November 18, 2019
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       Florida Senate - 2010                       CS for CS for SB 752
       
       
       
       By the Committees on Criminal Justice; and Health Regulation;
       and Senator Gaetz
       
       
       
       591-04389-10                                           2010752c2
    1                        A bill to be entitled                      
    2         An act relating to health care fraud; amending s.
    3         400.471, F.S.; prohibiting the Agency for Health Care
    4         Administration from issuing an initial license to a
    5         home health agency for the purpose of opening a new
    6         home health agency under certain conditions until a
    7         specified date; prohibiting the agency from issuing a
    8         change-of-ownership license to a home health agency
    9         under certain conditions until a specified date;
   10         providing an exception; amending s. 400.474, F.S.;
   11         authorizing the agency to revoke a home health agency
   12         license if the applicant or any controlling interest
   13         has been sanctioned for acts specified under s.
   14         400.471(10), F.S.; amending s. 408.815, F.S.; revising
   15         the grounds upon which the agency may deny or revoke
   16         an application for an initial license, a change-of
   17         ownership license, or a licensure renewal for certain
   18         health care entities listed in s. 408.802, F.S.;
   19         amending s. 409.907, F.S.; extending the number of
   20         years that Medicaid providers must retain Medicaid
   21         recipient records; adding additional requirements to
   22         the Medicaid provider agreement; revising
   23         applicability of screening requirements; revising
   24         conditions under which the agency is authorized to
   25         deny a Medicaid provider application; amending s.
   26         409.912, F.S.; revising requirements for Medicaid
   27         prepaid, fixed-sum, and managed care contracts;
   28         revising requirements for Medicaid durable medical
   29         equipment providers; repealing s. 409.9122(13), F.S.,
   30         relating to the enrollee assignment process of
   31         Medicaid managed prepaid health plans for those
   32         Medicaid managed prepaid health plans operating in
   33         Miami-Dade County; amending s. 409.913, F.S.; removing
   34         a required element from the joint Medicaid fraud and
   35         abuse report submitted by the agency and the Medicaid
   36         Fraud Control Unit of the Department of Legal Affairs;
   37         extending the number of years that Medicaid providers
   38         must retain Medicaid recipient records; authorizing
   39         the Medicaid program integrity staff to immediately
   40         suspend or terminate a Medicaid provider for engaging
   41         in specified conduct; removing a requirement for the
   42         agency to hold suspended Medicaid payments in a
   43         separate account; authorizing the agency to deny
   44         payment or require repayment to Medicaid providers
   45         convicted of certain crimes; authorizing the agency to
   46         terminate a Medicaid provider if the provider fails to
   47         reimburse a fine determined by a final order;
   48         authorizing the agency to withhold Medicaid
   49         reimbursement to a Medicaid provider that fails to pay
   50         a fine determined by a final order, fails to enter
   51         into a repayment plan, or fails to comply with a
   52         repayment plan or settlement agreement; requiring the
   53         biennial review of Medicaid fraud and abuse by the
   54         Office of Program Policy Analysis and Government
   55         Accountability to include a report on the Medicaid
   56         Fraud Control Unit within the Department of Legal
   57         Affairs; amending s. 409.9203, F.S.; providing that
   58         certain state employees are ineligible from receiving
   59         a reward for reporting Medicaid fraud; amending s.
   60         456.001, F.S.; defining the term “affiliate” or
   61         “affiliated person” as it relates to health
   62         professions and occupations; amending s. 456.041,
   63         F.S.; requiring the Department of Health to include
   64         administrative complaints and any conviction
   65         information relating to the practitioner’s profile;
   66         providing a disclaimer; amending s. 456.0635, F.S.;
   67         revising the grounds under which the Department of
   68         Health or corresponding board is required to refuse to
   69         admit a candidate to an examination and refuse to
   70         issue or renew a license, certificate, or registration
   71         of a health care practitioner; providing an exception;
   72         amending s. 456.072, F.S.; clarifying a ground under
   73         which disciplinary actions may be taken; amending s.
   74         456.073, F.S.; revising applicability of
   75         investigations and administrative complaints to
   76         include Medicaid fraud; amending s. 456.074, F.S.;
   77         authorizing the Department of Health to issue an
   78         emergency order suspending the license of any person
   79         licensed under ch. 456, F.S., who engages in specified
   80         criminal conduct; providing an effective date.
   81  
   82  Be It Enacted by the Legislature of the State of Florida:
   83  
   84         Section 1. Subsection (11) of section 400.471, Florida
   85  Statutes, is amended to read:
   86         400.471 Application for license; fee.—
   87         (11)(a) The agency may not issue an initial license to a
   88  home health agency under part II of chapter 408 or this part for
   89  the purpose of opening a new home health agency until July 1,
   90  2012 2010, in any county that has at least one actively licensed
   91  home health agency and a population of persons 65 years of age
   92  or older, as indicated in the most recent population estimates
   93  published by the Executive Office of the Governor, of fewer than
   94  1,200 per home health agency. In such counties, for any
   95  application received by the agency prior to July 1, 2009, which
   96  has been deemed by the agency to be complete except for proof of
   97  accreditation, the agency may issue an initial ownership license
   98  only if the applicant has applied for accreditation before May
   99  1, 2009, from an accrediting organization that is recognized by
  100  the agency.
  101         (b) Effective October 1, 2009, the agency may not issue a
  102  change of ownership license to a home health agency under part
  103  II of chapter 408 or this part until July 1, 2012 2010, in any
  104  county that has at least one actively licensed home health
  105  agency and a population of persons 65 years of age or older, as
  106  indicated in the most recent population estimates published by
  107  the Executive Office of the Governor, of fewer than 1,200 per
  108  home health agency. In such counties, for any application
  109  received by the agency before prior to October 1, 2009, which
  110  has been deemed by the agency to be complete except for proof of
  111  accreditation, the agency may issue a change of ownership
  112  license only if the applicant has applied for accreditation
  113  before August 1, 2009, from an accrediting organization that is
  114  recognized by the agency. This paragraph does not apply to an
  115  application for a change in ownership from an existing home
  116  health agency that is accredited, has been licensed by the state
  117  at least 5 years, and is in good standing with the agency.
  118         Section 2. Subsection (8) is added to section 400.474,
  119  Florida Statutes, to read:
  120         400.474 Administrative penalties.—
  121         (8)The agency may revoke the license of a home health
  122  agency that is not eligible for licensure renewal under s.
  123  400.471(10).
  124         Section 3. Subsection (4) of section 408.815, Florida
  125  Statutes, is amended, and subsection (5) is added to that
  126  section, to read:
  127         408.815 License or application denial; revocation.—
  128         (4) In addition to the grounds provided in authorizing
  129  statutes, the agency shall deny an application for an initial a
  130  license or a change-of-ownership license renewal if the
  131  applicant or a person having a controlling interest in the an
  132  applicant has been:
  133         (a) Has been convicted of, or entered enters a plea of
  134  guilty or nolo contendere to, regardless of adjudication, a
  135  felony under chapter 409, chapter 817, chapter 893, or a similar
  136  felony offense committed in another state or jurisdiction 21
  137  U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
  138  sentence and any subsequent period of probation for such
  139  conviction convictions or plea ended more than 15 years before
  140  prior to the date of the application;
  141         (b)Has been convicted of, or entered a plea of guilty or
  142  nolo contendere to, regardless of adjudication, a felony under
  143  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
  144  sentence and any subsequent period of probation for such
  145  conviction or plea ended more than 15 years before the date of
  146  the application;
  147         (c)(b)Has been terminated for cause from the Florida
  148  Medicaid program pursuant to s. 409.913, unless the applicant
  149  has been in good standing with the Florida Medicaid program for
  150  the most recent 5 years; or
  151         (d)(c)Has been terminated for cause, pursuant to the
  152  appeals procedures established by the state, or Federal
  153  Government, from the federal Medicare program or from any other
  154  state Medicaid program, unless the applicant has been in good
  155  standing with a state Medicaid program or the federal Medicare
  156  program for the most recent 5 years and the termination occurred
  157  at least 20 years before prior to the date of the application;
  158  or.
  159         (e)Is currently listed on the United States Department of
  160  Health and Human Services Office of Inspector General’s List of
  161  Excluded Individuals and Entities.
  162         (5)In addition to the grounds provided in authorizing
  163  statutes, the agency shall deny an application for licensure
  164  renewal if the applicant or a person having a controlling
  165  interest in the applicant:
  166         (a)Has been convicted of, or entered a plea of guilty or
  167  nolo contendere to, regardless of adjudication, a felony under
  168  chapter 409, chapter 817, chapter 893, or a similar felony
  169  offense committed in another state or jurisdiction since July 1,
  170  2009;
  171         (b)Has been convicted of, or entered a plea of guilty or
  172  nolo contendere to, regardless of adjudication, a felony under
  173  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
  174  2009;
  175         (c)Has been terminated for cause from the Florida Medicaid
  176  program pursuant to s. 409.913, unless the applicant has been in
  177  good standing with the Florida Medicaid program for the most
  178  recent 5 years;
  179         (d)Has been terminated for cause, pursuant to the appeals
  180  procedures established by the state, from any other state
  181  Medicaid program, unless the applicant has been in good standing
  182  with a state Medicaid program for the most recent 5 years and
  183  the termination occurred at least 20 years before the date of
  184  the application; or
  185         (e)Is currently listed on the United States Department of
  186  Health and Human Services Office of Inspector General’s List of
  187  Excluded Individuals and Entities.
  188         Section 4. Paragraph (c) of subsection (3) of section
  189  409.907, Florida Statutes, is amended, paragraph (k) is added to
  190  that subsection, and subsection (8), paragraph (b) of subsection
  191  (9), and subsection (10) of that section are amended, to read:
  192         409.907 Medicaid provider agreements.—The agency may make
  193  payments for medical assistance and related services rendered to
  194  Medicaid recipients only to an individual or entity who has a
  195  provider agreement in effect with the agency, who is performing
  196  services or supplying goods in accordance with federal, state,
  197  and local law, and who agrees that no person shall, on the
  198  grounds of handicap, race, color, or national origin, or for any
  199  other reason, be subjected to discrimination under any program
  200  or activity for which the provider receives payment from the
  201  agency.
