Ron DeSantis GOVERNOR Joseph A. Ladapo, MD, PhD STATE SURGEON GENERAL October 1 - December 31, 2023 Q2 Quarterly Performance Report Florida Department of Health A Medical Quality Assurance Publication
TABLE OF CONTENTS 2 | EXECUTIVE SUMMARY 3 | AROUND MQA 5 | PERFORMANCE STATISTICS 9 | ENFORCEMENT AT A GLANCE 11 | UNLICENSED ACTIVITY INVESTIGATIVE SPOTLIGHT 15 | FINANCIAL SUMMARY 16 | GLOSSARY 17 | CONTACT US MISSION To protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts. VALUES INNOVATION We search for creative solutions and manage resources wisely. COLLABORATION We use teamwork to achieve common goals and solve problems. ACCOUNTABILITY We perform with integrity and respect. RESPONSIVENESS We achieve our mission by serving our customers. EXCELLENCE We promote quality outcomes through learning and continuous performance improvement. VISION TO BE THE HEALTHIEST STATE IN THE NATION How We Work LICENSE ENFORCE INFORM
Jennifer L. Wenhold, MSW, CPM As we navigate the dynamic landscape of health care, our commitment to ensuring the highest standards of licensing and enforcement remains steadfast. It is with great pride that I present the latest edition of our quarterly report, a testament to the dedication and diligence of our teams. MQA continues to evolve to meet the everchanging needs of the health care landscape, and we are pleased to share the strides we have made in enhancing the efficiency and transparency of our enforcement, licensing, and information processes. As we forge ahead, let us remain united in our pursuit of safeguarding the well-being of Floridians and visitors. Commitment to excellence, paired with dedication to innovation and accountability, ensures that we collectively contribute to a health care environment that is both reliable and responsible. I encourage you to delve into the content within this report and to share your insights and feedback as we work together to shape the future of health care regulation in our great state. Together, we continue to build a health care landscape that prioritizes the quality, safety, and well-being of our community. LETTER FROM THE DIRECTOR EXECUTIVE SUMMARY Section 456.025(9), Florida Statutes, requires that the performance and financial health of the Division of Medical Quality Assurance (MQA) are reported quarterly to evaluate its efficiency in regulating health care professions and practitioners. Join us in reflecting on a productive quarter that resulted in various improvements for our health care workforce. LICENSING = 2,000 ENFORCEMENT 1,830 Online Complaints Received 300 Unlicensed Activity Complaints 122 Cease and Desist Orders Issued FINANCES $34 MILLION Overall Cash Balance at the End of Quarter Two Q2 • Quarterly Performance Report • FY 2023-24 2 License 31,786 Initial Applications Received 26,054 New Licenses Issued $ MQA’s inspectors conducted inspections for pharmacies and massage establishments, optical establishments, dental laboratories, and electrolysis facilities (M.O.D.E.) within 5.6-7.1 Days
Q2 • Quarterly Performance Report • FY 2023-24 3 STAYING SAFE ONLINE The month of October has been National Cybersecurity Awareness Month since 2004, a dedicated month for the public and private sectors to work together to raise awareness about the importance of cybersecurity. In the last quarter, MQA took proactive measures to enhance cybersecurity awareness among licensees, emphasizing the importance of remaining vigilant against predatory spoof calls and phishing emails designed to mislead licensees into providing their personal information. MQA staff actively shared valuable tips with licensees to prevent falling victim to scams and promptly report any suspicious activity by encouraging licensees to gather evidence of the solicitation (including details such as phone/fax numbers, email addresses, or postal mail envelopes), and promptly report it to MQA, the Office of the Attorney General, or the Florida Department of Law Enforcement as applicable. By empowering health care practitioners to recognize and respond to potential threats effectively, MQA is bolstering the resilience of Florida’s regulatory framework and ensuring the security of issued health care licenses. This proactive approach underscores our AROUND MQA commitment to safeguarding the interests of health care practitioners, applicants, and consumers alike, fostering a trusted and secure regulatory environment. STRENGTHENING REGULATORY EXCELLENCE WITH ANNUAL TRAINING In October, MQA convened its largest bureau for a comprehensive training session spanning the 11 investigative regions statewide. Skills were taught to the
