Senate Bill sb0032Ac1
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By the Committee on Banking and Insurance; and Senator
Alexander
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1 A bill to be entitled
2 An act relating to motor vehicle insurance
3 costs; providing a short title; providing
4 legislative findings and purpose; amending s.
5 119.105, F.S.; prohibiting disclosure of
6 confidential police reports for purposes of
7 commercial solicitation; amending s. 316.066,
8 F.S.; requiring the filing of a sworn statement
9 as a condition to accessing a crash report
10 stating the report will not be used for
11 commercial solicitation; providing a penalty;
12 creating part XIII of ch. 400, F.S., entitled
13 the Health Care Clinic Act; providing for
14 definitions and exclusions; providing for the
15 licensure, inspection, and regulation of health
16 care clinics by the Agency for Health Care
17 Administration; requiring licensure and
18 background screening; providing for clinic
19 inspections; providing rulemaking authority;
20 providing licensure fees; providing fines and
21 penalties for operating an unlicensed clinic;
22 providing for clinic responsibilities with
23 respect to personnel and operations; providing
24 accreditation requirements; providing for
25 injunctive proceedings and agency actions;
26 providing administrative penalties; amending s.
27 456.0375, F.S.; excluding certain entities from
28 clinic registration requirements; providing
29 retroactive application; amending s. 456.072,
30 F.S.; providing that making a claim with
31 respect to personal injury protection which is
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1 upcoded or which is submitted for payment of
2 services not rendered constitutes grounds for
3 disciplinary action; amending s. 627.732, F.S.;
4 providing definitions; amending s. 627.736,
5 F.S.; providing that benefits are void if fraud
6 is committed; providing for award of attorney's
7 fees in actions to recover benefits; providing
8 that consideration shall be given to certain
9 factors regarding the reasonableness of
10 charges; specifying claims or charges that an
11 insurer is not required to pay; requiring the
12 Department of Health, in consultation with
13 medical boards, to identify certain diagnostic
14 tests as non-compensable; specifying effective
15 dates; deleting certain provisions governing
16 arbitration; providing for compliance with
17 billing procedures; requiring certain providers
18 to require an insured to sign a disclosure
19 form; prohibiting insurers from authorizing
20 physicians to change opinion in reports;
21 providing requirements for physicians with
22 respect to maintaining such reports; expanding
23 provisions providing for a demand letter;
24 authorizing the Financial Services Commission
25 to determine cost savings under personal injury
26 protection benefits under specified conditions;
27 amending s. 627.739, F.S.; allowing a person
28 who elects a deductible or modified coverage to
29 claim the amount deducted from a person legally
30 responsible; specifying application of a
31 deductible amount; amending s. 817.234, F.S.;
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1 providing that it is a material omission and
2 insurance fraud for a physician or other
3 provider to waive a deductible or copayment or
4 not collect the total amount of a charge;
5 increasing the penalties for certain acts of
6 solicitation of accident victims; providing
7 mandatory minimum penalties; prohibiting
8 certain solicitation of accident victims;
9 providing penalties; prohibiting a person from
10 participating in an intentional motor vehicle
11 accident for the purpose of making motor
12 vehicle tort claims; providing penalties,
13 including mandatory minimum penalties; amending
14 s. 817.236, F.S.; increasing penalties for
15 false and fraudulent motor vehicle insurance
16 application; creating s. 817.2361, F.S.;
17 prohibiting the creation or use of false or
18 fraudulent motor vehicle insurance cards;
19 providing penalties; amending s. 921.0022,
20 F.S.; revising the offense severity ranking
21 chart of the Criminal Punishment Code to
22 reflect changes in penalties and the creation
23 of additional offenses under the act; providing
24 legislative intent with respect to the
25 retroactive application of certain provisions;
26 repealing s. 456.0375, F.S., relating to the
27 regulation of clinics by the Department of
28 Health; specifying the application of any
29 increase in benefits approved by the Financial
30 Services Commission; providing for application
31 of other provisions of the act; requiring
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1 reports; providing an appropriation and
2 authorizing additional positions; repealing of
3 ss. 627.730, 627.731, 627.732, 627.733,
4 627.734, 627.736, 627.737, 627.739, 627.7401,
5 627.7403, and 627.7405, F.S., relating to the
6 Florida Motor Vehicle No-Fault Law, unless
7 reenacted by the 2006 Regular Session, and
8 specifying certain effect; authorizing insurers
9 to include in policies a notice of termination
10 relating to such repeal; providing for
11 construction of the act in pari materia with
12 laws enacted during the Regular Session of the
13 Legislature; providing effective dates.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Florida Motor Vehicle Insurance
18 Affordability Reform Act; legislative findings; purpose.--
19 (1) This act may be cited as the "Florida Motor
20 Vehicle Insurance Affordability Reform Act."
21 (2) The Legislature finds and declares that:
22 (a) The Florida Motor Vehicle No-Fault Law, enacted 32
23 years ago, has provided valuable benefits over the years to
24 consumers in this state. The principle underlying the
25 philosophical basis of the no-fault or personal injury
26 protection (PIP) insurance system is that of a trade-off of
27 one benefit for another, specifically providing medical and
28 other benefits in return for a limitation on the right to sue
29 for nonserious injuries.
30 (b) The PIP insurance system has provided benefits in
31 the form of medical payments, lost wages, replacement
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1 services, funeral payments, and other benefits, without regard
2 to fault, to consumers injured in automobile accidents.
3 (c) However, the goals behind the adoption of the
4 no-fault law in 1971, which were to quickly and efficiently
5 compensate accident victims regardless of fault, to reduce the
6 volume of lawsuits by eliminating minor injuries from the tort
7 system, and to reduce overall motor vehicle insurance costs,
8 have been significantly compromised due to the fraud and abuse
9 that has permeated the PIP insurance market.
10 (d) Motor vehicle insurance fraud and abuse, other
11 than in the hospital setting, whether in the form of
12 inappropriate medical treatments, inflated claims, staged
13 accidents, solicitation of accident victims, falsification of
14 records, or in any other form, has increased premiums for
15 consumers and must be uncovered and vigorously prosecuted. The
16 problem of inappropriate medical treatment and inflated claims
17 for PIP have generally not occurred in the hospital setting.
18 (e) The no-fault system has been weakened in part due
19 to certain insurers not adequately or timely compensating
20 injured accident victims or health care providers. In
21 addition, the system has become increasingly litigious with
22 attorneys obtaining large fees by litigating, in certain
23 instances, over relatively small amounts that are in dispute.
24 (f) It is a matter of great public importance that, in
25 order to provide a healthy and competitive automobile
26 insurance market, consumers be able to obtain affordable
27 coverage, insurers be entitled to earn an adequate rate of
28 return, and providers of services be compensated fairly.
29 (g) It is further a matter of great public importance
30 that, in order to protect the public's health, safety, and
31 welfare, it is necessary to enact the provisions contained in
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1 this act in order to prevent PIP insurance fraud and abuse and
2 to curb escalating medical, legal, and other related costs,
3 and the Legislature finds that the provisions of this act are
4 the least restrictive actions necessary to achieve this goal.
5 (h) Therefore, the purpose of this act is to restore
6 the health of the PIP insurance market in Florida by
7 addressing these issues, preserving the no-fault system, and
8 realizing cost-savings for all people in this state.
9 Section 2. Section 119.105, Florida Statutes, is
10 amended to read:
11 119.105 Protection of victims of crimes or
12 accidents.--Police reports are public records except as
13 otherwise made exempt or confidential by general or special
14 law. Every person is allowed to examine nonexempt or
15 nonconfidential police reports. A No person who comes into
16 possession of exempt or confidential information contained in
17 police reports may not inspects or copies police reports for
18 the purpose of obtaining the names and addresses of the
19 victims of crimes or accidents shall use that any information
20 contained therein for any commercial solicitation of the
21 victims or relatives of the victims of the reported crimes or
22 accidents and may not knowingly disclose such information to
23 any third party for the purpose of such solicitation during
24 the period of time that information remains exempt or
25 confidential. This section does not Nothing herein shall
26 prohibit the publication of such information to the general
27 public by any news media legally entitled to possess that
28 information or the use of such information for any other data
29 collection or analysis purposes by those entitled to possess
30 that information.
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1 Section 3. Paragraph (c) of subsection (3) of section
2 316.066, Florida Statutes, is amended, and paragraph (f) is
3 added to that subsection, to read:
4 316.066 Written reports of crashes.--
5 (3)
6 (c) Crash reports required by this section which
7 reveal the identity, home or employment telephone number or
8 home or employment address of, or other personal information
9 concerning the parties involved in the crash and which are
10 received or prepared by any agency that regularly receives or
11 prepares information from or concerning the parties to motor
12 vehicle crashes are confidential and exempt from s. 119.07(1)
13 and s. 24(a), Art. I of the State Constitution for a period of
14 60 days after the date the report is filed. However, such
15 reports may be made immediately available to the parties
16 involved in the crash, their legal representatives, their
17 licensed insurance agents, their insurers or insurers to which
18 they have applied for coverage, persons under contract with
19 such insurers to provide claims or underwriting information,
20 prosecutorial authorities, radio and television stations
21 licensed by the Federal Communications Commission, newspapers
22 qualified to publish legal notices under ss. 50.011 and
23 50.031, and free newspapers of general circulation, published
24 once a week or more often, available and of interest to the
25 public generally for the dissemination of news. For the
26 purposes of this section, the following products or
27 publications are not newspapers as referred to in this
28 section: those intended primarily for members of a particular
29 profession or occupational group; those with the primary
30 purpose of distributing advertising; and those with the
31 primary purpose of publishing names and other personally
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1 identifying information concerning parties to motor vehicle
2 crashes. Any local, state, or federal agency, agent, or
3 employee that is authorized to have access to such reports by
4 any provision of law shall be granted such access in the
5 furtherance of the agency's statutory duties notwithstanding
6 the provisions of this paragraph. Any local, state, or federal
7 agency, agent, or employee receiving such crash reports shall
8 maintain the confidential and exempt status of those reports
9 and shall not disclose such crash reports to any person or
10 entity. As a condition precedent to accessing a Any person
11 attempting to access crash report reports within 60 days after
12 the date the report is filed, a person must present a valid
13 driver's license or other photographic identification, proof
14 of status legitimate credentials or identification that
15 demonstrates his or her qualifications to access that
16 information, and file a written sworn statement with the state
17 or local agency in possession of the information stating that
18 information from a crash report made confidential by this
19 section will not be used for any commercial solicitation of
20 accident victims, or knowingly disclosed to any third party
21 for the purpose of such solicitation, during the period of
22 time that the information remains confidential. In lieu of
23 requiring the written sworn statement, an agency may provide
24 crash reports by electronic means to third-party vendors under
25 contract with one or more insurers, but only when such
26 contract states that information from a crash report made
27 confidential by this section will not be used for any
28 commercial solicitation of accident victims by the vendors, or
29 knowingly disclosed by the vendors to any third party for the
30 purpose of such solicitation, during the period of time that
31 the information remains confidential, and only when a copy of
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1 such contract is furnished to the agency as proof of the
2 vendor's claimed status. This subsection does not prevent the
3 dissemination or publication of news to the general public by
4 any legitimate media entitled to access confidential
5 information pursuant to this section. A law enforcement
6 officer as defined in s. 943.10(1) may enforce this
7 subsection. This exemption is subject to the Open Government
8 Sunset Review Act of 1995 in accordance with s. 119.15, and
9 shall stand repealed on October 2, 2006, unless reviewed and
10 saved from repeal through reenactment by the Legislature.
11 (d) Any employee of a state or local agency in
12 possession of information made confidential by this section
13 who knowingly discloses such confidential information to a
14 person not entitled to access such information under this
15 section is guilty of a felony of the third degree, punishable
16 as provided in s. 775.082, s. 775.083, or s. 775.084.
17 (e) Any person, knowing that he or she is not entitled
18 to obtain information made confidential by this section, who
19 obtains or attempts to obtain such information is guilty of a
20 felony of the third degree, punishable as provided in s.
21 775.082, s. 775.083, or s. 775.084.
22 (f) Any person who knowingly uses confidential
23 information in violation of a filed written sworn statement or
24 contractual agreement required by this section commits a
25 felony of the third degree, punishable as provided in s.
26 775.082, s. 775.083, or s. 775.084.
27 Section 4. Effective October 1, 2003, part XIII of
28 chapter 400, Florida Statutes, consisting of sections 400.901,
29 400.903, 400.905, 400.907, 400.909, 400.911, 400.913, 400.915,
30 400.917, 400.919, and 400.921 is created to read:
31 400.901 Short title; legislative findings.--
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1 (1) This part, consisting of ss. 400.901-400.921, may
2 be cited as the "Health Care Clinic Act."
3 (2) The Legislature finds that the regulation of
4 health care clinics must be strengthened to prevent
5 significant cost and harm to consumers. The purpose of this
6 part is to provide for the licensure, establishment, and
7 enforcement of basic standards for health care clinics and to
8 provide administrative oversight by the Agency for Health Care
9 Administration.
10 400.903 Definitions.--
11 (1) "Agency" means the Agency for Health Care
12 Administration.
13 (2) "Applicant" means an individual owner,
14 corporation, partnership, firm, business, association, or
15 other entity that owns or controls, directly or indirectly, 5
16 percent or more of an interest in the clinic and that applies
17 for a clinic license.
