November 18, 2019
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       Florida Senate - 2010                CS for CS for CS for SB 752
       
       
       
       By the Committees on Health and Human Services Appropriations;
       Criminal Justice; and Health Regulation; and Senator Gaetz
       
       
       
       603-04846-10                                           2010752c3
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 400.471,
    3         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. 408.910, F.S.; revising the list of
   20         employers who are eligible to enroll in the Florida
   21         Health Choices Program; revising the membership of the
   22         board of directors of the Florida Health Choices,
   23         Inc.; requiring the President of the Senate and the
   24         Speaker of the House of Representatives to initially
   25         appoint members to the board of directors for
   26         staggered terms; requiring that the members of the
   27         board appoint new members to the board of directors
   28         after a specified date, subject to Senate
   29         confirmation; deleting a provision that prohibits
   30         board members from serving for more than a certain
   31         number of consecutive years; amending s. 409.907,
   32         F.S.; extending the number of years that Medicaid
   33         providers must retain Medicaid recipient records;
   34         adding additional requirements to the Medicaid
   35         provider agreement; revising applicability of
   36         screening requirements; revising conditions under
   37         which the agency is authorized to deny a Medicaid
   38         provider application; amending s. 409.912, F.S.;
   39         revising requirements for Medicaid prepaid, fixed-sum,
   40         and managed care contracts; revising requirements for
   41         Medicaid durable medical equipment providers;
   42         repealing s. 409.9122(13), F.S., relating to the
   43         enrollee assignment process of Medicaid managed
   44         prepaid health plans for those Medicaid managed
   45         prepaid health plans operating in Miami-Dade County;
   46         amending s. 409.913, F.S.; removing a required element
   47         from the joint Medicaid fraud and abuse report
   48         submitted by the agency and the Medicaid Fraud Control
   49         Unit of the Department of Legal Affairs; extending the
   50         number of years that Medicaid providers must retain
   51         Medicaid recipient records; authorizing the Medicaid
   52         program integrity staff to immediately suspend or
   53         terminate a Medicaid provider for engaging in
   54         specified conduct; removing a requirement for the
   55         agency to hold suspended Medicaid payments in a
   56         separate account; authorizing the agency to deny
   57         payment or require repayment to Medicaid providers
   58         convicted of certain crimes; authorizing the agency to
   59         terminate a Medicaid provider if the provider fails to
   60         reimburse a fine determined by a final order;
   61         authorizing the agency to withhold Medicaid
   62         reimbursement to a Medicaid provider that fails to pay
   63         a fine determined by a final order, fails to enter
   64         into a repayment plan, or fails to comply with a
   65         repayment plan or settlement agreement; requiring the
   66         biennial review of Medicaid fraud and abuse by the
   67         Office of Program Policy Analysis and Government
   68         Accountability to include a report on the Medicaid
   69         Fraud Control Unit within the Department of Legal
   70         Affairs; amending s. 409.9203, F.S.; providing that
   71         certain state employees are ineligible from receiving
   72         a reward for reporting Medicaid fraud; amending s.
   73         456.001, F.S.; defining the term “affiliate” or
   74         “affiliated person” as it relates to health
   75         professions and occupations; amending s. 456.041,
   76         F.S.; requiring the Department of Health to include
   77         administrative complaints and any conviction
   78         information relating to the practitioner’s profile;
   79         providing a disclaimer; amending s. 456.0635, F.S.;
   80         revising the grounds under which the Department of
   81         Health or corresponding board is required to refuse to
   82         admit a candidate to an examination and refuse to
   83         issue or renew a license, certificate, or registration
   84         of a health care practitioner; providing an exception;
   85         amending s. 456.072, F.S.; clarifying a ground under
   86         which disciplinary actions may be taken; amending s.
   87         456.073, F.S.; revising applicability of
   88         investigations and administrative complaints to
   89         include Medicaid fraud; amending s. 456.074, F.S.;
   90         authorizing the Department of Health to issue an
   91         emergency order suspending the license of any person
   92         licensed under ch. 456, F.S., who engages in specified
   93         criminal conduct; amending s. 499.01, F.S.; exempting
   94         certain persons from requirements for medical device
   95         manufacturer permits; providing an effective date.
   96  
   97  Be It Enacted by the Legislature of the State of Florida:
   98  
   99         Section 1. Subsection (11) of section 400.471, Florida
  100  Statutes, is amended to read:
  101         400.471 Application for license; fee.—
  102         (11)(a) The agency may not issue an initial license to a
  103  home health agency under part II of chapter 408 or this part for
  104  the purpose of opening a new home health agency until July 1,
  105  2012 2010, in any county that has at least one actively licensed
  106  home health agency and a population of persons 65 years of age
  107  or older, as indicated in the most recent population estimates
  108  published by the Executive Office of the Governor, of fewer than
  109  1,200 per home health agency. In such counties, for any
  110  application received by the agency prior to July 1, 2009, which
  111  has been deemed by the agency to be complete except for proof of
  112  accreditation, the agency may issue an initial ownership license
  113  only if the applicant has applied for accreditation before May
  114  1, 2009, from an accrediting organization that is recognized by
  115  the agency.
  116         (b) Effective October 1, 2009, the agency may not issue a
  117  change of ownership license to a home health agency under part
  118  II of chapter 408 or this part until July 1, 2012 2010, in any
  119  county that has at least one actively licensed home health
  120  agency and a population of persons 65 years of age or older, as
  121  indicated in the most recent population estimates published by
  122  the Executive Office of the Governor, of fewer than 1,200 per
  123  home health agency. In such counties, for any application
  124  received by the agency before prior to October 1, 2009, which
  125  has been deemed by the agency to be complete except for proof of
  126  accreditation, the agency may issue a change of ownership
  127  license only if the applicant has applied for accreditation
  128  before August 1, 2009, from an accrediting organization that is
  129  recognized by the agency. This paragraph does not apply to an
  130  application for a change in ownership from an existing home
  131  health agency that is accredited, has been licensed by the state
  132  at least 5 years, and is in good standing with the agency.
  133         Section 2. Subsection (8) is added to section 400.474,
  134  Florida Statutes, to read:
  135         400.474 Administrative penalties.—
  136         (8)The agency may revoke the license of a home health
  137  agency that is not eligible for licensure renewal under s.
  138  400.471(10).
  139         Section 3. Subsections (1) and (4) of section 408.815,
  140  Florida Statutes, are amended, and subsection (5) is added to
  141  that section, to read:
  142         408.815 License or application denial; revocation.—
  143         (1) In addition to the grounds provided in authorizing
  144  statutes, grounds that may be used by the agency for denying and
  145  revoking a license or change of ownership application include
  146  any of the following actions by a controlling interest:
  147         (a) False representation of a material fact in the license
  148  application or omission of any material fact from the
  149  application.
  150         (b) An intentional or negligent act materially affecting
  151  the health or safety of a client of the provider.
  152         (c) A violation of this part, authorizing statutes, or
  153  applicable rules.
  154         (d) A demonstrated pattern of deficient performance.
  155         (e) The applicant, licensee, or controlling interest has
  156  been or is currently excluded, suspended, or terminated from
  157  participation in the state Medicaid program, the Medicaid
  158  program of any other state, or the Medicare program.
  159         (f) The applicant, licensee, or controlling interest is or
  160  was an administrator or controlling interest in a facility or
  161  entity during the period an event that caused or contributed to
  162  the facility or entity being excluded, suspended, or terminated
  163  from participation in the state Medicaid program, the Medicaid
  164  program of any other state, or the Medicare program.
  165         (4) In addition to the grounds provided in authorizing
  166  statutes, the agency shall deny an application for an initial a
  167  license or a change-of-ownership license renewal if the
  168  applicant or a person having a controlling interest in the an
  169  applicant has been:
  170         (a) Has been convicted of, or entered enters a plea of
  171  guilty or nolo contendere to, regardless of adjudication, a
  172  felony under chapter 409, chapter 817, chapter 893, or a similar
  173  felony offense committed in another state or jurisdiction 21
  174  U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
  175  sentence and any subsequent period of probation for such
  176  conviction convictions or plea ended more than 15 years before
  177  prior to the date of the application;
  178         (b)Has been convicted of, or entered a plea of guilty or
  179  nolo contendere to, regardless of adjudication, a felony under
  180  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
  181  sentence and any subsequent period of probation for such
  182  conviction or plea ended more than 15 years before the date of
  183  the application;
  184         (c)(b)Has been terminated for cause from the Florida
  185  Medicaid program pursuant to s. 409.913, unless the applicant
  186  has been in good standing with the Florida Medicaid program for
  187  the most recent 5 years; or
  188         (d)(c)Has been terminated for cause, pursuant to the
  189  appeals procedures established by the state, or Federal
  190  Government, from the federal Medicare program or from any other
  191  state Medicaid program, unless the applicant has been in good
  192  standing with a state Medicaid program or the federal Medicare
  193  program for the most recent 5 years and the termination occurred
  194  at least 20 years before prior to the date of the application;
  195  or.
  196         (e)Is currently listed on the United States Department of
  197  Health and Human Services Office of Inspector General’s List of
  198  Excluded Individuals and Entities.
  199         (5)In addition to the grounds provided in authorizing
  200  statutes, the agency shall deny an application for licensure
  201  renewal if the applicant or a person having a controlling
  202  interest in the applicant:
  203         (a)Has been convicted of, or entered a plea of guilty or
  204  nolo contendere to, regardless of adjudication, a felony under
  205  chapter 409, chapter 817, chapter 893, or a similar felony
  206  offense committed in another state or jurisdiction since July 1,
  207  2009;
  208         (b)Has been convicted of, or entered a plea of guilty or
  209  nolo contendere to, regardless of adjudication, a felony under
  210  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
  211  2009;
  212         (c)Has been terminated for cause from the Florida Medicaid
  213  program pursuant to s. 409.913, unless the applicant has been in
  214  good standing with the Florida Medicaid program for the most
  215  recent 5 years;
  216         (d)Has been terminated for cause, pursuant to the appeals
  217  procedures established by the state, from any other state
  218  Medicaid program, unless the applicant has been in good standing
  219  with a state Medicaid program for the most recent 5 years and
  220  the termination occurred at least 20 years before the date of
  221  the application; or
  222         (e)Is currently listed on the United States Department of
  223  Health and Human Services Office of Inspector General’s List of
  224  Excluded Individuals and Entities.
  225         Section 4. Paragraph (a) of subsection (4) and subsection
  226  (11) of section 408.910, Florida Statutes, are amended to read:
  227         408.910 Florida Health Choices Program.—
  228         (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
  229  program is voluntary and shall be available to employers,
  230  individuals, vendors, and health insurance agents as specified
  231  in this subsection.
