Florida Board of Chiropractic Medicine to Meet August 5 Via Teleconference; Again on August 12 In Palm Beach

The Florida Board of Chiropractic Medicine will meet on August 5 via teleconference and again on August 12 in Palm Beach at The Breakers Hotel. Both meetings are open to the public and agendas and meeting materials are provided via hyperlink below.

As part of the August 12 agenda, the Board will discuss Florida's new "Docs and Glocks" law (HB 155) and consider various applications for new chiropractic licensure.


August 5, 2011- Telephone Conference Call

• FAW Notice (pdf - 19kb)
• General Agenda (pdf - 7kb)

August 12, 2011 Meeting in Palm Beach at the Breakers

• FAW Notice (pdf - 19kb)
• Disciplinary Agenda (pdf - 10kb)
• General Agenda (pdf - 7kb)

Notice of August 5 Meeting/Workshop Hearing

DEPARTMENT OF HEALTH
Board of Chiropractic

The Florida Board of Chiropractic Medicine announces a telephone conference call to which all persons are invited.
DATE AND TIME: Friday, August 5, 2011, 9:00 a.m.
PLACE: Department of Health, 4042 Bald Cypress Way, Tallahassee, Florida 32399-3257; Meet Me Number: 1(888)808-6959, Conference Code: 9849329103

GENERAL SUBJECT MATTER TO BE CONSIDERED: General board business.
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Sherra W. Causey. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

If any person decides to appeal any decision made by the Board with respect to any matter considered at this meeting or hearing, he/she will need to ensure that a verbatim record of the proceeding is made, which record includes the testimony and evidence from which the appeal is to be issued.


Notice of August 12 Meeting/Workshop Hearing

DEPARTMENT OF HEALTH
Board of Chiropractic

The Florida Board of Chiropractic Medicine announces a public meeting to which all persons are invited.

DATE AND TIME: Friday, August 12, 2011, 8:30 a.m.
PLACE: The Breakers, 1 South County Road, Palm Beach, Florida 33480, (561)655-6611

GENERAL SUBJECT MATTER TO BE CONSIDERED: General board business.



Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions. Services include: Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation. New patients & same-day appointments available. (954) 463-3036 or www.chiropractorwiltonmanors.com. On-call for emergencies 24 hours. Serving Broward, Miami-Dade and Palm Beach Counties.

THE NEWS SERVICE OF FLORIDA: First Priority of Florida's New Insurance Consumer Advocate Will Be Cracking Down on Personal Injury Protection Insurance Fraud

Above:  Florida's New Insurance Consumer Advocate, Robin Westcott, Is Committed to Cracking Down on PIP Fraud

Priority will be personal injury fraud

By MICHAEL PELTIER
The News Service of Florida
http://www.newsserviceflorida.com/

Published:  Saturday, July 23, 2011

TALLAHASSEE -- Cracking down on automobile insurance fraud and strengthening the property insurance market will help consumers in the long run and be at the top of her priority list, the state's newest insurance consumer advocate said Thursday.

Shortly after she was officially named Florida Insurance Consumer Advocate, Robin Westscott said the health of the market is directly linked to consumer satisfaction and protection, a relationship she will weigh as the state's top consumer advocate, a delicate and sometimes adversarial role that has pitted former advocates against the industry and the Legislature.

While property insurance rates are important and continue to make headlines, Westscott says she'll be looking beyond rates to make sure consumers are protected from shoddy companies and criminals trying to exploit the system.

"I don't know that I will be second guessing the actuaries at the Office of Insurance Regulation too often. They are very competent," Westscott said Thursday. "I think the consumer advocate's office needs to be looking at what do we do about these markets because the rates are not going to go down until we have a good, competitive market place for our citizens."

Westcott said an immediate priority will be trying to rein in personal injury protection fraud that industry representatives say is running rampant and costing law abiding automobile insurance policyholders millions in higher premiums because of staged crashes and bogus medical claims.

