Florida Senate - 2012                          SENATOR AMENDMENT
       Bill No. CS/CS/HB 119, 2nd Eng.
       
       
       
       
       
       
                                Barcode 918912                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AD/3R         .        Floor: SENA1/CA         
             03/07/2012 11:19 AM       .      03/09/2012 06:43 PM       
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       Senator Negron moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (1) of section 316.066, Florida
    6  Statutes, is amended to read:
    7         316.066 Written reports of crashes.—
    8         (1)(a) A Florida Traffic Crash Report, Long Form must is
    9  required to be completed and submitted to the department within
   10  10 days after completing an investigation is completed by the
   11  every law enforcement officer who in the regular course of duty
   12  investigates a motor vehicle crash that:
   13         1. Resulted in death or personal injury;.
   14         2. Involved a violation of s. 316.061(1) or s. 316.193;.
   15         3. Rendered a vehicle inoperable to a degree that required
   16  a wrecker to remove it from the scene of the crash; or
   17         4. Involved a commercial motor vehicle.
   18         (b) In any every crash for which a Florida Traffic Crash
   19  Report, Long Form is not required by this section and which
   20  occurs on the public roadways of this state, the law enforcement
   21  officer shall may complete a short-form crash report or provide
   22  a driver exchange-of-information form, to be completed by all
   23  drivers and passengers each party involved in the crash, which
   24  requires the identification of each vehicle that the drivers and
   25  passengers were in. The short-form report must include:
   26         1. The date, time, and location of the crash.
   27         2. A description of the vehicles involved.
   28         3. The names and addresses of the parties involved,
   29  including all drivers and passengers, and the identification of
   30  the vehicle in which each was a passenger.
   31         4. The names and addresses of witnesses.
   32         5. The name, badge number, and law enforcement agency of
   33  the officer investigating the crash.
   34         6. The names of the insurance companies for the respective
   35  parties involved in the crash.
   36         (c) Each party to the crash must provide the law
   37  enforcement officer with proof of insurance, which must be
   38  documented in the crash report. If a law enforcement officer
   39  submits a report on the crash, proof of insurance must be
   40  provided to the officer by each party involved in the crash. Any
   41  party who fails to provide the required information commits a
   42  noncriminal traffic infraction, punishable as a nonmoving
   43  violation as provided in chapter 318, unless the officer
   44  determines that due to injuries or other special circumstances
   45  such insurance information cannot be provided immediately. If
   46  the person provides the law enforcement agency, within 24 hours
   47  after the crash, proof of insurance that was valid at the time
   48  of the crash, the law enforcement agency may void the citation.
   49         (d) The driver of a vehicle that was in any manner involved
   50  in a crash resulting in damage to a any vehicle or other
   51  property which does not require a law enforcement report in an
   52  amount of $500 or more which was not investigated by a law
   53  enforcement agency, shall, within 10 days after the crash,
   54  submit a written report of the crash to the department. The
   55  report shall be submitted on a form approved by the department.
   56  The entity receiving the report may require witnesses of the
   57  crash to render reports and may require any driver of a vehicle
   58  involved in a crash of which a written report must be made to
   59  file supplemental written reports if the original report is
   60  deemed insufficient by the receiving entity.
   61         (e) Long-form and short-form crash reports prepared by law
   62  enforcement must be submitted to the department and may shall be
   63  maintained by the law enforcement officer’s agency.
   64         Section 2. Subsection (4) of section 400.9905, Florida
   65  Statutes, is amended to read:
   66         400.9905 Definitions.—
   67         (4) “Clinic” means an entity where at which health care
   68  services are provided to individuals and which tenders charges
   69  for reimbursement for such services, including a mobile clinic
   70  and a portable equipment provider. As used in For purposes of
   71  this part, the term does not include and the licensure
   72  requirements of this part do not apply to:
   73         (a) Entities licensed or registered by the state under
   74  chapter 395; or entities licensed or registered by the state and
   75  providing only health care services within the scope of services
   76  authorized under their respective licenses granted under ss.
   77  383.30-383.335, chapter 390, chapter 394, chapter 397, this
   78  chapter except part X, chapter 429, chapter 463, chapter 465,
   79  chapter 466, chapter 478, part I of chapter 483, chapter 484, or
   80  chapter 651; end-stage renal disease providers authorized under
   81  42 C.F.R. part 405, subpart U; or providers certified under 42
   82  C.F.R. part 485, subpart B or subpart H; or any entity that
   83  provides neonatal or pediatric hospital-based health care
   84  services or other health care services by licensed practitioners
   85  solely within a hospital licensed under chapter 395.
   86         (b) Entities that own, directly or indirectly, entities
   87  licensed or registered by the state pursuant to chapter 395; or
   88  entities that own, directly or indirectly, entities licensed or
   89  registered by the state and providing only health care services
   90  within the scope of services authorized pursuant to their
   91  respective licenses granted under ss. 383.30-383.335, chapter
   92  390, chapter 394, chapter 397, this chapter except part X,
   93  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
   94  part I of chapter 483, chapter 484, chapter 651; end-stage renal
   95  disease providers authorized under 42 C.F.R. part 405, subpart
   96  U; or providers certified under 42 C.F.R. part 485, subpart B or
   97  subpart H; or any entity that provides neonatal or pediatric
   98  hospital-based health care services by licensed practitioners
   99  solely within a hospital licensed under chapter 395.
  100         (c) Entities that are owned, directly or indirectly, by an
  101  entity licensed or registered by the state pursuant to chapter
  102  395; or entities that are owned, directly or indirectly, by an
  103  entity licensed or registered by the state and providing only
  104  health care services within the scope of services authorized
  105  pursuant to their respective licenses granted under ss. 383.30
  106  383.335, chapter 390, chapter 394, chapter 397, this chapter
  107  except part X, chapter 429, chapter 463, chapter 465, chapter
  108  466, chapter 478, part I of chapter 483, chapter 484, or chapter
  109  651; end-stage renal disease providers authorized under 42
  110  C.F.R. part 405, subpart U; or providers certified under 42
  111  C.F.R. part 485, subpart B or subpart H; or any entity that
  112  provides neonatal or pediatric hospital-based health care
  113  services by licensed practitioners solely within a hospital
  114  under chapter 395.
  115         (d) Entities that are under common ownership, directly or
  116  indirectly, with an entity licensed or registered by the state
  117  pursuant to chapter 395; or entities that are under common
  118  ownership, directly or indirectly, with an entity licensed or
  119  registered by the state and providing only health care services
  120  within the scope of services authorized pursuant to their
  121  respective licenses granted under ss. 383.30-383.335, chapter
  122  390, chapter 394, chapter 397, this chapter except part X,
  123  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
  124  part I of chapter 483, chapter 484, or chapter 651; end-stage
  125  renal disease providers authorized under 42 C.F.R. part 405,
  126  subpart U; or providers certified under 42 C.F.R. part 485,
  127  subpart B or subpart H; or any entity that provides neonatal or
  128  pediatric hospital-based health care services by licensed
  129  practitioners solely within a hospital licensed under chapter
  130  395.
  131         (e) An entity that is exempt from federal taxation under 26
  132  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
  133  under 26 U.S.C. s. 409 that has a board of trustees at least not
  134  less than two-thirds of which are Florida-licensed health care
  135  practitioners and provides only physical therapy services under
  136  physician orders, any community college or university clinic,
  137  and any entity owned or operated by the federal or state
  138  government, including agencies, subdivisions, or municipalities
  139  thereof.
  140         (f) A sole proprietorship, group practice, partnership, or
  141  corporation that provides health care services by physicians
  142  covered by s. 627.419, that is directly supervised by one or
  143  more of such physicians, and that is wholly owned by one or more
  144  of those physicians or by a physician and the spouse, parent,
  145  child, or sibling of that physician.
  146         (g) A sole proprietorship, group practice, partnership, or
  147  corporation that provides health care services by licensed
  148  health care practitioners under chapter 457, chapter 458,
  149  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
  150  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
  151  chapter 490, chapter 491, or part I, part III, part X, part
  152  XIII, or part XIV of chapter 468, or s. 464.012, and that is
  153  which are wholly owned by one or more licensed health care
  154  practitioners, or the licensed health care practitioners set
  155  forth in this paragraph and the spouse, parent, child, or
  156  sibling of a licensed health care practitioner if, so long as
  157  one of the owners who is a licensed health care practitioner is
  158  supervising the business activities and is legally responsible
  159  for the entity’s compliance with all federal and state laws.
  160  However, a health care practitioner may not supervise services
  161  beyond the scope of the practitioner’s license, except that, for
  162  the purposes of this part, a clinic owned by a licensee in s.
  163  456.053(3)(b) which that provides only services authorized
  164  pursuant to s. 456.053(3)(b) may be supervised by a licensee
  165  specified in s. 456.053(3)(b).
  166         (h) Clinical facilities affiliated with an accredited
  167  medical school at which training is provided for medical
  168  students, residents, or fellows.
  169         (i) Entities that provide only oncology or radiation
  170  therapy services by physicians licensed under chapter 458 or
  171  chapter 459 or entities that provide oncology or radiation
  172  therapy services by physicians licensed under chapter 458 or
  173  chapter 459 which are owned by a corporation whose shares are
  174  publicly traded on a recognized stock exchange.
  175         (j) Clinical facilities affiliated with a college of
  176  chiropractic accredited by the Council on Chiropractic Education
  177  at which training is provided for chiropractic students.
  178         (k) Entities that provide licensed practitioners to staff
  179  emergency departments or to deliver anesthesia services in
  180  facilities licensed under chapter 395 and that derive at least
  181  90 percent of their gross annual revenues from the provision of
  182  such services. Entities claiming an exemption from licensure
  183  under this paragraph must provide documentation demonstrating
  184  compliance.
  185         (l) Orthotic or prosthetic clinical facilities that are a
  186  publicly traded corporation or that are wholly owned, directly
  187  or indirectly, by a publicly traded corporation. As used in this
  188  paragraph, a publicly traded corporation is a corporation that
  189  issues securities traded on an exchange registered with the
  190  United States Securities and Exchange Commission as a national
  191  securities exchange.
  192  
  193  Notwithstanding this subsection, an entity shall be deemed a
  194  clinic and must be licensed under this part in order to receive
  195  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  196  627.730-627.7405, unless exempted under s. 627.736(5)(h). An
  197  entity required to be licensed in order to receive reimbursement
  198  under the Florida Motor Vehicle No-Fault Law is exempt from all
  199  license fees under this part.
