Bill Text: FL H1447 | 2010 | Regular Session | Introduced

---

Bill Title: Insurance Fraud and Abuse

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Insurance, Business, & Financial Affairs Policy (GGPC), companion bill(s) passed, see CS/CS/CS/CS/HB 663 (Ch. 2010-176), CS/CS/SB 1736 (Ch. 2010-90) [H1447 Detail]

Download: Florida-2010-H1447-Introduced.html

---

HB 1447

1	A bill to be entitled
2	An act relating to insurance fraud and abuse; providing a
3	short title; providing legislative findings and intent;
4	amending s. 316.066, F.S.; revising circumstances under
5	which a motor vehicle crash report is required; requiring
6	certain crash reports to include the names of passengers;
7	amending s. 400.991, F.S.; requiring certain documents
8	relating to health care clinic licensure and exemption to
9	include a specified notice; creating s. 400.9933, F.S.;
10	providing for reports of suspected violations relating to
11	licensure of health care clinics under specified
12	provisions and the sharing of information; providing
13	qualified immunities with respect to such reports;
14	amending s. 443.1715, F.S.; deleting certain consent
15	requirements with respect to requests for wage information
16	from workers' compensation employers or carriers to the
17	Agency for Workforce Innovation; amending s. 456.072,
18	F.S.; providing that certain violations relating to health
19	care clinics constitute grounds for disciplinary action
20	against health care professionals; amending s. 626.989,
21	F.S.; including the knowing submission of certain false,
22	fraudulent, or misleading documents relating to health
23	care clinic licensure or exemption within the definition
24	of the term "fraudulent insurance act"; amending s.
25	627.7011, F.S.; allowing residential policies to provide
26	that the full replacement cost will be paid only when the
27	subject property is repaired or replaced; allowing an
28	insurer to hold back a sum reflecting the difference
29	between the actual cash value and the replacement cost;
30	amending s. 627.70131, F.S.; providing a deadline for a
31	property insurer to pay or deny an initial or supplemental
32	claim; amending s. 627.706, F.S.; specifying when optional
33	sinkhole coverage must be made available; providing for
34	coverage limits for optional sinkhole coverage; amending
35	s. 627.7073, F.S.; defining the term "presumed correct"
36	for purposes of sinkhole reports; amending s. 627.7074,
37	F.S.; providing that the neutral evaluation process for
38	sinkhole losses does not supersede appraisal clauses;
39	amending s. 627.711, F.S.; revising who may sign a
40	mitigation verification form submitted to an insurer;
41	requiring the inspector to certify or attest to personal
42	inspection of the structure; specifying what constitutes
43	misconduct by an inspector; providing that misconduct is
44	grounds for discipline by a licensing board and the Office
45	of Insurance Regulation; providing criminal penalties for
46	knowingly providing or uttering a false or fraudulent
47	mitigation verification form with specified intent;
48	requiring a mitigation verification form to contain a
49	specified statement; providing that a policyholder who
50	receives a premium discount or other specified benefit
51	that is determined to have been false or fraudulent
52	mitigation shall pay the wind deductible as increased by
53	the amount of the fraudulent discount retroactive to when
54	the fraudulent discount was first applied; amending s.
55	627.736, F.S.; specifying a form that must be submitted by
56	health care clinics and other facilities along with
57	invoices for payment of personal injury protection medical
58	benefits; providing that certain deadlines are tolled
59	while suspected fraudulent insurance acts are under
60	investigation, subject to certain required notice;
61	providing that benefits are not payable with respect to
62	fraudulent insurance acts; requiring compliance with law
63	regulating health care clinics and practice acts;
64	requiring initial medical reports within a specified
65	period for charges to be valid; providing exceptions;
66	amending s. 932.701, F.S.; including certain real and
67	personal property related to a fraudulent insurance act
68	within the definition of "contraband article" for purposes
69	of the Florida Contraband Forfeiture Act; providing an
70	effective date.
71
72	Be It Enacted by the Legislature of the State of Florida:
73
74	Section 1. (1) SHORT TITLE.-This act may be cited as the
75	"Comprehensive Insurance Fraud Investigation and Prevention Act
76	of 2010."
77	(2) FINDINGS AND INTENT.-
78	(a) The intent of this act is to enhance the investigation
79	and prevention of fraudulent insurance acts in this state, to
80	provide additional sanctions for such acts, and to revise
81	provisions of law that may create incentives for fraudulent
82	insurance acts.
83	(b) The Legislature finds and declares as follows:
84	1. Automobile insurance fraud remains a major problem for
85	Florida consumers and insurers. According to the National
86	Insurance Crime Bureau, Florida has had the highest number of
87	staged accident questionable claims in the nation since at least
88	2007, and the number of staged accident questionable claims in
89	the state has grown rapidly.
90	2. The current regulatory process for health care clinics
91	under part X of chapter 400, Florida Statutes, which was
92	originally enacted in an effort to reduce automobile insurance
93	fraud, is not sufficient to prevent fraud with respect to
94	licensure exemptions and compliance with that part.
95	3. The ongoing crisis in the property insurance market,
96	which reduces availability and affordability of coverage for
97	consumers, is exacerbated by:
98	a. Fraudulent acts with respect to optional sinkhole
99	coverage under part X of chapter 627, Florida Statutes.
