Senate Bill sb0032A
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Florida Senate - 2003 SB 32-A
By Senator Alexander
17-2589-03
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. 626.7451,
4 F.S.; providing a per-policy fee to be remitted
5 to the insurer's Special Investigations Unit,
6 the Division of Insurance Fraud of the
7 Department of Financial Services, and the
8 Office of Statewide Prosecution for purposes of
9 preventing, detecting, and prosecuting motor
10 vehicle insurance fraud; amending s. 627.732,
11 F.S.; providing definitions; providing that
12 benefits are void if fraud is committed;
13 providing for award of attorney's fees in
14 actions to recover benefits; providing that
15 consideration shall be given to certain factors
16 regarding the reasonableness of charges;
17 specifying claims or charges that an insurer is
18 not required to pay; requiring the Department
19 of Health, in consultation with medical boards,
20 to identify certain diagnostic tests as
21 non-compensable; specifying effective dates;
22 deleting certain provisions governing
23 arbitration; providing for compliance with
24 billing procedures; requiring certain providers
25 to require an insured to sign a disclosure
26 form; prohibiting insurers from authorizing
27 physicians to change opinion in reports;
28 providing requirements for physicians with
29 respect to maintaining such reports; limiting
30 the application of contingency risk multipliers
31 for awards of attorney's fees; expanding
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1 provisions providing for a demand letter;
2 authorizing the Financial Services Commission
3 to determine cost savings under personal injury
4 protection benefits under specified conditions;
5 allowing a person who elects a deductible or
6 modified coverage to claim the amount deducted
7 from a person legally responsible; amending s.
8 627.739, F.S.; specifying application of a
9 deductible amount; amending s. 817.234, F.S.;
10 providing that it is a material omission and
11 insurance fraud for a physician or other
12 provider to waive a deductible or copayment or
13 not collect the total amount of a charge;
14 increasing the penalties for certain acts of
15 solicitation of accident victims; providing
16 mandatory minimum penalties; prohibiting
17 certain solicitation of accident victims;
18 providing penalties; prohibiting a person from
19 participating in an intentional motor vehicle
20 accident for the purpose of making motor
21 vehicle tort claims; providing penalties,
22 including mandatory minimum penalties; amending
23 s. 817.236, F.S.; increasing penalties for
24 false and fraudulent motor vehicle insurance
25 application; creating s. 817.2361, F.S.;
26 prohibiting the creation or use of false or
27 fraudulent motor vehicle insurance cards;
28 providing penalties; amending s. 921.0022,
29 F.S.; revising the offense severity ranking
30 chart of the Criminal Punishment Code to
31 reflect changes in penalties and the creation
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1 of additional offenses under the act; providing
2 legislative intent with respect to the
3 retroactive application of certain provisions;
4 repealing s. 456.0375, F.S., relating to the
5 regulation of clinics by the Department of
6 Health; requiring certain insurers to make a
7 rate filing to conform the per-policy fee to
8 the requirements of the act; specifying the
9 application of any increase in benefits
10 approved by the Financial Services Commission;
11 providing for application of other provisions
12 of the act; requiring reports; providing an
13 appropriation and authorizing additional
14 positions; repealing of ss. 627.730, 627.731,
15 627.732, 627.733, 627.734, 627.736, 627.737,
16 627.739, 627.7401, 627.7403, and 627.7405,
17 F.S., relating to the Florida Motor Vehicle
18 No-Fault Law, unless reenacted by the 2005
19 Regular Session, and specifying certain effect;
20 authorizing insurers to include in policies a
21 notice of termination relating to such repeal;
22 providing for construction of the act in pari
23 materia with laws enacted during the Regular
24 Session of the Legislature; providing effective
25 dates.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Florida Motor Vehicle Insurance
30 Affordability Reform Act; legislative findings; purpose.--
31
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1 (1) This act may be cited as the "Florida Motor
2 Vehicle Insurance Affordability Reform Act."
3 (2) The Legislature finds and declares that:
4 (a) The Florida Motor Vehicle No-Fault Law, enacted 32
5 years ago, has provided valuable benefits over the years to
6 consumers in this state. The principle underlying the
7 philosophical basis of the no-fault or personal injury
8 protection (PIP) insurance system is that of a trade-off of
9 one benefit for another, specifically providing medical and
10 other benefits in return for a limitation on the right to sue
11 for nonserious injuries.
12 (b) The PIP insurance system has provided benefits in
13 the form of medical payments, lost wages, replacement
14 services, funeral payments, and other benefits, without regard
15 to fault, to consumers injured in automobile accidents.
16 (c) However, the goals behind the adoption of the
17 no-fault law in 1971, which were to quickly and efficiently
18 compensate accident victims regardless of fault, to reduce the
19 volume of lawsuits by eliminating minor injuries from the tort
20 system, and to reduce overall motor vehicle insurance costs,
21 have been significantly compromised due to the fraud and abuse
22 that has permeated the PIP insurance market.
23 (d) Motor vehicle insurance fraud and abuse, other
24 than in the hospital setting, whether in the form of
25 inappropriate medical treatments, inflated claims, staged
26 accidents, solicitation of accident victims, falsification of
27 records, or in any other form, has increased premiums for
28 consumers and must be uncovered and vigorously prosecuted. The
29 problem of inappropriate medical treatment and inflated claims
30 for PIP have generally not occurred in the hospital setting.
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1 (e) The no-fault system has been weakened in part due
2 to certain insurers not adequately or timely compensating
3 injured accident victims or health care providers. In
4 addition, the system has become increasingly litigious with
5 attorneys obtaining large fees by litigating, in certain
6 instances, over relatively small amounts that are in dispute.
7 (f) It is a matter of great public importance that, in
8 order to provide a healthy and competitive automobile
9 insurance market, consumers be able to obtain affordable
10 coverage, insurers be entitled to earn an adequate rate of
11 return, and providers of services be compensated fairly.
12 (g) It is further a matter of great public importance
13 that, in order to protect the public's health, safety, and
14 welfare, it is necessary to enact the provisions contained in
15 this act in order to prevent PIP insurance fraud and abuse and
16 to curb escalating medical, legal, and other related costs,
17 and the Legislature finds that the provisions of this act are
18 the least restrictive actions necessary to achieve this goal.
19 (h) Therefore, the purpose of this act is to restore
20 the health of the PIP insurance market in Florida by
21 addressing these issues, preserving the no-fault system, and
22 realizing cost-savings for all people in this state.
23 Section 2. Section 119.105, Florida Statutes, is
24 amended to read:
25 119.105 Protection of victims of crimes or
26 accidents.--Police reports are public records except as
27 otherwise made exempt or confidential by general or special
28 law. Every person is allowed to examine nonexempt or
29 nonconfidential police reports. A No person who comes into
30 possession of exempt or confidential information contained in
31 police reports may not inspects or copies police reports for
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1 the purpose of obtaining the names and addresses of the
2 victims of crimes or accidents shall use that any information
3 contained therein for any commercial solicitation of the
4 victims or relatives of the victims of the reported crimes or
5 accidents and may not knowingly disclose such information to
6 any third party for the purpose of such solicitation during
7 the period of time that information remains exempt or
8 confidential. This section does not Nothing herein shall
9 prohibit the publication of such information to the general
10 public by any news media legally entitled to possess that
11 information or the use of such information for any other data
12 collection or analysis purposes by those entitled to possess
13 that information.
14 Section 3. Paragraph (c) of subsection (3) of section
15 316.066, Florida Statutes, is amended, and paragraph (f) is
16 added to that subsection, to read:
17 316.066 Written reports of crashes.--
18 (3)
19 (c) Crash reports required by this section which
20 reveal the identity, home or employment telephone number or
21 home or employment address of, or other personal information
22 concerning the parties involved in the crash and which are
23 received or prepared by any agency that regularly receives or
24 prepares information from or concerning the parties to motor
25 vehicle crashes are confidential and exempt from s. 119.07(1)
26 and s. 24(a), Art. I of the State Constitution for a period of
27 60 days after the date the report is filed. However, such
28 reports may be made immediately available to the parties
29 involved in the crash, their legal representatives, their
30 licensed insurance agents, their insurers or insurers to which
31 they have applied for coverage, persons under contract with
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1 such insurers to provide claims or underwriting information,
2 prosecutorial authorities, radio and television stations
3 licensed by the Federal Communications Commission, newspapers
4 qualified to publish legal notices under ss. 50.011 and
5 50.031, and free newspapers of general circulation, published
6 once a week or more often, available and of interest to the
7 public generally for the dissemination of news. For the
8 purposes of this section, the following products or
9 publications are not newspapers as referred to in this
10 section: those intended primarily for members of a particular
11 profession or occupational group; those with the primary
12 purpose of distributing advertising; and those with the
13 primary purpose of publishing names and other personally
14 identifying information concerning parties to motor vehicle
15 crashes. Any local, state, or federal agency, agent, or
16 employee that is authorized to have access to such reports by
17 any provision of law shall be granted such access in the
18 furtherance of the agency's statutory duties notwithstanding
19 the provisions of this paragraph. Any local, state, or federal
20 agency, agent, or employee receiving such crash reports shall
21 maintain the confidential and exempt status of those reports
22 and shall not disclose such crash reports to any person or
23 entity. As a condition precedent to accessing a Any person
24 attempting to access crash report reports within 60 days after
25 the date the report is filed, a person must present a valid
26 driver's license or other photographic identification, proof
27 of status legitimate credentials or identification that
28 demonstrates his or her qualifications to access that
29 information, and file a written sworn statement with the state
30 or local agency in possession of the information stating that
31 information from a crash report made confidential by this
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1 section will not be used for any commercial solicitation of
2 accident victims, or knowingly disclosed to any third party
3 for the purpose of such solicitation, during the period of
4 time that the information remains confidential. In lieu of
5 requiring the written sworn statement, an agency may provide
6 crash reports by electronic means to third-party vendors under
7 contract with one or more insurers, but only when such
8 contract states that information from a crash report made
9 confidential by this section will not be used for any
10 commercial solicitation of accident victims by the vendors, or
11 knowingly disclosed by the vendors to any third party for the
12 purpose of such solicitation, during the period of time that
13 the information remains confidential, and only when a copy of
14 such contract is furnished to the agency as proof of the
15 vendor's claimed status. This subsection does not prevent the
16 dissemination or publication of news to the general public by
17 any legitimate media entitled to access confidential
18 information pursuant to this section. A law enforcement
19 officer as defined in s. 943.10(1) may enforce this
20 subsection. This exemption is subject to the Open Government
21 Sunset Review Act of 1995 in accordance with s. 119.15, and
22 shall stand repealed on October 2, 2006, unless reviewed and
23 saved from repeal through reenactment by the Legislature.
24 (d) Any employee of a state or local agency in
25 possession of information made confidential by this section
26 who knowingly discloses such confidential information to a
27 person not entitled to access such information under this
28 section is guilty of a felony of the third degree, punishable
29 as provided in s. 775.082, s. 775.083, or s. 775.084.
30 (e) Any person, knowing that he or she is not entitled
31 to obtain information made confidential by this section, who
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1 obtains or attempts to obtain such information is guilty of a
2 felony of the third degree, punishable as provided in s.
3 775.082, s. 775.083, or s. 775.084.
4 (f) Any person who knowingly uses confidential
5 information in violation of a filed written sworn statement or
6 contractual agreement required by this section commits a
7 felony of the third degree, punishable as provided in s.
8 775.082, s. 775.083, or s. 775.084.
9 Section 4. Effective October 1, 2003, part XIII of
10 chapter 400, Florida Statutes, consisting of sections 400.901,
11 400.903, 400.905, 400.907, 400.909, 400.911, 400.913, 400.915,
12 400.917, 400.919, and 400.921 is created to read:
13 400.901 Short title; legislative findings.--
14 (1) This part, consisting of ss. 400.901-400.921, may
15 be cited as the "Health Care Clinic Act."
16 (2) The Legislature finds that the regulation of
17 health care clinics must be strengthened to prevent
18 significant cost and harm to consumers. The purpose of this
19 part is to provide for the licensure, establishment, and
20 enforcement of basic standards for health care clinics and to
21 provide administrative oversight by the Agency for Health Care
22 Administration.
23 400.903 Definitions.--
24 (1) "Agency" means the Agency for Health Care
25 Administration.
26 (2) "Applicant" means an individual owner,
27 corporation, partnership, firm, business, association, or
28 other entity that owns or controls, directly or indirectly, 5
29 percent or more of an interest in the clinic and that applies
30 for a clinic license.
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1 (3) "Clinic" means an entity at which health care
2 services are provided to individuals and which tenders charges
3 for reimbursement for such services. For purposes of this part
4 the term does not include and the licensure requirements of
5 this part do not apply to:
6 (a) Entities licensed or registered by the state under
7 chapter 390, chapter 394, chapter 395, chapter 397, this
8 chapter, chapter 463, chapter 465, chapter 466, chapter 478,
9 chapter 480, chapter 484, or chapter 651.
10 (b) Entities that own, directly or indirectly,
11 entities licensed or registered by the state pursuant to
12 chapter 390, chapter 394, chapter 395, chapter 397, this
13 chapter, chapter 463, chapter 465, chapter 466, chapter 478,
14 chapter 480, chapter 484, or chapter 651.
15 (c) Entities that are owned, directly or indirectly,
16 by an entity licensed or registered by the state pursuant to
17 chapter 390, chapter 394, chapter, 395, chapter 397, this
18 chapter, chapter 463, chapter 465, chapter 466, chapter 478,
19 chapter 480, chapter 484, or chapter 651.
20 (d) Entities that are under common ownership, directly
21 or indirectly, with an entity licensed or registered by the
22 state pursuant to chapter 390, chapter 394, chapter 395,
23 chapter 397, this chapter, chapter 463, chapter 465, chapter
24 466, chapter 478, chapter 480, chapter 484, or chapter 651.
25 (e) An entity that is exempt from federal taxation
26 under 26 U.S.C. s. 501(c)(3) and any community college or
27 university clinic.
