Senate Bill sb2594
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Florida Senate - 2004 SB 2594
By Senator Diaz de la Portilla
36-1918-04
1 A bill to be entitled
2 An act relating to medicaid provider fraud;
3 amending s. 409.920, F.S.; revising the
4 elements of the offense of Medicaid provider
5 fraud to require that a person must have
6 willfully engaged in certain prohibited
7 activities rather than only knowingly engaged
8 in those prohibited activities; providing that
9 proof of a false statement or representation
10 gives rise to an inference of the willful
11 submission of a fraudulent claim under certain
12 circumstances; reenacting s. 921.0022(3)(g),
13 F.S., relating to the offense severity ranking
14 chart of the Criminal Punishment Code, to
15 incorporate the amendment to s. 409.920, F.S.,
16 in a reference thereto; providing an effective
17 date.
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19 Be It Enacted by the Legislature of the State of Florida:
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21 Section 1. Subsections (2), (5), and (6) of section
22 409.920, Florida Statutes, are amended to read:
23 409.920 Medicaid provider fraud.--
24 (2) It is unlawful to:
25 (a) Knowingly and willfully make, cause to be made, or
26 aid and abet in the making of any false statement or false
27 representation of a material fact, by commission or omission,
28 in any claim submitted to the agency or its fiscal agent for
29 payment.
30 (b) Knowingly and willfully make, cause to be made, or
31 aid and abet in the making of a claim for items or services
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Florida Senate - 2004 SB 2594
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1 that are not authorized to be reimbursed by the Medicaid
2 program.
3 (c) Knowingly and willfully charge, solicit, accept,
4 or receive anything of value, other than an authorized
5 copayment from a Medicaid recipient, from any source in
6 addition to the amount legally payable for an item or service
7 provided to a Medicaid recipient under the Medicaid program or
8 knowingly and willfully fail to credit the agency or its
9 fiscal agent for any payment received from a third-party
10 source.
11 (d) Knowingly and willfully make or in any way cause
12 to be made any false statement or false representation of a
13 material fact, by commission or omission, in any document
14 containing items of income and expense that is or may be used
15 by the agency to determine a general or specific rate of
16 payment for an item or service provided by a provider.
17 (e) Knowingly and willfully solicit, offer, pay, or
18 receive any remuneration, including any kickback, bribe, or
19 rebate, directly or indirectly, overtly or covertly, in cash
20 or in kind, in return for referring an individual to a person
21 for the furnishing or arranging for the furnishing of any item
22 or service for which payment may be made, in whole or in part,
23 under the Medicaid program, or in return for obtaining,
24 purchasing, leasing, ordering, or arranging for or
25 recommending, obtaining, purchasing, leasing, or ordering any
26 goods, facility, item, or service, for which payment may be
27 made, in whole or in part, under the Medicaid program.
28 (f) Knowingly and willfully submit false or misleading
29 information or statements to the Medicaid program for the
30 purpose of being accepted as a Medicaid provider.
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Florida Senate - 2004 SB 2594
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1 A person who violates this subsection commits a felony of the
2 third degree, punishable as provided in s. 775.082, s.
3 775.083, or s. 775.084.
4 (5) Proof that a claim was submitted to the agency or
5 its fiscal agent which contained a false statement or a false
6 representation of a material fact, by commission or omission,
7 unless satisfactorily explained, gives rise to an inference
8 that the person whose signature appears as the provider's
9 authorizing signature on the claim form, or whose signature
10 appears on an agency electronic claim submission agreement
11 submitted for claims made to the fiscal agent by electronic
12 means, had knowledge of and willfully made the false statement
13 or false representation. This subsection applies whether the
14 signature appears on the claim form or the electronic claim
15 submission agreement by means of handwriting, typewriting,
16 facsimile signature stamp, computer impulse, initials, or
17 otherwise.
18 (6) Proof of submission to the agency or its fiscal
19 agent of a document containing items of income and expense,
20 which document is used or that may be used by the agency or
21 its fiscal agent to determine a general or specific rate of
22 payment and which document contains a false statement or a
23 false representation of a material fact, by commission or
24 omission, unless satisfactorily explained, gives rise to the
25 inference that the person who signed the certification of the
26 document had knowledge of and willfully made the false
27 statement or representation. This subsection applies whether
28 the signature appears on the document by means of handwriting,
29 typewriting, facsimile signature stamp, electronic
30 transmission, initials, or otherwise.