100	b. Fraudulent claims for payment of replacement cost with
101	respect to property that is not in fact repaired or replaced.
102	c. Fraudulent inspection reports that are used to obtain
103	hurricane loss mitigation premium discounts for unqualified
104	properties.
105	Section 2. Paragraphs (a) and (b) of subsection (3) of
106	section 316.066, Florida Statutes, are amended to read:
107	316.066 Written reports of crashes.-
108	(3)(a) Every law enforcement officer who in the regular
109	course of duty investigates a motor vehicle crash:
110	1. Which crash resulted in death or personal injury or
111	involved a vehicle that was transporting any passenger other
112	than the driver shall, within 10 days after completing the
113	investigation, forward a written report of the crash to the
114	department or traffic records center.
115	2. Which crash involved a violation of s. 316.061(1) or s.
116	316.193 shall, within 10 days after completing the
117	investigation, forward a written report of the crash to the
118	department or traffic records center.
119	3. In which crash a vehicle was rendered inoperative to a
120	degree which required a wrecker to remove it from traffic may,
121	within 10 days after completing the investigation, forward a
122	written report of the crash to the department or traffic records
123	center if such action is appropriate, in the officer's
124	discretion.
125	(b) In every case in which a crash report is required by
126	this section and a written report to a law enforcement officer
127	is not prepared, the law enforcement officer shall provide each
128	party involved in the crash a short-form report, prescribed by
129	the state, to be completed by the party. The short-form report
130	must include:
131	1. The date, time, and location of the crash;
132	2. A description of the vehicles involved;
133	3. The names and addresses of the parties involved and the
134	names and addresses of all passengers;
135	4. The names and addresses of witnesses;
136	5. The name, badge number, and law enforcement agency of
137	the officer investigating the crash; and
138	6. The names of the insurance companies for the respective
139	parties involved in the crash.
140	Section 3. Subsection (6) is added to section 400.991,
141	Florida Statutes, to read:
142	400.991 License requirements; background screenings;
143	prohibitions.-
144	(6) All forms that constitute part of the application for
145	licensure or exemption from licensure under this part must
146	contain the following statement:
147
148	INSURANCE FRAUD NOTICE: Knowingly submitting a false,
149	misleading, or fraudulent application or other
150	document relating to licensure as a health care
151	clinic, exemption from licensure as a health care
152	clinic, or compliance with part X of chapter 400,
153	Florida Statutes, is a fraudulent insurance act and is
154	also grounds for discipline by licensing boards of the
155	Florida Department of Health.
156
157	Section 4. Section 400.9933, Florida Statutes, is created
158	to read:
159	400.9933 Insurer reports of suspected violations.-A
160	designated employee of an insurer whose responsibilities include
161	the investigation and disposition of claims may provide
162	information to the agency relating to the suspicion that a
163	person knowingly provided or submitted to the agency or insurer
164	any false, misleading, or fraudulent application or other
165	document relating to licensure as a health care clinic under
166	this part, exemption from licensure under this part, or any
167	violation of this part and may also share such information with
168	other designated employees employed by the same or other
169	insurers whose responsibilities include the investigation and
170	disposition of claims relating to fraudulent insurance acts,
171	provided the Division of Insurance Fraud of the Department of
172	Financial Services has been given written notice of the names
173	and job titles of such designated employees prior to such
174	designated employees sharing information. Unless the designated
175	employees of the insurer act in bad faith or in reckless
176	disregard for the rights of any insured, neither the insurer nor
177	its designated employees are civilly liable for libel, slander,
178	or any similar tort, and a civil action does not arise against
179	the insurer or its designated employees for any such information
180	provided to an insurer or to the National Insurance Crime Bureau
181	or the National Association of Insurance Commissioners.
182	Section 5. Paragraph (b) of subsection (2) of section
183	443.1715, Florida Statutes, is amended to read:
184	443.1715 Disclosure of information; confidentiality.-
185	(2) DISCLOSURE OF INFORMATION.-
186	(b)1. The employer or the employer's workers' compensation
187	carrier against whom a claim for benefits under chapter 440 has
188	been made, or a representative of either, may request from the
189	Agency for Workforce Innovation or its tax collection service
190	provider division records of wages of the employee reported to
191	the Agency for Workforce Innovation or its tax collection
192	service provider division by any employer for the quarter that
193	includes the date of the accident that is the subject of such
194	claim and for subsequent quarters. The request must be made with
195	the authorization or consent of the employee or any employer who
196	paid wages to the employee subsequent to the date of the
197	accident.
198	2. The employer or carrier shall make the request on a
199	form prescribed by rule for such purpose by the Agency for
200	Workforce Innovation division. Such form shall contain a
201	certification by the requesting party that it is a party
202	entitled to the information requested as authorized by this
203	paragraph.
204	3. The Agency for Workforce Innovation or its tax
205	collection service provider division shall provide the most
206	current information readily available within 15 days after
207	receiving the request.