18 (3) "Clinic" means an entity at which health care
19 services are provided to individuals and which tenders charges
20 for reimbursement for such services. For purposes of this part
21 the term does not include and the licensure requirements of
22 this part do not apply to:
23 (a) Entities licensed or registered by the state under
24 chapter 390, chapter 394, chapter 395, chapter 397, this
25 chapter, chapter 463, chapter 465, chapter 466, chapter 478,
26 chapter 480, chapter 484, or chapter 651.
27 (b) Entities that own, directly or indirectly,
28 entities licensed or registered by the state pursuant to
29 chapter 390, chapter 394, chapter 395, chapter 397, this
30 chapter, chapter 463, chapter 465, chapter 466, chapter 478,
31 chapter 480, chapter 484, or chapter 651.
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1 (c) Entities that are owned, directly or indirectly,
2 by an entity licensed or registered by the state pursuant to
3 chapter 390, chapter 394, chapter, 395, chapter 397, this
4 chapter, chapter 463, chapter 465, chapter 466, chapter 478,
5 chapter 480, chapter 484, or chapter 651.
6 (d) Entities that are under common ownership, directly
7 or indirectly, with an entity licensed or registered by the
8 state pursuant to chapter 390, chapter 394, chapter 395,
9 chapter 397, this chapter, chapter 463, chapter 465, chapter
10 466, chapter 478, chapter 480, chapter 484, or chapter 651.
11 (e) An entity that is exempt from federal taxation
12 under 26 U.S.C. s. 501(c)(3) and any community college or
13 university clinic.
14 (f) A sole proprietorship, group practice,
15 partnership, or corporation that provides health care services
16 by licensed health care practitioners under chapter 457,
17 chapter 458, chapter 459, chapter 460, chapter 461, chapter
18 462, chapter 463, chapter 466, chapter 467, chapter 484,
19 chapter 486, chapter 490, chapter 491, or part I, part III,
20 part X, part XIII, or part XIV of chapter 468, or s. 464.012,
21 which are wholly owned by a licensed health care practitioner,
22 or the licensed health care practitioner and the spouse,
23 parent, or child of a licensed health care practitioner, so
24 long as one of the owners who is a licensed health care
25 practitioner is supervising the services performed therein and
26 is legally responsible for the entity's compliance with all
27 federal and state laws. However, a health care practitioner
28 may not supervise services beyond the scope of the
29 practitioner's license.
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1 (g) Clinical facilities affiliated with an accredited
2 medical school at which training is provided for medical
3 students, residents, or fellows.
4 (4) "Medical director" means a physician who is
5 employed or under contract with a clinic and who maintains a
6 full and unencumbered physician license in accordance with
7 chapter 458, chapter 459, chapter 460, or chapter 461.
8 However, if the clinic is limited to providing health care
9 services pursuant to chapter 457, chapter 484, chapter 486,
10 chapter 490, or chapter 491 or part I, part III, part X, part
11 XIII, or part XIV of chapter 468, the clinic may appoint a
12 health care practitioner licensed under that chapter to serve
13 as a clinic director who is responsible for the clinic's
14 activities. A health care practitioner may not serve as the
15 clinic director if the services provided at the clinic are
16 beyond the scope of that practitioner's license.
17 400.905 License requirements; background screenings;
18 prohibitions.--
19 (1) Each clinic, as defined in s. 400.903, must be
20 licensed and shall at all times maintain a valid license with
21 the agency. Each clinic location shall be licensed separately
22 regardless of whether the clinic is operated under the same
23 business name or management as another clinic. Mobile clinics
24 must provide to the agency, at least quarterly, their
25 projected street locations to enable the agency to locate and
26 inspect such clinics.
27 (2) The initial clinic license application shall be
28 filed with the agency by all clinics, as defined in s.
29 400.903, on or before March 1, 2004. A clinic license must be
30 renewed biennially.
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1 (3) Applicants that submit an application on or before
2 March 1, 2004, which meets all requirements for initial
3 licensure as specified in this section shall receive a
4 temporary license until the completion of an initial
5 inspection verifying that the applicant meets all requirements
6 in rules authorized by s. 400.911. However, a clinic engaged
7 in magnetic resonance imaging services may not receive a
8 temporary license unless it presents evidence satisfactory to
9 the agency that such clinic is making a good-faith effort and
10 substantial progress in seeking accreditation required under
11 s. 400.915.
12 (4) Application for an initial clinic license or for
13 renewal of an existing license shall be notarized on forms
14 furnished by the agency and must be accompanied by the
15 appropriate license fee as provided in s. 400.911. The agency
16 shall take final action on an initial license application
17 within 60 days after receipt of all required documentation.
18 (5) The application shall contain information that
19 includes, but need not be limited to, information pertaining
20 to the name, residence and business address, phone number,
21 social security number, and license number of the medical or
22 clinic director, of the licensed medical providers employed or
23 under contract with the clinic, and of each person who,
24 directly or indirectly, owns or controls 5 percent or more of
25 an interest in the clinic, or general partners in limited
26 liability partnerships.
27 (6) The applicant must file with the application
28 satisfactory proof that the clinic is in compliance with this
29 part and applicable rules, including:
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1 (a) A listing of services to be provided either
2 directly by the applicant or through contractual arrangements
3 with existing providers;
4 (b) The number and discipline of each professional
5 staff member to be employed; and
6 (c) Proof of financial ability to operate. An
7 applicant must demonstrate financial ability to operate a
8 clinic by submitting a balance sheet and an income and expense
9 statement for the first year of operation which provide
10 evidence of the applicant's having sufficient assets, credit,
11 and projected revenues to cover liabilities and expenses. The
12 applicant shall have demonstrated financial ability to operate
13 if the applicant's assets, credit, and projected revenues meet
14 or exceed projected liabilities and expenses. All documents
15 required under this subsection must be prepared in accordance
16 with generally accepted accounting principles, may be in a
17 compilation form, and the financial statement must be signed
18 by a certified public accountant. As an alternative to
19 submitting a balance sheet and an income and expense statement
20 for the first year of operation, the applicant may file a
21 surety bond of at least $500,000 which guarantees that the
22 clinic will act in full conformity with all legal requirements
23 for operating a clinic, payable to the agency. The agency may
24 adopt rules to specify related requirements for such surety
25 bond.
26 (7) Each applicant for licensure shall comply with the
27 following requirements:
28 (a) As used in this subsection, the term "applicant"
29 means individuals owning or controlling, directly or
30 indirectly, 5 percent or more of an interest in a clinic; the
31 medical or clinic director, or a similarly titled person who
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1 is responsible for the day-to-day operation of the licensed
2 clinic; the financial officer or similarly titled individual
3 who is responsible for the financial operation of the clinic;
4 and licensed medical providers at the clinic.
5 (b) Upon receipt of a completed, signed, and dated
6 application, the agency shall require background screening of
7 the applicant, in accordance with the level 2 standards for
8 screening set forth in chapter 435. Proof of compliance with
9 the level 2 background screening requirements of chapter 435
10 which has been submitted within the previous 5 years in
11 compliance with any other health care licensure requirements
12 of this state is acceptable in fulfillment of this paragraph.
13 (c) Each applicant must submit to the agency, with the
14 application, a description and explanation of any exclusions,
15 permanent suspensions, or terminations of an applicant from
16 the Medicare or Medicaid programs. Proof of compliance with
17 the requirements for disclosure of ownership and control
18 interest under the Medicaid or Medicare programs may be
19 accepted in lieu of this submission. The description and
20 explanation may indicate whether such exclusions, suspensions,
21 or terminations were voluntary or not voluntary on the part of
22 the applicant.
23 (d) A license may not be granted to a clinic if the
24 applicant has been found guilty of, regardless of
25 adjudication, or has entered a plea of nolo contendere or
26 guilty to, any offense prohibited under the level 2 standards
27 for screening set forth in chapter 435, or a violation of
28 insurance fraud under s. 817.234, within the past 5 years. If
29 the applicant has been convicted of an offense prohibited
30 under the level 2 standards or insurance fraud in any
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1 jurisdiction, the applicant must show that his or her civil
2 rights have been restored prior to submitting an application.
3 (e) The agency may deny or revoke licensure if the
4 applicant has falsely represented any material fact or omitted
5 any material fact from the application required by this part.
6 (8) Requested information omitted from an application
7 for licensure, license renewal, or transfer of ownership must
8 be filed with the agency within 21 days after receipt of the
9 agency's request for omitted information, or the application
10 shall be deemed incomplete and shall be withdrawn from further
11 consideration.
12 (9) The failure to file a timely renewal application
13 shall result in a late fee charged to the facility in an
14 amount equal to 50 percent of the current license fee.
15 400.907 Clinic inspections; emergency suspension;
16 costs.--
17 (1) Any authorized officer or employee of the agency
18 shall make inspections of the clinic as part of the initial
19 license application or renewal application. The application
20 for a clinic license issued under this part or for a renewal
21 license constitutes permission for an appropriate agency
22 inspection to verify the information submitted on or in
23 connection with the application or renewal.
24 (2) An authorized officer or employee of the agency
25 may make unannounced inspections of clinics licensed pursuant
26 to this part as are necessary to determine that the clinic is
27 in compliance with this part and with applicable rules. A
28 licensed clinic shall allow full and complete access to the
29 premises and to billing records or information to any
30 representative of the agency who makes an inspection to
31 determine compliance with this part and with applicable rules.
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1 (3) Failure by a clinic licensed under this part to
2 allow full and complete access to the premises and to billing
3 records or information to any representative of the agency who
4 makes a request to inspect the clinic to determine compliance
5 with this part or failure by a clinic to employ a qualified
6 medical director or clinic director constitutes a ground for
7 emergency suspension of the license by the agency pursuant to
8 s. 120.60(6).
9 (4) In addition to any administrative fines imposed,
10 the agency may assess a fee equal to the cost of conducting a
11 complaint investigation.
12 400.909 License renewal; transfer of ownership;
13 provisional license.--
14 (1) An application for license renewal must contain
15 information as required by the agency.
16 (2) Ninety days before the expiration date, an
17 application for renewal must be submitted to the agency.
18 (3) The clinic must file with the renewal application
19 satisfactory proof that it is in compliance with this part and
20 applicable rules. If there is evidence of financial
21 instability, the clinic must submit satisfactory proof of its
22 financial ability to comply with the requirements of this
23 part.
24 (4) When transferring the ownership of a clinic, the
25 transferee must submit an application for a license at least
26 60 days before the effective date of the transfer. An
27 application for change of ownership of a clinic is required
28 only when 45 percent or more of the ownership, voting shares,
29 or controlling interest of a clinic is transferred or
30 assigned, including the final transfer or assignment of
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1 multiple transfers or assignments over a 2-year period that
2 cumulatively total 45 percent or greater.
3 (5) The license may not be sold, leased, assigned, or
4 otherwise transferred, voluntarily or involuntarily, and is
5 valid only for the clinic owners and location for which
6 originally issued.
7 (6) A clinic against whom a revocation or suspension
8 proceeding is pending at the time of license renewal may be
9 issued a provisional license effective until final disposition
10 by the agency of such proceedings. If judicial relief is
11 sought from the final disposition, the agency that has
12 jurisdiction may issue a temporary permit for the duration of
13 the judicial proceeding.
14 400.911 Rulemaking authority; license fees.--
15 (1) The agency shall adopt rules necessary to
16 administer the clinic administration, regulation, and
17 licensure program, including rules establishing the specific
18 licensure requirements, procedures, forms, and fees. It shall
19 adopt rules establishing a procedure for the biennial renewal
20 of licenses. The agency may issue initial licenses for less
21 than the full 2-year period by charging a prorated licensure
22 fee and specifying a different renewal date than would
23 otherwise be required for biennial licensure. The rules shall
24 specify the expiration dates of licenses, the process of
25 tracking compliance with financial responsibility
26 requirements, and any other conditions of renewal required by
27 law or rule.
28 (2) The agency shall adopt rules specifying
29 limitations on the number of licensed clinics and licensees
30 for which a medical director or a clinic director may assume
31 responsibility for purposes of this part. In determining the
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1 quality of supervision a medical director or a clinic director
2 can provide, the agency shall consider the number of clinic
3 employees, the clinic location, and the health care services
4 provided by the clinic.
5 (3) License application and renewal fees must be
6 reasonably calculated by the agency to cover its costs in
7 carrying out its responsibilities under this part, including
8 the cost of licensure, inspection, and regulation of clinics,
9 and must be of such amount that the total fees collected do
10 not exceed the cost of administering and enforcing compliance
11 with this part. Clinic licensure fees are nonrefundable and
12 may not exceed $2,000. The agency shall adjust the license fee
13 annually by not more than the change in the Consumer Price
14 Index based on the 12 months immediately preceding the
15 increase. All fees collected under this part must be deposited
16 in the Health Care Trust Fund for the administration of this
17 part.
18 400.913 Unlicensed clinics; penalties; fines;
19 verification of licensure status.--
20 (1) It is unlawful to own, operate, or maintain a
21 clinic without obtaining a license under this part.
22 (2) Any person who owns, operates, or maintains an
23 unlicensed clinic commits a felony of the third degree,
24 punishable as provided in s. 775.082, s. 775.083, or s.
25 775.084. Each day of continued operation is a separate
26 offense.
27 (3) Any person found guilty of violating subsection
28 (2) a second or subsequent time commits a felony of the second
29 degree, punishable as provided under s. 775.082, s. 775.083,
30 or s. 775.084. Each day of continued operation is a separate
31 offense.
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1 (4) Any person who owns, operates, or maintains an
2 unlicensed clinic due to a change in this part or a
3 modification in agency rules within 6 months after the
4 effective date of such change or modification and who, within
5 10 working days after receiving notification from the agency,
6 fails to cease operation or apply for a license under this
7 part commits a felony of the third degree, punishable as
8 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
9 continued operation is a separate offense.
