HOUSE AMENDMENT Bill No. HB 25A
1	CHAMBER ACTION
2	Senate House
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12	Representatives Brown, Berfield, Clarke, Goodlette, and Ross
13	offered the following:
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15	Amendment (with title amendment)
16	Between line(s) 5243 and 5244, insert:
17	Section 39. Subsections (1) and (2) of section 443.1715,
18	Florida Statutes, are amended to read:
19	443.1715 Disclosure of information; confidentiality.--
20	(1) RECORDS AND REPORTS.--Information revealing the
21	employing unit's or individual's identity obtained from the
22	employing unit or from any individual pursuant to the
23	administration of this chapter, and any determination revealing
24	such information, except to the extent necessary for the proper
25	presentation of a claim or upon written authorization of the
26	claimant who has a workers’ compensation claim pending or is
27	receiving compensation benefits, must be held confidential and
28	exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I
29	of the State Constitution. Such information may be made
30	available only to public employees in the performance of their
31	public duties, including employees of the Department of
32	Education in obtaining information for the Florida Education and
33	Training Placement Information Program and the Office of
34	Tourism, Trade, and Economic Development in its administration
35	of the qualified defense contractor tax refund program
36	authorized by s. 288.1045 and the qualified target industry tax
37	refund program authorized by s. 288.106. Except as otherwise
38	provided by law, public employees receiving such information
39	must retain the confidentiality of such information. Any
40	claimant, or the claimant's legal representative, at a hearing
41	before an appeals referee or the commission shall be supplied
42	with information from such records to the extent necessary for
43	the proper presentation of her or his claim. Any employee or
44	member of the commission or any employee of the division, or any
45	other person receiving confidential information, who violates
46	any provision of this subsection commits a misdemeanor of the
47	second degree, punishable as provided in s. 775.082 or s.
48	775.083. However, the division may furnish to any employer
49	copies of any report previously submitted by such employer, upon
50	the request of such employer, and may furnish to any claimant
51	copies of any report previously submitted by such claimant, upon
52	the request of such claimant, and the division is authorized to
53	charge therefor such reasonable fee as the division may by rule
54	prescribe not to exceed the actual reasonable cost of the
55	preparation of such copies. Fees received by the division for
56	copies as provided in this subsection must be deposited to the
57	credit of the Employment Security Administration Trust Fund.
58	(2) DISCLOSURE OF INFORMATION.—
59	(a)Subject to such restrictions as the division
60	prescribes by rule, information declared confidential under this
61	section may be made available to any agency of this or any other
62	state, or any federal agency, charged with the administration of
63	any unemployment compensation law or the maintenance of a system
64	of public employment offices, or the Bureau of Internal Revenue
65	of the United States Department of the Treasury, or the Florida
66	Department of Revenue and information obtained in connection
67	with the administration of the employment service may be made
68	available to persons or agencies for purposes appropriate to the
69	operation of a public employment service or a job-preparatory or
70	career education or training program. The division shall on a
71	quarterly basis, furnish the National Directory of New Hires
72	with information concerning the wages and unemployment
73	compensation paid to individuals, by such dates, in such format
74	and containing such information as the Secretary of Health and
75	Human Services shall specify in regulations. Upon request
76	therefor, the division shall furnish any agency of the United
77	States charged with the administration of public works or
78	assistance through public employment, and may furnish to any
79	state agency similarly charged, the name, address, ordinary
80	occupation, and employment status of each recipient of benefits
81	and such recipient's rights to further benefits under this
82	chapter. Except as otherwise provided by law, the receiving
83	agency must retain the confidentiality of such information as
84	provided in this section. The division may request the
85	Comptroller of the Currency of the United States to cause an
86	examination of the correctness of any return or report of any
87	national banking association rendered pursuant to the provisions
88	of this chapter and may in connection with such request transmit
89	any such report or return to the Comptroller of the Currency of
90	the United States as provided in s. 3305(c) of the federal
91	Internal Revenue Code.
92	(b)1. The employer or the employer’s workers’ compensation
93	carrier against whom a claim for benefits under chapter 440 has
94	been made, or a representative of either, may request from the
95	division records of wages of the employee reported to the
96	division by any employer for the quarter that includes the date
97	of the accident that is the subject of such claim and for
98	subsequent quarters. The request must be made with the
99	authorization or consent of the employee or any employer who
100	paid wages to the employee subsequent to the date of the
101	accident.
