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The Florida Department of Health Accused me of Prostitution and Practicing without a Massage Therapy License…Now What?

What is a Massage?

According to Florida Statute, a “massage” means the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device, or the application to the human body of a chemical or herbal preparation.

A “massage therapist” is a person licensed by the Florida Department of Health (“DOH”) who administers massages for compensation. You must be at least 18 years old, possess a high school diploma or its equivalent and completed a course of study at a board-approved massage school or apprenticeship program in order to qualify for licensure as a massage therapist.

An “apprentice” means a person approved by the board to study massage under the instruction of a licensed massage therapist. A “designated establishment manager” is a Florida licensed massage therapist who is responsible for the operation of a message establishment and is designated as such with the DOH.

 

Massage Establishment Licensure Requirements

A massage establishment may only operate if it has received a license to do so by the DOH. If the DOH determines that the proposed establishment would fail to meet the standards of the Board of Massage Therapy (“Board”) the DOH must deny the application for license in writing and list the reason for the denial. The applicant has the opportunity to correct any deficiencies and reapply for licensure. If you show that you can reasonably meet the standards of the DOH for the operation of a massage establishment then the DOH will grant the license once the licensing fee is paid, subject to any restrictions that the DOH may impose.

A massage establishment license issued to an individual, partnership, corporation or limited liability company may not be transferred from the licensee to another individual, partnership, etc. However, a license may be transferred from one location to another after inspection and approval by the Board and payment of the inspection fee. Additionally, a license may be transferred from one business name to another after approval by the board and payment of the fee.

A massage establishment must have a designated establishment manager. Failure to have a designated establishment manager practicing at the location of the establishment will result in suspension of the establishment license.

By January 1, 2021, a massage establishment must implement a procedure for reporting suspected human trafficking to the National Human Trafficking Hotline or to a local law enforcement agency and must post in a conspicuous place within the establishment, which is accessible to employees a sign with the relevant provisions of the reporting procedure.

 

Documents Required while working in a Massage Establishment

Any person that is employed by a massage establishment and any person performing massages must provide to any DOH investigator or law enforcement officer a valid form of government identification while in the establishment. Examples of valid identification includes an unexpired driver license or identification card issued by any state or territory of the United States, a valid and unexpired United States passport, green card, employment authorization card, or a naturalization certificate.

If you operate a massage establishment you must provide a valid form of government identification and a copy of valid government identification for each employee and any person performing massages in your establishment. If you fail to provide these documents you can be punished with a maximum of 60 days in jail and/or a maximum fine of $500 for your first violation.

Prohibited Acts and Grounds for Discipline

  1. Valid License to Practice

No one may hold oneself out to the public as a massage therapist or practice massage therapy without a valid license to do so or special exemption from licensure. You may not operate a massage establishment without first receiving a license from the DOH. The owner of a massage establishment must not: (a) permit an employed person to practice massages without license to do so; (b) present as his or her own the license of another person; (c) allow the use of his or her license by an unlicensed person; (d) give false or forged evidence to the DOH in obtaining any license; and (e) falsely impersonate another license holder. If you do any of the aforementioned acts you may be found guilty of a misdemeanor of the first degree, which is punishable by imprisonment up to one year and/or a maximum fine of $1000 per occurrence.

 

2. Action Against your License

According to Florida Statute §480.046(1)(b), you may be subject to discipline by the DOH if your license to practice massage therapy has been revoked, suspended or otherwise acted against by the licensing authority of another state, territory or country. This means that if your license in New York is suspended then the Florida DOH may or may not decide to suspend your license as well or worse based on the facts and other circumstances. Other common acts that constitute grounds for discipline include, but are not limited to, (i) false, deceptive or misleading advertising; (ii) conviction of a crime in any jurisdiction which directly relates to the practice of massage or the ability to practice massage; (iii) attempting to induce or engage a client in unlawful sexual misconduct through advertising; (iv) aiding or assisting any unlicensed person to practice massage therapy; (v) being unable to practice massage with reasonable skill and safety due to illness or use of alcohol, drugs, narcotics, chemicals or any other material that impairs your mental or physical condition; (vi) practicing beyond the scope permitted by law when the licensee knows or has reason to know she is not competent to perform; (vii) delegating professional responsibilities to a person that the licensee knows or has reason to know is not qualified to perform; (vii) refusing to allow DOH inspector to inspect your massage establishment during regular business hours; (ix) failing to maintain clean and sanitary conditions in your massage establishment; and (x) practicing at a place that is not duly licensed as a massage establishment except for at the residence or office of a client, sports event, convention or a trade show.