  202         (3) The provider agreement developed by the agency, in
  203  addition to the requirements specified in subsections (1) and
  204  (2), shall require the provider to:
  205         (c) Retain all medical and Medicaid-related records for a
  206  period of 6 5 years to satisfy all necessary inquiries by the
  207  agency.
  208         (k)Report any change of any principal of the provider,
  209  including any officer, director, agent, managing employee, or
  210  affiliated person, or any partner or shareholder who has an
  211  ownership interest equal to 5 percent or more in the provider.
  212  The provider must report changes to the agency no later than 30
  213  days after the change occurs. Reporting changes in controlling
  214  interests to the agency pursuant to s. 408.810(3) shall serve as
  215  compliance with this paragraph for hospitals licensed under
  216  chapter 395 and nursing homes licensed under chapter 400.
  217         (8)(a) Each provider, or each principal of the provider if
  218  the provider is a corporation, partnership, association, or
  219  other entity, seeking to participate in the Medicaid program
  220  must submit a complete set of his or her fingerprints to the
  221  agency for the purpose of conducting a criminal history record
  222  check. Principals of the provider include any officer, director,
  223  billing agent, managing employee, or affiliated person, or any
  224  partner or shareholder who has an ownership interest equal to 5
  225  percent or more in the provider. However, for hospitals licensed
  226  under chapter 395 and nursing homes licensed under chapter 400,
  227  principals of the provider are those who meet the definition of
  228  a controlling interest in s. 408.803(7). A director of a not
  229  for-profit corporation or organization is not a principal for
  230  purposes of a background investigation as required by this
  231  section if the director: serves solely in a voluntary capacity
  232  for the corporation or organization, does not regularly take
  233  part in the day-to-day operational decisions of the corporation
  234  or organization, receives no remuneration from the not-for
  235  profit corporation or organization for his or her service on the
  236  board of directors, has no financial interest in the not-for
  237  profit corporation or organization, and has no family members
  238  with a financial interest in the not-for-profit corporation or
  239  organization; and if the director submits an affidavit, under
  240  penalty of perjury, to this effect to the agency and the not
  241  for-profit corporation or organization submits an affidavit,
  242  under penalty of perjury, to this effect to the agency as part
  243  of the corporation’s or organization’s Medicaid provider
  244  agreement application. Notwithstanding the above, the agency may
  245  require a background check for any person reasonably suspected
  246  by the agency to have been convicted of a crime. This subsection
  247  does shall not apply to:
  248         1.A hospital licensed under chapter 395;
  249         2.A nursing home licensed under chapter 400;
  250         3.A hospice licensed under chapter 400;
  251         4.An assisted living facility licensed under chapter 429;
  252         1.5. A unit of local government, except that requirements
  253  of this subsection apply to nongovernmental providers and
  254  entities when contracting with the local government to provide
  255  Medicaid services. The actual cost of the state and national
  256  criminal history record checks must be borne by the
  257  nongovernmental provider or entity; or
  258         2.6. Any business that derives more than 50 percent of its
  259  revenue from the sale of goods to the final consumer, and the
  260  business or its controlling parent either is required to file a
  261  form 10-K or other similar statement with the Securities and
  262  Exchange Commission or has a net worth of $50 million or more.
  263         (b) Background screening shall be conducted in accordance
  264  with chapter 435 and s. 408.809. The agency shall submit the
  265  fingerprints to the Department of Law Enforcement. The
  266  department shall conduct a state criminal-background
  267  investigation and forward the fingerprints to the Federal Bureau
  268  of Investigation for a national criminal-history record check.
  269  The cost of the state and national criminal record check shall
  270  be borne by the provider.
  271         (c)The agency may permit a provider to participate in the
  272  Medicaid program pending the results of the criminal record
  273  check. However, such permission is fully revocable if the record
  274  check reveals any crime-related history as provided in
  275  subsection (10).
  276         (c)(d) Proof of compliance with the requirements of level 2
  277  screening under s. 435.04 conducted within 12 months prior to
  278  the date that the Medicaid provider application is submitted to
  279  the agency shall fulfill the requirements of this subsection.
  280  Proof of compliance with the requirements of level 1 screening
  281  under s. 435.03 conducted within 12 months prior to the date
  282  that the Medicaid provider application is submitted to the
  283  agency shall meet the requirement that the Department of Law
  284  Enforcement conduct a state criminal history record check.
  285         (9) Upon receipt of a completed, signed, and dated
  286  application, and completion of any necessary background
  287  investigation and criminal history record check, the agency must
  288  either:
  289         (b) Deny the application if the agency finds that it is in
  290  the best interest of the Medicaid program to do so. The agency
  291  may consider any the factors listed in subsection (10), as well
  292  as any other factor that could affect the effective and
  293  efficient administration of the program, including, but not
  294  limited to, the applicant’s demonstrated ability to provide
  295  services, conduct business, and operate a financially viable
  296  concern; the current availability of medical care, services, or
  297  supplies to recipients, taking into account geographic location
  298  and reasonable travel time; the number of providers of the same
  299  type already enrolled in the same geographic area; and the
  300  credentials, experience, success, and patient outcomes of the
  301  provider for the services that it is making application to
  302  provide in the Medicaid program. The agency shall deny the
  303  application if the agency finds that a provider; any officer,
  304  director, agent, managing employee, or affiliated person; or any
  305  principal, partner, or shareholder having an ownership interest
  306  equal to 5 percent or greater in the provider if the provider is
  307  a corporation, partnership, or other business entity, has failed
  308  to pay all outstanding fines or overpayments assessed by final
  309  order of the agency or final order of the Centers for Medicare
  310  and Medicaid Services, not subject to further appeal, unless the
  311  provider agrees to a repayment plan that includes withholding
  312  Medicaid reimbursement until the amount due is paid in full.
  313         (10) The agency shall deny the application if may consider
  314  whether the provider, or any officer, director, agent, managing
  315  employee, or affiliated person, or any principal, partner, or
  316  shareholder having an ownership interest equal to 5 percent or
  317  greater in the provider if the provider is a corporation,
  318  partnership, or other business entity, has committed an offense
  319  listed in s. 409.913(13), and may deny the application if one of
  320  these persons has:
  321         (a) Made a false representation or omission of any material
  322  fact in making the application, including the submission of an
  323  application that conceals the controlling or ownership interest
  324  of any officer, director, agent, managing employee, affiliated
  325  person, or principal, partner, or shareholder who may not be
  326  eligible to participate;
  327         (b) Been or is currently excluded, suspended, terminated
  328  from, or has involuntarily withdrawn from participation in,
  329  Florida’s Medicaid program or any other state’s Medicaid
  330  program, or from participation in any other governmental or
  331  private health care or health insurance program;
  332         (c)Been convicted of a criminal offense relating to the
  333  delivery of any goods or services under Medicaid or Medicare or
  334  any other public or private health care or health insurance
  335  program including the performance of management or
  336  administrative services relating to the delivery of goods or
  337  services under any such program;
  338         (d)Been convicted under federal or state law of a criminal
  339  offense related to the neglect or abuse of a patient in
  340  connection with the delivery of any health care goods or
  341  services;
  342         (c)(e) Been convicted under federal or state law of a
  343  criminal offense relating to the unlawful manufacture,
  344  distribution, prescription, or dispensing of a controlled
  345  substance;
  346         (d)(f) Been convicted of any criminal offense relating to
  347  fraud, theft, embezzlement, breach of fiduciary responsibility,
  348  or other financial misconduct;
  349         (e)(g) Been convicted under federal or state law of a crime
  350  punishable by imprisonment of a year or more which involves
  351  moral turpitude;
  352         (f)(h) Been convicted in connection with the interference
  353  or obstruction of any investigation into any criminal offense
  354  listed in this subsection;
  355         (g)(i) Been found to have violated federal or state laws,
  356  rules, or regulations governing Florida’s Medicaid program or
  357  any other state’s Medicaid program, the Medicare program, or any
  358  other publicly funded federal or state health care or health
  359  insurance program, and been sanctioned accordingly;
  360         (h)(j) Been previously found by a licensing, certifying, or
  361  professional standards board or agency to have violated the
  362  standards or conditions relating to licensure or certification
  363  or the quality of services provided; or
  364         (i)(k) Failed to pay any fine or overpayment properly
  365  assessed under the Medicaid program in which no appeal is
  366  pending or after resolution of the proceeding by stipulation or
  367  agreement, unless the agency has issued a specific letter of
  368  forgiveness or has approved a repayment schedule to which the
  369  provider agrees to adhere.
  370  
  371  If the agency determines a provider did not participate or
  372  acquiesce in an offense specified in s. 409.913(13), the agency
  373  is not required to deny the provider application.
  374         Section 5. Subsections (10), (32), and (48) of section
  375  409.912, Florida Statutes, are amended to read:
  376         409.912 Cost-effective purchasing of health care.—The
  377  agency shall purchase goods and services for Medicaid recipients
  378  in the most cost-effective manner consistent with the delivery
  379  of quality medical care. To ensure that medical services are
  380  effectively utilized, the agency may, in any case, require a
  381  confirmation or second physician’s opinion of the correct
  382  diagnosis for purposes of authorizing future services under the
  383  Medicaid program. This section does not restrict access to
  384  emergency services or poststabilization care services as defined
  385  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  386  shall be rendered in a manner approved by the agency. The agency
  387  shall maximize the use of prepaid per capita and prepaid
  388  aggregate fixed-sum basis services when appropriate and other
  389  alternative service delivery and reimbursement methodologies,
  390  including competitive bidding pursuant to s. 287.057, designed
  391  to facilitate the cost-effective purchase of a case-managed
  392  continuum of care. The agency shall also require providers to
  393  minimize the exposure of recipients to the need for acute
  394  inpatient, custodial, and other institutional care and the
  395  inappropriate or unnecessary use of high-cost services. The
  396  agency shall contract with a vendor to monitor and evaluate the
  397  clinical practice patterns of providers in order to identify
  398  trends that are outside the normal practice patterns of a
  399  provider’s professional peers or the national guidelines of a
  400  provider’s professional association. The vendor must be able to
  401  provide information and counseling to a provider whose practice
  402  patterns are outside the norms, in consultation with the agency,
  403  to improve patient care and reduce inappropriate utilization.