Bureau of Enforcement by Deputy Sheriffs, certified medical specialists, drug diversion specialists, internal subject matter experts, and more. This gathering provided a vital platform to address emerging trends, legislative updates, updated protocols and processes, and best practices in health care regulation, reaffirming MQA's commitment to fostering excellence and staying at the forefront of investigative expertise. ELI UPDATE MQA’s Virtual Agent, ELI, is an artificially intelligent chatbot that provides real-time customer service on MQA’s board web pages. ELI is available after hours, during the weekend, and on holidays, which allows practitioners to manage licensure applications and receive assistance at times that are convenient for them. With this streamlined process, MQA agents are empowered to focus on complex inquiries, reduce wait times, expand MQA interaction channels, and enhance customer experience. In Quarter Two, MQA live agents answered over 50,000 phone calls and 4,200 chats from health care applicants, practitioners, and consumers while ELI fielded more than 129,000 voice calls and 41,000 web chats. By leveraging ELI and remaining committed to teamwork and outstanding customer service, MQA experienced a 17.4% growth in the number of calls answered in comparison to last year’s second quarter. To learn more about ELI, visit FLHealthSource.gov/ eli or interact with ELI at the bottom of any respective board website. CELEBRATING VETERAN HEALTH HEROES AND PAYING TRIBUTE TO THEIR SERVICE In 2023, MQA proudly unveiled the Florida Veteran Health Heroes publication, a tribute to those who have served in the armed forces and continue to make invaluable contributions to the health care landscape. This report not only highlights the dedication of our Florida Veteran Health Heroes but also showcases the Department of Health's (Department's) commitment to supporting military personnel in their professional endeavors. We call them Veteran Health Heroes; despite taking off their uniforms, they have never stopped serving. To learn more about the evolution of military licensure pathways, the Office of Veteran Licensure Services, and the 2023 Florida Veteran Health Heroes publication, visit FLHealthSource.gov/OVLS. Q2 • Quarterly Performance Report • FY 2023-24 4 In Quarter Two, ELI fielded 129,000 voice calls and 41,000 web chats. MQA answered over 50,000 phone calls from health care applicants
Q2 • Quarterly Performance Report • FY 2023-24 5 PERFORMANCE STATISTICS INITIAL APPLICATIONS Verifying practitioner credentials and issuing licenses accordingly is a key method by which MQA upholds quality health care services and public protection. In Quarter Two, 31,786 initial applications were received, resulting in the issuance of 26,054 new licenses. Prompt processing of these initial applications ensures that qualified individuals can quickly get to work in their profession. Measure: The average number of days to issue an initial license for qualified applicants. Definition: The average number of days an application is deemed qualified through the date that the license is issued. Goal: One day. To monitor its licensing and inspection progress effectively, MQA focuses on four specific performance metrics. The prompt completion of these tasks is pivotal for MQA to fulfill its mission of enhancing the health and well-being of all state residents. These metrics encompass the time taken to approve initial and renewal licensure applications, inspect M.O.D.E. establishments, and conduct pharmacy inspections. Figure 1: Initial Applications Received 26,054 New Licenses Issued 31,786 Initial Applications Received
Q2 • Quarterly Performance Report • FY 2023-24 6 LICENSE RENEWALS Rapid and effective renewal of licenses stands as a crucial gauge of MQA’s achievement in enabling qualified professionals to sustain their work. During Quarter Two, MQA handled 79,071 renewal applications, with a notable 99.0% processed online. Renewal applications were processed in 0.1 days on average, reflecting a decrease in the processing time overall. Measure: The average number of days to process a renewal application for a qualified applicant. Definition: The average number of days to renew a license for health care practitioners and facilities from receipt of the completed application through approval. Goal: One day. Initiative: This quarter, MQA processed over 4,100 license verifications and supported the mailing of more than 125,000 license renewal notifications. For more information about renewal requirements and renewal dates by profession, visit FLHealthSource. gov/requirements. Figure 2: Average Time to Process a Renewal Application for a Qualified Applicant 79,071 Renewal Applications
