October 26, 2020
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_h1447__
HB 1447

1
A bill to be entitled
2An act relating to insurance fraud and abuse; providing a
3short title; providing legislative findings and intent;
4amending s. 316.066, F.S.; revising circumstances under
5which a motor vehicle crash report is required; requiring
6certain crash reports to include the names of passengers;
7amending s. 400.991, F.S.; requiring certain documents
8relating to health care clinic licensure and exemption to
9include a specified notice; creating s. 400.9933, F.S.;
10providing for reports of suspected violations relating to
11licensure of health care clinics under specified
12provisions and the sharing of information; providing
13qualified immunities with respect to such reports;
14amending s. 443.1715, F.S.; deleting certain consent
15requirements with respect to requests for wage information
16from workers' compensation employers or carriers to the
17Agency for Workforce Innovation; amending s. 456.072,
18F.S.; providing that certain violations relating to health
19care clinics constitute grounds for disciplinary action
20against health care professionals; amending s. 626.989,
21F.S.; including the knowing submission of certain false,
22fraudulent, or misleading documents relating to health
23care clinic licensure or exemption within the definition
24of the term "fraudulent insurance act"; amending s.
25627.7011, F.S.; allowing residential policies to provide
26that the full replacement cost will be paid only when the
27subject property is repaired or replaced; allowing an
28insurer to hold back a sum reflecting the difference
29between the actual cash value and the replacement cost;
30amending s. 627.70131, F.S.; providing a deadline for a
31property insurer to pay or deny an initial or supplemental
32claim; amending s. 627.706, F.S.; specifying when optional
33sinkhole coverage must be made available; providing for
34coverage limits for optional sinkhole coverage; amending
35s. 627.7073, F.S.; defining the term "presumed correct"
36for purposes of sinkhole reports; amending s. 627.7074,
37F.S.; providing that the neutral evaluation process for
38sinkhole losses does not supersede appraisal clauses;
39amending s. 627.711, F.S.; revising who may sign a
40mitigation verification form submitted to an insurer;
41requiring the inspector to certify or attest to personal
42inspection of the structure; specifying what constitutes
43misconduct by an inspector; providing that misconduct is
44grounds for discipline by a licensing board and the Office
45of Insurance Regulation; providing criminal penalties for
46knowingly providing or uttering a false or fraudulent
47mitigation verification form with specified intent;
48requiring a mitigation verification form to contain a
49specified statement; providing that a policyholder who
50receives a premium discount or other specified benefit
51that is determined to have been false or fraudulent
52mitigation shall pay the wind deductible as increased by
53the amount of the fraudulent discount retroactive to when
54the fraudulent discount was first applied; amending s.
55627.736, F.S.; specifying a form that must be submitted by
56health care clinics and other facilities along with
57invoices for payment of personal injury protection medical
58benefits; providing that certain deadlines are tolled
59while suspected fraudulent insurance acts are under
60investigation, subject to certain required notice;
61providing that benefits are not payable with respect to
62fraudulent insurance acts; requiring compliance with law
63regulating health care clinics and practice acts;
64requiring initial medical reports within a specified
65period for charges to be valid; providing exceptions;
66amending s. 932.701, F.S.; including certain real and
67personal property related to a fraudulent insurance act
68within the definition of "contraband article" for purposes
69of the Florida Contraband Forfeiture Act; providing an
70effective date.
71
72Be 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
76of 2010."
77     (2)  FINDINGS AND INTENT.-
78     (a)  The intent of this act is to enhance the investigation
79and prevention of fraudulent insurance acts in this state, to
80provide additional sanctions for such acts, and to revise
81provisions of law that may create incentives for fraudulent
82insurance acts.
83     (b)  The Legislature finds and declares as follows:
84     1.  Automobile insurance fraud remains a major problem for
85Florida consumers and insurers. According to the National
86Insurance Crime Bureau, Florida has had the highest number of
87staged accident questionable claims in the nation since at least
882007, and the number of staged accident questionable claims in
89the state has grown rapidly.
90     2.  The current regulatory process for health care clinics
91under part X of chapter 400, Florida Statutes, which was
92originally enacted in an effort to reduce automobile insurance
93fraud, is not sufficient to prevent fraud with respect to
94licensure exemptions and compliance with that part.
95     3.  The ongoing crisis in the property insurance market,
96which reduces availability and affordability of coverage for
97consumers, is exacerbated by:
98     a.  Fraudulent acts with respect to optional sinkhole
99coverage under part X of chapter 627, Florida Statutes.
100     b.  Fraudulent claims for payment of replacement cost with
101respect to property that is not in fact repaired or replaced.
102     c.  Fraudulent inspection reports that are used to obtain
103hurricane loss mitigation premium discounts for unqualified
104properties.