Lawmakers were unsuccessful in passing meaningful PIP legislation this past session, a lack of progress that is testament to the complexities of the issues including questions of court access, clinic accountability and attorney fees.

"There are things we can do to protect consumers and make sure that we are fraud resistant," Westscott said. "It's very critical because we don't want to see our auto market devolve into what our property market is."

Appointed by State Chief Financial Officer Jeff Atwater, Westscott has been Department of Financial Services' executive director of Medicaid and Public Assistance Fraud Strike Force.

"Robin will be an ardent, outspoken and persistent advocate for Florida's insurance consumers," Atwater said in a statement. "She is committed to holding insurance companies accountable and to ensuring consumers get exactly what they pay for and are protected from fraud and abuse. She has seen firsthand the tactics used to game the system and simply won't stand for it."

Her lengthy resume includes four years as the director of property and casualty oversight at the Office of Insurance Regulation, where she also served as an acting deputy commissioner.

Among her more recent duties was spearheading an OIR look at sinkhole claims, which have exploded in recent years.

Her background also includes a long stint as an attorney with the Division of Rehabilitation and Liquidation, where she dealt with insolvency and other matters.

"She has an incredibly broad background with very high, very hands-on regulation of the insurance industry," said Sam Miller, executive vice president of Florida Insurance Council, an industry group.

Westscott said she believes that consumers benefit most when the private market offers viable options, a situation that does not always exist, especially in terms of Florida's property insurance market. Though she will defer to OIR on most rate decisions, she said the timing of rate hikes is also critical as homeowners adjust to the rising costs of insuring their homes.

Toward that end, she supports efforts to drawn down the number of policyholders in Citizens Property Insurance Corp. which is the largest property insurer in the state with 1.4 million policies in place. Long term, Citizens ranks can only be reduced if national companies return to the Florida market. And that can only happen if large insurers return to the basic tenet of insurance, reducing the cost of individual losses by spreading out the risk.

Admittedly a long process, Westscott said recent calamities in other parts of the country may make the idea of risk sharing more palatable

"It's not a valid argument to say that Florida stands alone in bearing all the risk for insurance peril," Westscott said. "We need to be standing united and the companies need to come back and spread the risk. I'm a really purist in that sense."


Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions.  Services include:  Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation.  New patients & same-day appointments available.   (954) 463-3036 or www.chiropractorwiltonmanors.com.  On-call for emergencies 24 hours.  Serving Broward, Miami-Dade and Palm Beach Counties.

Florida Governor Rick Scott Wants to Make Personal Protection Injury Coverage (PIP) Optional

From The Miami Herald's "Naked Politics" Blog on July 29, 2011:


Rick Scott:  Make PIP insurance coverage optional

Drivers should be able to choose whether they want personal injury protection as part of their auto insurance, Gov. Rick Scott told a Miami Spanish-language radio station Friday morning.

“We’ve got to pass a law that allows citizens the choice of what type of automobile insurance coverage they want,” Scott said on En Caliente (In the Heat), the popular morning show on WAQI-AM (710).

His response came to a question from co-host Ninoska Pérez-Castellón about what the state can do to lower auto insurance fraud, namely staged car accidents. Fraud would go down if drivers weren’t required to purchase policies with medical claims coverage, Scott said.

The state requires drivers to carry $10,000 worth of insurance so accident injuries are covered regardless of which driver causes the accident.

"If we allow the person who's going to buy the insurance to decide whether they want that insurance or not, then people won't buy it because that's too expensive and they don't need it," Scott said.

--PATRICIA MAZZEI AND JANET ZINK

Read more: http://miamiherald.typepad.com/nakedpolitics/2011/07/rick-scott-make-pip-insurance-coverage-optional.html#ixzz1TiVTWlw1

Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions.  Services include:  Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation.  New patients & same-day appointments available.   (954) 463-3036 or www.chiropractorwiltonmanors.com.  On-call for emergencies 24 hours.  Serving Broward, Miami-Dade and Palm Beach Counties.