  404  The agency may mandate prior authorization, drug therapy
  405  management, or disease management participation for certain
  406  populations of Medicaid beneficiaries, certain drug classes, or
  407  particular drugs to prevent fraud, abuse, overuse, and possible
  408  dangerous drug interactions. The Pharmaceutical and Therapeutics
  409  Committee shall make recommendations to the agency on drugs for
  410  which prior authorization is required. The agency shall inform
  411  the Pharmaceutical and Therapeutics Committee of its decisions
  412  regarding drugs subject to prior authorization. The agency is
  413  authorized to limit the entities it contracts with or enrolls as
  414  Medicaid providers by developing a provider network through
  415  provider credentialing. The agency may competitively bid single
  416  source-provider contracts if procurement of goods or services
  417  results in demonstrated cost savings to the state without
  418  limiting access to care. The agency may limit its network based
  419  on the assessment of beneficiary access to care, provider
  420  availability, provider quality standards, time and distance
  421  standards for access to care, the cultural competence of the
  422  provider network, demographic characteristics of Medicaid
  423  beneficiaries, practice and provider-to-beneficiary standards,
  424  appointment wait times, beneficiary use of services, provider
  425  turnover, provider profiling, provider licensure history,
  426  previous program integrity investigations and findings, peer
  427  review, provider Medicaid policy and billing compliance records,
  428  clinical and medical record audits, and other factors. Providers
  429  shall not be entitled to enrollment in the Medicaid provider
  430  network. The agency shall determine instances in which allowing
  431  Medicaid beneficiaries to purchase durable medical equipment and
  432  other goods is less expensive to the Medicaid program than long
  433  term rental of the equipment or goods. The agency may establish
  434  rules to facilitate purchases in lieu of long-term rentals in
  435  order to protect against fraud and abuse in the Medicaid program
  436  as defined in s. 409.913. The agency may seek federal waivers
  437  necessary to administer these policies.
  438         (10) The agency shall not contract on a prepaid or fixed
  439  sum basis for Medicaid services with an entity which knows or
  440  reasonably should know that any principal, officer, director,
  441  agent, managing employee, or owner of stock or beneficial
  442  interest in excess of 5 percent common or preferred stock, or
  443  the entity itself, has been found guilty of, regardless of
  444  adjudication, or entered a plea of nolo contendere, or guilty,
  445  to:
  446         (a) An offense listed in s. 408.809, s. 409.913(13), or s.
  447  435.04 Fraud;
  448         (b) Violation of federal or state antitrust statutes,
  449  including those proscribing price fixing between competitors and
  450  the allocation of customers among competitors;
  451         (c) Commission of a felony involving embezzlement, theft,
  452  forgery, income tax evasion, bribery, falsification or
  453  destruction of records, making false statements, receiving
  454  stolen property, making false claims, or obstruction of justice;
  455  or
  456         (d) Any crime in any jurisdiction which directly relates to
  457  the provision of health services on a prepaid or fixed-sum
  458  basis.
  459         (32) Each managed care plan that is under contract with the
  460  agency to provide health care services to Medicaid recipients
  461  shall annually conduct a background check with the Florida
  462  Department of Law Enforcement of all persons with ownership
  463  interest of 5 percent or more or executive management
  464  responsibility for the managed care plan and shall submit to the
  465  agency information concerning any such person who has been found
  466  guilty of, regardless of adjudication, or has entered a plea of
  467  nolo contendere or guilty to, any of the offenses listed in s.
  468  408.809, s. 409.913(13), or s. 435.04 s. 435.03.
  469         (48)(a) A provider is not entitled to enrollment in the
  470  Medicaid provider network. The agency may implement a Medicaid
  471  fee-for-service provider network controls, including, but not
  472  limited to, competitive procurement and provider credentialing.
  473  If a credentialing process is used, the agency may limit its
  474  provider network based upon the following considerations:
  475  beneficiary access to care, provider availability, provider
  476  quality standards and quality assurance processes, cultural
  477  competency, demographic characteristics of beneficiaries,
  478  practice standards, service wait times, provider turnover,
  479  provider licensure and accreditation history, program integrity
  480  history, peer review, Medicaid policy and billing compliance
  481  records, clinical and medical record audit findings, and such
  482  other areas that are considered necessary by the agency to
  483  ensure the integrity of the program.
  484         (b) The agency shall limit its network of durable medical
  485  equipment and medical supply providers. For dates of service
  486  after January 1, 2009, the agency shall limit payment for
  487  durable medical equipment and supplies to providers that meet
  488  all the requirements of this paragraph.
  489         1. Providers must be accredited by a Centers for Medicare
  490  and Medicaid Services deemed accreditation organization for
  491  suppliers of durable medical equipment, prosthetics, orthotics,
  492  and supplies. The provider must maintain accreditation and is
  493  subject to unannounced reviews by the accrediting organization.
  494         2. Providers must provide the services or supplies directly
  495  to the Medicaid recipient or caregiver at the provider location
  496  or recipient’s residence or send the supplies directly to the
  497  recipient’s residence with receipt of mailed delivery.
  498  Subcontracting or consignment of the service or supply to a
  499  third party is prohibited.
  500         3. Notwithstanding subparagraph 2., a durable medical
  501  equipment provider may store nebulizers at a physician’s office
  502  for the purpose of having the physician’s staff issue the
  503  equipment if it meets all of the following conditions:
  504         a. The physician must document the medical necessity and
  505  need to prevent further deterioration of the patient’s
  506  respiratory status by the timely delivery of the nebulizer in
  507  the physician’s office.
  508         b. The durable medical equipment provider must have written
  509  documentation of the competency and training by a Florida
  510  licensed registered respiratory therapist of any durable medical
  511  equipment staff who participate in the training of physician
  512  office staff for the use of nebulizers, including cleaning,
  513  warranty, and special needs of patients.
  514         c. The physician’s office must have documented the training
  515  and competency of any staff member who initiates the delivery of
  516  nebulizers to patients. The durable medical equipment provider
  517  must maintain copies of all physician office training.
  518         d. The physician’s office must maintain inventory records
  519  of stored nebulizers, including documentation of the durable
  520  medical equipment provider source.
  521         e. A physician contracted with a Medicaid durable medical
  522  equipment provider may not have a financial relationship with
  523  that provider or receive any financial gain from the delivery of
  524  nebulizers to patients.
  525         4. Providers must have a physical business location and a
  526  functional landline business phone. The location must be within
  527  the state or not more than 50 miles from the Florida state line.
  528  The agency may make exceptions for providers of durable medical
  529  equipment or supplies not otherwise available from other
  530  enrolled providers located within the state.
  531         5. Physical business locations must be clearly identified
  532  as a business that furnishes durable medical equipment or
  533  medical supplies by signage that can be read from 20 feet away.
  534  The location must be readily accessible to the public during
  535  normal, posted business hours and must operate no less than 5
  536  hours per day and no less than 5 days per week, with the
  537  exception of scheduled and posted holidays. The location may not
  538  be located within or at the same numbered street address as
  539  another enrolled Medicaid durable medical equipment or medical
  540  supply provider or as an enrolled Medicaid pharmacy that is also
  541  enrolled as a durable medical equipment provider. A licensed
  542  orthotist or prosthetist that provides only orthotic or
  543  prosthetic devices as a Medicaid durable medical equipment
  544  provider is exempt from the provisions in this paragraph.
  545         6. Providers must maintain a stock of durable medical
  546  equipment and medical supplies on site that is readily available
  547  to meet the needs of the durable medical equipment business
  548  location’s customers.
  549         7. Providers must provide a surety bond of $50,000 for each
  550  provider location, up to a maximum of 5 bonds statewide or an
  551  aggregate bond of $250,000 statewide, as identified by Federal
  552  Employer Identification Number. Providers who post a statewide
  553  or an aggregate bond must identify all of their locations in any
  554  Medicaid durable medical equipment and medical supply provider
  555  enrollment application or bond renewal. Each provider location’s
  556  surety bond must be renewed annually and the provider must
  557  submit proof of renewal even if the original bond is a
  558  continuous bond. A licensed orthotist or prosthetist that
  559  provides only orthotic or prosthetic devices as a Medicaid
  560  durable medical equipment provider is exempt from the provisions
  561  in this paragraph.
  562         8. Providers must obtain a level 2 background screening, in
  563  accordance with chapter 435 and s. 408.809 as provided under s.
  564  435.04, for each provider employee in direct contact with or
  565  providing direct services to recipients of durable medical
  566  equipment and medical supplies in their homes. This requirement
  567  includes, but is not limited to, repair and service technicians,
  568  fitters, and delivery staff. The provider shall pay for the cost
  569  of the background screening.
  570         9. The following providers are exempt from the requirements
  571  of subparagraphs 1. and 7.:
  572         a. Durable medical equipment providers owned and operated
  573  by a government entity.
  574         b. Durable medical equipment providers that are operating
  575  within a pharmacy that is currently enrolled as a Medicaid
  576  pharmacy provider.
  577         c. Active, Medicaid-enrolled orthopedic physician groups,
  578  primarily owned by physicians, which provide only orthotic and
  579  prosthetic devices.