28 (f) A sole proprietorship, group practice,
29 partnership, or corporation that provides health care services
30 by licensed health care practitioners under chapter 457,
31 chapter 458, chapter 459, chapter 460, chapter 461, chapter
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1 462, chapter 463, chapter 466, chapter 467, chapter 484,
2 chapter 486, chapter 490, chapter 491, or part I, part III,
3 part X, part XIII, or part XIV of chapter 468, or s. 464.012,
4 which are wholly owned by a licensed health care practitioner,
5 or the licensed health care practitioner and the spouse,
6 parent, or child of a licensed health care practitioner, so
7 long as one of the owners who is a licensed health care
8 practitioner is supervising the services performed therein and
9 is legally responsible for the entity's compliance with all
10 federal and state laws. However, a health care practitioner
11 may not supervise services beyond the scope of the
12 practitioner's license.
13 (g) Clinical facilities affiliated with an accredited
14 medical school at which training is provided for medical
15 students, residents, or fellows.
16 (4) "Medical director" means a physician who is
17 employed or under contract with a clinic and who maintains a
18 full and unencumbered physician license in accordance with
19 chapter 458, chapter 459, chapter 460, or chapter 461.
20 However, if the clinic is limited to providing health care
21 services pursuant to chapter 457, chapter 484, chapter 486,
22 chapter 490, or chapter 491 or part I, part III, part X, part
23 XIII, or part XIV of chapter 468, the clinic may appoint a
24 health care practitioner licensed under that chapter to serve
25 as a clinic director who is responsible for the clinic's
26 activities. A health care practitioner may not serve as the
27 clinic director if the services provided at the clinic are
28 beyond the scope of that practitioner's license.
29 400.905 License requirements; background screenings;
30 prohibitions.--
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1 (1) Each clinic, as defined in s. 400.903, must be
2 licensed and shall at all times maintain a valid license with
3 the agency. Each clinic location shall be licensed separately
4 regardless of whether the clinic is operated under the same
5 business name or management as another clinic. Mobile clinics
6 must provide to the agency, at least quarterly, their
7 projected street locations to enable the agency to locate and
8 inspect such clinics.
9 (2) The initial clinic license application shall be
10 filed with the agency by all clinics, as defined in s.
11 400.903, on or before March 1, 2004. A clinic license must be
12 renewed biennially.
13 (3) Applicants that submit an application on or before
14 March 1, 2004, which meets all requirements for initial
15 licensure as specified in this section shall receive a
16 temporary license until the completion of an initial
17 inspection verifying that the applicant meets all requirements
18 in rules authorized by s. 400.911. However, a clinic engaged
19 in magnetic resonance imaging services may not receive a
20 temporary license unless it presents evidence satisfactory to
21 the agency that such clinic is making a good-faith effort and
22 substantial progress in seeking accreditation required under
23 s. 400.915.
24 (4) Application for an initial clinic license or for
25 renewal of an existing license shall be notarized on forms
26 furnished by the agency and must be accompanied by the
27 appropriate license fee as provided in s. 400.911. The agency
28 shall take final action on an initial license application
29 within 60 days after receipt of all required documentation.
30 (5) The application shall contain information that
31 includes, but need not be limited to, information pertaining
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1 to the name, residence and business address, phone number,
2 social security number, and license number of the medical or
3 clinic director, of the licensed medical providers employed or
4 under contract with the clinic, and of each person who,
5 directly or indirectly, owns or controls 5 percent or more of
6 an interest in the clinic, or general partners in limited
7 liability partnerships.
8 (6) The applicant must file with the application
9 satisfactory proof that the clinic is in compliance with this
10 part and applicable rules, including:
11 (a) A listing of services to be provided either
12 directly by the applicant or through contractual arrangements
13 with existing providers;
14 (b) The number and discipline of each professional
15 staff member to be employed; and
16 (c) Proof of financial ability to operate. An
17 applicant must demonstrate financial ability to operate a
18 clinic by submitting a balance sheet and an income and expense
19 statement for the first year of operation which provide
20 evidence of the applicant's having sufficient assets, credit,
21 and projected revenues to cover liabilities and expenses. The
22 applicant shall have demonstrated financial ability to operate
23 if the applicant's assets, credit, and projected revenues meet
24 or exceed projected liabilities and expenses. All documents
25 required under this subsection must be prepared in accordance
26 with generally accepted accounting principles, may be in a
27 compilation form, and the financial statement must be signed
28 by a certified public accountant. As an alternative to
29 submitting a balance sheet and an income and expense statement
30 for the first year of operation, the applicant may file a
31 surety bond of at least $500,000 which guarantees that the
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1 clinic will act in full conformity with all legal requirements
2 for operating a clinic, payable to the agency. The agency may
3 adopt rules to specify related requirements for such surety
4 bond.
5 (7) Each applicant for licensure shall comply with the
6 following requirements:
7 (a) As used in this subsection, the term "applicant"
8 means individuals owning or controlling, directly or
9 indirectly, 5 percent or more of an interest in a clinic; the
10 medical or clinic director, or a similarly titled person who
11 is responsible for the day-to-day operation of the licensed
12 clinic; the financial officer or similarly titled individual
13 who is responsible for the financial operation of the clinic;
14 and licensed medical providers at the clinic.
15 (b) Upon receipt of a completed, signed, and dated
16 application, the agency shall require background screening of
17 the applicant, in accordance with the level 2 standards for
18 screening set forth in chapter 435. Proof of compliance with
19 the level 2 background screening requirements of chapter 435
20 which has been submitted within the previous 5 years in
21 compliance with any other health care licensure requirements
22 of this state is acceptable in fulfillment of this paragraph.
23 (c) Each applicant must submit to the agency, with the
24 application, a description and explanation of any exclusions,
25 permanent suspensions, or terminations of an applicant from
26 the Medicare or Medicaid programs. Proof of compliance with
27 the requirements for disclosure of ownership and control
28 interest under the Medicaid or Medicare programs may be
29 accepted in lieu of this submission. The description and
30 explanation may indicate whether such exclusions, suspensions,
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1 or terminations were voluntary or not voluntary on the part of
2 the applicant.
3 (d) A license may not be granted to a clinic if the
4 applicant has been found guilty of, regardless of
5 adjudication, or has entered a plea of nolo contendere or
6 guilty to, any offense prohibited under the level 2 standards
7 for screening set forth in chapter 435, or a violation of
8 insurance fraud under s. 817.234, within the past 5 years. If
9 the applicant has been convicted of an offense prohibited
10 under the level 2 standards or insurance fraud in any
11 jurisdiction, the applicant must show that his or her civil
12 rights have been restored prior to submitting an application.
13 (e) The agency may deny or revoke licensure if the
14 applicant has falsely represented any material fact or omitted
15 any material fact from the application required by this part.
16 (8) Requested information omitted from an application
17 for licensure, license renewal, or transfer of ownership must
18 be filed with the agency within 21 days after receipt of the
19 agency's request for omitted information, or the application
20 shall be deemed incomplete and shall be withdrawn from further
21 consideration.
22 (9) The failure to file a timely renewal application
23 shall result in a late fee charged to the facility in an
24 amount equal to 50 percent of the current license fee.
25 400.907 Clinic inspections; emergency suspension;
26 costs.--
27 (1) Any authorized officer or employee of the agency
28 shall make inspections of the clinic as part of the initial
29 license application or renewal application. The application
30 for a clinic license issued under this part or for a renewal
31 license constitutes permission for an appropriate agency
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1 inspection to verify the information submitted on or in
2 connection with the application or renewal.
3 (2) An authorized officer or employee of the agency
4 may make unannounced inspections of clinics licensed pursuant
5 to this part as are necessary to determine that the clinic is
6 in compliance with this part and with applicable rules. A
7 licensed clinic shall allow full and complete access to the
8 premises and to billing records or information to any
9 representative of the agency who makes an inspection to
10 determine compliance with this part and with applicable rules.
11 (3) Failure by a clinic licensed under this part to
12 allow full and complete access to the premises and to billing
13 records or information to any representative of the agency who
14 makes a request to inspect the clinic to determine compliance
15 with this part or failure by a clinic to employ a qualified
16 medical director or clinic director constitutes a ground for
17 emergency suspension of the license by the agency pursuant to
18 s. 120.60(6).
19 (4) In addition to any administrative fines imposed,
20 the agency may assess a fee equal to the cost of conducting a
21 complaint investigation.
22 400.909 License renewal; transfer of ownership;
23 provisional license.--
24 (1) An application for license renewal must contain
25 information as required by the agency.
26 (2) Ninety days before the expiration date, an
27 application for renewal must be submitted to the agency.
28 (3) The clinic must file with the renewal application
29 satisfactory proof that it is in compliance with this part and
30 applicable rules. If there is evidence of financial
31 instability, the clinic must submit satisfactory proof of its
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1 financial ability to comply with the requirements of this
2 part.
3 (4) When transferring the ownership of a clinic, the
4 transferee must submit an application for a license at least
5 60 days before the effective date of the transfer. An
6 application for change of ownership of a license is required
7 only when 45 percent or more of the ownership, voting shares,
8 or controlling interest of a clinic is transferred or
9 assigned, including the final transfer or assignment of
10 multiple transfers or assignments over a 2-year period that
11 cumulatively total 45 percent or greater.
12 (5) The license may not be sold, leased, assigned, or
13 otherwise transferred, voluntarily or involuntarily, and is
14 valid only for the clinic owners and location for which
15 originally issued.
16 (6) A clinic against whom a revocation or suspension
17 proceeding is pending at the time of license renewal may be
18 issued a provisional license effective until final disposition
19 by the agency of such proceedings. If judicial relief is
20 sought from the final disposition, the agency that has
21 jurisdiction may issue a temporary permit for the duration of
22 the judicial proceeding.
23 400.911 Rulemaking authority; license fees.--
24 (1) The agency shall adopt rules necessary to
25 administer the clinic administration, regulation, and
26 licensure program, including rules establishing the specific
27 licensure requirements, procedures, forms, and fees. It shall
28 adopt rules establishing a procedure for the biennial renewal
29 of licenses. The rules shall specify the expiration dates of
30 licenses, the process of tracking compliance with financial
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1 responsibility requirements, and any other conditions of
2 renewal required by law or rule.
3 (2) The agency shall adopt rules specifying
4 limitations on the number of licensed clinics and licensees
5 for which a medical director or a clinic director may assume
6 responsibility for purposes of this part. In determining the
7 quality of supervision a medical director or a clinic director
8 can provide, the agency shall consider the number of clinic
9 employees, the clinic location, and the health care services
10 provided by the clinic.
11 (3) License application and renewal fees must be
12 reasonably calculated by the agency to cover its costs in
13 carrying out its responsibilities under this part, including
14 the cost of licensure, inspection, and regulation of clinics,
15 and must be of such amount that the total fees collected do
16 not exceed the cost of administering and enforcing compliance
17 with this part. Clinic licensure fees are nonrefundable and
18 may not exceed $2,000. The agency shall adjust the license fee
19 annually by not more than the change in the Consumer Price
20 Index based on the 12 months immediately preceding the
21 increase. All fees collected under this part must be deposited
22 in the Health Care Trust Fund for the administration of this
23 part.
24 400.913 Unlicensed clinics; penalties; fines;
25 verification of licensure status.--
26 (1) It is unlawful to own, operate, or maintain a
27 clinic without obtaining a license under this part.
28 (2) Any person who owns, operates, or maintains an
29 unlicensed clinic commits a felony of the third degree,
30 punishable as provided in s. 775.082, s. 775.083, or s.
31
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1 775.084. Each day of continued operation is a separate
2 offense.
3 (3) Any person found guilty of violating subsection
4 (2) a second or subsequent time commits a felony of the second
5 degree, punishable as provided under s. 775.082, s. 775.083,
6 or s. 775.084. Each day of continued operation is a separate
7 offense.
8 (4) Any person who owns, operates, or maintains an
9 unlicensed clinic due to a change in this part or a
10 modification in agency rules within 6 months after the
11 effective date of such change or modification and who, within
12 10 working days after receiving notification from the agency,
13 fails to cease operation or apply for a license under this
14 part commits a felony of the third degree, punishable as
15 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
16 continued operation is a separate offense.
17 (5) Any clinic that fails to cease operation after
18 agency notification may be fined for each day of noncompliance
19 pursuant to this part.
20 (6) When a person has an interest in more than one
21 clinic, and fails to obtain a license for any one of these
22 clinics, the agency may revoke the license, impose a
23 moratorium, or impose a fine pursuant to this part on any or
24 all of the licensed clinics until such time as the unlicensed
25 clinic is licensed or ceases operation.
26 (7) Any person aware of the operation of an unlicensed
27 clinic must report that facility to the agency.
28 (8) Any health care provider who is aware of the
29 operation of an unlicensed clinic shall report that facility
30 to the agency. Failure to report a clinic that the provider
31
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1 knows or has reasonable cause to suspect is unlicensed shall
2 be reported to the provider's licensing board.
3 (9) The agency may not issue a license to a clinic
4 that has any unpaid fines assessed under this part.
5 400.915 Clinic responsibilities.--
6 (1) Each clinic shall appoint a medical director or
7 clinic director who shall agree in writing to accept legal
8 responsibility for the following activities on behalf of the
9 clinic. The medical director or the clinic director shall:
10 (a) Have signs identifying the medical director or
11 clinic director posted in a conspicuous location within the
12 clinic readily visible to all patients.
13 (b) Ensure that all practitioners providing health
14 care services or supplies to patients maintain a current
15 active and unencumbered Florida license.
16 (c) Review any patient referral contracts or
17 agreements executed by the clinic.
18 (d) Ensure that all health care practitioners at the
19 clinic have active appropriate certification or licensure for
20 the level of care being provided.
21 (e) Serve as the clinic records owner as defined in s.
22 456.057.
23 (f) Ensure compliance with the recordkeeping, office
24 surgery, and adverse incident reporting requirements of
25 chapter 456, the respective practice acts, and rules adopted
26 under this part.
27 (g) Conduct systematic reviews of clinic billings to
28 ensure that the billings are not fraudulent or unlawful. Upon
29 discovery of an unlawful charge, the medical director or
30 clinic director shall take immediate corrective action.
