. Purpose 'of Settlement Agreement - Respondent, for the purpose of avoiding further administrative action with respect to this cause, executes this Settlement Agreement in this regard, Respondent authorizes the Board to review and examine all investigative file materials concerning Respondent prior to or in conjunction with consideration of the Settlement Agreement. Respondent agrees to support this Settlement Agreement at the time it is presented to the Board and shall offer no evidence, testimony or argument that disputes or contravenes any stipulated fact or conclusion of law. Furthermore, should this Settlement Agreement not be accepted by the Board, it is agreed that presentation to and consideration of this Settlement Agreement and other documents and matters by the Board shall not unfairly or illegally prejudice the Board or any of its members from further participation, consideration or resolution of these proceedings. 7. No piggi u112112laddjkatialproceedings - Respondent and the Department fully understand that this Settlement Agreement and subsequent Final Order incorporating same will in no way preclude additional proceedings by the Board and/or the Department against DOH v. Tanya Rae Kahl, D,C. 18 Case Nos , , , , , , , , ,

23 Respondent for acts or omissions net specifically set forth in the Administrative Complaint attached as Exhibit A. 8. Waiver. of Monocles Fw..and gi9sts -.Upon the Board's adoption of this Settlement Agreement, the parties hereby agree that with the exception of costs noted above, the patties will bear their own attorney's fees and costs resulting from prosecution or defense of this matter. Respondent waives the right to seek any attorney's fees or costs from the Department and/or the Board in connection with this matter under Florida Statutes, Chapters 57, 120, 456, and 460, or on any other basis. g. Waiver.,...,_rtigtPixtgaggrit.ares of Fu 1 - Upon the Board's adoption of this Settlement Agreement, Respondent expressly waives all further procedural sups and expressly waives all rights to seek judicial review of or to otherwise challenge or contest the validity of the Settlement Agreement and the Final Order of the Board incorporating said Settlement Agreement, SIGNED this 29 day of eptembet TANYA E KAHL, -D.C. DON V. Tanya RIM Kai* 1),C. 19 Case Nos, $, q55, S6, k , ,, , ,2011-M58

24 Before me, personally appeared Respon..ent TANYA AE whose identity is known to me by _ (type of identification) and who, under oath, acktiowle_ 1it hs/her signature appears above.: Sworn to and sobscribed before me this, day of VW M. &TALLY My COMMISStON #FP1476R 13 EXPIRES: AUH 04, noricni if:roi:o1; itc Notary Public State Of Florida Printed Name:_:\11-1 Commission No )(7 49I& Commission Expires: '78-- -Jjs APPROVED day iohn H. Armstrong, MD,. FACS State Surgeon General.* Secretary... BY: Tani RossittO-Van Wirikier RN., Assistant General Counsel Department of Health Prosecution Services Unit 4052 Baid Cypress Way, Bin 0,65 Tallahassee, FL (850) ext 8139 FAX (850) Florida Sr # O61390 Tattrossitio-vanwinkleRilpgiMmy, rice v. Tanya Rao k 61, D.C. 20 Case Nos, ?, , , ,57, % , % ,, , R 417

25 STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO TANYA RAE KAHL, D.C. RESPONDENT, ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Chiropractic Medicine against Respondent, Tanya Rae Kahl, D.C. In support Petitioner alleges: 1. Petitioner is the state department charged with regulating the practice of Chiropractic Medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 460, Florida Statutes. 2. At all times material to this Complaint, Respondent was a chiropractic physician within the State of Florida, having been issued license number CH 7840 on or about January 6, DOH v. Tanya Rae Kahl, D.0 Case No

26 3. Respondent's address of record is 400 Carolina Ave., Fort Lauderdale, Florida At all times relevant to this case, Respondent was the president and Registered Agent of Synergy Chiropractic of South Dade, Inc., located at 175 Fontainebleau Boulevard, Suite 2G-6, Miami, Florida At all times relevant to this case, Respondent was the sole shareholder of Synergy Chiropractic of South Dade, Inc. 6. At all times relevant to this case, Respondent was employed by Synergy Chiropractic of South Dade, Inc. 7. At all times relevant to this case, Respondent was an employee of Synergy Chiropractic of South Dade, Inc. 8. At all times relevant to this case, Respondent was responsible for the day to day operations of Synergy Chiropractic of South Dade, Inc. 9. At all times relevant to this case, Respondent provided direct patient care to patient I.A. at Synergy Chiropractic of South Dade, Inc,. 10. At all times relevant to this case, Respondent hired A. Sainz, C.C.P.A., to work at Synergy Chiropractic of South Dade, Inc. DOH v. Tanya Rae Kahl, D.C. 2 Case No

