Senate Bill 1640c1
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Florida Senate - 1998 CS for SB 1640
By the Committee on Banking and Insurance; and Senator Kurth
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1 A bill to be entitled
2 An act relating to insurance fraud; amending s.
3 626.989, F.S.; applying the requirements of
4 this section to health maintenance
5 organizations, which requirements relate to
6 insurance fraud and the Division of Insurance
7 Fraud of the Department of Insurance;
8 specifying designated employees who are immune
9 from civil liability for certain actions;
10 amending s. 626.9891, F.S.; requiring insurers
11 to provide for investigation of fraudulent
12 claims; requiring insurers to adopt an
13 anti-fraud plan; providing criteria and
14 procedures; requiring insurers to file an
15 anti-fraud report with the department;
16 specifying contents; authorizing the department
17 to adopt rules; creating s. 626.9892, F.S.;
18 establishing the Anti-Fraud Reward Program in
19 the department; providing for awarding rewards
20 under certain circumstances; exempting certain
21 department actions from Florida Administrative
22 Code requirements; creating s. 641.3915, F.S.;
23 requiring certain health maintenance
24 organizations to provide for investigation of
25 fraudulent claims; requiring health maintenance
26 organizations to adopt an anti-fraud plan;
27 providing criteria and procedures; requiring
28 health maintenance organizations to file an
29 anti-fraud report with the department;
30 specifying contents; authorizing the department
31 to adopt rules; amending s. 817.234, F.S.;
1
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1 specifying a schedule of criminal penalties for
2 committing insurance fraud or insurance
3 solicitation; providing definitions; providing
4 a period of limitations for undertaking certain
5 proceedings; applying the provisions of the
6 section to health maintenance organizations;
7 providing an appropriation; providing an
8 effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Section 626.989, Florida Statutes, is
13 amended to read:
14 626.989 Division of Insurance Fraud; definition;
15 investigative, subpoena powers; protection from civil
16 liability; reports to division; division investigator's power
17 to execute warrants and make arrests.--
18 (1) For the purposes of this section, a person commits
19 a "fraudulent insurance act" if the person knowingly and with
20 intent to defraud presents, causes to be presented, or
21 prepares with knowledge or belief that it will be presented,
22 to or by an insurer, self-insurer, self-insurance fund,
23 servicing corporation, purported insurer, broker, or any agent
24 thereof, any written statement as part of, or in support of,
25 an application for the issuance of, or the rating of, any
26 insurance policy, or a claim for payment or other benefit
27 pursuant to any insurance policy, which the person knows to
28 contain materially false information concerning any fact
29 material thereto or if the person conceals, for the purpose of
30 misleading another, information concerning any fact material
31 thereto. For the purposes of this section, the term "insurer"
2
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1 also includes any health maintenance organization, and the
2 term "insurance policy" also includes a health maintenance
3 organization subscriber contract.
4 (2) If, by its own inquiries or as a result of
5 complaints, the department or its Division of Insurance Fraud
6 has reason to believe that a person has engaged in, or is
7 engaging in, a fraudulent insurance act, an act or practice
8 that violates s. 626.9541 or s. 817.234, or an act or practice
9 punishable under s. 624.15, it may administer oaths and
10 affirmations, request the attendance of witnesses or
11 proffering of matter, and collect evidence. The department
12 shall not compel the attendance of any person or matter in any
13 such investigation except pursuant to subsection (4).
14 (3) If matter that the department or its division
15 seeks to obtain by request is located outside the state, the
16 person so requested may make it available to the division or
17 its representative to examine the matter at the place where it
18 is located. The division may designate representatives,
19 including officials of the state in which the matter is
20 located, to inspect the matter on its behalf, and it may
21 respond to similar requests from officials of other states.
22 (4)(a) The department or its division may request that
23 an individual who refuses to comply with any such request be
24 ordered by the circuit court to provide the testimony or
25 matter. The court shall not order such compliance unless the
26 department or its division has demonstrated to the
27 satisfaction of the court that the testimony of the witness or
28 the matter under request has a direct bearing on the
29 commission of a fraudulent insurance act, on a violation of s.