  580         Section 6. Subsection (13) of section 409.9122, Florida
  581  Statutes, is repealed.
  582         Section 7. Section 409.913, Florida Statutes, is amended to
  583  read:
  584         409.913 Oversight of the integrity of the Medicaid
  585  program.—The agency shall operate a program to oversee the
  586  activities of Florida Medicaid recipients, and providers and
  587  their representatives, to ensure that fraudulent and abusive
  588  behavior and neglect of recipients occur to the minimum extent
  589  possible, and to recover overpayments and impose sanctions as
  590  appropriate. Beginning January 1, 2003, and each year
  591  thereafter, the agency and the Medicaid Fraud Control Unit of
  592  the Department of Legal Affairs shall submit a joint report to
  593  the Legislature documenting the effectiveness of the state’s
  594  efforts to control Medicaid fraud and abuse and to recover
  595  Medicaid overpayments during the previous fiscal year. The
  596  report must describe the number of cases opened and investigated
  597  each year; the sources of the cases opened; the disposition of
  598  the cases closed each year; the amount of overpayments alleged
  599  in preliminary and final audit letters; the number and amount of
  600  fines or penalties imposed; any reductions in overpayment
  601  amounts negotiated in settlement agreements or by other means;
  602  the amount of final agency determinations of overpayments; the
  603  amount deducted from federal claiming as a result of
  604  overpayments; the amount of overpayments recovered each year;
  605  the amount of cost of investigation recovered each year; the
  606  average length of time to collect from the time the case was
  607  opened until the overpayment is paid in full; the amount
  608  determined as uncollectible and the portion of the uncollectible
  609  amount subsequently reclaimed from the Federal Government; the
  610  number of providers, by type, that are terminated from
  611  participation in the Medicaid program as a result of fraud and
  612  abuse; and all costs associated with discovering and prosecuting
  613  cases of Medicaid overpayments and making recoveries in such
  614  cases. The report must also document actions taken to prevent
  615  overpayments and the number of providers prevented from
  616  enrolling in or reenrolling in the Medicaid program as a result
  617  of documented Medicaid fraud and abuse and must include policy
  618  recommendations necessary to prevent or recover overpayments and
  619  changes necessary to prevent and detect Medicaid fraud. All
  620  policy recommendations in the report must include a detailed
  621  fiscal analysis, including, but not limited to, implementation
  622  costs, estimated savings to the Medicaid program, and the return
  623  on investment. The agency must submit the policy recommendations
  624  and fiscal analyses in the report to the appropriate estimating
  625  conference, pursuant to s. 216.137, by February 15 of each year.
  626  The agency and the Medicaid Fraud Control Unit of the Department
  627  of Legal Affairs each must include detailed unit-specific
  628  performance standards, benchmarks, and metrics in the report,
  629  including projected cost savings to the state Medicaid program
  630  during the following fiscal year.
  631         (1) For the purposes of this section, the term:
  632         (a) “Abuse” means:
  633         1. Provider practices that are inconsistent with generally
  634  accepted business or medical practices and that result in an
  635  unnecessary cost to the Medicaid program or in reimbursement for
  636  goods or services that are not medically necessary or that fail
  637  to meet professionally recognized standards for health care.
  638         2. Recipient practices that result in unnecessary cost to
  639  the Medicaid program.
  640         (b) “Complaint” means an allegation that fraud, abuse, or
  641  an overpayment has occurred.
  642         (c) “Fraud” means an intentional deception or
  643  misrepresentation made by a person with the knowledge that the
  644  deception results in unauthorized benefit to herself or himself
  645  or another person. The term includes any act that constitutes
  646  fraud under applicable federal or state law.
  647         (d) “Medical necessity” or “medically necessary” means any
  648  goods or services necessary to palliate the effects of a
  649  terminal condition, or to prevent, diagnose, correct, cure,
  650  alleviate, or preclude deterioration of a condition that
  651  threatens life, causes pain or suffering, or results in illness
  652  or infirmity, which goods or services are provided in accordance
  653  with generally accepted standards of medical practice. For
  654  purposes of determining Medicaid reimbursement, the agency is
  655  the final arbiter of medical necessity. Determinations of
  656  medical necessity must be made by a licensed physician employed
  657  by or under contract with the agency and must be based upon
  658  information available at the time the goods or services are
  659  provided.
  660         (e) “Overpayment” includes any amount that is not
  661  authorized to be paid by the Medicaid program whether paid as a
  662  result of inaccurate or improper cost reporting, improper
  663  claiming, unacceptable practices, fraud, abuse, or mistake.
  664         (f) “Person” means any natural person, corporation,
  665  partnership, association, clinic, group, or other entity,
  666  whether or not such person is enrolled in the Medicaid program
  667  or is a provider of health care.
  668         (2) The agency shall conduct, or cause to be conducted by
  669  contract or otherwise, reviews, investigations, analyses,
  670  audits, or any combination thereof, to determine possible fraud,
  671  abuse, overpayment, or recipient neglect in the Medicaid program
  672  and shall report the findings of any overpayments in audit
  673  reports as appropriate. At least 5 percent of all audits shall
  674  be conducted on a random basis. As part of its ongoing fraud
  675  detection activities, the agency shall identify and monitor, by
  676  contract or otherwise, patterns of overutilization of Medicaid
  677  services based on state averages. The agency shall track
  678  Medicaid provider prescription and billing patterns and evaluate
  679  them against Medicaid medical necessity criteria and coverage
  680  and limitation guidelines adopted by rule. Medical necessity
  681  determination requires that service be consistent with symptoms
  682  or confirmed diagnosis of illness or injury under treatment and
  683  not in excess of the patient’s needs. The agency shall conduct
  684  reviews of provider exceptions to peer group norms and shall,
  685  using statistical methodologies, provider profiling, and
  686  analysis of billing patterns, detect and investigate abnormal or
  687  unusual increases in billing or payment of claims for Medicaid
  688  services and medically unnecessary provision of services.
  689         (3) The agency may conduct, or may contract for, prepayment
  690  review of provider claims to ensure cost-effective purchasing;
  691  to ensure that billing by a provider to the agency is in
  692  accordance with applicable provisions of all Medicaid rules,
  693  regulations, handbooks, and policies and in accordance with
  694  federal, state, and local law; and to ensure that appropriate
  695  care is rendered to Medicaid recipients. Such prepayment reviews
  696  may be conducted as determined appropriate by the agency,
  697  without any suspicion or allegation of fraud, abuse, or neglect,
  698  and may last for up to 1 year. Unless the agency has reliable
  699  evidence of fraud, misrepresentation, abuse, or neglect, claims
  700  shall be adjudicated for denial or payment within 90 days after
  701  receipt of complete documentation by the agency for review. If
  702  there is reliable evidence of fraud, misrepresentation, abuse,
  703  or neglect, claims shall be adjudicated for denial of payment
  704  within 180 days after receipt of complete documentation by the
  705  agency for review.
  706         (4) Any suspected criminal violation identified by the
  707  agency must be referred to the Medicaid Fraud Control Unit of
  708  the Office of the Attorney General for investigation. The agency
  709  and the Attorney General shall enter into a memorandum of
  710  understanding, which must include, but need not be limited to, a
  711  protocol for regularly sharing information and coordinating
  712  casework. The protocol must establish a procedure for the
  713  referral by the agency of cases involving suspected Medicaid
  714  fraud to the Medicaid Fraud Control Unit for investigation, and
  715  the return to the agency of those cases where investigation
  716  determines that administrative action by the agency is
  717  appropriate. Offices of the Medicaid program integrity program
  718  and the Medicaid Fraud Control Unit of the Department of Legal
  719  Affairs, shall, to the extent possible, be collocated. The
  720  agency and the Department of Legal Affairs shall periodically
  721  conduct joint training and other joint activities designed to
  722  increase communication and coordination in recovering
  723  overpayments.
  724         (5) A Medicaid provider is subject to having goods and
  725  services that are paid for by the Medicaid program reviewed by
  726  an appropriate peer-review organization designated by the
  727  agency. The written findings of the applicable peer-review
  728  organization are admissible in any court or administrative
  729  proceeding as evidence of medical necessity or the lack thereof.
  730         (6) Any notice required to be given to a provider under
  731  this section is presumed to be sufficient notice if sent to the
  732  address last shown on the provider enrollment file. It is the
  733  responsibility of the provider to furnish and keep the agency
  734  informed of the provider’s current address. United States Postal
  735  Service proof of mailing or certified or registered mailing of
  736  such notice to the provider at the address shown on the provider
  737  enrollment file constitutes sufficient proof of notice. Any
  738  notice required to be given to the agency by this section must
  739  be sent to the agency at an address designated by rule.
  740         (7) When presenting a claim for payment under the Medicaid
  741  program, a provider has an affirmative duty to supervise the
  742  provision of, and be responsible for, goods and services claimed
  743  to have been provided, to supervise and be responsible for
  744  preparation and submission of the claim, and to present a claim
  745  that is true and accurate and that is for goods and services
  746  that:
  747         (a) Have actually been furnished to the recipient by the
  748  provider prior to submitting the claim.
  749         (b) Are Medicaid-covered goods or services that are
  750  medically necessary.
  751         (c) Are of a quality comparable to those furnished to the
  752  general public by the provider’s peers.
  753         (d) Have not been billed in whole or in part to a recipient
  754  or a recipient’s responsible party, except for such copayments,
  755  coinsurance, or deductibles as are authorized by the agency.
  756         (e) Are provided in accord with applicable provisions of
  757  all Medicaid rules, regulations, handbooks, and policies and in
  758  accordance with federal, state, and local law.
  759         (f) Are documented by records made at the time the goods or
  760  services were provided, demonstrating the medical necessity for
  761  the goods or services rendered. Medicaid goods or services are
  762  excessive or not medically necessary unless both the medical
  763  basis and the specific need for them are fully and properly
  764  documented in the recipient’s medical record.
  765  
  766  The agency shall deny payment or require repayment for goods or
  767  services that are not presented as required in this subsection.
