1 | The Insurance Committee recommends the following: |
2 |
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3 | Council/Committee Substitute |
4 | Remove the entire bill and insert: |
5 | A bill to be entitled |
6 | An act relating to offenses involving insurance; amending |
7 | s. 400.9935, F.S.; requiring health care clinics to |
8 | display signs displaying certain information relating to |
9 | insurance fraud; authorizing compliance inspections by the |
10 | Division of Insurance Fraud; requiring clinics to allow |
11 | inspection access; amending s. 440.105, F.S.; providing |
12 | criminal penalties for employers who fail to provide |
13 | required workers' compensation coverage for employees |
14 | under certain circumstances; amending s. 624.15, F.S.; |
15 | specifying violations of department rule as misdemeanors; |
16 | specifying a violation of department emergency rules or |
17 | orders as a felony of the third degree; providing |
18 | penalties; amending s. 624.155, F.S.; providing that civil |
19 | actions may be brought against any person acting as an |
20 | insurer without a certificate of authority if damaged by |
21 | such acting; amending s. 626.112, F.S.; providing a |
22 | criminal penalty for transacting insurance without a |
23 | license; amending s. 626.901, F.S.; clarifying |
24 | nonapplication to certain independently procured coverage |
25 | of a prohibition against representing or aiding an |
26 | unauthorized insurer; amending s. 626.918, F.S.; providing |
27 | that certain letters of credit issued or confirmed by a |
28 | qualified United States financial institution may be used |
29 | for certain purposes; providing a definition; amending s. |
30 | 626.938, F.S.; revising provisions requiring a report and |
31 | taxation of independently procured coverages; specifying |
32 | nonauthorization of independent procurement of workers' |
33 | compensation, life, or health insurance; amending s. |
34 | 626.989, F.S.; including self-insured entities associated |
35 | with the National Insurance Crime Bureau within a list of |
36 | entities required to report insurance fraud; authorizing |
37 | the division to adopt rules for standardized reporting of |
38 | fraudulent activity; amending s. 817.234, F.S.; clarifying |
39 | provisions specifying material omission and insurance |
40 | fraud; prohibiting scheming to create documentation of a |
41 | motor vehicle crash that did not occur; providing a |
42 | criminal penalty; amending s. 817.2361, F.S.; providing |
43 | that creating, presenting, or marketing fraudulent proof |
44 | of motor vehicle insurance is a felony of the third |
45 | degree; amending s. 817.50, F.S.; specifying |
46 | nonapplication of provisions specifying evidence of intent |
47 | to defraud to certain investigative actions taken by law |
48 | enforcement officers; amending s. 817.505, F.S.; providing |
49 | an additional patient brokering prohibition; revising a |
50 | definition; amending s. 843.08, F.S.; providing a criminal |
51 | penalty for falsely assuming or pretending to be an |
52 | officer of the Department of Financial Services; providing |
53 | severability; providing an effective date. |
54 |
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55 | Be It Enacted by the Legislature of the State of Florida: |
56 |
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57 | Section 1. Subsection (13) is added to section 400.9935, |
58 | Florida Statutes, to read: |
59 | 400.9935 Clinic responsibilities.-- |
60 | (13) The clinic shall display a sign in a conspicuous |
61 | location within the clinic readily visible to all patients |
62 | indicating that pursuant to s. 626.9892, the Department of |
63 | Financial Services may pay rewards of up to $25,000 to persons |
64 | providing information leading to the arrest and conviction of |
65 | persons committing crimes investigated by the Division of |
66 | Insurance Fraud arising from violations of s. 440.105, s. |
67 | 624.15, s. 626.9541, s. 626.989, or s. 817.234. An authorized |
68 | employee of the Division of Insurance Fraud may make unannounced |
69 | inspections of clinics licensed pursuant to this part as |
70 | necessary to determine that the clinic is in compliance with |
71 | this subsection. A licensed clinic shall allow full and complete |
72 | access to the premises to such authorized employee of the |
73 | division who makes an inspection to determine compliance with |
74 | this subsection. |
75 | Section 2. Subsection (4) of section 440.105, Florida |
76 | Statutes, is amended to read: |
77 | 440.105 Prohibited activities; reports; penalties; |
78 | limitations.-- |
79 | (4) Unless otherwise specifically provided, whoever |
80 | violates any provision of this subsection commits insurance |
81 | fraud, punishable as provided in paragraph (f). |
82 | (a) It shall be unlawful for any employer to knowingly: |