30 626.9541 or s. 817.234, or on an act or practice punishable
31
3
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1 under s. 624.15 or is pertinent and necessary to further such
2 investigation.
3 (b) Except in a prosecution for perjury, an individual
4 who complies with a court order to provide testimony or matter
5 after asserting a privilege against self-incrimination to
6 which the individual is entitled by law may not be subjected
7 to a criminal proceeding or to a civil penalty with respect to
8 the act concerning which the individual is required to testify
9 or produce relevant matter.
10 (c) In the absence of fraud or bad faith, a person is
11 not subject to civil liability for libel, slander, or any
12 other relevant tort by virtue of filing reports, without
13 malice, or furnishing other information, without malice,
14 required by this section or required by the department or
15 division under the authority granted in this section, and no
16 civil cause of action of any nature shall arise against such
17 person:
18 1. For any information relating to suspected
19 fraudulent insurance acts furnished to or received from law
20 enforcement officials, their agents, or employees;
21 2. For any information relating to suspected
22 fraudulent insurance acts furnished to or received from other
23 persons subject to the provisions of this chapter; or
24 3. For any such information furnished in reports to
25 the department, division, the National Insurance Crime Bureau,
26 or the National Association of Insurance Commissioners.
27 (d) In addition to the immunity granted in paragraph
28 (c), persons identified as designated employees whose
29 responsibilities include the investigation and disposition of
30 claims relating to suspected fraudulent insurance acts may
31 share information relating to persons suspected of committing
4
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1 fraudulent insurance acts with other designated employees
2 employed by the same or other insurers whose responsibilities
3 include the investigation and disposition of claims relating
4 to fraudulent insurance acts, provided the department has been
5 given written notice of the names and job titles of such
6 designated employees prior to such designated employees
7 sharing information. As used in this paragraph, the term
8 "designated employees of an insurer" includes employees of
9 another entity or person with whom the insurer contracts in
10 accordance with s. 626.9891 or otherwise to investigate
11 possible fraudulent claims or suspected fraudulent insurance
12 acts. Unless the designated employees of the insurer or of
13 such third party act in bad faith or in reckless disregard for
14 the rights of any insured, neither the insurer, such third
15 party, and their nor its designated employees are not civilly
16 liable for libel, slander, or any other relevant tort, and a
17 civil action does not arise against the insurer, such third
18 party, or their its designated employees:
19 1. For any information related to suspected fraudulent
20 insurance acts provided to an insurer; or
21 2. For any information relating to suspected
22 fraudulent insurance acts provided to the National Insurance
23 Crime Bureau or the National Association of Insurance
24 Commissioners.
25
26 Provided, however, that the qualified immunity against civil
27 liability conferred on any insurer or its designated employees
28 shall be forfeited with respect to the exchange or publication
29 of any defamatory information with third persons not expressly
30 authorized by this paragraph to share in such information.
31
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1 (e) The Insurance Commissioner and any employee or
2 agent of the department or division, when acting without
3 malice and in the absence of fraud or bad faith, is not
4 subject to civil liability for libel, slander, or any other
5 relevant tort, and no civil cause of action of any nature
6 exists against such person by virtue of the execution of
7 official activities or duties of the department under this
8 section or by virtue of the publication of any report or
9 bulletin related to the official activities or duties of the
10 department or division under this section.
11 (f) This section does not abrogate or modify in any
12 way any common-law or statutory privilege or immunity
13 heretofore enjoyed by any person.