105     Section 2.  Paragraphs (a) and (b) of subsection (3) of
106section 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
109course of duty investigates a motor vehicle crash:
110     1.  Which crash resulted in death or personal injury or
111involved a vehicle that was transporting any passenger other
112than the driver shall, within 10 days after completing the
113investigation, forward a written report of the crash to the
114department or traffic records center.
115     2.  Which crash involved a violation of s. 316.061(1) or s.
116316.193 shall, within 10 days after completing the
117investigation, forward a written report of the crash to the
118department or traffic records center.
119     3.  In which crash a vehicle was rendered inoperative to a
120degree which required a wrecker to remove it from traffic may,
121within 10 days after completing the investigation, forward a
122written report of the crash to the department or traffic records
123center if such action is appropriate, in the officer's
124discretion.
125     (b)  In every case in which a crash report is required by
126this section and a written report to a law enforcement officer
127is not prepared, the law enforcement officer shall provide each
128party involved in the crash a short-form report, prescribed by
129the state, to be completed by the party. The short-form report
130must 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
134names and addresses of all passengers;
135     4.  The names and addresses of witnesses;
136     5.  The name, badge number, and law enforcement agency of
137the officer investigating the crash; and
138     6.  The names of the insurance companies for the respective
139parties involved in the crash.
140     Section 3.  Subsection (6) is added to section 400.991,
141Florida Statutes, to read:
142     400.991  License requirements; background screenings;
143prohibitions.-
144     (6)  All forms that constitute part of the application for
145licensure or exemption from licensure under this part must
146contain the following statement:
147
148INSURANCE FRAUD NOTICE: Knowingly submitting a false,
149misleading, or fraudulent application or other
150document relating to licensure as a health care
151clinic, exemption from licensure as a health care
152clinic, or compliance with part X of chapter 400,
153Florida Statutes, is a fraudulent insurance act and is
154also grounds for discipline by licensing boards of the
155Florida Department of Health.
156
157     Section 4.  Section 400.9933, Florida Statutes, is created
158to read:
159     400.9933  Insurer reports of suspected violations.-A
160designated employee of an insurer whose responsibilities include
161the investigation and disposition of claims may provide
162information to the agency relating to the suspicion that a
163person knowingly provided or submitted to the agency or insurer
164any false, misleading, or fraudulent application or other
165document relating to licensure as a health care clinic under
166this part, exemption from licensure under this part, or any
167violation of this part and may also share such information with
168other designated employees employed by the same or other
169insurers whose responsibilities include the investigation and
170disposition of claims relating to fraudulent insurance acts,
171provided the Division of Insurance Fraud of the Department of
172Financial Services has been given written notice of the names
173and job titles of such designated employees prior to such
174designated employees sharing information. Unless the designated
175employees of the insurer act in bad faith or in reckless
176disregard for the rights of any insured, neither the insurer nor
177its designated employees are civilly liable for libel, slander,
178or any similar tort, and a civil action does not arise against
179the insurer or its designated employees for any such information
180provided to an insurer or to the National Insurance Crime Bureau
181or the National Association of Insurance Commissioners.
182     Section 5.  Paragraph (b) of subsection (2) of section
183443.1715, 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
187carrier against whom a claim for benefits under chapter 440 has
188been made, or a representative of either, may request from the
189Agency for Workforce Innovation or its tax collection service
190provider division records of wages of the employee reported to
191the Agency for Workforce Innovation or its tax collection
192service provider division by any employer for the quarter that
193includes the date of the accident that is the subject of such
194claim and for subsequent quarters. The request must be made with
195the authorization or consent of the employee or any employer who
196paid wages to the employee subsequent to the date of the
197accident.
198     2.  The employer or carrier shall make the request on a
199form prescribed by rule for such purpose by the Agency for
200Workforce Innovation division. Such form shall contain a
201certification by the requesting party that it is a party
202entitled to the information requested as authorized by this
203paragraph.
204     3.  The Agency for Workforce Innovation or its tax
205collection service provider division shall provide the most
206current information readily available within 15 days after
207receiving the request.
208     Section 6.  Paragraph (mm) is added to subsection (1) of
209section 456.072, Florida Statutes, to read:
210     456.072  Grounds for discipline; penalties; enforcement.-
211     (1)  The following acts shall constitute grounds for which
212the disciplinary actions specified in subsection (2) may be
213taken:
214     (mm)  Knowingly providing or submitting to the Agency for
215Health Care Administration or to any insurer any false,
216misleading, or fraudulent application or other document relating
217to licensure as a health care clinic under part X of chapter
218400, exemption from licensure as a health care clinic, or
219compliance with part X of chapter 400.