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Florida Senate - 2004 SB 2594
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1 Section 2. For the purpose of incorporating the
2 amendment made by this act to section 409.920, Florida
3 Statutes, in a reference thereto, paragraph (g) of subsection
4 (3) of section 921.0022, Florida Statutes, is reenacted to
5 read:
6 921.0022 Criminal Punishment Code; offense severity
7 ranking chart.--
8 (3) OFFENSE SEVERITY RANKING CHART
9
10 Florida Felony
11 Statute Degree Description
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14 (g) LEVEL 7
15 316.027(1)(b) 2nd Accident involving death, failure
16 to stop; leaving scene.
17 316.193(3)(c)2. 3rd DUI resulting in serious bodily
18 injury.
19 327.35(3)(c)2. 3rd Vessel BUI resulting in serious
20 bodily injury.
21 402.319(2) 2nd Misrepresentation and negligence
22 or intentional act resulting in
23 great bodily harm, permanent
24 disfiguration, permanent
25 disability, or death.
26 409.920(2) 3rd Medicaid provider fraud.
27 456.065(2) 3rd Practicing a health care
28 profession without a license.
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1 456.065(2) 2nd Practicing a health care
2 profession without a license
3 which results in serious bodily
4 injury.
5 458.327(1) 3rd Practicing medicine without a
6 license.
7 459.013(1) 3rd Practicing osteopathic medicine
8 without a license.
9 460.411(1) 3rd Practicing chiropractic medicine
10 without a license.
11 461.012(1) 3rd Practicing podiatric medicine
12 without a license.
13 462.17 3rd Practicing naturopathy without a
14 license.
15 463.015(1) 3rd Practicing optometry without a
16 license.
17 464.016(1) 3rd Practicing nursing without a
18 license.
19 465.015(2) 3rd Practicing pharmacy without a
20 license.
21 466.026(1) 3rd Practicing dentistry or dental
22 hygiene without a license.
23 467.201 3rd Practicing midwifery without a
24 license.
25 468.366 3rd Delivering respiratory care
26 services without a license.
27 483.828(1) 3rd Practicing as clinical laboratory
28 personnel without a license.
29 483.901(9) 3rd Practicing medical physics
30 without a license.
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1 484.013(1)(c) 3rd Preparing or dispensing optical
2 devices without a prescription.
3 484.053 3rd Dispensing hearing aids without a
4 license.
5 494.0018(2) 1st Conviction of any violation of
6 ss. 494.001-494.0077 in which the
7 total money and property
8 unlawfully obtained exceeded
9 $50,000 and there were five or
10 more victims.
11 560.123(8)(b)1. 3rd Failure to report currency or
12 payment instruments exceeding
13 $300 but less than $20,000 by
14 money transmitter.
15 560.125(5)(a) 3rd Money transmitter business by
16 unauthorized person, currency or
17 payment instruments exceeding
18 $300 but less than $20,000.
19 655.50(10)(b)1. 3rd Failure to report financial
20 transactions exceeding $300 but
21 less than $20,000 by financial
22 institution.
23 782.051(3) 2nd Attempted felony murder of a
24 person by a person other than the
25 perpetrator or the perpetrator of
26 an attempted felony.
27 782.07(1) 2nd Killing of a human being by the
28 act, procurement, or culpable
29 negligence of another
30 (manslaughter).
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1 782.071 2nd Killing of human being or viable
2 fetus by the operation of a motor
3 vehicle in a reckless manner
4 (vehicular homicide).
5 782.072 2nd Killing of a human being by the
6 operation of a vessel in a
7 reckless manner (vessel
8 homicide).
9 784.045(1)(a)1. 2nd Aggravated battery; intentionally
10 causing great bodily harm or
11 disfigurement.
12 784.045(1)(a)2. 2nd Aggravated battery; using deadly
13 weapon.
14 784.045(1)(b) 2nd Aggravated battery; perpetrator
15 aware victim pregnant.
16 784.048(4) 3rd Aggravated stalking; violation of
17 injunction or court order.
18 784.07(2)(d) 1st Aggravated battery on law
19 enforcement officer.
20 784.074(1)(a) 1st Aggravated battery on sexually
21 violent predators facility staff.
22 784.08(2)(a) 1st Aggravated battery on a person 65
23 years of age or older.
24 784.081(1) 1st Aggravated battery on specified
25 official or employee.
26 784.082(1) 1st Aggravated battery by detained
27 person on visitor or other
28 detainee.
29 784.083(1) 1st Aggravated battery on code
30 inspector.
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1 790.07(4) 1st Specified weapons violation
2 subsequent to previous conviction
3 of s. 790.07(1) or (2).