14 (5) The department's papers, documents, reports, or
15 evidence relative to the subject of an investigation under
16 this section are confidential and exempt from the provisions
17 of s. 119.07(1) until such investigation is completed or
18 ceases to be active. For purposes of this subsection, an
19 investigation is considered "active" while the investigation
20 is being conducted by the department with a reasonable, good
21 faith belief that it could lead to the filing of
22 administrative, civil, or criminal proceedings. An
23 investigation does not cease to be active if the department is
24 proceeding with reasonable dispatch and has a good faith
25 belief that action could be initiated by the department or
26 other administrative or law enforcement agency. After an
27 investigation is completed or ceases to be active, portions of
28 records relating to the investigation shall remain exempt from
29 the provisions of s. 119.07(1) if disclosure would:
30 (a) Jeopardize the integrity of another active
31 investigation;
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1 (b) Impair the safety and soundness of an insurer;
2 (c) Reveal personal financial information;
3 (d) Reveal the identity of a confidential source;
4 (e) Defame or cause unwarranted damage to the good
5 name or reputation of an individual or jeopardize the safety
6 of an individual; or
7 (f) Reveal investigative techniques or procedures.
8 Further, such papers, documents, reports, or evidence relative
9 to the subject of an investigation under this section shall
10 not be subject to discovery until the investigation is
11 completed or ceases to be active. Department or division
12 investigators shall not be subject to subpoena in civil
13 actions by any court of this state to testify concerning any
14 matter of which they have knowledge pursuant to a pending
15 insurance fraud investigation by the division.
16 (6) Any person, other than an insurer, agent, or other
17 person licensed under the code, or an employee thereof, having
18 knowledge or who believes that a fraudulent insurance act or
19 any other act or practice which, upon conviction, constitutes
20 a felony or a misdemeanor under the code, or under s. 817.234,
21 is being or has been committed may send to the Division of
22 Insurance Fraud a report or information pertinent to such
23 knowledge or belief and such additional information relative
24 thereto as the department may request. Any professional
25 practitioner licensed or regulated by the Department of
26 Business and Professional Regulation, except as otherwise
27 provided by law, any medical review committee as defined in s.
28 766.101, any private medical review committee, and any
29 insurer, agent, or other person licensed under the code, or an
30 employee thereof, having knowledge or who believes that a
31 fraudulent insurance act or any other act or practice which,
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1 upon conviction, constitutes a felony or a misdemeanor under
2 the code, or under s. 817.234, is being or has been committed
3 shall send to the Division of Insurance Fraud a report or
4 information pertinent to such knowledge or belief and such
5 additional information relative thereto as the department may
6 require. The Division of Insurance Fraud shall review such
7 information or reports and select such information or reports
8 as, in its judgment, may require further investigation. It
9 shall then cause an independent examination of the facts
10 surrounding such information or report to be made to determine
11 the extent, if any, to which a fraudulent insurance act or any
12 other act or practice which, upon conviction, constitutes a
13 felony or a misdemeanor under the code, or under s. 817.234,
14 is being committed. The Division of Insurance Fraud shall
15 report any alleged violations of law which its investigations
16 disclose to the appropriate licensing agency and state
17 attorney or other prosecuting agency having jurisdiction with
18 respect to any such violation, as provided in s. 624.310. If
19 prosecution by the state attorney or other prosecuting agency
20 having jurisdiction with respect to such violation is not
21 begun within 60 days of the division's report, the state
22 attorney or other prosecuting agency having jurisdiction with
23 respect to such violation shall inform the division of the
24 reasons for the lack of prosecution.
25 (7) Division investigators shall have the power to
26 make arrests for criminal violations established as a result
27 of investigations only. The general laws applicable to
28 arrests by law enforcement officers of this state shall also
29 be applicable to such investigators. Such investigators shall
30 have the power to execute arrest warrants and search warrants
31 for the same criminal violations; to serve subpoenas issued
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1 for the examination, investigation, and trial of all offenses
2 determined by their investigations; and to arrest upon
3 probable cause without warrant any person found in the act of
4 violating any of the provisions of applicable laws.