220     Section 7.  Subsection (1) of section 626.989, Florida
221Statutes, is amended to read:
222     626.989  Investigation by department or Division of
223Insurance Fraud; compliance; immunity; confidential information;
224reports to division; division investigator's power of arrest.-
225     (1)(a)  For the purposes of this section, a person commits
226a "fraudulent insurance act" if:
227     1.  The person knowingly and with intent to defraud
228presents, causes to be presented, or prepares with knowledge or
229belief that it will be presented, to or by an insurer, self-
230insurer, self-insurance fund, servicing corporation, purported
231insurer, broker, or any agent thereof, any written statement as
232part of, or in support of, an application for the issuance of,
233or the rating of, any insurance policy, or a claim for payment
234or other benefit pursuant to any insurance policy, which the
235person knows to contain materially false information concerning
236any fact material thereto or if the person conceals, for the
237purpose of misleading another, information concerning any fact
238material thereto.
239     2.  Except as provided in s. 400.9933, the person knowingly
240provides or submits to the Agency for Health Care Administration
241or to any insurer any false, misleading, or fraudulent
242application or other document relating to licensure as a health
243care clinic under part X of chapter 400, exemption from
244licensure as a health care clinic, or compliance with part X of
245chapter 400.
246     (b)  For the purposes of this section, the term "insurer"
247also includes any health maintenance organization and the term
248"insurance policy" also includes a health maintenance
249organization subscriber contract.
250     Section 8.  Subsection (3) of section 627.7011, Florida
251Statutes, is amended to read:
252     627.7011  Homeowners' policies; offer of replacement cost
253coverage and law and ordinance coverage.-
254     (3)  In order to reduce the incentive for claims fraud, the
255policy may provide that in the event of a loss for which a
256dwelling or personal property is insured on the basis of
257replacement costs, the insurer need not pay the full replacement
258cost until shall pay the replacement cost without reservation or
259holdback of any depreciation in value, whether or not the
260insured replaces or repairs the dwelling or property and may
261hold back a sum reflecting the difference between the actual
262cash value and the replacement cost.
263     Section 9.  Paragraph (a) of subsection (5) of section
264627.70131, Florida Statutes, is amended to read:
265     627.70131  Insurer's duty to acknowledge communications
266regarding claims; investigation.-
267     (5)(a)  Within 90 days after an insurer receives notice of
268an initial or supplemental a property insurance claim from a
269policyholder, the insurer shall pay or deny such claim or a
270portion of the claim unless the failure to pay such claim or a
271portion of the claim is caused by factors beyond the control of
272the insurer which reasonably prevent such payment. Any payment
273of a claim or portion of a claim paid 90 days after the insurer
274receives notice of the claim, or paid more than 15 days after
275there are no longer factors beyond the control of the insurer
276which reasonably prevented such payment, whichever is later,
277shall bear interest at the rate set forth in s. 55.03. Interest
278begins to accrue from the date the insurer receives notice of
279the claim. The provisions of this subsection may not be waived,
280voided, or nullified by the terms of the insurance policy. If
281there is a right to prejudgment interest, the insured shall
282select whether to receive prejudgment interest or interest under
283this subsection. Interest is payable when the claim or portion
284of the claim is paid. Failure to comply with this subsection
285constitutes a violation of this code. However, failure to comply
286with this subsection shall not form the sole basis for a private
287cause of action.
288     Section 10.  Subsection (1) of section 627.706, Florida
289Statutes, is amended to read:
290     627.706  Sinkhole insurance; catastrophic ground cover
291collapse; definitions.-
292     (1)  Every insurer authorized to transact property
293insurance in this state shall provide coverage for a
294catastrophic ground cover collapse and shall make available, for
295an appropriate additional premium, coverage for sinkhole losses
296on any structure, including contents of personal property
297contained therein, to the extent provided in the form to which
298the coverage attaches. The insurer shall make such coverage
299available at the time of the policyholder's initial application
300for coverage or, with respect to coverage in effect on October
3011, 2010, at the first renewal of the policy after October 1,
3022010. In order to reduce the impact of sinkhole-related
303insurance fraud, the insurer making sinkhole coverage available
304under this subsection shall specify a sinkhole coverage limit
305equal to no more than 25 percent of the structure ("Coverage A")
306limit under the policy. The sinkhole coverage limit does not
307affect the coverage limit for catastrophic ground cover
308collapse. The coverage limit for sinkhole losses includes
309payments for both indemnification and expenses. A policy for
310residential property insurance may include a deductible amount
311applicable to sinkhole losses equal to 1 percent, 2 percent, 5
312percent, or 10 percent of the policy dwelling limits, with
313appropriate premium discounts offered with each deductible
314amount.
315     Section 11.  Paragraph (c) of subsection (1) of section
316627.7073, Florida Statutes, is amended to read:
317     627.7073  Sinkhole reports.-
318     (1)  Upon completion of testing as provided in s. 627.7072,
319the professional engineer or professional geologist shall issue
320a report and certification to the insurer and the policyholder
321as provided in this section.