State Farm Notes in St. Pete Times That Fraudulent Personal Injury Protection Claims (PIP) Are the Reason Behind Florida's Increasing Auto Insurance Rates

Auto insurance rates just keep on climbing

By JEFF HARRINGTON St. Petersburg Times

Published: Sunday, July 31, 2011

Auto insurance rates in Florida have been rising steadily since


State Farm, Geico, Progressive and Allstate -- the big four auto insurers in Florida -- have been aggressively battling for your business on the airwaves, with each promising lower rates than the other guy.

You'd think auto insurance is getting cheaper.

You'd be wrong.

Auto rates in what is already one of the most expensive states in the country have been on the rise through a steady stream of twice-a-year increases by many insurers since late 2009. All of the big four insurers have been hiking rates.

Take giant State Farm, which insures one out of every five vehicles driven in Florida.

Since November 2009, State Farm has raised its average auto rates four times, between 4.3 and 9 percent each time. That means if you were paying $200 for auto insurance a year and a half ago, the same coverage would cost about $252 today, roughly 26 percent more. Why? "I can tell you in one word," State Farm spokesman Chris Neal says. "It's PIP. PIP losses continue to accelerate with no end in sight. It's almost the sole reason behind those increases."

PIP, or personal injury protection, covers drivers and passengers hurt in auto accidents. Under the state's no-fault insurance laws, anyone injured is covered for up to $10,000 in medical bills.

The problem: PIP claims have skyrocketed in Florida, along with allegations of PIP fraud. Insurers and the state investigators cite increased reports of staged accidents in which people with minor or no injuries go to medical clinics for treatment and those clinics, in turn, collect up to $10,000 per person in insurance payouts.

A push to clamp down on PIP fraud failed in the Legislature the last session, in part because of concerns that it was overreaching. Personal injury attorneys and some legislators objected that it gave insurers up to three months to pay legitimate claims and said a limit on attorney fees could discourage people from going after insurance companies that deny legitimate claims.

Regardless of what percentage of PIP claims are legitimate, it's clear that claims are on the rise.

A report this year showed that PIP filings rose 28 percent from 2006 to 2010 in Florida. The number of PIP-related lawsuits in which the insurer was the defendant increased by 387 percent in the same four-year period.

In January, economist and Insurance Information Institute president Bob Hartwig said the cost to insurers of covering no-fault fraud is rising by 70 percent annually, and "these costs will eventually be passed along to Florida drivers."

"Eventually" has arrived. In addition to the string of State Farm filings:

Geico General imposed a pair of rate increases this year, an average 4.5 percent increase effective Jan. 27 and a 5 percent boost effective June 30. Its sister company, Geico Indemnity, imposed rate increases of 4.8 percent and 4.3 percent, respectively, for the same time periods. In a letter to some customers, Geico blamed a continual sharp increase in the number of people claiming injury for every 100 accidents, "although the rate of accidents has remained fairly stable."

Progressive has raised auto rates about 10 percent since early 2010.

The two biggest Allstate units in Florida -- Allstate Property & Casualty and Allstate Insurance Co. -- are raising their auto rates 20 percent and 6 percent, respectively, effective this Monday. That's on top of hikes of 13 percent and 3 percent, respectively, last year.

Neal of State Farm said the percentage change reflects the overall increase in the average premium. Collision and comprehensive coverage has actually gotten cheaper, so policies including them may not rise as much. On the other hand, a customer with a bare-bones policy -- the state-mandated PIP coverage and property damage liability -- could see their premiums go up 20 or 30 percent at renewal time instead of 5 percent, Neal said.

"People that have a lower socioeconomic standing are probably the ones carrying minimum coverage," he said. "So these rate increases hit those that can least afford it."