  200         Section 3. Subsection (6) is added to section 400.991,
  201  Florida Statutes, to read:
  202         400.991 License requirements; background screenings;
  203  prohibitions.—
  204         (6) All agency forms for licensure application or exemption
  205  from licensure under this part must contain the following
  206  statement:
  207  
  208         INSURANCE FRAUD NOTICE.—A person who knowingly submits
  209         a false, misleading, or fraudulent application or
  210         other document when applying for licensure as a health
  211         care clinic, seeking an exemption from licensure as a
  212         health care clinic, or demonstrating compliance with
  213         part X of chapter 400, Florida Statutes, with the
  214         intent to use the license, exemption from licensure,
  215         or demonstration of compliance to provide services or
  216         seek reimbursement under the Florida Motor Vehicle No
  217         Fault Law, commits a fraudulent insurance act, as
  218         defined in s. 626.989, Florida Statutes. A person who
  219         presents a claim for personal injury protection
  220         benefits knowing that the payee knowingly submitted
  221         such health care clinic application or document,
  222         commits insurance fraud, as defined in s. 817.234,
  223         Florida Statutes.
  224         Section 4. Subsection (1) of section 626.989, Florida
  225  Statutes, is amended to read:
  226         626.989 Investigation by department or Division of
  227  Insurance Fraud; compliance; immunity; confidential information;
  228  reports to division; division investigator’s power of arrest.—
  229         (1) For the purposes of this section:,
  230         (a) A person commits a “fraudulent insurance act” if the
  231  person:
  232         1. Knowingly and with intent to defraud presents, causes to
  233  be presented, or prepares with knowledge or belief that it will
  234  be presented, to or by an insurer, self-insurer, self-insurance
  235  fund, servicing corporation, purported insurer, broker, or any
  236  agent thereof, any written statement as part of, or in support
  237  of, an application for the issuance of, or the rating of, any
  238  insurance policy, or a claim for payment or other benefit
  239  pursuant to any insurance policy, which the person knows to
  240  contain materially false information concerning any fact
  241  material thereto or if the person conceals, for the purpose of
  242  misleading another, information concerning any fact material
  243  thereto.
  244         2. Knowingly submits:
  245         a. A false, misleading, or fraudulent application or other
  246  document when applying for licensure as a health care clinic,
  247  seeking an exemption from licensure as a health care clinic, or
  248  demonstrating compliance with part X of chapter 400 with an
  249  intent to use the license, exemption from licensure, or
  250  demonstration of compliance to provide services or seek
  251  reimbursement under the Florida Motor Vehicle No-Fault Law.
  252         b. A claim for payment or other benefit pursuant to a
  253  personal injury protection insurance policy under the Florida
  254  Motor Vehicle No-Fault Law if the person knows that the payee
  255  knowingly submitted a false, misleading, or fraudulent
  256  application or other document when applying for licensure as a
  257  health care clinic, seeking an exemption from licensure as a
  258  health care clinic, or demonstrating compliance with part X of
  259  chapter 400. For the purposes of this section,
  260         (b) The term “insurer” also includes a any health
  261  maintenance organization, and the term “insurance policy” also
  262  includes a health maintenance organization subscriber contract.
  263         Section 5. Section 626.9581, Florida Statutes, is amended
  264  to read:
  265         626.9581 Cease and desist and penalty orders.—After the
  266  hearing provided in s. 626.9571, the department or office shall
  267  enter a final order in accordance with s. 120.569. If it is
  268  determined that the person charged has engaged in an unfair or
  269  deceptive act or practice or the unlawful transaction of
  270  insurance, the department or office shall also issue an order
  271  requiring the violator to cease and desist from engaging in such
  272  method of competition, act, or practice or the unlawful
  273  transaction of insurance. Further, if the act or practice is a
  274  violation of s. 626.9541, or s. 626.9551, or s. 627.736(11), the
  275  department or office may, at its discretion, order any one or
  276  more of the following:
  277         (1) Suspension or revocation of the person’s certificate of
  278  authority, license, or eligibility for any certificate of
  279  authority or license, if he or she knew, or reasonably should
  280  have known, he or she was in violation of this act. However, the
  281  office must revoke the certificate of authority of an insurer
  282  that violates s. 627.736(11) for at least 5 years, and all board
  283  members of such insurer are prohibited from serving on the board
  284  of another insurer for 5 years.
  285         (2) Such other relief as may be provided under in the
  286  insurance code.
  287         Section 6. Subsection (5) of section 626.9894, Florida
  288  Statutes, is amended to read:
  289         626.9894 Gifts and grants.—
  290         (5) Notwithstanding the provisions of s. 216.301 and
  291  pursuant to s. 216.351, any balance of moneys deposited into the
  292  Insurance Regulatory Trust Fund pursuant to this section or s.
  293  626.9895 remaining at the end of any fiscal year is shall be
  294  available for carrying out the duties and responsibilities of
  295  the division. The department may request annual appropriations
  296  from the grants and donations received pursuant to this section
  297  or s. 626.9895 and cash balances in the Insurance Regulatory
  298  Trust Fund for the purpose of carrying out its duties and
  299  responsibilities related to the division’s anti-fraud efforts,
  300  including the funding of dedicated prosecutors and related
  301  personnel.
  302         Section 7. Section 626.9895, Florida Statutes, is created
  303  to read:
  304         626.9895Motor vehicle insurance fraud direct-support
  305  organization.—
  306         (1) DEFINITIONS.—As used in this section, the term:
  307         (a) “Division” means the Division of Insurance Fraud of the
  308  Department of Financial Services.
  309         (b) “Motor vehicle insurance fraud” means any act defined
  310  as a “fraudulent insurance act” under s. 626.989, which relates
  311  to the coverage of motor vehicle insurance as described in part
  312  XI of chapter 627.
  313         (c) “Organization” means the direct-support organization
  314  established under this section.
  315         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  316  direct-support organization, to be known as the “Automobile
  317  Insurance Fraud Strike Force,” whose sole purpose is to support
  318  the prosecution, investigation, and prevention of motor vehicle
  319  insurance fraud. The organization shall:
  320         (a) Be a not-for-profit corporation incorporated under
  321  chapter 617 and approved by the Department of State.
  322         (b) Be organized and operated to conduct programs and
  323  activities; raise funds; request and receive grants, gifts, and
  324  bequests of money; acquire, receive, hold, invest, and
  325  administer, in its own name, securities, funds, objects of
  326  value, or other property, real or personal; and make grants and
  327  expenditures to or for the direct or indirect benefit of the
  328  division, state attorneys’ offices, the statewide prosecutor,
  329  the Agency for Health Care Administration, and the Department of
  330  Health to the extent that such grants and expenditures are used
  331  exclusively to advance the prosecution, investigation, or
  332  prevention of motor vehicle insurance fraud. Grants and
  333  expenditures may include the cost of salaries or benefits of
  334  motor vehicle insurance fraud investigators, prosecutors, or
  335  support personnel if such grants and expenditures do not
  336  interfere with prosecutorial independence or otherwise create
  337  conflicts of interest which threaten the success of
  338  prosecutions.
  339         (c) Be determined by the division to operate in a manner
  340  that promotes the goals of laws relating to motor vehicle
  341  insurance fraud, that is in the best interest of the state, and
  342  that is in accordance with the adopted goals and mission of the
  343  division.
  344         (d) Use all of its grants and expenditures solely for the
  345  purpose of preventing and decreasing motor vehicle insurance
  346  fraud, and not for the purpose of lobbying as defined in s.
  347  11.045.
  348         (e) Be subject to an annual financial audit in accordance
  349  with s. 215.981.
  350         (3) CONTRACT.—The organization shall operate under written
  351  contract with the division. The contract must provide for:
  352         (a) Approval of the articles of incorporation and bylaws of
  353  the organization by the division.
  354         (b) Submission of an annual budget for approval of the
  355  division. The budget must require the organization to minimize
  356  costs to the division and its members at all times by using
  357  existing personnel and property and allowing for telephonic
  358  meetings if appropriate.
  359         (c) Certification by the division that the organization is
  360  complying with the terms of the contract and in a manner
  361  consistent with the goals and purposes of the department and in
  362  the best interest of the state. Such certification must be made
  363  annually and reported in the official minutes of a meeting of
  364  the organization.
  365         (d) Allocation of funds to address motor vehicle insurance
  366  fraud.
  367         (e) Reversion of moneys and property held in trust by the
  368  organization for motor vehicle insurance fraud prosecution,
  369  investigation, and prevention to the division if the
  370  organization is no longer approved to operate for the department
  371  or if the organization ceases to exist, or to the state if the
  372  division ceases to exist.
  373         (f) Specific criteria to be used by the organization’s
  374  board of directors to evaluate the effectiveness of funding used
  375  to combat motor vehicle insurance fraud.
  376         (g) The fiscal year of the organization, which begins July
  377  1 of each year and ends June 30 of the following year.
  378         (h) Disclosure of the material provisions of the contract,
  379  and distinguishing between the department and the organization
  380  to donors of gifts, contributions, or bequests, including
  381  providing such disclosure on all promotional and fundraising
  382  publications.
  383         (4) BOARD OF DIRECTORS.—
  384         (a) The board of directors of the organization shall
  385  consist of the following eleven members:
  386         1. The Chief Financial Officer, or designee, who shall
  387  serve as chair.
  388         2. Two state attorneys, one of whom shall be appointed by
  389  the Chief Financial Officer and one of whom shall be appointed
  390  by the Attorney General.
  391         3. Two representatives of motor vehicle insurers appointed
  392  by the Chief Financial Officer.
  393         4. Two representatives of local law enforcement agencies,
  394  one of whom shall be appointed by the Chief Financial Officer
  395  and one of whom shall be appointed by the Attorney General.
  396         5. Two representatives of the types of health care
  397  providers who regularly make claims for benefits under ss.
  398  627.730-627.7405, one of whom shall be appointed by the
  399  President of the Senate and one of whom shall be appointed by
  400  the Speaker of the House of Representatives. The appointees may
  401  not represent the same type of health care provider.
  402         6. A private attorney that has experience in representing
  403  claimants in actions for benefits under ss. 627.730-627.7405,
  404  who shall be appointed by the President of the Senate.
  405         7. A private attorney who has experience in representing
  406  insurers in actions for benefits under ss. 627.730-627.7405, who
  407  shall be appointed by the Speaker of the House of
  408  Representatives.
  409         (b) The officer who appointed a member of the board may
  410  remove that member for cause. The term of office of an appointed
  411  member expires at the same time as the term of the officer who
  412  appointed him or her or at such earlier time as the person
  413  ceases to be qualified.
  414         (5) USE OF PROPERTY.—The department may authorize, without
  415  charge, appropriate use of fixed property and facilities of the
  416  division by the organization, subject to this subsection.
  417         (a) The department may prescribe any condition with which
  418  the organization must comply in order to use the division’s
  419  property or facilities.
  420         (b) The department may not authorize the use of the
  421  division’s property or facilities if the organization does not
  422  provide equal membership and employment opportunities to all
  423  persons regardless of race, religion, sex, age, or national
  424  origin.
  425         (c) The department shall adopt rules prescribing the
  426  procedures by which the organization is governed and any
  427  conditions with which the organization must comply to use the
  428  division’s property or facilities.
