Florida Senate - 2010 CS for CS for SB 752
By the Committees on Criminal Justice; and Health Regulation;
and Senator Gaetz
591-04389-10 2010752c2
1 A bill to be entitled
2 An act relating to health care fraud; amending s.
3 400.471, F.S.; prohibiting the Agency for Health Care
4 Administration from issuing an initial license to a
5 home health agency for the purpose of opening a new
6 home health agency under certain conditions until a
7 specified date; prohibiting the agency from issuing a
8 change-of-ownership license to a home health agency
9 under certain conditions until a specified date;
10 providing an exception; amending s. 400.474, F.S.;
11 authorizing the agency to revoke a home health agency
12 license if the applicant or any controlling interest
13 has been sanctioned for acts specified under s.
14 400.471(10), F.S.; amending s. 408.815, F.S.; revising
15 the grounds upon which the agency may deny or revoke
16 an application for an initial license, a change-of
17 ownership license, or a licensure renewal for certain
18 health care entities listed in s. 408.802, F.S.;
19 amending s. 409.907, F.S.; extending the number of
20 years that Medicaid providers must retain Medicaid
21 recipient records; adding additional requirements to
22 the Medicaid provider agreement; revising
23 applicability of screening requirements; revising
24 conditions under which the agency is authorized to
25 deny a Medicaid provider application; amending s.
26 409.912, F.S.; revising requirements for Medicaid
27 prepaid, fixed-sum, and managed care contracts;
28 revising requirements for Medicaid durable medical
29 equipment providers; repealing s. 409.9122(13), F.S.,
30 relating to the enrollee assignment process of
31 Medicaid managed prepaid health plans for those
32 Medicaid managed prepaid health plans operating in
33 Miami-Dade County; amending s. 409.913, F.S.; removing
34 a required element from the joint Medicaid fraud and
35 abuse report submitted by the agency and the Medicaid
36 Fraud Control Unit of the Department of Legal Affairs;
37 extending the number of years that Medicaid providers
38 must retain Medicaid recipient records; authorizing
39 the Medicaid program integrity staff to immediately
40 suspend or terminate a Medicaid provider for engaging
41 in specified conduct; removing a requirement for the
42 agency to hold suspended Medicaid payments in a
43 separate account; authorizing the agency to deny
44 payment or require repayment to Medicaid providers
45 convicted of certain crimes; authorizing the agency to
46 terminate a Medicaid provider if the provider fails to
47 reimburse a fine determined by a final order;
48 authorizing the agency to withhold Medicaid
49 reimbursement to a Medicaid provider that fails to pay
50 a fine determined by a final order, fails to enter
51 into a repayment plan, or fails to comply with a
52 repayment plan or settlement agreement; requiring the
53 biennial review of Medicaid fraud and abuse by the
54 Office of Program Policy Analysis and Government
55 Accountability to include a report on the Medicaid
56 Fraud Control Unit within the Department of Legal
57 Affairs; amending s. 409.9203, F.S.; providing that
58 certain state employees are ineligible from receiving
59 a reward for reporting Medicaid fraud; amending s.
60 456.001, F.S.; defining the term “affiliate” or
61 “affiliated person” as it relates to health
62 professions and occupations; amending s. 456.041,
63 F.S.; requiring the Department of Health to include
64 administrative complaints and any conviction
65 information relating to the practitioner’s profile;
66 providing a disclaimer; amending s. 456.0635, F.S.;
67 revising the grounds under which the Department of
68 Health or corresponding board is required to refuse to
69 admit a candidate to an examination and refuse to
70 issue or renew a license, certificate, or registration
71 of a health care practitioner; providing an exception;
72 amending s. 456.072, F.S.; clarifying a ground under
73 which disciplinary actions may be taken; amending s.
74 456.073, F.S.; revising applicability of
75 investigations and administrative complaints to
76 include Medicaid fraud; amending s. 456.074, F.S.;
77 authorizing the Department of Health to issue an
78 emergency order suspending the license of any person
79 licensed under ch. 456, F.S., who engages in specified
80 criminal conduct; providing an effective date.
81
82 Be It Enacted by the Legislature of the State of Florida:
83
84 Section 1. Subsection (11) of section 400.471, Florida
85 Statutes, is amended to read:
86 400.471 Application for license; fee.—
87 (11)(a) The agency may not issue an initial license to a
88 home health agency under part II of chapter 408 or this part for
89 the purpose of opening a new home health agency until July 1,
90 2012 2010, in any county that has at least one actively licensed
91 home health agency and a population of persons 65 years of age
92 or older, as indicated in the most recent population estimates
93 published by the Executive Office of the Governor, of fewer than
94 1,200 per home health agency. In such counties, for any
95 application received by the agency prior to July 1, 2009, which
96 has been deemed by the agency to be complete except for proof of
97 accreditation, the agency may issue an initial ownership license
98 only if the applicant has applied for accreditation before May
99 1, 2009, from an accrediting organization that is recognized by
100 the agency.
101 (b) Effective October 1, 2009, the agency may not issue a
102 change of ownership license to a home health agency under part
103 II of chapter 408 or this part until July 1, 2012 2010, in any
104 county that has at least one actively licensed home health
105 agency and a population of persons 65 years of age or older, as
106 indicated in the most recent population estimates published by
107 the Executive Office of the Governor, of fewer than 1,200 per
108 home health agency. In such counties, for any application
109 received by the agency before prior to October 1, 2009, which
110 has been deemed by the agency to be complete except for proof of
111 accreditation, the agency may issue a change of ownership
112 license only if the applicant has applied for accreditation
113 before August 1, 2009, from an accrediting organization that is
114 recognized by the agency. This paragraph does not apply to an
115 application for a change in ownership from an existing home
116 health agency that is accredited, has been licensed by the state
117 at least 5 years, and is in good standing with the agency.
118 Section 2. Subsection (8) is added to section 400.474,
119 Florida Statutes, to read:
120 400.474 Administrative penalties.—
121 (8) The agency may revoke the license of a home health
122 agency that is not eligible for licensure renewal under s.
123 400.471(10).
124 Section 3. Subsection (4) of section 408.815, Florida
125 Statutes, is amended, and subsection (5) is added to that
126 section, to read:
127 408.815 License or application denial; revocation.—
128 (4) In addition to the grounds provided in authorizing
129 statutes, the agency shall deny an application for an initial a
130 license or a change-of-ownership license renewal if the
131 applicant or a person having a controlling interest in the an
132 applicant has been:
133 (a) Has been convicted of, or entered enters a plea of
134 guilty or nolo contendere to, regardless of adjudication, a
135 felony under chapter 409, chapter 817, chapter 893, or a similar
136 felony offense committed in another state or jurisdiction 21
137 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
138 sentence and any subsequent period of probation for such
139 conviction convictions or plea ended more than 15 years before
140 prior to the date of the application;
141 (b) Has been convicted of, or entered a plea of guilty or
142 nolo contendere to, regardless of adjudication, a felony under
143 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
144 sentence and any subsequent period of probation for such
145 conviction or plea ended more than 15 years before the date of
146 the application;
147 (c)(b) Has been terminated for cause from the Florida
148 Medicaid program pursuant to s. 409.913, unless the applicant
149 has been in good standing with the Florida Medicaid program for
150 the most recent 5 years; or
151 (d)(c) Has been terminated for cause, pursuant to the
152 appeals procedures established by the state, or Federal
153 Government, from the federal Medicare program or from any other
154 state Medicaid program, unless the applicant has been in good
155 standing with a state Medicaid program or the federal Medicare
156 program for the most recent 5 years and the termination occurred
157 at least 20 years before prior to the date of the application;
158 or.
159 (e) Is currently listed on the United States Department of
160 Health and Human Services Office of Inspector General’s List of
161 Excluded Individuals and Entities.
162 (5) In addition to the grounds provided in authorizing
163 statutes, the agency shall deny an application for licensure
164 renewal if the applicant or a person having a controlling
165 interest in the applicant:
166 (a) Has been convicted of, or entered a plea of guilty or
167 nolo contendere to, regardless of adjudication, a felony under
168 chapter 409, chapter 817, chapter 893, or a similar felony
169 offense committed in another state or jurisdiction since July 1,
170 2009;
171 (b) Has been convicted of, or entered a plea of guilty or
172 nolo contendere to, regardless of adjudication, a felony under
173 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
174 2009;
175 (c) Has been terminated for cause from the Florida Medicaid
176 program pursuant to s. 409.913, unless the applicant has been in
177 good standing with the Florida Medicaid program for the most
178 recent 5 years;
179 (d) Has been terminated for cause, pursuant to the appeals
180 procedures established by the state, from any other state
181 Medicaid program, unless the applicant has been in good standing
182 with a state Medicaid program for the most recent 5 years and
183 the termination occurred at least 20 years before the date of
184 the application; or
185 (e) Is currently listed on the United States Department of
186 Health and Human Services Office of Inspector General’s List of
187 Excluded Individuals and Entities.
188 Section 4. Paragraph (c) of subsection (3) of section
189 409.907, Florida Statutes, is amended, paragraph (k) is added to
190 that subsection, and subsection (8), paragraph (b) of subsection
191 (9), and subsection (10) of that section are amended, to read:
192 409.907 Medicaid provider agreements.—The agency may make
193 payments for medical assistance and related services rendered to
194 Medicaid recipients only to an individual or entity who has a
195 provider agreement in effect with the agency, who is performing
196 services or supplying goods in accordance with federal, state,
197 and local law, and who agrees that no person shall, on the
198 grounds of handicap, race, color, or national origin, or for any
199 other reason, be subjected to discrimination under any program
200 or activity for which the provider receives payment from the
201 agency.