5 Investigators empowered to make arrests under this section
6 shall be empowered to bear arms in the performance of their
7 duties. In such a situation, the investigator must be
8 certified in compliance with the provisions of s. 943.1395 or
9 must meet the temporary employment or appointment exemption
10 requirements of s. 943.131 until certified.
11 (8) It is unlawful for any person to resist an arrest
12 authorized by this section or in any manner to interfere,
13 either by abetting or assisting such resistance or otherwise
14 interfering, with division investigators in the duties imposed
15 upon them by law or department rule.
16 Section 2. Section 626.9891, Florida Statutes, is
17 amended to read:
18 (Substantial rewording of section. See
19 s. 626.9891, F.S., for present text.)
20 626.9891 Insurer anti-fraud plans, reports, and
21 investigative units.--
22 (1) Each authorized insurer that had $10 million or
23 more in direct premiums written during the previous calendar
24 year shall:
25 (a) Establish and maintain a unit or division within
26 the company to investigate possible fraudulent claims by
27 insureds or by persons making claims for services or repairs
28 against policies held by insureds; or
29 (b) Contract with others to investigate possible
30 fraudulent claims for services or repairs against policies
31 held by insureds.
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1
2 For purposes of this section, the term "unit or division"
3 includes the assignment of fraud investigation to employees
4 whose principal responsibilities are the investigation and
5 disposition of claims. If an insurer creates a distinct unit
6 or division, hires additional employees, or contracts with
7 another entity to fulfill the requirements of this section,
8 the additional cost incurred must be included as an
9 administrative expense for ratemaking purposes.
10 (2)(a) Each authorized insurer writing direct
11 insurance shall adopt an anti-fraud plan, which shall be filed
12 with the department prior to January 1, 1999.
13 (b) Any insurer that previously filed an anti-fraud
14 plan with the department shall amend the plan to comply with
15 the requirements of subsection (3) and shall file all plan
16 amendments with the department prior to January 1, 1999.
17 (c) Any insurer that files an application for a
18 certificate of authority with the department prior to January
19 1, 1999, shall, if the certificate is not issued as of that
20 date, comply with the requirements of this section within 90
21 days after the issuance of a certificate of authority.
22 (d) Any insurer that files an application for a
23 certificate of authority with the department on or after
24 January 1, 1999, shall comply with the requirements of this
25 section when the application is filed.
26 (3) Each insurer's anti-fraud plan shall include:
27 (a) A description of the unit or division established,
28 or a copy of the contract and related documents required under
29 subsection (1), if applicable.
30 (b) A description of the insurer's policies and
31 procedures that facilitate the detection and investigation of
10
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1 possible fraudulent insurance acts, including specific policy
2 provisions and investigative procedures intended to combat
3 complex instances of fraud with respect to each of the
4 following coverages: health, property, casualty, and workers'
5 compensation and employer's liability.
6 (c) A description of the insurer's procedures for the
7 mandatory reporting of possible fraudulent insurance acts to
8 the department.
9 (d) A description of the insurer's procedures for
10 auditing workers' compensation insureds to verify covered
11 employees and to ensure proper classification, loss experience
12 reporting, and premium collection practices.
13 (e) A description of the insurer's anti-fraud
14 education and training program for claims adjusters or other
15 personnel.
16 (f) A description or chart that includes the
17 organizational arrangement of the insurer's anti-fraud
18 personnel and the education, training, and claims adjusting,
19 law enforcement, or other investigative experience of such
20 personnel responsible for the investigation of possible
21 fraudulent insurance acts.
22 (4) Each insurer shall file an anti-fraud report with
23 the department prior to March 1, 2000, and annually
24 thereafter, which shall include, for the previous calendar
25 year:
26 (a) Material changes or amendments to personnel,
27 policies, or procedures in the insurer's anti-fraud plan.
28 (b) A summary of significant actions taken by the
29 insurer to combat or prosecute cases of insurance fraud and
30 cases of workers' compensation insurance premium fraud.