  429         (6) CONTRIBUTIONS FROM INSURERS.—Contributions from an
  430  insurer to the organization shall be allowed as an appropriate
  431  business expense of the insurer for all regulatory purposes.
  432         (7) DEPOSITORY ACCOUNT.—Any moneys received by the
  433  organization may be held in a separate depository account in the
  434  name of the organization and subject to the contract with the
  435  division.
  436         (8) DIVISION’S RECEIPT OF PROCEEDS.—Proceeds received by
  437  the division from the organization shall be deposited into the
  438  Insurance Regulatory Trust Fund.
  439         Section 8. Effective January 1, 2013, subsections (1), (4),
  440  (5), (6), (8), (9), (10), and (11) of section 627.736, Florida
  441  Statutes, are amended, and subsection (17) is added to that
  442  section, to read:
  443         627.736 Required personal injury protection benefits;
  444  exclusions; priority; claims.—
  445         (1) REQUIRED BENEFITS.—An Every insurance policy complying
  446  with the security requirements of s. 627.733 must shall provide
  447  personal injury protection to the named insured, relatives
  448  residing in the same household, persons operating the insured
  449  motor vehicle, passengers in the such motor vehicle, and other
  450  persons struck by the such motor vehicle and suffering bodily
  451  injury while not an occupant of a self-propelled vehicle,
  452  subject to the provisions of subsection (2) and paragraph
  453  (4)(e), to a limit of $10,000 in medical and disability benefits
  454  and $5,000 in death benefits resulting from for loss sustained
  455  by any such person as a result of bodily injury, sickness,
  456  disease, or death arising out of the ownership, maintenance, or
  457  use of a motor vehicle as follows:
  458         (a) Medical benefits.—Eighty percent of all reasonable
  459  expenses for medically necessary medical, surgical, X-ray,
  460  dental, and rehabilitative services, including prosthetic
  461  devices, and medically necessary ambulance, hospital, and
  462  nursing services if the individual receives initial services and
  463  care pursuant to subparagraph 1. within 14 days after the motor
  464  vehicle accident. However, The medical benefits shall provide
  465  reimbursement only for: such
  466         1. Initial services and care that are lawfully provided,
  467  supervised, ordered, or prescribed by a physician licensed under
  468  chapter 458 or chapter 459, a dentist licensed under chapter
  469  466, or a chiropractic physician licensed under chapter 460 or
  470  that are provided in a hospital or in a facility that owns, or
  471  is wholly owned by, a hospital. Initial services and care may
  472  also be provided by a person or entity licensed under part III
  473  of chapter 401 which provides emergency transportation and
  474  treatment.
  475         2. Followup services and care consistent with the
  476  underlying medical diagnosis rendered pursuant to subparagraph
  477  1. which may be provided, supervised, ordered, or prescribed
  478  only by a physician licensed under chapter 458 or chapter 459, a
  479  chiropractic physician licensed under chapter 460, a dentist
  480  licensed under chapter 466, or, to the extent permitted by
  481  applicable law and under the supervision of such physician,
  482  osteopathic physician, chiropractic physician, or dentist, by a
  483  physician assistant licensed under chapter 458 or chapter 459 or
  484  an advanced registered nurse practitioner licensed under chapter
  485  464. Followup services and care may also be provided by any of
  486  the following persons or entities:
  487         a.1. A hospital or ambulatory surgical center licensed
  488  under chapter 395.
  489         2. A person or entity licensed under ss. 401.2101-401.45
  490  that provides emergency transportation and treatment.
  491         b.3. An entity wholly owned by one or more physicians
  492  licensed under chapter 458 or chapter 459, chiropractic
  493  physicians licensed under chapter 460, or dentists licensed
  494  under chapter 466 or by such practitioner or practitioners and
  495  the spouse, parent, child, or sibling of such that practitioner
  496  or those practitioners.
  497         c.4. An entity that owns or is wholly owned, directly or
  498  indirectly, by a hospital or hospitals.
  499         d. A physical therapist licensed under chapter 486.
  500         e.5. A health care clinic licensed under part X of chapter
  501  400 which ss. 400.990-400.995 that is:
  502         a. accredited by the Joint Commission on Accreditation of
  503  Healthcare Organizations, the American Osteopathic Association,
  504  the Commission on Accreditation of Rehabilitation Facilities, or
  505  the Accreditation Association for Ambulatory Health Care, Inc.,;
  506  or
  507         b. A health care clinic that:
  508         (I) Has a medical director licensed under chapter 458,
  509  chapter 459, or chapter 460;
  510         (II) Has been continuously licensed for more than 3 years
  511  or is a publicly traded corporation that issues securities
  512  traded on an exchange registered with the United States
  513  Securities and Exchange Commission as a national securities
  514  exchange; and
  515         (III) Provides at least four of the following medical
  516  specialties:
  517         (A) General medicine.
  518         (B) Radiography.
  519         (C) Orthopedic medicine.
  520         (D) Physical medicine.
  521         (E) Physical therapy.
  522         (F) Physical rehabilitation.
  523         (G) Prescribing or dispensing outpatient prescription
  524  medication.
  525         (H) Laboratory services.
  526         3. Reimbursement for services and care provided by each
  527  type of licensed medical provider authorized to render such
  528  services and care is limited to the lesser of 24 visits or to
  529  services or care rendered within 12 weeks after the date of the
  530  initial treatment, whichever comes first, unless the insurer
  531  authorizes additional services or care.
  532         4. Medical benefits do not include massage as defined in s.
  533  480.033 or acupuncture as defined in s. 457.102, regardless of
  534  the person, entity, or licensee providing massage or
  535  acupuncture, and a licensed massage therapist or licensed
  536  acupuncturist may not be reimbursed for medical benefits under
  537  this section.
  538         5. The Financial Services Commission shall adopt by rule
  539  the form that must be used by an insurer and a health care
  540  provider specified in sub-subparagraph 2.b., sub-subparagraph
  541  2.c., or sub-subparagraph 2.e. subparagraph 3., subparagraph 4.,
  542  or subparagraph 5. to document that the health care provider
  543  meets the criteria of this paragraph, which rule must include a
  544  requirement for a sworn statement or affidavit.
  545         (b) Disability benefits.—Sixty percent of any loss of gross
  546  income and loss of earning capacity per individual from
  547  inability to work proximately caused by the injury sustained by
  548  the injured person, plus all expenses reasonably incurred in
  549  obtaining from others ordinary and necessary services in lieu of
  550  those that, but for the injury, the injured person would have
  551  performed without income for the benefit of his or her
  552  household. All disability benefits payable under this provision
  553  must shall be paid at least not less than every 2 weeks.
  554         (c) Death benefits.—Death benefits equal to the lesser of
  555  $5,000 or the remainder of unused personal injury protection
  556  benefits per individual. Death benefits are in addition to the
  557  medical and disability benefits provided under the insurance
  558  policy. The insurer may pay death such benefits to the executor
  559  or administrator of the deceased, to any of the deceased’s
  560  relatives by blood, or legal adoption, or connection by
  561  marriage, or to any person appearing to the insurer to be
  562  equitably entitled to such benefits thereto.
  563  
  564  Only insurers writing motor vehicle liability insurance in this
  565  state may provide the required benefits of this section, and no
  566  such insurer may not shall require the purchase of any other
  567  motor vehicle coverage other than the purchase of property
  568  damage liability coverage as required by s. 627.7275 as a
  569  condition for providing such required benefits. Insurers may not
  570  require that property damage liability insurance in an amount
  571  greater than $10,000 be purchased in conjunction with personal
  572  injury protection. Such insurers shall make benefits and
  573  required property damage liability insurance coverage available
  574  through normal marketing channels. An Any insurer writing motor
  575  vehicle liability insurance in this state who fails to comply
  576  with such availability requirement as a general business
  577  practice violates shall be deemed to have violated part IX of
  578  chapter 626, and such violation constitutes shall constitute an
  579  unfair method of competition or an unfair or deceptive act or
  580  practice involving the business of insurance. An; and any such
  581  insurer committing such violation is shall be subject to the
  582  penalties provided under that afforded in such part, as well as
  583  those provided which may be afforded elsewhere in the insurance
  584  code.
  585         (4) PAYMENT OF BENEFITS; WHEN DUE.—Benefits due from an
  586  insurer under ss. 627.730-627.7405 are shall be primary, except
  587  that benefits received under any workers’ compensation law must
  588  shall be credited against the benefits provided by subsection
  589  (1) and are shall be due and payable as loss accrues, upon
  590  receipt of reasonable proof of such loss and the amount of
  591  expenses and loss incurred which are covered by the policy
  592  issued under ss. 627.730-627.7405. If When the Agency for Health
  593  Care Administration provides, pays, or becomes liable for
  594  medical assistance under the Medicaid program related to injury,
  595  sickness, disease, or death arising out of the ownership,
  596  maintenance, or use of a motor vehicle, the benefits under ss.
  597  627.730-627.7405 are shall be subject to the provisions of the
  598  Medicaid program. However, within 30 days after receiving notice
  599  that the Medicaid program paid such benefits, the insurer shall
  600  repay the full amount of the benefits to the Medicaid program.
  601         (a) An insurer may require written notice to be given as
  602  soon as practicable after an accident involving a motor vehicle
  603  with respect to which the policy affords the security required
  604  by ss. 627.730-627.7405.
  605         (b) Personal injury protection insurance benefits paid
  606  pursuant to this section are shall be overdue if not paid within
  607  30 days after the insurer is furnished written notice of the
  608  fact of a covered loss and of the amount of same. However:
  609         1. If such written notice of the entire claim is not
  610  furnished to the insurer as to the entire claim, any partial
  611  amount supported by written notice is overdue if not paid within
  612  30 days after such written notice is furnished to the insurer.
  613  Any part or all of the remainder of the claim that is
  614  subsequently supported by written notice is overdue if not paid
  615  within 30 days after such written notice is furnished to the
  616  insurer.
  617         2. If When an insurer pays only a portion of a claim or
  618  rejects a claim, the insurer shall provide at the time of the
  619  partial payment or rejection an itemized specification of each
  620  item that the insurer had reduced, omitted, or declined to pay
  621  and any information that the insurer desires the claimant to
  622  consider related to the medical necessity of the denied
  623  treatment or to explain the reasonableness of the reduced charge
  624  if, provided that this does shall not limit the introduction of
  625  evidence at trial.; and The insurer must also shall include the
  626  name and address of the person to whom the claimant should
  627  respond and a claim number to be referenced in future
  628  correspondence.
  629         3. If an insurer pays only a portion of a claim or rejects
  630  a claim due to an alleged error in the claim, the insurer, at
  631  the time of the partial payment or rejection, shall provide an
  632  itemized specification or explanation of benefits due to the
  633  specified error. Upon receiving the specification or
  634  explanation, the person making the claim, at the person’s option
  635  and without waiving any other legal remedy for payment, has 15
  636  days to submit a revised claim, which shall be considered a
  637  timely submission of written notice of a claim.