31
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1 (2) Any business that becomes a clinic after
2 commencing operations must, within 5 days after becoming a
3 clinic, file a license application under this part and shall
4 be subject to all provisions of this part applicable to a
5 clinic.
6 (3) Any contract to serve as a medical director or a
7 clinic director entered into or renewed by a physician or a
8 licensed health care practitioner in violation of this part is
9 void as contrary to public policy. This subsection shall apply
10 to contracts entered into or renewed on or after March 1,
11 2004.
12 (4) All charges or reimbursement claims made by or on
13 behalf of a clinic that is required to be licensed under this
14 part, but that is not so licensed, or that is otherwise
15 operating in violation of this part, are unlawful charges, and
16 therefore are noncompensable and unenforceable.
17 (5) Any person establishing, operating, or managing an
18 unlicensed clinic otherwise required to be licensed under this
19 part, or any person who knowingly files a false or misleading
20 license application or license renewal application, or false
21 or misleading information related to such application or
22 department rule, commits a felony of the third degree,
23 punishable as provided in s. 775.082, s. 775.083, or s.
24 775.084.
25 (6) Any licensed health care provider who violates
26 this part is subject to discipline in accordance with this
27 chapter and his or her respective practice act.
28 (7) The agency may fine, or suspend or revoke the
29 license of, any clinic licensed under this part for operating
30 in violation of the requirements of this part or the rules
31 adopted by the agency.
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1 (8) The agency shall investigate allegations of
2 noncompliance with this part and the rules adopted under this
3 part.
4 (9) Any person or entity providing health care
5 services which is not a clinic, as defined under s. 400.903,
6 may voluntarily apply for licensure under its exempt status
7 with the agency on a form that sets forth its name or names
8 and addresses, a statement of the reasons why it cannot be
9 defined as a clinic, and other information deemed necessary by
10 the agency.
11 (10) The clinic shall display its license in a
12 conspicuous location within the clinic readily visible to all
13 patients.
14 (11)(a) Each clinic engaged in magnetic resonance
15 imaging services must be accredited by the Joint Commission on
16 Accreditation of Healthcare Organizations, the American
17 College of Radiology, or the Accreditation Association for
18 Ambulatory Health Care, within 1 year after licensure.
19 However, a clinic may request a single, 6-month extension if
20 it provides evidence to the agency establishing that, for good
21 cause shown, such clinic can not be accredited within 1 year
22 after licensure, and that such accreditation will be completed
23 within the 6-month extension. After obtaining accreditation as
24 required by this subsection, each such clinic must maintain
25 accreditation as a condition of renewal of its license.
26 (b) The agency may disallow the application of any
27 entity formed for the purpose of avoiding compliance with the
28 accreditation provisions of this subsection and whose
29 principals were previously principals of an entity that was
30 unable to meet the accreditation requirements within the
31
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1 specified timeframes. The agency may adopt rules as to the
2 accreditation of magnetic resonance imaging clinics.
3 (12) The agency shall give full faith and credit
4 pertaining to any past variance and waiver granted to a
5 magnetic resonance imaging clinic from Rule 64-2002, Florida
6 Administrative Code, by the Department of Health, until
7 September 2004. After that date, such clinic must request a
8 variance and waiver from the agency under s. 120.542.
9 400.917 Injunctions.--
10 (1) The agency may institute injunctive proceedings in
11 a court of competent jurisdiction in order to:
12 (a) Enforce the provisions of this part or any minimum
13 standard, rule, or order issued or entered into pursuant to
14 this part if the attempt by the agency to correct a violation
15 through administrative fines has failed; if the violation
16 materially affects the health, safety, or welfare of clinic
17 patients; or if the violation involves any operation of an
18 unlicensed clinic.
19 (b) Terminate the operation of a clinic if a violation
20 of any provision of this part, or any rule adopted pursuant to
21 this part, materially affects the health, safety, or welfare
22 of clinic patients.
23 (2) Such injunctive relief may be temporary or
24 permanent.
25 (3) If action is necessary to protect clinic patients
26 from life-threatening situations, the court may allow a
27 temporary injunction without bond upon proper proof being
28 made. If it appears by competent evidence or a sworn,
29 substantiated affidavit that a temporary injunction should
30 issue, the court, pending the determination on final hearing,
31 shall enjoin operation of the clinic.
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1 400.919 Agency actions.--Administrative proceedings
2 challenging agency licensure enforcement action shall be
3 reviewed on the basis of the facts and conditions that
4 resulted in the agency action.
5 400.921 Agency administrative penalties.--
6 (1) The agency may impose administrative penalties
7 against clinics of up to $5,000 per violation for violations
8 of the requirements of this part. In determining if a penalty
9 is to be imposed and in fixing the amount of the fine, the
10 agency shall consider the following factors:
11 (a) The gravity of the violation, including the
12 probability that death or serious physical or emotional harm
13 to a patient will result or has resulted, the severity of the
14 action or potential harm, and the extent to which the
15 provisions of the applicable laws or rules were violated.
16 (b) Actions taken by the owner, medical director, or
17 clinic director to correct violations.
18 (c) Any previous violations.
19 (d) The financial benefit to the clinic of committing
20 or continuing the violation.
21 (2) Each day of continuing violation after the date
22 fixed for termination of the violation, as ordered by the
23 agency, constitutes an additional, separate, and distinct
24 violation.
25 (3) Any action taken to correct a violation shall be
26 documented in writing by the owner, medical director, or
27 clinic director of the clinic and verified through followup
28 visits by agency personnel. The agency may impose a fine and,
29 in the case of an owner-operated clinic, revoke or deny a
30 clinic's license when a clinic medical director or clinic
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1 director fraudulently misrepresents actions taken to correct a
2 violation.
3 (4) For fines that are upheld following administrative
4 or judicial review, the violator shall pay the fine, plus
5 interest at the rate as specified in s. 55.03, for each day
6 beyond the date set by the agency for payment of the fine.
7 (5) Any unlicensed clinic that continues to operate
8 after agency notification is subject to a $1,000 fine per day.
9 (6) Any licensed clinic whose owner, medical director,
10 or clinic director concurrently operates an unlicensed clinic
11 shall be subject to an administrative fine of $5,000 per day.
12 (7) Any clinic whose owner fails to apply for a
13 change-of-ownership license in accordance with s. 400.909 and
14 operates the clinic under the new ownership is subject to a
15 fine of $5,000.
16 (8) The agency, as an alternative to or in conjunction
17 with an administrative action against a clinic for violations
18 of this part and adopted rules, shall make a reasonable
19 attempt to discuss each violation and recommended corrective
20 action with the owner, medical director, or clinic director of
21 the clinic, prior to written notification. The agency, instead
22 of fixing a period within which the clinic shall enter into
23 compliance with standards, may request a plan of corrective
24 action from the clinic which demonstrates a good-faith effort
25 to remedy each violation by a specific date, subject to the
26 approval of the agency.
27 (9) Administrative fines paid by any clinic under this
28 section shall be deposited into the Health Care Trust Fund.
29 Section 5. Paragraph (b) of subsection (1) of section
30 456.0375, Florida Statutes, is amended to read:
31
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1 456.0375 Registration of certain clinics;
2 requirements; discipline; exemptions.--
3 (1)
4 (b) For purposes of this section, the term "clinic"
5 does not include and the registration requirements herein do
6 not apply to:
7 1. Entities licensed or registered by the state
8 pursuant to chapter 390, chapter 394, chapter 395, chapter
9 397, chapter 400, chapter 463, chapter 465, chapter 466,
10 chapter 478, chapter 480, or chapter 484, or chapter 651.
11 2. Entities that own, directly or indirectly, entities
12 licensed or registered by the state pursuant to chapter 390,
13 chapter 394, chapter 395, chapter 397, chapter 400, chapter
14 463, chapter 465, chapter 466, chapter 478, chapter 480,
15 chapter 484, or chapter 651.
16 3. Entities that are owned, directly or indirectly, by
17 an entity licensed or registered by the state pursuant to
18 chapter 390, chapter 394, chapter 395, chapter 397, chapter
19 400, chapter 463, chapter 465, chapter 466, chapter 478,
20 chapter 480, chapter 484, or chapter 651.
21 4. Entities that are under common ownership, directly
22 or indirectly, with an entity licensed or registered by the
23 state pursuant to chapter 390, chapter 394, chapter 395,
24 chapter 397, chapter 400, chapter 463, chapter 465, chapter
25 466, chapter 478, chapter 480, chapter 484, or chapter 651.
26 5.2. Entities exempt from federal taxation under 26
27 U.S.C. s. 501(c)(3) and community college and university
28 clinics.
29 6.3. Sole proprietorships, group practices,
30 partnerships, or corporations that provide health care
31 services by licensed health care practitioners pursuant to
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1 chapters 457, 458, 459, 460, 461, 462, 463, 466, 467, 484,
2 486, 490, 491, or part I, part III, part X, part XIII, or part
3 XIV of chapter 468, or s. 464.012, which are wholly owned by
4 licensed health care practitioners or the licensed health care
5 practitioner and the spouse, parent, or child of a licensed
6 health care practitioner, so long as one of the owners who is
7 a licensed health care practitioner is supervising the
8 services performed therein and is legally responsible for the
9 entity's compliance with all federal and state laws. However,
10 no health care practitioner may supervise services beyond the
11 scope of the practitioner's license.
12 7. Clinical facilities affiliated with an accredited
13 medical school at which training is provided for medical
14 students, residents, or fellows.
15 Section 6. Paragraphs (dd) and (ee) are added to
16 subsection (1) of section 456.072, Florida Statutes, to read:
17 456.072 Grounds for discipline; penalties;
18 enforcement.--
19 (1) The following acts shall constitute grounds for
20 which the disciplinary actions specified in subsection (2) may
21 be taken:
22 (dd) With respect to making a personal injury
23 protection claim as required by s. 627.736, intentionally
24 submitting a claim statement, or bill that has been "upcoded"
25 as defined in s. 627.732.
26 (ee) With respect to making a personal injury
27 protection claim as required by s. 627.736, intentionally
28 submitting a claim, statement, or bill for payment of services
29 that were not rendered.
30 Section 7. Subsection (11) of section 626.7451,
31 Florida Statutes, is amended to read:
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1 626.7451 Managing general agents; required contract
2 provisions.--No person acting in the capacity of a managing
3 general agent shall place business with an insurer unless
4 there is in force a written contract between the parties which
5 sets forth the responsibility for a particular function,
6 specifies the division of responsibilities, and contains the
7 following minimum provisions:
8 (11) A licensed managing general agent, when placing
9 business with an insurer under this code, may charge a
10 per-policy fee not to exceed $40 $25. In no instance shall
11 the aggregate of per-policy fees for a placement of business
12 authorized under this section, when combined with any other
13 per-policy fee charged by the insurer, result in per-policy
14 fees which exceed the aggregate amount of $40 $25. The
15 per-policy fee shall be a component of the insurer's rate
16 filing and shall be fully earned. A managing general agent
17 that collects a per-policy fee shall remit a minimum of $5 per
18 policy to the Division of Insurance Fraud of the Department of
19 Financial Services, which shall be dedicated to the prevention
20 and detection of motor vehicle insurance fraud, and an
21 additional $5 per policy, 95 percent of which shall be
22 remitted to the Justice Administration Commission, which shall
23 distribute the collected fees to the state attorneys of the 20
24 judicial circuits for investigating and prosecuting cases of
25 motor vehicle insurance fraud. The state attorneys must adopt
26 an allocation formula that ensures equitable distribution
27 among the 20 circuits which includes, but is not limited to,
28 the population area served. The remaining 5 percent shall be
29 remitted to the Office of Statewide Prosecution for
30 investigating and prosecuting cases of motor vehicle insurance
31 fraud. An insurer that writes directly without a managing
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1 general agent and that charges a per-policy fee shall charge
2 an additional policy fee of $5 per policy to be remitted to
3 the Division of Insurance Fraud of the Department of Financial
4 Services, which shall be dedicated to the prevention and
5 detection of motor vehicle insurance fraud, and an additional
6 per-policy fee of $5, 95 percent of which is to be remitted to
7 the Justice Administration Commission, to be distributed as
8 provided in this subsection. The remaining 5 percent shall be
9 remitted to the Office of Statewide Prosecution for
10 investigating and prosecuting cases of motor vehicle insurance
11 fraud. No later than July 1, 2005, the state attorneys and the
12 Office of Statewide Prosecutor must provide a report to the
13 President of the Senate and the Speaker of the House of
14 Representatives evaluating the effectiveness of the
15 investigation, detection, and prosecution of motor vehicle
16 insurance fraud as it related to the moneys generated by the
17 per-policy fee.
18
19 For the purposes of this section and ss. 626.7453 and
20 626.7454, the term "controlling person" or "controlling" has
21 the meaning set forth in s. 625.012(5)(b)1., and the term
22 "controlled person" or "controlled" has the meaning set forth
23 in s. 625.012(5)(b)2.
24 Section 8. Subsection (1) of section 627.732, Florida
25 Statutes, as amended by chapter 2003-2, Laws of Florida, is
26 amended, and subsections (8) through (16) are added to that
27 section, to read:
28 627.732 Definitions.--As used in ss. 627.730-627.7405,
29 the term:
30 (1) "Broker" means any person not possessing a license
31 under chapter 395, chapter 400, chapter 458, chapter 459,
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1 chapter 460, chapter 461, or chapter 641 who charges or
2 receives compensation for any use of medical equipment and is
3 not the 100-percent owner or the 100-percent lessee of such
4 equipment. For purposes of this section, such owner or lessee
5 may be an individual, a corporation, a partnership, or any
6 other entity and any of its 100-percent-owned affiliates and
7 subsidiaries. For purposes of this subsection, the term
8 "lessee" means a long-term lessee under a capital or operating
9 lease, but does not include a part-time lessee. The term
10 "broker" does not include a hospital or physician management
11 company whose medical equipment is ancillary to the practices
12 managed, a debt collection agency, or an entity that has
13 contracted with the insurer to obtain a discounted rate for
14 such services; nor does the term include a management company
15 that has contracted to provide general management services for
16 a licensed physician or health care facility and whose
17 compensation is not materially affected by the usage or
18 frequency of usage of medical equipment or an entity that is
19 100-percent owned by one or more hospitals or physicians. The
20 term "broker" does not include a person or entity that
21 certifies, upon request of an insurer, that:
22 (a) It is a clinic registered under s. 456.0375 or
23 licensed under ss. 400.901-400.921;
24 (b) It is a 100-percent owner of medical equipment;
25 and
26 (c) The owner's only part-time lease of medical
27 equipment for personal injury protection patients is on a
28 temporary basis not to exceed 30 days in a 12-month period,
29 and such lease is solely for the purposes of necessary repair
30 or maintenance of the 100-percent-owned medical equipment or
31 pending the arrival and installation of the newly purchased or
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1 a replacement for the 100-percent-owned medical equipment, or
2 for patients for whom, because of physical size or
3 claustrophobia, it is determined by the medical director or
4 clinical director to be medically necessary that the test be
5 performed in medical equipment that is open-style. The leased
6 medical equipment cannot be used by patients who are not
7 patients of the registered clinic for medical treatment of
8 services. Any person or entity making a false certification
9 under this subsection commits insurance fraud as defined in s.