10 (5) Any clinic that fails to cease operation after
11 agency notification may be fined for each day of noncompliance
12 pursuant to this part.
13 (6) When a person has an interest in more than one
14 clinic, and fails to obtain a license for any one of these
15 clinics, the agency may revoke the license, impose a
16 moratorium, or impose a fine pursuant to this part on any or
17 all of the licensed clinics until such time as the unlicensed
18 clinic is licensed or ceases operation.
19 (7) Any person aware of the operation of an unlicensed
20 clinic must report that facility to the agency.
21 (8) Any health care provider who is aware of the
22 operation of an unlicensed clinic shall report that facility
23 to the agency. Failure to report a clinic that the provider
24 knows or has reasonable cause to suspect is unlicensed shall
25 be reported to the provider's licensing board.
26 (9) The agency may not issue a license to a clinic
27 that has any unpaid fines assessed under this part.
28 400.915 Clinic responsibilities.--
29 (1) Each clinic shall appoint a medical director or
30 clinic director who shall agree in writing to accept legal
31
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1 responsibility for the following activities on behalf of the
2 clinic. The medical director or the clinic director shall:
3 (a) Have signs identifying the medical director or
4 clinic director posted in a conspicuous location within the
5 clinic readily visible to all patients.
6 (b) Ensure that all practitioners providing health
7 care services or supplies to patients maintain a current
8 active and unencumbered Florida license.
9 (c) Review any patient referral contracts or
10 agreements executed by the clinic.
11 (d) Ensure that all health care practitioners at the
12 clinic have active appropriate certification or licensure for
13 the level of care being provided.
14 (e) Serve as the clinic records owner as defined in s.
15 456.057.
16 (f) Ensure compliance with the recordkeeping, office
17 surgery, and adverse incident reporting requirements of
18 chapter 456, the respective practice acts, and rules adopted
19 under this part.
20 (g) Conduct systematic reviews of clinic billings to
21 ensure that the billings are not fraudulent or unlawful. Upon
22 discovery of an unlawful charge, the medical director or
23 clinic director shall take immediate corrective action.
24 (2) Any business that becomes a clinic after
25 commencing operations must, within 5 days after becoming a
26 clinic, file a license application under this part and shall
27 be subject to all provisions of this part applicable to a
28 clinic.
29 (3) Any contract to serve as a medical director or a
30 clinic director entered into or renewed by a physician or a
31 licensed health care practitioner in violation of this part is
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1 void as contrary to public policy. This subsection shall apply
2 to contracts entered into or renewed on or after March 1,
3 2004.
4 (4) All charges or reimbursement claims made by or on
5 behalf of a clinic that is required to be licensed under this
6 part, but that is not so licensed, or that is otherwise
7 operating in violation of this part, are unlawful charges, and
8 therefore are noncompensable and unenforceable.
9 (5) Any person establishing, operating, or managing an
10 unlicensed clinic otherwise required to be licensed under this
11 part, or any person who knowingly files a false or misleading
12 license application or license renewal application, or false
13 or misleading information related to such application or
14 department rule, commits a felony of the third degree,
15 punishable as provided in s. 775.082, s. 775.083, or s.
16 775.084.
17 (6) Any licensed health care provider who violates
18 this part is subject to discipline in accordance with this
19 chapter and his or her respective practice act.
20 (7) The agency may fine, or suspend or revoke the
21 license of, any clinic licensed under this part for operating
22 in violation of the requirements of this part or the rules
23 adopted by the agency.
24 (8) The agency shall investigate allegations of
25 noncompliance with this part and the rules adopted under this
26 part.
27 (9) Any person or entity providing health care
28 services which is not a clinic, as defined under s. 400.903,
29 may voluntarily apply for a certificate of exemption from
30 licensure under its exempt status with the agency on a form
31 that sets forth its name or names and addresses, a statement
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1 of the reasons why it cannot be defined as a clinic, and other
2 information deemed necessary by the agency.
3 (10) The clinic shall display its license in a
4 conspicuous location within the clinic readily visible to all
5 patients.
6 (11)(a) Each clinic engaged in magnetic resonance
7 imaging services must be accredited by the Joint Commission on
8 Accreditation of Healthcare Organizations, the American
9 College of Radiology, or the Accreditation Association for
10 Ambulatory Health Care, within 1 year after licensure.
11 However, a clinic may request a single, 6-month extension if
12 it provides evidence to the agency establishing that, for good
13 cause shown, such clinic can not be accredited within 1 year
14 after licensure, and that such accreditation will be completed
15 within the 6-month extension. After obtaining accreditation as
16 required by this subsection, each such clinic must maintain
17 accreditation as a condition of renewal of its license.
18 (b) The agency may disallow the application of any
19 entity formed for the purpose of avoiding compliance with the
20 accreditation provisions of this subsection and whose
21 principals were previously principals of an entity that was
22 unable to meet the accreditation requirements within the
23 specified timeframes. The agency may adopt rules as to the
24 accreditation of magnetic resonance imaging clinics.
25 (12) The agency shall give full faith and credit
26 pertaining to any past variance and waiver granted to a
27 magnetic resonance imaging clinic from Rule 64-2002, Florida
28 Administrative Code, by the Department of Health, until
29 September 2004. After that date, such clinic must request a
30 variance and waiver from the agency under s. 120.542.
31 400.917 Injunctions.--
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1 (1) The agency may institute injunctive proceedings in
2 a court of competent jurisdiction in order to:
3 (a) Enforce the provisions of this part or any minimum
4 standard, rule, or order issued or entered into pursuant to
5 this part if the attempt by the agency to correct a violation
6 through administrative fines has failed; if the violation
7 materially affects the health, safety, or welfare of clinic
8 patients; or if the violation involves any operation of an
9 unlicensed clinic.
10 (b) Terminate the operation of a clinic if a violation
11 of any provision of this part, or any rule adopted pursuant to
12 this part, materially affects the health, safety, or welfare
13 of clinic patients.
14 (2) Such injunctive relief may be temporary or
15 permanent.
16 (3) If action is necessary to protect clinic patients
17 from life-threatening situations, the court may allow a
18 temporary injunction without bond upon proper proof being
19 made. If it appears by competent evidence or a sworn,
20 substantiated affidavit that a temporary injunction should
21 issue, the court, pending the determination on final hearing,
22 shall enjoin operation of the clinic.
23 400.919 Agency actions.--Administrative proceedings
24 challenging agency licensure enforcement action shall be
25 reviewed on the basis of the facts and conditions that
26 resulted in the agency action.
27 400.921 Agency administrative penalties.--
28 (1) The agency may impose administrative penalties
29 against clinics of up to $5,000 per violation for violations
30 of the requirements of this part. In determining if a penalty
31
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1 is to be imposed and in fixing the amount of the fine, the
2 agency shall consider the following factors:
3 (a) The gravity of the violation, including the
4 probability that death or serious physical or emotional harm
5 to a patient will result or has resulted, the severity of the
6 action or potential harm, and the extent to which the
7 provisions of the applicable laws or rules were violated.
8 (b) Actions taken by the owner, medical director, or
9 clinic director to correct violations.
10 (c) Any previous violations.
11 (d) The financial benefit to the clinic of committing
12 or continuing the violation.
13 (2) Each day of continuing violation after the date
14 fixed for termination of the violation, as ordered by the
15 agency, constitutes an additional, separate, and distinct
16 violation.
17 (3) Any action taken to correct a violation shall be
18 documented in writing by the owner, medical director, or
19 clinic director of the clinic and verified through followup
20 visits by agency personnel. The agency may impose a fine and,
21 in the case of an owner-operated clinic, revoke or deny a
22 clinic's license when a clinic medical director or clinic
23 director fraudulently misrepresents actions taken to correct a
24 violation.
25 (4) For fines that are upheld following administrative
26 or judicial review, the violator shall pay the fine, plus
27 interest at the rate as specified in s. 55.03, for each day
28 beyond the date set by the agency for payment of the fine.
29 (5) Any unlicensed clinic that continues to operate
30 after agency notification is subject to a $1,000 fine per day.
31
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1 (6) Any licensed clinic whose owner, medical director,
2 or clinic director concurrently operates an unlicensed clinic
3 shall be subject to an administrative fine of $5,000 per day.
4 (7) Any clinic whose owner fails to apply for a
5 change-of-ownership license in accordance with s. 400.909 and
6 operates the clinic under the new ownership is subject to a
7 fine of $5,000.
8 (8) The agency, as an alternative to or in conjunction
9 with an administrative action against a clinic for violations
10 of this part and adopted rules, shall make a reasonable
11 attempt to discuss each violation and recommended corrective
12 action with the owner, medical director, or clinic director of
13 the clinic, prior to written notification. The agency, instead
14 of fixing a period within which the clinic shall enter into
15 compliance with standards, may request a plan of corrective
16 action from the clinic which demonstrates a good-faith effort
17 to remedy each violation by a specific date, subject to the
18 approval of the agency.
19 (9) Administrative fines paid by any clinic under this
20 section shall be deposited into the Health Care Trust Fund.
21 Section 5. Paragraph (b) of subsection (1) of section
22 456.0375, Florida Statutes, is amended to read:
23 456.0375 Registration of certain clinics;
24 requirements; discipline; exemptions.--
25 (1)
26 (b) For purposes of this section, the term "clinic"
27 does not include and the registration requirements herein do
28 not apply to:
29 1. Entities licensed or registered by the state
30 pursuant to chapter 390, chapter 394, chapter 395, chapter
31
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1 397, chapter 400, chapter 463, chapter 465, chapter 466,
2 chapter 478, chapter 480, or chapter 484, or chapter 651.
3 2. Entities that own, directly or indirectly, entities
4 licensed or registered by the state pursuant to chapter 390,
5 chapter 394, chapter 395, chapter 397, chapter 400, chapter
6 463, chapter 465, chapter 466, chapter 478, chapter 480,
7 chapter 484, or chapter 651.
8 3. Entities that are owned, directly or indirectly, by
9 an entity licensed or registered by the state pursuant to
10 chapter 390, chapter 394, chapter 395, chapter 397, chapter
11 400, chapter 463, chapter 465, chapter 466, chapter 478,
12 chapter 480, chapter 484, or chapter 651.
13 4. Entities that are under common ownership, directly
14 or indirectly, with an entity licensed or registered by the
15 state pursuant to chapter 390, chapter 394, chapter 395,
16 chapter 397, chapter 400, chapter 463, chapter 465, chapter
17 466, chapter 478, chapter 480, chapter 484, or chapter 651.
18 5.2. Entities exempt from federal taxation under 26
19 U.S.C. s. 501(c)(3) and community college and university
20 clinics.
21 6.3. Sole proprietorships, group practices,
22 partnerships, or corporations that provide health care
23 services by licensed health care practitioners pursuant to
24 chapters 457, 458, 459, 460, 461, 462, 463, 466, 467, 484,
25 486, 490, 491, or part I, part III, part X, part XIII, or part
26 XIV of chapter 468, or s. 464.012, which are wholly owned by
27 licensed health care practitioners or the licensed health care
28 practitioner and the spouse, parent, or child of a licensed
29 health care practitioner, so long as one of the owners who is
30 a licensed health care practitioner is supervising the
31 services performed therein and is legally responsible for the
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1 entity's compliance with all federal and state laws. However,
2 no health care practitioner may supervise services beyond the
3 scope of the practitioner's license.
4 7. Clinical facilities affiliated with an accredited
5 medical school at which training is provided for medical
6 students, residents, or fellows.
7 Section 6. Paragraphs (dd) and (ee) are added to
8 subsection (1) of section 456.072, Florida Statutes, to read:
9 456.072 Grounds for discipline; penalties;
10 enforcement.--
11 (1) The following acts shall constitute grounds for
12 which the disciplinary actions specified in subsection (2) may
13 be taken:
14 (dd) With respect to making a personal injury
15 protection claim as required by s. 627.736, intentionally
16 submitting a claim statement, or bill that has been "upcoded"
17 as defined in s. 627.732.
18 (ee) With respect to making a personal injury
19 protection claim as required by s. 627.736, intentionally
20 submitting a claim, statement, or bill for payment of services
21 that were not rendered.
22 Section 7. Subsection (1) of section 627.732, Florida
23 Statutes, as amended by chapter 2003-2, Laws of Florida, is
24 amended, and subsections (8) through (16) are added to that
25 section, to read:
26 627.732 Definitions.--As used in ss. 627.730-627.7405,
27 the term:
28 (1) "Broker" means any person not possessing a license
29 under chapter 395, chapter 400, chapter 458, chapter 459,
30 chapter 460, chapter 461, or chapter 641 who charges or
31 receives compensation for any use of medical equipment and is
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1 not the 100-percent owner or the 100-percent lessee of such
2 equipment. For purposes of this section, such owner or lessee
3 may be an individual, a corporation, a partnership, or any
4 other entity and any of its 100-percent-owned affiliates and
5 subsidiaries. For purposes of this subsection, the term
6 "lessee" means a long-term lessee under a capital or operating
7 lease, but does not include a part-time lessee. The term
8 "broker" does not include a hospital or physician management
9 company whose medical equipment is ancillary to the practices
10 managed, a debt collection agency, or an entity that has
11 contracted with the insurer to obtain a discounted rate for
12 such services; nor does the term include a management company
13 that has contracted to provide general management services for
14 a licensed physician or health care facility and whose
15 compensation is not materially affected by the usage or
16 frequency of usage of medical equipment or an entity that is
17 100-percent owned by one or more hospitals or physicians. The
18 term "broker" does not include a person or entity that
19 certifies, upon request of an insurer, that:
20 (a) It is a clinic registered under s. 456.0375 or
21 licensed under ss. 400.901-400.921;
22 (b) It is a 100-percent owner of medical equipment;
23 and
24 (c) The owner's only part-time lease of medical
25 equipment for personal injury protection patients is on a
26 temporary basis not to exceed 30 days in a 12-month period,
27 and such lease is solely for the purposes of necessary repair
28 or maintenance of the 100-percent-owned medical equipment or
29 pending the arrival and installation of the newly purchased or
30 a replacement for the 100-percent-owned medical equipment, or
31 for patients for whom, because of physical size or
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1 claustrophobia, it is determined by the medical director or
2 clinical director to be medically necessary that the test be
3 performed in medical equipment that is open-style. The leased
4 medical equipment cannot be used by patients who are not
5 patients of the registered clinic for medical treatment of
6 services. Any person or entity making a false certification
7 under this subsection commits insurance fraud as defined in s.