  638         4.However, Notwithstanding the fact that written notice
  639  has been furnished to the insurer, any payment is shall not be
  640  deemed overdue if when the insurer has reasonable proof to
  641  establish that the insurer is not responsible for the payment.
  642         5. For the purpose of calculating the extent to which any
  643  benefits are overdue, payment shall be treated as being made on
  644  the date a draft or other valid instrument that which is
  645  equivalent to payment was placed in the United States mail in a
  646  properly addressed, postpaid envelope or, if not so posted, on
  647  the date of delivery.
  648         6. This paragraph does not preclude or limit the ability of
  649  the insurer to assert that the claim was unrelated, was not
  650  medically necessary, or was unreasonable or that the amount of
  651  the charge was in excess of that permitted under, or in
  652  violation of, subsection (5). Such assertion by the insurer may
  653  be made at any time, including after payment of the claim or
  654  after the 30-day time period for payment set forth in this
  655  paragraph.
  656         (c) Upon receiving notice of an accident that is
  657  potentially covered by personal injury protection benefits, the
  658  insurer must reserve $5,000 of personal injury protection
  659  benefits for payment to physicians licensed under chapter 458 or
  660  chapter 459 or dentists licensed under chapter 466 who provide
  661  emergency services and care, as defined in s. 395.002(9), or who
  662  provide hospital inpatient care. The amount required to be held
  663  in reserve may be used only to pay claims from such physicians
  664  or dentists until 30 days after the date the insurer receives
  665  notice of the accident. After the 30-day period, any amount of
  666  the reserve for which the insurer has not received notice of
  667  such claims a claim from a physician or dentist who provided
  668  emergency services and care or who provided hospital inpatient
  669  care may then be used by the insurer to pay other claims. The
  670  time periods specified in paragraph (b) for required payment of
  671  personal injury protection benefits are shall be tolled for the
  672  period of time that an insurer is required by this paragraph to
  673  hold payment of a claim that is not from such a physician or
  674  dentist who provided emergency services and care or who provided
  675  hospital inpatient care to the extent that the personal injury
  676  protection benefits not held in reserve are insufficient to pay
  677  the claim. This paragraph does not require an insurer to
  678  establish a claim reserve for insurance accounting purposes.
  679         (d) All overdue payments shall bear simple interest at the
  680  rate established under s. 55.03 or the rate established in the
  681  insurance contract, whichever is greater, for the year in which
  682  the payment became overdue, calculated from the date the insurer
  683  was furnished with written notice of the amount of covered loss.
  684  Interest is shall be due at the time payment of the overdue
  685  claim is made.
  686         (e) The insurer of the owner of a motor vehicle shall pay
  687  personal injury protection benefits for:
  688         1. Accidental bodily injury sustained in this state by the
  689  owner while occupying a motor vehicle, or while not an occupant
  690  of a self-propelled vehicle if the injury is caused by physical
  691  contact with a motor vehicle.
  692         2. Accidental bodily injury sustained outside this state,
  693  but within the United States of America or its territories or
  694  possessions or Canada, by the owner while occupying the owner’s
  695  motor vehicle.
  696         3. Accidental bodily injury sustained by a relative of the
  697  owner residing in the same household, under the circumstances
  698  described in subparagraph 1. or subparagraph 2., if provided the
  699  relative at the time of the accident is domiciled in the owner’s
  700  household and is not himself or herself the owner of a motor
  701  vehicle with respect to which security is required under ss.
  702  627.730-627.7405.
  703         4. Accidental bodily injury sustained in this state by any
  704  other person while occupying the owner’s motor vehicle or, if a
  705  resident of this state, while not an occupant of a self
  706  propelled vehicle, if the injury is caused by physical contact
  707  with such motor vehicle, if provided the injured person is not
  708  himself or herself:
  709         a. The owner of a motor vehicle with respect to which
  710  security is required under ss. 627.730-627.7405; or
  711         b. Entitled to personal injury benefits from the insurer of
  712  the owner or owners of such a motor vehicle.
  713         (f) If two or more insurers are liable for paying to pay
  714  personal injury protection benefits for the same injury to any
  715  one person, the maximum payable is shall be as specified in
  716  subsection (1), and the any insurer paying the benefits is shall
  717  be entitled to recover from each of the other insurers an
  718  equitable pro rata share of the benefits paid and expenses
  719  incurred in processing the claim.
  720         (g) It is a violation of the insurance code for an insurer
  721  to fail to timely provide benefits as required by this section
  722  with such frequency as to constitute a general business
  723  practice.
  724         (h) Benefits are shall not be due or payable to or on the
  725  behalf of an insured person if that person has committed, by a
  726  material act or omission, any insurance fraud relating to
  727  personal injury protection coverage under his or her policy, if
  728  the fraud is admitted to in a sworn statement by the insured or
  729  if it is established in a court of competent jurisdiction. Any
  730  insurance fraud voids shall void all coverage arising from the
  731  claim related to such fraud under the personal injury protection
  732  coverage of the insured person who committed the fraud,
  733  irrespective of whether a portion of the insured person’s claim
  734  may be legitimate, and any benefits paid before prior to the
  735  discovery of the insured person’s insurance fraud is shall be
  736  recoverable by the insurer in its entirety from the person who
  737  committed insurance fraud in their entirety. The prevailing
  738  party is entitled to its costs and attorney attorney’s fees in
  739  any action in which it prevails in an insurer’s action to
  740  enforce its right of recovery under this paragraph.
  741         (i) If an insurer has a reasonable belief that a fraudulent
  742  insurance act, as defined in s. 626.989 or s. 817.234, has been
  743  committed, the insurer shall notify the claimant in writing
  744  within 30 days after submission of the claim that the claim is
  745  being investigated for suspected fraud and execute and provide
  746  to the insured and the office an affidavit under oath stating
  747  that there is a factual basis that there is a probability of
  748  fraud. The insurer has an additional 60 days, beginning at the
  749  end of the initial 30-day period, to conduct its fraud
  750  investigation. Notwithstanding subsection (10), no later than
  751  the 90th day after the submission of the claim, the insurer must
  752  deny the claim or pay the claim along with simple interest as
  753  provided in paragraph (d). All claims denied for suspected
  754  fraudulent insurance acts shall be reported to the Division of
  755  Insurance Fraud.
  756         (j) An insurer shall create and maintain for each insured a
  757  log of personal injury protection benefits paid by the insurer
  758  on behalf of the insured. If litigation is commenced, the
  759  insurer shall provide to the insured, or an assignee of the
  760  insured, a copy of the log within 30 days after receiving a
  761  request for the log from the insured or the assignee.
  762         (5) CHARGES FOR TREATMENT OF INJURED PERSONS.—
  763         (a)1.A Any physician, hospital, clinic, or other person or
  764  institution lawfully rendering treatment to an injured person
  765  for a bodily injury covered by personal injury protection
  766  insurance may charge the insurer and injured party only a
  767  reasonable amount pursuant to this section for the services and
  768  supplies rendered, and the insurer providing such coverage may
  769  pay for such charges directly to such person or institution
  770  lawfully rendering such treatment, if the insured receiving such
  771  treatment or his or her guardian has countersigned the properly
  772  completed invoice, bill, or claim form approved by the office
  773  upon which such charges are to be paid for as having actually
  774  been rendered, to the best knowledge of the insured or his or
  775  her guardian. In no event, However, may such a charge may not
  776  exceed be in excess of the amount the person or institution
  777  customarily charges for like services or supplies. In
  778  determining With respect to a determination of whether a charge
  779  for a particular service, treatment, or otherwise is reasonable,
  780  consideration may be given to evidence of usual and customary
  781  charges and payments accepted by the provider involved in the
  782  dispute, and reimbursement levels in the community and various
  783  federal and state medical fee schedules applicable to motor
  784  vehicle automobile and other insurance coverages, and other
  785  information relevant to the reasonableness of the reimbursement
  786  for the service, treatment, or supply.
  787         1.2. The insurer may limit reimbursement to 80 percent of
  788  the following schedule of maximum charges:
  789         a. For emergency transport and treatment by providers
  790  licensed under chapter 401, 200 percent of Medicare.
  791         b. For emergency services and care provided by a hospital
  792  licensed under chapter 395, 75 percent of the hospital’s usual
  793  and customary charges.
  794         c. For emergency services and care as defined by s.
  795  395.002(9) provided in a facility licensed under chapter 395
  796  rendered by a physician or dentist, and related hospital
  797  inpatient services rendered by a physician or dentist, the usual
  798  and customary charges in the community.
  799         d. For hospital inpatient services, other than emergency
  800  services and care, 200 percent of the Medicare Part A
  801  prospective payment applicable to the specific hospital
  802  providing the inpatient services.
  803         e. For hospital outpatient services, other than emergency
  804  services and care, 200 percent of the Medicare Part A Ambulatory
  805  Payment Classification for the specific hospital providing the
  806  outpatient services.
  807         f. For all other medical services, supplies, and care, 200
  808  percent of the allowable amount under:
  809         (I) The participating physicians fee schedule of Medicare
  810  Part B, except as provided in sub-sub-subparagraphs (II) and
  811  (III).
  812         (II) Medicare Part B, in the case of services, supplies,
  813  and care provided by ambulatory surgical centers and clinical
  814  laboratories.
  815         (III) The Durable Medical Equipment Prosthetics/Orthotics
  816  and Supplies fee schedule of Medicare Part B, in the case of
  817  durable medical equipment.
  818  
  819  However, if such services, supplies, or care is not reimbursable
  820  under Medicare Part B, as provided in this sub-subparagraph, the
  821  insurer may limit reimbursement to 80 percent of the maximum
  822  reimbursable allowance under workers’ compensation, as
  823  determined under s. 440.13 and rules adopted thereunder which
  824  are in effect at the time such services, supplies, or care is
  825  provided. Services, supplies, or care that is not reimbursable
  826  under Medicare or workers’ compensation is not required to be
  827  reimbursed by the insurer.
  828         2.3. For purposes of subparagraph 1. 2., the applicable fee
  829  schedule or payment limitation under Medicare is the fee
  830  schedule or payment limitation in effect on January 1 of the
  831  year in which at the time the services, supplies, or care is was
  832  rendered and for the area in which such services, supplies, or
  833  care is were rendered, and the applicable fee schedule or
  834  payment limitation applies throughout the remainder of that
  835  year, notwithstanding any subsequent change made to the fee
  836  schedule or payment limitation, except that it may not be less
  837  than the allowable amount under the applicable participating
  838  physicians schedule of Medicare Part B for 2007 for medical
  839  services, supplies, and care subject to Medicare Part B.