322     (c)  The respective findings, opinions, and recommendations
323of the professional engineer or professional geologist as to the
324cause of distress to the property and the findings, opinions,
325and recommendations of the professional engineer as to land and
326building stabilization and foundation repair shall be presumed
327correct. For purposes of this paragraph, the term "presumed
328correct" means that the party disputing a finding, opinion, or
329recommendation has the burden of proving by a preponderance of
330the evidence that the finding, opinion, or recommendation is not
331valid.
332     Section 12.  Subsection (3) of section 627.7074, Florida
333Statutes, is amended to read:
334     627.7074  Alternative procedure for resolution of disputed
335sinkhole insurance claims.-
336     (3)  Following the receipt of the report provided under s.
337627.7073 or the denial of a claim for a sinkhole loss, the
338insurer shall notify the policyholder of his or her right to
339participate in the neutral evaluation program under this
340section. Neutral evaluation supersedes the alternative dispute
341resolution process under s. 627.7015, but does not supersede the
342appraisal clause, if any, of the insurance policy. The insurer
343shall provide to the policyholder the consumer information
344pamphlet prepared by the department pursuant to paragraph
345(2)(b).
346     Section 13.  Section 627.711, Florida Statutes, is amended
347to read:
348     627.711  Notice of premium discounts for hurricane loss
349mitigation; uniform mitigation verification inspection form.-
350     (1)  Using a form prescribed by the Office of Insurance
351Regulation, the insurer shall clearly notify the applicant or
352policyholder of any personal lines residential property
353insurance policy, at the time of the issuance of the policy and
354at each renewal, of the availability and the range of each
355premium discount, credit, other rate differential, or reduction
356in deductibles, and combinations of discounts, credits, rate
357differentials, or reductions in deductibles, for properties on
358which fixtures or construction techniques demonstrated to reduce
359the amount of loss in a windstorm can be or have been installed
360or implemented. The prescribed form shall describe generally
361what actions the policyholders may be able to take to reduce
362their windstorm premium. The prescribed form and a list of such
363ranges approved by the office for each insurer licensed in the
364state and providing such discounts, credits, other rate
365differentials, or reductions in deductibles for properties
366described in this subsection shall be available for electronic
367viewing and download from the Department of Financial Services'
368or the Office of Insurance Regulation's Internet website. The
369Financial Services Commission may adopt rules to implement this
370subsection.
371     (2)  By July 1, 2007, The Financial Services Commission
372shall develop by rule a uniform mitigation verification
373inspection form that shall be used by all insurers when
374submitted by policyholders for the purpose of factoring
375discounts for wind insurance. In developing the form, the
376commission shall seek input from insurance, construction, and
377building code representatives. Further, the commission shall
378provide guidance as to the length of time the inspection results
379are valid. An insurer shall accept as valid a uniform mitigation
380verification form certified by the Department of Financial
381Services or signed by:
382     (a)  A hurricane mitigation inspector certified by the My
383Safe Florida Home program;
384     (a)(b)  A building code inspector certified under s.
385468.607;
386     (b)(c)  A general, building, or residential contractor
387licensed under s. 489.111;
388     (c)(d)  A professional engineer licensed under s. 471.015
389who has passed the appropriate equivalency test of the building
390code training program as required by s. 553.841;
391     (d)(e)  A professional architect licensed under s. 481.213;
392or
393     (e)(f)  Any other individual or entity recognized by the
394insurer as possessing the necessary qualifications to properly
395complete a uniform mitigation verification form.
396     (3)  An individual or entity that is authorized to sign the
397mitigation verification form must certify or attest to personal
398inspection of the structures referenced by the form.
399     (4)  An individual or entity that signs a uniform
400mitigation form may not commit misconduct in performing
401hurricane mitigation inspections or in completing a uniform
402mitigation form that causes financial harm to a customer or the
403customer's insurer or that jeopardizes a customer's health,
404safety, and welfare. Misconduct occurs when an authorized
405mitigation inspector signs a uniform mitigation verification
406form:
407     (a)  Falsely indicating that he or she personally inspected
408the structures referenced by the form;
409     (b)  Falsely indicating the existence of a feature that
410entitles an insured to a mitigation discount that the inspector
411knows does not exist or did not personally inspect;
412     (c)  Containing erroneous information due to the gross
413negligence of the inspector; or
414     (d)  Containing a pattern of demonstrably false information
415regarding the existence of mitigation features that the
416inspector knows could give an insured a false evaluation of the
417ability of the structure to withstand major damage from a
418hurricane, endangering the safety of the insured's life and
419property.
420     (5)  The licensing board of an authorized mitigation
421inspector who violates subsection (4) may commence disciplinary
422proceedings and impose administrative fines and other sanctions
423authorized under the inspector's licensing act.