8 817.234. However, the 30-day period provided in this paragraph
9 may be extended for an additional 60 days as applicable to
10 magnetic resonance imaging equipment if the owner certifies
11 that the extension otherwise complies with this paragraph.
12 (8) "Certify" means to swear or attest to being true
13 or represented in writing.
14 (9) "Immediate personal supervision," as it relates to
15 the performance of medical services by nonphysicians not in a
16 hospital, means that an individual licensed to perform the
17 medical service or provide the medical supplies must be
18 present within the confines of the physical structure where
19 the medical services are performed or where the medical
20 supplies are provided such that the licensed individual can
21 respond immediately to any emergencies if needed.
22 (10) "Incident," with respect to services considered
23 as incident to a physician's professional service, for a
24 physician licensed under chapter 458, chapter 459, chapter
25 460, or chapter 461, if not furnished in a hospital, means
26 such services must be an integral, even if incidental, part of
27 a covered physician's service.
28 (11) "Knowingly" means that a person, with respect to
29 information, has actual knowledge of the information; acts in
30 deliberate ignorance of the truth or falsity of the
31
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1 information; or acts in reckless disregard of the information,
2 and proof of specific intent to defraud is not required.
3 (12) "Lawful" or "lawfully" means in substantial
4 compliance with all relevant applicable criminal, civil, and
5 administrative requirements of state and federal law related
6 to the provision of medical services or treatment.
7 (13) "Hospital" means a facility that, at the time
8 services or treatment were rendered, was licensed under
9 chapter 395.
10 (14) "Properly completed" means providing truthful,
11 substantially complete, and substantially accurate responses
12 as to all material elements to each applicable request for
13 information or statement by a means that may lawfully be
14 provided and that complies with this section, or as agreed by
15 the parties.
16 (15) "Upcoding" means an action that submits a billing
17 code that would result in payment greater in amount than would
18 be paid using a billing code that accurately describes the
19 services performed. The term does not include an otherwise
20 lawful bill by a magnetic resonance imaging facility, which
21 globally combines both technical and professional components,
22 if the amount of the global bill is not more than the
23 components if billed separately; however, payment of such a
24 bill constitutes payment in full for all components of such
25 service.
26 (16) "Unbundling" means an action that submits a
27 billing code that is properly billed under one billing code,
28 but that has been separated into two or more billing codes,
29 and would result in payment greater in amount than would be
30 paid using one billing code.
31
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1 Section 8. Subsections (4), (5), (6), (7), and (11) of
2 section 627.736, Florida Statutes, are amended, present
3 subsection (13) of that section is redesignated as subsection
4 (14), and amended, and a new subsection (13) is added to that
5 section, to read:
6 627.736 Required personal injury protection benefits;
7 exclusions; priority; claims.--
8 (4) BENEFITS; WHEN DUE.--Benefits due from an insurer
9 under ss. 627.730-627.7405 shall be primary, except that
10 benefits received under any workers' compensation law shall be
11 credited against the benefits provided by subsection (1) and
12 shall be due and payable as loss accrues, upon receipt of
13 reasonable proof of such loss and the amount of expenses and
14 loss incurred which are covered by the policy issued under ss.
15 627.730-627.7405. When the Agency for Health Care
16 Administration provides, pays, or becomes liable for medical
17 assistance under the Medicaid program related to injury,
18 sickness, disease, or death arising out of the ownership,
19 maintenance, or use of a motor vehicle, benefits under ss.
20 627.730-627.7405 shall be subject to the provisions of the
21 Medicaid program.
22 (a) An insurer may require written notice to be given
23 as soon as practicable after an accident involving a motor
24 vehicle with respect to which the policy affords the security
25 required by ss. 627.730-627.7405.
26 (b) Personal injury protection insurance benefits paid
27 pursuant to this section shall be overdue if not paid within
28 30 days after the insurer is furnished written notice of the
29 fact of a covered loss and of the amount of same. If such
30 written notice is not furnished to the insurer as to the
31 entire claim, any partial amount supported by written notice
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1 is overdue if not paid within 30 days after such written
2 notice is furnished to the insurer. Any part or all of the
3 remainder of the claim that is subsequently supported by
4 written notice is overdue if not paid within 30 days after
5 such written notice is furnished to the insurer. When an
6 insurer pays only a portion of a claim or rejects a claim, the
7 insurer shall provide at the time of the partial payment or
8 rejection an itemized specification of each item that the
9 insurer had reduced, omitted, or declined to pay and any
10 information that the insurer desires the claimant to consider
11 related to the medical necessity of the denied treatment or to
12 explain the reasonableness of the reduced charge, provided
13 that this shall not limit the introduction of evidence at
14 trial; and the insurer shall include the name and address of
15 the person to whom the claimant should respond and a claim
16 number to be referenced in future correspondence. However,
17 notwithstanding the fact that written notice has been
18 furnished to the insurer, any payment shall not be deemed
19 overdue when the insurer has reasonable proof to establish
20 that the insurer is not responsible for the payment. For the
21 purpose of calculating the extent to which any benefits are
22 overdue, payment shall be treated as being made on the date a
23 draft or other valid instrument which is equivalent to payment
24 was placed in the United States mail in a properly addressed,
25 postpaid envelope or, if not so posted, on the date of
26 delivery. This paragraph does not preclude or limit the
27 ability of the insurer to assert that the claim was unrelated,
28 was not medically necessary, or was unreasonable or that the
29 amount of the charge was in excess of that permitted under, or
30 in violation of, subsection (5). Such assertion by the insurer
31 may be made at any time, including after payment of the claim
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1 or after the 30-day time period for payment set forth in this
2 paragraph.
3 (c) All overdue payments shall bear simple interest at
4 the rate established by the Comptroller under s. 55.03 or the
5 rate established in the insurance contract, whichever is
6 greater, for the year in which the payment became overdue,
7 calculated from the date the insurer was furnished with
8 written notice of the amount of covered loss. Interest shall
9 be due at the time payment of the overdue claim is made.
10 (d) The insurer of the owner of a motor vehicle shall
11 pay personal injury protection benefits for:
12 1. Accidental bodily injury sustained in this state by
13 the owner while occupying a motor vehicle, or while not an
14 occupant of a self-propelled vehicle if the injury is caused
15 by physical contact with a motor vehicle.
16 2. Accidental bodily injury sustained outside this
17 state, but within the United States of America or its
18 territories or possessions or Canada, by the owner while
19 occupying the owner's motor vehicle.
20 3. Accidental bodily injury sustained by a relative of
21 the owner residing in the same household, under the
22 circumstances described in subparagraph 1. or subparagraph 2.,
23 provided the relative at the time of the accident is domiciled
24 in the owner's household and is not himself or herself the
25 owner of a motor vehicle with respect to which security is
26 required under ss. 627.730-627.7405.
27 4. Accidental bodily injury sustained in this state by
28 any other person while occupying the owner's motor vehicle or,
29 if a resident of this state, while not an occupant of a
30 self-propelled vehicle, if the injury is caused by physical
31
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1 contact with such motor vehicle, provided the injured person
2 is not himself or herself:
3 a. The owner of a motor vehicle with respect to which
4 security is required under ss. 627.730-627.7405; or
5 b. Entitled to personal injury benefits from the
6 insurer of the owner or owners of such a motor vehicle.
7 (e) If two or more insurers are liable to pay personal
8 injury protection benefits for the same injury to any one
9 person, the maximum payable shall be as specified in
10 subsection (1), and any insurer paying the benefits shall be
11 entitled to recover from each of the other insurers an
12 equitable pro rata share of the benefits paid and expenses
13 incurred in processing the claim.
14 (f) It is a violation of the insurance code for an
15 insurer to fail to timely provide benefits as required by this
16 section with such frequency as to constitute a general
17 business practice.
18 (g) Benefits shall not be due or payable to or on the
19 behalf of an insured person if that person has committed, by a
20 material act or omission, any insurance fraud relating to
21 personal injury protection coverage under his or her policy,
22 if the fraud is admitted to in a sworn statement by the
23 insured or if it is established in a court of competent
24 jurisdiction. Any insurance fraud shall void all coverage
25 arising from the claim related to such fraud under the
26 personal injury protection coverage of the insured person who
27 committed the fraud, irrespective of whether a portion of the
28 insured person's claim may be legitimate, and any benefits
29 paid prior to the discovery of the insured person's insurance
30 fraud shall be recoverable by the insurer from the person who
31 committed insurance fraud in their entirety. The prevailing
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1 party is entitled to its costs and attorney's fees in any
2 action in which it prevails in an insurer's action to enforce
3 its right of recovery under this paragraph.
4 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
5 (a) Any physician, hospital, clinic, or other person
6 or institution lawfully rendering treatment to an injured
7 person for a bodily injury covered by personal injury
8 protection insurance may charge the insurer and injured party
9 only a reasonable amount pursuant to this section for the
10 services and supplies rendered, and the insurer providing such
11 coverage may pay for such charges directly to such person or
12 institution lawfully rendering such treatment, if the insured
13 receiving such treatment or his or her guardian has
14 countersigned the properly completed invoice, bill, or claim
15 form approved by the Department of Insurance upon which such
16 charges are to be paid for as having actually been rendered,
17 to the best knowledge of the insured or his or her guardian.
18 In no event, however, may such a charge be in excess of the
19 amount the person or institution customarily charges for like
20 services or supplies in cases involving no insurance. With
21 respect to a determination of whether a charge for a
22 particular service, treatment, or otherwise is reasonable,
23 consideration may be given to evidence of usual and customary
24 charges and payments accepted by the provider involved in the
25 dispute, and reimbursement levels in the community and various
26 federal and state medical fee schedules applicable to
27 automobile and other insurance coverages, and other
28 information relevant to the reasonableness of the
29 reimbursement for the service, treatment or supply.
30 (b)1. An insurer or insured is not required to pay a
31 claim or charges:
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1 a. Made by a broker or by a person making a claim on
2 behalf of a broker;.
3 b. For any service or treatment that was not lawful at
4 the time rendered;
5 c. To any person who knowingly submits a false or
6 misleading statement relating to the claim or charges;
7 d. With respect to a bill or statement that does not
8 substantially meet the applicable requirements of paragraph
9 (d);
10 e. For any treatment or service that is upcoded, or
11 that is unbundled when such treatment or services should be
12 bundled, in accordance with paragraph (d). To facilitate
13 prompt payment of lawful services, an insurer may change codes
14 that it determines to have been improperly or incorrectly
15 upcoded or unbundled, and may make payment based on the
16 changed codes, without affecting the right of the provider to
17 dispute the change by the insurer, provided that before doing
18 so, the insurer must contact the health care provider and
19 discuss the reasons for the insurer's change and the health
20 care provider's reason for the coding, or make a reasonable
21 good-faith effort to do so, as documented in the insurer's
22 file; and
23 f. For medical services or treatment billed by a
24 physician and not provided in a hospital unless such services
25 are rendered by the physician or are incident to his or her
26 professional services and are included on the physician's
27 bill, including documentation verifying that the physician is
28 responsible for the medical services that were rendered and
29 billed.
30 2. Charges for medically necessary cephalic
31 thermograms, peripheral thermograms, spinal ultrasounds,
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1 extremity ultrasounds, video fluoroscopy, and surface
2 electromyography shall not exceed the maximum reimbursement
3 allowance for such procedures as set forth in the applicable
4 fee schedule or other payment methodology established pursuant
5 to s. 440.13.
6 3. Allowable amounts that may be charged to a personal
7 injury protection insurance insurer and insured for medically
8 necessary nerve conduction testing when done in conjunction
9 with a needle electromyography procedure and both are
10 performed and billed solely by a physician licensed under
11 chapter 458, chapter 459, chapter 460, or chapter 461 who is
12 also certified by the American Board of Electrodiagnostic
13 Medicine or by a board recognized by the American Board of
14 Medical Specialties or the American Osteopathic Association or
15 who holds diplomate status with the American Chiropractic
16 Neurology Board or its predecessors shall not exceed 200
17 percent of the allowable amount under the participating
18 physician fee schedule of Medicare Part B for year 2001, for
19 the area in which the treatment was rendered, adjusted
20 annually on August 1 to reflect the prior calendar year's
21 changes in the annual Medical Care Item of the Consumer Price
22 Index for All Urban Consumers in the South Region as
23 determined by the Bureau of Labor Statistics of the United
24 States Department of Labor by an additional amount equal to
25 the medical Consumer Price Index for Florida.
26 4. Allowable amounts that may be charged to a personal
27 injury protection insurance insurer and insured for medically
28 necessary nerve conduction testing that does not meet the
29 requirements of subparagraph 3. shall not exceed the
30 applicable fee schedule or other payment methodology
31 established pursuant to s. 440.13.