Q2 • Quarterly Performance Report • FY 2023-24 7 M.O.D.E. INSPECTIONS Ensuring massage therapy, optometry, dentistry, and electrolysis practitioners work in safe, sterile environments aligned with their profession's standards is the objective of M.O.D.E. inspections. These inspections occur periodically throughout a facility's lifespan or upon inspection requests. In Quarter Two, MQA completed inspections within 5.6 days on average, maintaining efficient performance below the 10-day goal. Measure: Average number of days to complete a M.O.D.E. inspection. MASSAGE ESTABLISHMENTS OPTICAL ESTABLISHMENTS DENTAL LABORATORIES ELECTROLYSIS FACILITIES Definition: The average number of days from the date the facility requests inspection to the date the inspection is completed. This measure does not include those facilities that request a delay in inspections. Goal: 10 days. 5.6 Days Inspection Average Figure 3: Average Days to Complete a M.O.D.E. Inspection
Q2 • Quarterly Performance Report • FY 2023-24 8 PHARMACY INSPECTIONS Pharmacy facility inspectors aim to verify compliance with operational and practice standards regarding record-keeping, inventory management, and substance control. During Quarter Two, these inspections were completed in 7.1 days on average, staying comfortably under the 14-day goal. Measure: Average days to complete a pharmacy inspection. Definition: The average number of days from the date an applicant is ready for an opening inspection to the date the inspection is completed. Goal: 14 days. 7.1 Days Inspection Average Figure 4: Average Days to Complete a Pharmacy Inspection
Q2 • Quarterly Performance Report • FY 2023-24 9 ENFORCEMENT AT A GLANCE Per sections 20.43 and 456, Florida Statutes, MQA is responsible for upholding statutes, laws, and regulations governing the professions overseen by the Department of Health, prioritizing public health, safety, and welfare. To fulfill this mandate, MQA formed the Bureau of Enforcement, which houses the Consumer Services Unit (CSU), Investigative Services Unit (ISU), and Compliance Management Unit (CMU). Together, these units receive, investigate, and adjudicate complaints lodged against health care practitioners and facilities. During Quarter Two, MQA handled 10,390 total complaints. Enforcement personnel conducted 1,264 investigations and carried out inspections at 2,695 facilities. Upon case evaluation, MQA identified 1,279 instances as legally sufficient for potential prosecution. MQA investigators acted by issuing 122 cease and desist orders against violations. The number of active enforcement cases this quarter rose by 15% compared to Quarter One of FY 2023-24, increasing from 26,830 to 31,318 cases. Among the units, CSU managed the most open enforcement cases, totaling 20,293 of the overall active cases. CMU oversaw 5,344 active cases, PSU handled 4,909, and ISU managed 772. CMU CSU PSU ISU OPEN CASES 20,293 5,344 4,909 772 Figure 5: Orders to Cease and Desist
Section 456.074, Florida Statutes, grants PSU authority to demand the immediate halt of activities believed to pose an imminent threat to the public. These mandates, known as Emergency Orders, bear the signature of the State Surgeon General. Emergency Restriction Orders set boundaries on a suspect practitioner's professional activities, while Emergency Suspension Orders temporarily deactivate the practitioner's license as specified in the order. During Quarter Two, PSU issued 56 Emergency Orders, marking a 11.8% decrease from the first quarter of the fiscal year. Among these, 48% constituted Emergency Restriction Orders (27), while 52% comprised Emergency Suspension Orders (29). Q2 • Quarterly Performance Report • FY 2023-24 10 52% Emergency Suspension Orders Emergency Restriction Orders 48% 56 EMERGENCY ORDERS ISSUED THE PATH OF A COMPLAINT Figure 6: Complaints Received
Q2 • Quarterly Performance Report • FY 2023-24 11 UNLICENSED ACTIVITY INVESTIGATIVE SPOTLIGHT MQA’s Unlicensed Activity (ULA) Program aims to inform the public about the risks associated with obtaining health care services from unlicensed practitioners. Per section 456.072, Florida Statutes, providing medical care without a license can result in fines, civil penalties, and potential incarceration. Collaborating with law enforcement agencies and state attorneys, the ULA Program actively investigates and prosecutes unlicensed practitioners. ULA OUTREACH Outreach stands as a crucial element of the ULA Program, aiming to educate the community about the serious repercussions of engaging in unlicensed health care activities. During these outreach