424     (6)  The Office of Insurance Regulation may commence
425disciplinary proceedings against an individual or entity
426authorized to sign a uniform mitigation form under paragraph
427(2)(e) who violates subsection (4) and may impose administrative
428fines and other sanctions authorized under s. 624.310.
429     (7)(3)  An individual or entity who knowingly provides or
430utters a false or fraudulent mitigation verification form with
431the intent to obtain or receive a discount on an insurance
432premium to which the individual or entity is not entitled
433commits, for a first violation, a misdemeanor of the second
434first degree, punishable as provided in s. 775.082 or s.
435775.083. An individual or entity who commits a second or
436subsequent violation commits a felony of the third degree,
437punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
438     (8)  Any mitigation verification form prepared by an
439inspector or submitted by or on behalf of an insured must
440contain the following statement in boldface type no smaller than
44112 points:
442
443INSURANCE FRAUD NOTICE: Fraudulent mitigation forms may
444subject you to substantial fines or imprisonment. Knowingly
445preparing or submitting a false, misleading, or fraudulent
446mitigation verification form or other document relating to
447a mitigation discount may be a felony under section
448817.234, Florida Statutes. In addition, for an individual
449or entity to knowingly provide or utter a false or
450fraudulent mitigation verification form with the intent to
451obtain or receive a discount on an insurance premium to
452which the individual or entity is not entitled is a second
453degree misdemeanor for a first violation under section
454627.711, Florida Statutes, and a felony under section
455627.711, Florida Statutes, for a subsequent violation.
456
457     (9)  A policyholder who receives a premium discount,
458credit, other rate differential, or reduction in deductibles, or
459a combination of discounts, credits, rate differentials, or
460reductions in deductibles for properties on which fixtures or
461construction techniques to reduce the amount of loss in a
462windstorm can be or have been installed or implemented that is
463determined to have been false or fraudulent mitigation shall pay
464the wind deductible plus the amount of the fraudulent discount,
465credit, other rate differential, and reduction in deductibles
466received. This payment shall apply retroactively from the policy
467year 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
471paragraph (h) is added to subsection (5) of that section, to
472read:
473     627.736  Required personal injury protection benefits;
474exclusions; priority; claims.-
475     (1)  REQUIRED BENEFITS.-Every insurance policy complying
476with the security requirements of s. 627.733 shall provide
477personal injury protection to the named insured, relatives
478residing in the same household, persons operating the insured
479motor vehicle, passengers in such motor vehicle, and other
480persons struck by such motor vehicle and suffering bodily injury
481while not an occupant of a self-propelled vehicle, subject to
482the provisions of subsection (2) and paragraph (4)(e), to a
483limit of $10,000 for loss sustained by any such person as a
484result of bodily injury, sickness, disease, or death arising out
485of the ownership, maintenance, or use of a motor vehicle as
486follows:
487     (a)  Medical benefits.-Eighty percent of all reasonable
488expenses for medically necessary medical, surgical, X-ray,
489dental, and rehabilitative services, including prosthetic
490devices, and medically necessary ambulance, hospital, and
491nursing services. However, the medical benefits shall provide
492reimbursement only for such services and care that are lawfully
493provided, supervised, ordered, or prescribed by a physician
494licensed under chapter 458 or chapter 459, a dentist licensed
495under chapter 466, or a chiropractic physician licensed under
496chapter 460 or that are provided by any of the following persons
497or entities:
498     1.  A hospital or ambulatory surgical center licensed under
499chapter 395.
500     2.  A person or entity licensed under ss. 401.2101-401.45
501that provides emergency transportation and treatment.
502     3.  An entity wholly owned by one or more physicians
503licensed under chapter 458 or chapter 459, chiropractic
504physicians licensed under chapter 460, or dentists licensed
505under chapter 466 or by such practitioner or practitioners and
506the spouse, parent, child, or sibling of that practitioner or
507those practitioners.
508     4.  An entity wholly owned, directly or indirectly, by a
509hospital or hospitals.
510     5.  A health care clinic licensed under ss. 400.990-400.995
511that is:
512     a.  Accredited by the Joint Commission on Accreditation of
513Healthcare Organizations, the American Osteopathic Association,
514the Commission on Accreditation of Rehabilitation Facilities, or
515the Accreditation Association for Ambulatory Health Care, Inc.;
516or
517     b.  A health care clinic that:
518     (I)  Has a medical director licensed under chapter 458,
519chapter 459, or chapter 460;
520     (II)  Has been continuously licensed for more than 3 years
521or is a publicly traded corporation that issues securities
522traded on an exchange registered with the United States
523Securities and Exchange Commission as a national securities
524exchange; and
525     (III)  Provides at least four of the following medical
526specialties:
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
534medication.
535     (H)  Laboratory services.