  232         (a) Employers eligible to enroll in the program include:
  233         1. Employers that have 1 to 50 employees.
  234         2. Fiscally constrained counties described in s. 218.67.
  235         3. Municipalities having populations of fewer than 50,000
  236  residents.
  237         4. School districts in fiscally constrained counties.
  238         5. State universities and community colleges.
  239         (11) CORPORATION.—There is created the Florida Health
  240  Choices, Inc., which shall be registered, incorporated,
  241  organized, and operated in compliance with part III of chapter
  242  112 and chapters 119, 286, and 617. The purpose of the
  243  corporation is to administer the program created in this section
  244  and to conduct such other business as may further the
  245  administration of the program.
  246         (a)1. The corporation shall be governed by a five-member
  247  15-member board of directors consisting of:
  248         1.Three ex officio, nonvoting members to include:
  249         a.The Secretary of Health Care Administration or a
  250  designee with expertise in health care services.
  251         b.The Secretary of Management Services or a designee with
  252  expertise in state employee benefits.
  253         c.The commissioner of the Office of Insurance Regulation
  254  or a designee with expertise in insurance regulation.
  255         a.2.One member Four members appointed by and serving at
  256  the pleasure of the Governor.
  257         b.3.Two Four members appointed by and serving at the
  258  pleasure of the President of the Senate.
  259         c.4.Two Four members appointed by and serving at the
  260  pleasure of the Speaker of the House of Representatives.
  261         2.5. Board members may not include insurers, health
  262  insurance agents or brokers, health care providers, health
  263  maintenance organizations, prepaid service providers, or any
  264  other entity, affiliate or subsidiary of eligible vendors.
  265         (b)1. Members shall be appointed for terms of up to 4 3
  266  years. In order to establish staggered terms, for the initial
  267  appointments the President of the Senate and the Speaker of the
  268  House of Representatives shall each appoint one member to a 2
  269  year term and one member to a 4-year term. Any member is
  270  eligible for reappointment. A vacancy on the board shall be
  271  filled for the unexpired portion of the term in the same manner
  272  as the original appointment.
  273         2. Beginning July 1, 2011, the members of the board of
  274  directors shall appoint new members to the board of directors,
  275  subject to confirmation by the Senate.
  276         (c) The board shall select a chief executive officer for
  277  the corporation who shall be responsible for the selection of
  278  such other staff as may be authorized by the corporation’s
  279  operating budget as adopted by the board.
  280         (d) Board members are entitled to receive, from funds of
  281  the corporation, reimbursement for per diem and travel expenses
  282  as provided by s. 112.061. No other compensation is authorized.
  283         (e) There is no liability on the part of, and no cause of
  284  action shall arise against, any member of the board or its
  285  employees or agents for any action taken by them in the
  286  performance of their powers and duties under this section.
  287         (f) The board shall develop and adopt bylaws and other
  288  corporate procedures as necessary for the operation of the
  289  corporation and carrying out the purposes of this section. The
  290  bylaws shall:
  291         1. Specify procedures for selection of officers and
  292  qualifications for reappointment, provided that no board member
  293  shall serve more than 9 consecutive years.
  294         2. Require an annual membership meeting that provides an
  295  opportunity for input and interaction with individual
  296  participants in the program.
  297         3. Specify policies and procedures regarding conflicts of
  298  interest, including the provisions of part III of chapter 112,
  299  which prohibit a member from participating in any decision that
  300  would inure to the benefit of the member or the organization
  301  that employs the member. The policies and procedures shall also
  302  require public disclosure of the interest that prevents the
  303  member from participating in a decision on a particular matter.
  304         (g) The corporation may exercise all powers granted to it
  305  under chapter 617 necessary to carry out the purposes of this
  306  section, including, but not limited to, the power to receive and
  307  accept grants, loans, or advances of funds from any public or
  308  private agency and to receive and accept from any source
  309  contributions of money, property, labor, or any other thing of
  310  value to be held, used, and applied for the purposes of this
  311  section.
  312         (h) The corporation may establish technical advisory panels
  313  consisting of interested parties, including consumers, health
  314  care providers, individuals with expertise in insurance
  315  regulation, and insurers.
  316         (i) The corporation shall:
  317         1. Determine eligibility of employers, vendors,
  318  individuals, and agents in accordance with subsection (4).
  319         2. Establish procedures necessary for the operation of the
  320  program, including, but not limited to, procedures for
  321  application, enrollment, risk assessment, risk adjustment, plan
  322  administration, performance monitoring, and consumer education.
  323         3. Arrange for collection of contributions from
  324  participating employers and individuals.
  325         4. Arrange for payment of premiums and other appropriate
  326  disbursements based on the selections of products and services
  327  by the individual participants.
  328         5. Establish criteria for disenrollment of participating
  329  individuals based on failure to pay the individual’s share of
  330  any contribution required to maintain enrollment in selected
  331  products.
  332         6. Establish criteria for exclusion of vendors pursuant to
  333  paragraph (4)(d).
  334         7. Develop and implement a plan for promoting public
  335  awareness of and participation in the program.
  336         8. Secure staff and consultant services necessary to the
  337  operation of the program.
  338         9. Establish policies and procedures regarding
  339  participation in the program for individuals, vendors, health
  340  insurance agents, and employers.
  341         10. Develop a plan, in coordination with the Department of
  342  Revenue, to establish tax credits or refunds for employers that
  343  participate in the program. The corporation shall submit the
  344  plan to the Governor, the President of the Senate, and the
  345  Speaker of the House of Representatives by January 1, 2009.
  346         Section 5. Paragraph (c) of subsection (3) of section
  347  409.907, Florida Statutes, is amended, paragraph (k) is added to
  348  that subsection, and subsection (8), paragraph (b) of subsection
  349  (9), and subsection (10) of that section are amended, to read:
  350         409.907 Medicaid provider agreements.—The agency may make
  351  payments for medical assistance and related services rendered to
  352  Medicaid recipients only to an individual or entity who has a
  353  provider agreement in effect with the agency, who is performing
  354  services or supplying goods in accordance with federal, state,
  355  and local law, and who agrees that no person shall, on the
  356  grounds of handicap, race, color, or national origin, or for any
  357  other reason, be subjected to discrimination under any program
  358  or activity for which the provider receives payment from the
  359  agency.
  360         (3) The provider agreement developed by the agency, in
  361  addition to the requirements specified in subsections (1) and
  362  (2), shall require the provider to:
  363         (c) Retain all medical and Medicaid-related records for a
  364  period of 6 5 years to satisfy all necessary inquiries by the
  365  agency.
  366         (k)Report any change of any principal of the provider,
  367  including any officer, director, agent, managing employee, or
  368  affiliated person, or any partner or shareholder who has an
  369  ownership interest equal to 5 percent or more in the provider.
  370  The provider must report changes to the agency no later than 30
  371  days after the change occurs. Reporting changes in controlling
  372  interests to the agency pursuant to s. 408.810(3) shall serve as
  373  compliance with this paragraph for hospitals licensed under
  374  chapter 395 and nursing homes licensed under chapter 400.
  375         (8)(a) Each provider, or each principal of the provider if
  376  the provider is a corporation, partnership, association, or
  377  other entity, seeking to participate in the Medicaid program
  378  must submit a complete set of his or her fingerprints to the
  379  agency for the purpose of conducting a criminal history record
  380  check. Principals of the provider include any officer, director,
  381  billing agent, managing employee, or affiliated person, or any
  382  partner or shareholder who has an ownership interest equal to 5
  383  percent or more in the provider. However, for hospitals licensed
  384  under chapter 395 and nursing homes licensed under chapter 400,
  385  principals of the provider are those who meet the definition of
  386  a controlling interest in s. 408.803(7). A director of a not
  387  for-profit corporation or organization is not a principal for
  388  purposes of a background investigation as required by this
  389  section if the director: serves solely in a voluntary capacity
  390  for the corporation or organization, does not regularly take
  391  part in the day-to-day operational decisions of the corporation
  392  or organization, receives no remuneration from the not-for
  393  profit corporation or organization for his or her service on the
  394  board of directors, has no financial interest in the not-for
  395  profit corporation or organization, and has no family members
  396  with a financial interest in the not-for-profit corporation or
  397  organization; and if the director submits an affidavit, under
  398  penalty of perjury, to this effect to the agency and the not
  399  for-profit corporation or organization submits an affidavit,
  400  under penalty of perjury, to this effect to the agency as part
  401  of the corporation’s or organization’s Medicaid provider
  402  agreement application. Notwithstanding the above, the agency may
  403  require a background check for any person reasonably suspected
  404  by the agency to have been convicted of a crime. This subsection
  405  does shall not apply to:
  406         1.A hospital licensed under chapter 395;
  407         2.A nursing home licensed under chapter 400;
  408         3.A hospice licensed under chapter 400;
  409         4.An assisted living facility licensed under chapter 429;
  410         1.5. A unit of local government, except that requirements
  411  of this subsection apply to nongovernmental providers and
  412  entities when contracting with the local government to provide
  413  Medicaid services. The actual cost of the state and national
  414  criminal history record checks must be borne by the
  415  nongovernmental provider or entity; or
  416         2.6. Any business that derives more than 50 percent of its
  417  revenue from the sale of goods to the final consumer, and the
  418  business or its controlling parent either is required to file a
  419  form 10-K or other similar statement with the Securities and
  420  Exchange Commission or has a net worth of $50 million or more.
  421         (b) Background screening shall be conducted in accordance
  422  with chapter 435 and s. 408.809. The agency shall submit the
  423  fingerprints to the Department of Law Enforcement. The
  424  department shall conduct a state criminal-background
  425  investigation and forward the fingerprints to the Federal Bureau
  426  of Investigation for a national criminal-history record check.