10 817.234. However, the 30-day period provided in this paragraph
11 may be extended for an additional 60 days as applicable to
12 magnetic resonance imaging equipment if the owner certifies
13 that the extension otherwise complies with this paragraph.
14 (8) "Certify" means to swear or attest to being true
15 or represented in writing.
16 (9) "Immediate personal supervision," as it relates to
17 the performance of medical services by nonphysicians not in a
18 hospital, means that an individual licensed to perform the
19 medical service or provide the medical supplies must be
20 present within the confines of the physical structure where
21 the medical services are performed or where the medical
22 supplies are provided such that the licensed individual can
23 respond immediately to any emergencies if needed.
24 (10) "Incident," with respect to services considered
25 as incident to a physician's professional service, for a
26 physician licensed under chapter 458, chapter 459, chapter
27 460, or chapter 461, if not furnished in a hospital, means
28 such services must be an integral, even if incidental, part of
29 a covered physician's service.
30 (11) "Knowingly" means that a person, with respect to
31 information, has actual knowledge of the information; acts in
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1 deliberate ignorance of the truth or falsity of the
2 information; or acts in reckless disregard of the information,
3 and proof of specific intent to defraud is not required.
4 (12) "Lawful" or "lawfully" means in substantial
5 compliance with all relevant applicable criminal, civil, and
6 administrative requirements of state and federal law related
7 to the provision of medical services or treatment.
8 (13) "Hospital" means a facility that, at the time
9 services or treatment were rendered, was licensed under
10 chapter 395.
11 (14) "Properly completed" means providing truthful,
12 substantially complete, and substantially accurate responses
13 as to all material elements to each applicable request for
14 information or statement by a means that may lawfully be
15 provided and that complies with this section, or as agreed by
16 the parties.
17 (15) "Upcoding" means an action that submits a billing
18 code that would result in payment greater in amount than would
19 be paid using a billing code that accurately describes the
20 services performed. The term does not include an otherwise
21 lawful bill by a magnetic resonance imaging facility, which
22 globally combines both technical and professional components
23 for services listed in that definition, if the amount of the
24 global bill is not more than the components if billed
25 separately; however, payment of such a bill constitutes
26 payment in full for all components of such service.
27 (16) "Unbundling" means an action that submits a
28 billing code that is properly billed under one billing code,
29 but that has been separated into two or more billing codes,
30 and would result in payment greater in amount than would be
31 paid using one billing code.
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1 Section 9. Subsections (3), (4), (5), (6), (7), (8),
2 (10), (11), and (12) of section 627.736, Florida Statutes, are
3 amended, present subsection (13) of that section is
4 redesignated as subsection (14), and amended, and a new
5 subsection (13) is added to that section, to read:
6 627.736 Required personal injury protection benefits;
7 exclusions; priority; claims.--
8 (3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
9 TORT CLAIMS.--No insurer shall have a lien on any recovery in
10 tort by judgment, settlement, or otherwise for personal injury
11 protection benefits, whether suit has been filed or settlement
12 has been reached without suit. An injured party who is
13 entitled to bring suit under the provisions of ss.
14 627.730-627.7405, or his or her legal representative, shall
15 have no right to recover any damages for which personal injury
16 protection benefits are paid or payable. The plaintiff may
17 prove all of his or her special damages notwithstanding this
18 limitation, but if special damages are introduced in evidence,
19 the trier of facts, whether judge or jury, shall not award
20 damages for personal injury protection benefits paid or
21 payable. In all cases in which a jury is required to fix
22 damages, the court shall instruct the jury that the plaintiff
23 shall not recover such special damages for personal injury
24 protection benefits paid or payable.
25 (4) BENEFITS; WHEN DUE.--Benefits due from an insurer
26 under ss. 627.730-627.7405 shall be primary, except that
27 benefits received under any workers' compensation law shall be
28 credited against the benefits provided by subsection (1) and
29 shall be due and payable as loss accrues, upon receipt of
30 reasonable proof of such loss and the amount of expenses and
31 loss incurred which are covered by the policy issued under ss.
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1 627.730-627.7405. When the Agency for Health Care
2 Administration provides, pays, or becomes liable for medical
3 assistance under the Medicaid program related to injury,
4 sickness, disease, or death arising out of the ownership,
5 maintenance, or use of a motor vehicle, benefits under ss.
6 627.730-627.7405 shall be subject to the provisions of the
7 Medicaid program.
8 (a) An insurer may require written notice to be given
9 as soon as practicable after an accident involving a motor
10 vehicle with respect to which the policy affords the security
11 required by ss. 627.730-627.7405.
12 (b) Personal injury protection insurance benefits paid
13 pursuant to this section shall be overdue if not paid within
14 30 days after the insurer is furnished written notice of the
15 fact of a covered loss and of the amount of same. If such
16 written notice is not furnished to the insurer as to the
17 entire claim, any partial amount supported by written notice
18 is overdue if not paid within 30 days after such written
19 notice is furnished to the insurer. Any part or all of the
20 remainder of the claim that is subsequently supported by
21 written notice is overdue if not paid within 30 days after
22 such written notice is furnished to the insurer. When an
23 insurer pays only a portion of a claim or rejects a claim, the
24 insurer shall provide at the time of the partial payment or
25 rejection an itemized specification of each item that the
26 insurer had reduced, omitted, or declined to pay and any
27 information that the insurer desires the claimant to consider
28 related to the medical necessity of the denied treatment or to
29 explain the reasonableness of the reduced charge, provided
30 that this shall not limit the introduction of evidence at
31 trial; and the insurer shall include the name and address of
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1 the person to whom the claimant should respond and a claim
2 number to be referenced in future correspondence. However,
3 notwithstanding the fact that written notice has been
4 furnished to the insurer, any payment shall not be deemed
5 overdue when the insurer has reasonable proof to establish
6 that the insurer is not responsible for the payment. For the
7 purpose of calculating the extent to which any benefits are
8 overdue, payment shall be treated as being made on the date a
9 draft or other valid instrument which is equivalent to payment
10 was placed in the United States mail in a properly addressed,
11 postpaid envelope or, if not so posted, on the date of
12 delivery. This paragraph does not preclude or limit the
13 ability of the insurer to assert that the claim was unrelated,
14 was not medically necessary, or was unreasonable or that the
15 amount of the charge was in excess of that permitted under, or
16 in violation of, subsection (5). Such assertion by the insurer
17 may be made at any time, including after payment of the claim
18 or after the 30-day time period for payment set forth in this
19 paragraph.
20 (c) All overdue payments shall bear simple interest at
21 the rate established by the Comptroller under s. 55.03 or the
22 rate established in the insurance contract, whichever is
23 greater, for the year in which the payment became overdue,
24 calculated from the date the insurer was furnished with
25 written notice of the amount of covered loss. Interest shall
26 be due at the time payment of the overdue claim is made.
27 (d) The insurer of the owner of a motor vehicle shall
28 pay personal injury protection benefits for:
29 1. Accidental bodily injury sustained in this state by
30 the owner while occupying a motor vehicle, or while not an
31
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1 occupant of a self-propelled vehicle if the injury is caused
2 by physical contact with a motor vehicle.
3 2. Accidental bodily injury sustained outside this
4 state, but within the United States of America or its
5 territories or possessions or Canada, by the owner while
6 occupying the owner's motor vehicle.
7 3. Accidental bodily injury sustained by a relative of
8 the owner residing in the same household, under the
9 circumstances described in subparagraph 1. or subparagraph 2.,
10 provided the relative at the time of the accident is domiciled
11 in the owner's household and is not himself or herself the
12 owner of a motor vehicle with respect to which security is
13 required under ss. 627.730-627.7405.
14 4. Accidental bodily injury sustained in this state by
15 any other person while occupying the owner's motor vehicle or,
16 if a resident of this state, while not an occupant of a
17 self-propelled vehicle, if the injury is caused by physical
18 contact with such motor vehicle, provided the injured person
19 is not himself or herself:
20 a. The owner of a motor vehicle with respect to which
21 security is required under ss. 627.730-627.7405; or
22 b. Entitled to personal injury benefits from the
23 insurer of the owner or owners of such a motor vehicle.
24 (e) If two or more insurers are liable to pay personal
25 injury protection benefits for the same injury to any one
26 person, the maximum payable shall be as specified in
27 subsection (1), and any insurer paying the benefits shall be
28 entitled to recover from each of the other insurers an
29 equitable pro rata share of the benefits paid and expenses
30 incurred in processing the claim.
31
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1 (f) It is a violation of the insurance code for an
2 insurer to fail to timely provide benefits as required by this
3 section with such frequency as to constitute a general
4 business practice.
5 (g) Benefits shall not be due or payable to or on the
6 behalf of an insured person if that person has committed, by a
7 material act or omission, any insurance fraud relating to
8 personal injury protection coverage under his or her policy,
9 if the fraud is admitted to in a sworn statement by the
10 insured or if it is established in a court of competent
11 jurisdiction. Any insurance fraud shall void all coverage
12 arising from the claim related to such fraud under the
13 personal injury protection coverage of the insured person who
14 committed the fraud, irrespective of whether a portion of the
15 insured person's claim may be legitimate, and any benefits
16 paid prior to the discovery of the insured person's insurance
17 fraud shall be recoverable by the insurer from the person who
18 committed insurance fraud in their entirety. The prevailing
19 party is entitled to its costs and attorney's fees in any
20 action in which it prevails in an insurer's action to enforce
21 its right of recovery under this paragraph.
22 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
23 (a) Any physician, hospital, clinic, or other person
24 or institution lawfully rendering treatment to an injured
25 person for a bodily injury covered by personal injury
26 protection insurance may charge the insurer and injured party
27 only a reasonable amount pursuant to this section for the
28 services and supplies rendered, and the insurer providing such
29 coverage may pay for such charges directly to such person or
30 institution lawfully rendering such treatment, if the insured
31 receiving such treatment or his or her guardian has
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1 countersigned the properly completed invoice, bill, or claim
2 form approved by the Department of Insurance upon which such
3 charges are to be paid for as having actually been rendered,
4 to the best knowledge of the insured or his or her guardian.
5 In no event, however, may such a charge be in excess of the
6 amount the person or institution customarily charges for like
7 services or supplies in cases involving no insurance. With
8 respect to a determination of whether a charge for a
9 particular service, treatment, or otherwise is reasonable,
10 consideration may be given to evidence of usual and customary
11 charges and payments accepted by the provider involved in the
12 dispute, and reimbursement levels in the community and various
13 federal and state medical fee schedules applicable to
14 automobile and other insurance coverages, and other
15 information relevant to the reasonableness of the
16 reimbursement for the service, treatment or supply.
17 (b)1. An insurer or insured is not required to pay a
18 claim or charges:
19 a. Made by a broker or by a person making a claim on
20 behalf of a broker;.
21 b. For any service or treatment that was not lawful at
22 the time rendered;
23 c. To any person who knowingly submits a false or
24 misleading statement relating to the claim or charges;
25 d. With respect to a bill or statement that does not
26 substantially meet the applicable requirements of paragraph
27 (d);
28 e. For any treatment or service that is upcoded, or
29 that is unbundled when such treatment or services should be
30 bundled, in accordance with paragraph (d). To facilitate
31 prompt payment of lawful services, an insurer may change codes
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1 that it determines to have been improperly or incorrectly
2 upcoded or unbundled, and may make payment based on the
3 changed codes, without affecting the right of the provider to
4 dispute the change by the insurer, provided that before doing
5 so, the insurer must contact the health care provider and
6 discuss the reasons for the insurer's change and the health
7 care provider's reason for the coding, or make a reasonable
8 good-faith effort to do so, as documented in the insurer's
9 file; and
10 f. For medical services or treatment billed by a
11 physician and not provided in a hospital unless such services
12 are rendered by the physician or are incident to his or her
13 professional services and are included on the physician's
14 bill, including documentation verifying that the physician is
15 responsible for the medical services that were rendered and
16 billed.
17 2. Charges for medically necessary cephalic
18 thermograms, peripheral thermograms, spinal ultrasounds,
19 extremity ultrasounds, video fluoroscopy, and surface
20 electromyography shall not exceed the maximum reimbursement
21 allowance for such procedures as set forth in the applicable
22 fee schedule or other payment methodology established pursuant
23 to s. 440.13.
24 3. Allowable amounts that may be charged to a personal
25 injury protection insurance insurer and insured for medically
26 necessary nerve conduction testing when done in conjunction
27 with a needle electromyography procedure and both are
28 performed and billed solely by a physician licensed under
29 chapter 458, chapter 459, chapter 460, or chapter 461 who is
30 also certified by the American Board of Electrodiagnostic
31 Medicine or by a board recognized by the American Board of
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1 Medical Specialties or the American Osteopathic Association or
2 who holds diplomate status with the American Chiropractic
3 Neurology Board or its predecessors shall not exceed 200
4 percent of the allowable amount under the participating
5 physician fee schedule of Medicare Part B for year 2001, for
6 the area in which the treatment was rendered, adjusted
7 annually on July 1 to reflect the prior calendar year's
8 changes in the annual Medical Care Item of the Consumer Price
9 Index for All Urban Consumers in the South Region as
10 determined by the Bureau of Labor Statistics of the United
11 States Department of Labor by an additional amount equal to
12 the medical Consumer Price Index for Florida.
