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Can I get a U.S. Trademark Registration to Protect My Brand?

While there are many factors that determine whether or not a particular brand or mark can be registered with the U.S. Patent and Trademark Office, the three most important factors are distinctiveness, likelihood of confusion, and use in interstate commerce. Your brand must be distinctive, this is a legal term of art that will be described later. Also, your brand must not confuse consumers into thinking your brand is represents some other entities goods or services. And finally, you must actually be using your mark in commerce.

Distinctiveness

It is generally accepted that there are five levels of distinctiveness. They are listed below from most distinctive to least distinctive.

  • Artful/Fanciful: This level is the most distinctive. They are words that were invented to represent the product or service. The words have no meaning other than the invented meaning. Examples include: Xerox, Google, Kodak, Bidzuku.
  • Arbitrary: These are words that have a dictionary meaning, but that meaning does not relate to the product or service. The most notable example of this is ‘Apple’ for a computer company.
  • Suggestive: These are marks that ‘suggest’ what a product is by the name. These marks are more than just ‘merely descriptive’ of the product and are considered distinctive by the Trademark Office. Be careful because these levels are subjective and what may be suggestive to you could be merely descriptive to the Trademark Office. Examples include: Citibank, Playboy, and Mustang.
  • Descriptive: These are marks that merely describe the product or service. While there are methods for registering descriptive marks, for all intents and purposes, these marks are not distinct enough to be registered with the Trademark Office. Also note that surnames usually fall within this level. Examples include: Qik Print, Eyeglass Superstore, Chinese Restaurant.
  • Generic: These marks merely describes the category of goods or services. These marks are not protected. E.g. Food, Restaurant, Computer.

For you to register your mark, the United States Patent and Trademark Office (USPTO) must determine that your mark is at least suggestive. While there are ways to register a descriptive mark, that is outside of the scope of this post.

Likelihood of Confusion

Your brand cannot mislead or confuse consumers. This usually occurs when your mark is the same or similar to existing trademarks. For example, it might be possible for two companies to use the mark ‘Apple’ if one was selling computers and the other was selling teaching supplies. Conversely, even if the mark is different, if it is similar enough and in the same or similar class, consumers may still be confused. For example ‘Teachbook’ may infringe on ‘Facebook’s’ mark. Even if there is not a similar mark registered with the U.S. Trademark Office, there may still be uses of your mark that will affect your rights. Trademarks can also be filed with a state or acquired through use (this is called a common law trademark). While these marks may not preclude you from registering with the U.S. Trademark Office, they can prevent you from using your mark where they have priority over your mark. This is why a good trademark search is vital before attempting to register your mark.

Use In Commerce

This is another term of art, but it basically means that the mark is actually being used to sell goods or services. Thus if you are still in the planning phase of your project, you cannot get a trademark. You must actually be using the mark. However, there is an ‘Intent to Use’ application that can be filed when you know you want to use a mark, but are not yet using it. This does not grant you any actual protection, but it will provide a record of your use of the mark if you are worried someone might try to steal your brand. If you do file an Intent to Use application, you will still be required to file an actual registration to obtain any rights.

Conclusion

This is just a general overview of some of the key issues when it comes to eligibility to receive a U.S. Trademark Registration. Your specific situation will affect if your mark can be registered. If you have any questions, please feel free to contact us here.

CON for SNF Beds: New Opportunities for ALF Operators

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After a 13 year moratorium on issuing Certificates of Need for new Skilled Nursing Facility beds, Florida is poised for the return of nursing home CON beginning in October. This will present new opportunities for owners and operators of Assisted Living Facilities. Those existing ALFs that would like to obtain approval to offer Skilled Nursing Facility services should be making plans now. It is expected that the competition for approval of new SNF beds will be substantial. But for those who plan ahead and develop a strong argument for need to offer SNF services as part of an overall continuum of care, the rewards can be well worth the effort.

Nursing Home CON Return

Under 2014-174, Laws of Florida, the Legislature has lifted the 13 year ban on CON for skilled nursing facility beds. The imposition of the moratorium was first put in place in 2001 as a Medicaid cost saving measure. The moratorium was originally intended to last 5 years but was extended in 2006 and again in 2011. In recent years, there has been growing pressure to lift the moratorium and to begin preparing for the aging of the baby boomers. Responding to calls to allow for new development of Skilled Nursing Facilities and beds, the legislature authorized the return of CON.

The legislation lifting the moratorium includes new exemptions and expedited reviews for current owners and operators of SNF facilities. For a full summary of the provisions in the bill, please see: www.smithlawtlh.com, and click on Articles.

Opportunities for ALF Operators

It’s certainly no secret that many ALF operators are seeing increasing acuity among their resident populations. This is especially true for those ALF providers with Limited Nursing Services and Extended Congregate Care licenses. Indeed, many ALF operators have complained that the moratorium on SNF beds has resulted in increased pressure to care for higher acuity residents who, in many instances, might be better served in a SNF setting if beds were available.

The lifting of the moratorium will allow some ALF operators to expand the scope of services they offer to include a broader continuum of care. For some, this may be the addition of a SNF unit to their existing ALF facility; for others, it may mean the conversion of an existing ALF to SNF. Ultimately, some providers may seek to offer a full continuum of independent living, Assisted Living, and SNF on one single campus.

Different Architectural and License Requirements

Those interested in seeking SNF beds should thoroughly investigate the differences between SNF and ALF services in terms of the architectural and physical plant requirements as well as the operational and licensure requirements. A full discussion is beyond the scope of this Article, but generally SNF facilities will be evaluated under Florida Building Code requirements for institutional construction and, of course, will be subject to the provisions of Chapter 400, Florida Statutes and Chapter 59A-4, Florida Administrative Code. A CON Application must document the applicant’s ability to meet these standards.

The Upcoming Time Line to Seek SNF Approvals Launches in October

Under existing Rules, AHCA has a schedule that governs the procedures and a detailed time-line for applying for a Certificate of Need. Applications for new skilled nursing facilities and bed additions may be submitted two times per year in the “batching cycle” for “other beds and programs.” A “batching cycle” review is required for any party that wishes to obtain a CON for a new facility or bed addition that is not authorized under an exemption or expedited review. The key dates for the next available batching cycle are as follows:

Event Deadline
Fixed Need Pool Projections 10/03/14
10 days to File Notice of Errors in a Fixed Need Pool 10/13/14
21 Days to File Formal Challenge to Fixed Need Pool 10/24/14
Letter of Intent Filing Deadline 10/20/14
16-day Grace Period Letter of Intent Filing Deadline 11/05/14
CON Initial Application Filing Deadline 11/19/14
Request Public Hearing 14 Days After Publication Of Application Filing in Florida Administrative Register
CON Application Omissions Response Deadline 12/24/14
State Agency Action Reports (SAARs) Issued 2/20/15
Deadline to File Petition for Formal Administrative Hearing to Challenge a SAAR 21 Days After Publication of the SAAR Results in the Florida Administrative Register

Based on the schedule for the next batching cycle, any party wishing to submit a CON Application should immediately begin the process of putting together a “CON Application Team” consisting of at least the following members:

  • Key management for owner/operators;
  • Experienced CON counsel;
  • Experienced health planner;
  • Experienced financial planner; and
  • A health care architect.

Conclusion

Those interested in expanding their scope of services to include SNF beds should pay careful attention to the CON process that will begin in the next several weeks. Letters of Intent must be filed by October 20th for an applicant to be considered in the upcoming batching cycle.

Geoffrey D. Smith is a shareholder in the law firm of Smith & Associates, and has practiced in the area of health care law and CON regulation for over 20 years.

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Nursing Home CON Batching Cycle Rapidly Approaching

Now that the moratorium on Certificates of Need for Nursing Homes has been lifted, nursing homes seeking to add beds must participate in AHCA’s CON batching cycles. The first of these batching cycles since the lifting of the moratorium is rapidly approaching. On October 3, 2014, less than a month from now, AHCA will publish its Summary Need Projections in the F.A.W. Once this is published, nursing homes seeking to add beds to their facilities need to comply with a series of rules and deadlines in order to compete for the fixed number of beds available in their district. To learn more about the rules and deadlines read our article here.

A nursing home wishing to compete in this batching cycle needs to begin preparing now. If you need help competing in this upcoming batching cycle, contact the experienced counsel at Smith & Associates.

PREPARING FOR THE RETURN OF NURSING HOME CON PROCEEDINGS

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It’s now old news that the Florida Legislature has lifted the 13-year moratorium on the Certificate of Need program for new nursing homes in Florida. In addition to allowing new skilled nursing facility development projects to be authorized by CON, the legislation includes a variety of provisions that create new CON exemptions and expedited reviews for certain bed additions and facility replacement projects, as well as relaxing some of the standards for assessing need for new skilled nursing facilities and beds. For a full review of the specific provisions adopted in the CON law, see my newsletter article posted on-line at www.smithlawtlh.com. Below I address what skilled nursing facility owners and operators, and potential applicants, should be doing to prepare for the return of nursing home CON proceedings in Florida.

The Batching Cycle Deadlines

Under existing Rules, AHCA has a schedule that governs the procedures and a detailed time-line for applying for a Certificate of Need. Applications for new skilled nursing facilities and bed additions may be submitted two times per year in the “batching cycle” for “other beds and programs.” A “batching cycle” review is required for any party that wishes to obtain a CON for a new facility or bed addition that is not authorized under an exemption or expedited review. The key dates for the next available batching cycle are as follows:

Event Deadline
Fixed Need Pool Projections 10/03/14
10 days to File Notice of Errors in a Fixed Need Pool 10/13/14
21 Days to File Formal Challenge to Fixed Need Pool 10/24/14
Letter of Intent Filing Deadline 10/20/14
16-day Grace Period Letter of Intent Filing Deadline 11/05/14
CON Initial Application Filing Deadline 11/19/14
Request Public Hearing 14 Days After Publication Of Application Filing in Florida Administrative Register
CON Application Omissions Response Deadline 12/24/14
State Agency Action Reports (SAARs) Issued 2/20/15
Deadline to File Petition for Formal Administrative Hearing to Challenge a SAAR 21 Days After Publication of the SAAR Results in the Florida Administrative Register


Based on the schedule for the next batching cycle, any party wishing to submit a CON Application should immediately begin the process of putting together a “CON Application Team” consisting of at least the following members:

  • Key management for owner/operators;
  • Experienced CON counsel;
  • Experienced health planner;
  • Experienced financial planner; and
  • A health care architect.

FIXED NEED POOL PUBLICATION AND CHALLENGES

The process for CON Applications will commence with the publication of fixed need pools on October 3, 2014. The fixed need pool is a projection of the number of new skilled nursing facility beds that will be needed in each nursing home sub-district for a planning horizon that is three years in the future. The Need formula included in AHCA’s existing Rule (which should be adjusted by the changes required in the recent legislation lifting the moratorium) takes into account a variety of factors including: a) current and future population in two age groups (65-74 and 75 and older); b) the most recent bed rates for skilled nursing facilities in the District; c) occupancy rates in the district; d) a target occupancy rate; and e) allocation of beds among sub-districts. The “Net Need” number will be published in the Florida Administrative Register providing any interested parties with notice of AHCA’s projections of the number of needed beds that will be applied to review of any CON Applications submitted in the batching cycle. Unless a party successfully challenges a Fixed Need Pool publication, then the Need is “fixed” and will be applied to all applications in the batch.

The CON statute and applicable rules allow for a party to file a challenge to the publication of a Fixed Need Pool to correct any errors identified in the calculation. A party wishing to challenge a Fixed Need Pool must notify AHCA in writing within 10 days of publication of the Fixed Need Pool detailing any errors in the calculation. If AHCA agrees that an error was made, then it will file and publish a Notice of Corrected Fixed Need Pool. If AHCA disagrees that any error was made, a party may file a Petition for Formal Administrative Hearing within 21 days of the original Fixed Need Pool publication, and the matter will be referred to an Administrative Law Judge at the Division of Administrative Hearings for a formal hearing on the evidence.