208	Section 6. Paragraph (mm) is added to subsection (1) of
209	section 456.072, Florida Statutes, to read:
210	456.072 Grounds for discipline; penalties; enforcement.-
211	(1) The following acts shall constitute grounds for which
212	the disciplinary actions specified in subsection (2) may be
213	taken:
214	(mm) Knowingly providing or submitting to the Agency for
215	Health Care Administration or to any insurer any false,
216	misleading, or fraudulent application or other document relating
217	to licensure as a health care clinic under part X of chapter
218	400, exemption from licensure as a health care clinic, or
219	compliance with part X of chapter 400.
220	Section 7. Subsection (1) of section 626.989, Florida
221	Statutes, is amended to read:
222	626.989 Investigation by department or Division of
223	Insurance Fraud; compliance; immunity; confidential information;
224	reports to division; division investigator's power of arrest.-
225	(1)(a) For the purposes of this section, a person commits
226	a "fraudulent insurance act" if:
227	1. The person knowingly and with intent to defraud
228	presents, causes to be presented, or prepares with knowledge or
229	belief that it will be presented, to or by an insurer, self-
230	insurer, self-insurance fund, servicing corporation, purported
231	insurer, broker, or any agent thereof, any written statement as
232	part of, or in support of, an application for the issuance of,
233	or the rating of, any insurance policy, or a claim for payment
234	or other benefit pursuant to any insurance policy, which the
235	person knows to contain materially false information concerning
236	any fact material thereto or if the person conceals, for the
237	purpose of misleading another, information concerning any fact
238	material thereto.
239	2. Except as provided in s. 400.9933, the person knowingly
240	provides or submits to the Agency for Health Care Administration
241	or to any insurer any false, misleading, or fraudulent
242	application or other document relating to licensure as a health
243	care clinic under part X of chapter 400, exemption from
244	licensure as a health care clinic, or compliance with part X of
245	chapter 400.
246	(b) For the purposes of this section, the term "insurer"
247	also includes any health maintenance organization and the term
248	"insurance policy" also includes a health maintenance
249	organization subscriber contract.
250	Section 8. Subsection (3) of section 627.7011, Florida
251	Statutes, is amended to read:
252	627.7011 Homeowners' policies; offer of replacement cost
253	coverage and law and ordinance coverage.-
254	(3) In order to reduce the incentive for claims fraud, the
255	policy may provide that in the event of a loss for which a
256	dwelling or personal property is insured on the basis of
257	replacement costs, the insurer need not pay the full replacement
258	cost until shall pay the replacement cost without reservation or
259	holdback of any depreciation in value, whether or not the
260	insured replaces or repairs the dwelling or property and may
261	hold back a sum reflecting the difference between the actual
262	cash value and the replacement cost.
263	Section 9. Paragraph (a) of subsection (5) of section
264	627.70131, Florida Statutes, is amended to read:
265	627.70131 Insurer's duty to acknowledge communications
266	regarding claims; investigation.-
267	(5)(a) Within 90 days after an insurer receives notice of
268	an initial or supplemental a property insurance claim from a
269	policyholder, the insurer shall pay or deny such claim or a
270	portion of the claim unless the failure to pay such claim or a
271	portion of the claim is caused by factors beyond the control of
272	the insurer which reasonably prevent such payment. Any payment
273	of a claim or portion of a claim paid 90 days after the insurer
274	receives notice of the claim, or paid more than 15 days after
275	there are no longer factors beyond the control of the insurer
276	which reasonably prevented such payment, whichever is later,
277	shall bear interest at the rate set forth in s. 55.03. Interest
278	begins to accrue from the date the insurer receives notice of
279	the claim. The provisions of this subsection may not be waived,
280	voided, or nullified by the terms of the insurance policy. If
281	there is a right to prejudgment interest, the insured shall
282	select whether to receive prejudgment interest or interest under
283	this subsection. Interest is payable when the claim or portion
284	of the claim is paid. Failure to comply with this subsection
285	constitutes a violation of this code. However, failure to comply
286	with this subsection shall not form the sole basis for a private
287	cause of action.
288	Section 10. Subsection (1) of section 627.706, Florida
289	Statutes, is amended to read:
290	627.706 Sinkhole insurance; catastrophic ground cover
291	collapse; definitions.-
292	(1) Every insurer authorized to transact property
293	insurance in this state shall provide coverage for a
294	catastrophic ground cover collapse and shall make available, for
295	an appropriate additional premium, coverage for sinkhole losses
296	on any structure, including contents of personal property
297	contained therein, to the extent provided in the form to which
298	the coverage attaches. The insurer shall make such coverage
299	available at the time of the policyholder's initial application
300	for coverage or, with respect to coverage in effect on October
301	1, 2010, at the first renewal of the policy after October 1,
302	2010. In order to reduce the impact of sinkhole-related
303	insurance fraud, the insurer making sinkhole coverage available
304	under this subsection shall specify a sinkhole coverage limit
305	equal to no more than 25 percent of the structure ("Coverage A")
306	limit under the policy. The sinkhole coverage limit does not
307	affect the coverage limit for catastrophic ground cover
308	collapse. The coverage limit for sinkhole losses includes
309	payments for both indemnification and expenses. A policy for
310	residential property insurance may include a deductible amount
311	applicable to sinkhole losses equal to 1 percent, 2 percent, 5
312	percent, or 10 percent of the policy dwelling limits, with
313	appropriate premium discounts offered with each deductible
314	amount.