  427  The cost of the state and national criminal record check shall
  428  be borne by the provider.
  429         (c)The agency may permit a provider to participate in the
  430  Medicaid program pending the results of the criminal record
  431  check. However, such permission is fully revocable if the record
  432  check reveals any crime-related history as provided in
  433  subsection (10).
  434         (c)(d) Proof of compliance with the requirements of level 2
  435  screening under s. 435.04 conducted within 12 months prior to
  436  the date that the Medicaid provider application is submitted to
  437  the agency shall fulfill the requirements of this subsection.
  438  Proof of compliance with the requirements of level 1 screening
  439  under s. 435.03 conducted within 12 months prior to the date
  440  that the Medicaid provider application is submitted to the
  441  agency shall meet the requirement that the Department of Law
  442  Enforcement conduct a state criminal history record check.
  443         (9) Upon receipt of a completed, signed, and dated
  444  application, and completion of any necessary background
  445  investigation and criminal history record check, the agency must
  446  either:
  447         (b) Deny the application if the agency finds that it is in
  448  the best interest of the Medicaid program to do so. The agency
  449  may consider any the factors listed in subsection (10), as well
  450  as any other factor that could affect the effective and
  451  efficient administration of the program, including, but not
  452  limited to, the applicant’s demonstrated ability to provide
  453  services, conduct business, and operate a financially viable
  454  concern; the current availability of medical care, services, or
  455  supplies to recipients, taking into account geographic location
  456  and reasonable travel time; the number of providers of the same
  457  type already enrolled in the same geographic area; and the
  458  credentials, experience, success, and patient outcomes of the
  459  provider for the services that it is making application to
  460  provide in the Medicaid program. The agency shall deny the
  461  application if the agency finds that a provider; any officer,
  462  director, agent, managing employee, or affiliated person; or any
  463  principal, partner, or shareholder having an ownership interest
  464  equal to 5 percent or greater in the provider if the provider is
  465  a corporation, partnership, or other business entity, has failed
  466  to pay all outstanding fines or overpayments assessed by final
  467  order of the agency or final order of the Centers for Medicare
  468  and Medicaid Services, not subject to further appeal, unless the
  469  provider agrees to a repayment plan that includes withholding
  470  Medicaid reimbursement until the amount due is paid in full.
  471         (10) The agency shall deny the application if may consider
  472  whether the provider, or any officer, director, agent, managing
  473  employee, or affiliated person, or any principal, partner, or
  474  shareholder having an ownership interest equal to 5 percent or
  475  greater in the provider if the provider is a corporation,
  476  partnership, or other business entity, has committed an offense
  477  listed in s. 409.913(13), and may deny the application if one of
  478  these persons has:
  479         (a) Made a false representation or omission of any material
  480  fact in making the application, including the submission of an
  481  application that conceals the controlling or ownership interest
  482  of any officer, director, agent, managing employee, affiliated
  483  person, or principal, partner, or shareholder who may not be
  484  eligible to participate;
  485         (b) Been or is currently excluded, suspended, terminated
  486  from, or has involuntarily withdrawn from participation in,
  487  Florida’s Medicaid program or any other state’s Medicaid
  488  program, or from participation in any other governmental or
  489  private health care or health insurance program;
  490         (c)Been convicted of a criminal offense relating to the
  491  delivery of any goods or services under Medicaid or Medicare or
  492  any other public or private health care or health insurance
  493  program including the performance of management or
  494  administrative services relating to the delivery of goods or
  495  services under any such program;
  496         (d)Been convicted under federal or state law of a criminal
  497  offense related to the neglect or abuse of a patient in
  498  connection with the delivery of any health care goods or
  499  services;
  500         (c)(e) Been convicted under federal or state law of a
  501  criminal offense relating to the unlawful manufacture,
  502  distribution, prescription, or dispensing of a controlled
  503  substance;
  504         (d)(f) Been convicted of any criminal offense relating to
  505  fraud, theft, embezzlement, breach of fiduciary responsibility,
  506  or other financial misconduct;
  507         (e)(g) Been convicted under federal or state law of a crime
  508  punishable by imprisonment of a year or more which involves
  509  moral turpitude;
  510         (f)(h) Been convicted in connection with the interference
  511  or obstruction of any investigation into any criminal offense
  512  listed in this subsection;
  513         (g)(i) Been found to have violated federal or state laws,
  514  rules, or regulations governing Florida’s Medicaid program or
  515  any other state’s Medicaid program, the Medicare program, or any
  516  other publicly funded federal or state health care or health
  517  insurance program, and been sanctioned accordingly;
  518         (h)(j) Been previously found by a licensing, certifying, or
  519  professional standards board or agency to have violated the
  520  standards or conditions relating to licensure or certification
  521  or the quality of services provided; or
  522         (i)(k) Failed to pay any fine or overpayment properly
  523  assessed under the Medicaid program in which no appeal is
  524  pending or after resolution of the proceeding by stipulation or
  525  agreement, unless the agency has issued a specific letter of
  526  forgiveness or has approved a repayment schedule to which the
  527  provider agrees to adhere.
  528  
  529  If the agency determines a provider did not participate or
  530  acquiesce in an offense specified in s. 409.913(13), the agency
  531  is not required to deny the provider application.
  532         Section 6. Subsections (10), (32), and (48) of section
  533  409.912, Florida Statutes, are amended to read:
  534         409.912 Cost-effective purchasing of health care.—The
  535  agency shall purchase goods and services for Medicaid recipients
  536  in the most cost-effective manner consistent with the delivery
  537  of quality medical care. To ensure that medical services are
  538  effectively utilized, the agency may, in any case, require a
  539  confirmation or second physician’s opinion of the correct
  540  diagnosis for purposes of authorizing future services under the
  541  Medicaid program. This section does not restrict access to
  542  emergency services or poststabilization care services as defined
  543  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  544  shall be rendered in a manner approved by the agency. The agency
  545  shall maximize the use of prepaid per capita and prepaid
  546  aggregate fixed-sum basis services when appropriate and other
  547  alternative service delivery and reimbursement methodologies,
  548  including competitive bidding pursuant to s. 287.057, designed
  549  to facilitate the cost-effective purchase of a case-managed
  550  continuum of care. The agency shall also require providers to
  551  minimize the exposure of recipients to the need for acute
  552  inpatient, custodial, and other institutional care and the
  553  inappropriate or unnecessary use of high-cost services. The
  554  agency shall contract with a vendor to monitor and evaluate the
  555  clinical practice patterns of providers in order to identify
  556  trends that are outside the normal practice patterns of a
  557  provider’s professional peers or the national guidelines of a
  558  provider’s professional association. The vendor must be able to
  559  provide information and counseling to a provider whose practice
  560  patterns are outside the norms, in consultation with the agency,
  561  to improve patient care and reduce inappropriate utilization.
  562  The agency may mandate prior authorization, drug therapy
  563  management, or disease management participation for certain
  564  populations of Medicaid beneficiaries, certain drug classes, or
  565  particular drugs to prevent fraud, abuse, overuse, and possible
  566  dangerous drug interactions. The Pharmaceutical and Therapeutics
  567  Committee shall make recommendations to the agency on drugs for
  568  which prior authorization is required. The agency shall inform
  569  the Pharmaceutical and Therapeutics Committee of its decisions
  570  regarding drugs subject to prior authorization. The agency is
  571  authorized to limit the entities it contracts with or enrolls as
  572  Medicaid providers by developing a provider network through
  573  provider credentialing. The agency may competitively bid single
  574  source-provider contracts if procurement of goods or services
  575  results in demonstrated cost savings to the state without
  576  limiting access to care. The agency may limit its network based
  577  on the assessment of beneficiary access to care, provider
  578  availability, provider quality standards, time and distance
  579  standards for access to care, the cultural competence of the
  580  provider network, demographic characteristics of Medicaid
  581  beneficiaries, practice and provider-to-beneficiary standards,
  582  appointment wait times, beneficiary use of services, provider
  583  turnover, provider profiling, provider licensure history,
  584  previous program integrity investigations and findings, peer
  585  review, provider Medicaid policy and billing compliance records,
  586  clinical and medical record audits, and other factors. Providers
  587  shall not be entitled to enrollment in the Medicaid provider
  588  network. The agency shall determine instances in which allowing
  589  Medicaid beneficiaries to purchase durable medical equipment and
  590  other goods is less expensive to the Medicaid program than long
  591  term rental of the equipment or goods. The agency may establish
  592  rules to facilitate purchases in lieu of long-term rentals in
  593  order to protect against fraud and abuse in the Medicaid program
  594  as defined in s. 409.913. The agency may seek federal waivers
  595  necessary to administer these policies.
  596         (10) The agency shall not contract on a prepaid or fixed
  597  sum basis for Medicaid services with an entity which knows or
  598  reasonably should know that any principal, officer, director,
  599  agent, managing employee, or owner of stock or beneficial
  600  interest in excess of 5 percent common or preferred stock, or
  601  the entity itself, has been found guilty of, regardless of
  602  adjudication, or entered a plea of nolo contendere, or guilty,
  603  to:
  604         (a) An offense listed in s. 408.809, s. 409.913(13), or s.
  605  435.04 Fraud;
  606         (b) Violation of federal or state antitrust statutes,
  607  including those proscribing price fixing between competitors and
  608  the allocation of customers among competitors;
  609         (c) Commission of a felony involving embezzlement, theft,
  610  forgery, income tax evasion, bribery, falsification or
  611  destruction of records, making false statements, receiving
  612  stolen property, making false claims, or obstruction of justice;
  613  or
  614         (d) Any crime in any jurisdiction which directly relates to
  615  the provision of health services on a prepaid or fixed-sum
  616  basis.