  840         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  841  any limitation on the number of treatments or other utilization
  842  limits that apply under Medicare or workers’ compensation. An
  843  insurer that applies the allowable payment limitations of
  844  subparagraph 1. 2. must reimburse a provider who lawfully
  845  provided care or treatment under the scope of his or her
  846  license, regardless of whether such provider is would be
  847  entitled to reimbursement under Medicare due to restrictions or
  848  limitations on the types or discipline of health care providers
  849  who may be reimbursed for particular procedures or procedure
  850  codes.
  851         4.5. If an insurer limits payment as authorized by
  852  subparagraph 1. 2., the person providing such services,
  853  supplies, or care may not bill or attempt to collect from the
  854  insured any amount in excess of such limits, except for amounts
  855  that are not covered by the insured’s personal injury protection
  856  coverage due to the coinsurance amount or maximum policy limits.
  857         5. Effective July 1, 2012, an insurer may limit payment as
  858  authorized by this paragraph only if the insurance policy
  859  includes a notice at the time of issuance or renewal that the
  860  insurer may limit payment pursuant to the schedule of charges
  861  specified in this paragraph. A policy form approved by the
  862  office satisfies this requirement. If a provider submits a
  863  charge for an amount less than the amount allowed under
  864  subparagraph 1., the insurer may pay the amount of the charge
  865  submitted.
  866         (b)1. An insurer or insured is not required to pay a claim
  867  or charges:
  868         a. Made by a broker or by a person making a claim on behalf
  869  of a broker;
  870         b. For any service or treatment that was not lawful at the
  871  time rendered;
  872         c. To any person who knowingly submits a false or
  873  misleading statement relating to the claim or charges;
  874         d. With respect to a bill or statement that does not
  875  substantially meet the applicable requirements of paragraph (d);
  876         e. For any treatment or service that is upcoded, or that is
  877  unbundled when such treatment or services should be bundled, in
  878  accordance with paragraph (d). To facilitate prompt payment of
  879  lawful services, an insurer may change codes that it determines
  880  to have been improperly or incorrectly upcoded or unbundled, and
  881  may make payment based on the changed codes, without affecting
  882  the right of the provider to dispute the change by the insurer,
  883  if, provided that before doing so, the insurer contacts must
  884  contact the health care provider and discusses discuss the
  885  reasons for the insurer’s change and the health care provider’s
  886  reason for the coding, or makes make a reasonable good faith
  887  effort to do so, as documented in the insurer’s file; and
  888         f. For medical services or treatment billed by a physician
  889  and not provided in a hospital unless such services are rendered
  890  by the physician or are incident to his or her professional
  891  services and are included on the physician’s bill, including
  892  documentation verifying that the physician is responsible for
  893  the medical services that were rendered and billed.
  894         2. The Department of Health, in consultation with the
  895  appropriate professional licensing boards, shall adopt, by rule,
  896  a list of diagnostic tests deemed not to be medically necessary
  897  for use in the treatment of persons sustaining bodily injury
  898  covered by personal injury protection benefits under this
  899  section. The initial list shall be adopted by January 1, 2004,
  900  and shall be revised from time to time as determined by the
  901  Department of Health, in consultation with the respective
  902  professional licensing boards. Inclusion of a test on the list
  903  of invalid diagnostic tests shall be based on lack of
  904  demonstrated medical value and a level of general acceptance by
  905  the relevant provider community and may shall not be dependent
  906  for results entirely upon subjective patient response.
  907  Notwithstanding its inclusion on a fee schedule in this
  908  subsection, an insurer or insured is not required to pay any
  909  charges or reimburse claims for an any invalid diagnostic test
  910  as determined by the Department of Health.
  911         (c)1. With respect to any treatment or service, other than
  912  medical services billed by a hospital or other provider for
  913  emergency services and care as defined in s. 395.002 or
  914  inpatient services rendered at a hospital-owned facility, the
  915  statement of charges must be furnished to the insurer by the
  916  provider and may not include, and the insurer is not required to
  917  pay, charges for treatment or services rendered more than 35
  918  days before the postmark date or electronic transmission date of
  919  the statement, except for past due amounts previously billed on
  920  a timely basis under this paragraph, and except that, if the
  921  provider submits to the insurer a notice of initiation of
  922  treatment within 21 days after its first examination or
  923  treatment of the claimant, the statement may include charges for
  924  treatment or services rendered up to, but not more than, 75 days
  925  before the postmark date of the statement. The injured party is
  926  not liable for, and the provider may shall not bill the injured
  927  party for, charges that are unpaid because of the provider’s
  928  failure to comply with this paragraph. Any agreement requiring
  929  the injured person or insured to pay for such charges is
  930  unenforceable.
  931         1.2. If, however, the insured fails to furnish the provider
  932  with the correct name and address of the insured’s personal
  933  injury protection insurer, the provider has 35 days from the
  934  date the provider obtains the correct information to furnish the
  935  insurer with a statement of the charges. The insurer is not
  936  required to pay for such charges unless the provider includes
  937  with the statement documentary evidence that was provided by the
  938  insured during the 35-day period demonstrating that the provider
  939  reasonably relied on erroneous information from the insured and
  940  either:
  941         a. A denial letter from the incorrect insurer; or
  942         b. Proof of mailing, which may include an affidavit under
  943  penalty of perjury, reflecting timely mailing to the incorrect
  944  address or insurer.
  945         2.3. For emergency services and care as defined in s.
  946  395.002 rendered in a hospital emergency department or for
  947  transport and treatment rendered by an ambulance provider
  948  licensed pursuant to part III of chapter 401, the provider is
  949  not required to furnish the statement of charges within the time
  950  periods established by this paragraph,; and the insurer is shall
  951  not be considered to have been furnished with notice of the
  952  amount of covered loss for purposes of paragraph (4)(b) until it
  953  receives a statement complying with paragraph (d), or copy
  954  thereof, which specifically identifies the place of service to
  955  be a hospital emergency department or an ambulance in accordance
  956  with billing standards recognized by the federal Centers for
  957  Medicare and Medicaid Services Health Care Finance
  958  Administration.
  959         3.4. Each notice of the insured’s rights under s. 627.7401
  960  must include the following statement in at least 12-point type
  961  in type no smaller than 12 points:
  962  
  963         BILLING REQUIREMENTS.—Florida law provides
  964         Statutes provide that with respect to any treatment or
  965         services, other than certain hospital and emergency
  966         services, the statement of charges furnished to the
  967         insurer by the provider may not include, and the
  968         insurer and the injured party are not required to pay,
  969         charges for treatment or services rendered more than
  970         35 days before the postmark date of the statement,
  971         except for past due amounts previously billed on a
  972         timely basis, and except that, if the provider submits
  973         to the insurer a notice of initiation of treatment
  974         within 21 days after its first examination or
  975         treatment of the claimant, the statement may include
  976         charges for treatment or services rendered up to, but
  977         not more than, 75 days before the postmark date of the
  978         statement.
  979  
  980         (d) All statements and bills for medical services rendered
  981  by a any physician, hospital, clinic, or other person or
  982  institution shall be submitted to the insurer on a properly
  983  completed Centers for Medicare and Medicaid Services (CMS) 1500
  984  form, UB 92 forms, or any other standard form approved by the
  985  office or adopted by the commission for purposes of this
  986  paragraph. All billings for such services rendered by providers
  987  must shall, to the extent applicable, follow the Physicians’
  988  Current Procedural Terminology (CPT) or Healthcare Correct
  989  Procedural Coding System (HCPCS), or ICD-9 in effect for the
  990  year in which services are rendered and comply with the Centers
  991  for Medicare and Medicaid Services (CMS) 1500 form instructions,
  992  and the American Medical Association Current Procedural
  993  Terminology (CPT) Editorial Panel, and the Healthcare Correct
  994  Procedural Coding System (HCPCS). All providers, other than
  995  hospitals, must shall include on the applicable claim form the
  996  professional license number of the provider in the line or space
  997  provided for “Signature of Physician or Supplier, Including
  998  Degrees or Credentials.” In determining compliance with
  999  applicable CPT and HCPCS coding, guidance shall be provided by
 1000  the Physicians’ Current Procedural Terminology (CPT) or the
 1001  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1002  for the year in which services were rendered, the Office of the
 1003  Inspector General (OIG), Physicians Compliance Guidelines, and
 1004  other authoritative treatises designated by rule by the Agency
 1005  for Health Care Administration. A No statement of medical
 1006  services may not include charges for medical services of a
 1007  person or entity that performed such services without possessing
 1008  the valid licenses required to perform such services. For
 1009  purposes of paragraph (4)(b), an insurer is shall not be
 1010  considered to have been furnished with notice of the amount of
 1011  covered loss or medical bills due unless the statements or bills
 1012  comply with this paragraph, and unless the statements or bills
 1013  are properly completed in their entirety as to all material
 1014  provisions, with all relevant information being provided
 1015  therein.
 1016         (e)1. At the initial treatment or service provided, each
 1017  physician, other licensed professional, clinic, or other medical
 1018  institution providing medical services upon which a claim for
 1019  personal injury protection benefits is based shall require an
 1020  insured person, or his or her guardian, to execute a disclosure
 1021  and acknowledgment form, which reflects at a minimum that:
 1022         a. The insured, or his or her guardian, must countersign
 1023  the form attesting to the fact that the services set forth
 1024  therein were actually rendered;
 1025         b. The insured, or his or her guardian, has both the right
 1026  and affirmative duty to confirm that the services were actually
 1027  rendered;
 1028         c. The insured, or his or her guardian, was not solicited
 1029  by any person to seek any services from the medical provider;
 1030         d. The physician, other licensed professional, clinic, or
 1031  other medical institution rendering services for which payment
 1032  is being claimed explained the services to the insured or his or
 1033  her guardian; and
 1034         e. If the insured notifies the insurer in writing of a
 1035  billing error, the insured may be entitled to a certain
 1036  percentage of a reduction in the amounts paid by the insured’s
 1037  motor vehicle insurer.
 1038         2. The physician, other licensed professional, clinic, or
 1039  other medical institution rendering services for which payment
 1040  is being claimed has the affirmative duty to explain the
 1041  services rendered to the insured, or his or her guardian, so
 1042  that the insured, or his or her guardian, countersigns the form
 1043  with informed consent.
 1044         3. Countersignature by the insured, or his or her guardian,
 1045  is not required for the reading of diagnostic tests or other
 1046  services that are of such a nature that they are not required to
 1047  be performed in the presence of the insured.
 1048         4. The licensed medical professional rendering treatment
 1049  for which payment is being claimed must sign, by his or her own
 1050  hand, the form complying with this paragraph.
 1051         5. The original completed disclosure and acknowledgment
 1052  form shall be furnished to the insurer pursuant to paragraph
 1053  (4)(b) and may not be electronically furnished.
 1054         6. The This disclosure and acknowledgment form is not
 1055  required for services billed by a provider for emergency
 1056  services as defined in s. 395.002, for emergency services and
 1057  care as defined in s. 395.002 rendered in a hospital emergency
 1058  department, or for transport and treatment rendered by an
 1059  ambulance provider licensed pursuant to part III of chapter 401.