315	Section 11. Paragraph (c) of subsection (1) of section
316	627.7073, Florida Statutes, is amended to read:
317	627.7073 Sinkhole reports.-
318	(1) Upon completion of testing as provided in s. 627.7072,
319	the professional engineer or professional geologist shall issue
320	a report and certification to the insurer and the policyholder
321	as provided in this section.
322	(c) The respective findings, opinions, and recommendations
323	of the professional engineer or professional geologist as to the
324	cause of distress to the property and the findings, opinions,
325	and recommendations of the professional engineer as to land and
326	building stabilization and foundation repair shall be presumed
327	correct. For purposes of this paragraph, the term "presumed
328	correct" means that the party disputing a finding, opinion, or
329	recommendation has the burden of proving by a preponderance of
330	the evidence that the finding, opinion, or recommendation is not
331	valid.
332	Section 12. Subsection (3) of section 627.7074, Florida
333	Statutes, is amended to read:
334	627.7074 Alternative procedure for resolution of disputed
335	sinkhole insurance claims.-
336	(3) Following the receipt of the report provided under s.
337	627.7073 or the denial of a claim for a sinkhole loss, the
338	insurer shall notify the policyholder of his or her right to
339	participate in the neutral evaluation program under this
340	section. Neutral evaluation supersedes the alternative dispute
341	resolution process under s. 627.7015, but does not supersede the
342	appraisal clause, if any, of the insurance policy. The insurer
343	shall provide to the policyholder the consumer information
344	pamphlet prepared by the department pursuant to paragraph
345	(2)(b).
346	Section 13. Section 627.711, Florida Statutes, is amended
347	to read:
348	627.711 Notice of premium discounts for hurricane loss
349	mitigation; uniform mitigation verification inspection form.-
350	(1) Using a form prescribed by the Office of Insurance
351	Regulation, the insurer shall clearly notify the applicant or
352	policyholder of any personal lines residential property
353	insurance policy, at the time of the issuance of the policy and
354	at each renewal, of the availability and the range of each
355	premium discount, credit, other rate differential, or reduction
356	in deductibles, and combinations of discounts, credits, rate
357	differentials, or reductions in deductibles, for properties on
358	which fixtures or construction techniques demonstrated to reduce
359	the amount of loss in a windstorm can be or have been installed
360	or implemented. The prescribed form shall describe generally
361	what actions the policyholders may be able to take to reduce
362	their windstorm premium. The prescribed form and a list of such
363	ranges approved by the office for each insurer licensed in the
364	state and providing such discounts, credits, other rate
365	differentials, or reductions in deductibles for properties
366	described in this subsection shall be available for electronic
367	viewing and download from the Department of Financial Services'
368	or the Office of Insurance Regulation's Internet website. The
369	Financial Services Commission may adopt rules to implement this
370	subsection.
371	(2) By July 1, 2007, The Financial Services Commission
372	shall develop by rule a uniform mitigation verification
373	inspection form that shall be used by all insurers when
374	submitted by policyholders for the purpose of factoring
375	discounts for wind insurance. In developing the form, the
376	commission shall seek input from insurance, construction, and
377	building code representatives. Further, the commission shall
378	provide guidance as to the length of time the inspection results
379	are valid. An insurer shall accept as valid a uniform mitigation
380	verification form certified by the Department of Financial
381	Services or signed by:
382	(a) A hurricane mitigation inspector certified by the My
383	Safe Florida Home program;
384	(a)(b) A building code inspector certified under s.
385	468.607;
386	(b)(c) A general, building, or residential contractor
387	licensed under s. 489.111;
388	(c)(d) A professional engineer licensed under s. 471.015
389	who has passed the appropriate equivalency test of the building
390	code training program as required by s. 553.841;
391	(d)(e) A professional architect licensed under s. 481.213;
392	or
393	(e)(f) Any other individual or entity recognized by the
394	insurer as possessing the necessary qualifications to properly
395	complete a uniform mitigation verification form.
396	(3) An individual or entity that is authorized to sign the
397	mitigation verification form must certify or attest to personal
398	inspection of the structures referenced by the form.
399	(4) An individual or entity that signs a uniform
400	mitigation form may not commit misconduct in performing
401	hurricane mitigation inspections or in completing a uniform
402	mitigation form that causes financial harm to a customer or the
403	customer's insurer or that jeopardizes a customer's health,
404	safety, and welfare. Misconduct occurs when an authorized
405	mitigation inspector signs a uniform mitigation verification
406	form:
407	(a) Falsely indicating that he or she personally inspected
408	the structures referenced by the form;
409	(b) Falsely indicating the existence of a feature that
410	entitles an insured to a mitigation discount that the inspector
411	knows does not exist or did not personally inspect;
412	(c) Containing erroneous information due to the gross
413	negligence of the inspector; or
414	(d) Containing a pattern of demonstrably false information
415	regarding the existence of mitigation features that the
416	inspector knows could give an insured a false evaluation of the
417	ability of the structure to withstand major damage from a
418	hurricane, endangering the safety of the insured's life and
419	property.
420	(5) The licensing board of an authorized mitigation
421	inspector who violates subsection (4) may commence disciplinary
422	proceedings and impose administrative fines and other sanctions
423	authorized under the inspector's licensing act.