LETTERS OF INTENT AND GRACE PERIOD LETTERS OF INTENT

In the upcoming batching cycle, any party interested in filing a Certificate of Need application for skilled nursing facilities or bed additions (non-exempt) must file a Letter of Intent by the deadline of October 20, 2014. If any party files a Letter of Intent in a sub-district, a “grace period” is triggered which allows any other party to submit competing a Letter of Intent to file a competing CON Application in the same sub-district where an applicant has already filed a Letter of Intent. The grace period deadline is November 5, 2014.

THE INITIAL CON APPLICATION

The initial CON Application deadline in the upcoming batching cycle is November 19, 2014. It is not uncommon for parties and their CON team to meet with representatives of AHCA prior to filing the initial CON Application to discuss any potential concerns or issues, and simply to obtain some insight to any issues that AHCA staff may feel are particularly important to address in the CON Application.

Typically a party will file only what is called a “shell application” by the initial application deadline—that is simply signing a blank application form and noting that the remainder of any information will be submitted with the Omissions Response.

Upon receipt of the Initial CON Applications, AHCA notifies each party of any Omissions in the initial Application. These Omissions letters have become boilerplate over the years, and AHCA typically sends a form letter indicating that all responses to all sections of the Application form are required to be submitted by the Omissions deadline.

PUBLIC HEARINGS AND WRITTEN OPPOSITION STATEMENTS

A Public Hearing may be requested after initial CON Applications are filed. A public hearing is an opportunity for interested members of the public, or any party, to provide AHCA with comments in support of or in opposition to any Application. The date and time of the Public Hearing will be published by AHCA. The hearings are typically held in the local Health Council offices in the area where the proposed project will be located shortly after the Omissions deadline. A party may use the Public Records Law to obtain a copy of the CON Application prior to the public hearing.

In lieu of a Public Hearing, parties may submit written statements to AHCA. It is not unusual for AHCA to receive detailed opposition statements from existing providers in the same District in response to a CON Application. Opposition statements must be submitted prior to the Omissions deadline, unless a Public Hearing is requested and held in which case written opposition materials can also be submitted at a public hearing.

OMISSIONS RESPONSES AND REVIEW CRITERIA

The deadline in the next batching cycle to file the Omissions Response to a CON Application is December 24, 2014. The Omissions Response is typically the real meat of the Application, and will usually be a document of 150 pages or more of narrative responses addressing the various CON review criteria, along with required financial schedules, audited financial statements, a financial feasibility analysis, and architectural schematic drawings of the proposed facility or bed addition.

CON Review Criteria set forth in Section 408.035(1), Florida Statutes, include the following:

(a) The need for the health care facilities and health services being proposed.

(b) The availability, quality of care, accessibility, and extent of utilization of existing health care facilities and health services in the service district of the applicant.

(c) The ability of the applicant to provide quality of care and the applicant’s record of providing quality of care.

(d) The availability of resources, including health personnel, management personnel, and funds for capital and operating expenditures, for project accomplishment and operation.

(e) The extent to which the proposed services will enhance access to health care for residents of the service district.

(f) The immediate and long-term financial feasibility of the proposal.

(g) The extent to which the proposal will foster competition that promotes quality and cost-effectiveness.

(h) The costs and methods of the proposed construction, including the costs and methods of energy provision and the availability of alternative, less costly, or more effective methods of construction.

(i) The applicant’s past and proposed provision of health care services to Medicaid patients and the medically indigent.

(j) The applicant’s designation as a Gold Seal Program nursing facility pursuant to s. 400.235, when the applicant is requesting additional nursing home beds at that facility.

There are a number of required schedules that pertain to the CON Application financial analysis, including the following:
     Schedule 1: Estimated Project Costs
     Schedule 2: Capital Projects List
     Schedule 3: Source of Funds Documentation
     Schedule 4: Historic Utilization
     Schedule 5: Projected Utilization
     Schedule 6: Staffing and Salaries
     Schedule 7: Projected Revenues
     Schedule 8: Projected Expenses and Net Income
     Schedule 9: Architectural Criteria
     Schedule 10: Project Completion Forecast
     Schedule 11: Fines, Levies and Overpayments.

Additionally, the CON Application includes a required Form setting forth Conditions Predicated on Award of CON. This form allows an Applicant to accept specific Conditions on the CON which may include “enticements” or “sweeteners” offered by an Applicant to make its CON Application more appealing than other applicants. Common conditions include a specific site location; implementation of a specific program or service that may be lacking in the community; enhanced staff or staff qualifications; and a specific minimum percentage of charity, indigent or unfunded patients to be served. Virtually anything may be offered as a Condition, and in some instances CON Conditions may make the difference between approval and denial of an application.

The Nursing Facility CON Rule (59C-1.036(3), Florida Administrative Code) also includes the following Review Criteria pertaining to an Applicant’s Quality of Care:

(e) Quality of Care. In assessing the applicant’s ability to provide quality of care pursuant to Section 408.035(1)(c), F.S., the agency shall evaluate the following facts and circumstances:

1. Whether the applicant has had a Chapter 400, F.S., nursing facility license denied, revoked, or suspended within the 36 months prior to the application.

2. Whether the applicant has had a nursing facility placed into receivership at any time during the period of ownership, management, or leasing of a nursing facility in the 36 months prior to the current application.

3. The extent to which the conditions identified within subparagraphs 1. and 2. threatened or resulted in direct, significant harm to the health, safety or welfare of the nursing facility residents.

4. The extent to which the conditions identified within subparagraph 3. were corrected within the time frames allowed by the appropriate state agency in each respective state and in a manner satisfactory to the agency.

(f) Harmful Conditions. The agency shall question the ability of the applicant to provide quality of care within any nursing facility when the conditions identified in subparagraphs (e)1. and (e)2. resulted in direct, significant harm to the health, safety or welfare of a nursing facility resident, and were not corrected within the time frames allowed by the appropriate state agency in each respective state and in a manner satisfactory to the agency.

There are also additional Review Criteria set forth in Rule 59C-1.030, Florida Administrative Code, which address specific needs of various underserved population groups, and how the applicant proposes to enhance access to services for such groups.

Finally, Applicants typically will include an “adverse impact” analysis to demonstrate that approval of the CON Application will not imperil or jeopardize the continued operation of other existing skilled nursing facilities.

COMPARATIVE REVIEW AND THE STATE AGENCY ACTION REPORT

Once all CON Omissions Responses are filed, AHCA then conducts a comparative review of CON Applications that are submitted for beds or facilities located in the same sub-district. The review includes an assessment of each Applicant’s proposal, and a determination ultimately of which applicant or applicants best meet the statutory and rule review criteria. There is no fixed weight applied to any criteria, and the analysis by AHCA involves a weighing and balancing of all the review criteria.

AHCA’s initial decision for all CON Applications submitted in each sub-district is announced in a State Agency Action Report (SAAR). The SAAR sets forth the comparative review of the CON Applications, and the key points that resulted in AHCA’s recommendation to approve or deny an Application. Because so many applications are similar, it is often difficult for AHCA to articulate the precise reasons why one applicant may have been selected for approval over other applicants.

In a bygone era of CON review, decisions to outright deny or disqualify a CON Applicant from consideration were often made based upon perceived technical defects in an Application. Today, such disqualification of a defective CON Application is less common. Decisions typically address AHCA’s perception of the relative merits of each applicant’s proposal; although technical defects can still hurt the overall review of the merits of an application.

FORMAL ADMINISTRATIVE HEARINGS

After issuance of a SAAR, any co-batched applicant, as well as any existing provider of skilled nursing facility services in the same health planning District, may file a Petition for Formal Administrative Hearing to challenge AHCA’s initial decision. Thus, a co-batched applicant can request a formal hearing to demonstrate through evidence that its application is superior to other applicants that were approved, or conversely that other applicants had defects or problems with the application that should have resulted in denial. Similarly, an existing provider in the same District may challenge the approval of an applicant for a new facility based upon a demonstration that its existing facility will suffer an adverse impact, and that a preliminarily approved application does not on balance meet the CON review criteria set forth in statute and rule.

If Petitions are filed, the cases are referred to the Division of Administrative Hearings (DOAH) for assignment of an Administrative Law Judge to review the decisions being challenged. This hearing is considered a “de novo” proceeding, which means that the ALJ should not be influenced by AHCA’s preliminary decision set forth in the SAAR—and the SAAR is “not clothed with a presumption of correctness.”

An administrative hearing is similar to a civil court trial, with slightly relaxed rules of evidence. Parties conduct written discovery, and conduct pre-trial depositions of witnesses. The parties then present their case through expert testimony, lay witness testimony, and submission of documentary evidence. There is an opening statement, direct examination and cross examination of witnesses by attorneys, and legal arguments over admissibility of evidence. One of the most common arguments in CON cases concerns whether the evidence being presented amounts to an “impermissible amendment” of a CON Application. By Rule and established case law, a CON Applicant cannot amend its application to include new concepts or theories for approval that were not set forth in the CON Application. However, an Applicant may introduce new evidence, new or updated data, and testimony that elaborates and explains concepts or theories that were included in the CON Application. These issues are often hotly debated during the course of a CON hearing.

By statute, a party requesting a hearing has a right to demand that the hearing be commenced within 60 days of assignment of an ALJ at DOAH. Most hearings are not done on this expedited schedule, however, and it is not unusual for the hearing process to take 4-6 months or longer. Hearings typically last about 2-3 days for each party involved. In multi-party proceedings involving several applicants, existing providers, and AHCA, a final hearing may last 3-4 weeks. All final hearings are held at DOAH headquarters in Tallahassee.

Upon conclusion of a formal hearing, the parties are required to submit a Proposed Recommended Order (PRO) for the ALJ’s review and consideration. This is typically filed 30 days or so after the final hearing. The PRO includes proposed Findings of Fact as well as proposed Conclusions of Law. By Rule a PRO is supposed to be no longer than 40 pages; but is not unusual for an ALJ to expand the number of pages to 60 or 80 pages depending on the number of parties involved. The ALJ reviews all PROs submitted by the parties and then issues a decision in a Recommended Order.

EXCEPTIONS AND THE FINAL ORDER

Once the ALJ issues a Recommended Order, the case is remanded back to AHCA for issuance of a Final Order. Parties may file “Exceptions” to the Recommended Order to explain why the ALJ’s decision is in error. In issuing a Final Order, AHCA may not reject an ALJ’s findings of fact, unless the Agency reviews the entire record, and finds that there is no “competent, substantial evidence” to support a specific finding. It is not the role of AHCA to reweigh the evidence, or judge the credibility of witnesses, or to substitute its balancing of the evidence for that of the ALJ. As to Conclusions of Law, AHCA cannot disturb a conclusion unless it is on a legal matter that is within AHCA’s expertise and jurisdiction (e.g., its governing statute and rules) and AHCA must state with particularity its reasons for rejecting or modifying the conclusion of the ALJ, and must make a finding that its substituted or modified conclusion of law is as or more reasonable than the ALJ’s conclusion.

The issuance of a Final Order by AHCA is the end of the formal hearing process, and unless a judicial appeal is taken, the CONs will be issued or denied as set forth in the Final Order.

FURTHER APPEALS

A party may appeal the Final Order to a District Court of Appeal. This appeal is limited only to a review of the record by a three judge panel based upon legal arguments submitted by the parties’ attorneys in legal briefs.

CONCLUSION

Anyone who operates or wishes to operate a Skilled Nursing Facility in Florida should pay careful attention to the CON process that will begin in October of this year. There will be ample opportunities for parties that are seeking to expand skilled nursing operations in Florida. The CON process also includes protections for those with existing operations that could be adversely impacted by a CON being issued to another facility. Thus, whether you are seeking approval for new nursing home development or are simply seeking to protect your existing operation, the return of nursing home CON in Florida is likely to be of interest.