83 | 1. Present or cause to be presented any false, fraudulent, |
84 | or misleading oral or written statement to any person as |
85 | evidence of compliance with s. 440.38. |
86 | 2. Make a deduction from the pay of any employee entitled |
87 | to the benefits of this chapter for the purpose of requiring the |
88 | employee to pay any portion of premium paid by the employer to a |
89 | carrier or to contribute to a benefit fund or department |
90 | maintained by such employer for the purpose of providing |
91 | compensation or medical services and supplies as required by |
92 | this chapter. |
93 | 3. Fail to secure workers' payment of compensation |
94 | coverage if required to do so by this chapter. |
95 | a. However, if an employer knowingly fails to secure |
96 | workers' compensation coverage for an employee as required by |
97 | this chapter, and such employee subsequently suffers a work- |
98 | related injury requiring hospitalization, the employer commits a |
99 | felony of the second degree, punishable as provided in s. |
100 | 775.082, s. 775.083, or s. 775.084. |
101 | b. However, if an employer knowingly fails to secure |
102 | workers' compensation coverage for an employee as required by |
103 | this chapter, and such employee subsequently suffers a work |
104 | related death, the employer commits a felony of the first |
105 | degree, punishable as provided in s. 775.082, s. 775.083, or s. |
106 | 775.084. |
107 | (b) It shall be unlawful for any person: |
108 | 1. To knowingly make, or cause to be made, any false, |
109 | fraudulent, or misleading oral or written statement for the |
110 | purpose of obtaining or denying any benefit or payment under |
111 | this chapter. |
112 | 2. To present or cause to be presented any written or oral |
113 | statement as part of, or in support of, a claim for payment or |
114 | other benefit pursuant to any provision of this chapter, knowing |
115 | that such statement contains any false, incomplete, or |
116 | misleading information concerning any fact or thing material to |
117 | such claim. |
118 | 3. To prepare or cause to be prepared any written or oral |
119 | statement that is intended to be presented to any employer, |
120 | insurance company, or self-insured program in connection with, |
121 | or in support of, any claim for payment or other benefit |
122 | pursuant to any provision of this chapter, knowing that such |
123 | statement contains any false, incomplete, or misleading |
124 | information concerning any fact or thing material to such claim. |
125 | 4. To knowingly assist, conspire with, or urge any person |
126 | to engage in activity prohibited by this section. |
127 | 5. To knowingly make any false, fraudulent, or misleading |
128 | oral or written statement, or to knowingly omit or conceal |
129 | material information, required by s. 440.185 or s. 440.381, for |
130 | the purpose of obtaining workers' compensation coverage or for |
131 | the purpose of avoiding, delaying, or diminishing the amount of |
132 | payment of any workers' compensation premiums. |
133 | 6. To knowingly misrepresent or conceal payroll, |
134 | classification of workers, or information regarding an |
135 | employer's loss history which would be material to the |
136 | computation and application of an experience rating modification |
137 | factor for the purpose of avoiding or diminishing the amount of |
138 | payment of any workers' compensation premiums. |
139 | 7. To knowingly present or cause to be presented any |
140 | false, fraudulent, or misleading oral or written statement to |
141 | any person as evidence of compliance with s. 440.38, as evidence |
142 | of eligibility for a certificate of exemption under s. 440.05. |
143 | 8. To knowingly violate a stop-work order issued by the |
144 | department pursuant to s. 440.107. |
145 | 9. To knowingly present or cause to be presented any |
146 | false, fraudulent, or misleading oral or written statement to |
147 | any person as evidence of identity for the purpose of obtaining |
148 | employment or filing or supporting a claim for workers' |
149 | compensation benefits. |
150 | (c) It shall be unlawful for any physician licensed under |
151 | chapter 458, osteopathic physician licensed under chapter 459, |
152 | chiropractic physician licensed under chapter 460, podiatric |
153 | physician licensed under chapter 461, optometric physician |
154 | licensed under chapter 463, or any other practitioner licensed |
155 | under the laws of this state to knowingly and willfully assist, |
156 | conspire with, or urge any person to fraudulently violate any of |
157 | the provisions of this chapter. |
158 | (d) It shall be unlawful for any person or governmental |
159 | entity licensed under chapter 395 to maintain or operate a |
160 | hospital in such a manner so that such person or governmental |