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1 5. Effective upon this act becoming a law and before
2 November 1, 2001, allowable amounts that may be charged to a
3 personal injury protection insurance insurer and insured for
4 magnetic resonance imaging services shall not exceed 200
5 percent of the allowable amount under Medicare Part B for year
6 2001, for the area in which the treatment was rendered.
7 Beginning November 1, 2001, allowable amounts that may be
8 charged to a personal injury protection insurance insurer and
9 insured for magnetic resonance imaging services shall not
10 exceed 175 percent of the allowable amount under the
11 participating physician fee schedule of Medicare Part B for
12 year 2001, for the area in which the treatment was rendered,
13 adjusted annually on August 1 to reflect the prior calendar
14 year's changes in the annual Medical Care Item of the Consumer
15 Price Index for All Urban Consumers in the South Region as
16 determined by the Bureau of Labor Statistics of the United
17 States Department of Labor for the 12-month period ending June
18 30 of that year by an additional amount equal to the medical
19 Consumer Price Index for Florida, except that allowable
20 amounts that may be charged to a personal injury protection
21 insurance insurer and insured for magnetic resonance imaging
22 services provided in facilities accredited by the American
23 College of Radiology or the Joint Commission on Accreditation
24 of Healthcare Organizations shall not exceed 200 percent of
25 the allowable amount under the participating physician fee
26 schedule of Medicare Part B for year 2001, for the area in
27 which the treatment was rendered, adjusted annually on August
28 1 to reflect the prior calendar year's changes in the annual
29 Medical Care Item of the Consumer Price Index for All Urban
30 Consumers in the South Region as determined by the Bureau of
31 Labor Statistics of the United States Department of Labor for
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1 the 12-month period ending June 30 of that year by an
2 additional amount equal to the medical Consumer Price Index
3 for Florida. This paragraph does not apply to charges for
4 magnetic resonance imaging services and nerve conduction
5 testing for inpatients and emergency services and care as
6 defined in chapter 395 rendered by facilities licensed under
7 chapter 395.
8 6. The Department of Health, in consultation with the
9 appropriate professional licensing boards, shall adopt, by
10 rule, a list of diagnostic tests deemed not be medically
11 necessary for use in the treatment of persons sustaining
12 bodily injury covered by personal injury protection benefits
13 under this section. The initial list shall be adopted by
14 January 1, 2004, and shall be revised from time to time as
15 determined by the Department of Health, in consultation with
16 the respective professional licensing boards. Inclusion of a
17 test on the list of invalid diagnostic tests shall be based on
18 lack of demonstrated medical value and a level of general
19 acceptance by the relevant provider community and shall not be
20 dependent for results entirely upon subjective patient
21 response. Notwithstanding its inclusion on a fee schedule in
22 this subsection, an insurer or insured is not required to pay
23 any charges or reimburse claims for any invalid diagnostic
24 test as determined by the Department of Health.
25 (c)1. With respect to any treatment or service, other
26 than medical services billed by a hospital or other provider
27 for emergency services as defined in s. 395.002 or inpatient
28 services rendered at a hospital-owned facility, the statement
29 of charges must be furnished to the insurer by the provider
30 and may not include, and the insurer is not required to pay,
31 charges for treatment or services rendered more than 35 days
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1 before the postmark date of the statement, except for past due
2 amounts previously billed on a timely basis under this
3 paragraph, and except that, if the provider submits to the
4 insurer a notice of initiation of treatment within 21 days
5 after its first examination or treatment of the claimant, the
6 statement may include charges for treatment or services
7 rendered up to, but not more than, 75 days before the postmark
8 date of the statement. The injured party is not liable for,
9 and the provider shall not bill the injured party for, charges
10 that are unpaid because of the provider's failure to comply
11 with this paragraph. Any agreement requiring the injured
12 person or insured to pay for such charges is unenforceable.
13 2. If, however, the insured fails to furnish the
14 provider with the correct name and address of the insured's
15 personal injury protection insurer, the provider has 35 days
16 from the date the provider obtains the correct information to
17 furnish the insurer with a statement of the charges. The
18 insurer is not required to pay for such charges unless the
19 provider includes with the statement documentary evidence that
20 was provided by the insured during the 35-day period
21 demonstrating that the provider reasonably relied on erroneous
22 information from the insured and either:
23 a.1. A denial letter from the incorrect insurer; or
24 b.2. Proof of mailing, which may include an affidavit
25 under penalty of perjury, reflecting timely mailing to the
26 incorrect address or insurer.
27 3. For emergency services and care as defined in s.
28 395.002 rendered in a hospital emergency department or for
29 transport and treatment rendered by an ambulance provider
30 licensed pursuant to part III of chapter 401, the provider is
31 not required to furnish the statement of charges within the
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1 time periods established by this paragraph; and the insurer
2 shall not be considered to have been furnished with notice of
3 the amount of covered loss for purposes of paragraph (4)(b)
4 until it receives a statement complying with paragraph (d)
5 (e), or copy thereof, which specifically identifies the place
6 of service to be a hospital emergency department or an
7 ambulance in accordance with billing standards recognized by
8 the Health Care Finance Administration.
9 4. Each notice of insured's rights under s. 627.7401
10 must include the following statement in type no smaller than
11 12 points:
12 BILLING REQUIREMENTS.--Florida Statutes provide
13 that with respect to any treatment or services,
14 other than certain hospital and emergency
15 services, the statement of charges furnished to
16 the insurer by the provider may not include,
17 and the insurer and the injured party are not
18 required to pay, charges for treatment or
19 services rendered more than 35 days before the
20 postmark date of the statement, except for past
21 due amounts previously billed on a timely
22 basis, and except that, if the provider submits
23 to the insurer a notice of initiation of
24 treatment within 21 days after its first
25 examination or treatment of the claimant, the
26 statement may include charges for treatment or
27 services rendered up to, but not more than, 75
28 days before the postmark date of the statement.
29 (d) Every insurer shall include a provision in its
30 policy for personal injury protection benefits for binding
31 arbitration of any claims dispute involving medical benefits
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1 arising between the insurer and any person providing medical
2 services or supplies if that person has agreed to accept
3 assignment of personal injury protection benefits. The
4 provision shall specify that the provisions of chapter 682
5 relating to arbitration shall apply. The prevailing party
6 shall be entitled to attorney's fees and costs. For purposes
7 of the award of attorney's fees and costs, the prevailing
8 party shall be determined as follows:
9 1. When the amount of personal injury protection
10 benefits determined by arbitration exceeds the sum of the
11 amount offered by the insurer at arbitration plus 50 percent
12 of the difference between the amount of the claim asserted by
13 the claimant at arbitration and the amount offered by the
14 insurer at arbitration, the claimant is the prevailing party.
15 2. When the amount of personal injury protection
16 benefits determined by arbitration is less than the sum of the
17 amount offered by the insurer at arbitration plus 50 percent
18 of the difference between the amount of the claim asserted by
19 the claimant at arbitration and the amount offered by the
20 insurer at arbitration, the insurer is the prevailing party.
21 3. When neither subparagraph 1. nor subparagraph 2.
22 applies, there is no prevailing party. For purposes of this
23 paragraph, the amount of the offer or claim at arbitration is
24 the amount of the last written offer or claim made at least 30
25 days prior to the arbitration.
26 4. In the demand for arbitration, the party requesting
27 arbitration must include a statement specifically identifying
28 the issues for arbitration for each examination or treatment
29 in dispute. The other party must subsequently issue a
30 statement specifying any other examinations or treatment and
31 any other issues that it intends to raise in the arbitration.
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1 The parties may amend their statements up to 30 days prior to
2 arbitration, provided that arbitration shall be limited to
3 those identified issues and neither party may add additional
4 issues during arbitration.
5 (d)(e) All statements and bills for medical services
6 rendered by any physician, hospital, clinic, or other person
7 or institution shall be submitted to the insurer on a properly
8 completed Centers for Medicare and Medicaid Services (CMS)
9 Health Care Finance Administration 1500 form, UB 92 forms, or
10 any other standard form approved by the department for
11 purposes of this paragraph. All billings for such services
12 rendered by providers shall, to the extent applicable, follow
13 the Physicians' Current Procedural Terminology (CPT) or
14 Healthcare Correct Procedural Coding System (HCPCS), or ICD-9
15 in effect for the year in which services are rendered and
16 comply with the Centers for Medicare and Medicaid Services
17 (CMS) 1500 form instructions and the American Medical
18 Association Current Procedural Terminology (CPT) Editorial
19 Panel and Healthcare Correct Procedural Coding System (HCPCS).
20 All providers other than hospitals shall include on the
21 applicable claim form the professional license number of the
22 provider in the line or space provided for "Signature of
23 Physician or Supplier, Including Degrees or Credentials." In
24 determining compliance with applicable CPT and HCPCS coding,
25 guidance shall be provided by the Physicians' Current
26 Procedural Terminology (CPT) or the Healthcare Correct
27 Procedural Coding System (HCPCS) in effect for the year in
28 which services were rendered, the Office of the Inspector
29 General (OIG), Physicians Compliance Guidelines, and other
30 authoritative treatises designated by rule by the Agency for
31 Health Care Administration. No statement of medical services
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1 may include charges for medical services of a person or entity
2 that performed such services without possessing the valid
3 licenses required to perform such services. For purposes of
4 paragraph (4)(b), an insurer shall not be considered to have
5 been furnished with notice of the amount of covered loss or
6 medical bills due unless the statements or bills comply with
7 this paragraph, and unless the statements or bills are
8 properly completed in their entirety as to all material
9 provisions, with all relevant information being provided
10 therein.
11 (e)1. At the initial treatment or service provided,
12 each physician, other licensed professional, clinic, or other
13 medical institution providing medical services upon which a
14 claim for personal injury protection benefits is based shall
15 require an insured person, or his or her guardian, to execute
16 a disclosure and acknowledgment form, which reflects at a
17 minimum that:
18 a. The insured, or his or her guardian, must
19 countersign the form attesting to the fact that the services
20 set forth therein were actually rendered;
21 b. The insured, or his or her guardian, has both the
22 right and affirmative duty to confirm that the services were
23 actually rendered;
24 c. The insured, or his or her guardian, was not
25 solicited by any person to seek any services from the medical
26 provider;
27 d. That the physician, other licensed professional,
28 clinic, or other medical institution rendering services for
29 which payment is being claimed explained the services to the
30 insured or his or her guardian; and
31
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1 e. If the insured notifies the insurer in writing of a
2 billing error, the insured may be entitled to a certain
3 percentage of a reduction in the amounts paid by the insured's
4 motor vehicle insurer.
5 2. The physician, other licensed professional, clinic,
6 or other medical institution rendering services for which
7 payment is being claimed has the affirmative duty to explain
8 the services rendered to the insured, or his or her guardian,
9 so that the insured, or his or her guardian, countersigns the
10 form with informed consent.
11 3. Countersignature by the insured, or his or her
12 guardian, is not required for the reading of diagnostic tests
13 or other services that are of such a nature that they are not
14 required to be performed in the presence of the insured.
15 4. The licensed medical professional rendering
16 treatment for which payment is being claimed must sign, by his
17 or her own hand, the form complying with this paragraph.
18 5. The original completed disclosure and
19 acknowledgement form shall be furnished to the insurer
20 pursuant to paragraph (4)(b) and may not be electronically
21 furnished.
22 6. This disclosure and acknowledgement form is not
23 required for services billed by a provider for emergency
24 services as defined in s. 395.002, for emergency services and
25 care as defined in s. 395.002 rendered in a hospital emergency
26 department, or for transport and treatment rendered by an
27 ambulance provider licensed pursuant to part III of chapter
28 401.
29 7. The Financial Services Commission shall adopt, by
30 rule, a standard disclosure and acknowledgment form that shall
31 be used to fulfill the requirements of this paragraph,
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1 effective 90 days after such form is adopted and becomes
2 final. The commission shall adopt a proposed rule by October
3 1, 2003. Until the rule is final, the provider may use a form
4 of its own which otherwise complies with the requirements of
5 this paragraph.
6 8. As used in this paragraph, "countersigned" means a
7 second or verifying signature, as on a previously signed
8 document, and is not satisfied by the statement "signature on
9 file" or any similar statement.
10 9. The requirements of this paragraph apply only with
11 respect to the initial treatment or service of the insured by
12 a provider. For subsequent treatments or service, the provider
13 must maintain a patient log signed by the patient, in
14 chronological order by date of service, that is consistent
15 with the services being rendered to the patient as claimed.
16 The requirements of this subparagraph for maintaining a
17 patient log signed by the patient may be met by a hospital
18 that maintains medical records as required by s. 395.3025 and
19 applicable rules and makes such records available to the
20 insurer upon request.
21 (f) Upon written notification by any person, an
22 insurer shall investigate any claim of improper billing by a
23 physician or other medical provider. The insurer shall
24 determine if the insured was properly billed for only those
25 services and treatments that the insured actually received. If
26 the insurer determines that the insured has been improperly
27 billed, the insurer shall notify the insured, the person
28 making the written notification and the provider of its
29 findings and shall reduce the amount of payment to the
30 provider by the amount determined to be improperly billed. If
31 a reduction is made due to such written notification by any
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1 person, the insurer shall pay to the person 20 percent of the
2 amount of the reduction, up to $500. If the provider is
3 arrested due to the improper billing, then the insurer shall
4 pay to the person 40 percent of the amount of the reduction,
5 up to $500.