202 (3) The provider agreement developed by the agency, in
203 addition to the requirements specified in subsections (1) and
204 (2), shall require the provider to:
205 (c) Retain all medical and Medicaid-related records for a
206 period of 6 5 years to satisfy all necessary inquiries by the
207 agency.
208 (k) Report any change of any principal of the provider,
209 including any officer, director, agent, managing employee, or
210 affiliated person, or any partner or shareholder who has an
211 ownership interest equal to 5 percent or more in the provider.
212 The provider must report changes to the agency no later than 30
213 days after the change occurs. Reporting changes in controlling
214 interests to the agency pursuant to s. 408.810(3) shall serve as
215 compliance with this paragraph for hospitals licensed under
216 chapter 395 and nursing homes licensed under chapter 400.
217 (8)(a) Each provider, or each principal of the provider if
218 the provider is a corporation, partnership, association, or
219 other entity, seeking to participate in the Medicaid program
220 must submit a complete set of his or her fingerprints to the
221 agency for the purpose of conducting a criminal history record
222 check. Principals of the provider include any officer, director,
223 billing agent, managing employee, or affiliated person, or any
224 partner or shareholder who has an ownership interest equal to 5
225 percent or more in the provider. However, for hospitals licensed
226 under chapter 395 and nursing homes licensed under chapter 400,
227 principals of the provider are those who meet the definition of
228 a controlling interest in s. 408.803(7). A director of a not
229 for-profit corporation or organization is not a principal for
230 purposes of a background investigation as required by this
231 section if the director: serves solely in a voluntary capacity
232 for the corporation or organization, does not regularly take
233 part in the day-to-day operational decisions of the corporation
234 or organization, receives no remuneration from the not-for
235 profit corporation or organization for his or her service on the
236 board of directors, has no financial interest in the not-for
237 profit corporation or organization, and has no family members
238 with a financial interest in the not-for-profit corporation or
239 organization; and if the director submits an affidavit, under
240 penalty of perjury, to this effect to the agency and the not
241 for-profit corporation or organization submits an affidavit,
242 under penalty of perjury, to this effect to the agency as part
243 of the corporation’s or organization’s Medicaid provider
244 agreement application. Notwithstanding the above, the agency may
245 require a background check for any person reasonably suspected
246 by the agency to have been convicted of a crime. This subsection
247 does shall not apply to:
248 1. A hospital licensed under chapter 395;
249 2. A nursing home licensed under chapter 400;
250 3. A hospice licensed under chapter 400;
251 4. An assisted living facility licensed under chapter 429;
252 1.5. A unit of local government, except that requirements
253 of this subsection apply to nongovernmental providers and
254 entities when contracting with the local government to provide
255 Medicaid services. The actual cost of the state and national
256 criminal history record checks must be borne by the
257 nongovernmental provider or entity; or
258 2.6. Any business that derives more than 50 percent of its
259 revenue from the sale of goods to the final consumer, and the
260 business or its controlling parent either is required to file a
261 form 10-K or other similar statement with the Securities and
262 Exchange Commission or has a net worth of $50 million or more.
263 (b) Background screening shall be conducted in accordance
264 with chapter 435 and s. 408.809. The agency shall submit the
265 fingerprints to the Department of Law Enforcement. The
266 department shall conduct a state criminal-background
267 investigation and forward the fingerprints to the Federal Bureau
268 of Investigation for a national criminal-history record check.
269 The cost of the state and national criminal record check shall
270 be borne by the provider.
271 (c) The agency may permit a provider to participate in the
272 Medicaid program pending the results of the criminal record
273 check. However, such permission is fully revocable if the record
274 check reveals any crime-related history as provided in
275 subsection (10).
276 (c)(d) Proof of compliance with the requirements of level 2
277 screening under s. 435.04 conducted within 12 months prior to
278 the date that the Medicaid provider application is submitted to
279 the agency shall fulfill the requirements of this subsection.
280 Proof of compliance with the requirements of level 1 screening
281 under s. 435.03 conducted within 12 months prior to the date
282 that the Medicaid provider application is submitted to the
283 agency shall meet the requirement that the Department of Law
284 Enforcement conduct a state criminal history record check.
285 (9) Upon receipt of a completed, signed, and dated
286 application, and completion of any necessary background
287 investigation and criminal history record check, the agency must
288 either:
289 (b) Deny the application if the agency finds that it is in
290 the best interest of the Medicaid program to do so. The agency
291 may consider any the factors listed in subsection (10), as well
292 as any other factor that could affect the effective and
293 efficient administration of the program, including, but not
294 limited to, the applicant’s demonstrated ability to provide
295 services, conduct business, and operate a financially viable
296 concern; the current availability of medical care, services, or
297 supplies to recipients, taking into account geographic location
298 and reasonable travel time; the number of providers of the same
299 type already enrolled in the same geographic area; and the
300 credentials, experience, success, and patient outcomes of the
301 provider for the services that it is making application to
302 provide in the Medicaid program. The agency shall deny the
303 application if the agency finds that a provider; any officer,
304 director, agent, managing employee, or affiliated person; or any
305 principal, partner, or shareholder having an ownership interest
306 equal to 5 percent or greater in the provider if the provider is
307 a corporation, partnership, or other business entity, has failed
308 to pay all outstanding fines or overpayments assessed by final
309 order of the agency or final order of the Centers for Medicare
310 and Medicaid Services, not subject to further appeal, unless the
311 provider agrees to a repayment plan that includes withholding
312 Medicaid reimbursement until the amount due is paid in full.
313 (10) The agency shall deny the application if may consider
314 whether the provider, or any officer, director, agent, managing
315 employee, or affiliated person, or any principal, partner, or
316 shareholder having an ownership interest equal to 5 percent or
317 greater in the provider if the provider is a corporation,
318 partnership, or other business entity, has committed an offense
319 listed in s. 409.913(13), and may deny the application if one of
320 these persons has:
321 (a) Made a false representation or omission of any material
322 fact in making the application, including the submission of an
323 application that conceals the controlling or ownership interest
324 of any officer, director, agent, managing employee, affiliated
325 person, or principal, partner, or shareholder who may not be
326 eligible to participate;
327 (b) Been or is currently excluded, suspended, terminated
328 from, or has involuntarily withdrawn from participation in,
329 Florida’s Medicaid program or any other state’s Medicaid
330 program, or from participation in any other governmental or
331 private health care or health insurance program;
332 (c) Been convicted of a criminal offense relating to the
333 delivery of any goods or services under Medicaid or Medicare or
334 any other public or private health care or health insurance
335 program including the performance of management or
336 administrative services relating to the delivery of goods or
337 services under any such program;
338 (d) Been convicted under federal or state law of a criminal
339 offense related to the neglect or abuse of a patient in
340 connection with the delivery of any health care goods or
341 services;
342 (c)(e) Been convicted under federal or state law of a
343 criminal offense relating to the unlawful manufacture,
344 distribution, prescription, or dispensing of a controlled
345 substance;
346 (d)(f) Been convicted of any criminal offense relating to
347 fraud, theft, embezzlement, breach of fiduciary responsibility,
348 or other financial misconduct;
349 (e)(g) Been convicted under federal or state law of a crime
350 punishable by imprisonment of a year or more which involves
351 moral turpitude;
352 (f)(h) Been convicted in connection with the interference
353 or obstruction of any investigation into any criminal offense
354 listed in this subsection;
355 (g)(i) Been found to have violated federal or state laws,
356 rules, or regulations governing Florida’s Medicaid program or
357 any other state’s Medicaid program, the Medicare program, or any
358 other publicly funded federal or state health care or health
359 insurance program, and been sanctioned accordingly;
360 (h)(j) Been previously found by a licensing, certifying, or
361 professional standards board or agency to have violated the
362 standards or conditions relating to licensure or certification
363 or the quality of services provided; or
364 (i)(k) Failed to pay any fine or overpayment properly
365 assessed under the Medicaid program in which no appeal is
366 pending or after resolution of the proceeding by stipulation or
367 agreement, unless the agency has issued a specific letter of
368 forgiveness or has approved a repayment schedule to which the
369 provider agrees to adhere.
370
371 If the agency determines a provider did not participate or
372 acquiesce in an offense specified in s. 409.913(13), the agency
373 is not required to deny the provider application.
374 Section 5. Subsections (10), (32), and (48) of section
375 409.912, Florida Statutes, are amended to read:
376 409.912 Cost-effective purchasing of health care.—The
377 agency shall purchase goods and services for Medicaid recipients
378 in the most cost-effective manner consistent with the delivery
379 of quality medical care. To ensure that medical services are
380 effectively utilized, the agency may, in any case, require a
381 confirmation or second physician’s opinion of the correct
382 diagnosis for purposes of authorizing future services under the
383 Medicaid program. This section does not restrict access to
384 emergency services or poststabilization care services as defined
385 in 42 C.F.R. part 438.114. Such confirmation or second opinion
386 shall be rendered in a manner approved by the agency. The agency
387 shall maximize the use of prepaid per capita and prepaid
388 aggregate fixed-sum basis services when appropriate and other
389 alternative service delivery and reimbursement methodologies,
390 including competitive bidding pursuant to s. 287.057, designed
391 to facilitate the cost-effective purchase of a case-managed
392 continuum of care. The agency shall also require providers to
393 minimize the exposure of recipients to the need for acute
394 inpatient, custodial, and other institutional care and the
395 inappropriate or unnecessary use of high-cost services. The
396 agency shall contract with a vendor to monitor and evaluate the
397 clinical practice patterns of providers in order to identify
398 trends that are outside the normal practice patterns of a
399 provider’s professional peers or the national guidelines of a
400 provider’s professional association. The vendor must be able to
401 provide information and counseling to a provider whose practice
402 patterns are outside the norms, in consultation with the agency,
403 to improve patient care and reduce inappropriate utilization.