Geoffrey D. Smith is a shareholder in the law firm of Smith & Associates, and has practiced in the area of health care law and CON regulation for over 20 years.

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Assisted Living in Florida, How is it Changing?

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An Assisted Living Facility (ALF) is a residential establishment that is designed to provide personal care services to one or more persons in the least restrictive and most home-like environment. Personal services that are provided to residents of an ALF are services such as physical assistance with, or supervision of, the activities of daily living and the self-administration of medication. ALFs can range in size from one resident to several hundred and may offer a wide variety of personal and nursing services designed specifically to meet an individual’s personal needs. The services available in these facilities are intended to help residents remain as independent as possible and for some to “age in place” when their health care needs increase.

Standard Licensed ALFs

A standard ALF must be licensed by the Agency for Health Care Administration (AHCA). The official definition of an assisted living facility is any building or buildings, section or distinct part of a building, private home, boarding home, home for the aged, or other residential facility, whether operated for profit or not, which undertakes through its ownership or management to provide housing, meals, and one or more personal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator. Specialty licensed facilities are available for individuals with increased health care needs. There are three types of specialty licenses: Extended Congregate Care License, Limited Nursing Services License and Limited Mental Health License.

Regardless of the facility’s license status, residents living in ALFs cannot have conditions that require 24-hour nursing supervision. The only exception to this is for an existing resident who qualifies for and receives hospice services from a licensed hospice while continuing to reside in an ALF.

Specialty License: Extended Congregate Care

An Extended Congregate Care (ECC) license is issued to an assisted living facility that provides services beyond those authorized for a standard ALF, meaning that they may provide additional nursing services and total assistance with personal care services. New facilities may apply for an ECC license at the time of initial application. Existing facilities qualifying to provide extended congregate care services must have maintained a standard license and may not have been subject to administrative sanctions during the previous two years, or since initial licensure if the facility has been licensed for less than two years. Mandatory services that must be provided include, but are not limited to total help with the activities of daily living, more frequent nursing assessments and assistance with administered and self-administered medications.

Specialty License: Limited Nursing Services

A Limited Nursing Services (LNS) License is issued to an ALF that provides nursing services that are beyond what a standard ALF is licensed to provide. Residents living in an ALF with a LNS license must meet the same residency criteria for a standard licensed ALF; however, they may also receive a limited number of nursing services. Existing facilities qualifying to provide limited nursing services shall have maintained a standard license and may not have been subject to administrative sanctions that affect the health, safety, and welfare of residents for the previous two years or since initial licensure of the facility has been licensed for less thantwo years. The nursing services available in a limited nursing services facility are more extensive than what is provided in a standard ALF and are provided pursuant to the resident’s service plan.

Specialty License: Limited Mental Health

A Limited Mental Health (LMH) License is issued to a standard ALF that serves three or more mental health residents. A mental health resident is an individual who receives social security disability income or supplemental security income due to a mental disorder as determined by the Social Security Administration and receives optional state supplementation. To obtain a limited mental health license, a facility must hold a standard license as an assisted living facility, must not have any current uncorrected deficiencies or violations, and must ensure that, within six months after receiving a limited mental health license, the facility administrator and the staff of the facility who are in direct contact with mental health residents must complete specified training.

ALF Staff Training

Administrators and Managers: Administrators and other ALF staff must meet minimum training and education requirements that are established by the Department of Elder Affairs, that are comprised of “core” training, in-service training and continuing education that is required throughout their tenure. Every facility shall be under the supervision of an administrator who is responsible for the operation and maintenance of the facility including the management of all staff and the provision of adequate care to all residents. Administrators who supervise more than one facility shall appoint in writing a separate “manager” for each facility.

Staff: Staff with direct care responsibilities are required to have in-service training that covers a variety of topics, including infection control training, elopement training, training on “do not resuscitate” orders and may have to complete training on special topics such as self-administration of medication, Alzheimer’s disease and related disorders, and HIV/AIDS training. Staff in “direct contact” means direct care staff and staff whose duties take them into resident living areas and require them to interact with residents (this does not include maintenance, food service, or administrative staff). There are additional specific requirements for ECC staff and LMH staff, such as continuing education on ECC and LMH specific topics.

Resident Rights

Each resident living in an ALF has special rights that are delineated in Florida Statutes. An example of some of these rights are that no resident of a facility shall be deprived of any civil or legal rights, benefits, or privileges guaranteed by law, the Constitution of the State of Florida, or the Constitution of the United States as a resident of a facility; every resident shall have the right to live in a safe and decent living environment, free from abuse and neglect; be treated with consideration, respect and with due recognition of personal dignity, individuality, and the need for privacy. Each patient is given a copy of their rights upon entering the ALF.

Protection of Resident Rights

The Long-Term Care Ombudsman Program is comprised of 17 local councils across Florida, all offering free, localized advocacy services. The Ombudsman program is housed in the Department of Elder Affairs (DOEA) and is headed by the State Long-Term Care Ombudsman, Leigh Davis, who is appointed by the DOEA secretary. An ombudsman is a specially-trained and certified volunteer who has been given authority under federal and state law to identify, investigate and resolve complaints made by, or on behalf of, long-term care facility residents. Ombudsmen respond to resident complaints and concerns ranging from issues with medication and care administration to matters of dignity and respect. It is the ombudsman’s role to protect the legal rights of residents and assure that they receive appropriate treatment and quality care. Anyone can report a concern, including residents, relatives, friends, facility staff, legal representatives and other concerned citizens. Complaints may be related to the facility, its employees, or any agency or person who threatens or violates the rights, health, safety or welfare of a resident. Complaints filed with the Long-Term Care Ombudsman Program are kept completely confidential, unless permission is given by the resident or complainant to disclose related information.

Changing Law

Over the past two legislative sessions, lawmakers have been trying to strengthen the regulation of ALFs. This legislative push was prompted by the Miami Herald’s investigative series “Neglected to Death” published in April 2011. This series reported numerous instances where the investigative journalists alleged that AHCA failed in its duty to protect the residents of Florida’s ALFs. The investigative series reported on a series of incidents that occurred in licensed ALFs that resulted in death or serious injury to a resident. The journalists created the impression that these incidents were caused by lax enforcement efforts by AHCA. The article stated that AHCA repeatedly caught facilities breaking the law; however, AHCA failed to act on the violations, or in some cases only partially punished the violators agreeing to reduced fines and suspensions rather than full fines and revocation of licenses. As reported in the article, the ombudsman program was reporting more and more occurrences of abuse and neglect in Florida ALFs, however according to the articles, AHCA failed to investigate a large portion of the cases.

Prompted by the Miami Herald investigative reports, in July 2011, Governor Rick Scott directed AHCA to examine the regulation and oversight of ALFs. AHCA’s response was to increase its enforcement efforts, and Administrative Complaints with severe sanctions for ALF operators found not to be in compliance with licensure standards. AHCA also created a workgroup with the objective to make recommendations that would improve the monitoring of safety in ALFs. The workgroup had two phases and produced a final report to the Governor and Legislature on November 26, 2012. In June 2012, the DOEA, in consultation with AHCA, the Department of Children and Families (DCF) and the Department of Health (DOH), began rulemaking meetings to address the problems with ALF regulation.

In the 2013 legislative session, an “ALF reform bill” was proposed but failed to pass. In the most recent 2014 legislative session Senate Bill 248, with a proposed effective date of July 1, 2014, was proposed to strengthen the regulation of ALFs and make other regulatory changes to improve their quality. Among other goals, the bill would have clarified issues regarding mental health residents in an ALF relating to necessary services and would require facilities with one or more, rather than three or more state supported mental health residents to obtain a Limited Mental Health License. The bill proposed changes to resident rights regarding the protection against retaliatory action for presenting grievances. The proposed bill also authorized additional staff duties in the assistance with self administration of medication and required additional training for staff. However, the bulk of the bill was directed at the regulation of ALFs by AHCA through increased fines for violations, double fines for repeated violations, fines against a facility that does not show good cause for terminating the residency of an individual, specifying the circumstances under which AHCA must impose an immediate moratorium on a facility, and even authorizing AHCA to revoke the license of a facility that has or had a 25 percent or greater financial ownership interest in a second facility which closed due to financial inability to operate or was the subject of other specified administrative actions.

The proposed bill was estimated to generate approximately $1.1 million of additional net revenues for AHCA per year based on the revised fine amounts. Of course, one aspect of the increased administrative penalties and fines that would be handed out by AHCA is that there will be an increased number of legal cases brought on by the harsher penalties and fines. In the face of opposition from many in the ALF industry, the bill failed to pass.

What does this mean for providers?

Although Senate Bill 248 did not pass during this legislative session, the fact remains that lawmakers will most likely continue in their pursuit of stricter regulation of ALFs. In fact, AHCA has already launched a regulatory “crackdown” on ALFs. If an ALF is cited for deficiencies during a survey, investigation or monitoring visit, AHCA may file an Administrative Complaint and seek to impose sanctions. Civil penalty sanctions available to AHCA depend on the class of violation. There are four classes: Class I violation penalties are between $5,000 and $10,000 for each violation; for each Class II violation between $1,000 and $5,000; for each Class III violation between $500 and $1,000; and for each Class IV violation between $100 and $200 for each violation if the problem is not corrected. During fiscal years 2011-2013 AHCA entered 115 final orders for Class I violations, 749 final orders for Class II violations, 507 final orders for uncorrected Class III violations, and 18 final orders for uncorrected Class IV violations.

In addition to financial penalties, AHCA may also sanction an ALF by imposing an emergency moratorium or suspension on patient admissions, denial of a license, temporary license suspension and permanent revocation of the ALF license. For the period between July 1, 2012 and June 30, 2013, the current count for AHCA actions against ALFs is 43 cases involving suspension, revocation, moratorium on admissions or denial of licenses. Below are examples of AHCA’s crackdown and all providers should be aware that they are susceptible to increased scrutiny by AHCA.

Premier Adult Care:

  • Owned two houses, one in Titusville operating as a five-bed adult family care home and one in Merritt Island operating as a two-bed ALF seeking to operate under the exemption that “Any person who provides housing, meals, and one or more personal services on a 24-hour basis in the person’s own home to not more than two adults who do not receive optional state supplementation. The person who provides the housing, meals, and personal services must own or rent the home and reside therein.”
  • The Merritt Island home was under a lease agreement between the owner and the caregiver who provided services to the two residents of the Merritt Island home that was operating as an ALF under the “exception.”
  • AHCA filed an administrative complaint against the ALF stating that it was operated and maintained without a license, which the Agency determined directly threatened the physical or emotional health, safety, or security of the residents; and also that it failed to maintain its operation in accordance with the minimum requirements of law, failing to provide care and services at mandated minimum standards, and intentionally operated an unlicensed ALF. AHCA sought fines in the amount of $7,000.
  • The case did not involve any allegation of abuse, neglect, or mistreatment in any manner whatsoever of any resident of either the Merritt Island or Titusville homes. The sole issue was whether the Merritt Island home was required to obtain a license, or was instead exempt from licensure.
  • Although the Administrative Law Judge recommended only a temporary suspension and payment of a fine, AHCA over-ruled the recommendation and the ALF’s license was permanently revoked.

Pompano Retirement Village

  • Owner and vice president of the ALF Pompano Retirement Village was a controlling interest as defined by Florida Statute.
  • 3/5/12 A criminal information filed charging the Owner with unlawful receipt of kickbacks in a federal health care program, considered to be a disqualifying offense.
  • 4/5/12 Owner of the ALF was arrested.
  • April 2012 Plea was entered.
  • 6/15/12 Judgment entered against Owner.
  • 7/12/12 Documents filed with Florida Division of Corporations evidencing the resignation of Owner as vice president of the ALF.
  • 10/19/12 AHCA filed an Amended Administrative Complaint charging the ALF with not timely removing Owner from his position with the ALF, constituting an act upon which a license may be denied and furthermore that it failed to abide by the background screening standards of the Florida Statutes.
  • The ALF’s license was therefore revoked.

