DEPARTMENT OF HEALTH, STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE PETITIONER, v. CASE NO. 2014-04393 CRAIG SAMUEL ADERHOLDT, D.C. RESPONDENT. ADMINISTRATIVE COMPLAINT Petitioner, Department of Health ("Department"), by and through its undersigned counsel, files this Administrative Complaint before the Board of Chiropractic Medicine ("Board") against Respondent, Craig Samuel Aderholdt, D.C. ("Respondent"). In support, Petitioner alleges: 1. Petitioner is the state department charged with regulating the practice of Chiropractic Medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 460 Florida Statutes. 2. At all times material to this Complaint, Respondent was licensed to practice chiropractic medicine in the State of Florida, having been issued License Number CH 7814. 1
3. Respondent's address of record is 5221 26th Street West, Bradenton, Florida 34207. 4. From on or about April 2013, through on or about June 2013, ("treatment period"), Respondent treated Patient B.O., a then seventyeight-year-old female, for back pain. 5. Prior to treatment, Respondent advised Patient B.O. that he could relieve her back pain through use of an activator adjustment. 6. Respondent informed Patient B.O. that her insurance would cover the cost of treatment; however, Patient B.O. would be responsible for paying the co-payment of twenty-five ($25.00) dollars due to Respondent being out-of-network. 7. On one or more occasion, Respondent billed Patient B.O. twenty-five dollars ($25.00) as the co-payment for each visit. 8. Subsequently, Patient B.O. reviewed her Explanation of Benefits from Patient B.O.'s insurance provider (hereinafter "Blue Shield") to discover that her treatment by Respondent was considered in-network which resulted in her co-payment being fifteen dollars ($15.00) per visit and not the twenty-five dollars ($25.00) per visit as instructed and billed by Respondent. 2
9. On one or more occasion, Patient B.O. informed Respondent of the overpayments made to his office but Respondent failed to reimburse Patient B.O. any overpayments. 10. Patient B.O. requested medical records from Respondent. 11. Respondent failed to provide Patient B.O. with medical records. 12. Patient B.O. requested updated patient ledger information from Respondent. 13. Respondent failed to provide Patient B.O. with updated patient ledger information. 14. During the treatment period for Patient B.O., Respondent billed Blue Shield for treatment provided to Patient B.O. that Respondent did not actually provide to Patient B.O. COUNT I 15. Petitioner re-alleges and incorporates paragraphs one (1) through three (3), and thirteen (13), as if fully set forth herein. 16. Section 460.413(1)(x), Florida Statutes (2012-2013), provides that submitting to any third-party payor a claim for a service or treatment which was not actually provided to a patient shall be grounds for discipline. 17. Respondent violated section 460.413(1)(x), Florida Statutes, 3
when on one or more occasion he submitted a claim to a third-party payor for treatment of Patient B.O. when he did not provide Patient B.O. with treatment or service on that date. 18. Based on the foregoing, Respondent violated Section 460.413(1)(x), Florida Statutes, by submitting a claim to a third-party payor for treatment or services that were not actually provided. COUNT H 19. Petitioner re-alleges and incorporates paragraphs one (1) through three (3), nine (9), and ten (10), as if fully set forth herein. 20. Section 460.413(1)(i), Florida Statutes (2012-2013), provides that failing to perform any statutory or legal obligation placed upon a licensed chiropractic physician shall be grounds for discipline. 21. Rule 64B2-17.0055(1), Florida Administrative Code (2012-2013), provides that any person licensed pursuant to Chapter 460, Florida Statutes, is required to release copies of patient medical records upon request of the patient or his legal representative. 22. Respondent violated section 460.413(1)(i), Florida Statutes by violating rule 64B2-17.0055(1), Florida Administrative Code (2012-2013), when Respondent failed to provide Patient B.O. with her medical records. 4
23. Based on the foregoing, Respondent violated section 460.413(1)(i), Florida Statutes, by violating 6462-17.0055 Florida Administrative Code, when he failed to provide Patient B.O. with her medical records. COUNT III 24. Petitioner re-alleges and incorporates paragraphs one (1) through three (3), eleven (11), and twelve (12), as if fully set forth herein. 25. Section 460.413(1)(aa), Florida Statutes (2012-2013), provides that failing to provide, upon request of the insured, a copy of a claim submitted to any third-party payor for service or treatment of the insured shall be grounds for discipline. 26. Respondent failed to provide Patient B.O. with copies of her updated claim information upon her request. 27. Based on the foregoing, Respondent violated section 460.413(1)(aa), Florida Statutes (2012-2013), by failing to provide, upon request of the insured, a copy of a claim submitted to any third-party payor for service or treatment of the insured. 5
COUNT IV 28. Petitioner re-alleges and incorporates paragraphs one (1) through thirteen (13), as if fully set forth herein. 29. Section 460.413(1)(k), Florida Statutes (2012-2013), provides that making misleading, deceptive, untrue, or fraudulent representations in the practice of chiropractic medicine or employing a trick or scheme in the practice of chiropractic medicine when such trick or scheme fails to conform to the generally prevailing standards of treatment in the chiropractic medical community shall be grounds for discipline. 30. Respondent violated section 460.413(1)(k), Florida Statutes in the following ways: a. by telling Patient B.O. that Respondent's treatment of Patient B.O. was out-of-network when her treatment by Respondent was innetwork; b. by billing Patient B.O. twenty-five dollars ($25.00) as copayment for each visit when she was only responsible for paying fifteen dollars ($15.00) for each visit; c. by billing Blue Shield for medical visits for Patient B.O. that did not occur on one or more occasion; 6
d. by failing to provide Patient B.O. with any form of reimbursement that he had received from Blue Shield; 31. Based on the foregoing, Respondent violated section 460.413(1)(k), Florida Statutes, when he made a misleading, deceptive, untrue, or fraudulent representation to Patient B.O. in the practice of chiropractic which failed to conform to the prevailing standard of care in the chiropractic medical community. WHEREFORE, the Petitioner respectfully requests that the Board of Chiropractic Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board of Chiropractic Medicine deems appropriate {Remainder of Page Intentionally Left Blank} 7
SIGNED this RC) day of 34..)ne 2018. Celeste Philip, M.D., M.P.H. Surgeon General and Secretary, D EPART PILED MENT DEPUTY OF HEAL TH DATE CLERK Angel Sanders CLERK juti 0 208 PCP Date: 6-19-18 PCP Panel Members: Fox and Vogel Derrick J. McBurows Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar #1002311 Phone 850-558-9906 FAX 850-245-4684 derrick.mcburrows@flhealth.gov 8
NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. Please send your request to: If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule 28-106.2015(5), Florida Administrative Code. Please be advised that mediation under Section 120.573, Florida Statutes, is not available for administrative disputes involving this agency action. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4)1 Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. 9