27 11. At all times relevant to this case, Respondent was A. Sainz, C.C.P.A.'s, supervising chiropractic physidan at Synergy Chiropractic of South Dade, Inc. Facts Related to Patient I.A. 12. On or about January 19, 2009, Patient 1.A., a 34 year-old male gentlemen of Hispanic descent, presented to Respondent for chiropractic care and treatment of injuries allegedly sustained in an automobile accident on or about December 12, At all times relevant herein, Patient I.A. was covered by an automobile insurance policy with United Automobile Insurance Company, which policy contained Personal Injury Protection (hereafter referred to as "PIP") benefits for the payment of medical expenses related to the automobile accident of on or about December 12, On January 19, 2009, Patient I.A. related the following complaints to Respondent: severe neck pain, moderate to severe midthoracic pain, moderate to severe low back pain, and right anterior upper arm pain. 15. On January 19, 2009, Respondent examined Patient I.A. DOH v. Tanya Rae Kahl, D.C. 3 Case No

28 16. International Classification of Diseases, Ninth Revision, Clinical Modification (Here after "ICD-9-CM") is the World Health Organization's Ninth Revision, of the International Classification of Diseases; and is the official system of assigning codes to diagnoses and procedures associated with healthcare utilization in the United States. 17. Respondent made the following diagnoses for Patient I.A. using ICD-9-CM codes: ICD-9-CM cervical strain/sprain; ICD-9-CM thoracic strain/sprain; ICD-9-CM lumbar strain/sprain. 18. Patient I.A. returned to Synergy Chiropractic of South Dade, Inc., to receive chiropractic treatment approximately forty-six (46) additional times with the last visit on or about April 29, Patient I.A.'s medical records from Respondent indicate that he received chiropractic care and treatment from the Respondent, or others under her direct or indirect supervision, on or about forty-six (46) separate occasions at Synergy Chiropractic of South Dade, Inc., between January 19, 2009, to April 29, Current Procedural Terminology (hereafter referred to as "CPT") is a listing of descriptive terms and identifying codes for reporting medical services and procedures. DOH v. Tanya Rae Kahl, D.C. Case No

29 21. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and thereby serves as an effective means for reliable nationwide communication among physicians and other healthcare providers, patients, and third parties. 22. CPT is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. 23. Between January 19, 2009, and April 29, 2009, Respondent promoted, and recommended, that Patient I.A. undergo one or more of the following treatment modalities on each visit: Hot/Colds Packs (CPT code 97010); Electrical Muscle Stimulation (Hereafter referred to as "E.MS.") (CPT code 97014); Vibratory Massage (CPT code 97124); Ultrasound (CPT code 97035); Mechanical Traction (CPT code 97012); Therapeutic Exercises (CPT code with and without a 59 modifier); Self Care/Home Care Management Training (CPT code 97535); and Chiropractic Adjustments 3-4 Regions (CPT code 98941). 24. Between January 19, 2009, and April 29, 2009, Respondent also promoted, and recommended, that Patient I.A. undergo Healthcare DOH v. Tanya Rae Kahl, D.C. 5 Case No

30 Common Procedure Coding System (hereafter referred to as "HCPCS") Low Level Laser (HCPCS code S8948). 25. HCPCS is the acronym for the Centers for Medicare and Medicaid Services' coding system to establish a uniform method for providers and suppliers to report their services, procedures and supplies. 26. Between January 19, 2009, and April 29, 2009, and based upon Respondent's recommendations and promotional efforts, Patient I.A. agreed to undergo one or more of the following treatment modalities on each visit at Synergy Chiropractic of South Dade, Inc.: Hot/Colds Packs (CPT code 97010); E.M.S. (CPT code 97014); Vibratory Massage (CPT code 97124); Ultrasound (CPT code 97035); Mechanical Traction (CPT code 97012); Therapeutic Exercises (CPT code with and without a 59 modifier); Self Care/Home Care Management Training (CPT code 97535); Low Level Laser (HCPCS code S8948); and Chiropractic Adjustments 3-4 Regions (CPT code 98941). 27. Between January 19, 2009, and April 29, 2009, Patient I.A. was provided by Respondent, or others under her direct or indirect supervision at Synergy Chiropractic of South Dade, Inc., with one or more of the following treatment modalities on each visit at Synergy Chiropractic of DOH v. Tanya Rae Kahl, D.C. 6 Case No