102	2. The employer or carrier shall make the request on a
103	form prescribed by rule for such purpose by the division. Such
104	form shall contain a certification by the requesting party that
105	it is a party entitled to the information requested as
106	authorized by this paragraph.
107	3. The division shall provide the most current information
108	readily available within 15 days after receiving the request.
109	Section 40. Subsection (9) of section 626.989, Florida
110	Statutes, is amended to read:
111	626.989 Investigation by department or Division of
112	Insurance Fraud; compliance; immunity; confidential information;
113	reports to division; division investigator's power of arrest.--
114	(9) In recognition of the complementary roles of
115	investigating instances of workers' compensation fraud and
116	enforcing compliance with the workers' compensation coverage
117	requirements under chapter 440, the Department of Financial
118	Services shallInsurance is directed toprepare and submit a
119	joint performance report to the President of the Senate and the
120	Speaker of the House of Representatives by November 1, 2003, and
121	then by January 1 of each yearNovember 1 every 3 years
122	thereafter, describing the results obtained in achieving
123	compliance with the workers' compensation coverage requirements
124	and reducing the incidence of workers' compensation fraud. The
125	annual report must include, but need not be limited to:
126	(a) The total number of initial referrals received, cases
127	opened, cases presented for prosecution, cases closed, and
128	convictions resulting from cases presented for prosecution by
129	the Bureau of Workers’ Compensation Insurance Fraud by type of
130	workers’ compensation fraud and circuit.
131	(b) The number of referrals received from insurers and the
132	Division of Workers’ Compensation and the outcome of those
133	referrals.
134	(c) The number of investigations undertaken by the office
135	which were not the result of a referral from an insurer or the
136	Division of Workers’ Compensation.
137	(d) The number of investigations that resulted in a
138	referral to a regulatory agency and the disposition of those
139	referrals.
140	(e) The number and reasons provided by local prosecutors
141	or the statewide prosecutor for declining prosecution of a case
142	presented by the office by circuit.
143	(f) The total number of employees assigned to the office
144	and the Division of Workers’ Compliance unit delineated by
145	location of staff assigned and the number and location of
146	employees assigned to the office who were assigned to work other
147	types of fraud cases.
148	(g) The average caseload and turnaround time by type of
149	case for each investigator and division compliance employee.
150	(h) The training provided during the year to workers’
151	compensation fraud investigators and the division’s compliance
152	employees.
153	Section 41. Section 626.9891, Florida Statutes, is amended
154	to read:
155	626.9891 Insurer anti-fraud investigative units; reporting
156	requirements; penalties for noncompliance.--
157	(1) Every insurer admitted to do business in this state
158	who in the previous calendar year, at any time during that year,
159	had $10 million or more in direct premiums written shall:
160	(a) Establish and maintain a unit or division within the
161	company to investigate possible fraudulent claims by insureds or
162	by persons making claims for services or repairs against
163	policies held by insureds; or
164	(b) Contract with others to investigate possible
165	fraudulent claims for services or repairs against policies held
166	by insureds.
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168	An insurer subject to this subsection shall file with the
169	Division of Insurance Fraud of the department on or before July
170	1, 1996, a detailed description of the unit or division
171	established pursuant to paragraph (a) or a copy of the contract
172	and related documents required by paragraph (b).
