Many states place restrictions on how medical doctors, optometrists, and dentists may organize themselves and conduct business within the state. Some states place significant restrictions on these healthcare providers while others are more lenient. Several states have enacted laws that prohibit certain healthcare providers from being employed by or controlled by any corporation or business, which is not entirely owned by other physicians. This is referred to as the prohibition of the “corporate practice of medicine.” Florida is unique in many ways, including its approach to regulating how these healthcare providers can organize themselves. Florida does not place the same corporate prohibitions on medical doctors as it does with dentists and optometrists.
Under Florida law, licensed healthcare professionals may organize themselves as professional service corporations (“P.A.”) or as professional limited liability companies (“PLC”). However, if a provider organizes her business as a P.A. or PLC she is only allowed to have other members who are in the same profession in her association. They may act as shareholders, officers, or directors of the corporation. For example, a P.A. may only be comprised of M.D.’s and is prohibited from allowing other healthcare providers such as, D.O.’s, dentists or optometrists from becoming shareholders of that P.A.
In Florida, Healthcare providers may also choose to organize themselves as a regular business corporation, with the “Inc.” designation, or as a Florida limited liability company.
Florida professional corporations are governed by the laws contained in Florida Statutes §§ 607, 620 and 621. Additionally, certain healthcare providers are regulated by one or more of the following statutes, Florida Statutes §§ 456 – 468, depending on the type of healthcare services that they provide and the licenses that they hold. Healthcare providers must ensure that they strictly comply with all applicable Florida Statutes and the Florida Administrative Code. Therefore, it is extremely important to hire a knowledgeable attorney that specializes in health law to ensure that your practice is complying with the applicable laws.
Corporate Practice of Medicine
As of April 2018, Florida does not have any laws that expressly prohibits the corporate practice of medicine. In other words, a physician (M.D. or D.O) may be employed by or contracted by non-physician owned corporations for the provision of healthcare services.
Throughout the years, several Declaratory Statements have been issued the Florida Department of Health indicating that there is no prohibition on the practice of medicine by physicians as corporate employees. In re Crow, Crow was a Florida licensed physician who sold his practice to a corporation and was then hired as an employee by that corporation and was provided a flat-fee salary for the provision of his services. Dr. Crow informed each patient of his relationship with the corporation but maintained exclusive control over the medical diagnosis and treatment of patients, and the corporation had no authority to exercise control over Dr. Crow’s professional judgment or the manner in which he rendered medical care to patients. The Board found that this arrangement was permissible so long as the fees generated for the corporation by professional services were actually provided by Dr. Crow and those under his direct supervision.
Corporate Practice of Optometry
Unlike the corporate practice of medicine, Florida expressly prohibits the corporate practice of optometry. Florida Statute §463.014 states that no corporation, lay person, organization or individual other than a licensed practitioner can engage in the practice of optometry by engaging the services, through paying a salary, commission, or other means of inducement to any Florida licensed optometrist.
The law does allow for a licensed practitioner, such as an optometrist, to associate with a multidisciplinary group of licensed healthcare professionals, the primary purpose of which is the diagnosis and treatment of the human body. Optometrists may also employ, or form partnerships or professional associations with Florida licensed practitioners or healthcare professionals, the primary purpose of which is the diagnosis and treatment of the human body.
Corporate Practice of Dentistry
The corporate practice of dentistry is prohibited under Florida law. Florida Statute §466.0285 states that no person other than a Florida licensed dentist or any entity other than a professional corporation or limited liability company composed of dentists may:
- Employ a dentist or dental hygienist in the operation of a dental office.
- Control the use of any dental equipment or material while such equipment or material is being used for the provision of dental services, whether those services are provided by a dentist, a dental hygienist, or dental assistant.
- Direct, control, or interfere with a dentist’s clinical judgment.
- Have a relationship with a dentist which would allow the non-dentist or entity to exercise control over:
- The selection of a course of treatment for a patient, the procedures or materials to be used as part of such course of treatment, and the manner in which such course of treatment is carried out by the dentist;
- The patient records of a dentist;
- Policies and decisions relating to pricing, credit, refunds, warranties, and advertising; and
- Decisions relating to office personnel and hours of practice.
Any lease agreement, rental agreement, or other arrangement between a non-dentist and a dentist whereby the non-dentist provides the dentist with dental equipment or dental materials must provide that the dentist maintains complete care, custody, and control of the equipment or practice.
Dentists must examine the administrative rules implemented by the Florida Board of Dentistry because these rules provide guidance in addition to the statutory law. The Florida Board of Optometry also has its own set of rules that could impact an optometrist’s relationship with others and how it conducts its business.
Whether you are considering creating a corporation for your healthcare practice to take advantage of tax benefits or to limit your exposure to certain types of liability you must determine whether the proposed structure for your corporation is compliant with applicable healthcare laws. For example, Florida law prohibits “fee-splitting” by healthcare professionals. Failure to do so could result in fines, penalties, closure of your office, or imprisonment.