3424_Ins Fraud Draft FEB 3 10 _2_

Document Sample
3424_Ins Fraud Draft FEB 3 10 _2_ Powered By Docstoc
					F   L      O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

           

           BILL                                       ORIGINAL                                                  YEAR

    1                                         A bill to be entitled
    2              An act relating to insurance fraud; amending s. 400.9935,
    3              F.S.; requiring certain providers of health care services
    4              which are not clinics to obtain certificates of exemption;
    5              prohibiting false or misleading applications for such
    6              certificates; providing penalties; creating s. 626.9894,
    7              F.S.; providing for creation of a direct-support
    8              organization to support the prosecution, investigation,
    9              and prevention of insurance fraud; providing definitions;
10                 providing for a contract between the organization and the
11                 Division of Insurance Fraud of the Department of Financial
12                 Services; providing for a board of directors; providing
13                 for use of division property by the organization;
14                 providing rulemaking authority; providing for the receipt
15                 and deposit of contributions; providing for an annual
16                 audit; amending s. 627.736, F.S.; requiring that bills for
17                 medical treatment or services received under personal
18                 injury protection benefits include the provider's
19                 signature and license number; amending s. 817.234, F.S.;
20                 requiring a mandatory suspension of the license of a
21                 physician or practitioner convicted of insurance fraud
22                 that involves a claim for personal injury protection
23                 benefits; requiring that persons convicted of specified
24                 offenses involving staged or faked motor vehicle crashes
25                 reimburse government entities for costs related to the
26                 crash involved in the violation; providing a definition;
27                 providing an effective date.
28
                                                       Page 1 of 10
        Document1
        CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                        V
F   L   O   R   I   D   A     H    O   U   S   E     O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

        

        BILL                                       ORIGINAL                                                  YEAR

29      Be It Enacted by the Legislature of the State of Florida:
30
31              Section 1.          Subsection (6) of section 400.9935, Florida
32      Statutes, is amended to read:
33              400.9935          Clinic responsibilities.—
34              (6)     Any person or entity providing health care services
35      which is not a clinic, as defined under s. 400.9905, must may
36      voluntarily apply for a certificate of exemption from licensure
37      under its exempt status with the agency on a form that sets
38      forth its name or names and addresses, a statement of the
39      reasons why it cannot be defined as a clinic, and other
40      information deemed necessary by the agency. An exemption is not
41      transferable. The agency may charge an applicant for a
42      certificate of exemption in an amount equal to $100 or the
43      actual cost of processing the certificate, whichever is less.
44      Any person who knowingly files a false or misleading application
45      for a certificate of exemption, or provides false or misleading
46      information related to such application, commits a felony of the
47      third degree, punishable as provided in s. 775.082, s. 775.083,
48      or s. 775.084.
49              Section 2.          Section 626.9894, Florida Statutes, is created
50      to read:
51              626.9894          Direct-support organization; definition; use of
52      property; board of directors; audit.—
53              (1)     DEFINITIONS.—As used in this section:
54              (a)     "Direct-support organization" means an organization
55      whose sole purpose is to support the prosecution, investigation,
56      and prevention of insurance fraud and which meets all of the
                                                    Page 2 of 10
     Document1
     CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                     V
F   L   O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

        

        BILL                                       ORIGINAL                                                  YEAR

57      following:
58              1.      The organization must be a corporation not-for-profit
59      incorporated under chapter 617 and approved by the Department of
60      State.
61              2.      The organization must be organized and operated to
62      conduct programs and activities; raise funds; request and
63      receive grants, gifts, and bequests of moneys; acquire, receive,
64      hold, invest, and administer, in its own name, securities,
65      funds, objects of value, or other property, real or personal;
66      and make grants and expenditures to or for the direct or
67      indirect benefit of the division, state attorneys' offices, and
68      the statewide prosecutor to the extent that such expenditures
69      are to be used exclusively to advance the purpose of
70      prosecuting, investigating, or preventing insurance fraud.
71      Grants and expenditures may include the cost of salaries or
72      benefits of dedicated insurance fraud prosecutors or support
73      personnel, provided that such grants do not interfere with
74      prosecutorial independence or otherwise create conflicts of
75      interest that threaten the success of prosecutions.
76              3.      The organization must be determined by the division to
77      be consistent with the goals of the laws relating to insurance
78      fraud, in the best interest of the state, and in accordance with
79      the adopted goals and mission of the division.
80
81      All grants and expenditures of the organization shall be
82      expressly used to prevent and ameliorate insurance fraud. The
83      expenditures of the direct-support organization may not be used
84      for the purpose of lobbying as defined in s. 11.045.
                                                    Page 3 of 10
     Document1
     CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                     V
F   L    O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