Personal Care:

  • Two facilities and each location had 14 beds.
  • The ALF was threatened with an Emergency Suspension Order after a diabetic resident had to be transported to the hospital with a stage 3 decubitus ulcer on her foot.
  • AHCA filed at least five Administrative Complaints against these two facilities collectively over a period of two years, alleging any combination of the following: failure to keep medication records updated, provide proper assistance with medication, failure to document changes in medications, failure to have background checks on employees, failure to provide safe and decent living environments (medications not in lock box), and similar deficiencies.
  • AHCA sought license revocation and administrative fines.
  • AHCA settled for a voluntary relinquishment of both ALF licenses within one year and no fines.

The Paradise ALF:

  • Administrative complaint seeking a $1,000 fine was filed after AHCA conducted a survey and alleged that two staff members were lacking in background screening clearance.
  • Administrative complaint seeking a $5,000 fine and revocation of license filed after a complaint survey wherein it was alleged that among other things, the ALF failed to protect the residents from unsafe conditions and deficient practices that exist in the facility.
  • AHCA issued an Immediate Moratorium on Admissions and Emergency Suspension of License Order after the complaint survey.
  • The ALF failed to timely respond to the Administrative Complaint and Election of Rights, thus waiving its right to a hearing to contest the allegations and sanctions sought in the Administrative Complaint.
  • The ALF’s license was therefore revoked.

Provider Rights

If an ALF receives an Administrative Complaint from AHCA, it is notified of the right to request an administrative hearing. If the ALF elects to seek an administrative hearing, there are two options, an informal administrative hearing or a formal administrative hearing. The ALF must request the hearing within 21 days of the day the Administrative Complaint was received. At an informal hearing, the ALF may submit testimony and written evidence to AHCA to show that the proposed agency action contained in the Administrative Complaint is too severe or that the fine should be reduced. If a formal hearing is requested, the ALF will have the opportunity to present its case in front of an administrative law judge appointed by the Division of Administrative Hearings, not just to plead their case with AHCA. The attorney for the ALF will be able to present testimony and witnesses, can cross-examine witnesses presented by AHCA, can conduct formal discovery to obtain information that AHCA possesses and will have the opportunity to submit proposed findings of fact and conclusions of law for consideration by the administrative law judge. The attorney has the opportunity to fight for the ALF’s rights to operate and that decision will be made by an administrative law judge, not AHCA.

Conclusion

All ALFs will need to increase their vigilance in complying with licensure standards, training standards and resident care. The purpose of increased standards is to protect the residents of ALFs. Unfortunately, sometimes the side effect of stricter fines and heavier penalties is unfair policing of providers which results in higher agency revenue. If you have recently had a survey with poor results and an Administrative Complaint is imminent, call us today. Don’t wait.

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Early Effects of the New CON Laws

We posted before about how the lifting of the moratorium CON Regulations for Nursing Homes would alter the nursing home regulation landscape. Now that the law has been passed and the moratorium actually lifted, the effects are beginning to be felt. Recently, AHCA posted its list of applicants for the “1st Other Beds & Programs Batching Cycle of 2014.” The list can be found here.

What is readily apparent is that the existing providers are getting in early to raise the bar before competitors have a chance to enter the market now that the CON moratorium has been lifted. If you are a nursing home provider and you need help navigating these new laws, we can help. Contact us here for a free consultation.

Protecting Your Online Brand

To compete in today’s online world, most companies need to have an online presence. Beyond just having a company web page, many companies choose to engage with their customers and potential customers via social media, as well. And while the Internet has created new avenues for these companies to generate business, they have also created new ways for competitors to deceive and mislead consumers. While false advertising by competitors has always been around, the Internet has allowed businesses to cheaply reach large audiences with their misleading advertisements. These false and misleading advertisements can damage a company’s brand and cause them to lose serious revenue.

One of the quickest and easiest ways for a competitor to damage a brand online is for it to scam review sites. Websites like Yelp allow customers to rate their experience for everyone on the Internet to see. In certain industries, like the restaurant industry, these reviews have a massive impact on a consumer’s decision to patronize the business. While honest reviews are good for consumers, false reviews can hurt consumers and the businesses that play by the rules. Companies have found they can scam these sites by posting fake, positive reviews about themselves or by posting fake, negative reviews about their competitors. Some companies take it upon themselves to do the hard work and to actually post the fake reviews themselves like in Yelp, Inc. v. McMillan Law Group, Inc. In that case, Yelp accused McMillan of using his employees to set up fake Yelp accounts to post fake, positive reviews of his own law-firm in an effort to overshadow one negative review he had received. However, if the company is too busy to do it itself, there are entire businesses set up that do nothing but post fake reviews on review sites (see Edmunds v. Humankind Designs, Ltd.). All a company needs to do is pay some money and watch the positive reviews roll in. While review sites seem to be aggressive in stopping these fake, positive reviews, they are much more protective of the negative reviews. In Yelp, Inc. v. Hadeed Carpet Cleaning, Hadeed believed that many of the negative comments on Yelp about its business were fake and from a competing business. Hadeed attempted to get the identities of the reviewers from Yelp and Yelp refused to disclose them. Hadeed had to fight all the way to the Virginia Supreme Court just to get the names of the anonymous reviewers revealed.

While scamming online reviews requires little effort, some companies have taken deception to a whole new level. In Avepoint, Inc. v. Power Tools, Inc. d/b/a Axceler, Avepoint accused Axceler of creating a fake LinkedIn profile that purported to be an employee Avepoint. The LinkedIn profile stated that the fake employee was based in China and used this to mislead consumers into believing that Avepoint was a Chinese company that produced its software in China. An Axceler sales executive even went so far as to tweet about meeting this fake employee – “Just ran into Jim Chung from Avepoint, Good guy.” Keep in mind, Jim Chung doesn’t actually exist. Avepoint claims that these actions, along with other deceptive and misleading claims, caused consumers to leave them for Axceler.

With all of the opportunities for a competitor to scam the system, how can a company protect itself? Fortunately, there are numerous causes of action that can protect a company from false, deceptive, and defamatory comments and advertisements online. For example, in the Avepoint case, the Court refused to dismiss Avepoint’s trademark infringement, defamation, and deceptive and unfair trade practices claims against Axceler. However, to stop these illegal actions, a company needs to be aware that they are happening. Companies should regularly monitor their online presence by keeping tabs on the reviews being posted about it, Googling the company name, and searching Twitter and Facebook for the company name. That way, the company sees its brand the way consumers see its brand and, if there is false or deceptive content online, the company will become aware of it and can take action.

Social media and review sites are the norm for customers and businesses. Customers rely on these sites when deciding where to spend their money. Sadly, due to this opportunity to make money, less than ethical companies have found ways to scam the system. To stay competitive, ethical companies need to monitor their online brand and be prepared to take action to protect it from fake, online content.

If you have been a victim of online trademark infringement or false advertising or need help determining if you have been a victim, contact us at Smith & Associates at 321-676-5555 for a free consultation.

Unfairness or Public Corruption in Government Contracting

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So you have been through the public procurement bid process and were awarded a contract, but the government has not acted in good faith to implement the contract. Commonly, disputes over government contracts occur where multiple parties have been awarded contracts in response to a public procurement bid offering. Typically, there are disputes over whether one of the awarded bidders is receiving preferential treatment in the allocation of work under the contracts. Sometimes there is public corruption in the process.

What are the legal remedies where the material fairness of the public bid process has been compromised after the contracts have been awarded? Depending on the specific facts, there are potential remedies under Florida law, including but not limited to: (1) breach of contract; (2) breach of covenant of good faith and fair dealing; (3) fraud in the inducement; (4) deceptive and unfair trade practices; (5) public corruption; (6) tortuous interference with a business relationship; and (7) The Florida Whistleblower Act. This article will address some of the potential causes of action, remedies, and statute of limitations for the various causes of action that might be brought where the fundamental fairness of a public procurement contract has been compromised. While outside the scope of this article, there are also several potential federal law claims that might be applicable as well.

BREACH OF CONTRACT

A contract is “a promise or a set of promises for the breach of which the law gives a remedy, or the performance of which the law in some way recognizes as a duty.” Restatement (Second) of Contracts § 1 (1981); see also 1 Samuel Williston & Richard A. Lord, A Treatise on the Law of Contracts § 1:1 (4th ed. 2007). In order to prevail on a breach of contract claim, a plaintiff must prove: (1) the existence of a valid contract; (2) performance or tendered performance by the plaintiff; (3) breach of the contract by the defendant; and (4) damages sustained by the plaintiff as a result of the breach.

There are two distinct categories of remedies available for a breach of contract: general damages and special damages. General damages flow naturally from a breach of contract. See 24 Samuel Williston & Richard A. Lord, A Treatise on the Law of Contracts § 64:12 (4th ed. 2002). Special damages compensate a plaintiff for additional losses that are incurred as a result of a defendant’s breach, but that do not include the value of the promised performance. The classic example of a special damage is lost profits because lost profits do not necessarily result from a breach of a contract, but may be recoverable if the lost profits were both proximately caused by the alleged breach and reasonably foreseeable at the time the parties entered into the contract. Id. Whether or not damages exist is a question of fact for a jury. See 23 Samuel Williston & Richard A. Lord, A Treatise on the Law of Contracts § 63:5 (4th ed. 2002).

If damages are difficult to establish, the amount of damages does not need to be established with absolute certainty. Reasonable certainty will suffice where a plaintiff provides a basis upon which damages may be estimated. See Mercer Mgmt. Consulting, Inc. v. Wilde, 920 F. Supp. 219, 238 (D.D.C. 1996)(citing Garcia v. Llerena, 599 A.2d 1138, 1142 (D.C. Cir. 1991)); see also Restatement (Second) of Contracts § 352 (1981)(stating “[d]amages are not recoverable for loss beyond an amount that the evidence permits to be established with reasonable certainty”). Permissible methods of estimating lost profits in connection with a breach of contract claim include evidence of past performance or demonstrating profits earned by others. See Schonfeld v. Hilliard, 218 F.3d 164, 175-76 (2d Cir. 2000).

Because damages for breach of contract are generally limited to the pecuniary loss sustained, punitive or exemplary damages are not ordinarily recoverable in actions for breach of contract, even where the breach is willful and flagrant or oppressive. However, where the breach of contract is accompanied by an independent tort, such as fraud, for which exemplary damages may be recovered, punitive damages can be awarded. Grupo Televisa, S.A. v. Telemundo Communications Group, Inc., 485 F.3d 1233 (11th Cir. 2007); Lewis v. Guthartz, 428 So. 2d 222 (Fla. 1982); Grossman Holdings Ltd. v. Hourihan, 414 So. 2d 1037, 41 A.L.R.4th 125 (Fla. 1982); Ghodrati v. Miami Paneling Corp., 770 So. 2d 181 (Fla. Dist. Ct. App. 3d Dist. 2000); U.S. Resico, Inc. v. Henry, 590 So. 2d 1107 (Fla. Dist. Ct. App. 2d Dist. 1991); Floyd v. Video Barn, Inc., 538 So. 2d 1322 (Fla. Dist. Ct. App. 1st Dist. 1989), cause dismissed, 542 So. 2d 1335 (Fla. 1989); Aero Intern. Corp. v. Florida Nat. Bank of Miami, 437 So. 2d 156 (Fla. Dist. Ct. App. 3d Dist. 1983). Pleading punitive damages requires court permission after a showing that there is a reasonable basis for an award of punitive damages. Fla. Stat. § 768.72 (2013).