161 | entity knowingly and willfully allows the use of the facilities |
162 | of such hospital by any person, in a scheme or conspiracy to |
163 | fraudulently violate any of the provisions of this chapter. |
164 | (e) It shall be unlawful for any attorney or other person, |
165 | in his or her individual capacity or in his or her capacity as a |
166 | public or private employee, or any firm, corporation, |
167 | partnership, or association, to knowingly assist, conspire with, |
168 | or urge any person to fraudulently violate any of the provisions |
169 | of this chapter. |
170 | (f) If the monetary value of any violation of this |
171 | subsection: |
172 | 1. Is less than $20,000, the offender commits a felony of |
173 | the third degree, punishable as provided in s. 775.082, s. |
174 | 775.083, or s. 775.084. |
175 | 2. Is $20,000 or more, but less than $100,000, the |
176 | offender commits a felony of the second degree, punishable as |
177 | provided in s. 775.082, s. 775.083, or s. 775.084. |
178 | 3. Is $100,000 or more, the offender commits a felony of |
179 | the first degree, punishable as provided in s. 775.082, s. |
180 | 775.083, or s. 775.084. |
181 | Section 3. Section 624.15, Florida Statutes, is amended to |
182 | read: |
183 | 624.15 General penalty.-- |
184 | (1) Each willful violation of this code or department rule |
185 | as to which a greater penalty is not provided by another |
186 | provision of this code, department rule, or by other applicable |
187 | laws of this state is a misdemeanor of the second degree and is, |
188 | in addition to any prescribed applicable denial, suspension, or |
189 | revocation of certificate of authority, license, or permit, |
190 | punishable as provided in s. 775.082 or s. 775.083. Each |
191 | instance of such violation shall be considered a separate |
192 | offense. |
193 | (2) Each willful violation of an emergency rule or order |
194 | adopted or issued by the department is a felony of the third |
195 | degree and, in addition to any prescribed applicable denial, |
196 | suspension, or revocation of a certificate of authority, |
197 | license, or permit, is punishable as provided in s. 775.082, s. |
198 | 775.083, or s. 775.084. Each instance of such violation shall be |
199 | considered a separate offense. |
200 | Section 4. Subsection (2) of section 624.155, Florida |
201 | Statutes, is amended to read: |
202 | 624.155 Civil remedy.-- |
203 | (2) Any party may bring a civil action against any person |
204 | acting as an unauthorized insurer without a certificate of |
205 | authority if such party is damaged by a violation of s. 624.401 |
206 | by that person the unauthorized insurer. |
207 | Section 5. Subsection (9) is added to section 626.112, |
208 | Florida Statutes, to read: |
209 | 626.112 License and appointment required; agents, customer |
210 | representatives, adjusters, insurance agencies, service |
211 | representatives, managing general agents.-- |
212 | (9) Any person who transacts insurance or otherwise |
213 | engages in insurance activities in this state without a license |
214 | in violation of this section commits a felony of the third |
215 | degree, punishable as provided in s. 775.082, s. 775.083, or s. |
216 | 775.084. |
217 | Section 6. Paragraph (d) of subsection (4) of section |
218 | 626.901, Florida Statutes, is amended to read: |
219 | 626.901 Representing or aiding unauthorized insurer |
220 | prohibited.-- |
221 | (4) This section does not apply to: |
222 | (d) Independently procured coverage written pursuant to s. |
223 | 626.938, which is not solicited, marketed, negotiated, or sold |
224 | within this state. |
225 | Section 7. Section 626.918, Florida Statutes, is amended |
226 | to read: |
227 | 626.918 Eligible surplus lines insurers.-- |
228 | (1) A No surplus lines agent may not shall place any |
229 | coverage with any unauthorized insurer which is not then an |
230 | eligible surplus lines insurer, except as permitted under |
231 | subsections (6)(5) and (7)(6). |
232 | (2) An No unauthorized insurer may not shall be or become |
233 | an eligible surplus lines insurer unless made eligible by the |
234 | office in accordance with the following conditions: |
235 | (a) Eligibility of the insurer must be requested in |
236 | writing by the Florida Surplus Lines Service Office; |
237 | (b) The insurer must be currently an authorized insurer in |
238 | the state or country of its domicile as to the kind or kinds of |
239 | insurance proposed to be so placed and must have been such an |
240 | insurer for not less than the 3 years next preceding or must be |
241 | the wholly owned subsidiary of such authorized insurer or must |
242 | be the wholly owned subsidiary of an already eligible surplus |
243 | lines insurer as to the kind or kinds of insurance proposed for |
244 | a period of not less than the 3 years next preceding. However, |