  617         (32) Each managed care plan that is under contract with the
  618  agency to provide health care services to Medicaid recipients
  619  shall annually conduct a background check with the Florida
  620  Department of Law Enforcement of all persons with ownership
  621  interest of 5 percent or more or executive management
  622  responsibility for the managed care plan and shall submit to the
  623  agency information concerning any such person who has been found
  624  guilty of, regardless of adjudication, or has entered a plea of
  625  nolo contendere or guilty to, any of the offenses listed in s.
  626  408.809, s. 409.913(13), or s. 435.04 s. 435.03.
  627         (48)(a) A provider is not entitled to enrollment in the
  628  Medicaid provider network. The agency may implement a Medicaid
  629  fee-for-service provider network controls, including, but not
  630  limited to, competitive procurement and provider credentialing.
  631  If a credentialing process is used, the agency may limit its
  632  provider network based upon the following considerations:
  633  beneficiary access to care, provider availability, provider
  634  quality standards and quality assurance processes, cultural
  635  competency, demographic characteristics of beneficiaries,
  636  practice standards, service wait times, provider turnover,
  637  provider licensure and accreditation history, program integrity
  638  history, peer review, Medicaid policy and billing compliance
  639  records, clinical and medical record audit findings, and such
  640  other areas that are considered necessary by the agency to
  641  ensure the integrity of the program.
  642         (b) The agency shall limit its network of durable medical
  643  equipment and medical supply providers. For dates of service
  644  after January 1, 2009, the agency shall limit payment for
  645  durable medical equipment and supplies to providers that meet
  646  all the requirements of this paragraph.
  647         1. Providers must be accredited by a Centers for Medicare
  648  and Medicaid Services deemed accreditation organization for
  649  suppliers of durable medical equipment, prosthetics, orthotics,
  650  and supplies. The provider must maintain accreditation and is
  651  subject to unannounced reviews by the accrediting organization.
  652         2. Providers must provide the services or supplies directly
  653  to the Medicaid recipient or caregiver at the provider location
  654  or recipient’s residence or send the supplies directly to the
  655  recipient’s residence with receipt of mailed delivery.
  656  Subcontracting or consignment of the service or supply to a
  657  third party is prohibited.
  658         3. Notwithstanding subparagraph 2., a durable medical
  659  equipment provider may store nebulizers at a physician’s office
  660  for the purpose of having the physician’s staff issue the
  661  equipment if it meets all of the following conditions:
  662         a. The physician must document the medical necessity and
  663  need to prevent further deterioration of the patient’s
  664  respiratory status by the timely delivery of the nebulizer in
  665  the physician’s office.
  666         b. The durable medical equipment provider must have written
  667  documentation of the competency and training by a Florida
  668  licensed registered respiratory therapist of any durable medical
  669  equipment staff who participate in the training of physician
  670  office staff for the use of nebulizers, including cleaning,
  671  warranty, and special needs of patients.
  672         c. The physician’s office must have documented the training
  673  and competency of any staff member who initiates the delivery of
  674  nebulizers to patients. The durable medical equipment provider
  675  must maintain copies of all physician office training.
  676         d. The physician’s office must maintain inventory records
  677  of stored nebulizers, including documentation of the durable
  678  medical equipment provider source.
  679         e. A physician contracted with a Medicaid durable medical
  680  equipment provider may not have a financial relationship with
  681  that provider or receive any financial gain from the delivery of
  682  nebulizers to patients.
  683         4. Providers must have a physical business location and a
  684  functional landline business phone. The location must be within
  685  the state or not more than 50 miles from the Florida state line.
  686  The agency may make exceptions for providers of durable medical
  687  equipment or supplies not otherwise available from other
  688  enrolled providers located within the state.
  689         5. Physical business locations must be clearly identified
  690  as a business that furnishes durable medical equipment or
  691  medical supplies by signage that can be read from 20 feet away.
  692  The location must be readily accessible to the public during
  693  normal, posted business hours and must operate no less than 5
  694  hours per day and no less than 5 days per week, with the
  695  exception of scheduled and posted holidays. The location may not
  696  be located within or at the same numbered street address as
  697  another enrolled Medicaid durable medical equipment or medical
  698  supply provider or as an enrolled Medicaid pharmacy that is also
  699  enrolled as a durable medical equipment provider. A licensed
  700  orthotist or prosthetist that provides only orthotic or
  701  prosthetic devices as a Medicaid durable medical equipment
  702  provider is exempt from the provisions in this paragraph.
  703         6. Providers must maintain a stock of durable medical
  704  equipment and medical supplies on site that is readily available
  705  to meet the needs of the durable medical equipment business
  706  location’s customers.
  707         7. Providers must provide a surety bond of $50,000 for each
  708  provider location, up to a maximum of 5 bonds statewide or an
  709  aggregate bond of $250,000 statewide, as identified by Federal
  710  Employer Identification Number. Providers who post a statewide
  711  or an aggregate bond must identify all of their locations in any
  712  Medicaid durable medical equipment and medical supply provider
  713  enrollment application or bond renewal. Each provider location’s
  714  surety bond must be renewed annually and the provider must
  715  submit proof of renewal even if the original bond is a
  716  continuous bond. A licensed orthotist or prosthetist that
  717  provides only orthotic or prosthetic devices as a Medicaid
  718  durable medical equipment provider is exempt from the provisions
  719  in this paragraph.
  720         8. Providers must obtain a level 2 background screening, in
  721  accordance with chapter 435 and s. 408.809 as provided under s.
  722  435.04, for each provider employee in direct contact with or
  723  providing direct services to recipients of durable medical
  724  equipment and medical supplies in their homes. This requirement
  725  includes, but is not limited to, repair and service technicians,
  726  fitters, and delivery staff. The provider shall pay for the cost
  727  of the background screening.
  728         9. The following providers are exempt from the requirements
  729  of subparagraphs 1. and 7.:
  730         a. Durable medical equipment providers owned and operated
  731  by a government entity.
  732         b. Durable medical equipment providers that are operating
  733  within a pharmacy that is currently enrolled as a Medicaid
  734  pharmacy provider.
  735         c. Active, Medicaid-enrolled orthopedic physician groups,
  736  primarily owned by physicians, which provide only orthotic and
  737  prosthetic devices.
  738         Section 7. Subsection (13) of section 409.9122, Florida
  739  Statutes, is repealed.
  740         Section 8. Section 409.913, Florida Statutes, is amended to
  741  read:
  742         409.913 Oversight of the integrity of the Medicaid
  743  program.—The agency shall operate a program to oversee the
  744  activities of Florida Medicaid recipients, and providers and
  745  their representatives, to ensure that fraudulent and abusive
  746  behavior and neglect of recipients occur to the minimum extent
  747  possible, and to recover overpayments and impose sanctions as
  748  appropriate. Beginning January 1, 2003, and each year
  749  thereafter, the agency and the Medicaid Fraud Control Unit of
  750  the Department of Legal Affairs shall submit a joint report to
  751  the Legislature documenting the effectiveness of the state’s
  752  efforts to control Medicaid fraud and abuse and to recover
  753  Medicaid overpayments during the previous fiscal year. The
  754  report must describe the number of cases opened and investigated
  755  each year; the sources of the cases opened; the disposition of
  756  the cases closed each year; the amount of overpayments alleged
  757  in preliminary and final audit letters; the number and amount of
  758  fines or penalties imposed; any reductions in overpayment
  759  amounts negotiated in settlement agreements or by other means;
  760  the amount of final agency determinations of overpayments; the
  761  amount deducted from federal claiming as a result of
  762  overpayments; the amount of overpayments recovered each year;
  763  the amount of cost of investigation recovered each year; the
  764  average length of time to collect from the time the case was
  765  opened until the overpayment is paid in full; the amount
  766  determined as uncollectible and the portion of the uncollectible
  767  amount subsequently reclaimed from the Federal Government; the
  768  number of providers, by type, that are terminated from
  769  participation in the Medicaid program as a result of fraud and
  770  abuse; and all costs associated with discovering and prosecuting
  771  cases of Medicaid overpayments and making recoveries in such
  772  cases. The report must also document actions taken to prevent
  773  overpayments and the number of providers prevented from
  774  enrolling in or reenrolling in the Medicaid program as a result
  775  of documented Medicaid fraud and abuse and must include policy
  776  recommendations necessary to prevent or recover overpayments and
  777  changes necessary to prevent and detect Medicaid fraud. All
  778  policy recommendations in the report must include a detailed
  779  fiscal analysis, including, but not limited to, implementation
  780  costs, estimated savings to the Medicaid program, and the return
  781  on investment. The agency must submit the policy recommendations
  782  and fiscal analyses in the report to the appropriate estimating
  783  conference, pursuant to s. 216.137, by February 15 of each year.
  784  The agency and the Medicaid Fraud Control Unit of the Department
  785  of Legal Affairs each must include detailed unit-specific
  786  performance standards, benchmarks, and metrics in the report,
  787  including projected cost savings to the state Medicaid program
  788  during the following fiscal year.
  789         (1) For the purposes of this section, the term:
  790         (a) “Abuse” means:
  791         1. Provider practices that are inconsistent with generally
  792  accepted business or medical practices and that result in an
  793  unnecessary cost to the Medicaid program or in reimbursement for
  794  goods or services that are not medically necessary or that fail
  795  to meet professionally recognized standards for health care.
  796         2. Recipient practices that result in unnecessary cost to
  797  the Medicaid program.
  798         (b) “Complaint” means an allegation that fraud, abuse, or
  799  an overpayment has occurred.
  800         (c) “Fraud” means an intentional deception or
  801  misrepresentation made by a person with the knowledge that the
  802  deception results in unauthorized benefit to herself or himself
  803  or another person. The term includes any act that constitutes
  804  fraud under applicable federal or state law.
  805         (d) “Medical necessity” or “medically necessary” means any
  806  goods or services necessary to palliate the effects of a
  807  terminal condition, or to prevent, diagnose, correct, cure,
  808  alleviate, or preclude deterioration of a condition that
  809  threatens life, causes pain or suffering, or results in illness
  810  or infirmity, which goods or services are provided in accordance
  811  with generally accepted standards of medical practice. For
  812  purposes of determining Medicaid reimbursement, the agency is
  813  the final arbiter of medical necessity. Determinations of
  814  medical necessity must be made by a licensed physician employed
  815  by or under contract with the agency and must be based upon
  816  information available at the time the goods or services are
  817  provided.