31 South Dade, Inc.: Hot/Colds Packs (CPT code 97010); E.M.S. (CPT code 97014); Vibratory Massage (CPT code 97124); Ultrasound (CPT code 97035); Mechanical Traction (CPT code 97012); Therapeutic Exercises (CPT code with and without a 59 modifier); Self Care/Home Care Management Training (CPT code 97535); Low Level Laser (HCPCS code S8948); and Chiropractic Adjustments 3-4 Regions (CPT code 98941). 28. Between January 19, 2009, and April 29, 2009, Respondent failed to justify the medical necessity for Patient I.A.'s course of treatment with one or more of the following treatment modalities recommended by Respondent to Patient I.A, and utilized with, Patient 1.A.: Hot/Colds Packs (CPT code 97010); E.M.S. (CPT code 97014); Vibratory Massage (CPT code 97124); Ultrasound (CPT code 97035); Mechanical Traction (CPT code 97012); Therapeutic Exercises (CPT code with and without a 59 modifier); Self Care/Home Care Management Training (CPT code 97535); Low Level Laser (HCPCS code S8948); and Chiropractic Adjustments 3-4 Regions (CPT code 98941). 29. Between January 19, 2009, and April 29, 2009, Respondent failed to document the frequency, location, duration, modality specifics, sequence of course of treatment and patient responses to one or more of DOH v. Tanya Rae Kahl, D.C. 7 Case No

32 the following treatment modalities recommended by Respondent to Patient 1.A, and utilized with, Patient LA.: Hot/Colds Packs (CPT code 97010); E.M.S. (CPT code 97014); Vibratory Massage (CPT code 97124); Ultrasound (CPT code 97035); Mechanical Traction (CPT code 97012); Therapeutic Exercises (CPT code with and without a 59 modifier); Self Care/Home Care Management Training (CPT code 97535); Low Level Laser (HCPCS code 58948); and Chiropractic Adjustments 3-4 Regions (CPT code 98941). 30. Between January 19, 2009, and April 29, 2009, Respondent failed to document the results achieved with the care and treatment utilized by Respondent on Patient I.A. with one or more of the following treatment modalities recommended by respondent to Patient I.A., and utilized with, Patient LA.: Hot/Colds Packs (CPT code 97010); E.M.S. (CPT code 97014); Vibratory Massage (CPT code 97124); Ultrasound (CPT code 97035); Mechanical Traction (CPT code 97012); Therapeutic Exercises (CPT code with and without a 59 modifier); Self Care/Home Care Management Training (CPT code 97535); Low Level Laser (HCPCS code S8948); and Chiropractic Adjustments 3-4 Regions (CPT code 98941). DOH v. Tanya Rae Kahl, D.C. 8 Case No

33 31. On January 23, 2009, based on Respondent's recommendations and promotions, Patient I.A. underwent an established patient reevaluation and management. 32. Respondent failed to justify the medical necessity for the January 23, 2009, re-evaluation of Patient I.A. which was the fourth visit after the initial examination. 33. Respondent, or others under her direct or indirect supervision and control, intentionally submitted a claim, statement or bill to Patient I.A.'s PIP insurance carrier, United Automobile Insurance Company, for the medically unnecessary established patient re-evaluation and management done January 23, 2009, using CPT code On April 29, 2009, based on Respondent's recommendations and promotions, Patient I.A. underwent another established patient reevaluation and management. 35. Respondent, or others under her direct or indirect supervision and control, billed Patient I.A.'s PIP insurance carrier, United Automobile Insurance Company, for the April 29, 2009, established patient reevaluation and management using CPT code DOH v. Tanya Rae Kahl, D.C. Case No