 1060         7. The Financial Services Commission shall adopt, by rule,
 1061  a standard disclosure and acknowledgment form to that shall be
 1062  used to fulfill the requirements of this paragraph, effective 90
 1063  days after such form is adopted and becomes final. The
 1064  commission shall adopt a proposed rule by October 1, 2003. Until
 1065  the rule is final, the provider may use a form of its own which
 1066  otherwise complies with the requirements of this paragraph.
 1067         8. As used in this paragraph, the term “countersign” or
 1068  “countersignature” “countersigned” means a second or verifying
 1069  signature, as on a previously signed document, and is not
 1070  satisfied by the statement “signature on file” or any similar
 1071  statement.
 1072         9. The requirements of this paragraph apply only with
 1073  respect to the initial treatment or service of the insured by a
 1074  provider. For subsequent treatments or service, the provider
 1075  must maintain a patient log signed by the patient, in
 1076  chronological order by date of service, which that is consistent
 1077  with the services being rendered to the patient as claimed. The
 1078  requirement to maintain requirements of this subparagraph for
 1079  maintaining a patient log signed by the patient may be met by a
 1080  hospital that maintains medical records as required by s.
 1081  395.3025 and applicable rules and makes such records available
 1082  to the insurer upon request.
 1083         (f) Upon written notification by any person, an insurer
 1084  shall investigate any claim of improper billing by a physician
 1085  or other medical provider. The insurer shall determine if the
 1086  insured was properly billed for only those services and
 1087  treatments that the insured actually received. If the insurer
 1088  determines that the insured has been improperly billed, the
 1089  insurer shall notify the insured, the person making the written
 1090  notification, and the provider of its findings and shall reduce
 1091  the amount of payment to the provider by the amount determined
 1092  to be improperly billed. If a reduction is made due to a such
 1093  written notification by any person, the insurer shall pay to the
 1094  person 20 percent of the amount of the reduction, up to $500. If
 1095  the provider is arrested due to the improper billing, then the
 1096  insurer shall pay to the person 40 percent of the amount of the
 1097  reduction, up to $500.
 1098         (g) An insurer may not systematically downcode with the
 1099  intent to deny reimbursement otherwise due. Such action
 1100  constitutes a material misrepresentation under s.
 1101  626.9541(1)(i)2.
 1102         (h) As provided in s. 400.9905, an entity excluded from the
 1103  definition of a clinic shall be deemed a clinic and must be
 1104  licensed under part X of chapter 400 in order to receive
 1105  reimbursement under ss. 627.730-627.7405. However, this
 1106  licensing requirement does not apply to:
 1107         1. An entity wholly owned by a physician licensed under
 1108  chapter 458 or chapter 459, or by the physician and the spouse,
 1109  parent, child, or sibling of the physician;
 1110         2. An entity wholly owned by a dentist licensed under
 1111  chapter 466, or by the dentist and the spouse, parent, child, or
 1112  sibling of the dentist;
 1113         3. An entity wholly owned by a chiropractic physician
 1114  licensed under chapter 460, or by the chiropractic physician and
 1115  the spouse, parent, child, or sibling of the chiropractic
 1116  physician;
 1117         4. A hospital or ambulatory surgical center licensed under
 1118  chapter 395;
 1119         5. An entity that wholly owns or is wholly owned, directly
 1120  or indirectly, by a hospital or hospitals licensed under chapter
 1121  395; or
 1122         6. An entity that is a clinical facility affiliated with an
 1123  accredited medical school at which training is provided for
 1124  medical students, residents, or fellows.
 1125         (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON; DISPUTES.—
 1126         (a) Every employer shall, If a request is made by an
 1127  insurer providing personal injury protection benefits under ss.
 1128  627.730-627.7405 against whom a claim has been made, an employer
 1129  must furnish forthwith, in a form approved by the office, a
 1130  sworn statement of the earnings, since the time of the bodily
 1131  injury and for a reasonable period before the injury, of the
 1132  person upon whose injury the claim is based.
 1133         (b) Every physician, hospital, clinic, or other medical
 1134  institution providing, before or after bodily injury upon which
 1135  a claim for personal injury protection insurance benefits is
 1136  based, any products, services, or accommodations in relation to
 1137  that or any other injury, or in relation to a condition claimed
 1138  to be connected with that or any other injury, shall, if
 1139  requested to do so by the insurer against whom the claim has
 1140  been made, furnish forthwith a written report of the history,
 1141  condition, treatment, dates, and costs of such treatment of the
 1142  injured person and why the items identified by the insurer were
 1143  reasonable in amount and medically necessary, together with a
 1144  sworn statement that the treatment or services rendered were
 1145  reasonable and necessary with respect to the bodily injury
 1146  sustained and identifying which portion of the expenses for such
 1147  treatment or services was incurred as a result of such bodily
 1148  injury, and produce forthwith, and allow permit the inspection
 1149  and copying of, his or her or its records regarding such
 1150  history, condition, treatment, dates, and costs of treatment if;
 1151  provided that this does shall not limit the introduction of
 1152  evidence at trial. Such sworn statement must shall read as
 1153  follows: “Under penalty of perjury, I declare that I have read
 1154  the foregoing, and the facts alleged are true, to the best of my
 1155  knowledge and belief.” A No cause of action for violation of the
 1156  physician-patient privilege or invasion of the right of privacy
 1157  may not be brought shall be permitted against any physician,
 1158  hospital, clinic, or other medical institution complying with
 1159  the provisions of this section. The person requesting such
 1160  records and such sworn statement shall pay all reasonable costs
 1161  connected therewith. If an insurer makes a written request for
 1162  documentation or information under this paragraph within 30 days
 1163  after having received notice of the amount of a covered loss
 1164  under paragraph (4)(a), the amount or the partial amount that
 1165  which is the subject of the insurer’s inquiry is shall become
 1166  overdue if the insurer does not pay in accordance with paragraph
 1167  (4)(b) or within 10 days after the insurer’s receipt of the
 1168  requested documentation or information, whichever occurs later.
 1169  As used in For purposes of this paragraph, the term “receipt”
 1170  includes, but is not limited to, inspection and copying pursuant
 1171  to this paragraph. An Any insurer that requests documentation or
 1172  information pertaining to reasonableness of charges or medical
 1173  necessity under this paragraph without a reasonable basis for
 1174  such requests as a general business practice is engaging in an
 1175  unfair trade practice under the insurance code.
 1176         (c) In the event of a any dispute regarding an insurer’s
 1177  right to discovery of facts under this section, the insurer may
 1178  petition a court of competent jurisdiction to enter an order
 1179  permitting such discovery. The order may be made only on motion
 1180  for good cause shown and upon notice to all persons having an
 1181  interest, and must it shall specify the time, place, manner,
 1182  conditions, and scope of the discovery. Such court may, In order
 1183  to protect against annoyance, embarrassment, or oppression, as
 1184  justice requires, the court may enter an order refusing
 1185  discovery or specifying conditions of discovery and may order
 1186  payments of costs and expenses of the proceeding, including
 1187  reasonable fees for the appearance of attorneys at the
 1188  proceedings, as justice requires.
 1189         (d) The injured person shall be furnished, upon request, a
 1190  copy of all information obtained by the insurer under the
 1191  provisions of this section, and shall pay a reasonable charge,
 1192  if required by the insurer.
 1193         (e) Notice to an insurer of the existence of a claim may
 1194  shall not be unreasonably withheld by an insured.
 1195         (f) In a dispute between the insured and the insurer, or
 1196  between an assignee of the insured’s rights and the insurer, the
 1197  insurer must notify the insured or the assignee that the policy
 1198  limits under this section have been reached within 15 days after
 1199  the limits have been reached.
 1200         (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY
 1201  ATTORNEY’S FEES.—
 1202         (a) With respect to any dispute under the provisions of ss.
 1203  627.730-627.7405 between the insured and the insurer, or between
 1204  an assignee of an insured’s rights and the insurer, the
 1205  provisions of ss. s. 627.428 and 768.79 shall apply, except as
 1206  provided in subsections (10) and (15), and except that any
 1207  attorney fees recovered must:
 1208         1. Comply with prevailing professional standards;
 1209         2. Ensure that the attorney fees for work performed by an
 1210  attorney does not duplicate work performed by a paralegal or
 1211  legal assistant; and
 1212         3. Not overstate or inflate the number of hours reasonably
 1213  necessary for a case of comparable skill or complexity.
 1214         (b) Notwithstanding s. 627.428 and this subsection, it
 1215  shall be presumed that any attorney fees awarded under ss.
 1216  627.730-627.7405 are calculated without regard to a contingency
 1217  risk multiplier. This presumption may be overcome only if the
 1218  court makes findings of fact based upon competent evidence in
 1219  the record which establishes that:
 1220         1. The party requesting the multiplier would have faced
 1221  substantial difficulties finding competent counsel to pursue the
 1222  case in the relevant market but for the consideration of a fee
 1223  multiplier;
 1224         2. Consideration of a fee multiplier was a necessary
 1225  incentive to obtain competent counsel to pursue the case;
 1226         3. The claim would not be economically feasible to hire an
 1227  attorney on a noncontingent, fixed-fee basis;
 1228         4. The attorney was unable to mitigate the risk of
 1229  nonpayment of attorney fees in any other way; and
 1230         5. The use of a multiplier is justified based on factors
 1231  such as the amount of risk undertaken by the attorney at the
 1232  outset of the case, the results obtained, and the type of fee
 1233  arrangement between the attorney and client.
 1234         (c) Paragraph (b) does not apply to a case where class
 1235  action status has been sought or granted, and a contingency risk
 1236  multiplier may be applied in such cases notwithstanding
 1237  paragraph (b).
 1238         (d) Upon the request of either party, a judge must make
 1239  written findings, substantiated by evidence presented at trial
 1240  or any hearings associated with the trial, that an award of
 1241  attorney fees complies with this subsection.
 1242         (9) PREFERRED PROVIDERS.—An insurer may negotiate and
 1243  contract enter into contracts with preferred licensed health
 1244  care providers for the benefits described in this section,
 1245  referred to in this section as “preferred providers,” which
 1246  shall include health care providers licensed under chapter
 1247  chapters 458, chapter 459, chapter 460, chapter 461, or chapter
 1248  and 463. The insurer may provide an option to an insured to use
 1249  a preferred provider at the time of purchasing purchase of the
 1250  policy for personal injury protection benefits, if the
 1251  requirements of this subsection are met. If the insured elects
 1252  to use a provider who is not a preferred provider, whether the
 1253  insured purchased a preferred provider policy or a nonpreferred
 1254  provider policy, the medical benefits provided by the insurer
 1255  shall be as required by this section. If the insured elects to
 1256  use a provider who is a preferred provider, the insurer may pay
 1257  medical benefits in excess of the benefits required by this
 1258  section and may waive or lower the amount of any deductible that
 1259  applies to such medical benefits. If the insurer offers a
 1260  preferred provider policy to a policyholder or applicant, it
 1261  must also offer a nonpreferred provider policy. The insurer
 1262  shall provide each insured policyholder with a current roster of
 1263  preferred providers in the county in which the insured resides
 1264  at the time of purchase of such policy, and shall make such list
 1265  available for public inspection during regular business hours at
 1266  the insurer’s principal office of the insurer within the state.