31
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1 (c) A statement of the insurer's total number of
2 referrals of suspected fraud made to the division by line of
3 coverage and monetary category, and the increase or decrease
4 in these referrals compared to previous calendar years. The
5 monetary categories shall be:
6 1. Suspected cases of fraud totaling less than
7 $20,000;
8 2. Suspected cases of fraud totaling $20,000 or more,
9 but less than $100,000; and
10 3. Suspected fraud totaling $100,000 or more.
11 (d) The amount of direct premiums written, by line of
12 coverage, in the previous calendar year and the number of
13 fraud referrals, by line of coverage, made by the insurer to
14 the department during the reporting period.
15 (5) The department may recommend changes or amendments
16 to an insurer's anti-fraud plan.
17 (6) Every authorized insurer shall describe, through
18 its anti-fraud plan required in subsection (3) and its
19 anti-fraud report required in subsection (4), the amount of
20 resources allocated to identify and combat fraud.
21 Section 3. Section 626.9892, Florida Statutes, is
22 created to read:
23 626.9892 Anti-Fraud Reward Program; reporting of
24 insurance fraud.--
25 (1) The Anti-Fraud Reward Program is hereby
26 established within the department, to be funded from the
27 Insurance Commissioner's Regulatory Trust Fund.
28 (2) The department may, at its discretion, pay rewards
29 of up to $25,000 to persons responsible for providing
30 information leading to the arrest and conviction of persons
31 committing complex and organized crimes, investigated by the
12
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1 Division of Insurance Fraud, arising from violations of the
2 insurance code, s. 440.105, or s. 817.234.
3 (3) Only a single reward amount may be awarded for
4 each case, regardless of the number of persons arrested and
5 convicted in connection with the case and regardless of how
6 many persons submit claims for the reward.
7 (4) The department shall establish procedures to
8 implement and administer the Anti-Fraud Reward Program.
9 Applications for rewards authorized by this section must be
10 made pursuant to the procedures established by the department.
11 (5) The decision of the department whether to make an
12 award under this section, or the decision of the department
13 with respect to the amount of a reward, is not a decision that
14 affects substantial interests for purposes of chapter 120.
15 Section 4. Section 641.3915, Florida Statutes, is
16 created to read:
17 641.3915 Health maintenance organization anti-fraud
18 plans, reports, and investigative units.--
19 (1) Each authorized health maintenance organization
20 that had $10 million or more in revenues during the previous
21 calendar year shall:
22 (a) Establish and maintain a unit or division within
23 the company to investigate possible fraudulent claims by
24 subscribers or by persons making claims for services against
25 policies held by subscribers; or
26 (b) Contract with others to investigate possible
27 fraudulent claims for services against policies held by
28 subscribers.
29
30 For purposes of this section, the term "unit or division"
31 includes the assignment of fraud investigation to employees
13
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1 whose principal responsibilities are the investigation and
2 disposition of claims. If a health maintenance organization
3 creates a distinct unit or division, hires additional
4 employees, or contracts with another entity to fulfill the
5 requirements of this section, the additional cost incurred
6 shall be included as an administrative expense for ratemaking
7 purposes.
8 (2)(a) Each authorized health maintenance organization
9 must adopt an anti-fraud plan and file it with the department
10 before January 1, 1999.
11 (b) Any health maintenance organization that has filed
12 an application for a certificate of authority with the
13 department prior to January 1, 1999, shall, if the certificate
14 is not issued as of that date, comply with the requirements of
15 this section within 90 days after the issuance of the
16 certificate of authority.
17 (c) Any health maintenance organization that files an
18 application for a certificate of authority with the department
19 on or after January 1, 1999, shall comply with the
20 requirements of this section when the application is filed.
21 (3) Each health maintenance organization's anti-fraud
22 plan shall include:
23 (a) A description of the unit or division established,
24 or a copy of the contract and related documents required under
25 subsection (1), if applicable.
26 (b) A description of the health maintenance
27 organization's policies and procedures that facilitate the
28 detection and investigation of possible fraudulent insurance
29 acts.