Copyright © 2011 HeraldTribune.com

Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions.  Services include:  Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation.  New patients & same-day appointments available.   (954) 463-3036 or www.chiropractorwiltonmanors.com.  On-call for emergencies 24 hours.  Serving Broward, Miami-Dade and Palm Beach Counties.

Lance Armstrong Chiropractor Dr. Eric Goodman, co-author with Peter Park of "Foundation: Redefine Your Core, Conquer Back Pain, and Move with Confidence" Says Core Involves Two Sets of Muscles

A fan runs by US Lance Armstrong during the 20th stage of the 92nd Tour de France cycling race, an individual time-trial in Saint-Etienne.
(Joel Saget/AFP Photo/Getty Images)


Taking your workout to the back of the body
A 4-to-1 ratio of back-to-front training builds your core, book authors say

By Dorene Internicola
Reuters
July 27, 2011

Crunches, curls and sit-ups may be standard workout fare in gyms, basements and living rooms across the land.
But the authors of a new book suggest people get plenty of that movement in their daily lives. They say that to get a really strong midsection, the back of the body needs to be worked.

"Sitting at desks, working on computers, waiting in traffic, we are continually contracting our abs, throwing our shoulders forward and, ultimately, shutting down the back of the body, said Dr. Eric Goodman, co-author with Peter Park of "Foundation: Redefine Your Core, Conquer Back Pain, and Move with Confidence."

"If we're going to keep our posture and our spines strong, it has to be done by exercising the back of the body as the core of the body," explained Goodman, a chiropractor based in Santa Barbara, Calif.
The exercises illustrated in the book require no machines or equipment and see the spine as the body's center of stability. In the signature, or founder exercise, knees are bent over ankles, the body hinges from the hip joint, and movement originates in the pelvis, hips and hip joints.

"You're sticking your butt out on everything," explained Park, a trainer. "We're aiming for the posterior chain."

Park is cycling great Lance Armstrong's strength and conditioning coach. The seven-time Tour de France winner wrote the forward for the book.

"Lance needed it more than anybody," Park said of the workout. "It opened him up. (With his) rounded back, rounded shoulders he almost looked funny off the bike."
The exercises are designed to augment, rather than replace, a regular fitness regime, Goodman said.
"We don't want people to stop doing yoga or Pilates. If you're currently doing cardio or other training, just add foundation to it," Goodman said. "If you're doing it properly, 20 minutes is plenty. It's hard."

Neal Pire, spokesman for the American College of Sports Medicine, said the concept of "hinging," or loading the posterior chain while maintaining neutral spine, is mainstream, but he's never seen a book entirely devoted to it.
"Extension is key, because we do indeed live in a flexed state," he said, adding that if the public perception is that abs are the core, the public is mistaken.
"The core involves two sets of muscles: deep muscles whose roles are primarily stabilizing the spine, or more generally the trunk, and shallower muscles whose primary role is movement," Pire explained.

Goodman advocates a 4-to-1 ratio of back-to-front training.

"For every four exercises you do for the back of the body, you get to do one for the front. I think that's the opposite of what most people are doing."
Park said too many workouts reinforce sedentary postures.
"You see a guy who is sedentary all day go to the gym, do bench presses and ride on a bike. He's reinforcing what he did all day," said Park.

"We're trying to bring everyone back to the center, where they should be. I think this is the missing link."
20 minutes: How long one should do foundation exercises in addition to their regular workout, authors say.
sunday@tribune.com


Copyright © 2011, Reuters

Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions.  Services include:  Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation.  New patients & same-day appointments available.   (954) 463-3036 or www.chiropractorwiltonmanors.com.  On-call for emergencies 24 hours.  Serving Broward, Miami-Dade and Palm Beach Counties.

Feds: Fake Philadelphia chiropractor made $1.1 million in false claims

From http://www.philly.com/
The Philadelphia Inquirer

July 27, 2011
Staff Report, Inquirer Staff Writer

A man operating a Center City holistic healing clinic has been indicted on charges of not only tricking patients into believing he was a chiropractor, but also submitting claims for treatments he never carried out.