  768         (8) The agency shall not reimburse any person or entity for
  769  any prescription for medications, medical supplies, or medical
  770  services if the prescription was written by a physician or other
  771  prescribing practitioner who is not enrolled in the Medicaid
  772  program. This section does not apply:
  773         (a) In instances involving bona fide emergency medical
  774  conditions as determined by the agency;
  775         (b) To a provider of medical services to a patient in a
  776  hospital emergency department, hospital inpatient or outpatient
  777  setting, or nursing home;
  778         (c) To bona fide pro bono services by preapproved non
  779  Medicaid providers as determined by the agency;
  780         (d) To prescribing physicians who are board-certified
  781  specialists treating Medicaid recipients referred for treatment
  782  by a treating physician who is enrolled in the Medicaid program;
  783         (e) To prescriptions written for dually eligible Medicare
  784  beneficiaries by an authorized Medicare provider who is not
  785  enrolled in the Medicaid program;
  786         (f) To other physicians who are not enrolled in the
  787  Medicaid program but who provide a medically necessary service
  788  or prescription not otherwise reasonably available from a
  789  Medicaid-enrolled physician; or
  790         (9) A Medicaid provider shall retain medical, professional,
  791  financial, and business records pertaining to services and goods
  792  furnished to a Medicaid recipient and billed to Medicaid for a
  793  period of 6 5 years after the date of furnishing such services
  794  or goods. The agency may investigate, review, or analyze such
  795  records, which must be made available during normal business
  796  hours. However, 24-hour notice must be provided if patient
  797  treatment would be disrupted. The provider is responsible for
  798  furnishing to the agency, and keeping the agency informed of the
  799  location of, the provider’s Medicaid-related records. The
  800  authority of the agency to obtain Medicaid-related records from
  801  a provider is neither curtailed nor limited during a period of
  802  litigation between the agency and the provider.
  803         (10) Payments for the services of billing agents or persons
  804  participating in the preparation of a Medicaid claim shall not
  805  be based on amounts for which they bill nor based on the amount
  806  a provider receives from the Medicaid program.
  807         (11) The agency shall deny payment or require repayment for
  808  inappropriate, medically unnecessary, or excessive goods or
  809  services from the person furnishing them, the person under whose
  810  supervision they were furnished, or the person causing them to
  811  be furnished.
  812         (12) The complaint and all information obtained pursuant to
  813  an investigation of a Medicaid provider, or the authorized
  814  representative or agent of a provider, relating to an allegation
  815  of fraud, abuse, or neglect are confidential and exempt from the
  816  provisions of s. 119.07(1):
  817         (a) Until the agency takes final agency action with respect
  818  to the provider and requires repayment of any overpayment, or
  819  imposes an administrative sanction;
  820         (b) Until the Attorney General refers the case for criminal
  821  prosecution;
  822         (c) Until 10 days after the complaint is determined without
  823  merit; or
  824         (d) At all times if the complaint or information is
  825  otherwise protected by law.
  826         (13) The agency shall immediately terminate participation
  827  of a Medicaid provider in the Medicaid program and may seek
  828  civil remedies or impose other administrative sanctions against
  829  a Medicaid provider, if the provider or any principal, officer,
  830  director, agent, managing employee, or affiliated person of the
  831  provider, or any partner or shareholder having an ownership
  832  interest in the provider equal to 5 percent or greater, has
  833  been:
  834         (a) Convicted of a criminal offense related to the delivery
  835  of any health care goods or services, including the performance
  836  of management or administrative functions relating to the
  837  delivery of health care goods or services;
  838         (b) Convicted of a criminal offense under federal law or
  839  the law of any state relating to the practice of the provider’s
  840  profession; or
  841         (c) Found by a court of competent jurisdiction to have
  842  neglected or physically abused a patient in connection with the
  843  delivery of health care goods or services.
  844  
  845  If the agency determines a provider did not participate or
  846  acquiesce in an offense specified in paragraph (a), paragraph
  847  (b), or paragraph (c), termination will not be imposed. If the
  848  agency effects a termination under this subsection, the agency
  849  shall issue an immediate termination final order as provided in
  850  subsection (16) pursuant to s. 120.569(2)(n).
  851         (14) If the provider has been suspended or terminated from
  852  participation in the Medicaid program or the Medicare program by
  853  the Federal Government or any state, the agency must immediately
  854  suspend or terminate, as appropriate, the provider’s
  855  participation in this state’s Medicaid program for a period no
  856  less than that imposed by the Federal Government or any other
  857  state, and may not enroll such provider in this state’s Medicaid
  858  program while such foreign suspension or termination remains in
  859  effect. The agency shall also immediately suspend or terminate,
  860  as appropriate, a provider’s participation in this state’s
  861  Medicaid program if the provider participated or acquiesced in
  862  any action for which any principal, officer, director, agent,
  863  managing employee, or affiliated person of the provider, or any
  864  partner or shareholder having an ownership interest in the
  865  provider equal to 5 percent or greater, was suspended or
  866  terminated from participating in the Medicaid program or the
  867  Medicare program by the Federal Government or any state. This
  868  sanction is in addition to all other remedies provided by law.
  869  If the agency suspends or terminates a provider’s participation
  870  in the state’s Medicaid program under this subsection, the
  871  agency shall issue an immediate suspension or immediate
  872  termination order as provided in subsection (16).
  873         (15) The agency shall seek a remedy provided by law,
  874  including, but not limited to, any remedy provided in
  875  subsections (13) and (16) and s. 812.035, if:
  876         (a) The provider’s license has not been renewed, or has
  877  been revoked, suspended, or terminated, for cause, by the
  878  licensing agency of any state;
  879         (b) The provider has failed to make available or has
  880  refused access to Medicaid-related records to an auditor,
  881  investigator, or other authorized employee or agent of the
  882  agency, the Attorney General, a state attorney, or the Federal
  883  Government;
  884         (c) The provider has not furnished or has failed to make
  885  available such Medicaid-related records as the agency has found
  886  necessary to determine whether Medicaid payments are or were due
  887  and the amounts thereof;
  888         (d) The provider has failed to maintain medical records
  889  made at the time of service, or prior to service if prior
  890  authorization is required, demonstrating the necessity and
  891  appropriateness of the goods or services rendered;
  892         (e) The provider is not in compliance with provisions of
  893  Medicaid provider publications that have been adopted by
  894  reference as rules in the Florida Administrative Code; with
  895  provisions of state or federal laws, rules, or regulations; with
  896  provisions of the provider agreement between the agency and the
  897  provider; or with certifications found on claim forms or on
  898  transmittal forms for electronically submitted claims that are
  899  submitted by the provider or authorized representative, as such
  900  provisions apply to the Medicaid program;
  901         (f) The provider or person who ordered or prescribed the
  902  care, services, or supplies has furnished, or ordered the
  903  furnishing of, goods or services to a recipient which are
  904  inappropriate, unnecessary, excessive, or harmful to the
  905  recipient or are of inferior quality;
  906         (g) The provider has demonstrated a pattern of failure to
  907  provide goods or services that are medically necessary;
  908         (h) The provider or an authorized representative of the
  909  provider, or a person who ordered or prescribed the goods or
  910  services, has submitted or caused to be submitted false or a
  911  pattern of erroneous Medicaid claims;
  912         (i) The provider or an authorized representative of the
  913  provider, or a person who has ordered or prescribed the goods or
  914  services, has submitted or caused to be submitted a Medicaid
  915  provider enrollment application, a request for prior
  916  authorization for Medicaid services, a drug exception request,
  917  or a Medicaid cost report that contains materially false or
  918  incorrect information;
  919         (j) The provider or an authorized representative of the
  920  provider has collected from or billed a recipient or a
  921  recipient’s responsible party improperly for amounts that should
  922  not have been so collected or billed by reason of the provider’s
  923  billing the Medicaid program for the same service;
  924         (k) The provider or an authorized representative of the
  925  provider has included in a cost report costs that are not
  926  allowable under a Florida Title XIX reimbursement plan, after
  927  the provider or authorized representative had been advised in an
  928  audit exit conference or audit report that the costs were not
  929  allowable;
  930         (l) The provider is charged by information or indictment
  931  with fraudulent billing practices or an offense under subsection
  932  (13). The sanction applied for this reason is limited to
  933  suspension of the provider’s participation in the Medicaid
  934  program for the duration of the indictment unless the provider
  935  is found guilty pursuant to the information or indictment;
  936         (m) The provider or a person who has ordered or prescribed
  937  the goods or services is found liable for negligent practice
  938  resulting in death or injury to the provider’s patient;
  939         (n) The provider fails to demonstrate that it had available
  940  during a specific audit or review period sufficient quantities
  941  of goods, or sufficient time in the case of services, to support
  942  the provider’s billings to the Medicaid program;
  943         (o) The provider has failed to comply with the notice and
  944  reporting requirements of s. 409.907;
  945         (p) The agency has received reliable information of patient
  946  abuse or neglect or of any act prohibited by s. 409.920; or
  947         (q) The provider has failed to comply with an agreed-upon
  948  repayment schedule.
  949  
  950  A provider is subject to sanctions for violations of this
  951  subsection as the result of actions or inactions of the
  952  provider, or actions or inactions of any principal, officer,
  953  director, agent, managing employee, or affiliated person of the
  954  provider, or any partner or shareholder having an ownership
  955  interest in the provider equal to 5 percent or greater, in which
  956  the provider participated or acquiesced. If the agency
  957  immediately suspends or immediately terminates a provider under
  958  this subsection, the agency shall issue an immediate suspension
  959  or immediate termination order as provided in subsection (16).
  960         (16) The agency shall impose any of the following sanctions
  961  or disincentives on a provider or a person for any of the acts
  962  described in subsection (15):
  963         (a) Suspension for a specific period of time of not more
  964  than 1 year. Suspension shall preclude participation in the
  965  Medicaid program, which includes any action that results in a
  966  claim for payment to the Medicaid program as a result of
  967  furnishing, supervising a person who is furnishing, or causing a
  968  person to furnish goods or services.