Sovereign immunity is waived by entering into a contract. See Pan-Am Tobacco Corp. v. Department of Corrections, 471 So. 2d 4 (Fla. 1984)(holding state sovereign immunity does not apply in breach of contract actions: “where the legislature has, by general law, authorized entities of the state to enter into contract or to undertake those activities which, as a matter of practicality, require entering into contract, the legislature has clearly intended that such contracts be valid and binding on both parties.”). However, sovereign immunity is only partially waived by the government for tort actions and does not include waiver for punitive damages. Generally, punitive damages can only be brought against government officials in their individual capacity and not against the sovereign. See Fla. § 768.28(9) (2013); see also Everton v. Willard, 468 So. 2d 936, fn 6 (Fla. 1985).

The statute of limitations for bringing a claim for breach of contract is five years. Fla. Stat. § 95.11(2)(b) (2013). However, there are factual issues that can toll the statutes of limitations in particular circumstances. See Morsani v. Major League Baseball, 739 So. 2d 610 (Fla. 2d DCA 1999).

BREACH OF COVENANT OF GOOD FAITH AND FAIR DEALING

Florida contract law recognizes the implied covenant of good faith and fair dealing in every contract. See Burger King Corp. v. Weaver, 169 F.3d 1310, 1315 (11th Cir.1999)(cert. denied, 528 U.S. 948, 120 S.Ct. 370, 145 L.Ed.2d 287 (1999)); Barnes v. Burger King Corp., 932 F.Supp. 1420, 1438 (S.D.Fla.1996); County of Brevard v. Miorelli Eng’g, Inc., 703 So. 2d 1049, 1050 (Fla.1997); Fernandez v. Vazquez, 397 So. 2d 1171, 1174 (Fla. 3d DCA 1981). This covenant is intended to protect “the reasonable expectations of the contracting parties in light of their express agreement.” Barnes, 932 F.Supp. at 1438.

However, there are two important restrictions on causes of action for the breach of good faith and fair dealing. First, the implied covenant of good faith and fair dealing should not be invoked to override the express terms of the agreement between the parties. See, e.g., Burger King Corp. v. Weaver, 169 F.3d 1310, 1317–18; Barnes, 932 F.Supp. at 1438; City of Riviera Beach v. John’s Towing, 691 So. 2d 519, 521 (Fla. 4th DCA 1997). Second, there must be an allegation that an express term of the contract has been breached. See, e.g., Burger King Corp. v. Weaver, 169 F.3d 1310, 1317–18; Nautica Int’l, Inc. v. Intermarine USA, L.P., 5 F.Supp.2d 1333, 1340 (S.D.Fla. 1998); Anthony Distrib., Inc. v. Miller Brewing Co., 941 F.Supp. 1567, 1574 (M.D.Fla. 1996); Barnes, 932 F.Supp. at 1438–39; Burger King Corp. v. Holder, 844 F.Supp., 1528, 1530 (S.D. Fla. 1993). The duty of good faith and fair dealing must relate to express term of the contract and is not an independent term of a contract which may be asserted as a breach when all other terms have been performed pursuant to the contract. Id.; see also Hospital Corp. of America v. Florida Med. Ctr., Inc., 710 So. 2d 573, 575 (Fla. 4th DCA 1998); Johnson Enter. of Jacksonville, Inc. v. FPL Group, Inc., 162 F.3d 1290, 1314 (11th Cir.1998)(“[G]ood faith requirement does not exist ‘in the air’. Rather, it attaches only to the performance of a specific contractual obligation.”). Allowing a claim for breach of the implied covenant of good faith and fair dealing “where no enforceable executory contractual obligation” remains would add an obligation to the contract that was not negotiated by the parties. Hospital Corp., 710 So. 2d at 575.

That said, Florida courts have inconsistently applied these caveats. For example, in Cox v. CSX Intermodal, Inc., 732 So. 2d 1092 (Fla. 1st DCA 1999), CSX had exclusive rights to the plaintiffs’ trucking services. CSX also had contracts with other trucking companies. Under the terms of the agreement, CSX was not required to furnish any specific amount of freight or number of loads for transport at any particular time or to any particular place. The plaintiffs sued alleging that CSX’s employee was exercising its discretion in allocating the loads to the various companies, in an arbitrary, fanciful and unreasonable manner. Although the appellate court found no breach of the express terms of the contract, it determined that issues of fact existed as to whether the manner in which CSX exercised its discretion violated the implied duty of good faith. Id. at 1098. However, that case was distinguished by the Fourth District Court of Appeal in Insurance Concepts and Design, Inc. v. Healthplan Services, Inc.,785 So. 2d 1232 (4th DCA 2001), holding: “Unlike the case at bar, in Cox there was an express provision in the contract, the allocation of loads between Cox and other carriers, that was allegedly not performed in good faith. The plaintiff here can point to no such provision in the contract.”

In Ernie Haire Ford, Inc. v. Ford Motor Co. 260 F.3d 1285 (11th C.A. Fla. 2001), the court distinguished the Cox case granting summary judgment precluding the contract claims holding:

With the implied covenant, one party cannot capriciously exercise discretion accorded it under a contract so as to thwart the contracting parties’ reasonable expectations. See Sepe v. City of Safety Harbor, 761 So.2d 1182, 1185 (Fla. 2d DCA 2000)(holding that, even where one party has “sole discretion” under a contract, that party, in exercising its discretion, must act in good-faith and in accordance with the contracting parties’ expectations); Cox v. CSX Intermodal, Inc., 732 So.2d 1092, 1097–98 (Fla. 1st DCA 1999)(stating “where the terms of the contract afford a party substantial discretion …, the duty to act in good faith … limits that party’s ability to act capriciously to contravene the reasonable contractual expectations of the other party”). Yet, the limit placed on a party’s discretion is not great. As the Florida Second District Court of Appeal has stated, “Unless no reasonable party … would have made the same discretionary decision …, it seems unlikely that [the party’s] decision would violate the covenant of good faith….” Sepe, 761 So.2d at 1185.
Appellants’ reliance on Cox is misplaced. The central purpose of the contract in Cox was the hauling of freight. By failing to assign freight, CSX frustrated that purpose and the reasonable expectations of the parties. Here, however, the central purpose of the Dealership Agreement was to sell cars, not to relocate the dealership. In disapproving the relocation, Appellee did not preclude Appellants from selling cars. Instead, based on “its best judgment,” Appellee forbid the relocation of the dealership to a site where, granted, Appellants would have financially benefitted. Although Appellee’s decision was not in Appellants’ best interests, it was neither capricious nor in contravention of the parties’ reasonable expectations. Therefore, the district court properly granted summary judgment on Appellants’ breach of contract claims.

In 2012, in Burger King Corp. v. Broad Street Licensing Group, LLC 469 Fed. Appx. 819 (11 Cir. C.A. Fla. 2012), the Eleventh Circuit addressed the Cox decision and the implied duty of good faith holding where discretion is a part of a contract and no methodology is supplied for applying the discretion, the implied covenant of good faith and fair dealing will be imposed as a gap-filling to determine how the discretion should be applied:

Broad Street also alleges that BKC’s repudiation of the licensing agreement breached the implied duty of good faith and fair dealing under Florida law. Where a contract vests a party with discretion, but provides no standards for exercising that discretion, Florida courts have held that the implied duty of good faith and fair dealing attaches as a gap-filling default rule. Speedway SuperAmerica, LLC v. Tropic Enter., Inc., 966 So. 2d 1, 3 (Fla.Dist.Ct.App. 2007); Publix Super Markets, Inc. v. Wilder Corp. of Del., 876 So.2d 652, 654–55 (Fla.Dist.Ct.App. 2004). This standard imposes a duty upon the party vested with discretion to act in a commercially reasonable manner, or a manner that satisfies the reasonable expectations of the other party. See, e.g., Publix Super Markets, 876 So. 2d at 655 (holding that exercise of discretion was reasonable based upon evidence of the commercial needs of the party vested with discretion); Cox v. CSX Intermodal, Inc., 732 So. 2d 1092, 1098 (Fla.Dist.Ct.App.1999)(considering whether exercise of discretion would unreasonably deprive other party of meeting its “costs of operation”).
We agree with Broad Street that paragraph 4(G) of the contract is governed by the implied duty of good faith and fair dealing. This paragraph vests BKC with discretion to terminate any licensing agreement without Broad Street’s approval. But, it contains no standards for BKC’s exercise of that discretion. See Cox, 732 So. 2d at 1098. Further, Broad Street has alleged an expectation that compensation for its services would consist of, in part, a percentage of any revenue collected and paid to BKC for any license agreement secured by Broad Street.

BKC argues in response that the implied duty of good faith and fair dealing “may not be imposed to override express terms in a contract.” Burger King Corp. v. Weaver, 169 F.3d 1310, 1316 (11th Cir.1999)(quotation marks and alterations omitted)(applying Florida law). While we agree with this generic statement of law, we do not believe that imposing a duty of good faith and fair dealing in this case would vary the terms of paragraph 4(G). As Florida courts have recognized, where a discretionary clause is “silent with regard to the methodology or standards to be used” in exercising that discretion, imposing a reasonableness standard of good faith and fair dealing does not vary any express contractual terms. Cox, 732 So. 2d at 1098. Therefore, insofar as Broad Street alleges that BKC breached the implied duty of good faith and fair dealing, we hold that it has successfully stated a claim, notwithstanding BKC’s rights under paragraph 4(G).

However, in that case in a footnote the court pointed out that paragraph 4(G) did not expressly vest BKC with absolute discretion to terminate a licensing agreement, and implied that if it had done so there could be a different result. Also, in that case, the court ultimately relied upon another provision in the contract to determine there were no damages for terminating the license because the implied duty of good faith could not overrule an express term of the contract.

In summary, the determination of whether there is a breach in the duty of good faith and fair dealing will be a factually specific determination. The issue will most likely turn on how necessary the implied duty of good faith and fair dealing is to purpose of the contract.

FRAUD IN THE INDUCEMENT

One of the essential elements of a contract is that parties to the contract enter into it freely without fraud, mistake, duress, or undue influence. Fla. Jur. 2d Contracts § 35 (1995). Fraud in the inducement in Florida is a tort independent of breach of contract. See, e.g., Burton v. Linotype Co., 556 So. 2d 1126, 1126 (Fla. 2d Dist. Ct. App. 1989); Johnson v. Bokor, 548 So. 2d 1185, 1186 (Fla. 2d Dist. Ct. App. 1989)(holding that a party fraudulently induced into a contract may sue for fraud in the inducement or breach of contract).

Fraud is a particularly difficult claim to prove because its elements require proof of intent to defraud and reasonable reliance on the misrepresentation. See Pettinelli v. Danzig, 722 F.2d 706, 709 (11th Cir. 1984). The elements of fraud are: (1) misrepresentation of material fact; (2) the representor of the misrepresentation knew or should have known of the statement’s falsity; (3) intent by the representor that the representation will induce another to rely and act on it; and (4) resulting injury to the party acting in justifiable reliance on the representation. See Lou Bachrodt Chevrolet, Inc. v. Savage, 570 So. 2d 306, 308 (Fla. 4th Dist. Ct. App. 1990).

To be actionable, the false representation must relate to an existing fact, as opposed to a prediction about a future event, and it must be known to be false at the time the statement is made. See Cavic v. Grand Bahama Development Co., 701 F.2d 879 (11th Cir.1983); Finney v. Frost, 228 So. 2d 617 (Fla. 4th Dist. Ct. App. 1969), cert. dismissed, 239 So. 2d 101 (Fla. 1970)(set aside a jury verdict based on insufficient evidence that defendant knowingly provided false information which was intended to induce the plaintiff to act); see also American Eagle Credit Corp. v. Select Holding, Inc., 865 F.Supp. 800 (S.D. Fla. 1994). In the seminal case of Besett v. Basnett, 389 So. 2d 995 (Fla. 1980), the Supreme Court of Florida held that a “recipient of a fraudulent misrepresentation is not justified in relying upon its truth if he knows that it is false or its falsity is obvious to him.” However, a plaintiff is not precluded from recovery in tort for failing to make an independent investigation of the statement. Id.; see also Johnson v. Davis, 480 So. 2d 625 (Fla. 1985)(holding the doctrine of caveat emptor does not exempt a seller from false statements that induced the buyer to purchase).