 85              (b)      "Division" means the Division of Insurance Fraud of
 86      the Department of Financial Services.
 87              (c)      "Insurance fraud" means any act defined as a
 88      "fraudulent insurance act" under s. 626.989 and includes any
 89      violation of any of the following provisions:
 90              1.      Section 817.22, making false invoice to defraud
 91      insurer.
 92              2.      Section 817.23, making false affidavit to defraud
 93      insurer.
 94              3.      Section 817.233, burning to defraud an insurer.
 95              4.      Section 817.234, false and fraudulent insurance claims.
 96              5.      Section 817.236, false and fraudulent motor vehicle
 97      insurance application.
 98              6.      Section 817.2361, false or fraudulent proof of motor
 99      vehicle insurance.
100              (2)      CONTRACT.—The direct-support organization shall
101      operate under written contract with the division. The contract
102      must provide for:
103              (a)      Approval of the articles of incorporation and bylaws
104      of the direct-support organization by the division.
105              (b)      Submission of an annual budget for the approval of the
106      division.
107              (c)      Certification by the division that the direct-support
108      organization is complying with the terms of the contract and in
109      a manner consistent with the goals and purposes of the
110      department and in the best interest of the state. Such
111      certification must be made annually and reported in the official
112      minutes of a meeting of the direct-support organization.
                                                     Page 4 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V
F   L    O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

113              (d)     Allocation of funds among the various types of
114      insurance fraud, provided that at least 30 percent of funding
115      provided by the organization must address motor vehicle
116      insurance fraud and at least 30 percent must address workers'
117      compensation fraud.
118              (e)     The reversion of moneys and property held in trust by
119      the direct-support organization for the benefit of the insurance
120      fraud prosecution, investigation, and prevention to the state if
121      the division ceases to exist or to the division if the direct-
122      support organization is no longer approved to operate for the
123      department or if the direct-support organization ceases to
124      exist.
125              (f)     The fiscal year of the direct-support organization,
126      which must begin July 1 of each year and end June 30 of the
127      following year.
128              (g)     The disclosure of material provisions of the contract,
129      and the distinction between the department and the direct-
130      support organization, to donors of gifts, contributions, or
131      bequests, including such disclosure on all promotional and
132      fundraising publications.
133              (3)     BOARD OF DIRECTORS.—There shall be a board of
134      directors of the direct-support organization. Members of the
135      board shall consist of the following seven members:
136              (a)     The Insurance Consumer Advocate, who shall serve as
137      chair.
138              (b)     Three state attorneys appointed by the Chief Financial
139      Officer.
140              (c)     Three representatives of insurers appointed by the
                                                     Page 5 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V
F   L    O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

141      Chief Financial Officer, at least one of whom represents motor
142      vehicle insurers.
143
144      The Chief Financial Officer may remove any member for cause. The
145      term of office of an appointed member expires at the same time
146      as the term of the Chief Financial Officer who appointed him or
147      her or such earlier time as the person ceases to be qualified.
148              (4)     USE OF PROPERTY.—The division may permit, without
149      charge, appropriate use of fixed property and facilities of the
150      division by the direct-support organization, subject to the
151      provisions of this section.
152              (a)     The division may prescribe any condition with which
153      the direct-support organization must comply in order to use
154      fixed property or facilities of the division.
155              (b)     The department may not permit the use of any fixed
156      property or facilities of the division by the direct-support
157      organization if it does not provide equal membership and
158      employment opportunities to all persons regardless of race,
159      color, religion, sex, age, or national origin.
160              (5)     RULES.—The division shall adopt rules prescribing the
161      procedures by which the direct-support organization is governed
162      and any conditions with which a direct-support organization must
163      comply to use property or facilities of the division.
164              (6)     CONTRIBUTIONS.—Any contributions made by an insurer to
165      the direct-support organization shall be allowed as appropriate
166      business expenses for all regulatory purposes.
167              (7)     DEPOSITORY.—Any moneys may be held in a separate
168      depository account in the name of the direct-support
                                                     Page 6 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V
F   L    O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

169      organization and subject to the provisions of the contract with
170      the division.
171              (8)     AUDIT.—The direct-support organization shall provide
172      for an annual financial audit in accordance with s. 215.981.
173              Section 3.         Paragraph (d) of subsection (5) of section
174      627.736, Florida Statutes, is amended to read:
175              627.736       Required personal injury protection benefits;
176      exclusions; priority; claims.—
177              (5)     CHARGES FOR TREATMENT OF INJURED PERSONS.—
178              (d)     All statements and bills for medical services rendered
179      by any physician, hospital, clinic, or other person or
180      institution shall be submitted to the insurer on a properly
181      completed Centers for Medicare and Medicaid Services (CMS) 1500
182      form, UB 92 forms, or any other standard form approved by the
183      office or adopted by the commission for purposes of this
184      paragraph. All billings for such services rendered by providers
185      shall, to the extent applicable, follow the Physicians' Current
186      Procedural Terminology (CPT) or Healthcare Correct Procedural
187      Coding System (HCPCS), or ICD-9 in effect for the year in which
188      services are rendered and comply with the Centers for Medicare
189      and Medicaid Services (CMS) 1500 form instructions and the
190      American Medical Association Current Procedural Terminology
191      (CPT) Editorial Panel and Healthcare Correct Procedural Coding
192      System (HCPCS). All providers other than hospitals shall include
193      on the applicable claim form the professional license number of
194      the provider in the line or space provided for "Signature of
195      Physician or Supplier, Including Degrees or Credentials." In
196      determining compliance with applicable CPT and HCPCS coding,
                                                     Page 7 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V
F   L    O   R   I   D   A     H    O   U   S   E     O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