  969         (b) Termination for a specific period of time of from more
  970  than 1 year to 20 years. Termination shall preclude
  971  participation in the Medicaid program, which includes any action
  972  that results in a claim for payment to the Medicaid program as a
  973  result of furnishing, supervising a person who is furnishing, or
  974  causing a person to furnish goods or services.
  975         (c) Imposition of a fine of up to $5,000 for each
  976  violation. Each day that an ongoing violation continues, such as
  977  refusing to furnish Medicaid-related records or refusing access
  978  to records, is considered, for the purposes of this section, to
  979  be a separate violation. Each instance of improper billing of a
  980  Medicaid recipient; each instance of including an unallowable
  981  cost on a hospital or nursing home Medicaid cost report after
  982  the provider or authorized representative has been advised in an
  983  audit exit conference or previous audit report of the cost
  984  unallowability; each instance of furnishing a Medicaid recipient
  985  goods or professional services that are inappropriate or of
  986  inferior quality as determined by competent peer judgment; each
  987  instance of knowingly submitting a materially false or erroneous
  988  Medicaid provider enrollment application, request for prior
  989  authorization for Medicaid services, drug exception request, or
  990  cost report; each instance of inappropriate prescribing of drugs
  991  for a Medicaid recipient as determined by competent peer
  992  judgment; and each false or erroneous Medicaid claim leading to
  993  an overpayment to a provider is considered, for the purposes of
  994  this section, to be a separate violation.
  995         (d) Immediate suspension, if the agency has received
  996  information of patient abuse or neglect, or of any act
  997  prohibited by s. 409.920, or any conduct listed in subsection
  998  (13) or subsection (14). Upon suspension, the agency must issue
  999  an immediate suspension final order, which shall state that the
 1000  agency has reasonable cause to believe that the provider,
 1001  person, or entity named is engaging in or has engaged in patient
 1002  abuse or neglect, any act prohibited by s. 409.920, or any
 1003  conduct listed in subsection (13) or subsection (14). The order
 1004  shall provide notice of administrative hearing rights under ss.
 1005  120.569 and 120.57 and is effective immediately upon notice to
 1006  the provider, person, or entity under s. 120.569(2)(n).
 1007         (e)Immediate termination, if the agency has received
 1008  information of a conviction based on patient abuse or neglect,
 1009  any act prohibited by s. 409.920, or any conduct listed in
 1010  subsection (13) or subsection (14). Upon termination, the agency
 1011  must issue an immediate termination order, which shall state
 1012  that the agency has reasonable cause to believe that the
 1013  provider, person, or entity named has been convicted of patient
 1014  abuse or neglect, any act prohibited by s. 409.920, or any
 1015  conduct listed in subsection (13) or subsection (14). The
 1016  termination order shall provide notice of administrative hearing
 1017  rights under ss. 120.569 and 120.57 and is effective immediately
 1018  upon notice to the provider, person, or entity.
 1019         (f)(e) A fine, not to exceed $10,000, for a violation of
 1020  paragraph (15)(i).
 1021         (g)(f) Imposition of liens against provider assets,
 1022  including, but not limited to, financial assets and real
 1023  property, not to exceed the amount of fines or recoveries
 1024  sought, upon entry of an order determining that such moneys are
 1025  due or recoverable.
 1026         (h)(g) Prepayment reviews of claims for a specified period
 1027  of time.
 1028         (i)(h) Comprehensive followup reviews of providers every 6
 1029  months to ensure that they are billing Medicaid correctly.
 1030         (j)(i) Corrective-action plans that would remain in effect
 1031  for providers for up to 3 years and that would be monitored by
 1032  the agency every 6 months while in effect.
 1033         (k)(j) Other remedies as permitted by law to effect the
 1034  recovery of a fine or overpayment.
 1035  
 1036  The Secretary of Health Care Administration may make a
 1037  determination that imposition of a sanction or disincentive is
 1038  not in the best interest of the Medicaid program, in which case
 1039  a sanction or disincentive shall not be imposed.
 1040         (17) In determining the appropriate administrative sanction
 1041  to be applied, or the duration of any suspension or termination,
 1042  the agency shall consider:
 1043         (a) The seriousness and extent of the violation or
 1044  violations.
 1045         (b) Any prior history of violations by the provider
 1046  relating to the delivery of health care programs which resulted
 1047  in either a criminal conviction or in administrative sanction or
 1048  penalty.
 1049         (c) Evidence of continued violation within the provider’s
 1050  management control of Medicaid statutes, rules, regulations, or
 1051  policies after written notification to the provider of improper
 1052  practice or instance of violation.
 1053         (d) The effect, if any, on the quality of medical care
 1054  provided to Medicaid recipients as a result of the acts of the
 1055  provider.
 1056         (e) Any action by a licensing agency respecting the
 1057  provider in any state in which the provider operates or has
 1058  operated.
 1059         (f) The apparent impact on access by recipients to Medicaid
 1060  services if the provider is suspended or terminated, in the best
 1061  judgment of the agency.
 1062  
 1063  The agency shall document the basis for all sanctioning actions
 1064  and recommendations.
 1065         (18) The agency may take action to sanction, suspend, or
 1066  terminate a particular provider working for a group provider,
 1067  and may suspend or terminate Medicaid participation at a
 1068  specific location, rather than or in addition to taking action
 1069  against an entire group.
 1070         (19) The agency shall establish a process for conducting
 1071  followup reviews of a sampling of providers who have a history
 1072  of overpayment under the Medicaid program. This process must
 1073  consider the magnitude of previous fraud or abuse and the
 1074  potential effect of continued fraud or abuse on Medicaid costs.
 1075         (20) In making a determination of overpayment to a
 1076  provider, the agency must use accepted and valid auditing,
 1077  accounting, analytical, statistical, or peer-review methods, or
 1078  combinations thereof. Appropriate statistical methods may
 1079  include, but are not limited to, sampling and extension to the
 1080  population, parametric and nonparametric statistics, tests of
 1081  hypotheses, and other generally accepted statistical methods.
 1082  Appropriate analytical methods may include, but are not limited
 1083  to, reviews to determine variances between the quantities of
 1084  products that a provider had on hand and available to be
 1085  purveyed to Medicaid recipients during the review period and the
 1086  quantities of the same products paid for by the Medicaid program
 1087  for the same period, taking into appropriate consideration sales
 1088  of the same products to non-Medicaid customers during the same
 1089  period. In meeting its burden of proof in any administrative or
 1090  court proceeding, the agency may introduce the results of such
 1091  statistical methods as evidence of overpayment.
 1092         (21) When making a determination that an overpayment has
 1093  occurred, the agency shall prepare and issue an audit report to
 1094  the provider showing the calculation of overpayments.
 1095         (22) The audit report, supported by agency work papers,
 1096  showing an overpayment to a provider constitutes evidence of the
 1097  overpayment. A provider may not present or elicit testimony,
 1098  either on direct examination or cross-examination in any court
 1099  or administrative proceeding, regarding the purchase or
 1100  acquisition by any means of drugs, goods, or supplies; sales or
 1101  divestment by any means of drugs, goods, or supplies; or
 1102  inventory of drugs, goods, or supplies, unless such acquisition,
 1103  sales, divestment, or inventory is documented by written
 1104  invoices, written inventory records, or other competent written
 1105  documentary evidence maintained in the normal course of the
 1106  provider’s business. Notwithstanding the applicable rules of
 1107  discovery, all documentation that will be offered as evidence at
 1108  an administrative hearing on a Medicaid overpayment must be
 1109  exchanged by all parties at least 14 days before the
 1110  administrative hearing or must be excluded from consideration.
 1111         (23)(a) In an audit or investigation of a violation
 1112  committed by a provider which is conducted pursuant to this
 1113  section, the agency is entitled to recover all investigative,
 1114  legal, and expert witness costs if the agency’s findings were
 1115  not contested by the provider or, if contested, the agency
 1116  ultimately prevailed.
 1117         (b) The agency has the burden of documenting the costs,
 1118  which include salaries and employee benefits and out-of-pocket
 1119  expenses. The amount of costs that may be recovered must be
 1120  reasonable in relation to the seriousness of the violation and
 1121  must be set taking into consideration the financial resources,
 1122  earning ability, and needs of the provider, who has the burden
 1123  of demonstrating such factors.
 1124         (c) The provider may pay the costs over a period to be
 1125  determined by the agency if the agency determines that an
 1126  extreme hardship would result to the provider from immediate
 1127  full payment. Any default in payment of costs may be collected
 1128  by any means authorized by law.
 1129         (24) If the agency imposes an administrative sanction
 1130  pursuant to subsection (13), subsection (14), or subsection
 1131  (15), except paragraphs (15)(e) and (o), upon any provider or
 1132  any principal, officer, director, agent, managing employee, or
 1133  affiliated person of the provider who is regulated by another
 1134  state entity, the agency shall notify that other entity of the
 1135  imposition of the sanction within 5 business days. Such
 1136  notification must include the provider’s or person’s name and
 1137  license number and the specific reasons for sanction.
 1138         (25)(a) The agency shall withhold Medicaid payments, in
 1139  whole or in part, to a provider upon receipt of reliable
 1140  evidence that the circumstances giving rise to the need for a
 1141  withholding of payments involve fraud, willful
 1142  misrepresentation, or abuse under the Medicaid program, or a
 1143  crime committed while rendering goods or services to Medicaid
 1144  recipients. If the provider is not paid within 14 days after the
 1145  agency receives evidence it is determined that fraud, willful
 1146  misrepresentation, abuse, or a crime did not occur, interest
 1147  shall accrue at a rate of 10 percent a year the payments
 1148  withheld must be paid to the provider within 14 days after such
 1149  determination with interest at the rate of 10 percent a year.
 1150  Any money withheld in accordance with this paragraph shall be
 1151  placed in a suspended account, readily accessible to the agency,
 1152  so that any payment ultimately due the provider shall be made
 1153  within 14 days.