Punitive damages are available in judicial proceedings where there is a fraud claim. See Hialeah Automotive, LLC v. Basulto, App. 3 Dist., 22 So. 3d 586 (2009), rehearing denied, review granted 116 So.3d 1259. In HGI Associates, Inc., v. Wetmore Printing Company, 427 F.3d 867, (11th Cir. C.A. 2005) the court held punitive damage, lost profits, and future lost profits were all appropriate damages for fraud in the inducement:

punitive damages are awardable for sufficient fraudulent inducement claims, even when those claims involve facts related to a collateral breach of contract claim. The general rule in Florida states that punitive damages are not awarded for breach of contract claims. See, e.g., Griffith v. Shamrock Vill., Inc., 94 So. 2d 854, 858 (Fla. 1957). However, “where the acts constituting a breach of contract also amount to a cause of action in tort there may be a recovery of exemplary damages upon proper allegations and proof.” Id.; accord Ferguson Transp., Inc. v. North Am. Van Lines, Inc., 687 So. 2d 821, 822–23 (Fla. 1996) (per curiam); Southern Bell Tel. & Tel. Co. v. Hanft, 436 So. 2d 40, 42 (Fla.1983); see also Kee, 918 F.2d at 1543. The underlying tort cause of action must be based on some sort of “intentional wrong, willful or wanton misconduct, or culpable negligence, the extent of which amounts to an independent tort.” Hanft, 436 So.2d at 42.
Wetmore relies on our decision in Kee to assert that punitive damages are not recoverable when the compensatory damages for the breach of contract and fraudulent inducement are the same. That reasoning, however, has been rejected in fraudulent inducement cases. In Kee, we based much of our decision on the Florida Supreme Court’s holding in AFM Corp. v. Southern Bell Telephone & Telegraph Co. that stated, “without some conduct resulting in personal injury or property damage, there can be no independent tort flowing from a contractual breach which would justify a tort claim solely for economic losses.” 515 So.2d 180, 181–82 (Fla.1987); accord Kee, 918 F.2d at 1543. The Florida Supreme Court, however, has subsequently rejected the use of this language to eliminate a legitimate fraudulent inducement cause of action on the sole basis that breach-of-contract claims recover for the same alleged economic injuries. See HTP, Ltd. v. Lineas Aereas Costarricenses, S.A., 685 So. 2d 1238, 1239 (Fla.1996).

In HTP, the court resolved a conflict between the Florida Courts of Appeal regarding whether a claim of fraudulent inducement is barred in a breach of contract action. See id. at 1238. The court held that a fraudulent inducement is a separate and independent tort when compared to breach of contract. See id. at 1239. The facts concerning fraud committed during the formation of a contract can be distinguished from the facts resulting in the breach of that contract. See id. Thus, an “action on a contract and for fraud in inducing plaintiff to enter into such a contract may exist at the same time, and a recovery on one of the causes will not bar a subsequent action on the other.” Id. (citations and quotations omitted).

Florida courts have further explained that the decision in HTP allows an award of punitive damages for fraudulent inducement despite additional claims for breach of contract. See Connecticut Gen. Life Ins. Co. v. Jones, 764 So. 2d 677, 680–82 (Fla.Dist.Ct.App. 2000). Indeed, even we have recognized the ability of a party to seek punitive damages for fraud and compensatory damages for breach of contract under Florida law, despite both claims arising from the same facts. See Palm Beach Atl. Coll., Inc. v. First United Fund, Ltd., 928 F.2d 1538, 1547 (11th Cir.1991). Thus, we conclude that the district court properly granted punitive damages for the acts of fraud perpetuated by Wetmore.

However, sovereign immunity is not waived under Florida law for tort claims so punitive damages can only be brought against the individual government officials in their individual capacity and not against the sovereign. Fla. § 768.28(9) (2013).

The statute of limitations for bringing a claim for fraud in the inducement is four years. Fla. Stat. § 95.11(3)(j) (2013).

DECEPTIVE AND UNFAIR TRADE PRACTICES

The Florida Deceptive and Unfair Trade Practices Act (“FDUTPA”) makes unlawful “[u]nfair methods of competition or deceptive acts or practices in the conduct of any trade or commerce.” There are three elements to establish a claim pursuant to FDUTPA: (1) a deceptive act or unfair practice; (2) causation; and (3) actual damages. Generally, FDUTPA is an attractive claim for plaintiffs because it provides for statutory damages, which are additive to other damages, and has a prevailing party attorneys’ fees provision.

Outside of Florida, some courts have held that similar laws only protect “consumers.” Thus, where the party filing the claim was the “seller” in the transaction, the claim cannot be actionable. See e.g. Channel Companies, Inc. v. Britton, 167 N.J. Super. 417, 400 A.2d 1221 (App. Div. 1979)(holding a seller is not a “consumer” under the New Jersey Consumer Fraud Act); Tex. Bus. & Com. Code §§ 17.41 et seq., (A seller of metering devices is not a “consumer” under the Texas Deceptive Trade Practices Consumer Protection Act); Bostwick v. Liquor Control Systems, Inc., 599 S.W.2d 129 (Tex. Civ. App. Waco 1980)(the Texas Deceptive Trade Practices Consumer Protection Act defines a “consumer” as an “individual, partnership, corporation, or governmental entity who seeks or acquires by purchase or lease any goods or services.” “Goods” are defined as “tangible chattels or real property purchased or leased for use.” Applying these definitions to the facts, the court reversed the trial court’s decision and rendered judgment for the individual, reasoning that the mere act of receiving a check in exchange for a purchase by the individual does not make the supplier a “consumer” under the law). While the issue has not been squarely decided in Florida, the precedent from other states and the overall intention of the federal consumer protection act raises concerns for an awarded bidder to bring this cause of action.

Sovereign immunity could also be a concern. There is only one reported Florida case where FDUTPA was raised against a government entity. See State, Dept. of Lottery v. Curcio, 71 So. 3d 931 (Fla. 1st DCA 2011). The reported case law shows the FDUTPA claim survived an interlocutory appeal. However, on remand the trial court entered an order of summary judgment on the FDUTPA claim based upon sovereign immunity. The issue is likely to be subject to an appeal.

The risk to bringing this cause of action is that FDTPA has a prevailing party attorneys’ fees provision. Thus, if the plaintiff wins on all other claims, but lose on this particular legal theory, the plaintiff could still end up paying the other parties’ attorneys’ fees.

No action may be brought by the enforcing authority under this section more than 4 years after the occurrence of a violation of this part or more than 2 years after the last payment in a transaction involved in a violation of this part, whichever is later. Fla. Stat. § 501.207 (5) (2013).

PUBLIC CORRUPTION

In certain instances there could be facts that amount to public corruption and might be actionable against the government employee that committed the acts. Article 2 §8 (c) of the Florida Constitution provides:

Any public officer or employee who breaches the public trust for private gain and any person or entity inducing such breach shall be liable to the state for all financial benefits obtained by such actions. The manner of recovery and additional damages may be provided by law.

However,. in St. John Medical Plans, Inc., St. John Clinic Medical Center, Inc., and Miguel Angel Cruz Peraza, on behalf of The State of Florida, v. Alberto Gutman, 721 So. 2d 717(Fla. 1998) Supreme Court of Florida held this constitutional provision was not self executing, meaning there must be a separate statutory cause of action to give an individual standing. There are tax payer standing cases where specific injury to a plaintiff has allowed these types of claims to survive. See e.g. Lainhart v. Burr, 438 So. 711 (Fla. 1905)(holding a violation of the public trust does not require a violation of a specific statute); Lovejoy v. Grubbs, 432 So. 2d 678 (5th DCA 1983)(holding one cannot serve two masters and that actions against public policy do not require a statute to enforce them as the statute would merely be a declaration of public policy). In Lovejoy, the court also held taxpayers have the right to bring suit against officials that squander public funds. Id.

TORTUOUS INTERFERENCE WITH A BUSINESS RELATIONSHIP

Depending on the specific facts, in some instances there may be a claim for tortuous interference with a business relationship. Florida law defines tortuous interference with a business relationship as the unjustified and intentional interference with a contract or advantageous business relationship between two other parties where injury occurs as a result of the interference. See Symon v. J. Rolfe Davis, 245 So. 2d 278, 280 (Fla. 4th DCA 1971); see also Restatement (Second) Torts § 766. Tortuous interference has five elements: (1) existence of a contract; (2) the defendant’s knowledge of a contract; (3) intentional interference with the contract; (4) interference with lack of justification or privilege; and (5) damage resulting from the breach. See Special Purpose Accounts Receivable Co-op Corp. v. Prime One Capital Co., 125 F. Supp. 2d 1093, 1103 (S.D. Fla. 2000); McKinney-Green, Inc. v. Davis, 606 So. 2d 393(Fla. 1st DCA 1992).
To maintain a claim for tortuous interference the defendant’s interference must be intentional and direct. See McCurdy v. Collis, 508 So. 2d at 383; Rosa v. Florida Coast Bank, 484 So. 2d 57, 58 (Fla. 4th DCA 1986); Lawler v. Eugene Wuesthoff Memorial Hospital Association, 497 So. 2d 1261, 1263 (Fla. 5th DCA 1986). The party claiming tortuous interference has the initial burden of proving it. See Ahern v. Boeing, 701 F.2d 142, 144 (11th Cir. 1983)(citing Unistar Corp. v. Child, 415 So. 2d 733, 734 (Fla. 3d DCA 1982). Once all of the elements are proven, the burden shifts to the defending party to prove that the interference was justified or privileged, or to establish any other possible defenses. See United Yacht Brokers v. Gillespie, 377 So. 2d 668, 672 (Fla. 1979).
Damages for tortuous interference with a business relationship must reasonably flow from the defendant’s interference. See Ethan Allen, 647 So. 2d 812, 815 (Fla. 1994). The interference of the contract must be the legal or direct cause of the injury suffered. See Tietig v. Southeast Regional Const. Corp., 557 So. 2d 98, 98 (Fla. 3d DCA 1990). In Ethan Allen, the furniture dealer told the manufacture that it was no longer selling its furniture. Id. at 814. So, the manufacturer placed an ad announcing the business split and noting that the dealer still had outstanding debt owed to the manufacturer. Id. The dealer claimed that the ad interfered with the prospective relationship with the previous people who shopped at its store. Id. However, the court disagreed with the claim and held the dealer did not suffer any injury from the interference because dealer had no identifiable agreement with the past customers. Id. at 815. Similarly, if no contractual rights are violated, then no damage from the interference occurs. See International Expositions, Inc. v. City of Miami Beach, 274 So. 2d 29, 31 (Fla. 3d DCA 1973).

The main defenses against a claim for tortuous interference of a contract are justification, privilege, and sovereign immunity. To determine if the defendant was justified in interfering, the court will balance the importance of the objective obtained through the interference with the importance of the plaintiff’s interest that was interfered with. See Heavener, Ogier Services, Inc. v. R.W. Florida Region, Inc., 418 So. 2d 1074, 1076 (Fla. 5th DCA 1982). Additionally, Restatement (second) of Torts § 767 looks at other factors to determine if an actor’s conduct was proper or justified. The Restatement looks at: (1) the nature of the actor’s conduct; (2) the actor’s motive; (3) the interests of the other with which the actor’s conduct interferes; (4) the interests sought to be advanced by the actor; (5) the social interests in protecting the freedom of action of the actor and the contractual interests of the other; (6) the proximity or remoteness of the actor’s conduct to the interference; and (7) relations between the parties.