efforts, MQA investigators emphasize not just the physical consequences but also the mental and financial impacts of unlicensed health care activities. They address penalty fines for violations, potential criminal charges, and procedures for reporting unlicensed health care activities. Read on to learn more about MQA’s ULA outreach efforts. COMBATTING DRUG DIVERSION In October, ISU joined the nation’s leading drug diversion training organization for an annual conference to receive information, support, and resources that help fight against the misuse and abuse of pharmaceutical drugs and psychoactive substances. The informative sessions and information-sharing platform were hosted by the National Association of Drug Diversion Investigators (NADDI), which empowered MQA staff with new strategies to combat drug diversion, which occurs when a health practitioner uses medication for personal use, sale, or distribution to others. As a result, staff fortified their resolve to educate and prosecute, contributing to the broader efforts aimed at curbing drug diversion tactics, mitigating overdoses, and combatting the opioid crisis.
Q2 • Quarterly Performance Report • FY 2023-24 ENGAGING OLDER ADULTS Targeting older adults for unlicensed activity outreach programs is essential for protecting well-being while also addressing broader public health concerns and promoting advocacy and education. As a vulnerable population, older adults may be more susceptible to deceptive health care practices due to factors such as isolation, cognitive decline, or reliance on caregivers. Some may receive substandard or unsafe care without proper oversight, leading to adverse health outcomes or exacerbating existing health conditions. Older adults may also suffer financial losses as a result of unlicensed activity, such as paying for ineffective or unnecessary treatments or being victims of financial exploitation. Knowing this, ISU staff partnered with the Tallahassee Senior Center in November to host a lunch and learn and equip older adults with unlicensed activity information. By educating this demographic about the dangers of unlicensed activity, MQA is not only safeguarding public health but empowering consumers to advocate for their own health and safety. 12 While MQA has several resources to combat unlicensed activity, help from licensed health care practitioners, partnering organizations, and consumers is crucial to educating others. If you suspect unlicensed activity, you can report what you know by submitting information through MQA’s Online Complaint Portal or by calling 1-877-HALT-ULT to speak directly with an investigator. MQA also encourages you to know before you go; verify that your practitioner has a license by looking them up via MQA’s License Verification Portal and beware of the signs of unauthorized practice to detect when it may be happening, which can be found at FLHealthSource.gov/ULA. A CALL TO ACTION
Q2 • Quarterly Performance Report • FY 2023-24 13 EMPOWERING YOUTH AT THE RESTORING HOPE SUMMIT In October, MQA joined the Florida Department of Juvenile Justice during the 5th Annual Restoring Hope Summit, which brought together a diverse array of stakeholders including juvenile justice professionals, law enforcement, educators, and community partners to address critical issues affecting youth in Florida. MQA seized the opportunity to educate attendees about the recent market trends and risks associated with unlicensed activity practices targeting youth like the unauthorized selling of tooth gems and mouth grills. By collaborating with like-minded stakeholders to further protect youth from such harmful activities, MQA is contributing to better outcomes for youth. MENTAL HEALTH IS WEALTH: EMPOWERING FUTURE PRACTITIONERS In November, MQA emphasized the importance of seeking licensed mental health professionals by attending the Worldwide Mental Health Day at the Florida Agricultural and Mechanical University campus. Involving college campuses in awareness campaigns like this is vital as students are often in a transitional phase where they may seek health care independently for the first time. These nursing and psychology students are also future health care practitioners who will play a significant role in shaping and delivering quality patient care. By educating graduating students about the risks associated with unlicensed practitioners, MQA is not only preventing students from falling victims to fraudulent practices and fostering a culture of informed decision-making and advocacy, but also upholding the reputation and credibility of these health care professions for generations to come.