  818         (e) “Overpayment” includes any amount that is not
  819  authorized to be paid by the Medicaid program whether paid as a
  820  result of inaccurate or improper cost reporting, improper
  821  claiming, unacceptable practices, fraud, abuse, or mistake.
  822         (f) “Person” means any natural person, corporation,
  823  partnership, association, clinic, group, or other entity,
  824  whether or not such person is enrolled in the Medicaid program
  825  or is a provider of health care.
  826         (2) The agency shall conduct, or cause to be conducted by
  827  contract or otherwise, reviews, investigations, analyses,
  828  audits, or any combination thereof, to determine possible fraud,
  829  abuse, overpayment, or recipient neglect in the Medicaid program
  830  and shall report the findings of any overpayments in audit
  831  reports as appropriate. At least 5 percent of all audits shall
  832  be conducted on a random basis. As part of its ongoing fraud
  833  detection activities, the agency shall identify and monitor, by
  834  contract or otherwise, patterns of overutilization of Medicaid
  835  services based on state averages. The agency shall track
  836  Medicaid provider prescription and billing patterns and evaluate
  837  them against Medicaid medical necessity criteria and coverage
  838  and limitation guidelines adopted by rule. Medical necessity
  839  determination requires that service be consistent with symptoms
  840  or confirmed diagnosis of illness or injury under treatment and
  841  not in excess of the patient’s needs. The agency shall conduct
  842  reviews of provider exceptions to peer group norms and shall,
  843  using statistical methodologies, provider profiling, and
  844  analysis of billing patterns, detect and investigate abnormal or
  845  unusual increases in billing or payment of claims for Medicaid
  846  services and medically unnecessary provision of services.
  847         (3) The agency may conduct, or may contract for, prepayment
  848  review of provider claims to ensure cost-effective purchasing;
  849  to ensure that billing by a provider to the agency is in
  850  accordance with applicable provisions of all Medicaid rules,
  851  regulations, handbooks, and policies and in accordance with
  852  federal, state, and local law; and to ensure that appropriate
  853  care is rendered to Medicaid recipients. Such prepayment reviews
  854  may be conducted as determined appropriate by the agency,
  855  without any suspicion or allegation of fraud, abuse, or neglect,
  856  and may last for up to 1 year. Unless the agency has reliable
  857  evidence of fraud, misrepresentation, abuse, or neglect, claims
  858  shall be adjudicated for denial or payment within 90 days after
  859  receipt of complete documentation by the agency for review. If
  860  there is reliable evidence of fraud, misrepresentation, abuse,
  861  or neglect, claims shall be adjudicated for denial of payment
  862  within 180 days after receipt of complete documentation by the
  863  agency for review.
  864         (4) Any suspected criminal violation identified by the
  865  agency must be referred to the Medicaid Fraud Control Unit of
  866  the Office of the Attorney General for investigation. The agency
  867  and the Attorney General shall enter into a memorandum of
  868  understanding, which must include, but need not be limited to, a
  869  protocol for regularly sharing information and coordinating
  870  casework. The protocol must establish a procedure for the
  871  referral by the agency of cases involving suspected Medicaid
  872  fraud to the Medicaid Fraud Control Unit for investigation, and
  873  the return to the agency of those cases where investigation
  874  determines that administrative action by the agency is
  875  appropriate. Offices of the Medicaid program integrity program
  876  and the Medicaid Fraud Control Unit of the Department of Legal
  877  Affairs, shall, to the extent possible, be collocated. The
  878  agency and the Department of Legal Affairs shall periodically
  879  conduct joint training and other joint activities designed to
  880  increase communication and coordination in recovering
  881  overpayments.
  882         (5) A Medicaid provider is subject to having goods and
  883  services that are paid for by the Medicaid program reviewed by
  884  an appropriate peer-review organization designated by the
  885  agency. The written findings of the applicable peer-review
  886  organization are admissible in any court or administrative
  887  proceeding as evidence of medical necessity or the lack thereof.
  888         (6) Any notice required to be given to a provider under
  889  this section is presumed to be sufficient notice if sent to the
  890  address last shown on the provider enrollment file. It is the
  891  responsibility of the provider to furnish and keep the agency
  892  informed of the provider’s current address. United States Postal
  893  Service proof of mailing or certified or registered mailing of
  894  such notice to the provider at the address shown on the provider
  895  enrollment file constitutes sufficient proof of notice. Any
  896  notice required to be given to the agency by this section must
  897  be sent to the agency at an address designated by rule.
  898         (7) When presenting a claim for payment under the Medicaid
  899  program, a provider has an affirmative duty to supervise the
  900  provision of, and be responsible for, goods and services claimed
  901  to have been provided, to supervise and be responsible for
  902  preparation and submission of the claim, and to present a claim
  903  that is true and accurate and that is for goods and services
  904  that:
  905         (a) Have actually been furnished to the recipient by the
  906  provider prior to submitting the claim.
  907         (b) Are Medicaid-covered goods or services that are
  908  medically necessary.
  909         (c) Are of a quality comparable to those furnished to the
  910  general public by the provider’s peers.
  911         (d) Have not been billed in whole or in part to a recipient
  912  or a recipient’s responsible party, except for such copayments,
  913  coinsurance, or deductibles as are authorized by the agency.
  914         (e) Are provided in accord with applicable provisions of
  915  all Medicaid rules, regulations, handbooks, and policies and in
  916  accordance with federal, state, and local law.
  917         (f) Are documented by records made at the time the goods or
  918  services were provided, demonstrating the medical necessity for
  919  the goods or services rendered. Medicaid goods or services are
  920  excessive or not medically necessary unless both the medical
  921  basis and the specific need for them are fully and properly
  922  documented in the recipient’s medical record.
  923  
  924  The agency shall deny payment or require repayment for goods or
  925  services that are not presented as required in this subsection.
  926         (8) The agency shall not reimburse any person or entity for
  927  any prescription for medications, medical supplies, or medical
  928  services if the prescription was written by a physician or other
  929  prescribing practitioner who is not enrolled in the Medicaid
  930  program. This section does not apply:
  931         (a) In instances involving bona fide emergency medical
  932  conditions as determined by the agency;
  933         (b) To a provider of medical services to a patient in a
  934  hospital emergency department, hospital inpatient or outpatient
  935  setting, or nursing home;
  936         (c) To bona fide pro bono services by preapproved non
  937  Medicaid providers as determined by the agency;
  938         (d) To prescribing physicians who are board-certified
  939  specialists treating Medicaid recipients referred for treatment
  940  by a treating physician who is enrolled in the Medicaid program;
  941         (e) To prescriptions written for dually eligible Medicare
  942  beneficiaries by an authorized Medicare provider who is not
  943  enrolled in the Medicaid program;
  944         (f) To other physicians who are not enrolled in the
  945  Medicaid program but who provide a medically necessary service
  946  or prescription not otherwise reasonably available from a
  947  Medicaid-enrolled physician; or
  948         (9) A Medicaid provider shall retain medical, professional,
  949  financial, and business records pertaining to services and goods
  950  furnished to a Medicaid recipient and billed to Medicaid for a
  951  period of 6 5 years after the date of furnishing such services
  952  or goods. The agency may investigate, review, or analyze such
  953  records, which must be made available during normal business
  954  hours. However, 24-hour notice must be provided if patient
  955  treatment would be disrupted. The provider is responsible for
  956  furnishing to the agency, and keeping the agency informed of the
  957  location of, the provider’s Medicaid-related records. The
  958  authority of the agency to obtain Medicaid-related records from
  959  a provider is neither curtailed nor limited during a period of
  960  litigation between the agency and the provider.
  961         (10) Payments for the services of billing agents or persons
  962  participating in the preparation of a Medicaid claim shall not
  963  be based on amounts for which they bill nor based on the amount
  964  a provider receives from the Medicaid program.
  965         (11) The agency shall deny payment or require repayment for
  966  inappropriate, medically unnecessary, or excessive goods or
  967  services from the person furnishing them, the person under whose
  968  supervision they were furnished, or the person causing them to
  969  be furnished.
  970         (12) The complaint and all information obtained pursuant to
  971  an investigation of a Medicaid provider, or the authorized
  972  representative or agent of a provider, relating to an allegation
  973  of fraud, abuse, or neglect are confidential and exempt from the
  974  provisions of s. 119.07(1):
  975         (a) Until the agency takes final agency action with respect
  976  to the provider and requires repayment of any overpayment, or
  977  imposes an administrative sanction;
  978         (b) Until the Attorney General refers the case for criminal
  979  prosecution;
  980         (c) Until 10 days after the complaint is determined without
  981  merit; or
  982         (d) At all times if the complaint or information is
  983  otherwise protected by law.
  984         (13) The agency shall immediately terminate participation
  985  of a Medicaid provider in the Medicaid program and may seek
  986  civil remedies or impose other administrative sanctions against
  987  a Medicaid provider, if the provider or any principal, officer,
  988  director, agent, managing employee, or affiliated person of the
  989  provider, or any partner or shareholder having an ownership
  990  interest in the provider equal to 5 percent or greater, has
  991  been:
  992         (a) Convicted of a criminal offense related to the delivery
  993  of any health care goods or services, including the performance
  994  of management or administrative functions relating to the
  995  delivery of health care goods or services;
  996         (b) Convicted of a criminal offense under federal law or
  997  the law of any state relating to the practice of the provider’s
  998  profession; or
  999         (c) Found by a court of competent jurisdiction to have
 1000  neglected or physically abused a patient in connection with the
 1001  delivery of health care goods or services.
 1002  
 1003  If the agency determines a provider did not participate or
 1004  acquiesce in an offense specified in paragraph (a), paragraph
 1005  (b), or paragraph (c), termination will not be imposed. If the
 1006  agency effects a termination under this subsection, the agency
 1007  shall issue an immediate termination final order as provided in
 1008  subsection (16) pursuant to s. 120.569(2)(n).
