There is one simple way for a Florida medical clinic to avoid being licensed and undergoing an annual inspection: Don't accept insurance.
A bill moving through the Legislature would close that loophole for so-called cash-only clinics, which can escape government oversight because the statutory definition of a clinic is interpreted as an operation that takes third-party insurance.
The bill (SB 746) sponsored by Sen. Eleanor Sobel, D-Hollywood, would require that all medical clinics be subject to licensure, renewal and inspection, whether they accept insurance or not.
Many of the cash-only clinics are run by business people with no connection to the medical field, but must hire a licensed doctor to oversee the operation and sign prescriptions. Because the clinics aren't licensed, the state doesn't know how many exist.
"There is no regulation of clinics, it truly is the Wild West out there," said Kenneth Woliner, a Boca Raton physician who thinks the clinics should be regulated. He said finding clinics that run without oversight is simple: The places open, treat patients and then quickly move on. The doctors who are hired to run the clinics are often "older doctors and they just need money and don't care," he said.
Sobel's bill is moving slowly, if at all. She looks at the disinterest in the statehouse as a problem of regionalism. Most of the unlicensed clinics are in her district and other parts of South Florida, so getting legislators from other parts of the state interested is difficult.
"This is often how the pill mills operate," Sobel said, referring to clinics and pharmacies that illicitly dispense prescription narcotics like painkillers. "But I'm not sure anyone up here knows that. They just don't have the problem to the extent we do."
Molly McKinstry, deputy secretary for health quality assurance at the state's Agency for Health Care Administration, said the current system is structured to prevent insurance fraud. She said that while the cash-only clinics aren't licensed, the doctors and nurses are.
"The concept of regulating providers where patients are paying for their own care is not part of that package. But the practitioners who work there, the doctor, is licensed and monitored by the Department of Health," McKinstry said.
One cash-only clinic is the Refinery, a South Florida company that advertises its services to provide testosterone and help for erectile dysfunction.
The operation, with four locations, is not registered with the state as a clinic nor as a medical facility and probably doesn't need to be under current law. The Refinery recently posted a Craigslist ad seeking a part-time doctor who would be paid $85 an hour. The group offered to train the suitable applicant on Friday or Saturday morning "and have you seeing patients next week if possible."
A person answering the phone at the Refinery said the company doesn't take insurance but will forward information on to the insurer on behalf of the patient.
Records show the Refinery's owners, Brandon and Simon Heath, are based in the Dallas area with a background in investments and realty.
Brandon Heath did not return two phone calls or an email. Phone numbers listed for Simon Heath were disconnected.
While no one accuses the Refinery or the Heaths of malfeasance, the idea of a clinic offering drug treatments without state knowledge is disconcerting, Sobel said.
"No one knows about a lot of this kind of activity if there's no investigative report to expose it," she said.