TIPS TO AVOID UNLICENSED HEALTH CARE ACTIVITY: Q2 • Quarterly Performance Report • FY 2023-24 14 1. ALACHUA This quarter, Alachua ISU continued to take proactive steps to increase awareness and foster a strong bond with leaders in the local community by hosting a meet and greet with the Agency for Health Care Administration. 2. ORLANDO Orlando ISU hosted a meet and greet with the Metropolitan Bureau of Investigation in December to discuss the dismantling of criminal organizations that affect Central Florida. Although the office does not work directly with victims of human trafficking, inspections are regularly conducted in health care facilities like massage establishments. In several instances, unlicensed massage establishments have been a hotspot for human trafficking and other illegal activity. By collaborating with specialized investigators focused on narcotics trafficking, organized crime, racketeering, human trafficking, and gambling, MQA is sharpening efforts to reduce the prevalence of human trafficking taking place in health care establishments. 3. FORT MYERS In December, Fort Myers ISU visited Sunstate Academy, a vocational school offering massage therapy, cosmetology, barbering, and other programs, to teach about the importance of licensed health care practice. Topics covered ranged from the importance of passing licensing exams, completing continuing education coursework, renewing health care licenses, and what constitutes as unlicensed activity. This proactive approach aims to ensure that future health care practitioners are equipped with the knowledge and commitment to uphold legal standards, thereby contributing to the prevention of unlicensed health care activity. MEET AND GREET EVENTS Networking through meet and greet events is a crucial and effective method employed by the ULA Program to establish connections between investigators and local law enforcement partners. Verify a license at FLHealthSource.gov. Beware of missing medical supplies or equipment. Ensure licenses and certificates are posted in the health care establishment. Check online reviews. 3 2 1
Per section 456.025(9), Florida Statutes, MQA sustains its operations by collecting fees and fines from health care professions and enforcement activities. These funds are allocated among the 22 regulatory boards and four councils responsible for executing daily licensure and enforcement duties. In Quarter Two, a total of $636,898.46 in regulatory fines and fees were levied, with $294,008.46 collected during this period. Five dollars from every practitioner’s application fee is specifically designated for ULA enforcement efforts. Disciplinary actions may involve the imposition of fines. These funds are held within the MQA Trust Fund and utilized for overseeing practitioner and facility regulation. Quarterly reports on the revenues and expenditures of this fund serve as indicators of MQA's effectiveness in compliance. At the close of Quarter Two, MQA maintained an overall cash balance of $34 million, dedicated to licensing activities, ULA monitoring, and marketing initiatives. The figure below encompasses the initial cash balance at the beginning of FY 2023-24, the total revenues and expenses, and the closing cash balance for the quarter's end. Q2 • Quarterly Performance Report • FY 2023-24 15 FINANCIAL SUMMARY QUARTER TWO REVENUES AND EXPENDITURES FY 2023-24 Beginning Cash Balance Licensed: $35,299,236 Unlicensed: $5,175,031 Total: $40,474,267 Total Revenues Licensed: $37,824,136 Unlicensed: $1,167,148 Total: $38,991,284 Total Expenditures Licensed: $43,454,072 Unlicensed: $1,963,672 Total: $45,417,744 Ending Cash Balance Licensed: $29,669,300 Unlicensed: $4,378,507 Total: $34,047,807