173	(2) Every insurer admitted to do business in this state,
174	which in the previous calendar year had less than $10 million in
175	direct premiums written, must adopt an anti-fraud plan and file
176	it with the Division of Insurance Fraud of the department on or
177	before July 1, 1996. An insurer may, in lieu of adopting and
178	filing an anti-fraud plan, comply with the provisions of
179	subsection (1).
180	(3) Each insurers anti-fraud plans shall include:
181	(a) A description of the insurer's procedures for
182	detecting and investigating possible fraudulent insurance acts;
183	(b) A description of the insurer's procedures for the
184	mandatory reporting of possible fraudulent insurance acts to the
185	Division of Insurance Fraud of the department;
186	(c) A description of the insurer's plan for anti-fraud
187	education and training of its claims adjusters or other
188	personnel; and
189	(d) A written description or chart outlining the
190	organizational arrangement of the insurer's anti-fraud personnel
191	who are responsible for the investigation and reporting of
192	possible fraudulent insurance acts.
193	(4) Any insurer who obtains a certificate of authority
194	after July 1, 1995, shall have 18 months in which to comply with
195	the requirements of this section.
196	(5) For purposes of this section, the term "unit or
197	division" includes the assignment of fraud investigation to
198	employees whose principal responsibilities are the investigation
199	and disposition of claims. If an insurer creates a distinct unit
200	or division, hires additional employees, or contracts with
201	another entity to fulfill the requirements of this section, the
202	additional cost incurred must be included as an administrative
203	expense for ratemaking purposes.
204	(6) Each insurer writing workers’ compensation insurance
205	shall report to the department, on or before August 1 of each
206	year, on its experience in implementing and maintaining an anti-
207	fraud investigative unit or an anti-fraud plan. The report must
208	include, at a minimum:
209	(a) The dollar amount of recoveries and losses
210	attributable to workers’ compensation fraud delineated by the
211	type of fraud: claimant, employer, provider, agent, or other.
212	(b) The number of referrals to the Bureau of Workers’
213	Compensation Fraud for the prior year.
214	(c) A description of the organization of the anti-fraud
215	investigative unit, if applicable, including the position titles
216	and descriptions of staffing.
217	(d) The rationale for the level of staffing and resources
218	being provided for the anti-fraud investigative unit, which may
219	include objective criteria such as number of policies written,
220	number of claims received on an annual basis, volume of
221	suspected fraudulent claims currently being detected, other
222	factors, and an assessment of optimal caseload that can be
223	handled by an investigator on an annual basis.
224	(e) The in-service education and training provided to
225	underwriting and claims personnel to assist in identifying and
226	evaluating instances of suspected fraudulent activity in
227	underwriting or claims activities.
228	(f) A description of a public awareness program focused on
229	the costs and frequency of insurance fraud and methods by which
230	the public can prevent it.
231	(7) If an insurer fails to submit a final anti-fraud plan
232	or otherwise fails to submit a plan, fails to implement the
233	provisions of a plan or an anti-fraud investigative unit, or
234	otherwise refuses to comply with the provisions of this section,
235	the department may:
236	(a) Impose an administrative fine of not more than $2,000
237	per day for such failure by an insurer, until the department
238	deems the insurer to be in compliance;
239	(b) Impose upon the insurer a fraud detection and
240	prevention plan that is deemed to be appropriate by the
241	department and that must be implemented by the insurer; or
242	(c) Impose the provisions of both paragraphs (a) and (b).
243	(8) The department may adopt rules to administer this
244	section.
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246	================= T I T L E A M E N D M E N T =================
247	Remove line(s) 102, and insert:
248
249	references; amending s. 443.1715, F.S.; revising
250	provisions relating to records and reports; providing for
251	disclosure of specified information; amending s. 625.989,
252	F.S.; providing that the Department of Financial Services
253	shall prepare an annual report relating to workers’
254	compensation fraud and compliance; amending s. 626.9891,
255	F.S.; amending reporting requirements for insurers;
256	providing penalties for noncompliance; providing for
257	rules; repealing s. 440.1925, F.S., relating to