197      guidance shall be provided by the Physicians' Current Procedural
198      Terminology (CPT) or the Healthcare Correct Procedural Coding
199      System (HCPCS) in effect for the year in which services were
200      rendered, the Office of the Inspector General (OIG), Physicians
201      Compliance Guidelines, and other authoritative treatises
202      designated by rule by the Agency for Health Care Administration.
203      No statement of medical services may include charges for medical
204      services of a person or entity that performed such services
205      without possessing the valid licenses required to perform such
206      services. All bills for treatment or service and all supporting
207      documentation of that treatment or service provided shall
208      include the signature and license number of the provider of the
209      treatment or service. For purposes of paragraph (4)(b), an
210      insurer shall not be considered to have been furnished with
211      notice of the amount of covered loss or medical bills due unless
212      the statements or bills comply with this paragraph, and unless
213      the statements or bills are properly completed in their entirety
214      as to all material provisions, with all relevant information
215      being provided therein.
216              Section 4.          Paragraph (a) of subsection (2) and subsections
217      (9) and (12) of section 817.234, Florida Statutes, are amended
218      to read:
219              817.234       False and fraudulent insurance claims.—
220              (2)(a)1.          Any physician licensed under chapter 458,
221      osteopathic physician licensed under chapter 459, chiropractic
222      physician licensed under chapter 460, or other practitioner
223      licensed under the laws of this state who knowingly and
224      willfully assists, conspires with, or urges any insured party to
                                                     Page 8 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V
F   L    O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

225      fraudulently violate any of the provisions of this section or
226      part XI of chapter 627, or any person who, due to such
227      assistance, conspiracy, or urging by said physician, osteopathic
228      physician, chiropractic physician, or practitioner, knowingly
229      and willfully benefits from the proceeds derived from the use of
230      such fraud, commits insurance fraud, punishable as provided in
231      subsection (11).
232              2.a.        In the event that a physician, osteopathic physician,
233      chiropractic physician, or practitioner described in
234      subparagraph 1. is adjudicated guilty of a violation of this
235      section, the Board of Medicine as set forth in chapter 458, the
236      Board of Osteopathic Medicine as set forth in chapter 459, the
237      Board of Chiropractic Medicine as set forth in chapter 460, or
238      other appropriate licensing authority shall hold an
239      administrative hearing to consider the imposition of
240      administrative sanctions as provided by law against the said
241      physician, osteopathic physician, chiropractic physician, or
242      practitioner.
243              b.      If a physician or practitioner described in
244      subparagraph 1. is convicted of insurance fraud that involves a
245      claim for personal injury protection benefits as required by s.
246      627.736, the appropriate board or other licensing authority
247      described in sub-subparagraph a. shall, in addition to any other
248      punishment less than revocation or relinquishment of the
249      physician's or practitioner's license, suspend the license of
250      the physician or practitioner for 12 months.
251              (9)     A person may not organize, plan, or knowingly
252      participate in an intentional motor vehicle crash or a scheme to
                                                     Page 9 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V
F   L    O   R   I   D   A     H   O   U   S   E      O   F      R   E   P    R   E   S   E   N   T   A   T   I   V   E   S

         

         BILL                                       ORIGINAL                                                  YEAR

253      create documentation of a motor vehicle crash that did not occur
254      for the purpose of making motor vehicle tort claims or claims
255      for personal injury protection benefits as required by s.
256      627.736. Any person who violates this subsection commits a
257      felony of the second degree, punishable as provided in s.
258      775.082, s. 775.083, or s. 775.084. A person who is convicted of
259      a violation of this subsection shall be sentenced to a minimum
260      term of imprisonment of 2 years. A person who is convicted of a
261      violation of this subsection shall also be ordered to reimburse
262      any costs incurred by state, county, or local government in
263      responding to the motor vehicle crash involved in the violation,
264      including, but not limited to, the costs incurred by responding
265      fire, rescue, or police personnel to the scene. Reimbursement
266      shall be made regardless of who requested government units to
267      respond. The request for reimbursement of these costs may be
268      made by the government agency that responded or by the Division
269      of Insurance Fraud on the agency's behalf.
270              (12)        As used in this section:
271              (a)     "Convicted" has the same meaning as provided in s.
272      775.0837.
273              (b)(a)        "Property" means property as defined in s. 812.012.
274              (c)(b)        "Value" means value as defined in s. 812.012.
275              Section 5.         This act shall take effect July 1, 2010.




                                                     Page 10 of 10
      Document1
      CODING: Words stricken are deletions; words underlined are additions.
                                                                                                                      V

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:2
posted:4/13/2012
language:
pages:10