404 The agency may mandate prior authorization, drug therapy
405 management, or disease management participation for certain
406 populations of Medicaid beneficiaries, certain drug classes, or
407 particular drugs to prevent fraud, abuse, overuse, and possible
408 dangerous drug interactions. The Pharmaceutical and Therapeutics
409 Committee shall make recommendations to the agency on drugs for
410 which prior authorization is required. The agency shall inform
411 the Pharmaceutical and Therapeutics Committee of its decisions
412 regarding drugs subject to prior authorization. The agency is
413 authorized to limit the entities it contracts with or enrolls as
414 Medicaid providers by developing a provider network through
415 provider credentialing. The agency may competitively bid single
416 source-provider contracts if procurement of goods or services
417 results in demonstrated cost savings to the state without
418 limiting access to care. The agency may limit its network based
419 on the assessment of beneficiary access to care, provider
420 availability, provider quality standards, time and distance
421 standards for access to care, the cultural competence of the
422 provider network, demographic characteristics of Medicaid
423 beneficiaries, practice and provider-to-beneficiary standards,
424 appointment wait times, beneficiary use of services, provider
425 turnover, provider profiling, provider licensure history,
426 previous program integrity investigations and findings, peer
427 review, provider Medicaid policy and billing compliance records,
428 clinical and medical record audits, and other factors. Providers
429 shall not be entitled to enrollment in the Medicaid provider
430 network. The agency shall determine instances in which allowing
431 Medicaid beneficiaries to purchase durable medical equipment and
432 other goods is less expensive to the Medicaid program than long
433 term rental of the equipment or goods. The agency may establish
434 rules to facilitate purchases in lieu of long-term rentals in
435 order to protect against fraud and abuse in the Medicaid program
436 as defined in s. 409.913. The agency may seek federal waivers
437 necessary to administer these policies.
438 (10) The agency shall not contract on a prepaid or fixed
439 sum basis for Medicaid services with an entity which knows or
440 reasonably should know that any principal, officer, director,
441 agent, managing employee, or owner of stock or beneficial
442 interest in excess of 5 percent common or preferred stock, or
443 the entity itself, has been found guilty of, regardless of
444 adjudication, or entered a plea of nolo contendere, or guilty,
445 to:
446 (a) An offense listed in s. 408.809, s. 409.913(13), or s.
447 435.04 Fraud;
448 (b) Violation of federal or state antitrust statutes,
449 including those proscribing price fixing between competitors and
450 the allocation of customers among competitors;
451 (c) Commission of a felony involving embezzlement, theft,
452 forgery, income tax evasion, bribery, falsification or
453 destruction of records, making false statements, receiving
454 stolen property, making false claims, or obstruction of justice;
455 or
456 (d) Any crime in any jurisdiction which directly relates to
457 the provision of health services on a prepaid or fixed-sum
458 basis.
459 (32) Each managed care plan that is under contract with the
460 agency to provide health care services to Medicaid recipients
461 shall annually conduct a background check with the Florida
462 Department of Law Enforcement of all persons with ownership
463 interest of 5 percent or more or executive management
464 responsibility for the managed care plan and shall submit to the
465 agency information concerning any such person who has been found
466 guilty of, regardless of adjudication, or has entered a plea of
467 nolo contendere or guilty to, any of the offenses listed in s.
468 408.809, s. 409.913(13), or s. 435.04 s. 435.03.
469 (48)(a) A provider is not entitled to enrollment in the
470 Medicaid provider network. The agency may implement a Medicaid
471 fee-for-service provider network controls, including, but not
472 limited to, competitive procurement and provider credentialing.
473 If a credentialing process is used, the agency may limit its
474 provider network based upon the following considerations:
475 beneficiary access to care, provider availability, provider
476 quality standards and quality assurance processes, cultural
477 competency, demographic characteristics of beneficiaries,
478 practice standards, service wait times, provider turnover,
479 provider licensure and accreditation history, program integrity
480 history, peer review, Medicaid policy and billing compliance
481 records, clinical and medical record audit findings, and such
482 other areas that are considered necessary by the agency to
483 ensure the integrity of the program.
484 (b) The agency shall limit its network of durable medical
485 equipment and medical supply providers. For dates of service
486 after January 1, 2009, the agency shall limit payment for
487 durable medical equipment and supplies to providers that meet
488 all the requirements of this paragraph.
489 1. Providers must be accredited by a Centers for Medicare
490 and Medicaid Services deemed accreditation organization for
491 suppliers of durable medical equipment, prosthetics, orthotics,
492 and supplies. The provider must maintain accreditation and is
493 subject to unannounced reviews by the accrediting organization.
494 2. Providers must provide the services or supplies directly
495 to the Medicaid recipient or caregiver at the provider location
496 or recipient’s residence or send the supplies directly to the
497 recipient’s residence with receipt of mailed delivery.
498 Subcontracting or consignment of the service or supply to a
499 third party is prohibited.
500 3. Notwithstanding subparagraph 2., a durable medical
501 equipment provider may store nebulizers at a physician’s office
502 for the purpose of having the physician’s staff issue the
503 equipment if it meets all of the following conditions:
504 a. The physician must document the medical necessity and
505 need to prevent further deterioration of the patient’s
506 respiratory status by the timely delivery of the nebulizer in
507 the physician’s office.
508 b. The durable medical equipment provider must have written
509 documentation of the competency and training by a Florida
510 licensed registered respiratory therapist of any durable medical
511 equipment staff who participate in the training of physician
512 office staff for the use of nebulizers, including cleaning,
513 warranty, and special needs of patients.
514 c. The physician’s office must have documented the training
515 and competency of any staff member who initiates the delivery of
516 nebulizers to patients. The durable medical equipment provider
517 must maintain copies of all physician office training.
518 d. The physician’s office must maintain inventory records
519 of stored nebulizers, including documentation of the durable
520 medical equipment provider source.
521 e. A physician contracted with a Medicaid durable medical
522 equipment provider may not have a financial relationship with
523 that provider or receive any financial gain from the delivery of
524 nebulizers to patients.
525 4. Providers must have a physical business location and a
526 functional landline business phone. The location must be within
527 the state or not more than 50 miles from the Florida state line.
528 The agency may make exceptions for providers of durable medical
529 equipment or supplies not otherwise available from other
530 enrolled providers located within the state.
531 5. Physical business locations must be clearly identified
532 as a business that furnishes durable medical equipment or
533 medical supplies by signage that can be read from 20 feet away.
534 The location must be readily accessible to the public during
535 normal, posted business hours and must operate no less than 5
536 hours per day and no less than 5 days per week, with the
537 exception of scheduled and posted holidays. The location may not
538 be located within or at the same numbered street address as
539 another enrolled Medicaid durable medical equipment or medical
540 supply provider or as an enrolled Medicaid pharmacy that is also
541 enrolled as a durable medical equipment provider. A licensed
542 orthotist or prosthetist that provides only orthotic or
543 prosthetic devices as a Medicaid durable medical equipment
544 provider is exempt from the provisions in this paragraph.
545 6. Providers must maintain a stock of durable medical
546 equipment and medical supplies on site that is readily available
547 to meet the needs of the durable medical equipment business
548 location’s customers.
549 7. Providers must provide a surety bond of $50,000 for each
550 provider location, up to a maximum of 5 bonds statewide or an
551 aggregate bond of $250,000 statewide, as identified by Federal
552 Employer Identification Number. Providers who post a statewide
553 or an aggregate bond must identify all of their locations in any
554 Medicaid durable medical equipment and medical supply provider
555 enrollment application or bond renewal. Each provider location’s
556 surety bond must be renewed annually and the provider must
557 submit proof of renewal even if the original bond is a
558 continuous bond. A licensed orthotist or prosthetist that
559 provides only orthotic or prosthetic devices as a Medicaid
560 durable medical equipment provider is exempt from the provisions
561 in this paragraph.
562 8. Providers must obtain a level 2 background screening, in
563 accordance with chapter 435 and s. 408.809 as provided under s.
564 435.04, for each provider employee in direct contact with or
565 providing direct services to recipients of durable medical
566 equipment and medical supplies in their homes. This requirement
567 includes, but is not limited to, repair and service technicians,
568 fitters, and delivery staff. The provider shall pay for the cost
569 of the background screening.
570 9. The following providers are exempt from the requirements
571 of subparagraphs 1. and 7.:
572 a. Durable medical equipment providers owned and operated
573 by a government entity.
574 b. Durable medical equipment providers that are operating
575 within a pharmacy that is currently enrolled as a Medicaid
576 pharmacy provider.
577 c. Active, Medicaid-enrolled orthopedic physician groups,
578 primarily owned by physicians, which provide only orthotic and
579 prosthetic devices.