245 | the office may waive the 3-year requirement if the insurer |
246 | provides a product or service not readily available to the |
247 | consumers of this state or has operated successfully for a |
248 | period of at least 1 year next preceding and has capital and |
249 | surplus of not less than $25 million; |
250 | (c) Before granting eligibility, the requesting surplus |
251 | lines agent or the insurer shall furnish the office with a duly |
252 | authenticated copy of its current annual financial statement in |
253 | the English language and with all monetary values therein |
254 | expressed in United States dollars, at an exchange rate (in the |
255 | case of statements originally made in the currencies of other |
256 | countries) then-current and shown in the statement, and with |
257 | such additional information relative to the insurer as the |
258 | office may request; |
259 | (d)1. The insurer must have and maintain surplus as to |
260 | policyholders of not less than $15 million; in addition, an |
261 | alien insurer must also have and maintain in the United States a |
262 | trust fund for the protection of all its policyholders in the |
263 | United States under terms deemed by the office to be reasonably |
264 | adequate, in an amount not less than $5.4 million. Any such |
265 | surplus as to policyholders or trust fund shall be represented |
266 | by investments consisting of eligible investments for like funds |
267 | of like domestic insurers under part II of chapter 625 provided, |
268 | however, that in the case of an alien insurance company, any |
269 | such surplus as to policyholders may be represented by |
270 | investments permitted by the domestic regulator of such alien |
271 | insurance company if such investments are substantially similar |
272 | in terms of quality, liquidity, and security to eligible |
273 | investments for like funds of like domestic insurers under part |
274 | II of chapter 625. Clean, irrevocable, unconditional, and |
275 | evergreen letters of credit issued or confirmed by a qualified |
276 | United States financial institution, as defined in subsection |
277 | (3), may be used to fund the trust; |
278 | 2. For those surplus lines insurers that were eligible on |
279 | January 1, 1994, and that maintained their eligibility |
280 | thereafter, the required surplus as to policyholders shall be: |
281 | a. On December 31, 1994, and until December 30, 1995, $2.5 |
282 | million. |
283 | b. On December 31, 1995, and until December 30, 1996, $3.5 |
284 | million. |
285 | c. On December 31, 1996, and until December 30, 1997, $4.5 |
286 | million. |
287 | d. On December 31, 1997, and until December 30, 1998, $5.5 |
288 | million. |
289 | e. On December 31, 1998, and until December 30, 1999, $6.5 |
290 | million. |
291 | f. On December 31, 1999, and until December 30, 2000, $8 |
292 | million. |
293 | g. On December 31, 2000, and until December 30, 2001, $9.5 |
294 | million. |
295 | h. On December 31, 2001, and until December 30, 2002, $11 |
296 | million. |
297 | i. On December 31, 2002, and until December 30, 2003, $13 |
298 | million. |
299 | j. On December 31, 2003, and thereafter, $15 million. |
300 | 3. The capital and surplus requirements as set forth in |
301 | subparagraph 2. do not apply in the case of an insurance |
302 | exchange created by the laws of individual states, where the |
303 | exchange maintains capital and surplus pursuant to the |
304 | requirements of that state, or maintains capital and surplus in |
305 | an amount not less than $50 million in the aggregate. For an |
306 | insurance exchange which maintains funds in the amount of at |
307 | least $12 million for the protection of all insurance exchange |
308 | policyholders, each individual syndicate shall maintain minimum |
309 | capital and surplus in an amount not less than $3 million. If |
310 | the insurance exchange does not maintain funds in the amount of |
311 | at least $12 million for the protection of all insurance |
312 | exchange policyholders, each individual syndicate shall meet the |
313 | minimum capital and surplus requirements set forth in |
314 | subparagraph 2.; |
315 | 4. A surplus lines insurer which is a member of an |
316 | insurance holding company that includes a member which is a |
317 | Florida domestic insurer as set forth in its holding company |
318 | registration statement, as set forth in s. 628.801 and rules |
319 | adopted thereunder, may elect to maintain surplus as to |
320 | policyholders in an amount equal to the requirements of s. |
321 | 624.408, subject to the requirement that the surplus lines |
322 | insurer shall at all times be in compliance with the |
323 | requirements of chapter 625. |
324 |
|
325 | The election shall be submitted to the office and shall be |
326 | effective upon the office's being satisfied that the |
