Florida: Ownership and Oversight
No general CPOM; licensure overlay (Health Care Clinic Act). Florida flips the usual analysis: almost anyone can own a medical practice, but ownership determines whether the entity needs a Health Care Clinic license, and operating without one is a felony that makes every claim uncollectible.
Who the statute actually covers
- "Clinic" (Fla. Stat. § 400.9905(4)): an entity at which health care services are provided and which tenders charges for reimbursement to third-party payors. Pure cash-pay entities are outside the definition entirely.
- The (g) exemption (§ 400.9905(4)(g)): entities wholly owned by licensed health care practitioners, or by practitioners plus a spouse/parent/child/sibling, where a practitioner-owner supervises the business. A practitioner may not supervise services beyond their own license scope: AHCA denied the exemption to a 100% PTA-owned PT entity on exactly that ground (Obstetric Physical Therapy Center, Case 22-006PH).
- "Medical director" (§ 400.9905(5)): a Florida-licensed physician employed or contracted by a licensed clinic; a statutory position with statutory duties (§ 400.9935).
- "Autonomous APRN" (§ 464.0123): an APRN registered with the Board of Nursing after 3,000 supervised clinical hours within the prior 5 years plus graduate coursework; autonomous scope is primary care only (plus autonomous CNM practice).
1. Who can own what
| Entity / Path | Who may own | Key limits |
|---|---|---|
| Physician-owned practice | Physicians may own through PAs, PLLCs (Ch. 621), or ordinary entities; wholly physician-owned practices are exempt from clinic licensure. | Dentistry (§ 466.0285) and optometry (§ 463.014) keep profession-only ownership rules; medicine does not. |
| APRN / PA / other practitioner ownership | Permitted. An APRN, PA, chiropractor, PT, or other listed practitioner may wholly own a practice and claim the (g) exemption, provided an owner-practitioner supervises the business and services stay within scopes the owner can lawfully supervise. | AHCA reads the supervision element strictly; scope mismatch kills the exemption. |
| Lay / investor ownership | Permitted, but the entity is a "clinic": it must obtain an AHCA Health Care Clinic license and appoint a statutory medical director. | Operating an unlicensed clinic is a third-degree felony (§ 400.9935(4)), up to $5,000/day, and charges from an unlicensed clinic are uncollectible. |
| MSO structures | Common and lawful; Florida's constraints are fee-splitting (§ 458.331(1)(i)), Patient Brokering Act (§ 817.505), and self-referral (§ 456.053). | Percentage fees tied to referrals are the danger zone. |
2. Collaborative and supervisory oversight
| Role | Agreement required | Oversight mechanics | Path to independence |
|---|---|---|---|
| PA | Supervising physician relationship under § 458.347 / § 459.022; supervision does not require on-site presence. | Ratio: a physician may supervise up to 10 currently practicing PAs (HB 431, effective July 1, 2021; raised from 4). Prescribing under a negative formulary. 14-day Schedule II psychotropics for minors only under specified supervising specialties. | None. |
| NP / APRN | Standard track: written supervisory protocol with a physician (§ 464.012). Autonomous track: Board of Nursing registration under § 464.0123. | Autonomous registration requires 3,000 clinical hours under physician supervision within the prior 5 years, 3 graduate semester hours each in differential diagnosis and pharmacology, and a clean 5-year disciplinary record. Autonomous scope is primary care only (BON includes behavioral/mental health within primary care) plus autonomous CNMs. Specialty, aesthetic, and medspa APRNs need a protocol regardless of autonomous status. | Yes, but narrow: autonomous registration ends physician supervision inside primary care only. |
3. Primary authorities
- Fla. Stat. §§ 400.990-400.995; § 400.9905(4)(g), (5); § 400.9935(4).
- AHCA, Obstetric Physical Therapy Center, LLC v. AHCA, Case No. 22-006PH.
- Fla. Stat. § 458.347, § 459.022 (HB 431, 2021).
- Fla. Stat. § 464.012; § 464.0123 (HB 607, 2020).
- Fla. Stat. § 458.331(1)(i); § 817.505; § 456.053.
Practical read: In Florida the question is never "can this person own it" but "does this ownership mix trigger clinic licensure, and is the billing model third-party or cash." The most expensive Florida mistake is an NP- or investor-owned practice that starts billing insurance while assuming the exemption applies. And the autonomous APRN registration is the most oversold credential in the state: it covers primary care, not the medspa.
General education, not legal advice.