 1154         (b) The agency shall deny payment, or require repayment, if
 1155  the goods or services were furnished, supervised, or caused to
 1156  be furnished by a person who has been convicted of a crime under
 1157  subsection (13) or who has been suspended or terminated from the
 1158  Medicaid program or Medicare program by the Federal Government
 1159  or any state.
 1160         (c) Overpayments owed to the agency bear interest at the
 1161  rate of 10 percent per year from the date of determination of
 1162  the overpayment by the agency, and payment arrangements for
 1163  overpayments and fines must be made within 35 days after the
 1164  date of the final order at the conclusion of legal proceedings.
 1165  A provider who does not enter into or adhere to an agreed-upon
 1166  repayment schedule may be terminated by the agency for
 1167  nonpayment or partial payment.
 1168         (d) The agency, upon entry of a final agency order, a
 1169  judgment or order of a court of competent jurisdiction, or a
 1170  stipulation or settlement, may collect the moneys owed by all
 1171  means allowable by law, including, but not limited to, notifying
 1172  any fiscal intermediary of Medicare benefits that the state has
 1173  a superior right of payment. Upon receipt of such written
 1174  notification, the Medicare fiscal intermediary shall remit to
 1175  the state the sum claimed.
 1176         (e) The agency may institute amnesty programs to allow
 1177  Medicaid providers the opportunity to voluntarily repay
 1178  overpayments. The agency may adopt rules to administer such
 1179  programs.
 1180         (26) The agency may impose administrative sanctions against
 1181  a Medicaid recipient, or the agency may seek any other remedy
 1182  provided by law, including, but not limited to, the remedies
 1183  provided in s. 812.035, if the agency finds that a recipient has
 1184  engaged in solicitation in violation of s. 409.920 or that the
 1185  recipient has otherwise abused the Medicaid program.
 1186         (27) When the Agency for Health Care Administration has
 1187  made a probable cause determination and alleged that an
 1188  overpayment to a Medicaid provider has occurred, the agency,
 1189  after notice to the provider, shall:
 1190         (a) Withhold, and continue to withhold during the pendency
 1191  of an administrative hearing pursuant to chapter 120, any
 1192  medical assistance reimbursement payments until such time as the
 1193  overpayment is recovered, unless within 30 days after receiving
 1194  notice thereof the provider:
 1195         1. Makes repayment in full; or
 1196         2. Establishes a repayment plan that is satisfactory to the
 1197  Agency for Health Care Administration.
 1198         (b) Withhold, and continue to withhold during the pendency
 1199  of an administrative hearing pursuant to chapter 120, medical
 1200  assistance reimbursement payments if the terms of a repayment
 1201  plan are not adhered to by the provider.
 1202         (28) Venue for all Medicaid program integrity overpayment
 1203  cases shall lie in Leon County, at the discretion of the agency.
 1204         (29) Notwithstanding other provisions of law, the agency
 1205  and the Medicaid Fraud Control Unit of the Department of Legal
 1206  Affairs may review a provider’s Medicaid-related and non
 1207  Medicaid-related records in order to determine the total output
 1208  of a provider’s practice to reconcile quantities of goods or
 1209  services billed to Medicaid with quantities of goods or services
 1210  used in the provider’s total practice.
 1211         (30) The agency shall terminate a provider’s participation
 1212  in the Medicaid program if the provider fails to reimburse an
 1213  overpayment or fine that has been determined by final order, not
 1214  subject to further appeal, within 35 days after the date of the
 1215  final order, unless the provider and the agency have entered
 1216  into a repayment agreement.
 1217         (31) If a provider requests an administrative hearing
 1218  pursuant to chapter 120, such hearing must be conducted within
 1219  90 days following assignment of an administrative law judge,
 1220  absent exceptionally good cause shown as determined by the
 1221  administrative law judge or hearing officer. Upon issuance of a
 1222  final order, the outstanding balance of the amount determined to
 1223  constitute the overpayment or fine shall become due. If a
 1224  provider fails to make payments in full, fails to enter into a
 1225  satisfactory repayment plan, or fails to comply with the terms
 1226  of a repayment plan or settlement agreement, the agency shall
 1227  withhold medical assistance reimbursement payments until the
 1228  amount due is paid in full.
 1229         (32) Duly authorized agents and employees of the agency
 1230  shall have the power to inspect, during normal business hours,
 1231  the records of any pharmacy, wholesale establishment, or
 1232  manufacturer, or any other place in which drugs and medical
 1233  supplies are manufactured, packed, packaged, made, stored, sold,
 1234  or kept for sale, for the purpose of verifying the amount of
 1235  drugs and medical supplies ordered, delivered, or purchased by a
 1236  provider. The agency shall provide at least 2 business days’
 1237  prior notice of any such inspection. The notice must identify
 1238  the provider whose records will be inspected, and the inspection
 1239  shall include only records specifically related to that
 1240  provider.
 1241         (33) In accordance with federal law, Medicaid recipients
 1242  convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
 1243  limited, restricted, or suspended from Medicaid eligibility for
 1244  a period not to exceed 1 year, as determined by the agency head
 1245  or designee.
 1246         (34) To deter fraud and abuse in the Medicaid program, the
 1247  agency may limit the number of Schedule II and Schedule III
 1248  refill prescription claims submitted from a pharmacy provider.
 1249  The agency shall limit the allowable amount of reimbursement of
 1250  prescription refill claims for Schedule II and Schedule III
 1251  pharmaceuticals if the agency or the Medicaid Fraud Control Unit
 1252  determines that the specific prescription refill was not
 1253  requested by the Medicaid recipient or authorized representative
 1254  for whom the refill claim is submitted or was not prescribed by
 1255  the recipient’s medical provider or physician. Any such refill
 1256  request must be consistent with the original prescription.
 1257         (35) The Office of Program Policy Analysis and Government
 1258  Accountability shall provide a report to the President of the
 1259  Senate and the Speaker of the House of Representatives on a
 1260  biennial basis, beginning January 31, 2006, on the agency’s and
 1261  the Medicaid Fraud Control Unit’s efforts to prevent, detect,
 1262  and deter, as well as recover funds lost to, fraud and abuse in
 1263  the Medicaid program.
 1264         (36) At least three times a year, the agency shall provide
 1265  to each Medicaid recipient or his or her representative an
 1266  explanation of benefits in the form of a letter that is mailed
 1267  to the most recent address of the recipient on the record with
 1268  the Department of Children and Family Services. The explanation
 1269  of benefits must include the patient’s name, the name of the
 1270  health care provider and the address of the location where the
 1271  service was provided, a description of all services billed to
 1272  Medicaid in terminology that should be understood by a
 1273  reasonable person, and information on how to report
 1274  inappropriate or incorrect billing to the agency or other law
 1275  enforcement entities for review or investigation. At least once
 1276  a year, the letter also must include information on how to
 1277  report criminal Medicaid fraud, the Medicaid Fraud Control
 1278  Unit’s toll-free hotline number, and information about the
 1279  rewards available under s. 409.9203. The explanation of benefits
 1280  may not be mailed for Medicaid independent laboratory services
 1281  as described in s. 409.905(7) or for Medicaid certified match
 1282  services as described in ss. 409.9071 and 1011.70.
 1283         (37) The agency shall post on its website a current list of
 1284  each Medicaid provider, including any principal, officer,
 1285  director, agent, managing employee, or affiliated person of the
 1286  provider, or any partner or shareholder having an ownership
 1287  interest in the provider equal to 5 percent or greater, who has
 1288  been terminated for cause from the Medicaid program or
 1289  sanctioned under this section. The list must be searchable by a
 1290  variety of search parameters and provide for the creation of
 1291  formatted lists that may be printed or imported into other
 1292  applications, including spreadsheets. The agency shall update
 1293  the list at least monthly.
 1294         (38) In order to improve the detection of health care
 1295  fraud, use technology to prevent and detect fraud, and maximize
 1296  the electronic exchange of health care fraud information, the
 1297  agency shall:
 1298         (a) Compile, maintain, and publish on its website a
 1299  detailed list of all state and federal databases that contain
 1300  health care fraud information and update the list at least
 1301  biannually;
 1302         (b) Develop a strategic plan to connect all databases that
 1303  contain health care fraud information to facilitate the
 1304  electronic exchange of health information between the agency,
 1305  the Department of Health, the Department of Law Enforcement, and
 1306  the Attorney General’s Office. The plan must include recommended
 1307  standard data formats, fraud identification strategies, and
 1308  specifications for the technical interface between state and
 1309  federal health care fraud databases;
 1310         (c) Monitor innovations in health information technology,
 1311  specifically as it pertains to Medicaid fraud prevention and
 1312  detection; and
 1313         (d) Periodically publish policy briefs that highlight
 1314  available new technology to prevent or detect health care fraud
 1315  and projects implemented by other states, the private sector, or
 1316  the Federal Government which use technology to prevent or detect
 1317  health care fraud.
 1318         Section 8. Subsection (5) is added to section 409.9203,
 1319  Florida Statutes, to read:
 1320         409.9203 Rewards for reporting Medicaid fraud.—
 1321         (5)An employee of the Agency for Health Care
 1322  Administration, the Department of Legal Affairs, the Department
 1323  of Health, or the Department of Law Enforcement whose job
 1324  responsibilities include the prevention, detection, and
 1325  prosecution of Medicaid fraud is not eligible to receive a
 1326  reward under this section.
 1327         Section 9. Subsection (8) is added to section 456.001,
 1328  Florida Statutes, to read:
 1329         456.001 Definitions.—As used in this chapter, the term:
 1330         (8)“Affiliate” or “affiliated person” means any person who
 1331  directly or indirectly manages, controls, or oversees the
 1332  operation of a corporation or other business entity, regardless
 1333  of whether such person is a partner, shareholder, owner,
 1334  officer, director, or agent of the entity.