13 4. Allowable amounts that may be charged to a personal
14 injury protection insurance insurer and insured for medically
15 necessary nerve conduction testing that does not meet the
16 requirements of subparagraph 3. shall not exceed the
17 applicable fee schedule or other payment methodology
18 established pursuant to s. 440.13.
19 5. Effective upon this act becoming a law and before
20 November 1, 2001, allowable amounts that may be charged to a
21 personal injury protection insurance insurer and insured for
22 magnetic resonance imaging services shall not exceed 200
23 percent of the allowable amount under Medicare Part B for year
24 2001, for the area in which the treatment was rendered.
25 Beginning November 1, 2001, allowable amounts that may be
26 charged to a personal injury protection insurance insurer and
27 insured for magnetic resonance imaging services shall not
28 exceed 175 percent of the allowable amount under Medicare Part
29 B for year 2001, for the area in which the treatment was
30 rendered, adjusted annually to reflect the changes in the
31 annual Medical Care Item of the Consumer Price Index for All
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1 Urban Consumers in the South Region as determined by the
2 Bureau of Labor Statistics of the United States Department of
3 Labor for the 12-month period ending June 30 of that year by
4 an additional amount equal to the medical Consumer Price Index
5 for Florida, except that allowable amounts that may be charged
6 to a personal injury protection insurance insurer and insured
7 for magnetic resonance imaging services provided in facilities
8 accredited by the American College of Radiology or the Joint
9 Commission on Accreditation of Healthcare Organizations shall
10 not exceed 200 percent of the allowable amount under Medicare
11 Part B for year 2001, for the area in which the treatment was
12 rendered, adjusted annually to reflect the changes in the
13 annual Medical Care Item of the Consumer Price Index for All
14 Urban Consumers in the South Region as determined by the
15 Bureau of Labor Statistics of the United States Department of
16 Labor for the 12-month period ending June 30 of that year by
17 an additional amount equal to the medical Consumer Price Index
18 for Florida. This paragraph does not apply to charges for
19 magnetic resonance imaging services and nerve conduction
20 testing for inpatients and emergency services and care as
21 defined in chapter 395 rendered by facilities licensed under
22 chapter 395.
23 6. The Department of Health, in consultation with the
24 appropriate professional licensing boards, shall adopt, by
25 rule, a list of diagnostic tests deemed not be medically
26 necessary for use in the treatment of persons sustaining
27 bodily injury covered by personal injury protection benefits
28 under this section. The initial list shall be adopted by
29 January 1, 2004, and shall be revised from time to time as
30 determined by the Department of Health, in consultation with
31 the respective professional licensing boards. Inclusion of a
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1 test on the list of invalid diagnostic tests shall be based on
2 lack of demonstrated medical value and a level of general
3 acceptance by the relevant provider community and shall not be
4 dependent for results entirely upon subjective patient
5 response. Notwithstanding its inclusion on a fee schedule in
6 this subsection, an insurer or insured is not required to pay
7 any charges or reimburse claims for any invalid diagnostic
8 test as determined by the Department of Health.
9 (c)1. With respect to any treatment or service, other
10 than medical services billed by a hospital or other provider
11 for emergency services as defined in s. 395.002 or inpatient
12 services rendered at a hospital-owned facility, the statement
13 of charges must be furnished to the insurer by the provider
14 and may not include, and the insurer is not required to pay,
15 charges for treatment or services rendered more than 35 days
16 before the postmark date of the statement, except for past due
17 amounts previously billed on a timely basis under this
18 paragraph, and except that, if the provider submits to the
19 insurer a notice of initiation of treatment within 21 days
20 after its first examination or treatment of the claimant, the
21 statement may include charges for treatment or services
22 rendered up to, but not more than, 75 days before the postmark
23 date of the statement. The injured party is not liable for,
24 and the provider shall not bill the injured party for, charges
25 that are unpaid because of the provider's failure to comply
26 with this paragraph. Any agreement requiring the injured
27 person or insured to pay for such charges is unenforceable.
28 2. If, however, the insured fails to furnish the
29 provider with the correct name and address of the insured's
30 personal injury protection insurer, the provider has 35 days
31 from the date the provider obtains the correct information to
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1 furnish the insurer with a statement of the charges. The
2 insurer is not required to pay for such charges unless the
3 provider includes with the statement documentary evidence that
4 was provided by the insured during the 35-day period
5 demonstrating that the provider reasonably relied on erroneous
6 information from the insured and either:
7 a.1. A denial letter from the incorrect insurer; or
8 b.2. Proof of mailing, which may include an affidavit
9 under penalty of perjury, reflecting timely mailing to the
10 incorrect address or insurer.
11 3. For emergency services and care as defined in s.
12 395.002 rendered in a hospital emergency department or for
13 transport and treatment rendered by an ambulance provider
14 licensed pursuant to part III of chapter 401, the provider is
15 not required to furnish the statement of charges within the
16 time periods established by this paragraph; and the insurer
17 shall not be considered to have been furnished with notice of
18 the amount of covered loss for purposes of paragraph (4)(b)
19 until it receives a statement complying with paragraph (d)
20 (e), or copy thereof, which specifically identifies the place
21 of service to be a hospital emergency department or an
22 ambulance in accordance with billing standards recognized by
23 the Health Care Finance Administration.
24 4. Each notice of insured's rights under s. 627.7401
25 must include the following statement in type no smaller than
26 12 points:
27 BILLING REQUIREMENTS.--Florida Statutes provide
28 that with respect to any treatment or services,
29 other than certain hospital and emergency
30 services, the statement of charges furnished to
31 the insurer by the provider may not include,
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1 and the insurer and the injured party are not
2 required to pay, charges for treatment or
3 services rendered more than 35 days before the
4 postmark date of the statement, except for past
5 due amounts previously billed on a timely
6 basis, and except that, if the provider submits
7 to the insurer a notice of initiation of
8 treatment within 21 days after its first
9 examination or treatment of the claimant, the
10 statement may include charges for treatment or
11 services rendered up to, but not more than, 75
12 days before the postmark date of the statement.
13 (d) Every insurer shall include a provision in its
14 policy for personal injury protection benefits for binding
15 arbitration of any claims dispute involving medical benefits
16 arising between the insurer and any person providing medical
17 services or supplies if that person has agreed to accept
18 assignment of personal injury protection benefits. The
19 provision shall specify that the provisions of chapter 682
20 relating to arbitration shall apply. The prevailing party
21 shall be entitled to attorney's fees and costs. For purposes
22 of the award of attorney's fees and costs, the prevailing
23 party shall be determined as follows:
24 1. When the amount of personal injury protection
25 benefits determined by arbitration exceeds the sum of the
26 amount offered by the insurer at arbitration plus 50 percent
27 of the difference between the amount of the claim asserted by
28 the claimant at arbitration and the amount offered by the
29 insurer at arbitration, the claimant is the prevailing party.
30 2. When the amount of personal injury protection
31 benefits determined by arbitration is less than the sum of the
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1 amount offered by the insurer at arbitration plus 50 percent
2 of the difference between the amount of the claim asserted by
3 the claimant at arbitration and the amount offered by the
4 insurer at arbitration, the insurer is the prevailing party.
5 3. When neither subparagraph 1. nor subparagraph 2.
6 applies, there is no prevailing party. For purposes of this
7 paragraph, the amount of the offer or claim at arbitration is
8 the amount of the last written offer or claim made at least 30
9 days prior to the arbitration.
10 4. In the demand for arbitration, the party requesting
11 arbitration must include a statement specifically identifying
12 the issues for arbitration for each examination or treatment
13 in dispute. The other party must subsequently issue a
14 statement specifying any other examinations or treatment and
15 any other issues that it intends to raise in the arbitration.
16 The parties may amend their statements up to 30 days prior to
17 arbitration, provided that arbitration shall be limited to
18 those identified issues and neither party may add additional
19 issues during arbitration.
20 (d)(e) All statements and bills for medical services
21 rendered by any physician, hospital, clinic, or other person
22 or institution shall be submitted to the insurer on a properly
23 completed Centers for Medicare and Medicaid Services (CMS)
24 Health Care Finance Administration 1500 form, UB 92 forms, or
25 any other standard form approved by the department for
26 purposes of this paragraph. All billings for such services
27 rendered by providers shall, to the extent applicable, follow
28 the Physicians' Current Procedural Terminology (CPT) or
29 Healthcare Correct Procedural Coding System (HCPCS), or ICD-9
30 in effect for the year in which services are rendered and
31 comply with the Centers for Medicare and Medicaid Services
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1 (CMS) 1500 form instructions and the American Medical
2 Association Current Procedural Terminology (CPT) Editorial
3 Panel and Healthcare Correct Procedural Coding System (HCPCS).
4 All providers other than hospitals shall include on the
5 applicable claim form the professional license number of the
6 provider in the line or space provided for "Signature of
7 Physician or Supplier, Including Degrees or Credentials." In
8 determining compliance with applicable CPT and HCPCS coding,
9 guidance shall be provided by the Physicians' Current
10 Procedural Terminology (CPT) or the Healthcare Correct
11 Procedural Coding System (HCPCS) in effect for the year in
12 which services were rendered, the Office of the Inspector
13 General (OIG), Physicians Compliance Guidelines, and other
14 authoritative treatises designated by rule by the Agency for
15 Health Care Administration. No statement of medical services
16 may include charges for medical services of a person or entity
17 that performed such services without possessing the valid
18 licenses required to perform such services. For purposes of
19 paragraph (4)(b), an insurer shall not be considered to have
20 been furnished with notice of the amount of covered loss or
21 medical bills due unless the statements or bills comply with
22 this paragraph, and unless the statements or bills are
23 properly completed in their entirety as to all material
24 provisions, with all relevant information being provided
25 therein.
26 (e)1. At the initial treatment or service provided,
27 each physician, other licensed professional, clinic, or other
28 medical institution providing medical services upon which a
29 claim for personal injury protection benefits is based shall
30 require an insured person, or his or her guardian, to execute
31
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1 a disclosure and acknowledgment form, which reflects at a
2 minimum that:
3 a. The insured, or his or her guardian, must
4 countersign the form attesting to the fact that the services
5 set forth therein were actually rendered;
6 b. The insured, or his or her guardian, has both the
7 right and affirmative duty to confirm that the services were
8 actually rendered;
9 c. The insured, or his or her guardian, was not
10 solicited by any person to seek any services from the medical
11 provider;
12 d. That the physician, other licensed professional,
13 clinic, or other medical institution rendering services for
14 which payment is being claimed explained the services to the
15 insured or his or her guardian; and
16 e. If the insured notifies the insurer in writing of a
17 billing error, the insured may be entitled to a certain
18 percentage of a reduction in the amounts paid by the insured's
19 motor vehicle insurer.
20 2. The physician, other licensed professional, clinic,
21 or other medical institution rendering services for which
22 payment is being claimed has the affirmative duty to explain
23 the services rendered to the insured, or his or her guardian,
24 so that the insured, or his or her guardian, countersigns the
25 form with informed consent.
26 3. Countersignature by the insured, or his or her
27 guardian, is not required for the reading of diagnostic tests
28 or other services that are of such a nature that they are not
29 required to be performed in the presence of the insured.
30
31
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1 4. The licensed medical professional rendering
2 treatment for which payment is being claimed must sign, by his
3 or her own hand, the form complying with this paragraph.
4 5. The original completed disclosure and
5 acknowledgement form shall be furnished to the insurer
6 pursuant to paragraph (4)(b) and may not be electronically
7 furnished.
8 6. This disclosure and acknowledgement form is not
9 required for services billed by a provider for emergency
10 services as defined in s. 395.002, for emergency services and
11 care as defined in s. 395.002 rendered in a hospital emergency
12 department, or for transport and treatment rendered by an
13 ambulance provider licensed pursuant to part III of chapter
14 401.
15 7. The Financial Services Commission shall adopt, by
16 rule, a standard disclosure and acknowledgment form that shall
17 be used to fulfill the requirements of this paragraph,
18 effective 90 days after such form is adopted and becomes
19 final. The commission shall adopt a proposed rule by October
20 1, 2003. Until the rule is final, the provider may use a form
21 of its own which otherwise complies with the requirements of
22 this paragraph.
23 8. As used in this paragraph, "countersigned" means a
24 second or verifying signature, as on a previously signed
25 document, and is not satisfied by the statement "signature on
26 file" or any similar statement.
27 9. The requirements of this paragraph apply only with
28 respect to the initial treatment or service of the insured by
29 a provider. For subsequent treatments or service, the provider
30 must maintain a patient log signed by the patient, in
31
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1 chronological order by date of service, that is consistent
2 with the services being rendered to the patient as claimed.
3 (f) Upon written notification by any person, an
4 insurer shall investigate any claim of improper billing by a
5 physician or other medical provider. The insurer shall
6 determine if the insured was properly billed for only those
7 services and treatments that the insured actually received. If
8 the insurer determines that the insured has been improperly
9 billed, the insurer shall notify the insured, the person
10 making the written notification and the provider of its
11 findings and shall reduce the amount of payment to the
12 provider by the amount determined to be improperly billed. If
13 a reduction is made due to such written notification by any
14 person, the insurer shall pay to the person 20 percent of the
15 amount of the reduction, up to $500. If the provider is
16 arrested due to the improper billing, then the insurer shall
17 pay to the person 40 percent of the amount of the reduction,
18 up to $500.
19 (h) An insurer may not systematically downcode with
20 the intent to deny reimbursement otherwise due. Such action
21 constitutes a material misrepresentation under s.
22 626.9541(1)(i)2.
23 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
24 DISPUTES.--
25 (a) Every employer shall, if a request is made by an
26 insurer providing personal injury protection benefits under
27 ss. 627.730-627.7405 against whom a claim has been made,
28 furnish forthwith, in a form approved by the department, a
29 sworn statement of the earnings, since the time of the bodily
30 injury and for a reasonable period before the injury, of the
31 person upon whose injury the claim is based.