6 (g) An insurer may not systematically downcode with
7 the intent to deny reimbursement otherwise due. Such action
8 constitutes a material misrepresentation under s.
9 626.9541(1)(i)2.
10 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
11 DISPUTES.--
12 (a) Every employer shall, if a request is made by an
13 insurer providing personal injury protection benefits under
14 ss. 627.730-627.7405 against whom a claim has been made,
15 furnish forthwith, in a form approved by the department, a
16 sworn statement of the earnings, since the time of the bodily
17 injury and for a reasonable period before the injury, of the
18 person upon whose injury the claim is based.
19 (b) Every physician, hospital, clinic, or other
20 medical institution providing, before or after bodily injury
21 upon which a claim for personal injury protection insurance
22 benefits is based, any products, services, or accommodations
23 in relation to that or any other injury, or in relation to a
24 condition claimed to be connected with that or any other
25 injury, shall, if requested to do so by the insurer against
26 whom the claim has been made, furnish forthwith a written
27 report of the history, condition, treatment, dates, and costs
28 of such treatment of the injured person and why the items
29 identified by the insurer were reasonable in amount and
30 medically necessary, together with a sworn statement that the
31 treatment or services rendered were reasonable and necessary
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1 with respect to the bodily injury sustained and identifying
2 which portion of the expenses for such treatment or services
3 was incurred as a result of such bodily injury, and produce
4 forthwith, and permit the inspection and copying of, his or
5 her or its records regarding such history, condition,
6 treatment, dates, and costs of treatment; provided that this
7 shall not limit the introduction of evidence at trial. Such
8 sworn statement shall read as follows: "Under penalty of
9 perjury, I declare that I have read the foregoing, and the
10 facts alleged are true, to the best of my knowledge and
11 belief." No cause of action for violation of the
12 physician-patient privilege or invasion of the right of
13 privacy shall be permitted against any physician, hospital,
14 clinic, or other medical institution complying with the
15 provisions of this section. The person requesting such records
16 and such sworn statement shall pay all reasonable costs
17 connected therewith. If an insurer makes a written request for
18 documentation or information under this paragraph within 30
19 days after having received notice of the amount of a covered
20 loss under paragraph (4)(a), the amount or the partial amount
21 which is the subject of the insurer's inquiry shall become
22 overdue if the insurer does not pay in accordance with
23 paragraph (4)(b) or within 10 days after the insurer's receipt
24 of the requested documentation or information, whichever
25 occurs later. For purposes of this paragraph, the term
26 "receipt" includes, but is not limited to, inspection and
27 copying pursuant to this paragraph. Any insurer that requests
28 documentation or information pertaining to reasonableness of
29 charges or medical necessity under this paragraph without a
30 reasonable basis for such requests as a general business
31
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1 practice is engaging in an unfair trade practice under the
2 insurance code.
3 (c) In the event of any dispute regarding an insurer's
4 right to discovery of facts under this section about an
5 injured person's earnings or about his or her history,
6 condition, or treatment, or the dates and costs of such
7 treatment, the insurer may petition a court of competent
8 jurisdiction to enter an order permitting such discovery. The
9 order may be made only on motion for good cause shown and upon
10 notice to all persons having an interest, and it shall specify
11 the time, place, manner, conditions, and scope of the
12 discovery. Such court may, in order to protect against
13 annoyance, embarrassment, or oppression, as justice requires,
14 enter an order refusing discovery or specifying conditions of
15 discovery and may order payments of costs and expenses of the
16 proceeding, including reasonable fees for the appearance of
17 attorneys at the proceedings, as justice requires.
18 (d) The injured person shall be furnished, upon
19 request, a copy of all information obtained by the insurer
20 under the provisions of this section, and shall pay a
21 reasonable charge, if required by the insurer.
22 (e) Notice to an insurer of the existence of a claim
23 shall not be unreasonably withheld by an insured.
24 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
25 REPORTS.--
26 (a) Whenever the mental or physical condition of an
27 injured person covered by personal injury protection is
28 material to any claim that has been or may be made for past or
29 future personal injury protection insurance benefits, such
30 person shall, upon the request of an insurer, submit to mental
31 or physical examination by a physician or physicians. The
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1 costs of any examinations requested by an insurer shall be
2 borne entirely by the insurer. Such examination shall be
3 conducted within the municipality where the insured is
4 receiving treatment, or in a location reasonably accessible to
5 the insured, which, for purposes of this paragraph, means any
6 location within the municipality in which the insured resides,
7 or any location within 10 miles by road of the insured's
8 residence, provided such location is within the county in
9 which the insured resides. If the examination is to be
10 conducted in a location reasonably accessible to the insured,
11 and if there is no qualified physician to conduct the
12 examination in a location reasonably accessible to the
13 insured, then such examination shall be conducted in an area
14 of the closest proximity to the insured's residence. Personal
15 protection insurers are authorized to include reasonable
16 provisions in personal injury protection insurance policies
17 for mental and physical examination of those claiming personal
18 injury protection insurance benefits. An insurer may not
19 withdraw payment of a treating physician without the consent
20 of the injured person covered by the personal injury
21 protection, unless the insurer first obtains a valid report by
22 a Florida physician licensed under the same chapter as the
23 treating physician whose treatment authorization is sought to
24 be withdrawn, stating that treatment was not reasonable,
25 related, or necessary. A valid report is one that is prepared
26 and signed by the physician examining the injured person or
27 reviewing the treatment records of the injured person and is
28 factually supported by the examination and treatment records
29 if reviewed and that has not been modified by anyone other
30 than the physician. The physician preparing the report must be
31 in active practice, unless the physician is physically
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1 disabled. Active practice means that during the 3 years
2 immediately preceding the date of the physical examination or
3 review of the treatment records the physician must have
4 devoted professional time to the active clinical practice of
5 evaluation, diagnosis, or treatment of medical conditions or
6 to the instruction of students in an accredited health
7 professional school or accredited residency program or a
8 clinical research program that is affiliated with an
9 accredited health professional school or teaching hospital or
10 accredited residency program. The physician preparing a report
11 at the request of an insurer and physicians rendering expert
12 opinions on behalf of persons claiming medical benefits for
13 personal injury protection, or on behalf of an insured through
14 an attorney or another entity, shall maintain, for at least 3
15 years, copies of all examination reports as medical records
16 and shall maintain, for at least 3 years, records of all
17 payments for the examinations and reports. Neither an insurer
18 nor any person acting at the direction of or on behalf of an
19 insurer may materially change an opinion in a report prepared
20 under this paragraph or direct the physician preparing the
21 report to change such opinion. The denial of a payment as the
22 result of such a changed opinion constitutes a material
23 misrepresentation under s. 626.9541(1)(i)2.; however, this
24 provision does not preclude the insurer from calling to the
25 attention of the physician errors of fact in the report based
26 upon information in the claim file.
27 (b) If requested by the person examined, a party
28 causing an examination to be made shall deliver to him or her
29 a copy of every written report concerning the examination
30 rendered by an examining physician, at least one of which
31 reports must set out the examining physician's findings and
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1 conclusions in detail. After such request and delivery, the
2 party causing the examination to be made is entitled, upon
3 request, to receive from the person examined every written
4 report available to him or her or his or her representative
5 concerning any examination, previously or thereafter made, of
6 the same mental or physical condition. By requesting and
7 obtaining a report of the examination so ordered, or by taking
8 the deposition of the examiner, the person examined waives any
9 privilege he or she may have, in relation to the claim for
10 benefits, regarding the testimony of every other person who
11 has examined, or may thereafter examine, him or her in respect
12 to the same mental or physical condition. If a person
13 unreasonably refuses to submit to an examination, the personal
14 injury protection carrier is no longer liable for subsequent
15 personal injury protection benefits.
16 (11) DEMAND LETTER.--
17 (a) As a condition precedent to filing any action for
18 an overdue claim for benefits under this section paragraph
19 (4)(b), the insurer must be provided with written notice of an
20 intent to initiate litigation; provided, however, that, except
21 with regard to a claim or amended claim or judgment for
22 interest only which was not paid or was incorrectly
23 calculated, such notice is not required for an overdue claim
24 that the insurer has denied or reduced, nor is such notice
25 required if the insurer has been provided documentation or
26 information at the insurer's request pursuant to subsection
27 (6). Such notice may not be sent until the claim is overdue,
28 including any additional time the insurer has to pay the claim
29 pursuant to paragraph (4)(b).
30
31
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1 (b) The notice required shall state that it is a
2 "demand letter under s. 627.736(11)" and shall state with
3 specificity:
4 1. The name of the insured upon which such benefits
5 are being sought, including a copy of the assignment giving
6 rights to the claimant if the claimant is not the insured.
7 2. The claim number or policy number upon which such
8 claim was originally submitted to the insurer.
9 3. To the extent applicable, the name of any medical
10 provider who rendered to an insured the treatment, services,
11 accommodations, or supplies that form the basis of such claim;
12 and an itemized statement specifying each exact amount, the
13 date of treatment, service, or accommodation, and the type of
14 benefit claimed to be due. A completed form satisfying the
15 requirements of paragraph (5)(d) or the lost-wage statement
16 previously submitted Health Care Finance Administration 1500
17 form, UB 92, or successor forms approved by the Secretary of
18 the United States Department of Health and Human Services may
19 be used as the itemized statement. To the extent that the
20 demand involves an insurer's withdrawal of payment under
21 paragraph (7)(a) for future treatment not yet rendered, the
22 claimant shall attach a copy of the insurer's notice
23 withdrawing such payment and an itemized statement of the
24 type, frequency, and duration of future treatment claimed to
25 be reasonable and medically necessary.
26 (c) Each notice required by this subsection section
27 must be delivered to the insurer by United States certified or
28 registered mail, return receipt requested. Such postal costs
29 shall be reimbursed by the insurer if so requested by the
30 claimant provider in the notice, when the insurer pays the
31 overdue claim. Such notice must be sent to the person and
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1 address specified by the insurer for the purposes of receiving
2 notices under this subsection section, on the document denying
3 or reducing the amount asserted by the filer to be overdue.
4 Each licensed insurer, whether domestic, foreign, or alien,
5 shall may file with the office department designation of the
6 name and address of the person to whom notices pursuant to
7 this subsection section shall be sent which the office shall
8 make available on its Internet website when such document does
9 not specify the name and address to whom the notices under
10 this section are to be sent or when there is no such document.
11 The name and address on file with the office department
12 pursuant to s. 624.422 shall be deemed the authorized
13 representative to accept notice pursuant to this subsection
14 section in the event no other designation has been made.
15 (d) If, within 15 7 business days after receipt of
16 notice by the insurer, the overdue claim specified in the
17 notice is paid by the insurer together with applicable
18 interest and a penalty of 10 percent of the overdue amount
19 paid by the insurer, subject to a maximum penalty of $250, no
20 action for nonpayment or late payment may be brought against
21 the insurer. If the demand involves an insurer's withdrawal of
22 payment under paragraph (7)(a) for future treatment not yet
23 rendered, no action may be brought against the insurer if,
24 within 15 days after its receipt of the notice, the insurer
25 mails to the person filing the notice a written statement of
26 the insurer's agreement to pay for such treatment in
27 accordance with the notice and to pay a penalty of 10 percent,
28 subject to a maximum penalty of $250, when it pays for such
29 future treatment in accordance with the requirements of this
30 section. To the extent the insurer determines not to pay any
31 the overdue amount demanded, the penalty shall not be payable
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1 in any subsequent action for nonpayment or late payment. For
2 purposes of this subsection, payment or the insurer's
3 agreement shall be treated as being made on the date a draft
4 or other valid instrument that is equivalent to payment, or
5 the insurer's written statement of agreement, is placed in the
6 United States mail in a properly addressed, postpaid envelope,
7 or if not so posted, on the date of delivery. The insurer
8 shall not be obligated to pay any attorney's fees if the
9 insurer pays the claim or mails its agreement to pay for
10 future treatment within the time prescribed by this
11 subsection.
12 (e) The applicable statute of limitation for an action
13 under this section shall be tolled for a period of 15 business
14 days by the mailing of the notice required by this subsection.
15 (f) Any insurer making a general business practice of
16 not paying valid claims until receipt of the notice required
17 by this subsection section is engaging in an unfair trade
18 practice under the insurance code.
19 (13) MINIMUM BENEFIT COVERAGE.--If the Financial
20 Services Commission determines that the cost savings under
21 personal injury protection insurance benefits paid by insurers
22 have been realized due to the provisions of this act, prior
23 legislative reforms, or other factors, the commission may
24 increase the minimum $10,000 benefit coverage requirement. In
25 establishing the amount of such increase, the commission must
26 determine that the additional premium for such coverage is
27 approximately equal to the premium cost savings that have been
28 realized for the personal injury protection coverage with
29 limits of $10,000.
30 Section 9. Subsections (1) and (2) of section 627.739,
31 Florida Statutes, are amended to read:
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1 627.739 Personal injury protection; optional
2 limitations; deductibles.--
3 (1) The named insured may elect a deductible or
4 modified coverage or combination thereof to apply to the named
5 insured alone or to the named insured and dependent relatives
6 residing in the same household, but may not elect a deductible
7 or modified coverage to apply to any other person covered
8 under the policy. Any person electing a deductible or modified
9 coverage, or a combination thereof, or subject to such
10 deductible or modified coverage as a result of the named
11 insured's election, shall have no right to claim or to recover
12 any amount so deducted from any owner, registrant, operator,
13 or occupant of a vehicle or any person or organization legally
14 responsible for any such person's acts or omissions who is
15 made exempt from tort liability by ss. 627.730-627.7405.
