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amount paid by the insurance companies to contracted providers. Any physician who believes that they have received an amount less than the usual and customary charge is encouraged to contact the FMA legal department at legal@flmedical.org. Other Points to Note: Ø The prohibition on billing the patient does not apply to the provision of “noncovered” services. Physicians are free to bill patients for the full amount of any service that is not covered by the patient’s insurance company. Ø A PPO/EPO plan must cover certain “emergency services” – “medical screening, examination, and evaluation by a physician . . . to determine if an emergency medical condition exists, and if it does, the care, treatment, or surgery for a covered service by a physician necessary to relieve or eliminate the emergency medical condition within the service capability of the hospital.” The PPO/EPO plan will always be solely responsible for the full payment (with the exception of copayments, coinsurance and deductibles) of all emergency services. Ø For nonemergency services, the prohibition on balance billing the patient applies only when services are provided by a nonparticipating provider in a contracted facility (defined as a hospital, ambulatory surgical center, or urgent care center) and only when the patient does not have the ability and opportunity to choose a participating provider available to treat the patient. If the patient chooses the services of a nonparticipating provider knowing that a participating provider is present and available, the balance billing ban does not apply. If the noncontracted nonemergency services are provided in a facility that does not have a contract with the patient’s PPO/EPO plan, the balance billing ban does not apply. Ø The ban on balance billing does not apply to noncontracted services provided outside of a hospital, ambulatory surgical center, or urgent care center. If you provide noncontracted services to a PPO/EPO patient in your office, you can balance bill the patient, even if the services are provided as a follow up to emergency services provided in a hospital. Ø HB 221 provides that it is grounds for discipline to fail to comply with s. 627.64194 (balance bill a PPO/EPO patient when prohibited) or s. 641.513. Such failure, however, must be willful and done with such frequency as to indicate a general business practice. Ø If there is a dispute with the PPO/EPO plan over the proper usual and customary charge, the noncontracted physician can elect to resolve the dispute in a court of competent jurisdiction, or through the dispute resolution process mentioned above. This dispute resolution process is voluntary. A physician need not go through this process prior to filing a lawsuit. Ø A noncontracted facility providing emergency services to a PPO/EPO patient may not balance bill the patient for any amount not covered by the patient’s PPO /EPO plan. If you have any questions related to balance billing of PPO/EPO patients please contact Jeff Scott at jscott@flmedical.org. 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: June 2016 CANADIAN DRUGS AND PRESCRIPTIONS Canadian law does not allow a Canadian pharmacist to fill a prescription written by a physician licensed only in the United States. A Canadian physician must issue the prescription (in fact, the Canadian province may require that the physician be licensed in that province.) Some Canadian physicians have been signing off en masse on U.S. issued prescriptions that are being brought into Canada to be filled, but Canadian medical authorities have started investigating the Canadian physicians who are doing this without adequate examination of the patient. While it is not illegal for a Florida physician to write a prescription that the patient is going to have filled in Canada, Florida physicians should refrain from giving any advice on the matter to their patients. The following information regarding Canadian drugs comes from Jay Fisher, JD, Legislative Analyst with the American Academy of Orthopedic Surgery: It is a violation of the Food, Drug and Cosmetic Act (21 USC) to import drugs into the United States from Canada by or for individual US consumers [21 USC]. The reason for this is that FDA approvals are "manufacturer-specific" and "product-specific," and they include many requirements relating to the drug including location, formulation, source and specifications of active ingredients, processing methods, manufacturing controls, container/closure systems and appearance. If a specific drug was originally manufactured in the US and then exported, it is permissible for it to be imported back to the States, but only if the importation is done by the US manufacturer [21 USC Section 381(d) (1)]. In the view of the FDA, virtually all shipments of prescription drugs imported from a Canadian pharmacy will run afoul of the Act. If parties are involved in violations of the Act, there are many potential avenues of liability. A court can enjoin violations of the Act. A person who violates the Act can also be held criminally liable. Those who can be found civilly and criminally liable under the Act include all who cause a prohibited act. Those who aid and abet a criminal violation of the Act, or conspire to violate the Act, can also be found criminally liable. FDA's "personal importation policy" is used in connection with importations of drugs by individuals for their personal use only. Under this policy, the Agency allows individuals and their physicians to bring into the United States small quantities of drugs sold abroad for the consumers' treatment for which effective medication is not available domestically. The Agency makes it very clear that its "personal importation policy" is not intended to allow importation of foreign versions of drugs that are already approved in the U.S. (FDA is apparently of the opinion that foreign versions of US-approved drugs are what Canadian pharmacies often sell to US consumers unbeknownst to them.) The Catch 22 situation, of course, is that if the drug is not a foreign version of a US drug (that is, it was manufactured in the US according to FDA guidelines and then exported), under the Food, Drug and Cosmetic Act it can only be imported back by the original manufacturer; that is, not an individual or a doctor. See above. FDA has further emphasized that its policy is not something that is formally permitted under federal law; it's simply a matter of "enforcement discretion." While the Agency acknowledges it has not often prosecuted individuals and providers importing illegal drugs into the US from Canada, it reserves the right to do so if it so chooses. 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: December 2009 CHILD, ELDER AND SPOUSAL VIOLENCE With the issue of domestic violence receiving headlines over the past several years, there has been renewed interest in the obligations of a physician to report suspected and known cases of domestic violence. Fortunately, Florida law is explicit with regard to the obligations of a physician to report suspected domestic violence, although the laws do differ with regard to child abuse, spousal abuse and elder abuse. The one common theme, however, is that virtually any known abuse must be reported to the appropriate authorities. With regard to child and elder abuse, the laws are virtually identical. Sections 39.201(1) and 415.1034,
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