580 Section 6. Subsection (13) of section 409.9122, Florida
581 Statutes, is repealed.
582 Section 7. Section 409.913, Florida Statutes, is amended to
583 read:
584 409.913 Oversight of the integrity of the Medicaid
585 program.—The agency shall operate a program to oversee the
586 activities of Florida Medicaid recipients, and providers and
587 their representatives, to ensure that fraudulent and abusive
588 behavior and neglect of recipients occur to the minimum extent
589 possible, and to recover overpayments and impose sanctions as
590 appropriate. Beginning January 1, 2003, and each year
591 thereafter, the agency and the Medicaid Fraud Control Unit of
592 the Department of Legal Affairs shall submit a joint report to
593 the Legislature documenting the effectiveness of the state’s
594 efforts to control Medicaid fraud and abuse and to recover
595 Medicaid overpayments during the previous fiscal year. The
596 report must describe the number of cases opened and investigated
597 each year; the sources of the cases opened; the disposition of
598 the cases closed each year; the amount of overpayments alleged
599 in preliminary and final audit letters; the number and amount of
600 fines or penalties imposed; any reductions in overpayment
601 amounts negotiated in settlement agreements or by other means;
602 the amount of final agency determinations of overpayments; the
603 amount deducted from federal claiming as a result of
604 overpayments; the amount of overpayments recovered each year;
605 the amount of cost of investigation recovered each year; the
606 average length of time to collect from the time the case was
607 opened until the overpayment is paid in full; the amount
608 determined as uncollectible and the portion of the uncollectible
609 amount subsequently reclaimed from the Federal Government; the
610 number of providers, by type, that are terminated from
611 participation in the Medicaid program as a result of fraud and
612 abuse; and all costs associated with discovering and prosecuting
613 cases of Medicaid overpayments and making recoveries in such
614 cases. The report must also document actions taken to prevent
615 overpayments and the number of providers prevented from
616 enrolling in or reenrolling in the Medicaid program as a result
617 of documented Medicaid fraud and abuse and must include policy
618 recommendations necessary to prevent or recover overpayments and
619 changes necessary to prevent and detect Medicaid fraud. All
620 policy recommendations in the report must include a detailed
621 fiscal analysis, including, but not limited to, implementation
622 costs, estimated savings to the Medicaid program, and the return
623 on investment. The agency must submit the policy recommendations
624 and fiscal analyses in the report to the appropriate estimating
625 conference, pursuant to s. 216.137, by February 15 of each year.
626 The agency and the Medicaid Fraud Control Unit of the Department
627 of Legal Affairs each must include detailed unit-specific
628 performance standards, benchmarks, and metrics in the report,
629 including projected cost savings to the state Medicaid program
630 during the following fiscal year.
631 (1) For the purposes of this section, the term:
632 (a) “Abuse” means:
633 1. Provider practices that are inconsistent with generally
634 accepted business or medical practices and that result in an
635 unnecessary cost to the Medicaid program or in reimbursement for
636 goods or services that are not medically necessary or that fail
637 to meet professionally recognized standards for health care.
638 2. Recipient practices that result in unnecessary cost to
639 the Medicaid program.
640 (b) “Complaint” means an allegation that fraud, abuse, or
641 an overpayment has occurred.
642 (c) “Fraud” means an intentional deception or
643 misrepresentation made by a person with the knowledge that the
644 deception results in unauthorized benefit to herself or himself
645 or another person. The term includes any act that constitutes
646 fraud under applicable federal or state law.
647 (d) “Medical necessity” or “medically necessary” means any
648 goods or services necessary to palliate the effects of a
649 terminal condition, or to prevent, diagnose, correct, cure,
650 alleviate, or preclude deterioration of a condition that
651 threatens life, causes pain or suffering, or results in illness
652 or infirmity, which goods or services are provided in accordance
653 with generally accepted standards of medical practice. For
654 purposes of determining Medicaid reimbursement, the agency is
655 the final arbiter of medical necessity. Determinations of
656 medical necessity must be made by a licensed physician employed
657 by or under contract with the agency and must be based upon
658 information available at the time the goods or services are
659 provided.
660 (e) “Overpayment” includes any amount that is not
661 authorized to be paid by the Medicaid program whether paid as a
662 result of inaccurate or improper cost reporting, improper
663 claiming, unacceptable practices, fraud, abuse, or mistake.
664 (f) “Person” means any natural person, corporation,
665 partnership, association, clinic, group, or other entity,
666 whether or not such person is enrolled in the Medicaid program
667 or is a provider of health care.
668 (2) The agency shall conduct, or cause to be conducted by
669 contract or otherwise, reviews, investigations, analyses,
670 audits, or any combination thereof, to determine possible fraud,
671 abuse, overpayment, or recipient neglect in the Medicaid program
672 and shall report the findings of any overpayments in audit
673 reports as appropriate. At least 5 percent of all audits shall
674 be conducted on a random basis. As part of its ongoing fraud
675 detection activities, the agency shall identify and monitor, by
676 contract or otherwise, patterns of overutilization of Medicaid
677 services based on state averages. The agency shall track
678 Medicaid provider prescription and billing patterns and evaluate
679 them against Medicaid medical necessity criteria and coverage
680 and limitation guidelines adopted by rule. Medical necessity
681 determination requires that service be consistent with symptoms
682 or confirmed diagnosis of illness or injury under treatment and
683 not in excess of the patient’s needs. The agency shall conduct
684 reviews of provider exceptions to peer group norms and shall,
685 using statistical methodologies, provider profiling, and
686 analysis of billing patterns, detect and investigate abnormal or
687 unusual increases in billing or payment of claims for Medicaid
688 services and medically unnecessary provision of services.
689 (3) The agency may conduct, or may contract for, prepayment
690 review of provider claims to ensure cost-effective purchasing;
691 to ensure that billing by a provider to the agency is in
692 accordance with applicable provisions of all Medicaid rules,
693 regulations, handbooks, and policies and in accordance with
694 federal, state, and local law; and to ensure that appropriate
695 care is rendered to Medicaid recipients. Such prepayment reviews
696 may be conducted as determined appropriate by the agency,
697 without any suspicion or allegation of fraud, abuse, or neglect,
698 and may last for up to 1 year. Unless the agency has reliable
699 evidence of fraud, misrepresentation, abuse, or neglect, claims
700 shall be adjudicated for denial or payment within 90 days after
701 receipt of complete documentation by the agency for review. If
702 there is reliable evidence of fraud, misrepresentation, abuse,
703 or neglect, claims shall be adjudicated for denial of payment
704 within 180 days after receipt of complete documentation by the
705 agency for review.
706 (4) Any suspected criminal violation identified by the
707 agency must be referred to the Medicaid Fraud Control Unit of
708 the Office of the Attorney General for investigation. The agency
709 and the Attorney General shall enter into a memorandum of
710 understanding, which must include, but need not be limited to, a
711 protocol for regularly sharing information and coordinating
712 casework. The protocol must establish a procedure for the
713 referral by the agency of cases involving suspected Medicaid
714 fraud to the Medicaid Fraud Control Unit for investigation, and
715 the return to the agency of those cases where investigation
716 determines that administrative action by the agency is
717 appropriate. Offices of the Medicaid program integrity program
718 and the Medicaid Fraud Control Unit of the Department of Legal
719 Affairs, shall, to the extent possible, be collocated. The
720 agency and the Department of Legal Affairs shall periodically
721 conduct joint training and other joint activities designed to
722 increase communication and coordination in recovering
723 overpayments.
724 (5) A Medicaid provider is subject to having goods and
725 services that are paid for by the Medicaid program reviewed by
726 an appropriate peer-review organization designated by the
727 agency. The written findings of the applicable peer-review
728 organization are admissible in any court or administrative
729 proceeding as evidence of medical necessity or the lack thereof.
730 (6) Any notice required to be given to a provider under
731 this section is presumed to be sufficient notice if sent to the
732 address last shown on the provider enrollment file. It is the
733 responsibility of the provider to furnish and keep the agency
734 informed of the provider’s current address. United States Postal
735 Service proof of mailing or certified or registered mailing of
736 such notice to the provider at the address shown on the provider
737 enrollment file constitutes sufficient proof of notice. Any
738 notice required to be given to the agency by this section must
739 be sent to the agency at an address designated by rule.
740 (7) When presenting a claim for payment under the Medicaid
741 program, a provider has an affirmative duty to supervise the
742 provision of, and be responsible for, goods and services claimed
743 to have been provided, to supervise and be responsible for
744 preparation and submission of the claim, and to present a claim
745 that is true and accurate and that is for goods and services
746 that:
747 (a) Have actually been furnished to the recipient by the
748 provider prior to submitting the claim.
749 (b) Are Medicaid-covered goods or services that are
750 medically necessary.
751 (c) Are of a quality comparable to those furnished to the
752 general public by the provider’s peers.
753 (d) Have not been billed in whole or in part to a recipient
754 or a recipient’s responsible party, except for such copayments,
755 coinsurance, or deductibles as are authorized by the agency.
756 (e) Are provided in accord with applicable provisions of
757 all Medicaid rules, regulations, handbooks, and policies and in
758 accordance with federal, state, and local law.
759 (f) Are documented by records made at the time the goods or
760 services were provided, demonstrating the medical necessity for
761 the goods or services rendered. Medicaid goods or services are
762 excessive or not medically necessary unless both the medical
763 basis and the specific need for them are fully and properly
764 documented in the recipient’s medical record.
765
766 The agency shall deny payment or require repayment for goods or
767 services that are not presented as required in this subsection.