Florida law also recognizes that interference with a contract is privileged or justified if the defendant is acting to protect or promote one’s own financial interest. See Metzler v. Bear Auto Service Co., SPX, 19 F. Supp. 2d 1345, 1364 (S. D. Fla. 1998). If a defendant interferes with a contract to protect his or her financial interest, it is generally determined that the defendant’s right to protect that interest outweighs the plaintiff’s right to be free from interference. See Heavener, Ogier Services, Inc., 418 So. 2d at 1076. Some cases require the financial interest to be an investment. See Yoder v. Shell Oil Co., 405 So. 2d 743, 744 (Fla. 2d DCA 1981).

Additionally, interference may be justified or privileged if the action constitutes legitimate competition for business. See Royal Typewriter Co., a Division of Litton Business Systems, Inc. v. Xerographic Supplies Corp., 719 F.2d 1091, 1105 (11th Cir. 1983); see also Ahern, 401 F.2d at 144 (holding that claim will not be actionable when lawful competition is present, even though a prima facie case of tortuous interference is established). In Royal Typewriter, Royal sold copy machines to Xerographic that they in turn sold to customers. Royal brought suit to recover unpaid amounts and Xerographic countersued claiming that Royal’s solicitations in another area interfered with Xerographic’s business. The court held that there was no tortuous interference of contract because Royal was only competing for customers. Id.; see also Lake Gateway Motor Inn, Inc. v. Matt’s Sunshine Gift Shops, 361 So. 2d 769, 771 (Fla. 4th DCA 1978)(holding landlord could negotiate with a potential new tenant even though an existing tenant was leasing the space).

Although lawful competition usually justifies interference, competition for business by a competitor may be actionable if the competitor is attempting to induce a customer to breach a contract that is not terminable at will. See Advantage Digital Systems, Inc. v. Digital Images Services, Inc., 870 So. 2d 111, 116 (Fla. 2d DCA 2003). The issue usually turns on whether the conduct is considered to be unfair according to contemporary business standards. See Azar v. Lehigh Corp., 364 So. 2d 860, 862 (Fla. 2d DCA 1978). Further, an action will not be privileged if undertaken out of malice. See Wagner v. Nottingham Associates, 464 So. 2d 166, 167(Fla. 3d DCA 1985).

THE FLORIDA TORT CLAIMS ACT

The Florida Tort Claims Act, sometime referred to as the Florida Whistle Blower Act, is intended to “prevent agencies or independent contractors from taking retaliatory action against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee.” Fla. Stat. §112.3187 (2013). The disclosure of this information must be made to the appropriate person. For violations involving a “local governmental entity, including any regional, county, or municipal entity, special district, community college district, or school district or any political subdivision of any of the foregoing, the information must be disclosed to a chief executive officer… or other appropriate local official.” Id. Courts have found that a person is an “appropriate local official” when they are empowered to investigate complaints and make reports or recommend corrective action. See e.g. Quintini v. Panama City Hous. Auth., 102 So. 3d 688, 690 (Fla. 1st DCA 2012) review denied, 116 So. 3d 383 (Fla. 2013) and Burden v. City of Opa Locka, 54 Employee Benefits Cas. 2108 (S.D. Fla. 2012).

In general this act includes remedies to reinstate employees or independent contractors and to make them as whole as they were before the retaliation occurred. However, there are several procedural steps that need to be taken in order to successfully proceed with a claim under this statute. These procedural steps vary based on the type of relationship the person disclosing the information has with the government or state agency. In the context of someone who has been awarded a government contract that is being corruptly administered, the person must make an attempt to resolve the situation by using all available administrative and contractual remedies. If those fail, the person must file an action in civil court within 180 days of the retaliatory act. Further, there is an attorneys’ fees provision for successfully bringing this claim. See id.

The specific facts of a particular case will control how sovereign immunity impacts this cause of action. While this statute evinces the intent of the legislature to waive sovereign immunity on a broad basis, it must be strictly construed. Fla. Jur. 2d, Government Tort Liability § 9. There are two broad exceptions to the statutory waiver of governmental tort immunity under this statute: (1) discretionary, planning-level governmental functions remain immune from tort liability; and (2) the governmental entity is not liable in tort for breaching a duty which the government owes to the public generally, as opposed to a special tort duty owed to a particular individual. If either exception to the waiver of sovereign tort immunity is applicable, the governmental entity sued is immune from tort liability. Fla. Jur. 2d, Government Tort Liability § 13

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Nursing Home Certificate Of Need Returning In Florida: Ready, Set, Go!

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After a moratorium that has lasted 13 years, Florida is preparing to reactivate its Certificate of Need (CON) program for new community nursing homes or skilled nursing facilities.  Originally enacted in 2001 as a response to concern over an ever-growing state Medicaid budget, Section 408.0435, Florida Statutes, prohibited the Agency for Health Care Administration (AHCA) from issuing any CON for a new nursing home.  Under the original legislative bill imposing this moratorium, it was to last only five years.  However, it was extended by the Legislature for five more years in 2006 and then extended again in 2011.  Now, under a pair of bills winding through the House and Senate, the Florida Legislature appears poised to repeal the moratorium and allow for new nursing home CONs to again be issued in the State.  Those in the nursing home or skilled nursing industry who have seen their development plans thwarted over the past decade can prepare now to take advantage of the re-opening of the CON program.

 Under committee substitutes for House Bill 287 (now CS/HB 287) and Senate Bill (now CS/SB 268) the moratorium enacted in Section 408.0435, Florida Statutes, would be repealed effective July 1, 2014, and the CON program for nursing homes would be reactivated with some new twists allowing for additional or expanded exemptions and “expedited review” for certain projects, including:

Exemptions: No CON Approval Needed

  • The existing CON exemption for replacement of a nursing home on the same site, or within 3 miles of the same site, would be expanded to allow for replacements within 5 miles of the existing site; and limits this exemption to only those replacements in the same nursing home “sub-district” under AHCA rules.
  • Creates a new exemption for facilities to add either 30 beds or 25% bed addition (whichever is less) to a facility that is being replaced.
  • Continues the existing “high occupancy” CON exemption to add 10 beds or 10% of the facility’s existing number of beds, but lowers the threshold to qualify from 96% annual occupancy to 94% annual occupancy.
  • Authorizes a new exemption for facilities with a common ownership interest to combine beds or transfer beds between facilities in the same district if there is no increase in the total number of beds in the district and the site to which beds are transferred is within 30 miles from the original location.

Expedited Reviews: Fast-Track Approval

  • Expands existing law allowing for expedited review to replace a nursing home within the same district under certain conditions, and now allows for replacement anywhere within a 30-mile radius, even outside of the existing District.
  • Allows for expedited review of replacement facilities that will be located outside of 30 miles from the existing site provided that the replacement location is within the same sub-district or an adjoining sub-district.  However, if the move will be to an adjoining sub-district, the existing nursing homes in the adjoining sub-district must have had at least 85% occupancy in the last six month.
  • Amends existing provisions for allowing for expedited review of relocation of beds to a facility in the same district, by allowing beds to be relocated to another facility or a new facility in the same district or in an adjoining district, so long as there is no increase in the overall number of beds in the state.

Standing to Challenge Exemptions and Expedited Review Applications

There are clear benefits to a CON exemption or expedited review application, chief among which is the ability to apply at any time without having to wait for the twice-per-year competitive review batching cycles and publication of a “fixed need pool” by AHCA.  Instead, an applicant for an exemption or expedited review can apply at any time, and the review and approval process is much shorter.

But does approval under an exemption or an expedited review process protect an applicant from potential legal challenges by existing providers in the same geographic area?  It is often erroneously believed by applicants for an exemption or an expedited project that AHCA’s decision to approve the project cannot be challenged.  However, Section 408.039(5)(c), Florida Statutes, specifically allows that existing providers in the same service district can challenge a proposed AHCA CON approval of a project whether that preliminary approval is the result of a batched comparative review or under an expedited review process.  While it is uncommon, there is legal standing for existing providers to challenge the issuance of an expedited CON approval through the normal process under the Florida Administrative Procedure Act (Chapter 120, Florida Statutes) which includes the right to seek a full formal administrative hearing to resolve any factual disputes before an independent Administrative Law Judge assigned by the Division of Administrative Hearings (DOAH).  Similarly, the granting of a CON exemption can be challenged and subject to a formal administrative hearing if there are factual disputes as to whether or not an applicant actually meets the legislative criteria for the CON exemption.  University Community Hospital v. Department of Health and Rehabilitative Services, 555 So. 2d 922 (Fla. 1st DCA 1990).

Comparative Review Process

In addition to the changes to CON exemptions and CON expedited review applications described above, the lifting of the moratorium on CON approvals for new nursing homes will revive the existing process for comparative review of competing CON Applications for new facilities or bed additions to existing facilities that are not exempt or subject to expedited review.  This process includes the following procedural steps with the changes being proposed in the pending House and Senate Bills noted:

Publication of a Fixed Need Pool:  Under the established CON process, AHCA will publish a “fixed need pool” for nursing home beds in the Florida Administrative Register two times per year under the formula set forth in Rule 59C-1.036, Florida Administrative Code.  The current rule formula projects the need for new nursing home beds in a future three year planning horizon, taking into account: the projected population in the District for population ages 65 to 74 and ages 74 and above; the use rates for usage of nursing homes by these age groups in the District; and the current bed inventory and occupancy.  Any party may challenge the accuracy of AHCA’s published fixed need pool by filing a notice of any errors within 10 days of the publication, and filing a Petition for Formal Administrative Hearing to challenge any uncorrected errors within 21 days of the published Fixed Need Pool.

Filing of Letters of Intent:  Once the need is established, any person or entity that wishes to apply for a new nursing home, or addition of beds, must first submit a “Letter of Intent” identifying the number of beds being sought and the location by District, sub-district and county.  The filing of a Letter of Intent triggers a “grace period” during which any other parties may submit a competing Letter of Intent for a project that will be located in the same District. A party is free to apply for any number of beds that are within AHCA’s published projection of fixed need.  A party may also apply for beds under “special circumstances” or “not normal circumstances” for a new facility or bed addition regardless of the number of beds projected in the published fixed need pool.

The CON Application and Omissions Response:  Once AHCA receives all initial and grace period Letters of Intent, the CON Applications are submitted by the applicants setting forth in detail the basis of the application and presenting data and analysis to demonstrate compliance with the statutory and Rule review criteria.  See Section 408.035, Florida Statutes, and Rule 59C-1.030 and 59C-1.036, Florida Administrative Code.  The Application is typically submitted in two filings: an initial or “Shell” application that includes the required forms, and an Omissions response with detailed information and analysis.  Typically, an application will include a Need Analysis, Utilization Forecast, Financial Pro Formas, a short-term and long-term financial feasibility analysis, and an architectural narrative and detailed schematic drawings for the proposed project.

If the application is alleging “not normal circumstances,” the applicant must demonstrate need by showing that existing facilities are unavailable or inaccessible, the quality of care in the service area is suffering from overutilization, or by providing other information to illustrate that the situation is not “normal” in the service area.  Humana, Inc. v. Department of Health and Rehabilitative Services, 469 So. 2d 889 (Fla. 1st DCA 1985); Department of Health and Rehabilitative Services v. Johnson & Johnson Home Health Care, Inc., 447 So. 2d 361, 363 (Fla. 1st DCA 1984); Balsam v. Department of Health and Rehabilitative Services, 486 So. 2d 1341 (Fla. 1st DCA 1986).  It has been held that there is no limitation to circumstances that may be shown to constitute a “not normal” situation warranting approval of an application in the absence of published need, but it is common for applicants to discuss “barriers to access” including geographic, financial, cultural or programmatic barriers.

AHCA Review of Competing Proposals in the Same District:  Once all applications and responses are submitted, AHCA is required to conduct a comparative review of applications for new facilities or beds located in the same District.  In conducting its review, AHCA approves the application or applications it finds best meet the projected need and the statutory and rule review criteria.