 

3. Prostitution

Prostitution means the giving or receiving of the body for sexual activity for hire but excludes sexual activity between spouses. It is unlawful to (a) own, establish, maintain, or operate any place for the purpose of prostitution; (b) offer or agree to secure another for the purpose of prostitution; (c) receive or agree to receive any person into any place for the purpose of prostitution or to permit any person to remain there for that purpose; (d) to solicit, induce, entice or procure another to commit prostitution; and (e) to purchase the services of any person engaged in prostitution.

DOH must issue an Emergency Order to suspend the license of a massage therapist or establishment if the DOH is notified that the massage therapist or any person with an ownership interest in the establishment has been found guilty of or has entered a guilty plea or nolo contendere, regardless of the adjudication, of any of the following felony offenses in this state or any other jurisdiction: kidnapping, false imprisonment, luring or enticing a child, human trafficking, human smuggling, sexual battery, relating to procuring a person under the age of 18 for prostitution, selling or buying of minors into prostitution, coercing another to become a prostitute, deriving support from the proceeds of prostitution, sexual performance by a child, transmission of material harmful to minors to a minor by electronic device or equipment, and lewd or lascivious acts committed upon or in the presence of a person under the age of 16 or any elderly or disables person, to name a few.

 

4. Penalties

If you perform any of the prohibited acts the DOH will deny your license or impose other penalties against an applicant for licensure. The DOH will revoke or suspend the license of the massage establishment if any jurisdiction has entered a final order or other disciplinary action taken for sexual misconduct involving prostitution, crimes related to the practice of massage therapy involving prostitution or a conviction or plea of  guilty or nolo contendere to any misdemeanor or felony crime related to prostitution. If this occurs, the establishment owner may not reapply for an establishment license and may not transfer the license. The designated establishment manager who was found to have committed one or more of these acts may not reapply for a license.

 

5. Hours of Operation

A person may not operate a massage establishment between the hours of midnight and 5 a.m. unless your establishment is located in a healthcare facility, healthcare clinic, hotel, motel, or bed and breakfast, a timeshare property, public airport or a pari-mutuel facility.

Notice from DOH Regarding Unlicensed Massage Therapy Activity

You will receive a Case Summary along with the notice, which will list all of the possible violations, the contact information for the informant (if available), the date that the report/complaint was received by DOH and any investigation notes available at that time. The Investigative Services Report will list Massage Establishment Requirements generally and whether or not you have met those requirements.

The DOH notice usually gives you 20 days after receiving the letter to either (1) submit a written response or (2) call DOH’s office to schedule an interview. Additionally, they ask for you to provide your curriculum vitae and specialty even if you choose not to submit a written response. Subsequently, a Probable Cause Panel will convene to determine whether based on the evidence before them that a violation has occurred. You can make a written request for a copy of the investigative file after the investigation is complete regardless of whether the Probable Cause Panel decided that you have committed a violation.

It is not mandatory to submit a written response to the Department of Health and you have the right to be represented by an attorney. However, depending on the circumstances, you may want to provide supporting documents to the DOH otherwise all the investigators (and potentially the Probable Cause Panel) have to go off of is the investigation notes. If you do submit a written response it becomes part of the public record and absent extenuating circumstances it can likely be used against you in an administrative proceeding before an Administrative Law Judge. Keep in mind that in order to alleviate DOH and the Board’s concerns about the alleged activity that there will be an unannounced re-inspection of the establishment at some point. It is important that any perceived violations do not remain during that re-inspection period or else you risk receiving an Administrative Complaint where the DOH may try to take significant action against your license.