424	(6) The Office of Insurance Regulation may commence
425	disciplinary proceedings against an individual or entity
426	authorized to sign a uniform mitigation form under paragraph
427	(2)(e) who violates subsection (4) and may impose administrative
428	fines and other sanctions authorized under s. 624.310.
429	(7)(3) An individual or entity who knowingly provides or
430	utters a false or fraudulent mitigation verification form with
431	the intent to obtain or receive a discount on an insurance
432	premium to which the individual or entity is not entitled
433	commits, for a first violation, a misdemeanor of the second
434	first degree, punishable as provided in s. 775.082 or s.
435	775.083. An individual or entity who commits a second or
436	subsequent violation commits a felony of the third degree,
437	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
438	(8) Any mitigation verification form prepared by an
439	inspector or submitted by or on behalf of an insured must
440	contain the following statement in boldface type no smaller than
441	12 points:
442
443	INSURANCE FRAUD NOTICE: Fraudulent mitigation forms may
444	subject you to substantial fines or imprisonment. Knowingly
445	preparing or submitting a false, misleading, or fraudulent
446	mitigation verification form or other document relating to
447	a mitigation discount may be a felony under section
448	817.234, Florida Statutes. In addition, for an individual
449	or entity to knowingly provide or utter a false or
450	fraudulent mitigation verification form with the intent to
451	obtain or receive a discount on an insurance premium to
452	which the individual or entity is not entitled is a second
453	degree misdemeanor for a first violation under section
454	627.711, Florida Statutes, and a felony under section
455	627.711, Florida Statutes, for a subsequent violation.
456
457	(9) A policyholder who receives a premium discount,
458	credit, other rate differential, or reduction in deductibles, or
459	a combination of discounts, credits, rate differentials, or
460	reductions in deductibles for properties on which fixtures or
461	construction techniques to reduce the amount of loss in a
462	windstorm can be or have been installed or implemented that is
463	determined to have been false or fraudulent mitigation shall pay
464	the wind deductible plus the amount of the fraudulent discount,
465	credit, other rate differential, and reduction in deductibles
466	received. This payment shall apply retroactively from the policy
467	year that the fraudulent discount was first applied.
468	Section 14. Paragraph (a) of subsection (1), paragraphs
469	(b) and (h) of subsection (4), and paragraph (b) of subsection
470	(5) of section 627.736, Florida Statutes, are amended, and
471	paragraph (h) is added to subsection (5) of that section, to
472	read:
473	627.736 Required personal injury protection benefits;
474	exclusions; priority; claims.-
475	(1) REQUIRED BENEFITS.-Every insurance policy complying
476	with the security requirements of s. 627.733 shall provide
477	personal injury protection to the named insured, relatives
478	residing in the same household, persons operating the insured
479	motor vehicle, passengers in such motor vehicle, and other
480	persons struck by such motor vehicle and suffering bodily injury
481	while not an occupant of a self-propelled vehicle, subject to
482	the provisions of subsection (2) and paragraph (4)(e), to a
483	limit of $10,000 for loss sustained by any such person as a
484	result of bodily injury, sickness, disease, or death arising out
485	of the ownership, maintenance, or use of a motor vehicle as
486	follows:
487	(a) Medical benefits.-Eighty percent of all reasonable
488	expenses for medically necessary medical, surgical, X-ray,
489	dental, and rehabilitative services, including prosthetic
490	devices, and medically necessary ambulance, hospital, and
491	nursing services. However, the medical benefits shall provide
492	reimbursement only for such services and care that are lawfully
493	provided, supervised, ordered, or prescribed by a physician
494	licensed under chapter 458 or chapter 459, a dentist licensed
495	under chapter 466, or a chiropractic physician licensed under
496	chapter 460 or that are provided by any of the following persons
497	or entities:
498	1. A hospital or ambulatory surgical center licensed under
499	chapter 395.
500	2. A person or entity licensed under ss. 401.2101-401.45
501	that provides emergency transportation and treatment.
502	3. An entity wholly owned by one or more physicians
503	licensed under chapter 458 or chapter 459, chiropractic
504	physicians licensed under chapter 460, or dentists licensed
505	under chapter 466 or by such practitioner or practitioners and
506	the spouse, parent, child, or sibling of that practitioner or
507	those practitioners.
508	4. An entity wholly owned, directly or indirectly, by a
509	hospital or hospitals.
510	5. A health care clinic licensed under ss. 400.990-400.995
511	that is:
512	a. Accredited by the Joint Commission on Accreditation of
513	Healthcare Organizations, the American Osteopathic Association,
514	the Commission on Accreditation of Rehabilitation Facilities, or
515	the Accreditation Association for Ambulatory Health Care, Inc.;
516	or
517	b. A health care clinic that:
518	(I) Has a medical director licensed under chapter 458,
519	chapter 459, or chapter 460;
520	(II) Has been continuously licensed for more than 3 years
521	or is a publicly traded corporation that issues securities
522	traded on an exchange registered with the United States
523	Securities and Exchange Commission as a national securities
524	exchange; and
525	(III) Provides at least four of the following medical
526	specialties:
527	(A) General medicine.
528	(B) Radiography.
