Embedded Files
Page 5
victim.” For example, if the victim objects to being moved, but the physician moves the victim anyway and provides emergency care, the physician will not be protected by this statute. Botte v. Pomeroy, 438 So.2d 544 (Fla. 4th DCA 1983), review den. 450 So.2d 488. In 2003, the FMA endeavored to change the Good Samaritan Act so that it provided a real measure of protection for volunteer physicians. After extensive lobbying and five special sessions, the legislature added a section that provided immunity to health care providers providing emergency services pursuant to obligations imposed by EMTALA and comparable state legislation. The addition to the Good Samaritan Act provides that there is no liability for providing such medical care unless it was done under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of another (Section 768.13 (b)1, Florida Statutes). This section provides a bit more protection from liability than the original above in that “reckless disregard” is defined as more than acting as an ordinary reasonably prudent person would have under the same or similar circumstances. For this addition “reckless disregard” is defined as “such conduct that a health care provider knew or should have known, at the time such services were rendered, created an unreasonable risk of injury so as to affect the life or health of another, and such risk was substantially greater that that which is necessary to make the conduct negligent.” Section 768.13 (b)3, Florida Statutes (emphasis added).Over the years, the state has provided further incentives for physicians to provide services to the poor and on behalf of the state. In 1992, Section 766.1115, Florida Statutes, was enacted to provide sovereign immunity to those physicians and §501(c) organizations which deliver health care services on a volunteer basis. As a result, physicians and nonprofit entities under which they provide their services may not be held liable for more than $100,000 per patient as a result of any medical malpractice. Unfortunately, this law did not provide sufficient protection to the individual physician who desired to provide volunteer services under the umbrella of the state or a nonprofit agency. For this reason, the state responded in 1993 by passing the Volunteer Protection Act (Section 768.1355, Florida Statutes), which stated that any person performing volunteer services for any nonprofit organization or any governmental entity would “incur no civil liability for any act or omission by such person which results in personal injury” as long as the person acted in good faith and “as an ordinary reasonably prudent person would have acted under the same or similar circumstances.”In addition, the injury must “not [be] caused by any wanton or willful misconduct on the part of such person in the performance of such duties.”During that same legislative session, the state passed the Professional Malpractice Immunity Act Section 768.1345, Florida Statutes), which explicitly stated that “[n]o person shall have a claim for professional malpractice against a licensed professional who provides services for which no compensation is sought or received to such person during the period of a declared emergency if the professional services arose out of the emergency and if the professional acted as an ordinary, reasonably prudent member of the profession would have acted under the same or similar circumstances.”As a result of these actions, physicians who wish to volunteer their services within the State of Florida have received substantial, although incomplete, liability protection for volunteer services rendered in good faith. To receive the maximum protection, however, physicians must, in all but emergency circumstances, provide their services through a recognized nonprofit agency or the state. Only in this way may physicians help others without the fear of hurting themselves. This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: October 2005 WORKERS’ COMPENSATION: CERTIFIED HEALTH CARE PROVIDER As a condition to eligibility for payment under Chapter 440, Florida Statutes, Workers’ Compensation, a health care provider who renders services must be a certified health care provider and must receive authorization from the carrier before providing treatment. This requirement does not apply to emergency care. The Agency for Health Care Administration (AHCA) adopts rules to implement the certification of health care providers. A "certified health care provider" means a health care provider who has been certified by AHCA or who has entered an agreement with a licensed managed care organization to provide treatment to injured workers. Certification of health care providers must include documentation that the health care provider has read and is familiar with the portions of the statute, impairment guides, practice parameters, protocols of treatment, and rules which govern the provision of remedial treatment, care, and attendance. Physicians licensed under Chapter 458, an osteopathic physician licensed under Chapter 459, a chiropractic physician licensed under Chapter 460, a podiatric physician licensed under Chapter 461, an optometrist licensed under Chapter 463, or a dentist licensed under Chapter 466, must be certified by AHCA prior to seeing injured employees insured under Florida workers’ compensation laws. This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: August 2016 BALANCE BILLING OF HMO PATIENTS Section 641.3154, Florida Statutes, sets forth the rules governing the balance billing of a subscriber of a health maintenance organization (HMO). The basic rule is as follows: If an HMO is liable for services rendered to a subscriber by a provider, regardless of whether a contract exists between the organization and the provider, the organization is liable for payment of fees to the provider and the subscriber is not liable for payment of fees to the provider. The key question then is when is the HMO liable for payment? Subsection (2) of the statute provides that an HMO is liable for services rendered to an eligible subscriber by a provider, if the provider follows the HMO’s authorization procedures and receives authorization for a covered service for an eligible subscriber, unless the provider provided information to the health maintenance organization with the willful intention to misinform the health maintenance organization. The law creates a presumption that a provider does not know and should not know that an HMO is liable unless:a. The provider is informed by the organization that it accepts liability; b. A court of competent jurisdiction determines that the organization is liable; c. The Agency for Health Care Administration (AHCA) make a final determination that the HMO is required to pay for such services subsequent to a recommendation made by the Statewide Provider and Subscriber Assistance Panel pursuant to Section 408.7056, Florida Statutes; or d. AHCA issues a final order that the organization is required to pay for such services subsequent to a recommendation made by a resolution organization pursuant to Section 408.7057, Florida Statutes. The following examples will help explain the applicability of the balance billing statute: 1. If an HMO patient, in a non-emergency situation, knowingly goes out of network to a non-contracted physician for
Google Sites
Report abuse