30
31
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1 (c) A description of the health maintenance
2 organization's procedures for the mandatory reporting of
3 possible fraudulent insurance acts to the department.
4 (d) A description of the health maintenance
5 organization's anti-fraud education and training program for
6 claims adjusters or other personnel.
7 (e) A description or chart that includes the
8 organizational arrangement of the health maintenance
9 organization's anti-fraud personnel and the education,
10 training, and claims adjusting, law enforcement, or other
11 investigative experience of such personnel responsible for the
12 investigation of fraudulent insurance acts.
13 (4) Each health maintenance organization shall file an
14 anti-fraud report with the department before March 1, 2000,
15 and annually thereafter, which shall include, for the previous
16 calendar year:
17 (a) Material changes or amendments to personnel,
18 policies, or procedures in the health maintenance
19 organization's anti-fraud plan.
20 (b) A summary of significant actions taken by the
21 health maintenance organization to combat or prosecute cases
22 of insurance fraud.
23 (c) A statement of the health maintenance
24 organization's total number of referrals of suspected fraud
25 made to the division by line of coverage and monetary
26 category, and the increase or decrease in these referrals
27 compared to previous calendar years. The monetary categories
28 shall be:
29 1. Suspected cases of fraud totaling less than
30 $20,000;
31
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1 2. Suspected cases of fraud totaling $20,000 or more,
2 but less than $100,000; and
3 3. Suspected fraud totaling $100,000 or more.
4 (d) The number of fraud referrals made by the health
5 maintenance organization to the department during the
6 reporting period.
7 (5) The department may recommend changes or amendments
8 to a health maintenance organization's anti-fraud plan.
9 (6) Every authorized health maintenance organization
10 shall describe, through its anti-fraud plan required in
11 subsection (3) and its anti-fraud report required in
12 subsection (4), the amount of resources allocated to identify
13 and combat fraud.
14 (7) Failure to comply with the requirements of this
15 section or authorized rules constitutes grounds for sanctions
16 or penalties pursuant to s. 641.25.
17 Section 5. Subsections (1), (2), (3), (4), (8), (9),
18 and (10) of section 817.234, Florida Statutes, are amended,
19 and subsections (11), (12), and (13) are added to that
20 section, to read:
21 817.234 False and fraudulent insurance claims.--
22 (1)(a) Any person who, with the intent to injure,
23 defraud, or deceive any insurer:
24 1. Presents or causes to be presented any written or
25 oral statement as part of, or in support of, a claim for
26 payment or other benefit pursuant to an insurance policy,
27 knowing that such statement contains any false, incomplete, or
28 misleading information concerning any fact or thing material
29 to such claim;
30 2. Prepares or makes any written or oral statement
31 that is intended to be presented to any insurer in connection
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1 with, or in support of, any claim for payment or other benefit
2 pursuant to an insurance policy, knowing that such statement
3 contains any false, incomplete, or misleading information
4 concerning any fact or thing material to such claim; or
5 3. Knowingly presents, causes to be presented, or
6 prepares or makes with knowledge or belief that it will be
7 presented to any insurer, purported insurer, servicing
8 corporation, insurance broker, or insurance agent, or any
9 employee or agent thereof, any false, incomplete, or
10 misleading information or written or oral statement as part
11 of, or in support of, an application for the issuance of, or
12 the rating of, any insurance policy, or who conceals
13 information concerning any fact material to such application,
14
15 commits insurance fraud a felony of the third degree,
16 punishable as provided in subsection (11) s. 775.082, s.
17 775.083, or s. 775.084.
18 (b) All claims and application forms shall contain a
19 statement that is approved by the Department of Insurance that
20 clearly states in substance the following: "Any person who
21 knowingly and with intent to injure, defraud, or deceive any
22 insurer files a statement of claim or an application
23 containing any false, incomplete, or misleading information is
24 guilty of a felony of the third degree." The changes in this
25 paragraph relating to applications shall take effect on March
26 1, 1996. This paragraph does not apply to reinsurance
27 contracts, reinsurance agreements, or reinsurance claims
28 transactions.