529	(C) Orthopedic medicine.
530	(D) Physical medicine.
531	(E) Physical therapy.
532	(F) Physical rehabilitation.
533	(G) Prescribing or dispensing outpatient prescription
534	medication.
535	(H) Laboratory services.
536
537	When any services under this paragraph are provided by an entity
538	or clinic described in subparagraph 3., subparagraph 4., or
539	subparagraph 5., the medical benefits shall provide
540	reimbursement for such services only if the entity or clinic
541	provides to the insurer a form adopted by rule of the Financial
542	Services Commission that documents that the entity or clinic
543	meets the criteria of subparagraph 3., subparagraph 4., or
544	subparagraph 5. and that includes a sworn statement or affidavit
545	to that effect. The Financial Services Commission shall adopt by
546	rule the form that must be used by an insurer and a health care
547	provider specified in subparagraph 3., subparagraph 4., or
548	subparagraph 5. to document that the health care provider meets
549	the criteria of this paragraph, which rule must include a
550	requirement for a sworn statement or affidavit.
551
552	Only insurers writing motor vehicle liability insurance in this
553	state may provide the required benefits of this section, and no
554	such insurer shall require the purchase of any other motor
555	vehicle coverage other than the purchase of property damage
556	liability coverage as required by s. 627.7275 as a condition for
557	providing such required benefits. Insurers may not require that
558	property damage liability insurance in an amount greater than
559	$10,000 be purchased in conjunction with personal injury
560	protection. Such insurers shall make benefits and required
561	property damage liability insurance coverage available through
562	normal marketing channels. Any insurer writing motor vehicle
563	liability insurance in this state who fails to comply with such
564	availability requirement as a general business practice shall be
565	deemed to have violated part IX of chapter 626, and such
566	violation shall constitute an unfair method of competition or an
567	unfair or deceptive act or practice involving the business of
568	insurance; and any such insurer committing such violation shall
569	be subject to the penalties afforded in such part, as well as
570	those which may be afforded elsewhere in the insurance code.
571	(4) BENEFITS; WHEN DUE.-Benefits due from an insurer under
572	ss. 627.730-627.7405 shall be primary, except that benefits
573	received under any workers' compensation law shall be credited
574	against the benefits provided by subsection (1) and shall be due
575	and payable as loss accrues, upon receipt of reasonable proof of
576	such loss and the amount of expenses and loss incurred which are
577	covered by the policy issued under ss. 627.730-627.7405. When
578	the Agency for Health Care Administration provides, pays, or
579	becomes liable for medical assistance under the Medicaid program
580	related to injury, sickness, disease, or death arising out of
581	the ownership, maintenance, or use of a motor vehicle, benefits
582	under ss. 627.730-627.7405 shall be subject to the provisions of
583	the Medicaid program.
584	(b) Personal injury protection insurance benefits paid
585	pursuant to this section shall be overdue if not paid within 30
586	days after the insurer is furnished written notice of the fact
587	of a covered loss and of the amount of same. If such written
588	notice is not furnished to the insurer as to the entire claim,
589	any partial amount supported by written notice is overdue if not
590	paid within 30 days after such written notice is furnished to
591	the insurer. Any part or all of the remainder of the claim that
592	is subsequently supported by written notice is overdue if not
593	paid within 30 days after such written notice is furnished to
594	the insurer. When an insurer pays only a portion of a claim or
595	rejects a claim, the insurer shall provide at the time of the
596	partial payment or rejection an itemized specification of each
597	item that the insurer had reduced, omitted, or declined to pay
598	and any information that the insurer desires the claimant to
599	consider related to the medical necessity of the denied
600	treatment or to explain the reasonableness of the reduced
601	charge, provided that this shall not limit the introduction of
602	evidence at trial; and the insurer shall include the name and
603	address of the person to whom the claimant should respond and a
604	claim number to be referenced in future correspondence. However,
605	notwithstanding the fact that written notice has been furnished
606	to the insurer, any payment shall not be deemed overdue when the
607	insurer has reasonable proof to establish that the insurer is
608	not responsible for the payment. For the purpose of calculating
609	the extent to which any benefits are overdue, payment shall be
610	treated as being made on the date a draft or other valid
611	instrument which is equivalent to payment was placed in the
612	United States mail in a properly addressed, postpaid envelope
613	or, if not so posted, on the date of delivery. This paragraph
614	does not preclude or limit the ability of the insurer to assert
615	that the claim was unrelated, was not medically necessary, or
616	was unreasonable or that the amount of the charge was in excess
617	of that permitted under, or in violation of, subsection (5).
618	Such assertion by the insurer may be made at any time, including
619	after payment of the claim or after the 30-day time period for
620	payment set forth in this paragraph. Notwithstanding any other
621	provisions of this paragraph, the 30-day deadline for payment or
622	denial is tolled with respect to any portion or portions of a
623	claim for which the insurer has a reasonable suspicion of a
624	fraudulent insurance act as defined in s. 626.989, while the
625	insurer is investigating the suspected fraudulent insurance
626	acts, if the insurer notifies the insured within the 30-day
627	period that it is investigating such portion or portions of the
628	claim.