Tahib Smith Ali, 34, is charged with 150 counts of health care fraud, filing false medical statements, and aggravated identity theft.

Ali, of Northeast Philadelphia, turned himself into federal authorities this morning and was ordered to surrender his passport and a hunting rifle at a hearing before U.S. Magistrate Timothy Rice.

Rice released Ali on a recognizance bond of $50,000 and continued the case until next week, when Ali said his attorney will be available.

Prosecutors say Ali submitted bills to Independence Blue Cross between 2009 and 2010 as he was posing as a chiropractor and physical therapist.

He then submitted claims, using the name of a licensed chiropractor who once owned the clinic on the posh 300 block of South 17th Street, the indictment says. But Ali, who was not licensed, had purchased the clinic in December, 2008.

The indictment alleges that starting in January, 2009, Ali began billing for services that were either not provided, or for patient visits that never occurred.

Prosecutors say he presented himself to patients as a chiropractor, going so far as to wear scrubs, while performing spinal manipulations and muscle stretches.

In all, the indictment said, he submitted more than $1 million in claims. Authorities say he went so far as to hire a real chiropractor. He would then submit bills in his own name for work carried out by the real chiropractor, according to the indictment.

Ali faces a mandatory sentence of 2 years in prison for each aggravated identity theft count, a statutory maximum of 10 years for each health care fraud count, and five years for each count false statements count, plus up to $25 million in fines.

The case was investigated by the Federal Bureau of Investigation and is being prosecuted by Assistant United States Attorney M. Beth Leahy.


--------------------------------------------------------------------------------
Nathan Gorenstein contributed to this article.
To view this article online, go to:  http://articles.philly.com/2011-07-27/news/29820986_1_chiropractor-health-care-fraud-identity-theft

Broward Chiropractor Dr. Troy Lomasky Notes New Research on Chiropractic and Autism Spectrum Disorder: Neurodevelopmental disorders have their root in a “perfect storm” of abnormal spinal development

Research in the Journal of Pediatric, Maternal & Family Health published on January 28, 2011 recounts chiropractic reporting on improvement in a 3 year old with Pervasive Developmental Disorder, which revealed that chiropractic may play an important role managing children with such disorders.

“Research is revealing that there is a relationship between abnormalities in the spine, the nervous system, and the brain” stated Dr. Morgan Handt, the author of the paper. “Basic science research shows that the proper development of the brain relies heavily on proper structure and movement of the spine from an early age.”
Research has shown not only that the developing brain relies on normal structural integrity and joint movement, but that complex neurochemical communication and pathways involved in helping humans to “feel good” are tied into spinal biomechanics and their related neurological pathways.

“It makes perfect sense when you think about it” stated Dr. Handt, “Neurobehavioral disorders such as autism may be related to how the entire body communicates with the brain and the most critical area for this is the spine.”

Some researchers believe that the increase in the diagnosis of such disorders as autism, ADHD, pervasive developmental disorder, Tourette’s Syndrome, obsessive compulsive disorder and other neurodevelopmental disorders, have their root in a “perfect storm” of abnormal spinal development.

According to Dr. Matthew McCoy, a chiropractor, public health researcher and editor of the journal that published the study “People’s nervous systems need the constant stimulation of movement in order to develop and function properly. Abnormal position or movement of the spinal vertebra can develop and this can lead to nerve interference. It is this interference, called vertebral subluxation, that chiropractors correct.”

The child reported on in the study experienced reduced social interaction, altered behavioral patterns, language deficits, and learning difficulties and was diagnosed with Pervasive Developmental Disorder by a Developmental Pediatrician. At the time that he presented for chiropractic care, he was also being seen by a speech pathologist, developmental pediatrician, an occupational therapist, and an applied behavioral analyst. The boy had subluxations in his upper neck and sacrum.