 

Conclusion

The DOH and law enforcement officers are making significant efforts to investigate and arrest people who are engaging in human trafficking and prostitution in massage establishments. In determining what action is appropriate the Board must consider what sanctions are necessary to protect the public. Typically, if the ground for disciplinary action is the first-time violation of a practice act for unprofessional conduct and no actual harm to the patient occurred, The Board, must issue a citation in accordance and assess a penalty. If the Board determines that revocation of a license is the appropriate penalty, the revocation is permanent. However, the Board may establish by rule requirements for reapplication by applicants whose licenses have been permanently revoked.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

 

AHCA Application for Exemption from Disqualification

If you are reading this article it means that you have probably received a letter from the Agency for Healthcare Administration (“AHCA”) stating that they have uncovered criminal offenses that disqualify you from working for a health care provider. AHCA may have uncovered this offense a result of background screening submitted as part of the employment process for a health care provider and/or participation as a Medicaid provider. This applies to clinical staff as well as facility owners, administrators and chief financial officers and those seeking enrollment as a provider in the Florida Medicaid program. Fear not, because you may be eligible to file an Exemption from Disqualification if you meet certain criteria.

Am I Eligible for Exemption?

Our firm can assist you with demonstrating to AHCA by clear and convincing evidence that an exemption from disqualification should be granted. The application will only be reviewed once all relevant supporting documents are received by AHCA. You are only eligible for Exemption from Disqualification if:

  1. You have been lawfully released from confinement, supervision or other nonmonetary condition imposed by the court for a disqualifying misdemeanor criminal offense;
  2. At least 3 years after you have been lawfully released from confinement, supervision, or other nonmonetary condition imposed by the court for a disqualifying felony criminal offense;
  3. You have completed any court-ordered fee, fine, fund, lien, civil judgment, application, costs of prosecution, trust, or restitution as part of the judgment and sentence for any disqualifying felony or misdemeanor in full; and
  4. If you have been designated as a sexual predator, sexual offender or career offender you are not eligible for an exemption from Disqualification.

 

Filing the Application

Filling out the application can be a bit tricky, so you should definitely hire a health law attorney that has experience with doing so in order to prevent delays in processing your application. In addition to completing the Application for Exemption from Disqualification you will need to provide AHCA with the following:

  1. Current Level II Screening;
  2. Arrest Reports;
  3. Court Dispositions;
  4. Signed Statement (only if you cannot obtain the arrest report and/or court disposition);
  5. Probation and/or Parole records;
  6. Letters of Reference; and
  7. Documentation of Rehabilitation

It is important to note that when you apply for exemption you must provide all arrest reports, including those that were not specifically listed in the notice that you received from AHCA. You will also need to provide all court dispositions no matter the plea, judgment, verdict or even if it was sealed or expunged from your record. All of these documents will need to be neatly organized and AHCA must receive the documents within 30 days from receipt of its letter. It may take a little bit of legwork to retrieve these documents, so it is important to contact our firm as soon as possible so that we don’t miss the deadline. AHCA rarely grants extensions for filing the application.

Finally, if you are a certified or licensed healthcare professional you may also have to file an application for exemption with the Florida Department of Health (“DOH”). Florida Statute 408.809(7)(a) states that AHCA may grant an exemption from disqualification to a person who is subject to this section and who: (1) Does not have an active professional license or certification from the DOH; or (2) has an active professional license or certification from the DOH but is not providing a service within the scope of that license or certification.You may also have to submit a signed background screening privacy policy acknowledging receipt of the privacy policy. Once the DOH receives your application they will review it and make a decision as long as that person is working in the scope of their license or certification.

What Happens After Filing?