34 36. The minimum standard to bill CPT code is an office, or other outpatient, visit for the evaluation and management of an established patient, which requires at least two (2) of the following three (3) components: a detailed history; a detailed examination; medical decision making of moderate complexity; and requires the physician to spend approximately 25 minutes face-to-face with the patient. 37. The detailed history required to bill a CPT code for a reevaluation requires, at a minimum, the following: a review of the status of three (3) chronic problems or four (4) findings regarding the History of the Present Illness, an extended review of two (2) to nine (9) systems pertinent to the problem, and one (1) finding relating to the patient's Past Medical, Family or Social History. 38. The detailed examination required to bill a CPT code for a re-evaluation requires, at a minimum, twelve (12) pertinent positive findings (2 findings in 6 physiological systems or 12 findings in 2 physiological systems). 39. The medical decision making of moderate complexity required to bill CPT code for a re-evaluation requires, at a minimum, the DOH v. Tanya Rae Kahl, D.C. 18 Case No

35 review of multiple diagnoses, the complex review of data from multiple lab tests or x-rays, and the morbidity or mortality risk is moderate. 40. On April 29, 2009, Respondent's re-evaluation of Patient I.A. failed to meet the minimum standard for billing CPT code as it failed to include a detailed history; a detailed examination; and medical decision making of moderate complexity. 41. On April 29, 2009, Respondent's re-evaluation of Patient I.A., billed to Patient I.A.'s PIP insurance carrier, United Automobile Insurance Company, using CPT code was "upcoded" as that term is defined in Section Florida Statutes (2008). 42. "Upcoding" means utilizing a billing code that would result in the payment of a greater amount than would be paid using the correct billing code that accurately describes the services performed. 43. In the alternative, Respondent's records of her re-evaluation of Patient I.A. on April 29, 2009, failed to document a detailed history; a detailed examination; and a medical decision making of moderate complexity. 44. Respondent, or others under her direct supervision and control intentionally submitted a claim, statement or bill to Patient I.A.'s PIP DOH V. Tanya Rae Kahl, D.C. 11 Case No

36 insurance carrier, United Automobile Insurance Company, for the April 29, 2009, established patient re-evaluation and management using CPT code Respondent, or others under her direct or indirect supervision or control, intentionally submitted a claim, statement or bill to Patient PIP insurance carrier, United Automobile Insurance Company, for the April 29, 2009, established patient re-evaluation and management using CPT code 99214, but failed to render to Patient I.A. the services necessary for an established patient re-examination that met the minimum requirements of CPT code The claim intentionally submitted by Respondent, or others under her direct or indirect supervision and control, to Patient LA.'s PIP insurance carrier, United Automobile Insurance Company, for the April 29, 2009, established patient re-evaluation and management using CPT code resulted in payment to Respondent of a greater amount than would have been paid her using a billing code that accurately described the services she actually performed. 47. Between January 19, 2009, and April 29, 2009, Respondent's billing records, document the Respondent, or others under her direct or DOH v. Tanya Rae Kahl, D.C. 12 Case No

37 indirect supervision and control at Synergy Chiropractic of South Dade, Inc., billed to Patient PIP Insurance Carrier, United Automobile Insurance Company, $19, Between January 19, 2009, and April 29, 2009, Respondent, or others under her direct or indirect supervision at Synergy Chiropractic of South Dade, Inc., intentionally submitted claims to Patient I.A.s PIP Insurance Carrier, United Automobile Insurance Company, for one or more of the following treatment modalities in the amounts noted: Hot/Colds Packs CPT code ($50.00 per treatment); E.M.S. CPT code ($60.00 per treatment); Vibratory Massage CPT code ($60.00 per treatment); Ultrasound CPT code ($55.00 per treatment); Mechanical Traction CPT code ($40.00 per treatment); Therapeutic Exercises CPT code with and without a 59 modifier ($70.00 per treatment); with and without a 59 modifier); Self Care/Home Care Management Training CPT code ($60.00 per training); Low Level Laser HCPCS code S8948 ($70.00 per treatment); and Chiropractic Adjustments 3-4 Regions CPT code ($95.00 per treatment). 49. Between January 19, 2009, through April 29, 2009, Respondent, or others under her direct or indirect supervision and control, DOH v. Tanya Rae Kahl, D.C. 13 Case No