327 | requirements of subparagraph 4. have been met. The initial date |
328 | of election shall be the date of office approval. The election |
329 | approval application shall be on a form adopted by commission |
330 | rule. The office may approve an election form submitted pursuant |
331 | to subparagraph 4. only if it was on file with the former |
332 | Department of Insurance before February 28, 1998; |
333 | (e) The insurer must be of good reputation as to the |
334 | providing of service to its policyholders and the payment of |
335 | losses and claims; |
336 | (f) The insurer must be eligible, as for authority to |
337 | transact insurance in this state, under s. 624.404(3); and |
338 | (g) This subsection does not apply as to unauthorized |
339 | insurers made eligible under s. 626.917 as to wet marine and |
340 | aviation risks. |
341 | (3) For purposes of subsection (2) relating to letters of |
342 | credit, the term "qualified United States financial institution" |
343 | means an institution that: |
344 | (a) Is organized or, in the case of a United States office |
345 | of a foreign banking organization, is licensed under the laws of |
346 | the United States or any state thereof. |
347 | (b) Is regulated, supervised, and examined by United |
348 | States or state authorities having regulatory authority over |
349 | banks and trust companies. |
350 | (c) Has been determined by the office or the Securities |
351 | Valuation Office of the National Association of Insurance |
352 | Commissioners to meet such standards of financial condition and |
353 | standing as are considered necessary and appropriate to regulate |
354 | the quality of financial institutions whose letters of credit |
355 | are acceptable to the office. |
356 | (4)(3) The office shall from time to time publish a list |
357 | of all currently eligible surplus lines insurers and shall mail |
358 | a copy thereof to each licensed surplus lines agent at his or |
359 | her office of record with the office. |
360 | (5)(4) This section shall not be deemed to cast upon the |
361 | office any duty or responsibility to determine the actual |
362 | financial condition or claims practices of any unauthorized |
363 | insurer; and the status of eligibility, if granted by the |
364 | office, shall indicate only that the insurer appears to be sound |
365 | financially and to have satisfactory claims practices and that |
366 | the office has no credible evidence to the contrary. |
367 | (6)(5) When it appears that any particular insurance risk |
368 | which is eligible for export, but on which insurance coverage, |
369 | in whole or in part, is not procurable from the eligible surplus |
370 | lines insurers, after a search of eligible surplus lines |
371 | insurers, then the surplus lines agent may file a supplemental |
372 | signed statement setting forth such facts and advising the |
373 | office that such part of the risk as shall be unprocurable, as |
374 | aforesaid, is being placed with named unauthorized insurers, in |
375 | the amounts and percentages set forth in the statement. Such |
376 | named unauthorized insurer shall, however, before accepting any |
377 | risk in this state, deposit with the department cash or |
378 | securities acceptable to the office and department of the market |
379 | value of $50,000 for each individual risk, contract, or |
380 | certificate, which deposit shall be held by the department for |
381 | the benefit of Florida policyholders only; and the surplus lines |
382 | agent shall procure from such unauthorized insurer and file with |
383 | the office a certified copy of its statement of condition as of |
384 | the close of the last calendar year. If such statement reveals, |
385 | including both capital and surplus, net assets of at least that |
386 | amount required for licensure of a domestic insurer, then the |
387 | surplus lines agent may proceed to consummate such contract of |
388 | insurance. Whenever any insurance risk, or any part thereof, is |
389 | placed with an unauthorized insurer, as provided herein, the |
390 | policy, binder, or cover note shall contain a statement signed |
391 | by the insured and the agent with the following notation: "The |
392 | insured is aware that certain insurers participating in this |
393 | risk have not been approved to transact business in Florida nor |
394 | have they been declared eligible as surplus lines insurers by |
395 | the Office of Insurance Regulation of Florida. The placing of |
396 | such insurance by a duly licensed surplus lines agent in Florida |
397 | shall not be construed as approval of such insurer by the Office |
398 | of Insurance Regulation of Florida. Consequently, the insured is |
399 | aware that the insured has severely limited the assistance |
400 | available under the insurance laws of Florida. The insured is |