 1267         (10) DEMAND LETTER.—
 1268         (a) As a condition precedent to filing any action for
 1269  benefits under this section, the insurer must be provided with
 1270  written notice of an intent to initiate litigation must be
 1271  provided to the insurer. Such notice may not be sent until the
 1272  claim is overdue, including any additional time the insurer has
 1273  to pay the claim pursuant to paragraph (4)(b).
 1274         (b) The notice must required shall state that it is a
 1275  “demand letter under s. 627.736(10)” and shall state with
 1276  specificity:
 1277         1. The name of the insured upon which such benefits are
 1278  being sought, including a copy of the assignment giving rights
 1279  to the claimant if the claimant is not the insured.
 1280         2. The claim number or policy number upon which such claim
 1281  was originally submitted to the insurer.
 1282         3. To the extent applicable, the name of any medical
 1283  provider who rendered to an insured the treatment, services,
 1284  accommodations, or supplies that form the basis of such claim;
 1285  and an itemized statement specifying each exact amount, the date
 1286  of treatment, service, or accommodation, and the type of benefit
 1287  claimed to be due. A completed form satisfying the requirements
 1288  of paragraph (5)(d) or the lost-wage statement previously
 1289  submitted may be used as the itemized statement. To the extent
 1290  that the demand involves an insurer’s withdrawal of payment
 1291  under paragraph (7)(a) for future treatment not yet rendered,
 1292  the claimant shall attach a copy of the insurer’s notice
 1293  withdrawing such payment and an itemized statement of the type,
 1294  frequency, and duration of future treatment claimed to be
 1295  reasonable and medically necessary.
 1296         (c) Each notice required by this subsection must be
 1297  delivered to the insurer by United States certified or
 1298  registered mail, return receipt requested, or by electronic
 1299  mail. Such postal costs shall be reimbursed by the insurer if so
 1300  requested by the claimant in the notice, when the insurer pays
 1301  the claim. Such notice must be sent to the person and address
 1302  specified by the insurer for the purposes of receiving notices
 1303  under this subsection. Each licensed insurer, whether domestic,
 1304  foreign, or alien, shall file with the office designation of the
 1305  name and physical and e-mail address of the designated person to
 1306  whom notices must pursuant to this subsection shall be sent
 1307  which the office shall make available on its Internet website.
 1308  The name and address on file with the office pursuant to s.
 1309  624.422 are shall be deemed the authorized representative to
 1310  accept notice pursuant to this subsection if in the event no
 1311  other designation has been made.
 1312         (d) If, within 30 days after receipt of notice by the
 1313  insurer, the overdue claim specified in the notice is paid by
 1314  the insurer together with applicable interest and a penalty of
 1315  10 percent of the overdue amount paid by the insurer, subject to
 1316  a maximum penalty of $250, no action may be brought against the
 1317  insurer. If the demand involves an insurer’s withdrawal of
 1318  payment under paragraph (7)(a) for future treatment not yet
 1319  rendered, no action may be brought against the insurer if,
 1320  within 30 days after its receipt of the notice, the insurer
 1321  mails to the person filing the notice a written statement of the
 1322  insurer’s agreement to pay for such treatment in accordance with
 1323  the notice and to pay a penalty of 10 percent, subject to a
 1324  maximum penalty of $250, when it pays for such future treatment
 1325  in accordance with the requirements of this section. To the
 1326  extent the insurer determines not to pay any amount demanded,
 1327  the penalty is shall not be payable in any subsequent action.
 1328  For purposes of this subsection, payment or the insurer’s
 1329  agreement shall be treated as being made on the date a draft or
 1330  other valid instrument that is equivalent to payment, or the
 1331  insurer’s written statement of agreement, is placed in the
 1332  United States mail in a properly addressed, postpaid envelope,
 1333  or if not so posted, on the date of delivery. The insurer is not
 1334  obligated to pay any attorney attorney’s fees if the insurer
 1335  pays the claim or mails its agreement to pay for future
 1336  treatment within the time prescribed by this subsection.
 1337         (e) The applicable statute of limitation for an action
 1338  under this section shall be tolled for a period of 30 business
 1339  days by the mailing of the notice required by this subsection.
 1340         (f) Any insurer making a general business practice of not
 1341  paying valid claims until receipt of the notice required by this
 1342  subsection is engaging in an unfair trade practice under the
 1343  insurance code.
 1344         (11) FAILURE TO PAY VALID CLAIMS; UNFAIR OR DECEPTIVE
 1345  PRACTICE.—
 1346         (a) If An insurer fails to pay valid claims for personal
 1347  injury protection with such frequency so as to indicate a
 1348  general business practice, the insurer is engaging in a
 1349  prohibited unfair or deceptive practice that is subject to the
 1350  penalties provided in s. 626.9521 and the office has the powers
 1351  and duties specified in ss. 626.9561-626.9601 if the insurer,
 1352  with such frequency so as to indicate a general business
 1353  practice: with respect thereto
 1354         1. Fails to pay valid claims for personal injury
 1355  protection; or
 1356         2. Fails to pay valid claims until receipt of the notice
 1357  required by subsection (10).
 1358         (b) Notwithstanding s. 501.212, the Department of Legal
 1359  Affairs may investigate and initiate actions for a violation of
 1360  this subsection, including, but not limited to, the powers and
 1361  duties specified in part II of chapter 501.
 1362         (17) REFERRAL FEES.—A person, entity, or licensee may not
 1363  accept a fee for the referral of the insured to a person,
 1364  entity, or licensee for medical benefits under paragraph (1)(a)
 1365  unless the person, entity, or licensee making the referral
 1366  discloses in writing to the insured and the insurer that he or
 1367  she has received a referral fee, the amount of the referral fee,
 1368  and the name and business address of the person or entity that
 1369  provided the referral fee. Reimbursement under the Florida Motor
 1370  Vehicle No-Fault Law to a person, entity, or licensee who
 1371  receives and fails to disclose a referral fee to the insured and
 1372  insurer as required by this subsection must be reduced by the
 1373  amount of the undisclosed referral fee.
 1374         Section 9. Effective December 1, 2012, subsection (16) of
 1375  section 627.736, Florida Statutes, is amended to read:
 1376         627.736 Required personal injury protection benefits;
 1377  exclusions; priority; claims.—
 1378         (16) SECURE ELECTRONIC DATA TRANSFER.—If all parties
 1379  mutually and expressly agree, A notice, documentation,
 1380  transmission, or communication of any kind required or
 1381  authorized under ss. 627.730-627.7405 may be transmitted
 1382  electronically if it is transmitted by secure electronic data
 1383  transfer that is consistent with state and federal privacy and
 1384  security laws.
 1385         Section 10. Section 627.7405, Florida Statutes, is amended
 1386  to read:
 1387         627.7405 Insurers’ right of reimbursement.—
 1388         (1) Notwithstanding any other provisions of ss. 627.730
 1389  627.7405, an any insurer providing personal injury protection
 1390  benefits on a private passenger motor vehicle shall have, to the
 1391  extent of any personal injury protection benefits paid to any
 1392  person as a benefit arising out of such private passenger motor
 1393  vehicle insurance, a right of reimbursement against the owner or
 1394  the insurer of the owner of a commercial motor vehicle, if the
 1395  benefits paid result from such person having been an occupant of
 1396  the commercial motor vehicle or having been struck by the
 1397  commercial motor vehicle while not an occupant of any self
 1398  propelled vehicle.
 1399         (2) The insurer’s right of reimbursement under this section
 1400  does not apply to an owner or registrant as identified in s.
 1401  627.733(1)(b).
 1402         Section 11. Subsections (1), (10), and (13) of section
 1403  817.234, Florida Statutes, are amended to read:
 1404         817.234 False and fraudulent insurance claims.—
 1405         (1)(a) A person commits insurance fraud punishable as
 1406  provided in subsection (11) if that person, with the intent to
 1407  injure, defraud, or deceive any insurer:
 1408         1. Presents or causes to be presented any written or oral
 1409  statement as part of, or in support of, a claim for payment or
 1410  other benefit pursuant to an insurance policy or a health
 1411  maintenance organization subscriber or provider contract,
 1412  knowing that such statement contains any false, incomplete, or
 1413  misleading information concerning any fact or thing material to
 1414  such claim;
 1415         2. Prepares or makes any written or oral statement that is
 1416  intended to be presented to any insurer in connection with, or
 1417  in support of, any claim for payment or other benefit pursuant
 1418  to an insurance policy or a health maintenance organization
 1419  subscriber or provider contract, knowing that such statement
 1420  contains any false, incomplete, or misleading information
 1421  concerning any fact or thing material to such claim; or
 1422         3.a. Knowingly presents, causes to be presented, or
 1423  prepares or makes with knowledge or belief that it will be
 1424  presented to any insurer, purported insurer, servicing
 1425  corporation, insurance broker, or insurance agent, or any
 1426  employee or agent thereof, any false, incomplete, or misleading
 1427  information or written or oral statement as part of, or in
 1428  support of, an application for the issuance of, or the rating
 1429  of, any insurance policy, or a health maintenance organization
 1430  subscriber or provider contract; or
 1431         b. Who Knowingly conceals information concerning any fact
 1432  material to such application; or.
 1433         4. Knowingly presents, causes to be presented, or prepares
 1434  or makes with knowledge or belief that it will be presented to
 1435  any insurer a claim for payment or other benefit under a
 1436  personal injury protection insurance policy if the person knows
 1437  that the payee knowingly submitted a false, misleading, or
 1438  fraudulent application or other document when applying for
 1439  licensure as a health care clinic, seeking an exemption from
 1440  licensure as a health care clinic, or demonstrating compliance
 1441  with part X of chapter 400.
 1442         (b) All claims and application forms must shall contain a
 1443  statement that is approved by the Office of Insurance Regulation
 1444  of the Financial Services Commission which clearly states in
 1445  substance the following: “Any person who knowingly and with
 1446  intent to injure, defraud, or deceive any insurer files a
 1447  statement of claim or an application containing any false,
 1448  incomplete, or misleading information is guilty of a felony of
 1449  the third degree.” This paragraph does shall not apply to
 1450  reinsurance contracts, reinsurance agreements, or reinsurance
 1451  claims transactions.
