The Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before offering certain new or expanded services. It is also considered a powerful tool in reducing health care fraud.

Compared to other states with a Certificate of Need policy, healthcare law in Florida is considered to be minimally regulated. The state established its Certificate of Need Law in 1973, but following the current healthcare policy, it does not regulate all hospital projects.

The Agency for Health Care Administration initially oversaw Florida’s Certificate of Need program. It historically required care providers to seek approval before the construction or expansion of their facilities, offering new services, or purchasing specific advanced equipment. 

Approvals were usually given after a proven need for the expanded facilities or services in a certain geographic area. This would often require health care providers to prove that these expansions were indeed necessary.  Without such proof, they could not obtain a license.

Repealing the Certificate of Need Law

Florida recently removed certain regulatory policies that had previously demanded healthcare facilities such as hospitals, nursing homes, and hospices to seek state approval to add services or buildings. To do that, the health care facility had to prove that the expansion of buildings or services was, in fact, necessary. The new health care bill sought to change that.

Initially, the Senate aimed to restrict this move, setting certain criteria for hospitals to bypass the regulations, such as having emergency rooms, charity practice, and providing services to Medicare and Medicaid patients. However, the restrictions were eventually removed from the final version of the health care bill.

In a 2018 federal healthcare report, the federal government stated that Certificate of Need (CON) laws interfere with patient choice and lead to rising health costs nationwide. Supporters of the new health care legislation believe that the removal of the CON regulations will result in increased competition between healthcare providers, which is eventually supposed to lead to decreased costs for patients. 

Updated Healthcare Policies

The current CON healthcare bill, known as HB 21, applies to hospitals, neonatal intensive care units, and organ transplant centers. These health care facilities have become exempt from the Certificate of Need as of July 1, 2019. Starting July 1, 2021, specialty hospitals will also no longer be required to comply with CON. However, the Certificate of Need regulations will still apply to nursing homes, hospices, and intermediate care facilities.

Repealing CON policies has curtailed the possibility for established healthcare providers to interfere with or oppose new care facilities, which could potentially pose a threat to their business.

These changes in the CON legislation are part of a shift currently taking place in many states across the country.  Once HB 21 was approved, Florida became the fifth state in which the Certificate of Need program was limited.

CON Repeal: Healthcare Fraud Concerns

Although repealing the Certificate of Need received broad support, the new legislation did not pass without certain criticism.

In particular, opponents of the updated healthcare bill have made claims that such a drastic reduction in regulation may lead to another increase in Medicare and Medicaid fraud. Despite attempts to bolster regulation, such as the False Claims Act of 1994 and anti-kickback laws, Florida already experiences more federal healthcare fraud than nearly any other state in the US,  with over $2 billion in Medicare fraud alone in 2018.

Concerns over growing healthcare fraud cases aren’t unwarranted, either. When home healthcare was deregulated in 2000, Florida saw a sharp uptick in health care fraud across the board. CON laws limit the number of open facilities reducing the chances of less-than-reputable organizations sneaking through the cracks. They also make it easier for Florida’s health care fraud prevention and enforcement units to track fraud across the state.

No Matter What, Our Healthcare Fraud Attorneys Have You Covered

The frequent shifts in Florida healthcare and fraud legislation can be confusing, but no matter what, you can always count on the healthcare fraud lawyers at Tache Bronis to provide reliable legal advice based on expertise and experience.

Defense Attorneys, Miami Florida

If you are in the Miami-Dade area and believe you may need an insurance fraud attorney, healthcare fraud attorney, or any type of healthcare fraud defense, we are happy to provide you with a free consultation. We have years of experience handling healthcare fraud cases and false claims act violations, and can help ensure your rights are protected. To discuss your fraud case with a leading Miami healthcare fraud lawyer, call Tache Bronis at 305-537-9565.

Disclaimer: The information in this blog post (“post”) is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.


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