401 | further aware that he or she may be charged a reasonable per |
402 | policy fee, as provided in s. 626.916(4), Florida Statutes, for |
403 | each policy certified for export." All other provisions of this |
404 | code shall apply to such placement the same as if such risks |
405 | were placed with an eligible surplus lines insurer. |
406 | (7)(6) When any particular insurance risk subject to |
407 | subsection (6)(5) is eligible for placement with an unauthorized |
408 | insurer and not more than 12.5 percent of the risk is so |
409 | subject, the office may, at its discretion, permit the agent to |
410 | obtain from the insured a signed statement as indicated in |
411 | subsection (6)(5). All other provisions of this code apply to |
412 | such placement the same as if such risks were placed with an |
413 | eligible surplus lines insurer. |
414 | Section 8. Subsections (1), (2), and (9) of section |
415 | 626.938, Florida Statutes, are amended to read: |
416 | 626.938 Report and tax of independently procured |
417 | coverages.-- |
418 | (1) Every insured who resides in this state and procures |
419 | or causes to be procured or continues or renews insurance from |
420 | another state or country with an unauthorized foreign or alien |
421 | insurer legitimately licensed in that jurisdiction, or any self- |
422 | insurer who resides in this state and so procures or continues |
423 | excess loss, catastrophe, or other insurance, upon a subject of |
424 | insurance resident, located, or to be performed within this |
425 | state, other than insurance procured through a surplus lines |
426 | agent pursuant to the Surplus Lines Law of this state or |
427 | exempted from tax under s. 626.932(4), shall, within 30 days |
428 | after the date such insurance was so procured, continued, or |
429 | renewed, file a report of the same with the Florida Surplus |
430 | Lines Service Office in writing and upon forms designated by the |
431 | Florida Surplus Lines Service Office and furnished to such an |
432 | insured upon request, or in a computer readable format as |
433 | determined by the Florida Surplus Lines Service Office. The |
434 | report shall show the name and address of the insured or |
435 | insureds, the name and address of the insurer, the subject of |
436 | the insurance, a general description of the coverage, the amount |
437 | of premium currently charged therefor, and such additional |
438 | pertinent information as is reasonably requested by the Florida |
439 | Surplus Lines Service Office. |
440 | (2) Any insurance in an unauthorized insurer legitimately |
441 | licensed in another state or country procured through |
442 | solicitations, negotiations, or an application, in whole or in |
443 | part occurring or made outside within or from within this state, |
444 | or for which premiums in whole or in part are remitted directly |
445 | or indirectly from within this state, shall be deemed to be |
446 | insurance procured, continued, or renewed in this state within |
447 | the intent of subsection (1). |
448 | (9) This section does not authorize independent |
449 | procurement of workers' compensation insurance, apply as to life |
450 | insurance, or health insurance. |
451 | Section 9. Subsection (6) of section 626.989, Florida |
452 | Statutes, is amended to read: |
453 | 626.989 Investigation by department or Division of |
454 | Insurance Fraud; compliance; immunity; confidential information; |
455 | reports to division; division investigator's power of arrest.-- |
456 | (6) Any person, other than an insurer, agent, or other |
457 | person licensed under the code, or an employee thereof, having |
458 | knowledge or who believes that a fraudulent insurance act or any |
459 | other act or practice which, upon conviction, constitutes a |
460 | felony or a misdemeanor under the code, or under s. 817.234, is |
461 | being or has been committed may send to the Division of |
462 | Insurance Fraud a report or information pertinent to such |
463 | knowledge or belief and such additional information relative |
464 | thereto as the department may request. However, any professional |
465 | practitioner licensed or regulated by the Department of Business |
466 | and Professional Regulation, except as otherwise provided by |
467 | law, any medical review committee as defined in s. 766.101, any |
468 | private medical review committee, any self-insured entity |
469 | contracting or associated with the National Insurance Crime |
470 | Bureau, and any insurer, agent, or other person licensed under |
471 | the code, or an employee thereof, having knowledge or who |
472 | believes that a fraudulent insurance act or any other act or |
473 | practice which, upon conviction, constitutes a felony or a |
474 | misdemeanor under the code, or under s. 817.234, is being or has |
475 | been committed shall send to the Division of Insurance Fraud a |