629	(h) Benefits shall not be due or payable to or on the
630	behalf of any an insured person if that person if that person
631	has committed, by a material act or omission, any insurance
632	fraud relating to personal injury protection coverage under the
633	his or her policy, if the fraud is admitted to in a sworn
634	statement by the insured or if it is established in a court of
635	competent jurisdiction. Any insurance fraud shall void all
636	coverage arising from the claim related to such fraud under the
637	personal injury protection coverage of the insured person who
638	committed the fraud, irrespective of whether a portion of the
639	insured person's claim may be legitimate, and any benefits paid
640	prior to the discovery of the insured person's insurance fraud
641	shall be recoverable by the insurer from the person who
642	committed insurance fraud in their entirety. As used in this
643	paragraph, the term "insurance fraud" includes any act or
644	omission included within the term "fraudulent insurance act"
645	under s. 626.989. The prevailing party is entitled to its costs
646	and attorney's fees in any action in which it prevails in an
647	insurer's action to enforce its right of recovery under this
648	paragraph.
649	(5) CHARGES FOR TREATMENT OF INJURED PERSONS.-
650	(b)1. An insurer or insured is not required to pay a claim
651	or charges:
652	a. Made by a broker or by a person making a claim on
653	behalf of a broker.;
654	b. For any service or treatment that was not lawful at the
655	time rendered.;
656	c.(I) To any person who, with respect to personal injury
657	protection coverage of a particular injured person or insured,
658	knowingly submits or attempts to submit a false or misleading
659	statement, record, or bill; knowingly submits or attempts to
660	submit false or misleading information relating to the claim or
661	charges; or has otherwise committed or attempted to commit a
662	fraudulent insurance act as defined in s. 626.989.
663	(II) A person described in sub-sub-subparagraph (I) is not
664	entitled to payment of any claims or charges with respect to the
665	injured person or insured, irrespective of whether some portion
666	of such person's claim or charges with respect to the injured
667	person or insured might not be false, misleading, or fraudulent
668	within the meaning of sub-sub-subparagraph (I). All personal
669	injury protection coverage with respect to services provided to
670	the injured person or insured by a person described in sub-sub-
671	subparagraph (I) is void, but this limitation does not affect
672	services provided to the injured person or insured by persons
673	other than a person described in sub-sub-subparagraph (I).
674	(III) In addition to any other remedies provided by law,
675	an insurer receiving a claim or charge as described in this sub-
676	subparagraph has the right, under any available common law or
677	statutory cause of action, to recover from a person described in
678	sub-sub-subparagraph (I) any sums it previously paid to such
679	person with respect to the injured person or insured.
680	(IV) The injured person or insured is not liable for, and
681	a provider or other person receiving an assignment of benefits
682	shall not bill the injured person or insured for, any claims or
683	charges that are denied by the insurer under sub-sub-
684	subparagraphs (I) and (II) or any amounts that the insurer
685	recovers under sub-sub-subparagraph (III). Any agreement
686	requiring the injured person or insured to pay such charges is
687	void and unenforceable.
688	d. With respect to a bill or statement that does not fully
689	substantially meet the applicable requirements of paragraph (d);
690	that is submitted by a facility that is not fully in compliance
691	with applicable requirements of part X of chapter 400, including
692	provisions relating to licensure, exemption from licensure, and
693	clinic responsibilities; or that is submitted by a practitioner
694	who is not in full compliance with the applicable practice act.
695	In the course of investigating compliance as required by this
696	sub-subparagraph, or as part of the investigation of a suspected
697	fraudulent insurance act under paragraph (4)(b), the insurer may
698	require an examination under oath of a provider, practitioner,
699	medical director, clinic director, or owner of a clinic or other
700	facility submitting a bill or statement.
701	e. For any treatment or service that is upcoded, or that
702	is unbundled when such treatment or services should be bundled,
703	in accordance with paragraph (d). To facilitate prompt payment
704	of lawful services, an insurer may change codes that it
705	determines to have been improperly or incorrectly upcoded or
706	unbundled, and may make payment based on the changed codes,
707	without affecting the right of the provider to dispute the
708	change by the insurer, provided that before doing so, the
709	insurer must contact the health care provider and discuss the
710	reasons for the insurer's change and the health care provider's
711	reason for the coding, or make a reasonable good faith effort to
712	do so, as documented in the insurer's file.; and
713	f. For medical services or treatment billed by a physician
714	and not provided in a hospital unless such services are rendered
715	by the physician or are incident to his or her professional
716	services and are included on the physician's bill, including
717	documentation verifying that the physician is responsible for
718	the medical services that were rendered and billed.
719	2. The Department of Health, in consultation with the
720	appropriate professional licensing boards, shall adopt, by rule,
721	a list of diagnostic tests deemed not to be medically necessary
722	for use in the treatment of persons sustaining bodily injury
723	covered by personal injury protection benefits under this
724	section. The initial list shall be adopted by January 1, 2004,
725	and shall be revised from time to time as determined by the
726	Department of Health, in consultation with the respective
727	professional licensing boards. Inclusion of a test on the list
728	of invalid diagnostic tests shall be based on lack of
729	demonstrated medical value and a level of general acceptance by
730	the relevant provider community and shall not be dependent for
731	results entirely upon subjective patient response.