During 5 months of chiropractic care and dietary modifications the patient responded well to chiropractic care. He started going to school again with teachers remarking that there was improvement in his abilities. He was making friends, had become interactive, was less defiant, and was an overall happier child

The researcher reviewed other studies of chiropractic which demonstrated improvements in autistic patients and calls for more research on chiropractic, subluxation, and autism.





Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions. Services include: Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation. New patients & same-day appointments available. (954) 463-3036 or www.chiropractorwiltonmanors.com. On-call for emergencies 24 hours. Serving Broward, Miami-Dade and Palm Beach Counties.

Dr. Troy Lomasky of Broward's Coast Chiropractic Notes New Paper from Journal of Upper Cervical Chiropractic Research Shows Chiropractic Helps with Parkinsons

Published in the Journal of Pediatric, Maternal, & Family Health on June 20, 2011:

Research reported in the Journal of Upper Cervical Chiropractic Research on improvement in a 66 year old woman with Parkinsons reveals that chiropractic could play an important role in managing these types of brain related neurological disorders.

The research discussed a case of a woman diagnosed with Parkinsons whose problems resolved following chiropractic care. “Research is revealing that there is a relationship between abnormalities in the spine, the nervous system and the brain” stated Dr. Robert Bello, the author of the research paper. “Basic science research shows that the proper development and function of the brain relies on proper structure and movement of the spine from an early age.”

Research has shown not only that the developing brain relies on normal structural integrity and joint movement, but that complex neurochemical communication and pathways involved in helping humans to adapt to their environment and even to “feel good” are tied into spinal biomechanics and their related neurological pathways.

“It makes perfect sense when you think about it” stated Dr. Bello. “The brain constantly needs and wants to know where our body is in space and what is going on relative to all functions of the body. If there is interference with the neurological communication between the spine and the brain all sorts of malfunctions can occur and this can lead to symptoms such as those seen in Parkinsons.”

Researchers studying the connection between chiropractic, brain stem compression and neurological disorders believe that these types of functional disorders can be caused by even slight misalignments of the bones in the upper part of the neck.

“There are very important functional relationships between the upper cervical spine and the brain that if disturbed can result in a host of problems with how the brain functions” remarked Dr. Matthew McCoy, a chiropractor, public health researcher and editor of the journal that published the study.

According to McCoy “If there is dysfunction of the upper part of the spinal cord from abnormal position or movement of the spinal vertebra this can lead to nerve interference. It is this interference, called vertebral subluxation, that chiropractors correct.”

The woman on in the study not only had vertebral subluxations but also had been diagnosed with Parkinsons. She had tremors in her arm so bad that she could hardly use it. A litany of other symptoms had emerged such as depression, fatigue and rigidity in her arms and legs. After being diagnosed with Parkinsons by her neurologist the patient was put on Sinemet (Levidopa/Carbidopa), which did not provide the patient any
perceived symptomatic relief.

After two years of constant and progressive suffering she sought the services of a chiropractor specializing in upper cervical chiropractic care and she responded after her first visit to correct an upper cervical subluxation. All of her symptoms resolved including the tremors, depression, fatigue and rigidity in her arms and legs. All that remains is some occasional rigidity of the third toe on both feet. There are one million cases of Parkinson’s disease in the US with 100,000 new cases annually and the annual costs in the US are $24 billion a year. The author of the study called for more research on the role of chiropractic care in these types of disorders.




Broward County Chiropractor Dr. Troy Lomasky heads Coast Chiropractic of Wilton Manors, Florida. A graduate of the famed New York Chiropractic College, he specializes in quickly treating pain from a variety of conditions. Services include: Consultation, X-ray, spinal adjustments & massage therapy, physiotherapy, spinal decompression for disc problems; spinal and muscular rehabilitation. New patients & same-day appointments available. (954) 463-3036 or www.chiropractorwiltonmanors.com. On-call for emergencies 24 hours. Serving Broward, Miami-Dade and Palm Beach Counties.