476 | report or information pertinent to such knowledge or belief and |
477 | such additional information relative thereto as the department |
478 | may require. The Division of Insurance Fraud shall review such |
479 | information or reports and select such information or reports |
480 | as, in its judgment, may require further investigation. It shall |
481 | then cause an independent examination of the facts surrounding |
482 | such information or report to be made to determine the extent, |
483 | if any, to which a fraudulent insurance act or any other act or |
484 | practice which, upon conviction, constitutes a felony or a |
485 | misdemeanor under the code, or under s. 817.234, is being |
486 | committed. The Division of Insurance Fraud shall report any |
487 | alleged violations of law which its investigations disclose to |
488 | the appropriate licensing agency and state attorney or other |
489 | prosecuting agency having jurisdiction with respect to any such |
490 | violation, as provided in s. 624.310. If prosecution by the |
491 | state attorney or other prosecuting agency having jurisdiction |
492 | with respect to such violation is not begun within 60 days of |
493 | the division's report, the state attorney or other prosecuting |
494 | agency having jurisdiction with respect to such violation shall |
495 | inform the division of the reasons for the lack of prosecution. |
496 | The division may adopt rules which set forth requirements for |
497 | the manner in which suspected fraudulent activity shall be |
498 | reported to the division through the use of a standard referral |
499 | form. |
500 | Section 10. Paragraph (a) of subsection (7) and subsection |
501 | (9) of section 817.234, Florida Statutes, are amended to read: |
502 | 817.234 False and fraudulent insurance claims.-- |
503 | (7)(a) It shall constitute a material omission and |
504 | insurance fraud, punishable as provided in subsection (11), for |
505 | any service physician or other provider, other than a hospital, |
506 | to engage in a general business practice of billing amounts as |
507 | its usual and customary charge, if such provider has agreed with |
508 | the insured patient or intends to waive deductibles or |
509 | copayments, or does not for any other reason intend to collect |
510 | the total amount of such charge. With respect to a determination |
511 | as to whether a service physician or other provider has engaged |
512 | in such general business practice, consideration shall be given |
513 | to evidence of whether the service physician or other provider |
514 | made a good faith attempt to collect such deductible or |
515 | copayment. This paragraph does not apply to physicians or other |
516 | providers who waive deductibles or copayments or reduce their |
517 | bills as part of a bodily injury settlement or verdict. |
518 | (9) A person may not organize, plan, or knowingly |
519 | participate in an intentional motor vehicle crash or a scheme to |
520 | create documentation of a motor vehicle crash that did not occur |
521 | for the purpose of making motor vehicle tort claims or claims |
522 | for personal injury protection benefits as required by s. |
523 | 627.736. Any person who violates this subsection commits a |
524 | felony of the second degree, punishable as provided in s. |
525 | 775.082, s. 775.083, or s. 775.084. A person who is convicted of |
526 | a violation of this subsection shall be sentenced to a minimum |
527 | term of imprisonment of 2 years. |
528 | Section 11. Section 817.2361, Florida Statutes, is amended |
529 | to read: |
530 | 817.2361 False or fraudulent proof of motor vehicle |
531 | insurance card.--Any person who, with intent to deceive any |
532 | other person, creates, markets, or presents a false or |
533 | fraudulent proof of motor vehicle insurance card commits a |
534 | felony of the third degree, punishable as provided in s. |
535 | 775.082, s. 775.083, or s. 775.084. |
536 | Section 12. Subsection (2) of section 817.50, Florida |
537 | Statutes, is amended to read: |
538 | 817.50 Fraudulently obtaining goods, services, etc., from |
539 | a health care provider.-- |
540 | (2) If any person gives to any health care provider in |
541 | this state a false or fictitious name or a false or fictitious |
542 | address or assigns to any health care provider the proceeds of |
543 | any health maintenance contract or insurance contract, then |
544 | knowing that such contract is no longer in force, is invalid, or |
545 | is void for any reason, such action shall be prima facie |
546 | evidence of the intent of such person to defraud the health care |
547 | provider. However, this subsection does not apply to |
548 | investigative actions taken by law enforcement officers for law |
549 | enforcement purposes in the course of their official duties. |