 1335         Section 10. Paragraph (c) of subsection (1) and subsections
 1336  (2) and (3) of section 456.041, Florida Statutes, are amended to
 1337  read:
 1338         456.041 Practitioner profile; creation.—
 1339         (1)
 1340         (c) Within 30 calendar days after receiving an update of
 1341  information required for the practitioner’s profile, the
 1342  department shall update the practitioner’s profile in accordance
 1343  with the requirements of subsection (8) (7).
 1344         (2) Beginning July 1, 2010, on the profile published under
 1345  subsection (1), the department shall include indicate if the
 1346  information provided under s. 456.039(1)(a)7. or s.
 1347  456.0391(1)(a)7. and indicate if the information is or is not
 1348  corroborated by a criminal history records check conducted
 1349  according to this subsection. The department must include in
 1350  each practitioner’s profile the following statement: “The
 1351  criminal history information, if any exists, may be incomplete.
 1352  Federal criminal history information is not available to the
 1353  public.” The department, or the board having regulatory
 1354  authority over the practitioner acting on behalf of the
 1355  department, shall investigate any information received by the
 1356  department or the board.
 1357         (3) Beginning July 1, 2010, the department shall include in
 1358  each practitioner’s profile any open administrative complaint
 1359  filed with the department against the practitioner in which
 1360  probable cause has been found. The Department of Health shall
 1361  include in each practitioner’s practitioner profile that
 1362  criminal information that directly relates to the practitioner’s
 1363  ability to competently practice his or her profession. The
 1364  department must include in each practitioner’s practitioner
 1365  profile the following statement: “The criminal history
 1366  information, if any exists, may be incomplete; federal criminal
 1367  history information is not available to the public.” The
 1368  department shall provide in each practitioner profile, for every
 1369  final disciplinary action taken against the practitioner, an
 1370  easy-to-read narrative description that explains the
 1371  administrative complaint filed against the practitioner and the
 1372  final disciplinary action imposed on the practitioner. The
 1373  department shall include a hyperlink to each final order listed
 1374  in its website report of dispositions of recent disciplinary
 1375  actions taken against practitioners.
 1376         Section 11. Section 456.0635, Florida Statutes, is amended
 1377  to read:
 1378         456.0635 Health care Medicaid fraud; disqualification for
 1379  license, certificate, or registration.—
 1380         (1) Medicaid Fraud in the practice of a health care
 1381  profession is prohibited.
 1382         (2) Each board within the jurisdiction of the department,
 1383  or the department if there is no board, shall refuse to admit a
 1384  candidate to any examination and refuse to issue or renew a
 1385  license, certificate, or registration to any applicant if the
 1386  candidate or applicant or any principal, officer, agent,
 1387  managing employee, or affiliated person of the applicant, has
 1388  been:
 1389         (a) Has been convicted of, or entered a plea of guilty or
 1390  nolo contendere to, regardless of adjudication, a felony under
 1391  chapter 409, chapter 817, chapter 893, or a similar felony
 1392  offense committed in another state or jurisdiction 21 U.S.C. ss.
 1393  801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any
 1394  subsequent period of probation for such conviction or plea pleas
 1395  ended: more than 15 years prior to the date of the application;
 1396         1.For felonies of the first or second degree more than 15
 1397  years before the date of application.
 1398         2.For felonies of the third degree more than 10 years
 1399  before the date of application, except for felonies of the third
 1400  degree under s. 893.13(6)(a).
 1401         3.For felonies of the third degree under s. 893.13(6)(a),
 1402  more than 5 years before the date of application.
 1403         4.For felonies in which the defendant entered a plea of
 1404  guilty or nolo contendere in an agreement with the court to
 1405  enter a pretrial intervention or drug diversion program, the
 1406  department shall not approve or deny the application for a
 1407  license, certificate, or registration until the final resolution
 1408  of the case.
 1409         (b)Has been convicted of, or entered a plea of guilty or
 1410  nolo contendere to, regardless of adjudication, a felony under
 1411  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
 1412  sentence and any subsequent period of probation for such
 1413  conviction or plea ended more than 15 years before the date of
 1414  the application;
 1415         (c)(b)Has been terminated for cause from the Florida
 1416  Medicaid program pursuant to s. 409.913, unless the applicant
 1417  has been in good standing with the Florida Medicaid program for
 1418  the most recent 5 years;
 1419         (d)(c)Has been terminated for cause, pursuant to the
 1420  appeals procedures established by the state or Federal
 1421  Government, from any other state Medicaid program or the federal
 1422  Medicare program, unless the applicant has been in good standing
 1423  with a state Medicaid program or the federal Medicare program
 1424  for the most recent 5 years and the termination occurred at
 1425  least 20 years before prior to the date of the application; or.
 1426         (e)Is currently listed on the United States Department of
 1427  Health and Human Services Office of Inspector General’s List of
 1428  Excluded Individuals and Entities.
 1429         (f) This subsection does not apply to applicants for
 1430  initial licensure or certification who were enrolled in an
 1431  educational or training program on or before July 1, 2009, which
 1432  was recognized by a board or, if there is no board, recognized
 1433  by the department, and who applied for licensure after July 1,
 1434  2009.
 1435         (3)Each board within the jurisdiction of the department,
 1436  or the department if there is no board, shall refuse to renew a
 1437  license, certificate, or registration of any applicant if the
 1438  candidate or applicant or any principal, officer, agent,
 1439  managing employee, or affiliated person of the applicant:
 1440         (a)Has been convicted of, or entered a plea of guilty or
 1441  nolo contendere to, regardless of adjudication, a felony under:
 1442  chapter 409, chapter 817, chapter 893, or a similar felony
 1443  offense committed in another state or jurisdiction since July 1,
 1444  2009.
 1445         (b)Has been convicted of, or entered a plea of guilty or
 1446  nolo contendere to, regardless of adjudication, a felony under
 1447  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
 1448  2009.
 1449         (c)Has been terminated for cause from the Florida Medicaid
 1450  program pursuant to s. 409.913, unless the applicant has been in
 1451  good standing with the Florida Medicaid program for the most
 1452  recent 5 years.
 1453         (d)Has been terminated for cause, pursuant to the appeals
 1454  procedures established by the state, from any other state
 1455  Medicaid program, unless the applicant has been in good standing
 1456  with a state Medicaid program for the most recent 5 years and
 1457  the termination occurred at least 20 years before the date of
 1458  the application.
 1459         (e)Is currently listed on the United States Department of
 1460  Health and Human Services Office of Inspector General’s List of
 1461  Excluded Individuals and Entities.
 1462         (f)For felonies in which the defendant entered a plea of
 1463  guilty or nolo contendere in an agreement with the court to
 1464  enter a pretrial intervention or drug diversion program, the
 1465  department shall not approve or deny the application for a
 1466  renewal of a license, certificate, or registration until the
 1467  final resolution of the case.
 1468         (4)(3) Licensed health care practitioners shall report
 1469  allegations of Medicaid fraud to the department, regardless of
 1470  the practice setting in which the alleged Medicaid fraud
 1471  occurred.
 1472         (5)(4) The acceptance by a licensing authority of a
 1473  candidate’s relinquishment of a license which is offered in
 1474  response to or anticipation of the filing of administrative
 1475  charges alleging Medicaid fraud or similar charges constitutes
 1476  the permanent revocation of the license.
 1477         (6)The department shall adopt rules to administer the
 1478  provisions of this section related to denial of licensure
 1479  renewal.
 1480         Section 12. Paragraph (kk) of subsection (1) of section
 1481  456.072, Florida Statutes, is amended to read:
 1482         456.072 Grounds for discipline; penalties; enforcement.—
 1483         (1) The following acts shall constitute grounds for which
 1484  the disciplinary actions specified in subsection (2) may be
 1485  taken:
 1486         (kk) Being terminated from the state Medicaid program
 1487  pursuant to s. 409.913 or, any other state Medicaid program, or
 1488  excluded from the federal Medicare program, unless eligibility
 1489  to participate in the program from which the practitioner was
 1490  terminated has been restored.
 1491         Section 13. Subsection (13) of section 456.073, Florida
 1492  Statutes, is amended to read:
 1493         456.073 Disciplinary proceedings.—Disciplinary proceedings
 1494  for each board shall be within the jurisdiction of the
 1495  department.
 1496         (13) Notwithstanding any provision of law to the contrary,
 1497  an administrative complaint against a licensee shall be filed
 1498  within 6 years after the time of the incident or occurrence
 1499  giving rise to the complaint against the licensee. If such
 1500  incident or occurrence involved fraud related to the Medicaid
 1501  program, criminal actions, diversion of controlled substances,
 1502  sexual misconduct, or impairment by the licensee, this
 1503  subsection does not apply to bar initiation of an investigation
 1504  or filing of an administrative complaint beyond the 6-year
 1505  timeframe. In those cases covered by this subsection in which it
 1506  can be shown that fraud, concealment, or intentional
 1507  misrepresentation of fact prevented the discovery of the
 1508  violation of law, the period of limitations is extended forward,
 1509  but in no event to exceed 12 years after the time of the
 1510  incident or occurrence.
 1511         Section 14. Subsection (1) of section 456.074, Florida
 1512  Statutes, is amended to read:
 1513         456.074 Certain health care practitioners; immediate
 1514  suspension of license.—
 1515         (1) The department shall issue an emergency order
 1516  suspending the license of any person licensed in a profession as
 1517  defined in this chapter under chapter 458, chapter 459, chapter
 1518  460, chapter 461, chapter 462, chapter 463, chapter 464, chapter
 1519  465, chapter 466, or chapter 484 who pleads guilty to, is
 1520  convicted or found guilty of, or who enters a plea of nolo
 1521  contendere to, regardless of adjudication, to:
 1522         (a) A felony under chapter 409, chapter 812, chapter 817,
 1523  or chapter 893, chapter 895, chapter 896, or under 21 U.S.C. ss.
 1524  801-970, or under 42 U.S.C. ss. 1395-1396; or
 1525         (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
 1526  285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
 1527  1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
 1528  Medicaid program.
 1529         Section 15. This act shall take effect July 1, 2010.

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