 1009         (14) If the provider has been suspended or terminated from
 1010  participation in the Medicaid program or the Medicare program by
 1011  the Federal Government or any state, the agency must immediately
 1012  suspend or terminate, as appropriate, the provider’s
 1013  participation in this state’s Medicaid program for a period no
 1014  less than that imposed by the Federal Government or any other
 1015  state, and may not enroll such provider in this state’s Medicaid
 1016  program while such foreign suspension or termination remains in
 1017  effect. The agency shall also immediately suspend or terminate,
 1018  as appropriate, a provider’s participation in this state’s
 1019  Medicaid program if the provider participated or acquiesced in
 1020  any action for which any principal, officer, director, agent,
 1021  managing employee, or affiliated person of the provider, or any
 1022  partner or shareholder having an ownership interest in the
 1023  provider equal to 5 percent or greater, was suspended or
 1024  terminated from participating in the Medicaid program or the
 1025  Medicare program by the Federal Government or any state. This
 1026  sanction is in addition to all other remedies provided by law.
 1027  If the agency suspends or terminates a provider’s participation
 1028  in the state’s Medicaid program under this subsection, the
 1029  agency shall issue an immediate suspension or immediate
 1030  termination order as provided in subsection (16).
 1031         (15) The agency shall seek a remedy provided by law,
 1032  including, but not limited to, any remedy provided in
 1033  subsections (13) and (16) and s. 812.035, if:
 1034         (a) The provider’s license has not been renewed, or has
 1035  been revoked, suspended, or terminated, for cause, by the
 1036  licensing agency of any state;
 1037         (b) The provider has failed to make available or has
 1038  refused access to Medicaid-related records to an auditor,
 1039  investigator, or other authorized employee or agent of the
 1040  agency, the Attorney General, a state attorney, or the Federal
 1041  Government;
 1042         (c) The provider has not furnished or has failed to make
 1043  available such Medicaid-related records as the agency has found
 1044  necessary to determine whether Medicaid payments are or were due
 1045  and the amounts thereof;
 1046         (d) The provider has failed to maintain medical records
 1047  made at the time of service, or prior to service if prior
 1048  authorization is required, demonstrating the necessity and
 1049  appropriateness of the goods or services rendered;
 1050         (e) The provider is not in compliance with provisions of
 1051  Medicaid provider publications that have been adopted by
 1052  reference as rules in the Florida Administrative Code; with
 1053  provisions of state or federal laws, rules, or regulations; with
 1054  provisions of the provider agreement between the agency and the
 1055  provider; or with certifications found on claim forms or on
 1056  transmittal forms for electronically submitted claims that are
 1057  submitted by the provider or authorized representative, as such
 1058  provisions apply to the Medicaid program;
 1059         (f) The provider or person who ordered or prescribed the
 1060  care, services, or supplies has furnished, or ordered the
 1061  furnishing of, goods or services to a recipient which are
 1062  inappropriate, unnecessary, excessive, or harmful to the
 1063  recipient or are of inferior quality;
 1064         (g) The provider has demonstrated a pattern of failure to
 1065  provide goods or services that are medically necessary;
 1066         (h) The provider or an authorized representative of the
 1067  provider, or a person who ordered or prescribed the goods or
 1068  services, has submitted or caused to be submitted false or a
 1069  pattern of erroneous Medicaid claims;
 1070         (i) The provider or an authorized representative of the
 1071  provider, or a person who has ordered or prescribed the goods or
 1072  services, has submitted or caused to be submitted a Medicaid
 1073  provider enrollment application, a request for prior
 1074  authorization for Medicaid services, a drug exception request,
 1075  or a Medicaid cost report that contains materially false or
 1076  incorrect information;
 1077         (j) The provider or an authorized representative of the
 1078  provider has collected from or billed a recipient or a
 1079  recipient’s responsible party improperly for amounts that should
 1080  not have been so collected or billed by reason of the provider’s
 1081  billing the Medicaid program for the same service;
 1082         (k) The provider or an authorized representative of the
 1083  provider has included in a cost report costs that are not
 1084  allowable under a Florida Title XIX reimbursement plan, after
 1085  the provider or authorized representative had been advised in an
 1086  audit exit conference or audit report that the costs were not
 1087  allowable;
 1088         (l) The provider is charged by information or indictment
 1089  with fraudulent billing practices or an offense under subsection
 1090  (13). The sanction applied for this reason is limited to
 1091  suspension of the provider’s participation in the Medicaid
 1092  program for the duration of the indictment unless the provider
 1093  is found guilty pursuant to the information or indictment;
 1094         (m) The provider or a person who has ordered or prescribed
 1095  the goods or services is found liable for negligent practice
 1096  resulting in death or injury to the provider’s patient;
 1097         (n) The provider fails to demonstrate that it had available
 1098  during a specific audit or review period sufficient quantities
 1099  of goods, or sufficient time in the case of services, to support
 1100  the provider’s billings to the Medicaid program;
 1101         (o) The provider has failed to comply with the notice and
 1102  reporting requirements of s. 409.907;
 1103         (p) The agency has received reliable information of patient
 1104  abuse or neglect or of any act prohibited by s. 409.920; or
 1105         (q) The provider has failed to comply with an agreed-upon
 1106  repayment schedule.
 1107  
 1108  A provider is subject to sanctions for violations of this
 1109  subsection as the result of actions or inactions of the
 1110  provider, or actions or inactions of any principal, officer,
 1111  director, agent, managing employee, or affiliated person of the
 1112  provider, or any partner or shareholder having an ownership
 1113  interest in the provider equal to 5 percent or greater, in which
 1114  the provider participated or acquiesced. If the agency
 1115  immediately suspends or immediately terminates a provider under
 1116  this subsection, the agency shall issue an immediate suspension
 1117  or immediate termination order as provided in subsection (16).
 1118         (16) The agency shall impose any of the following sanctions
 1119  or disincentives on a provider or a person for any of the acts
 1120  described in subsection (15):
 1121         (a) Suspension for a specific period of time of not more
 1122  than 1 year. Suspension shall preclude participation in the
 1123  Medicaid program, which includes any action that results in a
 1124  claim for payment to the Medicaid program as a result of
 1125  furnishing, supervising a person who is furnishing, or causing a
 1126  person to furnish goods or services.
 1127         (b) Termination for a specific period of time of from more
 1128  than 1 year to 20 years. Termination shall preclude
 1129  participation in the Medicaid program, which includes any action
 1130  that results in a claim for payment to the Medicaid program as a
 1131  result of furnishing, supervising a person who is furnishing, or
 1132  causing a person to furnish goods or services.
 1133         (c) Imposition of a fine of up to $5,000 for each
 1134  violation. Each day that an ongoing violation continues, such as
 1135  refusing to furnish Medicaid-related records or refusing access
 1136  to records, is considered, for the purposes of this section, to
 1137  be a separate violation. Each instance of improper billing of a
 1138  Medicaid recipient; each instance of including an unallowable
 1139  cost on a hospital or nursing home Medicaid cost report after
 1140  the provider or authorized representative has been advised in an
 1141  audit exit conference or previous audit report of the cost
 1142  unallowability; each instance of furnishing a Medicaid recipient
 1143  goods or professional services that are inappropriate or of
 1144  inferior quality as determined by competent peer judgment; each
 1145  instance of knowingly submitting a materially false or erroneous
 1146  Medicaid provider enrollment application, request for prior
 1147  authorization for Medicaid services, drug exception request, or
 1148  cost report; each instance of inappropriate prescribing of drugs
 1149  for a Medicaid recipient as determined by competent peer
 1150  judgment; and each false or erroneous Medicaid claim leading to
 1151  an overpayment to a provider is considered, for the purposes of
 1152  this section, to be a separate violation.
 1153         (d) Immediate suspension, if the agency has received
 1154  information of patient abuse or neglect, or of any act
 1155  prohibited by s. 409.920, or any conduct listed in subsection
 1156  (13) or subsection (14). Upon suspension, the agency must issue
 1157  an immediate suspension final order, which shall state that the
 1158  agency has reasonable cause to believe that the provider,
 1159  person, or entity named is engaging in or has engaged in patient
 1160  abuse or neglect, any act prohibited by s. 409.920, or any
 1161  conduct listed in subsection (13) or subsection (14). The order
 1162  shall provide notice of administrative hearing rights under ss.
 1163  120.569 and 120.57 and is effective immediately upon notice to
 1164  the provider, person, or entity under s. 120.569(2)(n).
 1165         (e)Immediate termination, if the agency has received
 1166  information of a conviction based on patient abuse or neglect,
 1167  any act prohibited by s. 409.920, or any conduct listed in
 1168  subsection (13) or subsection (14). Upon termination, the agency
 1169  must issue an immediate termination order, which shall state
 1170  that the agency has reasonable cause to believe that the
 1171  provider, person, or entity named has been convicted of patient
 1172  abuse or neglect, any act prohibited by s. 409.920, or any
 1173  conduct listed in subsection (13) or subsection (14). The
 1174  termination order shall provide notice of administrative hearing
 1175  rights under ss. 120.569 and 120.57 and is effective immediately
 1176  upon notice to the provider, person, or entity.
 1177         (f)(e) A fine, not to exceed $10,000, for a violation of
 1178  paragraph (15)(i).
 1179         (g)(f) Imposition of liens against provider assets,
 1180  including, but not limited to, financial assets and real
 1181  property, not to exceed the amount of fines or recoveries
 1182  sought, upon entry of an order determining that such moneys are
 1183  due or recoverable.
 1184         (h)(g) Prepayment reviews of claims for a specified period
 1185  of time.
 1186         (i)(h) Comprehensive followup reviews of providers every 6
 1187  months to ensure that they are billing Medicaid correctly.
 1188         (j)(i) Corrective-action plans that would remain in effect
 1189  for providers for up to 3 years and that would be monitored by
 1190  the agency every 6 months while in effect.