768 (8) The agency shall not reimburse any person or entity for
769 any prescription for medications, medical supplies, or medical
770 services if the prescription was written by a physician or other
771 prescribing practitioner who is not enrolled in the Medicaid
772 program. This section does not apply:
773 (a) In instances involving bona fide emergency medical
774 conditions as determined by the agency;
775 (b) To a provider of medical services to a patient in a
776 hospital emergency department, hospital inpatient or outpatient
777 setting, or nursing home;
778 (c) To bona fide pro bono services by preapproved non
779 Medicaid providers as determined by the agency;
780 (d) To prescribing physicians who are board-certified
781 specialists treating Medicaid recipients referred for treatment
782 by a treating physician who is enrolled in the Medicaid program;
783 (e) To prescriptions written for dually eligible Medicare
784 beneficiaries by an authorized Medicare provider who is not
785 enrolled in the Medicaid program;
786 (f) To other physicians who are not enrolled in the
787 Medicaid program but who provide a medically necessary service
788 or prescription not otherwise reasonably available from a
789 Medicaid-enrolled physician; or
790 (9) A Medicaid provider shall retain medical, professional,
791 financial, and business records pertaining to services and goods
792 furnished to a Medicaid recipient and billed to Medicaid for a
793 period of 6 5 years after the date of furnishing such services
794 or goods. The agency may investigate, review, or analyze such
795 records, which must be made available during normal business
796 hours. However, 24-hour notice must be provided if patient
797 treatment would be disrupted. The provider is responsible for
798 furnishing to the agency, and keeping the agency informed of the
799 location of, the provider’s Medicaid-related records. The
800 authority of the agency to obtain Medicaid-related records from
801 a provider is neither curtailed nor limited during a period of
802 litigation between the agency and the provider.
803 (10) Payments for the services of billing agents or persons
804 participating in the preparation of a Medicaid claim shall not
805 be based on amounts for which they bill nor based on the amount
806 a provider receives from the Medicaid program.
807 (11) The agency shall deny payment or require repayment for
808 inappropriate, medically unnecessary, or excessive goods or
809 services from the person furnishing them, the person under whose
810 supervision they were furnished, or the person causing them to
811 be furnished.
812 (12) The complaint and all information obtained pursuant to
813 an investigation of a Medicaid provider, or the authorized
814 representative or agent of a provider, relating to an allegation
815 of fraud, abuse, or neglect are confidential and exempt from the
816 provisions of s. 119.07(1):
817 (a) Until the agency takes final agency action with respect
818 to the provider and requires repayment of any overpayment, or
819 imposes an administrative sanction;
820 (b) Until the Attorney General refers the case for criminal
821 prosecution;
822 (c) Until 10 days after the complaint is determined without
823 merit; or
824 (d) At all times if the complaint or information is
825 otherwise protected by law.
826 (13) The agency shall immediately terminate participation
827 of a Medicaid provider in the Medicaid program and may seek
828 civil remedies or impose other administrative sanctions against
829 a Medicaid provider, if the provider or any principal, officer,
830 director, agent, managing employee, or affiliated person of the
831 provider, or any partner or shareholder having an ownership
832 interest in the provider equal to 5 percent or greater, has
833 been:
834 (a) Convicted of a criminal offense related to the delivery
835 of any health care goods or services, including the performance
836 of management or administrative functions relating to the
837 delivery of health care goods or services;
838 (b) Convicted of a criminal offense under federal law or
839 the law of any state relating to the practice of the provider’s
840 profession; or
841 (c) Found by a court of competent jurisdiction to have
842 neglected or physically abused a patient in connection with the
843 delivery of health care goods or services.
844
845 If the agency determines a provider did not participate or
846 acquiesce in an offense specified in paragraph (a), paragraph
847 (b), or paragraph (c), termination will not be imposed. If the
848 agency effects a termination under this subsection, the agency
849 shall issue an immediate termination final order as provided in
850 subsection (16) pursuant to s. 120.569(2)(n).
851 (14) If the provider has been suspended or terminated from
852 participation in the Medicaid program or the Medicare program by
853 the Federal Government or any state, the agency must immediately
854 suspend or terminate, as appropriate, the provider’s
855 participation in this state’s Medicaid program for a period no
856 less than that imposed by the Federal Government or any other
857 state, and may not enroll such provider in this state’s Medicaid
858 program while such foreign suspension or termination remains in
859 effect. The agency shall also immediately suspend or terminate,
860 as appropriate, a provider’s participation in this state’s
861 Medicaid program if the provider participated or acquiesced in
862 any action for which any principal, officer, director, agent,
863 managing employee, or affiliated person of the provider, or any
864 partner or shareholder having an ownership interest in the
865 provider equal to 5 percent or greater, was suspended or
866 terminated from participating in the Medicaid program or the
867 Medicare program by the Federal Government or any state. This
868 sanction is in addition to all other remedies provided by law.
869 If the agency suspends or terminates a provider’s participation
870 in the state’s Medicaid program under this subsection, the
871 agency shall issue an immediate suspension or immediate
872 termination order as provided in subsection (16).
873 (15) The agency shall seek a remedy provided by law,
874 including, but not limited to, any remedy provided in
875 subsections (13) and (16) and s. 812.035, if:
876 (a) The provider’s license has not been renewed, or has
877 been revoked, suspended, or terminated, for cause, by the
878 licensing agency of any state;
879 (b) The provider has failed to make available or has
880 refused access to Medicaid-related records to an auditor,
881 investigator, or other authorized employee or agent of the
882 agency, the Attorney General, a state attorney, or the Federal
883 Government;
884 (c) The provider has not furnished or has failed to make
885 available such Medicaid-related records as the agency has found
886 necessary to determine whether Medicaid payments are or were due
887 and the amounts thereof;
888 (d) The provider has failed to maintain medical records
889 made at the time of service, or prior to service if prior
890 authorization is required, demonstrating the necessity and
891 appropriateness of the goods or services rendered;
892 (e) The provider is not in compliance with provisions of
893 Medicaid provider publications that have been adopted by
894 reference as rules in the Florida Administrative Code; with
895 provisions of state or federal laws, rules, or regulations; with
896 provisions of the provider agreement between the agency and the
897 provider; or with certifications found on claim forms or on
898 transmittal forms for electronically submitted claims that are
899 submitted by the provider or authorized representative, as such
900 provisions apply to the Medicaid program;
901 (f) The provider or person who ordered or prescribed the
902 care, services, or supplies has furnished, or ordered the
903 furnishing of, goods or services to a recipient which are
904 inappropriate, unnecessary, excessive, or harmful to the
905 recipient or are of inferior quality;
906 (g) The provider has demonstrated a pattern of failure to
907 provide goods or services that are medically necessary;
908 (h) The provider or an authorized representative of the
909 provider, or a person who ordered or prescribed the goods or
910 services, has submitted or caused to be submitted false or a
911 pattern of erroneous Medicaid claims;
912 (i) The provider or an authorized representative of the
913 provider, or a person who has ordered or prescribed the goods or
914 services, has submitted or caused to be submitted a Medicaid
915 provider enrollment application, a request for prior
916 authorization for Medicaid services, a drug exception request,
917 or a Medicaid cost report that contains materially false or
918 incorrect information;
919 (j) The provider or an authorized representative of the
920 provider has collected from or billed a recipient or a
921 recipient’s responsible party improperly for amounts that should
922 not have been so collected or billed by reason of the provider’s
923 billing the Medicaid program for the same service;
924 (k) The provider or an authorized representative of the
925 provider has included in a cost report costs that are not
926 allowable under a Florida Title XIX reimbursement plan, after
927 the provider or authorized representative had been advised in an
928 audit exit conference or audit report that the costs were not
929 allowable;
930 (l) The provider is charged by information or indictment
931 with fraudulent billing practices or an offense under subsection
932 (13). The sanction applied for this reason is limited to
933 suspension of the provider’s participation in the Medicaid
934 program for the duration of the indictment unless the provider
935 is found guilty pursuant to the information or indictment;
936 (m) The provider or a person who has ordered or prescribed
937 the goods or services is found liable for negligent practice
938 resulting in death or injury to the provider’s patient;
939 (n) The provider fails to demonstrate that it had available
940 during a specific audit or review period sufficient quantities
941 of goods, or sufficient time in the case of services, to support
942 the provider’s billings to the Medicaid program;
943 (o) The provider has failed to comply with the notice and
944 reporting requirements of s. 409.907;
945 (p) The agency has received reliable information of patient
946 abuse or neglect or of any act prohibited by s. 409.920; or
947 (q) The provider has failed to comply with an agreed-upon
948 repayment schedule.
949
950 A provider is subject to sanctions for violations of this
951 subsection as the result of actions or inactions of the
952 provider, or actions or inactions of any principal, officer,
953 director, agent, managing employee, or affiliated person of the
954 provider, or any partner or shareholder having an ownership
955 interest in the provider equal to 5 percent or greater, in which
956 the provider participated or acquiesced. If the agency
957 immediately suspends or immediately terminates a provider under
958 this subsection, the agency shall issue an immediate suspension
959 or immediate termination order as provided in subsection (16).
960 (16) The agency shall impose any of the following sanctions
961 or disincentives on a provider or a person for any of the acts
962 described in subsection (15):
963 (a) Suspension for a specific period of time of not more
964 than 1 year. Suspension shall preclude participation in the
965 Medicaid program, which includes any action that results in a
966 claim for payment to the Medicaid program as a result of
967 furnishing, supervising a person who is furnishing, or causing a
968 person to furnish goods or services.