29 (2) Any physician licensed under chapter 458,
30 osteopathic physician licensed under chapter 459, chiropractor
31 licensed under chapter 460, or other practitioner licensed
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1 under the laws of this state who knowingly and willfully
2 assists, conspires with, or urges any insured party to
3 fraudulently violate any of the provisions of this section or
4 part XI of chapter 627, or any person who, due to such
5 assistance, conspiracy, or urging by said physician,
6 osteopathic physician, chiropractor, or practitioner,
7 knowingly and willfully benefits from the proceeds derived
8 from the use of such fraud, commits insurance fraud is guilty
9 of a felony of the third degree, punishable as provided in
10 subsection (11) s. 775.082, s. 775.083, or s. 775.084. In the
11 event that a physician, osteopathic physician, chiropractor,
12 or practitioner is adjudicated guilty of a violation of this
13 section, the Board of Medicine as set forth in chapter 458,
14 the Board of Osteopathic Medicine as set forth in chapter 459,
15 the Board of Chiropractic as set forth in chapter 460, or
16 other appropriate licensing authority shall hold an
17 administrative hearing to consider the imposition of
18 administrative sanctions as provided by law against said
19 physician, osteopathic physician, chiropractor, or
20 practitioner.
21 (3) Any attorney who knowingly and willfully assists,
22 conspires with, or urges any claimant to fraudulently violate
23 any of the provisions of this section or part XI of chapter
24 627, or any person who, due to such assistance, conspiracy, or
25 urging on such attorney's part, knowingly and willfully
26 benefits from the proceeds derived from the use of such fraud,
27 commits insurance fraud a felony of the third degree,
28 punishable as provided in subsection (11) s. 775.082, s.
29 775.083, or s. 775.084.
30 (4) Any No person or governmental unit licensed under
31 chapter 395 to maintain or operate a hospital, and any no
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1 administrator or employee of any such hospital, who shall
2 knowingly and willfully allows allow the use of the facilities
3 of said hospital by an insured party in a scheme or conspiracy
4 to fraudulently violate any of the provisions of this section
5 or part XI of chapter 627. Any hospital administrator or
6 employee who violates this subsection commits insurance fraud
7 a felony of the third degree, punishable as provided in
8 subsection (11) s. 775.082, s. 775.083, or s. 775.084. Any
9 adjudication of guilt for a violation of this subsection, or
10 the use of business practices demonstrating a pattern
11 indicating that the spirit of the law set forth in this
12 section or part XI of chapter 627 is not being followed, shall
13 be grounds for suspension or revocation of the license to
14 operate the hospital or the imposition of an administrative
15 penalty of up to $5,000 by the licensing agency, as set forth
16 in chapter 395.
17 (8) It is unlawful for any person, in his or her
18 individual capacity or in his or her capacity as a public or
19 private employee, or for any firm, corporation, partnership,
20 or association, to solicit any business in or about city
21 receiving hospitals, city and county receiving hospitals,
22 county hospitals, justice courts, or municipal courts; in any
23 public institution; in any public place; upon any public
24 street or highway; in or about private hospitals, sanitariums,
25 or any private institution; or upon private property of any
26 character whatsoever for the purpose of making motor vehicle
27 tort claims or claims for personal injury protection benefits
28 required by s. 627.736. Any person who violates the
29 provisions of this subsection commits insurance solicitation a
30 felony of the third degree, punishable as provided in
31 subsection (11) s. 775.082, s. 775.083, or s. 775.084.
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1 (9) It is unlawful for any attorney to solicit any
2 business relating to the representation of persons injured in
3 a motor vehicle accident for the purpose of filing a motor
4 vehicle tort claim or a claim for personal injury protection
5 benefits required by s. 627.736. The solicitation by
6 advertising of any business by an attorney relating to the
7 representation of a person injured in a specific motor vehicle
8 accident is prohibited by this section. Any attorney who
9 violates the provisions of this subsection commits insurance
10 solicitation a felony of the third degree, punishable as
11 provided in subsection (11) s. 775.082, s. 775.083, or s.