 1191         (k)(j) Other remedies as permitted by law to effect the
 1192  recovery of a fine or overpayment.
 1193  
 1194  The Secretary of Health Care Administration may make a
 1195  determination that imposition of a sanction or disincentive is
 1196  not in the best interest of the Medicaid program, in which case
 1197  a sanction or disincentive shall not be imposed.
 1198         (17) In determining the appropriate administrative sanction
 1199  to be applied, or the duration of any suspension or termination,
 1200  the agency shall consider:
 1201         (a) The seriousness and extent of the violation or
 1202  violations.
 1203         (b) Any prior history of violations by the provider
 1204  relating to the delivery of health care programs which resulted
 1205  in either a criminal conviction or in administrative sanction or
 1206  penalty.
 1207         (c) Evidence of continued violation within the provider’s
 1208  management control of Medicaid statutes, rules, regulations, or
 1209  policies after written notification to the provider of improper
 1210  practice or instance of violation.
 1211         (d) The effect, if any, on the quality of medical care
 1212  provided to Medicaid recipients as a result of the acts of the
 1213  provider.
 1214         (e) Any action by a licensing agency respecting the
 1215  provider in any state in which the provider operates or has
 1216  operated.
 1217         (f) The apparent impact on access by recipients to Medicaid
 1218  services if the provider is suspended or terminated, in the best
 1219  judgment of the agency.
 1220  
 1221  The agency shall document the basis for all sanctioning actions
 1222  and recommendations.
 1223         (18) The agency may take action to sanction, suspend, or
 1224  terminate a particular provider working for a group provider,
 1225  and may suspend or terminate Medicaid participation at a
 1226  specific location, rather than or in addition to taking action
 1227  against an entire group.
 1228         (19) The agency shall establish a process for conducting
 1229  followup reviews of a sampling of providers who have a history
 1230  of overpayment under the Medicaid program. This process must
 1231  consider the magnitude of previous fraud or abuse and the
 1232  potential effect of continued fraud or abuse on Medicaid costs.
 1233         (20) In making a determination of overpayment to a
 1234  provider, the agency must use accepted and valid auditing,
 1235  accounting, analytical, statistical, or peer-review methods, or
 1236  combinations thereof. Appropriate statistical methods may
 1237  include, but are not limited to, sampling and extension to the
 1238  population, parametric and nonparametric statistics, tests of
 1239  hypotheses, and other generally accepted statistical methods.
 1240  Appropriate analytical methods may include, but are not limited
 1241  to, reviews to determine variances between the quantities of
 1242  products that a provider had on hand and available to be
 1243  purveyed to Medicaid recipients during the review period and the
 1244  quantities of the same products paid for by the Medicaid program
 1245  for the same period, taking into appropriate consideration sales
 1246  of the same products to non-Medicaid customers during the same
 1247  period. In meeting its burden of proof in any administrative or
 1248  court proceeding, the agency may introduce the results of such
 1249  statistical methods as evidence of overpayment.
 1250         (21) When making a determination that an overpayment has
 1251  occurred, the agency shall prepare and issue an audit report to
 1252  the provider showing the calculation of overpayments.
 1253         (22) The audit report, supported by agency work papers,
 1254  showing an overpayment to a provider constitutes evidence of the
 1255  overpayment. A provider may not present or elicit testimony,
 1256  either on direct examination or cross-examination in any court
 1257  or administrative proceeding, regarding the purchase or
 1258  acquisition by any means of drugs, goods, or supplies; sales or
 1259  divestment by any means of drugs, goods, or supplies; or
 1260  inventory of drugs, goods, or supplies, unless such acquisition,
 1261  sales, divestment, or inventory is documented by written
 1262  invoices, written inventory records, or other competent written
 1263  documentary evidence maintained in the normal course of the
 1264  provider’s business. Notwithstanding the applicable rules of
 1265  discovery, all documentation that will be offered as evidence at
 1266  an administrative hearing on a Medicaid overpayment must be
 1267  exchanged by all parties at least 14 days before the
 1268  administrative hearing or must be excluded from consideration.
 1269         (23)(a) In an audit or investigation of a violation
 1270  committed by a provider which is conducted pursuant to this
 1271  section, the agency is entitled to recover all investigative,
 1272  legal, and expert witness costs if the agency’s findings were
 1273  not contested by the provider or, if contested, the agency
 1274  ultimately prevailed.
 1275         (b) The agency has the burden of documenting the costs,
 1276  which include salaries and employee benefits and out-of-pocket
 1277  expenses. The amount of costs that may be recovered must be
 1278  reasonable in relation to the seriousness of the violation and
 1279  must be set taking into consideration the financial resources,
 1280  earning ability, and needs of the provider, who has the burden
 1281  of demonstrating such factors.
 1282         (c) The provider may pay the costs over a period to be
 1283  determined by the agency if the agency determines that an
 1284  extreme hardship would result to the provider from immediate
 1285  full payment. Any default in payment of costs may be collected
 1286  by any means authorized by law.
 1287         (24) If the agency imposes an administrative sanction
 1288  pursuant to subsection (13), subsection (14), or subsection
 1289  (15), except paragraphs (15)(e) and (o), upon any provider or
 1290  any principal, officer, director, agent, managing employee, or
 1291  affiliated person of the provider who is regulated by another
 1292  state entity, the agency shall notify that other entity of the
 1293  imposition of the sanction within 5 business days. Such
 1294  notification must include the provider’s or person’s name and
 1295  license number and the specific reasons for sanction.
 1296         (25)(a) The agency shall withhold Medicaid payments, in
 1297  whole or in part, to a provider upon receipt of reliable
 1298  evidence that the circumstances giving rise to the need for a
 1299  withholding of payments involve fraud, willful
 1300  misrepresentation, or abuse under the Medicaid program, or a
 1301  crime committed while rendering goods or services to Medicaid
 1302  recipients. If the provider is not paid within 14 days after the
 1303  agency receives evidence it is determined that fraud, willful
 1304  misrepresentation, abuse, or a crime did not occur, interest
 1305  shall accrue at a rate of 10 percent a year the payments
 1306  withheld must be paid to the provider within 14 days after such
 1307  determination with interest at the rate of 10 percent a year.
 1308  Any money withheld in accordance with this paragraph shall be
 1309  placed in a suspended account, readily accessible to the agency,
 1310  so that any payment ultimately due the provider shall be made
 1311  within 14 days.
 1312         (b) The agency shall deny payment, or require repayment, if
 1313  the goods or services were furnished, supervised, or caused to
 1314  be furnished by a person who has been convicted of a crime under
 1315  subsection (13) or who has been suspended or terminated from the
 1316  Medicaid program or Medicare program by the Federal Government
 1317  or any state.
 1318         (c) Overpayments owed to the agency bear interest at the
 1319  rate of 10 percent per year from the date of determination of
 1320  the overpayment by the agency, and payment arrangements for
 1321  overpayments and fines must be made within 35 days after the
 1322  date of the final order at the conclusion of legal proceedings.
 1323  A provider who does not enter into or adhere to an agreed-upon
 1324  repayment schedule may be terminated by the agency for
 1325  nonpayment or partial payment.
 1326         (d) The agency, upon entry of a final agency order, a
 1327  judgment or order of a court of competent jurisdiction, or a
 1328  stipulation or settlement, may collect the moneys owed by all
 1329  means allowable by law, including, but not limited to, notifying
 1330  any fiscal intermediary of Medicare benefits that the state has
 1331  a superior right of payment. Upon receipt of such written
 1332  notification, the Medicare fiscal intermediary shall remit to
 1333  the state the sum claimed.
 1334         (e) The agency may institute amnesty programs to allow
 1335  Medicaid providers the opportunity to voluntarily repay
 1336  overpayments. The agency may adopt rules to administer such
 1337  programs.
 1338         (26) The agency may impose administrative sanctions against
 1339  a Medicaid recipient, or the agency may seek any other remedy
 1340  provided by law, including, but not limited to, the remedies
 1341  provided in s. 812.035, if the agency finds that a recipient has
 1342  engaged in solicitation in violation of s. 409.920 or that the
 1343  recipient has otherwise abused the Medicaid program.
 1344         (27) When the Agency for Health Care Administration has
 1345  made a probable cause determination and alleged that an
 1346  overpayment to a Medicaid provider has occurred, the agency,
 1347  after notice to the provider, shall:
 1348         (a) Withhold, and continue to withhold during the pendency
 1349  of an administrative hearing pursuant to chapter 120, any
 1350  medical assistance reimbursement payments until such time as the
 1351  overpayment is recovered, unless within 30 days after receiving
 1352  notice thereof the provider:
 1353         1. Makes repayment in full; or
 1354         2. Establishes a repayment plan that is satisfactory to the
 1355  Agency for Health Care Administration.
 1356         (b) Withhold, and continue to withhold during the pendency
 1357  of an administrative hearing pursuant to chapter 120, medical
 1358  assistance reimbursement payments if the terms of a repayment
 1359  plan are not adhered to by the provider.
 1360         (28) Venue for all Medicaid program integrity overpayment
 1361  cases shall lie in Leon County, at the discretion of the agency.
 1362         (29) Notwithstanding other provisions of law, the agency
 1363  and the Medicaid Fraud Control Unit of the Department of Legal
 1364  Affairs may review a provider’s Medicaid-related and non
 1365  Medicaid-related records in order to determine the total output
 1366  of a provider’s practice to reconcile quantities of goods or
 1367  services billed to Medicaid with quantities of goods or services
 1368  used in the provider’s total practice.
 1369         (30) The agency shall terminate a provider’s participation
 1370  in the Medicaid program if the provider fails to reimburse an
 1371  overpayment or fine that has been determined by final order, not
 1372  subject to further appeal, within 35 days after the date of the
 1373  final order, unless the provider and the agency have entered
 1374  into a repayment agreement.