969 (b) Termination for a specific period of time of from more
970 than 1 year to 20 years. Termination shall preclude
971 participation in the Medicaid program, which includes any action
972 that results in a claim for payment to the Medicaid program as a
973 result of furnishing, supervising a person who is furnishing, or
974 causing a person to furnish goods or services.
975 (c) Imposition of a fine of up to $5,000 for each
976 violation. Each day that an ongoing violation continues, such as
977 refusing to furnish Medicaid-related records or refusing access
978 to records, is considered, for the purposes of this section, to
979 be a separate violation. Each instance of improper billing of a
980 Medicaid recipient; each instance of including an unallowable
981 cost on a hospital or nursing home Medicaid cost report after
982 the provider or authorized representative has been advised in an
983 audit exit conference or previous audit report of the cost
984 unallowability; each instance of furnishing a Medicaid recipient
985 goods or professional services that are inappropriate or of
986 inferior quality as determined by competent peer judgment; each
987 instance of knowingly submitting a materially false or erroneous
988 Medicaid provider enrollment application, request for prior
989 authorization for Medicaid services, drug exception request, or
990 cost report; each instance of inappropriate prescribing of drugs
991 for a Medicaid recipient as determined by competent peer
992 judgment; and each false or erroneous Medicaid claim leading to
993 an overpayment to a provider is considered, for the purposes of
994 this section, to be a separate violation.
995 (d) Immediate suspension, if the agency has received
996 information of patient abuse or neglect, or of any act
997 prohibited by s. 409.920, or any conduct listed in subsection
998 (13) or subsection (14). Upon suspension, the agency must issue
999 an immediate suspension final order, which shall state that the
1000 agency has reasonable cause to believe that the provider,
1001 person, or entity named is engaging in or has engaged in patient
1002 abuse or neglect, any act prohibited by s. 409.920, or any
1003 conduct listed in subsection (13) or subsection (14). The order
1004 shall provide notice of administrative hearing rights under ss.
1005 120.569 and 120.57 and is effective immediately upon notice to
1006 the provider, person, or entity under s. 120.569(2)(n).
1007 (e) Immediate termination, if the agency has received
1008 information of a conviction based on patient abuse or neglect,
1009 any act prohibited by s. 409.920, or any conduct listed in
1010 subsection (13) or subsection (14). Upon termination, the agency
1011 must issue an immediate termination order, which shall state
1012 that the agency has reasonable cause to believe that the
1013 provider, person, or entity named has been convicted of patient
1014 abuse or neglect, any act prohibited by s. 409.920, or any
1015 conduct listed in subsection (13) or subsection (14). The
1016 termination order shall provide notice of administrative hearing
1017 rights under ss. 120.569 and 120.57 and is effective immediately
1018 upon notice to the provider, person, or entity.
1019 (f)(e) A fine, not to exceed $10,000, for a violation of
1020 paragraph (15)(i).
1021 (g)(f) Imposition of liens against provider assets,
1022 including, but not limited to, financial assets and real
1023 property, not to exceed the amount of fines or recoveries
1024 sought, upon entry of an order determining that such moneys are
1025 due or recoverable.
1026 (h)(g) Prepayment reviews of claims for a specified period
1027 of time.
1028 (i)(h) Comprehensive followup reviews of providers every 6
1029 months to ensure that they are billing Medicaid correctly.
1030 (j)(i) Corrective-action plans that would remain in effect
1031 for providers for up to 3 years and that would be monitored by
1032 the agency every 6 months while in effect.
1033 (k)(j) Other remedies as permitted by law to effect the
1034 recovery of a fine or overpayment.
1035
1036 The Secretary of Health Care Administration may make a
1037 determination that imposition of a sanction or disincentive is
1038 not in the best interest of the Medicaid program, in which case
1039 a sanction or disincentive shall not be imposed.
1040 (17) In determining the appropriate administrative sanction
1041 to be applied, or the duration of any suspension or termination,
1042 the agency shall consider:
1043 (a) The seriousness and extent of the violation or
1044 violations.
1045 (b) Any prior history of violations by the provider
1046 relating to the delivery of health care programs which resulted
1047 in either a criminal conviction or in administrative sanction or
1048 penalty.
1049 (c) Evidence of continued violation within the provider’s
1050 management control of Medicaid statutes, rules, regulations, or
1051 policies after written notification to the provider of improper
1052 practice or instance of violation.
1053 (d) The effect, if any, on the quality of medical care
1054 provided to Medicaid recipients as a result of the acts of the
1055 provider.
1056 (e) Any action by a licensing agency respecting the
1057 provider in any state in which the provider operates or has
1058 operated.
1059 (f) The apparent impact on access by recipients to Medicaid
1060 services if the provider is suspended or terminated, in the best
1061 judgment of the agency.
1062
1063 The agency shall document the basis for all sanctioning actions
1064 and recommendations.
1065 (18) The agency may take action to sanction, suspend, or
1066 terminate a particular provider working for a group provider,
1067 and may suspend or terminate Medicaid participation at a
1068 specific location, rather than or in addition to taking action
1069 against an entire group.
1070 (19) The agency shall establish a process for conducting
1071 followup reviews of a sampling of providers who have a history
1072 of overpayment under the Medicaid program. This process must
1073 consider the magnitude of previous fraud or abuse and the
1074 potential effect of continued fraud or abuse on Medicaid costs.
1075 (20) In making a determination of overpayment to a
1076 provider, the agency must use accepted and valid auditing,
1077 accounting, analytical, statistical, or peer-review methods, or
1078 combinations thereof. Appropriate statistical methods may
1079 include, but are not limited to, sampling and extension to the
1080 population, parametric and nonparametric statistics, tests of
1081 hypotheses, and other generally accepted statistical methods.
1082 Appropriate analytical methods may include, but are not limited
1083 to, reviews to determine variances between the quantities of
1084 products that a provider had on hand and available to be
1085 purveyed to Medicaid recipients during the review period and the
1086 quantities of the same products paid for by the Medicaid program
1087 for the same period, taking into appropriate consideration sales
1088 of the same products to non-Medicaid customers during the same
1089 period. In meeting its burden of proof in any administrative or
1090 court proceeding, the agency may introduce the results of such
1091 statistical methods as evidence of overpayment.
1092 (21) When making a determination that an overpayment has
1093 occurred, the agency shall prepare and issue an audit report to
1094 the provider showing the calculation of overpayments.
1095 (22) The audit report, supported by agency work papers,
1096 showing an overpayment to a provider constitutes evidence of the
1097 overpayment. A provider may not present or elicit testimony,
1098 either on direct examination or cross-examination in any court
1099 or administrative proceeding, regarding the purchase or
1100 acquisition by any means of drugs, goods, or supplies; sales or
1101 divestment by any means of drugs, goods, or supplies; or
1102 inventory of drugs, goods, or supplies, unless such acquisition,
1103 sales, divestment, or inventory is documented by written
1104 invoices, written inventory records, or other competent written
1105 documentary evidence maintained in the normal course of the
1106 provider’s business. Notwithstanding the applicable rules of
1107 discovery, all documentation that will be offered as evidence at
1108 an administrative hearing on a Medicaid overpayment must be
1109 exchanged by all parties at least 14 days before the
1110 administrative hearing or must be excluded from consideration.
1111 (23)(a) In an audit or investigation of a violation
1112 committed by a provider which is conducted pursuant to this
1113 section, the agency is entitled to recover all investigative,
1114 legal, and expert witness costs if the agency’s findings were
1115 not contested by the provider or, if contested, the agency
1116 ultimately prevailed.
1117 (b) The agency has the burden of documenting the costs,
1118 which include salaries and employee benefits and out-of-pocket
1119 expenses. The amount of costs that may be recovered must be
1120 reasonable in relation to the seriousness of the violation and
1121 must be set taking into consideration the financial resources,
1122 earning ability, and needs of the provider, who has the burden
1123 of demonstrating such factors.
1124 (c) The provider may pay the costs over a period to be
1125 determined by the agency if the agency determines that an
1126 extreme hardship would result to the provider from immediate
1127 full payment. Any default in payment of costs may be collected
1128 by any means authorized by law.
1129 (24) If the agency imposes an administrative sanction
1130 pursuant to subsection (13), subsection (14), or subsection
1131 (15), except paragraphs (15)(e) and (o), upon any provider or
1132 any principal, officer, director, agent, managing employee, or
1133 affiliated person of the provider who is regulated by another
1134 state entity, the agency shall notify that other entity of the
1135 imposition of the sanction within 5 business days. Such
1136 notification must include the provider’s or person’s name and
1137 license number and the specific reasons for sanction.
1138 (25)(a) The agency shall withhold Medicaid payments, in
1139 whole or in part, to a provider upon receipt of reliable
1140 evidence that the circumstances giving rise to the need for a
1141 withholding of payments involve fraud, willful
1142 misrepresentation, or abuse under the Medicaid program, or a
1143 crime committed while rendering goods or services to Medicaid
1144 recipients. If the provider is not paid within 14 days after the
1145 agency receives evidence it is determined that fraud, willful
1146 misrepresentation, abuse, or a crime did not occur, interest
1147 shall accrue at a rate of 10 percent a year the payments
1148 withheld must be paid to the provider within 14 days after such
1149 determination with interest at the rate of 10 percent a year.
1150 Any money withheld in accordance with this paragraph shall be
1151 placed in a suspended account, readily accessible to the agency,
1152 so that any payment ultimately due the provider shall be made
1153 within 14 days.