16 (2) Insurers shall offer to each applicant and to each
17 policyholder, upon the renewal of an existing policy,
18 deductibles, in amounts of $250, $500, and $1,000, and $2,000.
19 The deductible amount must be applied to 100 percent of the
20 expenses and losses described in s. 627.736. After the
21 deductible is met, each insured is eligible to receive up to
22 $10,000 in total benefits described in s. 627.736(1)., such
23 amount to be deducted from the benefits otherwise due each
24 person subject to the deduction. However, this subsection
25 shall not be applied to reduce the amount of any benefits
26 received in accordance with s. 627.736(1)(c).
27 Section 10. Subsections (7), (8), and (9) of section
28 817.234, Florida Statutes, are amended to read:
29 817.234 False and fraudulent insurance claims.--
30 (7)(a) It shall constitute a material omission and
31 insurance fraud for any physician or other provider, other
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1 than a hospital, to engage in a general business practice of
2 billing amounts as its usual and customary charge, if such
3 provider has agreed with the patient or intends to waive
4 deductibles or copayments, or does not for any other reason
5 intend to collect the total amount of such charge. This
6 paragraph does not apply to physicians or other providers who
7 waive deductibles or copayments or reduce their bills as part
8 of a bodily injury settlement or verdict.
9 (b) The provisions of this section shall also apply as
10 to any insurer or adjusting firm or its agents or
11 representatives who, with intent, injure, defraud, or deceive
12 any claimant with regard to any claim. The claimant shall
13 have the right to recover the damages provided in this
14 section.
15 (c) An insurer, or any person acting at the direction
16 of or on behalf of an insurer, may not change an opinion in a
17 mental or physical report prepared under s. 627.736(7) or
18 direct the physician preparing the report to change such
19 opinion; however, this provision does not preclude the insurer
20 from calling to the attention of the physician errors of fact
21 in the report based upon information in the claim file. Any
22 person who violates this paragraph commits a felony of the
23 third degree, punishable as provided in s. 775.082, s.
24 775.083, or s. 775.084.
25 (8)(a) It is unlawful for any person intending to
26 defraud any other person, in his or her individual capacity or
27 in his or her capacity as a public or private employee, or for
28 any firm, corporation, partnership, or association, to solicit
29 or cause to be solicited any business from a person involved
30 in a motor vehicle accident by any means of communication
31 other than advertising directed to the public for the purpose
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1 of making, adjusting, or settling motor vehicle tort claims or
2 claims for personal injury protection benefits required by s.
3 627.736. Charges for any services rendered by a health care
4 provider or attorney who violates this subsection in regard to
5 the person for whom such services were rendered are
6 noncompensable and unenforceable as a matter of law. Any
7 person who violates the provisions of this paragraph
8 subsection commits a felony of the second third degree,
9 punishable as provided in s. 775.082, s. 775.083, or s.
10 775.084. A person who is convicted of a violation of this
11 subsection shall be sentenced to a minimum term of
12 imprisonment of 2 years.
13 (b) A person may not solicit or cause to be solicited
14 any business from a person involved in a motor vehicle
15 accident by any means of communication other than advertising
16 directed to the public for the purpose of making motor vehicle
17 tort claims or claims for personal injury protection benefits
18 required by s. 627.736, within 60 days after the occurrence of
19 the motor vehicle accident. Any person who violates this
20 paragraph commits a felony of the third degree, punishable as
21 provided in s. 775.082, s. 775.083, or s. 775.084.
22 (c) A lawyer, health care practitioner as defined in
23 s. 456.001, or owner or medical director of a clinic required
24 to be licensed pursuant to s. 400.903 may not, at any time
25 after 60 days have elapsed from the occurrence of a motor
26 vehicle accident, solicit or cause to be solicited any
27 business from a person involved in a motor vehicle accident by
28 means of in-person or telephone contact at the person's
29 residence, for the purpose of making motor vehicle tort claims
30 or claims for personal injury protection benefits required by
31 s. 627.736. Any person who violates this paragraph commits a
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1 felony of the third degree, punishable as provided in s.
2 775.082, s. 775.083, or s. 775.084.
3 (d) Charges for any services rendered by any person
4 who violates this subsection in regard to the person for whom
5 such services were rendered are noncompensable and
6 unenforceable as a matter of law.
7 (9) A person may not organize, plan, or knowingly
8 participate in an intentional motor vehicle crash for the
9 purpose of making motor vehicle tort claims or claims for
10 personal injury protection benefits as required by s. 627.736.
11 It is unlawful for any attorney to solicit any business
12 relating to the representation of a person involved in a motor
13 vehicle accident for the purpose of filing a motor vehicle
14 tort claim or a claim for personal injury protection benefits
15 required by s. 627.736. The solicitation by advertising of
16 any business by an attorney relating to the representation of
17 a person injured in a specific motor vehicle accident is
18 prohibited by this section. Any person attorney who violates
19 the provisions of this paragraph subsection commits a felony
20 of the second third degree, punishable as provided in s.
21 775.082, s. 775.083, or s. 775.084. A person who is convicted
22 of a violation of this subsection shall be sentenced to a
23 minimum term of imprisonment of 2 years. Whenever any circuit
24 or special grievance committee acting under the jurisdiction
25 of the Supreme Court finds probable cause to believe that an
26 attorney is guilty of a violation of this section, such
27 committee shall forward to the appropriate state attorney a
28 copy of the finding of probable cause and the report being
29 filed in the matter. This section shall not be interpreted to
30 prohibit advertising by attorneys which does not entail a
31 solicitation as described in this subsection and which is
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1 permitted by the rules regulating The Florida Bar as
2 promulgated by the Florida Supreme Court.
3 Section 11. Section 817.236, Florida Statutes, is
4 amended to read:
5 817.236 False and fraudulent motor vehicle insurance
6 application.--Any person who, with intent to injure, defraud,
7 or deceive any motor vehicle insurer, including any
8 statutorily created underwriting association or pool of motor
9 vehicle insurers, presents or causes to be presented any
10 written application, or written statement in support thereof,
11 for motor vehicle insurance knowing that the application or
12 statement contains any false, incomplete, or misleading
13 information concerning any fact or matter material to the
14 application commits a felony misdemeanor of the third first
15 degree, punishable as provided in s. 775.082, or s. 775.083,
16 or s. 775.084.
17 Section 12. Section 817.2361, Florida Statutes, is
18 created to read:
19 817.2361 False or fraudulent motor vehicle insurance
20 card.--Any person who, with intent to deceive any other
21 person, creates, markets, or presents a false or fraudulent
22 motor vehicle insurance card commits a felony of the third
23 degree, punishable as provided in s. 775.082, s. 775.083, or
24 s. 775.084.
25 Section 13. Effective October 1, 2003, paragraphs (c)
26 and (g) of subsection (3) of section 921.0022, Florida
27 Statutes, are amended to read:
28 921.0022 Criminal Punishment Code; offense severity
29 ranking chart.--
30 (3) OFFENSE SEVERITY RANKING CHART
31
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1 Florida Felony
2 Statute Degree Description
3
4
5 (c) LEVEL 3
6 119.10(3) 3rd Unlawful use of confidential
7 information from police reports.
8 316.066(3)(d)-(f) 3rd Unlawfully obtaining or using
9 confidential crash reports.
10 316.193(2)(b) 3rd Felony DUI, 3rd conviction.
11 316.1935(2) 3rd Fleeing or attempting to elude
12 law enforcement officer in marked
13 patrol vehicle with siren and
14 lights activated.
15 319.30(4) 3rd Possession by junkyard of motor
16 vehicle with identification
17 number plate removed.
18 319.33(1)(a) 3rd Alter or forge any certificate of
19 title to a motor vehicle or
20 mobile home.
21 319.33(1)(c) 3rd Procure or pass title on stolen
22 vehicle.
23 319.33(4) 3rd With intent to defraud, possess,
24 sell, etc., a blank, forged, or
25 unlawfully obtained title or
26 registration.
27 327.35(2)(b) 3rd Felony BUI.
28 328.05(2) 3rd Possess, sell, or counterfeit
29 fictitious, stolen, or fraudulent
30 titles or bills of sale of
31 vessels.
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1 328.07(4) 3rd Manufacture, exchange, or possess
2 vessel with counterfeit or wrong
3 ID number.
4 376.302(5) 3rd Fraud related to reimbursement
5 for cleanup expenses under the
6 Inland Protection Trust Fund.
7 400.903(3) 3rd Operating a clinic without a
8 license or filing false license
9 application or other required
10 information.
11 501.001(2)(b) 2nd Tampers with a consumer product
12 or the container using materially
13 false/misleading information.
14 697.08 3rd Equity skimming.
15 790.15(3) 3rd Person directs another to
16 discharge firearm from a vehicle.
17 796.05(1) 3rd Live on earnings of a prostitute.
18 806.10(1) 3rd Maliciously injure, destroy, or
19 interfere with vehicles or
20 equipment used in firefighting.
21 806.10(2) 3rd Interferes with or assaults
22 firefighter in performance of
23 duty.
24 810.09(2)(c) 3rd Trespass on property other than
25 structure or conveyance armed
26 with firearm or dangerous weapon.
27 812.014(2)(c)2. 3rd Grand theft; $5,000 or more but
28 less than $10,000.
29 812.0145(2)(c) 3rd Theft from person 65 years of age
30 or older; $300 or more but less
31 than $10,000.
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1 815.04(4)(b) 2nd Computer offense devised to
2 defraud or obtain property.
3 817.034(4)(a)3. 3rd Engages in scheme to defraud
4 (Florida Communications Fraud
5 Act), property valued at less
6 than $20,000.
7 817.233 3rd Burning to defraud insurer.
8 817.234(8)
9 (b)-(c)&(9) 3rd Unlawful solicitation of persons
10 involved in motor vehicle
11 accidents.
12 817.234(11)(a) 3rd Insurance fraud; property value
13 less than $20,000.
14 817.236 3rd Filing a false motor vehicle
15 insurance application.
16 817.2361 3rd Creating, marketing, or
17 presenting a false or fraudulent
18 motor vehicle insurance card.
19 817.505(4) 3rd Patient brokering.
20 828.12(2) 3rd Tortures any animal with intent
21 to inflict intense pain, serious
22 physical injury, or death.
23 831.28(2)(a) 3rd Counterfeiting a payment
24 instrument with intent to defraud
25 or possessing a counterfeit
26 payment instrument.
27 831.29 2nd Possession of instruments for
28 counterfeiting drivers' licenses
29 or identification cards.
30 838.021(3)(b) 3rd Threatens unlawful harm to public
31 servant.
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1 843.19 3rd Injure, disable, or kill police
2 dog or horse.
3 870.01(2) 3rd Riot; inciting or encouraging.
4 893.13(1)(a)2. 3rd Sell, manufacture, or deliver
5 cannabis (or other s.
6 893.03(1)(c), (2)(c)1., (2)(c)2.,
7 (2)(c)3., (2)(c)5., (2)(c)6.,
8 (2)(c)7., (2)(c)8., (2)(c)9.,
9 (3), or (4) drugs).
10 893.13(1)(d)2. 2nd Sell, manufacture, or deliver s.
11 893.03(1)(c), (2)(c)1., (2)(c)2.,
12 (2)(c)3., (2)(c)5., (2)(c)6.,
13 (2)(c)7., (2)(c)8., (2)(c)9.,
14 (3), or (4) drugs within 200 feet
15 of university or public park.
16 893.13(1)(f)2. 2nd Sell, manufacture, or deliver s.
17 893.03(1)(c), (2)(c)1., (2)(c)2.,
18 (2)(c)3., (2)(c)5., (2)(c)6.,
19 (2)(c)7., (2)(c)8., (2)(c)9.,
20 (3), or (4) drugs within 200 feet
21 of public housing facility.
22 893.13(6)(a) 3rd Possession of any controlled
23 substance other than felony
24 possession of cannabis.
25 893.13(7)(a)8. 3rd Withhold information from
26 practitioner regarding previous
27 receipt of or prescription for a
28 controlled substance.
29 893.13(7)(a)9. 3rd Obtain or attempt to obtain
30 controlled substance by fraud,
31 forgery, misrepresentation, etc.
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1 893.13(7)(a)10. 3rd Affix false or forged label to
2 package of controlled substance.
3 893.13(7)(a)11. 3rd Furnish false or fraudulent
4 material information on any
5 document or record required by
6 chapter 893.
7 893.13(8)(a)1. 3rd Knowingly assist a patient, other
8 person, or owner of an animal in
9 obtaining a controlled substance
10 through deceptive, untrue, or
11 fraudulent representations in or
12 related to the practitioner's
13 practice.
14 893.13(8)(a)2. 3rd Employ a trick or scheme in the
15 practitioner's practice to assist
16 a patient, other person, or owner
17 of an animal in obtaining a
18 controlled substance.
19 893.13(8)(a)3. 3rd Knowingly write a prescription
20 for a controlled substance for a
21 fictitious person.
22 893.13(8)(a)4. 3rd Write a prescription for a
23 controlled substance for a
24 patient, other person, or an
25 animal if the sole purpose of
26 writing the prescription is a
27 monetary benefit for the
28 practitioner.
29 918.13(1)(a) 3rd Alter, destroy, or conceal
30 investigation evidence.
31
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1 944.47
2 (1)(a)1.-2. 3rd Introduce contraband to
3 correctional facility.
4 944.47(1)(c) 2nd Possess contraband while upon the
5 grounds of a correctional
6 institution.
7 985.3141 3rd Escapes from a juvenile facility
8 (secure detention or residential
9 commitment facility).
