The jury spoke November 8, 2023 in the pending litigation “State Farm Auto. Ins. Co. v. Michael Thomas Larocca, DC, et al,” case number 8:21-cv-2536-SCB-AEP. The 16 Defendants, which included chiropractors, medical doctors, and nurse practitioners were held not guilty of committing fraud, civil conspiracy, unjust enrichment, and violating the Florida Deceptive and Unfair Trade Practices Act (FDUTPA). State Farm had filed a claim against the 16 defendants back in 2021. The allegations were the usual elements raised by Special Investigation Units (SIU): non-medically necessary procedures and engaging in illegal patient brokering and kickback schemes based on the marketing activities performed by the chiropractic clinic.
For years the SIU has brought forth these sorts of allegations and audits against chiropractors and providers engaged in the personal injury space. November 8 was a big win for those providers. With the passing of HB837, it has been difficult to understand the future of the personal injury protection space and the bodily injury space. Providers are fighting back and are challenging draconian measures passed down by the motor vehicle insurers.
This case shows how lack of compliance with the Florida Patient Brokering Act, marketing practices, and referral relationships between providers allows for these payors to bring claims against a medical provider for Fraud, False Claims and FDUPTA. The only way to fight back without having to do so in court, such as in the Larocca case, is to meet compliance in your practice.
Another lesson that could be learned from this case is seeking skilled and knowledgeable counsel on these matters. Knowing the laws, the options, the risk and the landscape on how those laws are used are the cornerstone of the required legal representation when dealing with motor vehicle insurance SIU claims.
Many chiropractors and providers who are involved in the personal injury space are undergoing these investigations at this time and will continue to do so as long as motor vehicle accidents are around. Chiropractors and providers should have a few key elements in place when ensuring compliance, policies and procedures surrounding patient intake, billing and coding practices, proper employment and/or independent contractor agreements between the clinic and the providers performing the services, a functional electronic medical records platform, and proper documentation during patient encounters.
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Attorney Carlos H. Arce works with the Florida Healthcare Law Firm in Delray Beach, FL. He has deep experience with health law, business law, and mergers & acquisitions. Carlos has handled multi-million-dollar healthcare transactions and has served as out-of-house counsel to various small to large healthcare entities. He can be reached via email at carlos@floridahealthcarelawfirm.com or by calling 561-455-7700.