1154 (b) The agency shall deny payment, or require repayment, if
1155 the goods or services were furnished, supervised, or caused to
1156 be furnished by a person who has been convicted of a crime under
1157 subsection (13) or who has been suspended or terminated from the
1158 Medicaid program or Medicare program by the Federal Government
1159 or any state.
1160 (c) Overpayments owed to the agency bear interest at the
1161 rate of 10 percent per year from the date of determination of
1162 the overpayment by the agency, and payment arrangements for
1163 overpayments and fines must be made within 35 days after the
1164 date of the final order at the conclusion of legal proceedings.
1165 A provider who does not enter into or adhere to an agreed-upon
1166 repayment schedule may be terminated by the agency for
1167 nonpayment or partial payment.
1168 (d) The agency, upon entry of a final agency order, a
1169 judgment or order of a court of competent jurisdiction, or a
1170 stipulation or settlement, may collect the moneys owed by all
1171 means allowable by law, including, but not limited to, notifying
1172 any fiscal intermediary of Medicare benefits that the state has
1173 a superior right of payment. Upon receipt of such written
1174 notification, the Medicare fiscal intermediary shall remit to
1175 the state the sum claimed.
1176 (e) The agency may institute amnesty programs to allow
1177 Medicaid providers the opportunity to voluntarily repay
1178 overpayments. The agency may adopt rules to administer such
1179 programs.
1180 (26) The agency may impose administrative sanctions against
1181 a Medicaid recipient, or the agency may seek any other remedy
1182 provided by law, including, but not limited to, the remedies
1183 provided in s. 812.035, if the agency finds that a recipient has
1184 engaged in solicitation in violation of s. 409.920 or that the
1185 recipient has otherwise abused the Medicaid program.
1186 (27) When the Agency for Health Care Administration has
1187 made a probable cause determination and alleged that an
1188 overpayment to a Medicaid provider has occurred, the agency,
1189 after notice to the provider, shall:
1190 (a) Withhold, and continue to withhold during the pendency
1191 of an administrative hearing pursuant to chapter 120, any
1192 medical assistance reimbursement payments until such time as the
1193 overpayment is recovered, unless within 30 days after receiving
1194 notice thereof the provider:
1195 1. Makes repayment in full; or
1196 2. Establishes a repayment plan that is satisfactory to the
1197 Agency for Health Care Administration.
1198 (b) Withhold, and continue to withhold during the pendency
1199 of an administrative hearing pursuant to chapter 120, medical
1200 assistance reimbursement payments if the terms of a repayment
1201 plan are not adhered to by the provider.
1202 (28) Venue for all Medicaid program integrity overpayment
1203 cases shall lie in Leon County, at the discretion of the agency.
1204 (29) Notwithstanding other provisions of law, the agency
1205 and the Medicaid Fraud Control Unit of the Department of Legal
1206 Affairs may review a provider’s Medicaid-related and non
1207 Medicaid-related records in order to determine the total output
1208 of a provider’s practice to reconcile quantities of goods or
1209 services billed to Medicaid with quantities of goods or services
1210 used in the provider’s total practice.
1211 (30) The agency shall terminate a provider’s participation
1212 in the Medicaid program if the provider fails to reimburse an
1213 overpayment or fine that has been determined by final order, not
1214 subject to further appeal, within 35 days after the date of the
1215 final order, unless the provider and the agency have entered
1216 into a repayment agreement.
1217 (31) If a provider requests an administrative hearing
1218 pursuant to chapter 120, such hearing must be conducted within
1219 90 days following assignment of an administrative law judge,
1220 absent exceptionally good cause shown as determined by the
1221 administrative law judge or hearing officer. Upon issuance of a
1222 final order, the outstanding balance of the amount determined to
1223 constitute the overpayment or fine shall become due. If a
1224 provider fails to make payments in full, fails to enter into a
1225 satisfactory repayment plan, or fails to comply with the terms
1226 of a repayment plan or settlement agreement, the agency shall
1227 withhold medical assistance reimbursement payments until the
1228 amount due is paid in full.
1229 (32) Duly authorized agents and employees of the agency
1230 shall have the power to inspect, during normal business hours,
1231 the records of any pharmacy, wholesale establishment, or
1232 manufacturer, or any other place in which drugs and medical
1233 supplies are manufactured, packed, packaged, made, stored, sold,
1234 or kept for sale, for the purpose of verifying the amount of
1235 drugs and medical supplies ordered, delivered, or purchased by a
1236 provider. The agency shall provide at least 2 business days’
1237 prior notice of any such inspection. The notice must identify
1238 the provider whose records will be inspected, and the inspection
1239 shall include only records specifically related to that
1240 provider.
1241 (33) In accordance with federal law, Medicaid recipients
1242 convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
1243 limited, restricted, or suspended from Medicaid eligibility for
1244 a period not to exceed 1 year, as determined by the agency head
1245 or designee.
1246 (34) To deter fraud and abuse in the Medicaid program, the
1247 agency may limit the number of Schedule II and Schedule III
1248 refill prescription claims submitted from a pharmacy provider.
1249 The agency shall limit the allowable amount of reimbursement of
1250 prescription refill claims for Schedule II and Schedule III
1251 pharmaceuticals if the agency or the Medicaid Fraud Control Unit
1252 determines that the specific prescription refill was not
1253 requested by the Medicaid recipient or authorized representative
1254 for whom the refill claim is submitted or was not prescribed by
1255 the recipient’s medical provider or physician. Any such refill
1256 request must be consistent with the original prescription.
1257 (35) The Office of Program Policy Analysis and Government
1258 Accountability shall provide a report to the President of the
1259 Senate and the Speaker of the House of Representatives on a
1260 biennial basis, beginning January 31, 2006, on the agency’s and
1261 the Medicaid Fraud Control Unit’s efforts to prevent, detect,
1262 and deter, as well as recover funds lost to, fraud and abuse in
1263 the Medicaid program.
1264 (36) At least three times a year, the agency shall provide
1265 to each Medicaid recipient or his or her representative an
1266 explanation of benefits in the form of a letter that is mailed
1267 to the most recent address of the recipient on the record with
1268 the Department of Children and Family Services. The explanation
1269 of benefits must include the patient’s name, the name of the
1270 health care provider and the address of the location where the
1271 service was provided, a description of all services billed to
1272 Medicaid in terminology that should be understood by a
1273 reasonable person, and information on how to report
1274 inappropriate or incorrect billing to the agency or other law
1275 enforcement entities for review or investigation. At least once
1276 a year, the letter also must include information on how to
1277 report criminal Medicaid fraud, the Medicaid Fraud Control
1278 Unit’s toll-free hotline number, and information about the
1279 rewards available under s. 409.9203. The explanation of benefits
1280 may not be mailed for Medicaid independent laboratory services
1281 as described in s. 409.905(7) or for Medicaid certified match
1282 services as described in ss. 409.9071 and 1011.70.
1283 (37) The agency shall post on its website a current list of
1284 each Medicaid provider, including any principal, officer,
1285 director, agent, managing employee, or affiliated person of the
1286 provider, or any partner or shareholder having an ownership
1287 interest in the provider equal to 5 percent or greater, who has
1288 been terminated for cause from the Medicaid program or
1289 sanctioned under this section. The list must be searchable by a
1290 variety of search parameters and provide for the creation of
1291 formatted lists that may be printed or imported into other
1292 applications, including spreadsheets. The agency shall update
1293 the list at least monthly.
1294 (38) In order to improve the detection of health care
1295 fraud, use technology to prevent and detect fraud, and maximize
1296 the electronic exchange of health care fraud information, the
1297 agency shall:
1298 (a) Compile, maintain, and publish on its website a
1299 detailed list of all state and federal databases that contain
1300 health care fraud information and update the list at least
1301 biannually;
1302 (b) Develop a strategic plan to connect all databases that
1303 contain health care fraud information to facilitate the
1304 electronic exchange of health information between the agency,
1305 the Department of Health, the Department of Law Enforcement, and
1306 the Attorney General’s Office. The plan must include recommended
1307 standard data formats, fraud identification strategies, and
1308 specifications for the technical interface between state and
1309 federal health care fraud databases;
1310 (c) Monitor innovations in health information technology,
1311 specifically as it pertains to Medicaid fraud prevention and
1312 detection; and
1313 (d) Periodically publish policy briefs that highlight
1314 available new technology to prevent or detect health care fraud
1315 and projects implemented by other states, the private sector, or
1316 the Federal Government which use technology to prevent or detect
1317 health care fraud.
1318 Section 8. Subsection (5) is added to section 409.9203,
1319 Florida Statutes, to read:
1320 409.9203 Rewards for reporting Medicaid fraud.—
1321 (5) An employee of the Agency for Health Care
1322 Administration, the Department of Legal Affairs, the Department
1323 of Health, or the Department of Law Enforcement whose job
1324 responsibilities include the prevention, detection, and
1325 prosecution of Medicaid fraud is not eligible to receive a
1326 reward under this section.
1327 Section 9. Subsection (8) is added to section 456.001,
1328 Florida Statutes, to read:
1329 456.001 Definitions.—As used in this chapter, the term:
1330 (8) “Affiliate” or “affiliated person” means any person who
1331 directly or indirectly manages, controls, or oversees the
1332 operation of a corporation or other business entity, regardless
1333 of whether such person is a partner, shareholder, owner,
1334 officer, director, or agent of the entity.