536
537When any services under this paragraph are provided by an entity
538or clinic described in subparagraph 3., subparagraph 4., or
539subparagraph 5., the medical benefits shall provide
540reimbursement for such services only if the entity or clinic
541provides to the insurer a form adopted by rule of the Financial
542Services Commission that documents that the entity or clinic
543meets the criteria of subparagraph 3., subparagraph 4., or
544subparagraph 5. and that includes a sworn statement or affidavit
545to that effect. The Financial Services Commission shall adopt by
546rule the form that must be used by an insurer and a health care
547provider specified in subparagraph 3., subparagraph 4., or
548subparagraph 5. to document that the health care provider meets
549the criteria of this paragraph, which rule must include a
550requirement for a sworn statement or affidavit.
551
552Only insurers writing motor vehicle liability insurance in this
553state may provide the required benefits of this section, and no
554such insurer shall require the purchase of any other motor
555vehicle coverage other than the purchase of property damage
556liability coverage as required by s. 627.7275 as a condition for
557providing such required benefits. Insurers may not require that
558property damage liability insurance in an amount greater than
559$10,000 be purchased in conjunction with personal injury
560protection. Such insurers shall make benefits and required
561property damage liability insurance coverage available through
562normal marketing channels. Any insurer writing motor vehicle
563liability insurance in this state who fails to comply with such
564availability requirement as a general business practice shall be
565deemed to have violated part IX of chapter 626, and such
566violation shall constitute an unfair method of competition or an
567unfair or deceptive act or practice involving the business of
568insurance; and any such insurer committing such violation shall
569be subject to the penalties afforded in such part, as well as
570those which may be afforded elsewhere in the insurance code.
571     (4)  BENEFITS; WHEN DUE.-Benefits due from an insurer under
572ss. 627.730-627.7405 shall be primary, except that benefits
573received under any workers' compensation law shall be credited
574against the benefits provided by subsection (1) and shall be due
575and payable as loss accrues, upon receipt of reasonable proof of
576such loss and the amount of expenses and loss incurred which are
577covered by the policy issued under ss. 627.730-627.7405. When
578the Agency for Health Care Administration provides, pays, or
579becomes liable for medical assistance under the Medicaid program
580related to injury, sickness, disease, or death arising out of
581the ownership, maintenance, or use of a motor vehicle, benefits
582under ss. 627.730-627.7405 shall be subject to the provisions of
583the Medicaid program.
584     (b)  Personal injury protection insurance benefits paid
585pursuant to this section shall be overdue if not paid within 30
586days after the insurer is furnished written notice of the fact
587of a covered loss and of the amount of same. If such written
588notice is not furnished to the insurer as to the entire claim,
589any partial amount supported by written notice is overdue if not
590paid within 30 days after such written notice is furnished to
591the insurer. Any part or all of the remainder of the claim that
592is subsequently supported by written notice is overdue if not
593paid within 30 days after such written notice is furnished to
594the insurer. When an insurer pays only a portion of a claim or
595rejects a claim, the insurer shall provide at the time of the
596partial payment or rejection an itemized specification of each
597item that the insurer had reduced, omitted, or declined to pay
598and any information that the insurer desires the claimant to
599consider related to the medical necessity of the denied
600treatment or to explain the reasonableness of the reduced
601charge, provided that this shall not limit the introduction of
602evidence at trial; and the insurer shall include the name and
603address of the person to whom the claimant should respond and a
604claim number to be referenced in future correspondence. However,
605notwithstanding the fact that written notice has been furnished
606to the insurer, any payment shall not be deemed overdue when the
607insurer has reasonable proof to establish that the insurer is
608not responsible for the payment. For the purpose of calculating
609the extent to which any benefits are overdue, payment shall be
610treated as being made on the date a draft or other valid
611instrument which is equivalent to payment was placed in the
612United States mail in a properly addressed, postpaid envelope
613or, if not so posted, on the date of delivery. This paragraph
614does not preclude or limit the ability of the insurer to assert
615that the claim was unrelated, was not medically necessary, or
616was unreasonable or that the amount of the charge was in excess
617of that permitted under, or in violation of, subsection (5).
618Such assertion by the insurer may be made at any time, including
619after payment of the claim or after the 30-day time period for
620payment set forth in this paragraph. Notwithstanding any other
621provisions of this paragraph, the 30-day deadline for payment or
622denial is tolled with respect to any portion or portions of a
623claim for which the insurer has a reasonable suspicion of a
624fraudulent insurance act as defined in s. 626.989, while the
625insurer is investigating the suspected fraudulent insurance
626acts, if the insurer notifies the insured within the 30-day
627period that it is investigating such portion or portions of the
628claim.