550 | Section 13. Subsection (1) and paragraph (a) of subsection |
551 | (2) of section 817.505, Florida Statutes, are amended to read: |
552 | 817.505 Patient brokering prohibited; exceptions; |
553 | penalties.-- |
554 | (1) It is unlawful for any person, including any health |
555 | care provider or health care facility, to: |
556 | (a) Offer or pay any commission, bonus, rebate, kickback, |
557 | or bribe, directly or indirectly, in cash or in kind, or engage |
558 | in any split-fee arrangement, in any form whatsoever, to induce |
559 | the referral of patients or patronage to or from a health care |
560 | provider or health care facility; |
561 | (b) Solicit or receive any commission, bonus, rebate, |
562 | kickback, or bribe, directly or indirectly, in cash or in kind, |
563 | or engage in any split-fee arrangement, in any form whatsoever, |
564 | in return for referring patients or patronage to or from a |
565 | health care provider or health care facility; or |
566 | (c) Solicit or receive any commission, bonus, rebate, |
567 | kickback, or bribe, directly or indirectly, in cash or in kind, |
568 | or engage in any split-fee arrangement, in any form whatsoever, |
569 | in return for the acceptance or acknowledgement of treatment |
570 | from a health care provider or health care facility; or |
571 | (d)(c) Aid, abet, advise, or otherwise participate in the |
572 | conduct prohibited under paragraph (a), or paragraph (b), or |
573 | paragraph (c). |
574 | (2) For the purposes of this section, the term: |
575 | (a) "Health care provider or health care facility" means |
576 | any person or entity licensed, certified, or registered; |
577 | required to be licensed, certified, or registered; or lawfully |
578 | exempt from being required to be licensed, certified, or |
579 | registered with the Agency for Health Care Administration; any |
580 | person or entity that has contracted with the Agency for Health |
581 | Care Administration to provide goods or services to Medicaid |
582 | recipients as provided under s. 409.907; a county health |
583 | department established under part I of chapter 154; any |
584 | community service provider contracting with the Department of |
585 | Children and Family Services to furnish alcohol, drug abuse, or |
586 | mental health services under part IV of chapter 394; any |
587 | substance abuse service provider licensed under chapter 397; or |
588 | any federally supported primary care program such as a migrant |
589 | or community health center authorized under ss. 329 and 330 of |
590 | the United States Public Health Services Act. |
591 | Section 14. Section 843.08, Florida Statutes, is amended |
592 | to read: |
593 | 843.08 Falsely personating officer, etc.--A person who |
594 | falsely assumes or pretends to be a sheriff, officer of the |
595 | Florida Highway Patrol, officer of the Fish and Wildlife |
596 | Conservation Commission, officer of the Department of |
597 | Environmental Protection, officer of the Department of |
598 | Transportation, officer of the Department of Financial Services, |
599 | officer of the Department of Corrections, correctional probation |
600 | officer, deputy sheriff, state attorney or assistant state |
601 | attorney, statewide prosecutor or assistant statewide |
602 | prosecutor, state attorney investigator, coroner, police |
603 | officer, lottery special agent or lottery investigator, beverage |
604 | enforcement agent, or watchman, or any member of the Parole |
605 | Commission and any administrative aide or supervisor employed by |
606 | the commission, or any personnel or representative of the |
607 | Department of Law Enforcement, and takes upon himself or herself |
608 | to act as such, or to require any other person to aid or assist |
609 | him or her in a matter pertaining to the duty of any such |
610 | officer, commits a felony of the third degree, punishable as |
611 | provided in s. 775.082, s. 775.083, or s. 775.084; however, a |
612 | person who falsely personates any such officer during the course |
613 | of the commission of a felony commits a felony of the second |
614 | degree, punishable as provided in s. 775.082, s. 775.083, or s. |
615 | 775.084; except that if the commission of the felony results in |
616 | the death or personal injury of another human being, the person |
617 | commits a felony of the first degree, punishable as provided in |
618 | s. 775.082, s. 775.083, or s. 775.084. |
619 | Section 15. If any provision of this act or the |
620 | application thereof to any person or circumstance is held |
621 | invalid, the invalidity does not affect other provisions or |
622 | applications of the act which can be given effect without the |
623 | invalid provision or application, and to this end, the |
624 | provisions of this act are declared severable. |
625 | Section 16. This act shall take effect July 1, 2005. |