4 790.16(1) 1st Discharge of a machine gun under
5 specified circumstances.
6 790.165(2) 2nd Manufacture, sell, possess, or
7 deliver hoax bomb.
8 790.165(3) 2nd Possessing, displaying, or
9 threatening to use any hoax bomb
10 while committing or attempting to
11 commit a felony.
12 790.166(3) 2nd Possessing, selling, using, or
13 attempting to use a hoax weapon
14 of mass destruction.
15 790.166(4) 2nd Possessing, displaying, or
16 threatening to use a hoax weapon
17 of mass destruction while
18 committing or attempting to
19 commit a felony.
20 796.03 2nd Procuring any person under 16
21 years for prostitution.
22 800.04(5)(c)1. 2nd Lewd or lascivious molestation;
23 victim less than 12 years of age;
24 offender less than 18 years.
25 800.04(5)(c)2. 2nd Lewd or lascivious molestation;
26 victim 12 years of age or older
27 but less than 16 years; offender
28 18 years or older.
29 806.01(2) 2nd Maliciously damage structure by
30 fire or explosive.
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1 810.02(3)(a) 2nd Burglary of occupied dwelling;
2 unarmed; no assault or battery.
3 810.02(3)(b) 2nd Burglary of unoccupied dwelling;
4 unarmed; no assault or battery.
5 810.02(3)(d) 2nd Burglary of occupied conveyance;
6 unarmed; no assault or battery.
7 812.014(2)(a) 1st Property stolen, valued at
8 $100,000 or more; cargo stolen
9 valued at $50,000 or more;
10 property stolen while causing
11 other property damage; 1st degree
12 grand theft.
13 812.014(2)(b)3. 2nd Property stolen, emergency
14 medical equipment; 2nd degree
15 grand theft.
16 812.0145(2)(a) 1st Theft from person 65 years of age
17 or older; $50,000 or more.
18 812.019(2) 1st Stolen property; initiates,
19 organizes, plans, etc., the theft
20 of property and traffics in
21 stolen property.
22 812.131(2)(a) 2nd Robbery by sudden snatching.
23 812.133(2)(b) 1st Carjacking; no firearm, deadly
24 weapon, or other weapon.
25 817.234(8)(a) 2nd Solicitation of motor vehicle
26 accident victims with intent to
27 defraud.
28 817.234(9) 2nd Organizing, planning, or
29 participating in an intentional
30 motor vehicle collision.
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Florida Senate - 2004 SB 2594
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1 817.234(11)(c) 1st Insurance fraud; property value
2 $100,000 or more.
3 817.2341(2)(b)&
4 (3)(b) 1st Making false entries of material
5 fact or false statements
6 regarding property values
7 relating to the solvency of an
8 insuring entity which are a
9 significant cause of the
10 insolvency of that entity.
11 825.102(3)(b) 2nd Neglecting an elderly person or
12 disabled adult causing great
13 bodily harm, disability, or
14 disfigurement.
15 825.103(2)(b) 2nd Exploiting an elderly person or
16 disabled adult and property is
17 valued at $20,000 or more, but
18 less than $100,000.
19 827.03(3)(b) 2nd Neglect of a child causing great
20 bodily harm, disability, or
21 disfigurement.
22 827.04(3) 3rd Impregnation of a child under 16
23 years of age by person 21 years
24 of age or older.
25 837.05(2) 3rd Giving false information about
26 alleged capital felony to a law
27 enforcement officer.
28 838.015 2nd Bribery.
29 838.016 2nd Unlawful compensation or reward
30 for official behavior.
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1 838.021(3)(a) 2nd Unlawful harm to a public
2 servant.
3 838.22 2nd Bid tampering.
4 872.06 2nd Abuse of a dead human body.
5 893.13(1)(c)1. 1st Sell, manufacture, or deliver
6 cocaine (or other drug prohibited
7 under s. 893.03(1)(a), (1)(b),
8 (1)(d), (2)(a), (2)(b), or
9 (2)(c)4.) within 1,000 feet of a
10 child care facility, school, or
11 state, county, or municipal park
12 or publicly owned recreational
13 facility or community center.
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 3. This act shall take effect July 1, 2004.
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12 SENATE SUMMARY
13 Revises the elements of the offense of Medicaid fraud to
make it unlawful to willfully, rather than just
14 knowingly, provide false or misleading information to the
Agency of Health Care Administration. Provides that proof
15 that a document was submitted with false or misleading
information or proof of a false claim creates an
16 inference that the person whose signature appears knew of
and willfully made the false statement or
17 misrepresentation.
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