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1 (b) Every physician, hospital, clinic, or other
2 medical institution providing, before or after bodily injury
3 upon which a claim for personal injury protection insurance
4 benefits is based, any products, services, or accommodations
5 in relation to that or any other injury, or in relation to a
6 condition claimed to be connected with that or any other
7 injury, shall, if requested to do so by the insurer against
8 whom the claim has been made, furnish forthwith a written
9 report of the history, condition, treatment, dates, and costs
10 of such treatment of the injured person and why the items
11 identified by the insurer were reasonable in amount and
12 medically necessary, together with a sworn statement that the
13 treatment or services rendered were reasonable and necessary
14 with respect to the bodily injury sustained and identifying
15 which portion of the expenses for such treatment or services
16 was incurred as a result of such bodily injury, and produce
17 forthwith, and permit the inspection and copying of, his or
18 her or its records regarding such history, condition,
19 treatment, dates, and costs of treatment; provided that this
20 shall not limit the introduction of evidence at trial. Such
21 sworn statement shall read as follows: "Under penalty of
22 perjury, I declare that I have read the foregoing, and the
23 facts alleged are true, to the best of my knowledge and
24 belief." No cause of action for violation of the
25 physician-patient privilege or invasion of the right of
26 privacy shall be permitted against any physician, hospital,
27 clinic, or other medical institution complying with the
28 provisions of this section. The person requesting such records
29 and such sworn statement shall pay all reasonable costs
30 connected therewith. If an insurer makes a written request for
31 documentation or information under this paragraph within 30
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1 days after having received notice of the amount of a covered
2 loss under paragraph (4)(a), the amount or the partial amount
3 which is the subject of the insurer's inquiry shall become
4 overdue if the insurer does not pay in accordance with
5 paragraph (4)(b) or within 10 days after the insurer's receipt
6 of the requested documentation or information, whichever
7 occurs later. For purposes of this paragraph, the term
8 "receipt" includes, but is not limited to, inspection and
9 copying pursuant to this paragraph. Any insurer that requests
10 documentation or information pertaining to reasonableness of
11 charges or medical necessity under this paragraph without a
12 reasonable basis for such requests as a general business
13 practice is engaging in an unfair trade practice under the
14 insurance code.
15 (c) In the event of any dispute regarding an insurer's
16 right to discovery of facts under this section about an
17 injured person's earnings or about his or her history,
18 condition, or treatment, or the dates and costs of such
19 treatment, the insurer may petition a court of competent
20 jurisdiction to enter an order permitting such discovery. The
21 order may be made only on motion for good cause shown and upon
22 notice to all persons having an interest, and it shall specify
23 the time, place, manner, conditions, and scope of the
24 discovery. Such court may, in order to protect against
25 annoyance, embarrassment, or oppression, as justice requires,
26 enter an order refusing discovery or specifying conditions of
27 discovery and may order payments of costs and expenses of the
28 proceeding, including reasonable fees for the appearance of
29 attorneys at the proceedings, as justice requires.
30 (d) The injured person shall be furnished, upon
31 request, a copy of all information obtained by the insurer
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1 under the provisions of this section, and shall pay a
2 reasonable charge, if required by the insurer.
3 (e) Notice to an insurer of the existence of a claim
4 shall not be unreasonably withheld by an insured.
5 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
6 REPORTS.--
7 (a) Whenever the mental or physical condition of an
8 injured person covered by personal injury protection is
9 material to any claim that has been or may be made for past or
10 future personal injury protection insurance benefits, such
11 person shall, upon the request of an insurer, submit to mental
12 or physical examination by a physician or physicians. The
13 costs of any examinations requested by an insurer shall be
14 borne entirely by the insurer. Such examination shall be
15 conducted within the municipality where the insured is
16 receiving treatment, or in a location reasonably accessible to
17 the insured, which, for purposes of this paragraph, means any
18 location within the municipality in which the insured resides,
19 or any location within 10 miles by road of the insured's
20 residence, provided such location is within the county in
21 which the insured resides. If the examination is to be
22 conducted in a location reasonably accessible to the insured,
23 and if there is no qualified physician to conduct the
24 examination in a location reasonably accessible to the
25 insured, then such examination shall be conducted in an area
26 of the closest proximity to the insured's residence. Personal
27 protection insurers are authorized to include reasonable
28 provisions in personal injury protection insurance policies
29 for mental and physical examination of those claiming personal
30 injury protection insurance benefits. An insurer may not
31 withdraw payment of a treating physician without the consent
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1 of the injured person covered by the personal injury
2 protection, unless the insurer first obtains a valid report by
3 a Florida physician licensed under the same chapter as the
4 treating physician whose treatment authorization is sought to
5 be withdrawn, stating that treatment was not reasonable,
6 related, or necessary. A valid report is one that is prepared
7 and signed by the physician examining the injured person or
8 reviewing the treatment records of the injured person and is
9 factually supported by the examination and treatment records
10 if reviewed and that has not been modified by anyone other
11 than the physician. The physician preparing the report must be
12 in active practice, unless the physician is physically
13 disabled. Active practice means that during the 3 years
14 immediately preceding the date of the physical examination or
15 review of the treatment records the physician must have
16 devoted professional time to the active clinical practice of
17 evaluation, diagnosis, or treatment of medical conditions or
18 to the instruction of students in an accredited health
19 professional school or accredited residency program or a
20 clinical research program that is affiliated with an
21 accredited health professional school or teaching hospital or
22 accredited residency program. The physician preparing a report
23 at the request of an insurer and physicians rendering expert
24 opinions on behalf of persons claiming medical benefits for
25 personal injury protection, or on behalf of an insured through
26 an attorney or another entity, shall maintain, for at least 3
27 years, copies of all examination reports as medical records
28 and shall maintain, for at least 3 years, records of all
29 payments for the examinations and reports. Neither an insurer
30 nor any person acting at the direction of or on behalf of an
31 insurer may materially change an opinion in a report prepared
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1 under this paragraph or direct the physician preparing the
2 report to change such opinion. The denial of a payment as the
3 result of such a changed opinion constitutes a material
4 misrepresentation under s. 626.9541(1)(i)2.; however, this
5 provision does not preclude the insurer from calling to the
6 attention of the physician errors of fact in the report based
7 upon information in the claim file.
8 (b) If requested by the person examined, a party
9 causing an examination to be made shall deliver to him or her
10 a copy of every written report concerning the examination
11 rendered by an examining physician, at least one of which
12 reports must set out the examining physician's findings and
13 conclusions in detail. After such request and delivery, the
14 party causing the examination to be made is entitled, upon
15 request, to receive from the person examined every written
16 report available to him or her or his or her representative
17 concerning any examination, previously or thereafter made, of
18 the same mental or physical condition. By requesting and
19 obtaining a report of the examination so ordered, or by taking
20 the deposition of the examiner, the person examined waives any
21 privilege he or she may have, in relation to the claim for
22 benefits, regarding the testimony of every other person who
23 has examined, or may thereafter examine, him or her in respect
24 to the same mental or physical condition. If a person
25 unreasonably refuses to submit to an examination, the personal
26 injury protection carrier is no longer liable for subsequent
27 personal injury protection benefits.
28 (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
29 FEES.--With respect to any dispute under the provisions of ss.
30 627.730-627.7405 between the insured and the insurer, or
31 between an assignee of an insured's rights and the insurer,
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1 the provisions of s. 627.428 shall apply, except as provided
2 in subsection (11).
3 (10) An insurer may negotiate and enter into contracts
4 with licensed health care providers for the benefits described
5 in this section, referred to in this section as "preferred
6 providers," which shall include health care providers licensed
7 under chapters 458, 459, 460, 461, and 463. The insurer may
8 provide an option to an insured to use a preferred provider at
9 the time of purchase of the policy for personal injury
10 protection benefits, if the requirements of this subsection
11 are met. If the insured elects to use a provider who is not a
12 preferred provider, whether the insured purchased a preferred
13 provider policy or a nonpreferred provider policy, the medical
14 benefits provided by the insurer shall be as required by this
15 section. If the insured elects to use a provider who is a
16 preferred provider, the insurer may pay medical benefits in
17 excess of the benefits required by this section and may waive
18 or lower the amount of any deductible that applies to such
19 medical benefits. If the insurer offers a preferred provider
20 policy to a policyholder or applicant, it must also offer a
21 nonpreferred provider policy. The insurer shall provide each
22 policyholder with a current roster of preferred providers in
23 the county in which the insured resides at the time of
24 purchase of such policy, and shall make such list available
25 for public inspection during regular business hours at the
26 principal office of the insurer within the state.
27 (11) DEMAND LETTER.--
28 (a) As a condition precedent to filing any action for
29 an overdue claim for benefits under this section paragraph
30 (4)(b), the insurer must be provided with written notice of an
31 intent to initiate litigation; provided, however, that, except
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1 with regard to a claim or amended claim or judgment for
2 interest only which was not paid or was incorrectly
3 calculated, such notice is not required for an overdue claim
4 that the insurer has denied or reduced, nor is such notice
5 required if the insurer has been provided documentation or
6 information at the insurer's request pursuant to subsection
7 (6). Such notice may not be sent until the claim is overdue,
8 including any additional time the insurer has to pay the claim
9 pursuant to paragraph (4)(b).
10 (b) The notice required shall state that it is a
11 "demand letter under s. 627.736(11)" and shall state with
12 specificity:
13 1. The name of the insured upon which such benefits
14 are being sought, including a copy of the assignment giving
15 rights to the claimant if the claimant is not the insured.
16 2. The claim number or policy number upon which such
17 claim was originally submitted to the insurer.
18 3. To the extent applicable, the name of any medical
19 provider who rendered to an insured the treatment, services,
20 accommodations, or supplies that form the basis of such claim;
21 and an itemized statement specifying each exact amount, the
22 date of treatment, service, or accommodation, and the type of
23 benefit claimed to be due. A completed form satisfying the
24 requirements of paragraph (5)(d) or the lost-wage statement
25 previously submitted Health Care Finance Administration 1500
26 form, UB 92, or successor forms approved by the Secretary of
27 the United States Department of Health and Human Services may
28 be used as the itemized statement. To the extent that the
29 demand involves an insurer's withdrawal of payment under
30 paragraph (7)(a) for future treatment not yet rendered, the
31 claimant shall attach a copy of the insurer's notice
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1 withdrawing such payment and an itemized statement of the
2 type, frequency, and duration of future treatment claimed to
3 be reasonable and medically necessary.
4 (c) Each notice required by this subsection section
5 must be delivered to the insurer by United States certified or
6 registered mail, return receipt requested. Such postal costs
7 shall be reimbursed by the insurer if so requested by the
8 claimant provider in the notice, when the insurer pays the
9 overdue claim. Such notice must be sent to the person and
10 address specified by the insurer for the purposes of receiving
11 notices under this subsection section, on the document denying
12 or reducing the amount asserted by the filer to be overdue.
13 Each licensed insurer, whether domestic, foreign, or alien,
14 shall may file with the office department designation of the
15 name and address of the person to whom notices pursuant to
16 this subsection section shall be sent which the office shall
17 make available on its Internet website when such document does
18 not specify the name and address to whom the notices under
19 this section are to be sent or when there is no such document.
20 The name and address on file with the office department
21 pursuant to s. 624.422 shall be deemed the authorized
22 representative to accept notice pursuant to this subsection
23 section in the event no other designation has been made.
24 (d) If, within 15 7 business days after receipt of
25 notice by the insurer, the overdue claim specified in the
26 notice is paid by the insurer together with applicable
27 interest and a penalty of 10 percent of the overdue amount
28 paid by the insurer, subject to a maximum penalty of $250, no
29 action for nonpayment or late payment may be brought against
30 the insurer. If the demand involves an insurer's withdrawal of
31 payment under paragraph (7)(a) for future treatment not yet
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1 rendered, no action may be brought against the insurer if,
2 within 15 days after its receipt of the notice, the insurer
3 mails to the person filing the notice a written statement of
4 the insurer's agreement to pay for such treatment in
5 accordance with the notice and to pay a penalty of 10 percent,
6 subject to a maximum penalty of $250, when it pays for such
7 future treatment in accordance with the requirements of this
8 section. To the extent the insurer determines not to pay any
9 the overdue amount demanded, the penalty shall not be payable
10 in any subsequent action for nonpayment or late payment. For
11 purposes of this subsection, payment or the insurer's
12 agreement shall be treated as being made on the date a draft
13 or other valid instrument that is equivalent to payment, or
14 the insurer's written statement of agreement, is placed in the
15 United States mail in a properly addressed, postpaid envelope,
16 or if not so posted, on the date of delivery. The insurer
17 shall not be obligated to pay any attorney's fees if the
18 insurer pays the claim or mails its agreement to pay for
19 future treatment within the time prescribed by this
20 subsection.
21 (e) The applicable statute of limitation for an action
22 under this section shall be tolled for a period of 15 business
23 days by the mailing of the notice required by this subsection.
24 (f) Any insurer making a general business practice of
25 not paying valid claims until receipt of the notice required
26 by this subsection section is engaging in an unfair trade
27 practice under the insurance code.
28 (12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
29 shall have a cause of action against any person convicted of,
30 or who, regardless of adjudication of guilt, pleads guilty or
31 nolo contendere to insurance fraud under s. 817.234, patient
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1 brokering under s. 817.505, or kickbacks under s. 456.054,
2 associated with a claim for personal injury protection
3 benefits in accordance with this section. An insurer
4 prevailing in an action brought under this subsection may
5 recover compensatory, consequential, and punitive damages
6 subject to the requirements and limitations of part II of
7 chapter 768, and attorney's fees and costs incurred in
8 litigating a cause of action against any person convicted of,
9 or who, regardless of adjudication of guilt, pleads guilty or
10 nolo contendere to insurance fraud under s. 817.234, patient
11 brokering under s. 817.505, or kickbacks under s. 456.054,
12 associated with a claim for personal injury protection
13 benefits in accordance with this section.