Once AHCA received the documents, it will be transferred to the Exemption Team and assigned to one of their analysts. As stated earlier, the analyst is looking for clear and convincing evidence that the employee should not be disqualified from employment. The Agency will consider the following:

  • The circumstances surrounding the criminal incident(s) for which an exemption is sought;
  • The time period that has elapsed since the incident(s);
  • The nature of the harm caused to the victim;
  • The history of the employee since the incident(s);
  • Any other evidence or circumstances indicating that the employee will not present a danger if employed or continued employment is allowed; and
  • Whether the applicant has been arrested for or convicted of another crime, even if that crime is not a disqualifying offense.

Once you’ve submitted your application it takes approximately 30 days for AHCA to render its decision to you. Exemptions granted by one agency will be considered by other agencies, but it is not binding on subsequent agencies. It is possible for AHCA and DOH to deny your application even though you feel you meet the criteria for an exemption. In those instances, our firm will represent you before AHCA and DOH Boards if you chose to contest the Agency decision. You have 21 days from the date you sign for the certified letter to request an appeal. The administrative law judge will only decide whether the agency’s intended action is an abuse of discretion.

Job Status

Are you allowed to continue to work for your employer after you’ve submitted the application for Exemption from Disqualification? It depends on the circumstances. If you were screened and hired by your current employer on or before June 30, 2014 and this disqualification was due to a rescreening by the same employer, you may continue work if you meet all of the following criteria:

  1. You are eligible to apply for exemption;
  2. Your disqualifying offense was not disqualifying at the time of your last screening, but is now disqualifying and was committed before the date of your last screening;
  3. Your employer agrees that you may continue working; and
  4. You submit your application timely.

According to Florida Statute, 408.809(4) an employee may continue to perform her duties and her employer may continue to allow her to have contact with any vulnerable person (i.e. physical therapy patients) that would place employee in a role that requires background screening while her application for exemption from disqualification by the agency is being processed and under review. You also must make sure that your license stays active if you are a licensed healthcare provider, which means that you should submit any renewal forms and correct any omissions to prevent your license from expiring.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services please contact me using the contact information listed above.

All of the information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Reinstatement After A Healthcare Entity or Individual is Placed on the OIG and Florida’s Exclusion List

What is the Exclusion List?

The Office of Inspector General’s (“OIG”) list of Excluded Individuals and Entities (“LEIE”) provides information to the healthcare industry, patients and the public regarding individuals and entities currently excluded from participation on in Medicare, Medicaid and all other Federal healthcare programs.

OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. On May 8, 2013, the OIG released a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, which states that no federal healthcare program payment may be made for items or services furnished by (1) an excluded person or (2) at the medical direction or on the prescription of an excluded person.

 

What is the Administrative Process for LEIE?

When an individual or entity gets a “Notice of Intent to Exclude” (“NOI”), it does not necessarily mean that they will be excluded. OIG will carefully consider all material provided by the person who received the NOI before making a decision. All exclusions implemented by OIG may be appealed to an HHS Administrative Law Judge (“ALJ”), and any adverse decision may be appealed to the HHS Department Appeals Board (“DAB”). Judicial review in Federal court is only available after a final decision by the DAB.

If the OIG decided to proceed with exclusion, they will send the individual or entity a Notice of Exclusion along with information about the effect of the exclusion and appeal rights. Exclusions are effective 20 days are the Notice of Exclusion is mailed, and notice to the public is provided on OIG’s website.

When a permissive exclusion (discussed below) is being considered, the NOI allows the individual or entity to request an opportunity to present oral argument to an OIG official before a decision about whether to exclude is reached. This is in addition to the right to submit documentary evidence and written argument. The process and requirements vary depending on which section of the Social Security Act is violated.

 

How do I determine if I’ve been placed on the list?

The following are two options available to determine whether you are on the LEIE:

  1. The Online Searchable Database enables users to enter the name of an individual or entity and determine whether they are currently excluded. If a match is made on an individual, the database can verify with an individual’s Social Security Number that the match is unique. Employer Identification Numbers are available for verification of excluded entities.

 

  1. The Downloadable Database enables users to download the entire LEIE to a personal computer. Supplemental exclusion and reinstatement files are posted monthly to the OIG’s website, and these files can be merged with the previously downloaded data file to update the list.