629     (h)  Benefits shall not be due or payable to or on the
630behalf of any an insured person if that person if that person
631has committed, by a material act or omission, any insurance
632fraud relating to personal injury protection coverage under the
633his or her policy, if the fraud is admitted to in a sworn
634statement by the insured or if it is established in a court of
635competent jurisdiction. Any insurance fraud shall void all
636coverage arising from the claim related to such fraud under the
637personal injury protection coverage of the insured person who
638committed the fraud, irrespective of whether a portion of the
639insured person's claim may be legitimate, and any benefits paid
640prior to the discovery of the insured person's insurance fraud
641shall be recoverable by the insurer from the person who
642committed insurance fraud in their entirety. As used in this
643paragraph, the term "insurance fraud" includes any act or
644omission included within the term "fraudulent insurance act"
645under s. 626.989. The prevailing party is entitled to its costs
646and attorney's fees in any action in which it prevails in an
647insurer's action to enforce its right of recovery under this
648paragraph.
649     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.-
650     (b)1.  An insurer or insured is not required to pay a claim
651or charges:
652     a.  Made by a broker or by a person making a claim on
653behalf of a broker.;
654     b.  For any service or treatment that was not lawful at the
655time rendered.;
656     c.(I)  To any person who, with respect to personal injury
657protection coverage of a particular injured person or insured,
658knowingly submits or attempts to submit a false or misleading
659statement, record, or bill; knowingly submits or attempts to
660submit false or misleading information relating to the claim or
661charges; or has otherwise committed or attempted to commit a
662fraudulent insurance act as defined in s. 626.989.
663     (II)  A person described in sub-sub-subparagraph (I) is not
664entitled to payment of any claims or charges with respect to the
665injured person or insured, irrespective of whether some portion
666of such person's claim or charges with respect to the injured
667person or insured might not be false, misleading, or fraudulent
668within the meaning of sub-sub-subparagraph (I). All personal
669injury protection coverage with respect to services provided to
670the injured person or insured by a person described in sub-sub-
671subparagraph (I) is void, but this limitation does not affect
672services provided to the injured person or insured by persons
673other than a person described in sub-sub-subparagraph (I).
674     (III)  In addition to any other remedies provided by law,
675an insurer receiving a claim or charge as described in this sub-
676subparagraph has the right, under any available common law or
677statutory cause of action, to recover from a person described in
678sub-sub-subparagraph (I) any sums it previously paid to such
679person with respect to the injured person or insured.
680     (IV)  The injured person or insured is not liable for, and
681a provider or other person receiving an assignment of benefits
682shall not bill the injured person or insured for, any claims or
683charges that are denied by the insurer under sub-sub-
684subparagraphs (I) and (II) or any amounts that the insurer
685recovers under sub-sub-subparagraph (III). Any agreement
686requiring the injured person or insured to pay such charges is
687void and unenforceable.
688     d.  With respect to a bill or statement that does not fully
689substantially meet the applicable requirements of paragraph (d);
690that is submitted by a facility that is not fully in compliance
691with applicable requirements of part X of chapter 400, including
692provisions relating to licensure, exemption from licensure, and
693clinic responsibilities; or that is submitted by a practitioner
694who is not in full compliance with the applicable practice act.
695In the course of investigating compliance as required by this
696sub-subparagraph, or as part of the investigation of a suspected
697fraudulent insurance act under paragraph (4)(b), the insurer may
698require an examination under oath of a provider, practitioner,
699medical director, clinic director, or owner of a clinic or other
700facility submitting a bill or statement.
701     e.  For any treatment or service that is upcoded, or that
702is unbundled when such treatment or services should be bundled,
703in accordance with paragraph (d). To facilitate prompt payment
704of lawful services, an insurer may change codes that it
705determines to have been improperly or incorrectly upcoded or
706unbundled, and may make payment based on the changed codes,
707without affecting the right of the provider to dispute the
708change by the insurer, provided that before doing so, the
709insurer must contact the health care provider and discuss the
710reasons for the insurer's change and the health care provider's
711reason for the coding, or make a reasonable good faith effort to
712do so, as documented in the insurer's file.; and
713     f.  For medical services or treatment billed by a physician
714and not provided in a hospital unless such services are rendered
715by the physician or are incident to his or her professional
716services and are included on the physician's bill, including
717documentation verifying that the physician is responsible for
718the medical services that were rendered and billed.
719     2.  The Department of Health, in consultation with the
720appropriate professional licensing boards, shall adopt, by rule,
721a list of diagnostic tests deemed not to be medically necessary
722for use in the treatment of persons sustaining bodily injury
723covered by personal injury protection benefits under this
724section. The initial list shall be adopted by January 1, 2004,
725and shall be revised from time to time as determined by the
726Department of Health, in consultation with the respective
727professional licensing boards. Inclusion of a test on the list
728of invalid diagnostic tests shall be based on lack of
729demonstrated medical value and a level of general acceptance by
730the relevant provider community and shall not be dependent for
731results entirely upon subjective patient response.