The proposed legislation to lift the moratorium on nursing home CON approval includes some important changes to AHCA’s review of applications under existing statutes and rules, including the following:

  • Aggregating Need in Sub-Districts: Allows an Applicant to aggregate the need in contiguous sub-districts for purposes of demonstrating need for a new facility or new beds.  The current statute and rule require the applicant to only consider need in the sub-district where the facility will be located. If using an aggregated “need” from two or more sub-districts under the new bill requirements, the facility must be located in the sub-district where the highest annual occupancy of two sub-districts are aggregated. If more than two sub-districts are aggregated to support an argument for need, then the facility must be located so as to provide reasonable geographic access to residents of all the sub-districts.  Interestingly, the bills provide that need will continue to be shown under the Rule formula in contiguous sub-districts where the facility is not built, even though the facility is being located to address the projected need in that sub-district.
  • Lower Occupancy Target in Rule:  Requires that AHCA lower the desired occupancy rate that the agency uses in its rule for determining need from 94% to 92% occupancy in the sub-district.
  • Positive Treatment for De-licensing Beds in Areas with No Need:  The bills require that AHCA establish a positive CON application factor for an applicant in a sub-district where need has been published, if the applicant agrees to voluntarily relinquish licensed nursing home beds in one or more sub-districts where no need is projected.  The applicant must show that it operates, controls, or otherwise has an agreement with the owner to ensure that such relinquishment of beds will occur if the new application is approved.
  • Challenges to State Agency Action Reports:  AHCA’s decision is announced in a State Agency Action Report (SAAR). Any competing applicant in the same District, as well as existing providers in the same District, have legal standing to initiate or intervene in a formal administrative proceeding to challenge the Agency’s preliminary decision that is announced in the SAAR.  Thus, an applicant who believes it has a superior CON application, or who otherwise believes that AHCA improperly denied its application has the right to a formal hearing before an Administrative Law Judge (ALJ) at DOAH to present evidence to support its application, or to demonstrate that another applicant should not be approved or has an inferior application, or to demonstrate that more than one applicant should have been approved under the circumstances that exist.  Similarly, existing providers have the right to initiate or intervene in formal proceedings to demonstrate that a new applicant or applicants should not be approved under the statutory or rule review criteria.  The review by the ALJ is “de novo,” meaning that the agency’s SAAR is not entitled to any presumption of correctness; but, rather, the ALJ reviews the evidence anew to make a determination.

Parties in an administrative hearing have the right to present witnesses, documentary evidence, and to submit Proposed Recommended Orders that include Findings of Fact and Conclusions of Law.  An ALJ reviews the evidence, and the Proposed Recommended Orders and then issues a “Recommended Order.”

A party may file “Exceptions” to the Recommended Order within 15 days after the ALJ’s issuance of the order.  AHCA then reviews all Exceptions to the Recommended Order and issues a Final Order.  However, AHCA, as a state agency, is limited by the Administrative Procedure Act in its authority to overturn the findings by an ALJ.  Factual issues susceptible of ordinary methods of proof that are not infused with policy considerations are the prerogative of the ALJ as the finder of fact.”  Heifetz v. Dep’t of Bus. Regulation, Div. of Alcoholic Beverages & Tobacco, 475 So. 2d 1277, 1281 (Fla. 1st DCA 1985) (citing McDonald v. Dep’t of Banking & Fin., 346 So. 2d 569 (Fla. 1st DCA 1977)).  This includes consideration of the evidence presented, resolution of conflicts in the evidence, judging credibility of the witnesses, drawing permissible inferences from the evidence, and reaching “ultimate finding[s] of fact based on competent, substantial evidence.”  Id. (citing State Beverage Dep’t v. Ernal, Inc., 115 So. 2d 566 (Fla. 3d DCA 1959)).  An “agency may not reject the [ALJ’s] findings unless there is no competent, substantial evidence from which the finding could reasonably be inferred. The agency is not authorized to weigh the evidence presented, judge credibility of witnesses, or otherwise interpret the evidence to fit its desired ultimate conclusion.” Id. (emphasis added)  “If there is competent[,] substantial evidence in the record to support the ALJ’s findings of fact, the agency may not reject them, modify them, substitute its findings, or make new findings.”  Rogers v. Dep’t of Health, 920 So. 2d 27, 30 (Fla. 1st DCA 2005).  Only in the narrow area where a Conclusion of Law or recommendation is within the substantive jurisdiction of the agency under its governing statutes and rules, may the agency overturn such conclusions and recommendations.  Even in these narrow circumstances, the agency, in rejecting or modifying a conclusion of law by the ALJ, must state with particularity its reasons for rejecting or modifying the conclusion, and must make an affirmative finding that its conclusion is as, or more reasonable than, the ALJ’s conclusion that is being rejected.

A party may appeal the issuance of a Final Order to the District Court of Appeal where the project would be located, or to the First District Court of Appeal in Tallahassee.

Limitation on New Nursing Home CONs

Although the lifting of the moratorium on CONs for nursing homes will present some new opportunities, there are limitations.  First and foremost, the bills currently under consideration would each place a statewide cap on the number of new nursing home beds that could be approved from July 1, 2014 to July 1, 2019.  Under both the House and Senate Bills the cap would be 3,750 beds statewide.  Once the cap is reached, both bills provide that no further CONs may be granted by AHCA.

Based upon a preliminary analysis conducted by National Healthcare Associates (NHA), a national consulting firm with headquarters in Coral Gables, it is likely that positive fixed need for additional nursing home beds will occur under the rule need formula, including the new statutory changes.  Bed need using currently available data, would be shown for the following sub-districts:

  

Sub-district Counties Net Need
1-1 Escambia, Santa Rosa 185
1-2 Okaloosa 14
2-1 Gadsden, Holmes, Jackson, Washington 71
2-2 Bay 82
2-3 Calhoun, Franklin, Gulf, Liberty, Wakulla 33
2-4 Leon 106
2-5 Jefferson, Madison, Taylor 23
3-1 Columbia, Hamilton, Suwannee 121
3-2 Alachua, Bradford, Dixie, Gilchrist, Lafayette, Levy, Union 275
3-3 Putnam 57
3-4 Marion 167
3-5 Citrus 100
3-6 Hernando 82
3-7 Lake, Sumter 159
4-1 Nassau, Duval 144
4-2 Baker, Clay, Duval 214
4-3 St. Johns, Duval 178
4-4 Flagler, Volusia 160
5-1 Pasco 62
5-2 Pinellas 82
6-1 Hillsborough 219
6-2 Manatee 1
6-4 Highlands 30
6-5 Polk 244
7-1 Brevard 133
7-2 Orange 353
7-3 Osceola 151
7-4 Seminole 129
8-1 Charlotte 10
8-2 Collier 32
8-5 Lee 279
9-1 Indian River 12
9-2 Martin 2
9-3 Okeechobee 25
11-1 Miami-Dade 269

Under the new Bill changes, an applicant could have the option of aggregating the need in multiple contiguous sub-districts to demonstrate sufficient need for a new facility.  Importantly, the current need rule contains a “default to zero” provision based on occupancy rate in a sub-district – i.e., if the sub-district average occupancy is less than 85% for the most recent six month any calculated need defaults to zero.  There is presently no proposed legislative change to this required average occupancy.  According to NHA the average occupancy in the following sub-districts was below the required 85% based upon the most recent six month reporting period (July 1, 2013 through December 31, 2013), and therefore there would be no need for any additional beds under the “default to zero” provisions of the Rule:

1-3  (Walton)
6-2  (Manatee)
6-3  (Hardee)
8-1  (Charlotte)
8-3  (DeSoto)
8-4  (Glades and Hendry)
8-6  (Sarasota)
9-4  (Palm Beach)
9-5  (St. Lucie)
10  (Broward)
11-2  (Monroe)

 

Thus for large portions of the State, it is expected that there will be published numeric need and applicants will have the ability to compete for the published bed need.

Looking at factors other than published need, according to NHA, there are barriers that exist in some parts of the State.  These barriers must be identified and analyzed by an applicant to determine whether there is sound health planning justification for approval of a new facility, or of additional beds, even where there is zero published need.  Every area or sub-district must be analyzed based upon the unique facts and circumstances applicable to that area.

Conclusion

The lifting of the 13-year moratorium will bring dramatic changes to the CON landscape for nursing homes in Florida.  It will undoubtedly present new opportunities for nursing home and skilled nursing facility providers that have been unable to proceed with business expansion plans over the past 13 years.  For existing providers who are operating efficiently at high occupancy, the lifting of the moratorium may present challenges by prospective CON applicants and market entrants taking advantage of the new and expanded exemption and expedited review process.

Although the legislative session is not yet over, and it is possible that the bills to lift the moratorium will not pass, current progress of the bills indicates likely passage.  All nursing home and skilled nursing operators and prospective applicants should take note and should be ready to respond to this dramatic change.

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Geoffrey D. Smith is a shareholder in the law firm of Smith & Associates, and has practiced in the area of health care law and CON regulation for over 20 years. 

Expert Witness: Lending a Hand in Real Estate Cases

“Do I need an expert witness in my real estate case?” This is an important question, and its answer may surprise you. It is simply, “Yes.”

As in many legal cases, the facts in a civil real estate case can be mired in the standards and practices of the industry. It is vital for the success of a real estate case that you and your clients can successfully navigate these facts with confidence.

In most civil real estate cases, there is an element of fraud, fraudulent inducement, misrepresentation, or a number of other violations of Chapter 475, Florida Statutes at issue. The most common of these include violations of the statutory duties required of a transactional broker. For example, Section 475.278(2)(c), Florida Statutes, requires brokers to use skill, care and due diligence in all transactions. In these cases, the most important testimony given by an expert relates to a broker’s duties as set forth in Section 475.278, Florida Statutes. This chapter clearly defines the duties of a broker for the protection of the consumers.

Florida law has a clear presumption in favor of finding that a transactional brokerage relationship exists between a broker and a client, unless otherwise provided in writing at the onset of any real estate transaction. A Transaction Broker Relationship is defined by statute as providing a limited form of representation to a buyer, a seller, or both in a real estate transaction but does not represent either in a fiduciary capacity or as a single agent. Section 475.278(1), Florida Statutes. The duties of the real estate licensee in this limited form of representation include the following:

(a) Dealing honestly and fairly;

(b) Accounting for all funds;

(c) Using skill, care, and diligence in the transaction;

(d) Disclosing all known facts that materially affect the value of residential real property and are not readily observable to the buyer;

(e) Resenting all offers and counteroffers in a timely manner, unless a party has previously directed the licensee otherwise in writing;

(f) Limited confidentiality, unless waived in writing by a party. This limited confidentiality will prevent disclosure that the seller will accept a price less than the asking or listed price, that the buyer will pay a price greater than the price submitted in a written offer, of the motivation of any party for selling or buying property, that a seller or buyer will agree to financing terms other than those offered, or of any other information requested by a party to remain confidential.

An expert witness can be effective in clarifying these standards for the court as, quite often, the broker hides information that affects the value of real estate to fraudulently induce a contract. In addition, many brokers have poor recordkeeping habits and do not comply with paragraph (a) of this section: dealing fairly an honestly with all parties. In addition to the standards of the industry, realtors must comply with the National Association of Realtors Code of Ethics.

Our firm employs Jason Steele, a non-lawyer expert on real estate matters that can provide the testimony and support needed in real estate litigation. As the former Director of the Division of Real Estate within the Department of Business and Professional Regulation, Jason served eight years on the Florida Real Estate Commission and sat as a Quasi Judicial official on more than 3,000 disciplinary cases. In addition, he is a former senior real estate instructor for the Florida Association of Realtors and has 38 years of real estate experience.

If our firm can assist you with expert testimony and case development on a real estate matter, please do not hesitate to contact our offices.