38 billed Patient I.A.'s PIP Insurance Carrier, United Automobile Insurance Company, for the following treatment modalities, but failed to document the frequency, location, duration, modality specifics, sequence of course of treatment and patient responses to one or more of the following treatment modalities recommended by Respondent to Patient LA., and utilized with, Patient LA.: Hot/Colds Packs (46 applications); E.M.S. (46 applications); Vibratory Massage (46 applications); Ultrasound (26 applications); Mechanical Traction (46 applications); Therapeutic Exercises with and without a 59 modifier (43 applications); Self Care/Home Care Management Training (3 trainings); Low Level Laser (20 applications); and Chiropractic Adjustments 3-4 Regions (36 adjustments). 50. Respondent failed to adequately describe Patient I.A.'s objective findings in the daily treatment notes. 51. In the alternative, Respondent's notes failed to justify the course of care and treatment that was provided to Patient I.A. 52. Respondent provided medically unnecessary care to Patient I.A. 53. During the course of treatment, Respondent failed to adequately document the treatment provided to Patient I.A. DOH v. Tanya Rae Kahl, D.C. 14 Case No

39 Count I Record Keeping 54. Petitioner re-alleges paragraphs one (1) through fifty-three (53), as if set forth fully at length herein. 55. Section (1)(m), Florida Statutes (2009), provides that failing to keep legibly written chiropractic medical records that identify clearly by name and credentials the licensed chiropractic physician rendering, ordering, supervising, or billing for each examination or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories, examination results, X-rays, and diagnosis of a disease, condition, or injury is grounds for disciplinary action by the Board of Chiropractic Medicine. 56. Section (1)(ff), Florida Statutes (2009), subjects a chiropractic physician to discipline for violating any provision of this chapter, or chapter 456, or any rules adopted pursuant thereto. 57. Rule 64B (2), Florida Administrative Code (F.A.C.) (2009), sets forth the following minimum purposes for maintaining chiropractic medical records: (a) To serve as a basis for planning patient care and for continuity in the evaluation of the patient's condition and treatment. DOH v. Tanya Rae Kahl, D.C. 15 Case No

40 (b) To furnish documentary evidence of the course of the patient's medical evaluation, treatment, and change in condition. (c) To document communication between the practitioner responsible for the patient and any other health care professional who contributes to the patient's care. (d) To assist in protecting the legal interest of the patient, the hospital, and the practitioner responsible for the patient. 58. Rule , Florida Administrative Code (F.A.C.) (2009), also sets forth the minimal recordkeeping standards and is set forth below in pertinent part: a. Rule 64B (3), F.A.C. states that medical records shall be legibly maintained and shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs dispensed or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. Initial and follow-up services (daily records) shall consist of documentation to justify care. If abbreviations or symbols are used in the daily recordkeeping, a key must be provided. b. Rule 64B (4), F.A.C., states that all patient records shall include a patient history; symptomatology and/or wellness care; examination finding(s), including X-rays when medically or clinically indicated; a diagnosis; a prognosis; assessment(s); a treatment plan; and, treatments provided. DOH v. Tanya Rae Kahl, D.C. 16 Case No

41 c. Rule 64B (5), F.A.C., states all entries made into the medical records shall be accurately dated. The treating physician must be readily identifiable either by signature, initials, or printed name on the record. Late entries are permitted, but must be clearly and accurately noted as late entries and dated accurately when they are entered into the record. d. Rule 64B (6), FA.C, states that once a treatment plan is established, daily records shall include: (a) Subjective complaint(s); (b) Objective finding(s); (c) Assessment(s); (d) Treatment(s) provided, and (e) Periodic reassessments as indicated. 59. Respondent violated Section (1)(m) and (if), Florida Statutes (2009), and Rule 64B , F.A.C., in one or more of the following ways: (a) By failing to adequately describe Patient LA:s objective symptoms in the daily treatment soap notes on one or more occasions between January 19, 2009, and April 29, 2009; (b) By failing to document the justification for the course of chiropractic care and treatment rendered to Patient I.A. on one or more occasions between January 19, 2009, and April 29, 2009; (c) By failing to adequately document the care and treatment rendered to Patient T.A. on one or more occasions between January 19, 2009, and April 29, 2009; DOH v. Tanya Rae Kahl, D.C. 17 Case Na