10 (g) LEVEL 7
11 316.193(3)(c)2. 3rd DUI resulting in serious bodily
12 injury.
13 327.35(3)(c)2. 3rd Vessel BUI resulting in serious
14 bodily injury.
15 402.319(2) 2nd Misrepresentation and negligence
16 or intentional act resulting in
17 great bodily harm, permanent
18 disfiguration, permanent
19 disability, or death.
20 409.920(2) 3rd Medicaid provider fraud.
21 456.065(2) 3rd Practicing a health care
22 profession without a license.
23 456.065(2) 2nd Practicing a health care
24 profession without a license
25 which results in serious bodily
26 injury.
27 458.327(1) 3rd Practicing medicine without a
28 license.
29 459.013(1) 3rd Practicing osteopathic medicine
30 without a license.
31
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1 460.411(1) 3rd Practicing chiropractic medicine
2 without a license.
3 461.012(1) 3rd Practicing podiatric medicine
4 without a license.
5 462.17 3rd Practicing naturopathy without a
6 license.
7 463.015(1) 3rd Practicing optometry without a
8 license.
9 464.016(1) 3rd Practicing nursing without a
10 license.
11 465.015(2) 3rd Practicing pharmacy without a
12 license.
13 466.026(1) 3rd Practicing dentistry or dental
14 hygiene without a license.
15 467.201 3rd Practicing midwifery without a
16 license.
17 468.366 3rd Delivering respiratory care
18 services without a license.
19 483.828(1) 3rd Practicing as clinical laboratory
20 personnel without a license.
21 483.901(9) 3rd Practicing medical physics
22 without a license.
23 484.013(1)(c) 3rd Preparing or dispensing optical
24 devices without a prescription.
25 484.053 3rd Dispensing hearing aids without a
26 license.
27
28
29
30
31
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1 494.0018(2) 1st Conviction of any violation of
2 ss. 494.001-494.0077 in which the
3 total money and property
4 unlawfully obtained exceeded
5 $50,000 and there were five or
6 more victims.
7 560.123(8)(b)1. 3rd Failure to report currency or
8 payment instruments exceeding
9 $300 but less than $20,000 by
10 money transmitter.
11 560.125(5)(a) 3rd Money transmitter business by
12 unauthorized person, currency or
13 payment instruments exceeding
14 $300 but less than $20,000.
15 655.50(10)(b)1. 3rd Failure to report financial
16 transactions exceeding $300 but
17 less than $20,000 by financial
18 institution.
19 782.051(3) 2nd Attempted felony murder of a
20 person by a person other than the
21 perpetrator or the perpetrator of
22 an attempted felony.
23 782.07(1) 2nd Killing of a human being by the
24 act, procurement, or culpable
25 negligence of another
26 (manslaughter).
27 782.071 2nd Killing of human being or viable
28 fetus by the operation of a motor
29 vehicle in a reckless manner
30 (vehicular homicide).
31
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1 782.072 2nd Killing of a human being by the
2 operation of a vessel in a
3 reckless manner (vessel
4 homicide).
5 784.045(1)(a)1. 2nd Aggravated battery; intentionally
6 causing great bodily harm or
7 disfigurement.
8 784.045(1)(a)2. 2nd Aggravated battery; using deadly
9 weapon.
10 784.045(1)(b) 2nd Aggravated battery; perpetrator
11 aware victim pregnant.
12 784.048(4) 3rd Aggravated stalking; violation of
13 injunction or court order.
14 784.07(2)(d) 1st Aggravated battery on law
15 enforcement officer.
16 784.074(1)(a) 1st Aggravated battery on sexually
17 violent predators facility staff.
18 784.08(2)(a) 1st Aggravated battery on a person 65
19 years of age or older.
20 784.081(1) 1st Aggravated battery on specified
21 official or employee.
22 784.082(1) 1st Aggravated battery by detained
23 person on visitor or other
24 detainee.
25 784.083(1) 1st Aggravated battery on code
26 inspector.
27 790.07(4) 1st Specified weapons violation
28 subsequent to previous conviction
29 of s. 790.07(1) or (2).
30 790.16(1) 1st Discharge of a machine gun under
31 specified circumstances.
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1 790.165(2) 2nd Manufacture, sell, possess, or
2 deliver hoax bomb.
3 790.165(3) 2nd Possessing, displaying, or
4 threatening to use any hoax bomb
5 while committing or attempting to
6 commit a felony.
7 790.166(3) 2nd Possessing, selling, using, or
8 attempting to use a hoax weapon
9 of mass destruction.
10 790.166(4) 2nd Possessing, displaying, or
11 threatening to use a hoax weapon
12 of mass destruction while
13 committing or attempting to
14 commit a felony.
15 796.03 2nd Procuring any person under 16
16 years for prostitution.
17 800.04(5)(c)1. 2nd Lewd or lascivious molestation;
18 victim less than 12 years of age;
19 offender less than 18 years.
20 800.04(5)(c)2. 2nd Lewd or lascivious molestation;
21 victim 12 years of age or older
22 but less than 16 years; offender
23 18 years or older.
24 806.01(2) 2nd Maliciously damage structure by
25 fire or explosive.
26 810.02(3)(a) 2nd Burglary of occupied dwelling;
27 unarmed; no assault or battery.
28 810.02(3)(b) 2nd Burglary of unoccupied dwelling;
29 unarmed; no assault or battery.
30 810.02(3)(d) 2nd Burglary of occupied conveyance;
31 unarmed; no assault or battery.
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1 812.014(2)(a) 1st Property stolen, valued at
2 $100,000 or more; cargo stolen
3 valued at $50,000 or more;
4 property stolen while causing
5 other property damage; 1st degree
6 grand theft.
7 812.014(2)(b)3. 2nd Property stolen, emergency
8 medical equipment; 2nd degree
9 grand theft.
10 812.0145(2)(a) 1st Theft from person 65 years of age
11 or older; $50,000 or more.
12 812.019(2) 1st Stolen property; initiates,
13 organizes, plans, etc., the theft
14 of property and traffics in
15 stolen property.
16 812.131(2)(a) 2nd Robbery by sudden snatching.
17 812.133(2)(b) 1st Carjacking; no firearm, deadly
18 weapon, or other weapon.
19 817.234(8)(a) 2nd Solicitation of motor vehicle
20 accident victims with intent to
21 defraud.
22 817.234(9) 2nd Organizing, planning, or
23 participating in an intentional
24 motor vehicle collision.
25 817.234(11)(c) 1st Insurance fraud; property value
26 $100,000 or more.
27 825.102(3)(b) 2nd Neglecting an elderly person or
28 disabled adult causing great
29 bodily harm, disability, or
30 disfigurement.
31
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1 825.103(2)(b) 2nd Exploiting an elderly person or
2 disabled adult and property is
3 valued at $20,000 or more, but
4 less than $100,000.
5 827.03(3)(b) 2nd Neglect of a child causing great
6 bodily harm, disability, or
7 disfigurement.
8 827.04(3) 3rd Impregnation of a child under 16
9 years of age by person 21 years
10 of age or older.
11 837.05(2) 3rd Giving false information about
12 alleged capital felony to a law
13 enforcement officer.
14 872.06 2nd Abuse of a dead human body.
15 893.13(1)(c)1. 1st Sell, manufacture, or deliver
16 cocaine (or other drug prohibited
17 under s. 893.03(1)(a), (1)(b),
18 (1)(d), (2)(a), (2)(b), or
19 (2)(c)4.) within 1,000 feet of a
20 child care facility or school.
21 893.13(1)(e)1. 1st Sell, manufacture, or deliver
22 cocaine or other drug prohibited
23 under s. 893.03(1)(a), (1)(b),
24 (1)(d), (2)(a), (2)(b), or
25 (2)(c)4., within 1,000 feet of
26 property used for religious
27 services or a specified business
28 site.
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1 893.13(4)(a) 1st Deliver to minor cocaine (or
2 other s. 893.03(1)(a), (1)(b),
3 (1)(d), (2)(a), (2)(b), or
4 (2)(c)4. drugs).
5 893.135(1)(a)1. 1st Trafficking in cannabis, more
6 than 25 lbs., less than 2,000
7 lbs.
8 893.135
9 (1)(b)1.a. 1st Trafficking in cocaine, more than
10 28 grams, less than 200 grams.
11 893.135
12 (1)(c)1.a. 1st Trafficking in illegal drugs,
13 more than 4 grams, less than 14
14 grams.
15 893.135
16 (1)(d)1. 1st Trafficking in phencyclidine,
17 more than 28 grams, less than 200
18 grams.
19 893.135(1)(e)1. 1st Trafficking in methaqualone, more
20 than 200 grams, less than 5
21 kilograms.
22 893.135(1)(f)1. 1st Trafficking in amphetamine, more
23 than 14 grams, less than 28
24 grams.
25 893.135
26 (1)(g)1.a. 1st Trafficking in flunitrazepam, 4
27 grams or more, less than 14
28 grams.
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1 893.135
2 (1)(h)1.a. 1st Trafficking in
3 gamma-hydroxybutyric acid (GHB),
4 1 kilogram or more, less than 5
5 kilograms.
6 893.135
7 (1)(j)1.a. 1st Trafficking in 1,4-Butanediol, 1
8 kilogram or more, less than 5
9 kilograms.
10 893.135
11 (1)(k)2.a. 1st Trafficking in Phenethylamines,
12 10 grams or more, less than 200
13 grams.
14 896.101(5)(a) 3rd Money laundering, financial
15 transactions exceeding $300 but
16 less than $20,000.
17 896.104(4)(a)1. 3rd Structuring transactions to evade
18 reporting or registration
19 requirements, financial
20 transactions exceeding $300 but
21 less than $20,000.
22 Section 14. The amendment made by this act to section
23 456.0375(1)(b), Florida Statutes, is intended to clarify the
24 legislative intent of this provision as it existed at the time
25 the provision initially took effect. Accordingly, section
26 456.0375(1)(b), Florida Statutes, as amended by this act shall
27 operate retroactively to October 1, 2001.
28 Section 15. Effective March 1, 2004, section 456.0375,
29 Florida Statutes, is repealed.
30 Section 16. (1) Any increase in benefits approved by
31 the Financial Services Commission under subsection (13) of
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1 section 627.736, Florida Statutes, as added by this act, shall
2 apply to new and renewal policies that are effective 120 days
3 after the order issued by the commission becomes final.
4 Subsection (2) of section 627.739, Florida Statutes, as
5 amended by this act, shall apply to new and renewal policies
6 issued on or after October 1, 2003.
7 (2) Subsection (11) of section 627.736, Florida
8 Statutes, as amended by this act, shall apply to actions filed
9 on and after the effective date of this act.
10 (3) Paragraph (7)(a) of section 627.736, Florida
11 Statutes, as amended by this act, and paragraph (7)(c) of
12 section 817.234, Florida Statutes, as amended by this act,
13 shall apply to examinations conducted on and after October 1,
14 2003.
15 Section 17. By December 31, 2004, the Department of
16 Financial Services, the Department of Health, and the Agency
17 for Health Care Administration each shall submit a report on
18 the implementation of this act and recommendations, if any, to
19 further improve the automobile insurance market, reduce
20 automobile insurance costs, and reduce automobile insurance
21 fraud and abuse to the President of the Senate and the Speaker
22 of the House of Representatives. The report by the Department
23 of Financial Services shall include a study of the medical and
24 legal costs associated with personal injury protection
25 insurance claims.
26 Section 18. There is appropriated $2.5 million from
27 the Health Care Trust Fund, and 51 full-time equivalent
28 positions are authorized, for the Agency for Health Care
29 Administration to implement the provisions of this act.
30 Section 19. (1) Effective October 1, 2007, sections
31 627.730, 627.731, 627.732, 627.733, 627.734, 627.736, 627.737,
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1 627.739, 627.7401, 627.7403, and 627.7405, Florida Statutes,
2 constituting the Florida Motor Vehicle No-Fault Law, are
3 repealed, unless reenacted by the Legislature during the 2006
4 Regular Session and such reenactment becomes law to take
5 effect for policies issued or renewed on or after October 1,
6 2006.
7 (2) Insurers are authorized to provide, in all
8 policies issued or renewed after October 1, 2006, that such
9 policies may terminate on or after October 1, 2007, as
10 provided in subsection (1).
11 Section 20. If any law that is amended by this act was
12 also amended by a law enacted at the 2003 Regular Session of
13 the Legislature, such laws shall be construed as if they had
14 been enacted during the same session of the Legislature, and
15 full effect should be given to each if that is possible.
16 Section 21. Except as otherwise expressly provided in
17 this act, this act shall take effect July 1, 2003.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 32-A
3
4 The committee substitute does the following:
5 - Clarifies that the Agency for Health Care Administration
(AHCA) may issue an initial clinic license for less than
6 the full 2-year period and may charge a prorated fee.
7 - Clarifies that entities that are not clinics may apply to
AHCA for a "certificate of exemption" from licensure.
8
- Clarifies that an application for transferringownership
9 applies to a clinic, and not a license.
10 - Deletes the provision providing for an increase in agent
and insurer fees to fund entities to investigate and
11 prosecute motor vehicle insurance fraud.
12 - Clarifies that the relevant schedule is the
"participating physician fee schedule" of Medicare Part
13 B, and provides for an annual adjustment on August 1 to
reflect the change in the medical case item of the
14 Consumer Price Index.
15 - Allows hospitals, in lieu of maintaining a patient log,
to maintain specified medical records and make such
16 records available to insurers upon request.
17 - Provides an exemption for physicians or providers who
waive deductibles as part of a general business practice.
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- Makes other technical and conforming changes.
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