Get documents about "3424_Ins Fraud Draft FEB 3 10 _2_
Shared by: tangshuming
-
Stats
- views:
- 2
- posted:
- 4/13/2012
- language:
- pages:
- 10
Document Sample
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