732Notwithstanding its inclusion on a fee schedule in this
733subsection, an insurer or insured is not required to pay any
734charges or reimburse claims for any invalid diagnostic test as
735determined by the Department of Health.
736     (h)  Charges for treatment are not valid unless the
737provider of such treatment, within 14 days after initial contact
738with the injured person, provides to the insurer an initial
739medical report outlining the medical history, examination
740findings, and preliminary diagnosis and treatment plan. This
741paragraph does not apply to medical services billed by a
742hospital or other provider of emergency services and care as
743defined in s. 395.002 or inpatient services rendered at a
744hospital-owned facility.
745     Section 15.  Paragraph (a) of subsection (2) of section
746932.701, 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
751any substance, device, paraphernalia, or currency or other means
752of exchange that was used, was attempted to be used, or was
753intended to be used in violation of any provision of chapter
754893, if the totality of the facts presented by the state is
755clearly sufficient to meet the state's burden of establishing
756probable cause to believe that a nexus exists between the
757article seized and the narcotics activity, whether or not the
758use of the contraband article can be traced to a specific
759narcotics transaction.
760     2.  Any gambling paraphernalia, lottery tickets, money,
761currency, or other means of exchange which was used, was
762attempted, or intended to be used in violation of the gambling
763laws of the state.
764     3.  Any equipment, liquid or solid, which was being used,
765is being used, was attempted to be used, or intended to be used
766in violation of the beverage or tobacco laws of the state.
767     4.  Any motor fuel upon which the motor fuel tax has not
768been paid as required by law.
769     5.  Any personal property, including, but not limited to,
770any vessel, aircraft, item, object, tool, substance, device,
771weapon, machine, vehicle of any kind, money, securities, books,
772records, research, negotiable instruments, or currency, which
773was used or was attempted to be used as an instrumentality in
774the commission of, or in aiding or abetting in the commission
775of, any felony, whether or not comprising an element of the
776felony, or which is acquired by proceeds obtained as a result of
777a violation of the Florida Contraband Forfeiture Act.
778     6.  Any real property, including any right, title,
779leasehold, or other interest in the whole of any lot or tract of
780land, which was used, is being used, or was attempted to be used
781as an instrumentality in the commission of, or in aiding or
782abetting in the commission of, any felony, or which is acquired
783by proceeds obtained as a result of a violation of the Florida
784Contraband Forfeiture Act.
785     7.  Any personal property, including, but not limited to,
786equipment, money, securities, books, records, research,
787negotiable instruments, currency, or any vessel, aircraft, item,
788object, tool, substance, device, weapon, machine, or vehicle of
789any kind in the possession of or belonging to any person who
790takes aquaculture products in violation of s. 812.014(2)(c).
791     8.  Any motor vehicle offered for sale in violation of s.
792320.28.
793     9.  Any motor vehicle used during the course of committing
794an offense in violation of s. 322.34(9)(a).
795     10.  Any photograph, film, or other recorded image,
796including an image recorded on videotape, a compact disc,
797digital tape, or fixed disk, that is recorded in violation of s.
798810.145 and is possessed for the purpose of amusement,
799entertainment, sexual arousal, gratification, or profit, or for
800the purpose of degrading or abusing another person.
801     11.  Any real property, including any right, title,
802leasehold, or other interest in the whole of any lot or tract of
803land, which is acquired by proceeds obtained as a result of
804Medicaid fraud under s. 409.920 or s. 409.9201; any personal
805property, including, but not limited to, equipment, money,
806securities, books, records, research, negotiable instruments, or
807currency; or any vessel, aircraft, item, object, tool,
808substance, device, weapon, machine, or vehicle of any kind in
809the possession of or belonging to any person which is acquired
810by proceeds obtained as a result of Medicaid fraud under s.
811409.920 or s. 409.9201.
812     12.a.  Any personal property, including, but not limited
813to, any vessel, aircraft, item, object, tool, substance, device,
814weapon, machine, vehicle of any kind, money, securities, books,
815records, research, negotiable instruments, or currency, which
816was used or was attempted to be used as an instrumentality in
817the commission of, or in aiding or abetting in the commission
818of, any fraudulent insurance act as defined in s. 626.989,
819whether or not comprising an element of the fraudulent insurance
820act.
821     b.  Any real property, including any right, title,
822leasehold, or other interest in the whole of any lot or tract of
823land, which is used in or acquired by proceeds obtained as a
824result of a fraudulent insurance act as defined in s. 626.989.
825     c.  Any personal property, including, but not limited to,
826equipment, money, securities, books, records, research,
827negotiable instruments, or currency, or any vessel, aircraft,
828item, object, tool, substance, device, weapon, machine, or
829vehicle of any kind in the possession of or belonging to any
830person, which is acquired by proceeds obtained as a result of a
831fraudulent insurance act as defined in s. 626.989.
832     Section 16.  This act shall take effect October 1, 2010.


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