 1452         (10) A licensed health care practitioner who is found
 1453  guilty of insurance fraud under this section for an act relating
 1454  to a personal injury protection insurance policy loses his or
 1455  her license to practice for 5 years and may not receive
 1456  reimbursement for personal injury protection benefits for 10
 1457  years. As used in this section, the term “insurer” means any
 1458  insurer, health maintenance organization, self-insurer, self
 1459  insurance fund, or other similar entity or person regulated
 1460  under chapter 440 or chapter 641 or by the Office of Insurance
 1461  Regulation under the Florida Insurance Code.
 1462         (13) As used in this section, the term:
 1463         (a) “Insurer” means any insurer, health maintenance
 1464  organization, self-insurer, self-insurance fund, or similar
 1465  entity or person regulated under chapter 440 or chapter 641 or
 1466  by the Office of Insurance Regulation under the Florida
 1467  Insurance Code.
 1468         (b)(a) “Property” means property as defined in s. 812.012.
 1469         (c)(b) “Value” means value as defined in s. 812.012.
 1470         Section 12. Subsection (4) of section 316.065, Florida
 1471  Statutes, is amended to read:
 1472         316.065 Crashes; reports; penalties.—
 1473         (4) Any person who knowingly repairs a motor vehicle
 1474  without having made a report as required by subsection (3) is
 1475  guilty of a misdemeanor of the first degree, punishable as
 1476  provided in s. 775.082 or s. 775.083. The owner and driver of a
 1477  vehicle involved in a crash who makes a report thereof in
 1478  accordance with subsection (1) or s. 316.066(1) is not liable
 1479  under this section.
 1480         Section 13. Motor vehicle insurance rate rollback.—
 1481         (1) The Office of Insurance Regulation shall order insurers
 1482  writing personal injury protection insurance in this state to
 1483  make a rate filing before October 1, 2012, and effective January
 1484  1, 2013, which reduces rates for such insurance by a factor that
 1485  reflects the expected effect of the changes contained in this
 1486  act. In the absence of clear and convincing evidence to the
 1487  contrary, it shall be presumed that the expected impact of the
 1488  act will result in at least a 25 percent reduction in the rates
 1489  in effect for such insurance on December 31, 2012. In lieu of
 1490  making the rate filing required in this subsection, an insurer
 1491  may, upon notification to the office, implement a 25 percent
 1492  reduction of its rates, effective January 1, 2013.
 1493         (2) An insurer or rating organization that contends in the
 1494  January 1, 2013, rate filing or any subsequent rate filing made
 1495  on or before December 31, 2018, that the presumed reduced rate
 1496  provided for in subsection (1) is excessive, inadequate, or
 1497  unfairly discriminatory shall separately state in its filing the
 1498  rate it contends is appropriate and shall state with specificity
 1499  the factors or data that it contends should be considered in
 1500  order to produce such appropriate rate. The insurer or rating
 1501  organization shall be permitted to use all of the generally
 1502  accepted actuarial techniques, as provided in s. 627.062,
 1503  Florida Statutes, in making any filing pursuant to this
 1504  subsection. The Office of Insurance Regulation shall review each
 1505  exception and approve or disapprove it prior to use. It shall be
 1506  the insurer’s burden to actuarially justify by clear and
 1507  convincing evidence any deviation that results in a rate that is
 1508  higher than the presumed reduced rate as provided in subsection
 1509  (1).
 1510         (3) If any provision of this act is held invalid by a court
 1511  of competent jurisdiction, the Office of Insurance Regulation
 1512  shall permit an adjustment of all rates filed under this section
 1513  to reflect the impact of such holding on such rates so as to
 1514  ensure that the rates are not excessive, inadequate, or unfairly
 1515  discriminatory.
 1516         Section 14. The Office of Insurance Regulation shall
 1517  perform a comprehensive personal injury protection data call and
 1518  publish the results by January 1, 2015. It is the intent of the
 1519  Legislature that the office design the data call with the
 1520  expectation that the Legislature will use the data to help
 1521  evaluate market conditions relating to the Florida Motor Vehicle
 1522  No-Fault Law and the impact on the market of reforms to the law
 1523  made by this act. The elements of the data call must address,
 1524  but need not be limited to, the following components of the
 1525  Florida Motor Vehicle No-Fault Law:
 1526         (1) Quantity of personal injury protection claims.
 1527         (2) Type or nature of claimants.
 1528         (3) Amount and type of personal injury protection benefits
 1529  paid and expenses incurred.
 1530         (4) Type and quantity of, and charges for, medical
 1531  benefits.
 1532         (5)Attorney fees related to bringing and defending actions
 1533  for benefits.
 1534         (6) Direct earned premiums for personal injury protection
 1535  coverage, pure loss ratios, pure premiums, and other information
 1536  related to premiums and losses.
 1537         (7) Licensed drivers and accidents.
 1538         (8) Fraud and enforcement.
 1539         Section 15. If any provision of this act or its application
 1540  to any person or circumstance is held invalid, the invalidity
 1541  does not affect other provisions or applications of the act
 1542  which can be given effect without the invalid provision or
 1543  application, and to this end the provisions of this act are
 1544  severable.
 1545         Section 16. Except as otherwise expressly provided in this
 1546  act, this act shall take effect July 1, 2012.
 1547  
 1548  ================= T I T L E  A M E N D M E N T ================
 1549         And the title is amended as follows:
 1550         Delete everything before the enacting clause
 1551  and insert:
 1552                        A bill to be entitled                      
 1553         An act relating to motor vehicle personal injury
 1554         protection insurance; amending s. 316.066, F.S.;
 1555         revising the conditions for completing the long-form
 1556         traffic crash report; revising the information
 1557         contained in the short-form report; revising the
 1558         requirements relating to the driver’s responsibility
 1559         for submitting a report for crashes not requiring a
 1560         law enforcement report; amending s. 400.9905, F.S.;
 1561         providing that certain entities exempt from licensure
 1562         as a health care clinic must nonetheless be licensed
 1563         in order to receive reimbursement for the provision of
 1564         personal injury protection benefits; amending s.
 1565         400.991, F.S.; requiring that an application for
 1566         licensure, or exemption from licensure, as a health
 1567         care clinic include a statement regarding insurance
 1568         fraud; amending s. 626.989, F.S.; providing that
 1569         knowingly submitting false, misleading, or fraudulent
 1570         documents relating to licensure as a health care
 1571         clinic, or submitting a claim for personal injury
 1572         protection relating to clinic licensure documents, is
 1573         a fraudulent insurance act under certain conditions;
 1574         amending s. 626.9581, F.S.; requiring the Department
 1575         of Financial Services or the Office of Insurance
 1576         Regulation to revoke the certificate of authority of
 1577         an insurer that engages in unfair trade practices
 1578         while providing motor vehicle personal injury
 1579         protection insurance; amending s. 626.9894, F.S.;
 1580         conforming provisions to changes made by act; creating
 1581         s. 626.9895, F.S.; providing definitions; authorizing
 1582         the Division of Insurance Fraud of the Department of
 1583         Financial Services to establish a direct-support
 1584         organization for the purpose of prosecuting,
 1585         investigating, and preventing motor vehicle insurance
 1586         fraud; providing requirements for, and duties of, the
 1587         organization; requiring that the organization operate
 1588         pursuant to a contract with the division; providing
 1589         for the requirements of the contract; providing for a
 1590         board of directors; authorizing the organization to
 1591         use the division’s property and facilities subject to
 1592         certain requirements; requiring that the department
 1593         adopt rules relating to procedures for the
 1594         organization’s governance and relating to conditions
 1595         for the use of the division’s property or facilities;
 1596         authorizing contributions from insurers; authorizing
 1597         any moneys received by the organization to be held in
 1598         a separate depository account in the name of the
 1599         organization; requiring that the division deposit
 1600         certain proceeds into the Insurance Regulatory Trust
 1601         Fund; amending s. 627.736, F.S.; revising the cap on
 1602         benefits to provide that death benefits are in
 1603         addition to medical and disability benefits; revising
 1604         medical benefits; distinguishing between initial and
 1605         followup services; excluding massage and acupuncture
 1606         from medical benefits that may be reimbursed under the
 1607         Florida Motor Vehicle No-Fault Law; adding physical
 1608         therapists to the list of providers that may provide
 1609         services; requiring that an insurer repay any benefits
 1610         covered by the Medicaid program; requiring that an
 1611         insurer provide a claimant an opportunity to revise
 1612         claims that contain errors; authorizing an insurer to
 1613         provide notice to the claimant and conduct an
 1614         investigation if fraud is suspected; requiring that an
 1615         insurer create and maintain a log of personal injury
 1616         protection benefits paid and that the insurer provide
 1617         to the insured or an assignee of the insured, upon
 1618         request, a copy of the log if litigation is commenced;
 1619         revising the Medicare fee schedules that an insurer
 1620         may use as a basis for limiting reimbursement of
 1621         personal injury protection benefits; providing that
 1622         the Medicare fee schedule in effect on a specific date
 1623         applies for purposes of limiting reimbursement;
 1624         requiring that an insurer that limits payments based
 1625         on the statutory fee schedule include a notice in
 1626         insurance policies at the time of issuance or renewal;
 1627         deleting obsolete provisions; providing that certain
 1628         entities exempt from licensure as a clinic must
 1629         nonetheless be licensed to receive reimbursement for
 1630         the provision of personal injury protection benefits;
 1631         providing exceptions; requiring that an insurer notify
 1632         parties in disputes over personal injury protection
 1633         claims when policy limits are reached; providing
 1634         criteria for the award of attorney fees; providing a
 1635         presumption regarding the use of a contingency risk
 1636         multiplier; consolidating provisions relating to
 1637         unfair or deceptive practices under certain
 1638         conditions; providing for demand notices to be
 1639         submitted electronically; requiring that a person,
 1640         entity, or licensee that makes a referral for medical
 1641         benefits disclose referral fees in writing to the
 1642         insured and insurer; eliminating a requirement that
 1643         all parties mutually and expressly agree to the use of
 1644         electronic transmission of data; amending s. 627.7405,
 1645         F.S.; providing an exception from an insurer’s right
 1646         of reimbursement for certain owners or registrants;
 1647         amending s. 817.234, F.S.; providing that it is
 1648         insurance fraud to present a claim for personal injury
 1649         protection benefits payable to a person or entity that
 1650         knowingly submitted false, misleading, or fraudulent
 1651         documents relating to licensure as a health care
 1652         clinic; providing that a licensed health care
 1653         practitioner guilty of certain insurance fraud loses
 1654         his or her license and may not receive reimbursement
 1655         for personal injury protection benefits for a
 1656         specified period; defining the term “insurer”;
 1657         amending s. 316.065, F.S.; conforming a cross
 1658         reference; requiring personal injury protection motor
 1659         vehicle insurers to file rates with the Office of
 1660         Insurance Regulation for review under certain
 1661         circumstances; specifying a presumption with regard to
 1662         rates for personal injury protection motor vehicle
 1663         insurance; requiring that the Office of Insurance
 1664         Regulation perform a data call relating to personal
 1665         injury protection; prescribing required elements of
 1666         the data call; providing for severability; providing
 1667         effective dates.