14 (13) MINIMUM BENEFIT COVERAGE.--If the Financial
15 Services Commission determines that the cost savings under
16 personal injury protection insurance benefits paid by insurers
17 have been realized due to the provisions of this act, prior
18 legislative reforms, or other factors, the commission may
19 increase the minimum $10,000 benefit coverage requirement. In
20 establishing the amount of such increase, the commission must
21 determine that the additional premium for such coverage is
22 approximately equal to the premium cost savings that have been
23 realized for the personal injury protection coverage with
24 limits of $10,000.
25 Section 10. Subsections (1) and (2) of section
26 627.739, Florida Statutes, are amended to read:
27 627.739 Personal injury protection; optional
28 limitations; deductibles.--
29 (1) The named insured may elect a deductible or
30 modified coverage or combination thereof to apply to the named
31 insured alone or to the named insured and dependent relatives
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1 residing in the same household, but may not elect a deductible
2 or modified coverage to apply to any other person covered
3 under the policy. Any person electing a deductible or modified
4 coverage, or a combination thereof, or subject to such
5 deductible or modified coverage as a result of the named
6 insured's election, shall have no right to claim or to recover
7 any amount so deducted from any owner, registrant, operator,
8 or occupant of a vehicle or any person or organization legally
9 responsible for any such person's acts or omissions who is
10 made exempt from tort liability by ss. 627.730-627.7405.
11 (2) Insurers shall offer to each applicant and to each
12 policyholder, upon the renewal of an existing policy,
13 deductibles, in amounts of $250, $500, and $1,000, and $2,000.
14 The deductible amount must be applied to 100 percent of the
15 expenses and losses described in s. 627.736. After the
16 deductible is met, each insured is eligible to receive up to
17 $10,000 in total benefits described in s. 627.736(1)., such
18 amount to be deducted from the benefits otherwise due each
19 person subject to the deduction. However, this subsection
20 shall not be applied to reduce the amount of any benefits
21 received in accordance with s. 627.736(1)(c).
22 Section 11. Subsections (7), (8), and (9) of section
23 817.234, Florida Statutes, are amended to read:
24 817.234 False and fraudulent insurance claims.--
25 (7)(a) It shall constitute a material omission and
26 insurance fraud for any physician or other provider, other
27 than a hospital, to engage in a general business practice of
28 billing amounts as its usual and customary charge, if such
29 provider has agreed with the patient or intends to waive
30 deductibles or copayments, or does not for any other reason
31 intend to collect the total amount of such charge.
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1 (b) The provisions of this section shall also apply as
2 to any insurer or adjusting firm or its agents or
3 representatives who, with intent, injure, defraud, or deceive
4 any claimant with regard to any claim. The claimant shall
5 have the right to recover the damages provided in this
6 section.
7 (c) An insurer, or any person acting at the direction
8 of or on behalf of an insurer, may not change an opinion in a
9 mental or physical report prepared under s. 627.736(7) or
10 direct the physician preparing the report to change such
11 opinion; however, this provision does not preclude the insurer
12 from calling to the attention of the physician errors of fact
13 in the report based upon information in the claim file. Any
14 person who violates this paragraph commits a felony of the
15 third degree, punishable as provided in s. 775.082, s.
16 775.083, or s. 775.084.
17 (8)(a) It is unlawful for any person intending to
18 defraud any other person, in his or her individual capacity or
19 in his or her capacity as a public or private employee, or for
20 any firm, corporation, partnership, or association, to solicit
21 or cause to be solicited any business from a person involved
22 in a motor vehicle accident by any means of communication
23 other than advertising directed to the public for the purpose
24 of making, adjusting, or settling motor vehicle tort claims or
25 claims for personal injury protection benefits required by s.
26 627.736. Charges for any services rendered by a health care
27 provider or attorney who violates this subsection in regard to
28 the person for whom such services were rendered are
29 noncompensable and unenforceable as a matter of law. Any
30 person who violates the provisions of this paragraph
31 subsection commits a felony of the second third degree,
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1 punishable as provided in s. 775.082, s. 775.083, or s.
2 775.084. A person who is convicted of a violation of this
3 subsection shall be sentenced to a minimum term of
4 imprisonment of 2 years.
5 (b) A person may not solicit or cause to be solicited
6 any business from a person involved in a motor vehicle
7 accident by any means of communication other than advertising
8 directed to the public for the purpose of making motor vehicle
9 tort claims or claims for personal injury protection benefits
10 required by s. 627.736, within 60 days after the occurrence of
11 the motor vehicle accident. Any person who violates this
12 paragraph commits a felony of the third degree, punishable as
13 provided in s. 775.082, s. 775.083, or s. 775.084.
14 (c) A lawyer, health care practitioner as defined in
15 s. 456.001, or owner or medical director of a clinic required
16 to be licensed pursuant to s. 400.903 may not, at any time
17 after 60 days have elapsed from the occurrence of a motor
18 vehicle accident, solicit or cause to be solicited any
19 business from a person involved in a motor vehicle accident by
20 means of in-person or telephone contact at the person's
21 residence, for the purpose of making motor vehicle tort claims
22 or claims for personal injury protection benefits required by
23 s. 627.736. Any person who violates this paragraph commits a
24 felony of the third degree, punishable as provided in s.
25 775.082, s. 775.083, or s. 775.084.
26 (d) Charges for any services rendered by any person
27 who violates this subsection in regard to the person for whom
28 such services were rendered are noncompensable and
29 unenforceable as a matter of law.
30 (9) A person may not organize, plan, or knowingly
31 participate in an intentional motor vehicle crash for the
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1 purpose of making motor vehicle tort claims or claims for
2 personal injury protection benefits as required by s. 627.736.
3 It is unlawful for any attorney to solicit any business
4 relating to the representation of a person involved in a motor
5 vehicle accident for the purpose of filing a motor vehicle
6 tort claim or a claim for personal injury protection benefits
7 required by s. 627.736. The solicitation by advertising of
8 any business by an attorney relating to the representation of
9 a person injured in a specific motor vehicle accident is
10 prohibited by this section. Any person attorney who violates
11 the provisions of this paragraph subsection commits a felony
12 of the second third degree, punishable as provided in s.
13 775.082, s. 775.083, or s. 775.084. A person who is convicted
14 of a violation of this subsection shall be sentenced to a
15 minimum term of imprisonment of 2 years. Whenever any circuit
16 or special grievance committee acting under the jurisdiction
17 of the Supreme Court finds probable cause to believe that an
18 attorney is guilty of a violation of this section, such
19 committee shall forward to the appropriate state attorney a
20 copy of the finding of probable cause and the report being
21 filed in the matter. This section shall not be interpreted to
22 prohibit advertising by attorneys which does not entail a
23 solicitation as described in this subsection and which is
24 permitted by the rules regulating The Florida Bar as
25 promulgated by the Florida Supreme Court.
26 Section 12. Section 817.236, Florida Statutes, is
27 amended to read:
28 817.236 False and fraudulent motor vehicle insurance
29 application.--Any person who, with intent to injure, defraud,
30 or deceive any motor vehicle insurer, including any
31 statutorily created underwriting association or pool of motor
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1 vehicle insurers, presents or causes to be presented any
2 written application, or written statement in support thereof,
3 for motor vehicle insurance knowing that the application or
4 statement contains any false, incomplete, or misleading
5 information concerning any fact or matter material to the
6 application commits a felony misdemeanor of the third first
7 degree, punishable as provided in s. 775.082, or s. 775.083,
8 or s. 775.084.
9 Section 13. Section 817.2361, Florida Statutes, is
10 created to read:
11 817.2361 False or fraudulent motor vehicle insurance
12 card.--Any person who, with intent to deceive any other
13 person, creates, markets, or presents a false or fraudulent
14 motor vehicle insurance card commits a felony of the third
15 degree, punishable as provided in s. 775.082, s. 775.083, or
16 s. 775.084.
17 Section 14. Effective October 1, 2003, paragraphs (c)
18 and (g) of subsection (3) of section 921.0022, Florida
19 Statutes, are amended to read:
20 921.0022 Criminal Punishment Code; offense severity
21 ranking chart.--
22 (3) OFFENSE SEVERITY RANKING CHART
23
24 Florida Felony
25 Statute Degree Description
26
27
28 (c) LEVEL 3
29 119.10(3) 3rd Unlawful use of confidential
30 information from police reports.
31
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1 316.066(3)(d)-(f) 3rd Unlawfully obtaining or using
2 confidential crash reports.
3 316.193(2)(b) 3rd Felony DUI, 3rd conviction.
4 316.1935(2) 3rd Fleeing or attempting to elude
5 law enforcement officer in marked
6 patrol vehicle with siren and
7 lights activated.
8 319.30(4) 3rd Possession by junkyard of motor
9 vehicle with identification
10 number plate removed.
11 319.33(1)(a) 3rd Alter or forge any certificate of
12 title to a motor vehicle or
13 mobile home.
14 319.33(1)(c) 3rd Procure or pass title on stolen
15 vehicle.
16 319.33(4) 3rd With intent to defraud, possess,
17 sell, etc., a blank, forged, or
18 unlawfully obtained title or
19 registration.
20 327.35(2)(b) 3rd Felony BUI.
21 328.05(2) 3rd Possess, sell, or counterfeit
22 fictitious, stolen, or fraudulent
23 titles or bills of sale of
24 vessels.
25 328.07(4) 3rd Manufacture, exchange, or possess
26 vessel with counterfeit or wrong
27 ID number.
28 376.302(5) 3rd Fraud related to reimbursement
29 for cleanup expenses under the
30 Inland Protection Trust Fund.
31
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1 400.903(3) 3rd Operating a clinic without a
2 license or filing false license
3 application or other required
4 information.
5 501.001(2)(b) 2nd Tampers with a consumer product
6 or the container using materially
7 false/misleading information.
8 697.08 3rd Equity skimming.
9 790.15(3) 3rd Person directs another to
10 discharge firearm from a vehicle.
11 796.05(1) 3rd Live on earnings of a prostitute.
12 806.10(1) 3rd Maliciously injure, destroy, or
13 interfere with vehicles or
14 equipment used in firefighting.
15 806.10(2) 3rd Interferes with or assaults
16 firefighter in performance of
17 duty.
18 810.09(2)(c) 3rd Trespass on property other than
19 structure or conveyance armed
20 with firearm or dangerous weapon.
21 812.014(2)(c)2. 3rd Grand theft; $5,000 or more but
22 less than $10,000.
23 812.0145(2)(c) 3rd Theft from person 65 years of age
24 or older; $300 or more but less
25 than $10,000.
26 815.04(4)(b) 2nd Computer offense devised to
27 defraud or obtain property.
28 817.034(4)(a)3. 3rd Engages in scheme to defraud
29 (Florida Communications Fraud
30 Act), property valued at less
31 than $20,000.
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1 817.233 3rd Burning to defraud insurer.
2 817.234(8)
3 (b)-(c)&(9) 3rd Unlawful solicitation of persons
4 involved in motor vehicle
5 accidents.
6 817.234(11)(a) 3rd Insurance fraud; property value
7 less than $20,000.
8 817.236 3rd Filing a false motor vehicle
9 insurance application.
10 817.2361 3rd Creating, marketing, or
11 presenting a false or fraudulent
12 motor vehicle insurance card.
13 817.505(4) 3rd Patient brokering.
14 828.12(2) 3rd Tortures any animal with intent
15 to inflict intense pain, serious
16 physical injury, or death.
17 831.28(2)(a) 3rd Counterfeiting a payment
18 instrument with intent to defraud
19 or possessing a counterfeit
20 payment instrument.
21 831.29 2nd Possession of instruments for
22 counterfeiting drivers' licenses
23 or identification cards.
24 838.021(3)(b) 3rd Threatens unlawful harm to public
25 servant.
26 843.19 3rd Injure, disable, or kill police
27 dog or horse.
28 870.01(2) 3rd Riot; inciting or encouraging.
29
30
31
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1 893.13(1)(a)2. 3rd Sell, manufacture, or deliver
2 cannabis (or other s.
3 893.03(1)(c), (2)(c)1., (2)(c)2.,
4 (2)(c)3., (2)(c)5., (2)(c)6.,
5 (2)(c)7., (2)(c)8., (2)(c)9.,
6 (3), or (4) drugs).
7 893.13(1)(d)2. 2nd Sell, manufacture, or deliver s.
8 893.03(1)(c), (2)(c)1., (2)(c)2.,
9 (2)(c)3., (2)(c)5., (2)(c)6.,
10 (2)(c)7., (2)(c)8., (2)(c)9.,
11 (3), or (4) drugs within 200 feet
12 of university or public park.
13 893.13(1)(f)2. 2nd Sell, manufacture, or deliver s.
14 893.03(1)(c), (2)(c)1., (2)(c)2.,
15 (2)(c)3., (2)(c)5., (2)(c)6.,
16 (2)(c)7., (2)(c)8., (2)(c)9.,
17 (3), or (4) drugs within 200 feet
18 of public housing facility.
19 893.13(6)(a) 3rd Possession of any controlled
20 substance other than felony
21 possession of cannabis.
22 893.13(7)(a)8. 3rd Withhold information from
23 practitioner regarding previous
24 receipt of or prescription for a
25 controlled substance.
26 893.13(7)(a)9. 3rd Obtain or attempt to obtain
27 controlled substance by fraud,
28 forgery, misrepresentation, etc.
29 893.13(7)(a)10. 3rd Affix false or forged label to
30 package of controlled substance.
31
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1 893.13(7)(a)11. 3rd Furnish false or fraudulent
2 material information on any
3 document or record required by
4 chapter 893.
5 893.13(8)(a)1. 3rd Knowingly assist a patient, other
6 person, or owner of an animal in
7 obtaining a controlled substance
8 through deceptive, untrue, or
9 fraudulent representations in or
10 related to the practitioner's
11 practice.
12 893.13(8)(a)2. 3rd Employ a trick or scheme in the
13 practitioner's practice to assist
14 a patient, other person, or owner
15 of an animal in obtaining a
16 controlled substance.
17 893.13(8)(a)3. 3rd Knowingly write a prescription
18 for a controlled substance for a
19 fictitious person.