EMERGENCY ACTION An action taken by the State Surgeon General to suspend or restrict the ability to practice when a licensed health care practitioner poses an immediate and serious threat to the health, safety, and welfare of the public. EMERGENCY SUSPENSION ORDER (ESO) An order issued by the Department suspending the license of a practitioner. A practitioner may not practice in the state of Florida while under an emergency suspension order. EMERGENCY RESTRICTION ORDER (ERO) An order issued by the Department restricting the practice of a practitioner in the state of Florida under conditions specified by the Department. FINAL ORDER An order of a regulatory board or the Department outlining the finding of facts, and penalties in a disciplinary case against a licensee. The administrative complaint outlining the charges against the licensee is attached and becomes part of the final order when filed with the agency clerk. INVESTIGATIONS COMPLETED Investigations are initiated when a complaint is considered legally sufficient. All completed investigations are presented to the PSU with an Investigative Report and all documents related to the complaint. LEGALLY SUFFICIENT A complaint that contains ultimate facts that show that a violation of section 456.073(1), Florida Statutes, of any of the practice acts relating to the professions regulated by the Department, or of any rule adopted by the Department or a regulatory board in the Department has occurred. MQA TRUST FUND UNLICENSED ACTIVITY FEE A $5 fee collected at initial and renewal licensing that funds the investigation and enforcement of unlicensed activities, according to Florida law. PROBABLE CAUSE A determination that there is a reasonable basis to suspect that a person has violated or is violating the law. QUALIFIED APPLICANT A qualified applicant has met all requirements to become licensed and may be licensed on the day an application has concluded processing. This is different from an approved applicant who may still have to pass an examination or meet an additional requirement outside of having an application approved. UNLICENSED ACTIVITY (ULA) Unauthorized practice of a health care profession or delivery of health care or medical services by an individual not in possession of a valid or active license to practice that could cause injury, disease, or death. GLOSSARY Q2 • Quarterly Performance Report • FY 2023-24 16
Allen Hall Dietetics and Nutrition, Electrolysis, Occupational Therapy, Physical Therapy, Psychology, Respiratory Care, and School Psychology 850-245-4374 Allen.Hall@flhealth.gov Allison M. Dudley Dentistry and Pharmacy 850-245-4197 Allison.Dudley@flhealth.gov Ashleigh Irving Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, Athletic Training, Hearing Aid Specialists, Opticianry, Podiatric Medicine, Orthotists and Prosthetists, and Genetic Counseling 850-245-4462 Ashleigh.Irving@flhealth.gov Dayle Mooney Chiropractic Medicine, Clinical Laboratory Personnel, Nursing Home Administrators, Medical Physicists, Optometry, Radiologic Technologists, Emergency Medical Technicians and Paramedics 850-901-6830 Dayle.Mooney@flhealth.gov Joe Baker, Jr. Nursing and Certified Nursing Assistants 850-245-4158 Joe.Baker@flhealth.gov Paul Vazquez, JD Medical Doctors, Physician Assistants, Anesthesiologist Assistants, Office Surgery Registration, and Pain Management Clinic Registrations 850-245-4130 Paul.Vazquez@flhealth.gov Vacant Office of Veteran Licensure Services Stephanie Webster Acupuncture, Massage Therapy, Midwifery, Osteopathic Medicine, and Speech-Language Pathology and Audiology 850-245-4162 Stephanie.Webster@flhealth.gov EXECUTIVE DIRECTORS EXECUTIVE MANAGEMENT TEAM DIVISION DIRECTOR Jennifer L. Wenhold, MSW, CPM 850-245-4460 Jennifer.Wenhold@flhealth.gov CONTACT US For more information or to contact us, please visit MQA’s Virtual Agent, ELI, on the board and council websites. ELI uses artificial intelligence to improve the experience for health care applicants and practitioners by providing immediate information and suggestions and fielding inquiries outside of normal business through voice and online chat options. Q2 • Quarterly Performance Report • FY 2023-24 17 CHAT NOW Emily Roach, Chief Bureau of Operations 850-245-4064 Emily.Roach@flhealth.gov Matt Knispel, Chief Bureau of Enforcement 850-245-4123 Matthew.Knispel@flhealth.gov Jessica Sapp, Chief Bureau of Health Care Practitioner Regulation 850-245-4463 Jessica.Sapp@flhealth.gov
4052 Bald Cypress Way, Bin C-00, Tallahassee, FL 32399-3250 www.FLHealthSource.gov MedicalQualityAssurance@flhealth.gov
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