12 775.084. Whenever any circuit or special grievance committee
13 acting under the jurisdiction of the Supreme Court finds
14 probable cause to believe that an attorney is guilty of a
15 violation of this section, such committee shall forward to the
16 appropriate state attorney a copy of the finding of probable
17 cause and the report being filed in the matter. This section
18 shall not be interpreted to prohibit advertising by attorneys
19 which does not entail a solicitation as described in this
20 subsection and which is permitted by the rules regulating The
21 Florida Bar as promulgated by the Florida Supreme Court.
22 (10) As used in this section, the term "insurer" means
23 any insurer, health maintenance organization, self-insurer,
24 self-insurance fund, or other similar entity or person
25 regulated under chapter 440 or by the Department of Insurance
26 under the Florida Insurance Code, and the term "insurance
27 policy" includes a health maintenance organization subscriber
28 contract.
29 (11) If the value of any property involved in
30 violation of this section:
31
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1 (a) Is less than $20,000, the offender commits a
2 felony of the third degree, punishable as provided in s.
3 775.082, s. 775.083, or s. 775.084.
4 (b) Is $20,000 or more, but less than $100,000, the
5 offender commits a felony of the second degree, punishable as
6 provided in s. 775.082, s. 775.083, or s. 775.084.
7 (c) Is $100,000 or more, the offender commits a felony
8 of the first degree, punishable as provided in s. 775.082, s.
9 775.083, or s. 775.084.
10 (12) As used in this section:
11 (a) "Property" means property as defined in s.
12 812.012.
13 (b) "Value" means value as defined in s. 812.012.
14 (13) Notwithstanding any other provision of law, a
15 proceeding under this section may be commenced at any time
16 within 5 years after the cause of action accrues; however, in
17 such proceeding, the period of limitation is tolled whenever
18 the defendant is continuously absent from this state or is
19 without a reasonably ascertainable place of residence or work
20 within this state, but not to extend such period of limitation
21 by more than 1 year. If a criminal prosecution, action, or
22 other proceeding is brought, or intervened in, to punish,
23 prevent, or restrain any violation of this section, the
24 running of the period of limitation prescribed by this
25 section, which is based in whole or in part upon any matter
26 complained of in any such prosecution, action, or proceeding,
27 shall be tolled during the pendency of the prosecution,
28 action, or proceeding and for 2 years following the
29 termination of such prosecution, action, or proceeding.
30 Section 6. The sum of $250,000 is hereby appropriated
31 from the Insurance Commissioner's Regulatory Trust Fund in a
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1 nonoperating category to implement the purpose and provisions
2 of funding the anti-fraud reward program established by this
3 act.
4 Section 7. This act shall take effect upon becoming a
5 law.
6
7 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
8 Senate Bill 1640
9
10 Removes provisions allowing the Department of Insurance to
impose sanctions against insurers and Health Maintenance
11 Organizations (HMOs) for not allocating "sufficient resources
to identify and eliminate fraud."
12
Deletes the provision relating to Judges of Compensation
13 Claims and administrative law judges. Removes the revisions to
criminal penalties imposed for workers' compensation insurance
14 fraud and statute of limitations provisions and deletes the
provision expanding the jurisdiction of the Division of
15 Insurance Fraud to include violations of workers' compensation
insurance laws.
16
For purposes of immunity from civil liability, the term
17 "designated employees of insurers" would be expanded to
include employees of the entity with whom an insurer contracts
18 to investigate insurance fraud.
19 Expands the jurisdiction of the Division of Insurance Fraud to
include all criminal violations of HMO fraud. Provides that
20 criminal prohibitions against false and fraudulent insurance
claims and applications would include HMOs.
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