732	Notwithstanding its inclusion on a fee schedule in this
733	subsection, an insurer or insured is not required to pay any
734	charges or reimburse claims for any invalid diagnostic test as
735	determined by the Department of Health.
736	(h) Charges for treatment are not valid unless the
737	provider of such treatment, within 14 days after initial contact
738	with the injured person, provides to the insurer an initial
739	medical report outlining the medical history, examination
740	findings, and preliminary diagnosis and treatment plan. This
741	paragraph does not apply to medical services billed by a
742	hospital or other provider of emergency services and care as
743	defined in s. 395.002 or inpatient services rendered at a
744	hospital-owned facility.
745	Section 15. Paragraph (a) of subsection (2) of section
746	932.701, Florida Statutes, is amended to read:
747	932.701 Short title; definitions.-
748	(2) As used in the Florida Contraband Forfeiture Act:
749	(a) "Contraband article" means:
750	1. Any controlled substance as defined in chapter 893 or
751	any substance, device, paraphernalia, or currency or other means
752	of exchange that was used, was attempted to be used, or was
753	intended to be used in violation of any provision of chapter
754	893, if the totality of the facts presented by the state is
755	clearly sufficient to meet the state's burden of establishing
756	probable cause to believe that a nexus exists between the
757	article seized and the narcotics activity, whether or not the
758	use of the contraband article can be traced to a specific
759	narcotics transaction.
760	2. Any gambling paraphernalia, lottery tickets, money,
761	currency, or other means of exchange which was used, was
762	attempted, or intended to be used in violation of the gambling
763	laws of the state.
764	3. Any equipment, liquid or solid, which was being used,
765	is being used, was attempted to be used, or intended to be used
766	in violation of the beverage or tobacco laws of the state.
767	4. Any motor fuel upon which the motor fuel tax has not
768	been paid as required by law.
769	5. Any personal property, including, but not limited to,
770	any vessel, aircraft, item, object, tool, substance, device,
771	weapon, machine, vehicle of any kind, money, securities, books,
772	records, research, negotiable instruments, or currency, which
773	was used or was attempted to be used as an instrumentality in
774	the commission of, or in aiding or abetting in the commission
775	of, any felony, whether or not comprising an element of the
776	felony, or which is acquired by proceeds obtained as a result of
777	a violation of the Florida Contraband Forfeiture Act.
778	6. Any real property, including any right, title,
779	leasehold, or other interest in the whole of any lot or tract of
780	land, which was used, is being used, or was attempted to be used
781	as an instrumentality in the commission of, or in aiding or
782	abetting in the commission of, any felony, or which is acquired
783	by proceeds obtained as a result of a violation of the Florida
784	Contraband Forfeiture Act.
785	7. Any personal property, including, but not limited to,
786	equipment, money, securities, books, records, research,
787	negotiable instruments, currency, or any vessel, aircraft, item,
788	object, tool, substance, device, weapon, machine, or vehicle of
789	any kind in the possession of or belonging to any person who
790	takes aquaculture products in violation of s. 812.014(2)(c).
791	8. Any motor vehicle offered for sale in violation of s.
792	320.28.
793	9. Any motor vehicle used during the course of committing
794	an offense in violation of s. 322.34(9)(a).
795	10. Any photograph, film, or other recorded image,
796	including an image recorded on videotape, a compact disc,
797	digital tape, or fixed disk, that is recorded in violation of s.
798	810.145 and is possessed for the purpose of amusement,
799	entertainment, sexual arousal, gratification, or profit, or for
800	the purpose of degrading or abusing another person.
801	11. Any real property, including any right, title,
802	leasehold, or other interest in the whole of any lot or tract of
803	land, which is acquired by proceeds obtained as a result of
804	Medicaid fraud under s. 409.920 or s. 409.9201; any personal
805	property, including, but not limited to, equipment, money,
806	securities, books, records, research, negotiable instruments, or
807	currency; or any vessel, aircraft, item, object, tool,
808	substance, device, weapon, machine, or vehicle of any kind in
809	the possession of or belonging to any person which is acquired
810	by proceeds obtained as a result of Medicaid fraud under s.
811	409.920 or s. 409.9201.
812	12.a. Any personal property, including, but not limited
813	to, any vessel, aircraft, item, object, tool, substance, device,
814	weapon, machine, vehicle of any kind, money, securities, books,
815	records, research, negotiable instruments, or currency, which
816	was used or was attempted to be used as an instrumentality in
817	the commission of, or in aiding or abetting in the commission
818	of, any fraudulent insurance act as defined in s. 626.989,
819	whether or not comprising an element of the fraudulent insurance
820	act.
821	b. Any real property, including any right, title,
822	leasehold, or other interest in the whole of any lot or tract of
823	land, which is used in or acquired by proceeds obtained as a
824	result of a fraudulent insurance act as defined in s. 626.989.
825	c. Any personal property, including, but not limited to,
826	equipment, money, securities, books, records, research,
827	negotiable instruments, or currency, or any vessel, aircraft,
828	item, object, tool, substance, device, weapon, machine, or
829	vehicle of any kind in the possession of or belonging to any
830	person, which is acquired by proceeds obtained as a result of a
831	fraudulent insurance act as defined in s. 626.989.
832	Section 16. This act shall take effect October 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.