1335 Section 10. Paragraph (c) of subsection (1) and subsections
1336 (2) and (3) of section 456.041, Florida Statutes, are amended to
1337 read:
1338 456.041 Practitioner profile; creation.—
1339 (1)
1340 (c) Within 30 calendar days after receiving an update of
1341 information required for the practitioner’s profile, the
1342 department shall update the practitioner’s profile in accordance
1343 with the requirements of subsection (8) (7).
1344 (2) Beginning July 1, 2010, on the profile published under
1345 subsection (1), the department shall include indicate if the
1346 information provided under s. 456.039(1)(a)7. or s.
1347 456.0391(1)(a)7. and indicate if the information is or is not
1348 corroborated by a criminal history records check conducted
1349 according to this subsection. The department must include in
1350 each practitioner’s profile the following statement: “The
1351 criminal history information, if any exists, may be incomplete.
1352 Federal criminal history information is not available to the
1353 public.” The department, or the board having regulatory
1354 authority over the practitioner acting on behalf of the
1355 department, shall investigate any information received by the
1356 department or the board.
1357 (3) Beginning July 1, 2010, the department shall include in
1358 each practitioner’s profile any open administrative complaint
1359 filed with the department against the practitioner in which
1360 probable cause has been found. The Department of Health shall
1361 include in each practitioner’s practitioner profile that
1362 criminal information that directly relates to the practitioner’s
1363 ability to competently practice his or her profession. The
1364 department must include in each practitioner’s practitioner
1365 profile the following statement: “The criminal history
1366 information, if any exists, may be incomplete; federal criminal
1367 history information is not available to the public.” The
1368 department shall provide in each practitioner profile, for every
1369 final disciplinary action taken against the practitioner, an
1370 easy-to-read narrative description that explains the
1371 administrative complaint filed against the practitioner and the
1372 final disciplinary action imposed on the practitioner. The
1373 department shall include a hyperlink to each final order listed
1374 in its website report of dispositions of recent disciplinary
1375 actions taken against practitioners.
1376 Section 11. Section 456.0635, Florida Statutes, is amended
1377 to read:
1378 456.0635 Health care Medicaid fraud; disqualification for
1379 license, certificate, or registration.—
1380 (1) Medicaid Fraud in the practice of a health care
1381 profession is prohibited.
1382 (2) Each board within the jurisdiction of the department,
1383 or the department if there is no board, shall refuse to admit a
1384 candidate to any examination and refuse to issue or renew a
1385 license, certificate, or registration to any applicant if the
1386 candidate or applicant or any principal, officer, agent,
1387 managing employee, or affiliated person of the applicant, has
1388 been:
1389 (a) Has been convicted of, or entered a plea of guilty or
1390 nolo contendere to, regardless of adjudication, a felony under
1391 chapter 409, chapter 817, chapter 893, or a similar felony
1392 offense committed in another state or jurisdiction 21 U.S.C. ss.
1393 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any
1394 subsequent period of probation for such conviction or plea pleas
1395 ended: more than 15 years prior to the date of the application;
1396 1. For felonies of the first or second degree more than 15
1397 years before the date of application.
1398 2. For felonies of the third degree more than 10 years
1399 before the date of application, except for felonies of the third
1400 degree under s. 893.13(6)(a).
1401 3. For felonies of the third degree under s. 893.13(6)(a),
1402 more than 5 years before the date of application.
1403 4. For felonies in which the defendant entered a plea of
1404 guilty or nolo contendere in an agreement with the court to
1405 enter a pretrial intervention or drug diversion program, the
1406 department shall not approve or deny the application for a
1407 license, certificate, or registration until the final resolution
1408 of the case.
1409 (b) Has been convicted of, or entered a plea of guilty or
1410 nolo contendere to, regardless of adjudication, a felony under
1411 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
1412 sentence and any subsequent period of probation for such
1413 conviction or plea ended more than 15 years before the date of
1414 the application;
1415 (c)(b) Has been terminated for cause from the Florida
1416 Medicaid program pursuant to s. 409.913, unless the applicant
1417 has been in good standing with the Florida Medicaid program for
1418 the most recent 5 years;
1419 (d)(c) Has been terminated for cause, pursuant to the
1420 appeals procedures established by the state or Federal
1421 Government, from any other state Medicaid program or the federal
1422 Medicare program, unless the applicant has been in good standing
1423 with a state Medicaid program or the federal Medicare program
1424 for the most recent 5 years and the termination occurred at
1425 least 20 years before prior to the date of the application; or.
1426 (e) Is currently listed on the United States Department of
1427 Health and Human Services Office of Inspector General’s List of
1428 Excluded Individuals and Entities.
1429 (f) This subsection does not apply to applicants for
1430 initial licensure or certification who were enrolled in an
1431 educational or training program on or before July 1, 2009, which
1432 was recognized by a board or, if there is no board, recognized
1433 by the department, and who applied for licensure after July 1,
1434 2009.
1435 (3) Each board within the jurisdiction of the department,
1436 or the department if there is no board, shall refuse to renew a
1437 license, certificate, or registration of any applicant if the
1438 candidate or applicant or any principal, officer, agent,
1439 managing employee, or affiliated person of the applicant:
1440 (a) Has been convicted of, or entered a plea of guilty or
1441 nolo contendere to, regardless of adjudication, a felony under:
1442 chapter 409, chapter 817, chapter 893, or a similar felony
1443 offense committed in another state or jurisdiction since July 1,
1444 2009.
1445 (b) Has been convicted of, or entered a plea of guilty or
1446 nolo contendere to, regardless of adjudication, a felony under
1447 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
1448 2009.
1449 (c) Has been terminated for cause from the Florida Medicaid
1450 program pursuant to s. 409.913, unless the applicant has been in
1451 good standing with the Florida Medicaid program for the most
1452 recent 5 years.
1453 (d) Has been terminated for cause, pursuant to the appeals
1454 procedures established by the state, from any other state
1455 Medicaid program, unless the applicant has been in good standing
1456 with a state Medicaid program for the most recent 5 years and
1457 the termination occurred at least 20 years before the date of
1458 the application.
1459 (e) Is currently listed on the United States Department of
1460 Health and Human Services Office of Inspector General’s List of
1461 Excluded Individuals and Entities.
1462 (f) For felonies in which the defendant entered a plea of
1463 guilty or nolo contendere in an agreement with the court to
1464 enter a pretrial intervention or drug diversion program, the
1465 department shall not approve or deny the application for a
1466 renewal of a license, certificate, or registration until the
1467 final resolution of the case.
1468 (4)(3) Licensed health care practitioners shall report
1469 allegations of Medicaid fraud to the department, regardless of
1470 the practice setting in which the alleged Medicaid fraud
1471 occurred.
1472 (5)(4) The acceptance by a licensing authority of a
1473 candidate’s relinquishment of a license which is offered in
1474 response to or anticipation of the filing of administrative
1475 charges alleging Medicaid fraud or similar charges constitutes
1476 the permanent revocation of the license.
1477 (6) The department shall adopt rules to administer the
1478 provisions of this section related to denial of licensure
1479 renewal.
1480 Section 12. Paragraph (kk) of subsection (1) of section
1481 456.072, Florida Statutes, is amended to read:
1482 456.072 Grounds for discipline; penalties; enforcement.—
1483 (1) The following acts shall constitute grounds for which
1484 the disciplinary actions specified in subsection (2) may be
1485 taken:
1486 (kk) Being terminated from the state Medicaid program
1487 pursuant to s. 409.913 or, any other state Medicaid program, or
1488 excluded from the federal Medicare program, unless eligibility
1489 to participate in the program from which the practitioner was
1490 terminated has been restored.
1491 Section 13. Subsection (13) of section 456.073, Florida
1492 Statutes, is amended to read:
1493 456.073 Disciplinary proceedings.—Disciplinary proceedings
1494 for each board shall be within the jurisdiction of the
1495 department.
1496 (13) Notwithstanding any provision of law to the contrary,
1497 an administrative complaint against a licensee shall be filed
1498 within 6 years after the time of the incident or occurrence
1499 giving rise to the complaint against the licensee. If such
1500 incident or occurrence involved fraud related to the Medicaid
1501 program, criminal actions, diversion of controlled substances,
1502 sexual misconduct, or impairment by the licensee, this
1503 subsection does not apply to bar initiation of an investigation
1504 or filing of an administrative complaint beyond the 6-year
1505 timeframe. In those cases covered by this subsection in which it
1506 can be shown that fraud, concealment, or intentional
1507 misrepresentation of fact prevented the discovery of the
1508 violation of law, the period of limitations is extended forward,
1509 but in no event to exceed 12 years after the time of the
1510 incident or occurrence.
1511 Section 14. Subsection (1) of section 456.074, Florida
1512 Statutes, is amended to read:
1513 456.074 Certain health care practitioners; immediate
1514 suspension of license.—
1515 (1) The department shall issue an emergency order
1516 suspending the license of any person licensed in a profession as
1517 defined in this chapter under chapter 458, chapter 459, chapter
1518 460, chapter 461, chapter 462, chapter 463, chapter 464, chapter
1519 465, chapter 466, or chapter 484 who pleads guilty to, is
1520 convicted or found guilty of, or who enters a plea of nolo
1521 contendere to, regardless of adjudication, to:
1522 (a) A felony under chapter 409, chapter 812, chapter 817,
1523 or chapter 893, chapter 895, chapter 896, or under 21 U.S.C. ss.
1524 801-970, or under 42 U.S.C. ss. 1395-1396; or
1525 (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
1526 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
1527 1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
1528 Medicaid program.
1529 Section 15. This act shall take effect July 1, 2010.