The OIG recommends that you check the exclusion list on a monthly basis. Monthly checks should be documented so that an organization can demonstrate that they have acted in good faith to screen against excluded individuals or entities. Both databases are updated by the middle of each month. You can search here: https://exclusions.oig.hhs.gov/

Providers must also review Florida’s exclusion database while it is performing background searches.

 

Are there different types of exclusion?

There are two types of exclusions under the Social Security Act:

  1. Mandatory Exclusion – The OIG is required by law to exclude from participation in all federal healthcare programs individuals and entities convicted of the following criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other state healthcare programs; patient abuse or neglect; felony convictions for other healthcare related fraud, theft, or other financial misconduct; and felony convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

 

  1. Permissive Exclusion – The OIG has discretion to exclude individuals and entities on a number of grounds including, but not limited to, misdemeanor convictions related to healthcare fraud other than Medicare or a state health program; fraud in a program (other than a healthcare program) funded by any federal, state, or local government agency; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances, suspension, revocation, or surrender of a license to provide healthcare for reasons bearing on professional competence, professional performance, or other financial integrity; provision of unnecessary or substandard services; submission of false or fraudulent claims to a federal healthcare program; engaging in unlawful kickback arrangements; defaulting on a health education loan or scholarship obligation; and controlling a sanctioned entity as an owner, officer, or managing employee.

For all proposed mandatory exclusions lasting longer than the mandatory minimum five-year period, and most proposed permissive exclusions the administrative process is the same. OIG will send out a written NOI to any individual that they are considering excluding. The NOI included the basis for the proposed exclusion and a statement about the potential effect of an exclusion.

If you’ve already hired someone or contracted with a vendor prior to discovering that they are on the LEIE you may be required to Self-Disclose the hiring.

 

Reinstatement from the LEIE

Reinstatement of an excluded individual or entity is not automatic once the specified period of exclusion ends. In order to participate in Medicare, Medicaid, and all Federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted.

An individual or entity with a defined period of exclusion (e.g., 5 years) may begin the process of reinstatement 90 days before the end of the period specified in the exclusion notice letter.

An individual or entity excluded under section 1128(b)(4) of the Social Security Act, whose period of exclusion is indefinite, may apply for reinstatement when they have regained the license referenced in the exclusion notice. In addition, under some conditions an individual or entity excluded under section 1128(b)(4) or the Act may apply for reinstatement if they have (1) obtained a different healthcare license in the same state; (2) any healthcare license in a different state; or (3) have been excluded for a minimum period of 3 years.

To apply for reinstatement, an excluded individual or entity must send a written request to the OIG. If the individual is eligible to apply for reinstatement, the OIG will then mail Statement and Authorization forms that must be completed. Once the information have been evaluated, a written notification of OIG’s final decision on reinstatement will be provided via mail. If reinstatement is denied, the excluded individual or entity is eligible to reapply after one year.

Individuals and entities who have been reinstated are removed from the LEIE.

Penalties for Excluded Individuals or Entities

OIG may impose civil monetary penalties of up to $10,000 for each item or service furnished by the excluded person for which federal program payment is sought. They may also be forced to pay treble damages and program exclusion.

An excluded person may be civilly liable under the False Claims Act for knowingly presenting or causing to be presented a false or fraudulent claim for payment. Violations could also lead to criminal prosecutions if an excluded person knowingly conceals or fails to disclose any action affecting the ability to receive any benefit or payment with the intent to fraudulently receive such benefit or payment. Additional criminal statutes may also apply to such violations.

The information above only scratches the surface of dealing with LEIE issues. Depending on the facts of your case the circumstances, procedures, and potential outcome can vary greatly. If you have received an NOI, discovered that one of your contractors or employees is on the LEIE, or you have been excluded from receiving Federal program dollars and desire to be reinstated you should contact us immediately. We have experienced Health Law attorneys on staff who can help you navigate the entire process.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services please contact me using the information listed above.

All of the information and references made to laws, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

 

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