20 893.13(8)(a)4. 3rd Write a prescription for a
21 controlled substance for a
22 patient, other person, or an
23 animal if the sole purpose of
24 writing the prescription is a
25 monetary benefit for the
26 practitioner.
27 918.13(1)(a) 3rd Alter, destroy, or conceal
28 investigation evidence.
29 944.47
30 (1)(a)1.-2. 3rd Introduce contraband to
31 correctional facility.
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1 944.47(1)(c) 2nd Possess contraband while upon the
2 grounds of a correctional
3 institution.
4 985.3141 3rd Escapes from a juvenile facility
5 (secure detention or residential
6 commitment facility).
7 (g) LEVEL 7
8 316.193(3)(c)2. 3rd DUI resulting in serious bodily
9 injury.
10 327.35(3)(c)2. 3rd Vessel BUI resulting in serious
11 bodily injury.
12 402.319(2) 2nd Misrepresentation and negligence
13 or intentional act resulting in
14 great bodily harm, permanent
15 disfiguration, permanent
16 disability, or death.
17 409.920(2) 3rd Medicaid provider fraud.
18 456.065(2) 3rd Practicing a health care
19 profession without a license.
20 456.065(2) 2nd Practicing a health care
21 profession without a license
22 which results in serious bodily
23 injury.
24 458.327(1) 3rd Practicing medicine without a
25 license.
26 459.013(1) 3rd Practicing osteopathic medicine
27 without a license.
28 460.411(1) 3rd Practicing chiropractic medicine
29 without a license.
30 461.012(1) 3rd Practicing podiatric medicine
31 without a license.
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1 462.17 3rd Practicing naturopathy without a
2 license.
3 463.015(1) 3rd Practicing optometry without a
4 license.
5 464.016(1) 3rd Practicing nursing without a
6 license.
7 465.015(2) 3rd Practicing pharmacy without a
8 license.
9 466.026(1) 3rd Practicing dentistry or dental
10 hygiene without a license.
11 467.201 3rd Practicing midwifery without a
12 license.
13 468.366 3rd Delivering respiratory care
14 services without a license.
15 483.828(1) 3rd Practicing as clinical laboratory
16 personnel without a license.
17 483.901(9) 3rd Practicing medical physics
18 without a license.
19 484.013(1)(c) 3rd Preparing or dispensing optical
20 devices without a prescription.
21 484.053 3rd Dispensing hearing aids without a
22 license.
23 494.0018(2) 1st Conviction of any violation of
24 ss. 494.001-494.0077 in which the
25 total money and property
26 unlawfully obtained exceeded
27 $50,000 and there were five or
28 more victims.
29
30
31
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1 560.123(8)(b)1. 3rd Failure to report currency or
2 payment instruments exceeding
3 $300 but less than $20,000 by
4 money transmitter.
5 560.125(5)(a) 3rd Money transmitter business by
6 unauthorized person, currency or
7 payment instruments exceeding
8 $300 but less than $20,000.
9 655.50(10)(b)1. 3rd Failure to report financial
10 transactions exceeding $300 but
11 less than $20,000 by financial
12 institution.
13 782.051(3) 2nd Attempted felony murder of a
14 person by a person other than the
15 perpetrator or the perpetrator of
16 an attempted felony.
17 782.07(1) 2nd Killing of a human being by the
18 act, procurement, or culpable
19 negligence of another
20 (manslaughter).
21 782.071 2nd Killing of human being or viable
22 fetus by the operation of a motor
23 vehicle in a reckless manner
24 (vehicular homicide).
25 782.072 2nd Killing of a human being by the
26 operation of a vessel in a
27 reckless manner (vessel
28 homicide).
29 784.045(1)(a)1. 2nd Aggravated battery; intentionally
30 causing great bodily harm or
31 disfigurement.
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1 784.045(1)(a)2. 2nd Aggravated battery; using deadly
2 weapon.
3 784.045(1)(b) 2nd Aggravated battery; perpetrator
4 aware victim pregnant.
5 784.048(4) 3rd Aggravated stalking; violation of
6 injunction or court order.
7 784.07(2)(d) 1st Aggravated battery on law
8 enforcement officer.
9 784.074(1)(a) 1st Aggravated battery on sexually
10 violent predators facility staff.
11 784.08(2)(a) 1st Aggravated battery on a person 65
12 years of age or older.
13 784.081(1) 1st Aggravated battery on specified
14 official or employee.
15 784.082(1) 1st Aggravated battery by detained
16 person on visitor or other
17 detainee.
18 784.083(1) 1st Aggravated battery on code
19 inspector.
20 790.07(4) 1st Specified weapons violation
21 subsequent to previous conviction
22 of s. 790.07(1) or (2).
23 790.16(1) 1st Discharge of a machine gun under
24 specified circumstances.
25 790.165(2) 2nd Manufacture, sell, possess, or
26 deliver hoax bomb.
27 790.165(3) 2nd Possessing, displaying, or
28 threatening to use any hoax bomb
29 while committing or attempting to
30 commit a felony.
31
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1 790.166(3) 2nd Possessing, selling, using, or
2 attempting to use a hoax weapon
3 of mass destruction.
4 790.166(4) 2nd Possessing, displaying, or
5 threatening to use a hoax weapon
6 of mass destruction while
7 committing or attempting to
8 commit a felony.
9 796.03 2nd Procuring any person under 16
10 years for prostitution.
11 800.04(5)(c)1. 2nd Lewd or lascivious molestation;
12 victim less than 12 years of age;
13 offender less than 18 years.
14 800.04(5)(c)2. 2nd Lewd or lascivious molestation;
15 victim 12 years of age or older
16 but less than 16 years; offender
17 18 years or older.
18 806.01(2) 2nd Maliciously damage structure by
19 fire or explosive.
20 810.02(3)(a) 2nd Burglary of occupied dwelling;
21 unarmed; no assault or battery.
22 810.02(3)(b) 2nd Burglary of unoccupied dwelling;
23 unarmed; no assault or battery.
24 810.02(3)(d) 2nd Burglary of occupied conveyance;
25 unarmed; no assault or battery.
26 812.014(2)(a) 1st Property stolen, valued at
27 $100,000 or more; cargo stolen
28 valued at $50,000 or more;
29 property stolen while causing
30 other property damage; 1st degree
31 grand theft.
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1 812.014(2)(b)3. 2nd Property stolen, emergency
2 medical equipment; 2nd degree
3 grand theft.
4 812.0145(2)(a) 1st Theft from person 65 years of age
5 or older; $50,000 or more.
6 812.019(2) 1st Stolen property; initiates,
7 organizes, plans, etc., the theft
8 of property and traffics in
9 stolen property.
10 812.131(2)(a) 2nd Robbery by sudden snatching.
11 812.133(2)(b) 1st Carjacking; no firearm, deadly
12 weapon, or other weapon.
13 817.234(8)(a) 2nd Solicitation of motor vehicle
14 accident victims with intent to
15 defraud.
16 817.234(9) 2nd Organizing, planning, or
17 participating in an intentional
18 motor vehicle collision.
19 817.234(11)(c) 1st Insurance fraud; property value
20 $100,000 or more.
21 825.102(3)(b) 2nd Neglecting an elderly person or
22 disabled adult causing great
23 bodily harm, disability, or
24 disfigurement.
25 825.103(2)(b) 2nd Exploiting an elderly person or
26 disabled adult and property is
27 valued at $20,000 or more, but
28 less than $100,000.
29 827.03(3)(b) 2nd Neglect of a child causing great
30 bodily harm, disability, or
31 disfigurement.
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1 827.04(3) 3rd Impregnation of a child under 16
2 years of age by person 21 years
3 of age or older.
4 837.05(2) 3rd Giving false information about
5 alleged capital felony to a law
6 enforcement officer.
7 872.06 2nd Abuse of a dead human body.
8 893.13(1)(c)1. 1st Sell, manufacture, or deliver
9 cocaine (or other drug prohibited
10 under s. 893.03(1)(a), (1)(b),
11 (1)(d), (2)(a), (2)(b), or
12 (2)(c)4.) within 1,000 feet of a
13 child care facility or school.
14 893.13(1)(e)1. 1st Sell, manufacture, or deliver
15 cocaine or other drug prohibited
16 under s. 893.03(1)(a), (1)(b),
17 (1)(d), (2)(a), (2)(b), or
18 (2)(c)4., within 1,000 feet of
19 property used for religious
20 services or a specified business
21 site.
22 893.13(4)(a) 1st Deliver to minor cocaine (or
23 other s. 893.03(1)(a), (1)(b),
24 (1)(d), (2)(a), (2)(b), or
25 (2)(c)4. drugs).
26 893.135(1)(a)1. 1st Trafficking in cannabis, more
27 than 25 lbs., less than 2,000
28 lbs.
29 893.135
30 (1)(b)1.a. 1st Trafficking in cocaine, more than
31 28 grams, less than 200 grams.
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1 893.135
2 (1)(c)1.a. 1st Trafficking in illegal drugs,
3 more than 4 grams, less than 14
4 grams.
5 893.135
6 (1)(d)1. 1st Trafficking in phencyclidine,
7 more than 28 grams, less than 200
8 grams.
9 893.135(1)(e)1. 1st Trafficking in methaqualone, more
10 than 200 grams, less than 5
11 kilograms.
12 893.135(1)(f)1. 1st Trafficking in amphetamine, more
13 than 14 grams, less than 28
14 grams.
15 893.135
16 (1)(g)1.a. 1st Trafficking in flunitrazepam, 4
17 grams or more, less than 14
18 grams.
19 893.135
20 (1)(h)1.a. 1st Trafficking in
21 gamma-hydroxybutyric acid (GHB),
22 1 kilogram or more, less than 5
23 kilograms.
24 893.135
25 (1)(j)1.a. 1st Trafficking in 1,4-Butanediol, 1
26 kilogram or more, less than 5
27 kilograms.
28 893.135
29 (1)(k)2.a. 1st Trafficking in Phenethylamines,
30 10 grams or more, less than 200
31 grams.
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1 896.101(5)(a) 3rd Money laundering, financial
2 transactions exceeding $300 but
3 less than $20,000.
4 896.104(4)(a)1. 3rd Structuring transactions to evade
5 reporting or registration
6 requirements, financial
7 transactions exceeding $300 but
8 less than $20,000.
9 Section 15. The amendment made by this act to section
10 456.0375(1)(b), Florida Statutes, is intended to clarify the
11 legislative intent of this provision as it existed at the time
12 the provision initially took effect. Accordingly, section
13 456.0375(1)(b), Florida Statutes, as amended by this act shall
14 operate retroactively to October 1, 2001.
15 Section 16. Effective March 1, 2004, section 456.0375,
16 Florida Statutes, is repealed.
17 Section 17. (1) On or before January 1, 2004, every
18 insurer writing with a managing general agent and having a
19 per-policy fee in its rate filing shall make a rate filing
20 under section 627.062 or section 627.0651, Florida Statutes,
21 to conform its per-policy fee to the requirements of this act.
22 (2) Any increase in benefits approved by the Financial
23 Services Commission under subsection (12) of section 627.736,
24 Florida Statutes, as added by this act, shall apply to new and
25 renewal policies that are effective 120 days after the order
26 issued by the commission becomes final. Subsection (2) of
27 section 627.739, Florida Statutes, as amended by this act,
28 shall apply to new and renewal policies issued on or after
29 October 1, 2003.
30
31
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1 (3) Subsection (11) of section 627.736, Florida
2 Statutes, as amended by this act, shall apply to actions filed
3 on and after the effective date of this act.
4 (4) Paragraph (7)(a) of section 627.736, Florida
5 Statutes, as amended by this act, and paragraph (7)(c) of
6 section 817.234, Florida Statutes, as amended by this act,
7 shall apply to examinations conducted on and after October 1,
8 2003.
9 Section 18. By December 31, 2004, the Department of
10 Financial Services, the Department of Health, and the Agency
11 for Health Care Administration each shall submit a report on
12 the implementation of this act and recommendations, if any, to
13 further improve the automobile insurance market, reduce
14 automobile insurance costs, and reduce automobile insurance
15 fraud and abuse to the President of the Senate and the Speaker
16 of the House of Representatives. The report by the Department
17 of Financial Services shall include a study of the medical and
18 legal costs associated with personal injury protection
19 insurance claims.
20 Section 19. There is appropriated $2.5 million from
21 the Health Care Trust Fund, and 51 full-time equivalent
22 positions are authorized, for the Agency for Health Care
23 Administration to implement the provisions of this act.
24 Section 20. (1) Effective October 1, 2007, sections
25 627.730, 627.731, 627.732, 627.733, 627.734, 627.736, 627.737,
26 627.739, 627.7401, 627.7403, and 627.7405, Florida Statutes,
27 constituting the Florida Motor Vehicle No-Fault Law, are
28 repealed, unless reenacted by the Legislature during the 2006
29 Regular Session and such reenactment becomes law to take
30 effect for policies issued or renewed on or after October 1,
31 2006.
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1 (2) Insurers are authorized to provide, in all
2 policies issues or renewed after October 1, 2006, that such
3 policies may terminate on or after October 1, 2007, as
4 provided in subsection (1).
5 Section 21. If any law that is amended by this act was
6 also amended by a law enacted at the 2003 Regular Session of
7 the Legislature, such laws shall be construed as if they had
8 been enacted during the same session of the Legislature, and
9 full effect should be given to each if that is possible.
10 Section 22. Except as otherwise expressly provided in
11 this act, this act shall take effect July 1, 2003.
12
13 *****************************************
14 SENATE SUMMARY
15 Creates the "Florida Motor Vehicle Insurance
Affordability Reform Act." Restricts the use of crash
16 reports for the purpose of soliciting accident victims.
Creates the "Health Care Clinic Act." Transfers
17 regulation of clinics from the Department of Health to
the Agency for Health Care Administration. Provides
18 penalties for fraudulent actions by insurers and
providers. Revises payment schedules for injuries covered
19 by personal injury protection benefits. Requires the
Department of Financial Services, the Department of
20 Health, and the Agency for Health Care Administration to
submit reports and recommendations to the Legislature.
21 Provides an appropriation. (See bill for details.)
22
23
24
25
26
27
28
29
30
31
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