 1375         (31) If a provider requests an administrative hearing
 1376  pursuant to chapter 120, such hearing must be conducted within
 1377  90 days following assignment of an administrative law judge,
 1378  absent exceptionally good cause shown as determined by the
 1379  administrative law judge or hearing officer. Upon issuance of a
 1380  final order, the outstanding balance of the amount determined to
 1381  constitute the overpayment or fine shall become due. If a
 1382  provider fails to make payments in full, fails to enter into a
 1383  satisfactory repayment plan, or fails to comply with the terms
 1384  of a repayment plan or settlement agreement, the agency shall
 1385  withhold medical assistance reimbursement payments until the
 1386  amount due is paid in full.
 1387         (32) Duly authorized agents and employees of the agency
 1388  shall have the power to inspect, during normal business hours,
 1389  the records of any pharmacy, wholesale establishment, or
 1390  manufacturer, or any other place in which drugs and medical
 1391  supplies are manufactured, packed, packaged, made, stored, sold,
 1392  or kept for sale, for the purpose of verifying the amount of
 1393  drugs and medical supplies ordered, delivered, or purchased by a
 1394  provider. The agency shall provide at least 2 business days’
 1395  prior notice of any such inspection. The notice must identify
 1396  the provider whose records will be inspected, and the inspection
 1397  shall include only records specifically related to that
 1398  provider.
 1399         (33) In accordance with federal law, Medicaid recipients
 1400  convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
 1401  limited, restricted, or suspended from Medicaid eligibility for
 1402  a period not to exceed 1 year, as determined by the agency head
 1403  or designee.
 1404         (34) To deter fraud and abuse in the Medicaid program, the
 1405  agency may limit the number of Schedule II and Schedule III
 1406  refill prescription claims submitted from a pharmacy provider.
 1407  The agency shall limit the allowable amount of reimbursement of
 1408  prescription refill claims for Schedule II and Schedule III
 1409  pharmaceuticals if the agency or the Medicaid Fraud Control Unit
 1410  determines that the specific prescription refill was not
 1411  requested by the Medicaid recipient or authorized representative
 1412  for whom the refill claim is submitted or was not prescribed by
 1413  the recipient’s medical provider or physician. Any such refill
 1414  request must be consistent with the original prescription.
 1415         (35) The Office of Program Policy Analysis and Government
 1416  Accountability shall provide a report to the President of the
 1417  Senate and the Speaker of the House of Representatives on a
 1418  biennial basis, beginning January 31, 2006, on the agency’s and
 1419  the Medicaid Fraud Control Unit’s efforts to prevent, detect,
 1420  and deter, as well as recover funds lost to, fraud and abuse in
 1421  the Medicaid program.
 1422         (36) At least three times a year, the agency shall provide
 1423  to each Medicaid recipient or his or her representative an
 1424  explanation of benefits in the form of a letter that is mailed
 1425  to the most recent address of the recipient on the record with
 1426  the Department of Children and Family Services. The explanation
 1427  of benefits must include the patient’s name, the name of the
 1428  health care provider and the address of the location where the
 1429  service was provided, a description of all services billed to
 1430  Medicaid in terminology that should be understood by a
 1431  reasonable person, and information on how to report
 1432  inappropriate or incorrect billing to the agency or other law
 1433  enforcement entities for review or investigation. At least once
 1434  a year, the letter also must include information on how to
 1435  report criminal Medicaid fraud, the Medicaid Fraud Control
 1436  Unit’s toll-free hotline number, and information about the
 1437  rewards available under s. 409.9203. The explanation of benefits
 1438  may not be mailed for Medicaid independent laboratory services
 1439  as described in s. 409.905(7) or for Medicaid certified match
 1440  services as described in ss. 409.9071 and 1011.70.
 1441         (37) The agency shall post on its website a current list of
 1442  each Medicaid provider, including any principal, officer,
 1443  director, agent, managing employee, or affiliated person of the
 1444  provider, or any partner or shareholder having an ownership
 1445  interest in the provider equal to 5 percent or greater, who has
 1446  been terminated for cause from the Medicaid program or
 1447  sanctioned under this section. The list must be searchable by a
 1448  variety of search parameters and provide for the creation of
 1449  formatted lists that may be printed or imported into other
 1450  applications, including spreadsheets. The agency shall update
 1451  the list at least monthly.
 1452         (38) In order to improve the detection of health care
 1453  fraud, use technology to prevent and detect fraud, and maximize
 1454  the electronic exchange of health care fraud information, the
 1455  agency shall:
 1456         (a) Compile, maintain, and publish on its website a
 1457  detailed list of all state and federal databases that contain
 1458  health care fraud information and update the list at least
 1459  biannually;
 1460         (b) Develop a strategic plan to connect all databases that
 1461  contain health care fraud information to facilitate the
 1462  electronic exchange of health information between the agency,
 1463  the Department of Health, the Department of Law Enforcement, and
 1464  the Attorney General’s Office. The plan must include recommended
 1465  standard data formats, fraud identification strategies, and
 1466  specifications for the technical interface between state and
 1467  federal health care fraud databases;
 1468         (c) Monitor innovations in health information technology,
 1469  specifically as it pertains to Medicaid fraud prevention and
 1470  detection; and
 1471         (d) Periodically publish policy briefs that highlight
 1472  available new technology to prevent or detect health care fraud
 1473  and projects implemented by other states, the private sector, or
 1474  the Federal Government which use technology to prevent or detect
 1475  health care fraud.
 1476         Section 9. Subsection (5) is added to section 409.9203,
 1477  Florida Statutes, to read:
 1478         409.9203 Rewards for reporting Medicaid fraud.—
 1479         (5)An employee of the Agency for Health Care
 1480  Administration, the Department of Legal Affairs, the Department
 1481  of Health, or the Department of Law Enforcement whose job
 1482  responsibilities include the prevention, detection, and
 1483  prosecution of Medicaid fraud is not eligible to receive a
 1484  reward under this section.
 1485         Section 10. Subsection (8) is added to section 456.001,
 1486  Florida Statutes, to read:
 1487         456.001 Definitions.—As used in this chapter, the term:
 1488         (8)“Affiliate” or “affiliated person” means any person who
 1489  directly or indirectly manages, controls, or oversees the
 1490  operation of a corporation or other business entity, regardless
 1491  of whether such person is a partner, shareholder, owner,
 1492  officer, director, or agent of the entity.
 1493         Section 11. Paragraph (c) of subsection (1) and subsections
 1494  (2) and (3) of section 456.041, Florida Statutes, are amended to
 1495  read:
 1496         456.041 Practitioner profile; creation.—
 1497         (1)
 1498         (c) Within 30 calendar days after receiving an update of
 1499  information required for the practitioner’s profile, the
 1500  department shall update the practitioner’s profile in accordance
 1501  with the requirements of subsection (8) (7).
 1502         (2) Beginning July 1, 2010, on the profile published under
 1503  subsection (1), the department shall include indicate if the
 1504  information provided under s. 456.039(1)(a)7. or s.
 1505  456.0391(1)(a)7. and indicate if the information is or is not
 1506  corroborated by a criminal history records check conducted
 1507  according to this subsection. The department must include in
 1508  each practitioner’s profile the following statement: “The
 1509  criminal history information, if any exists, may be incomplete.
 1510  Federal criminal history information is not available to the
 1511  public.” The department, or the board having regulatory
 1512  authority over the practitioner acting on behalf of the
 1513  department, shall investigate any information received by the
 1514  department or the board.
 1515         (3) Beginning July 1, 2010, the department shall include in
 1516  each practitioner’s profile any open administrative complaint
 1517  filed with the department against the practitioner in which
 1518  probable cause has been found. The Department of Health shall
 1519  include in each practitioner’s practitioner profile that
 1520  criminal information that directly relates to the practitioner’s
 1521  ability to competently practice his or her profession. The
 1522  department must include in each practitioner’s practitioner
 1523  profile the following statement: “The criminal history
 1524  information, if any exists, may be incomplete; federal criminal
 1525  history information is not available to the public.” The
 1526  department shall provide in each practitioner profile, for every
 1527  final disciplinary action taken against the practitioner, an
 1528  easy-to-read narrative description that explains the
 1529  administrative complaint filed against the practitioner and the
 1530  final disciplinary action imposed on the practitioner. The
 1531  department shall include a hyperlink to each final order listed
 1532  in its website report of dispositions of recent disciplinary
 1533  actions taken against practitioners.
 1534         Section 12. Section 456.0635, Florida Statutes, is amended
 1535  to read:
 1536         456.0635 Health care Medicaid fraud; disqualification for
 1537  license, certificate, or registration.—
 1538         (1) Medicaid Fraud in the practice of a health care
 1539  profession is prohibited.
 1540         (2) Each board within the jurisdiction of the department,
 1541  or the department if there is no board, shall refuse to admit a
 1542  candidate to any examination and refuse to issue or renew a
 1543  license, certificate, or registration to any applicant if the
 1544  candidate or applicant or any principal, officer, agent,
 1545  managing employee, or affiliated person of the applicant, has
 1546  been:
 1547         (a) Has been convicted of, or entered a plea of guilty or
 1548  nolo contendere to, regardless of adjudication, a felony under
 1549  chapter 409, chapter 817, chapter 893, or a similar felony
 1550  offense committed in another state or jurisdiction 21 U.S.C. ss.
 1551  801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any
 1552  subsequent period of probation for such conviction or plea pleas
 1553  ended: more than 15 years prior to the date of the application;
 1554         1.For felonies of the first or second degree more than 15
 1555  years before the date of application.
 1556         2.For felonies of the third degree more than 10 years
 1557  before the date of application, except for felonies of the third
 1558  degree under s. 893.13(6)(a).
 1559         3.For felonies of the third degree under s. 893.13(6)(a),
 1560  more than 5 years before the date of application.
 1561         4.For felonies in which the defendant entered a plea of
 1562  guilty or nolo contendere in an agreement with the court to
 1563  enter a pretrial intervention or drug diversion program, the
 1564  department shall not approve or deny the application for a
 1565  license, certificate, or registration until the final resolution
 1566  of the case.
 1567         (b)Has been convicted of, or entered a plea of guilty or
 1568  nolo contendere to, regardless of adjudication, a felony under
 1569  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
 1570  sentence and any subsequent period of probation for such
 1571  conviction or plea ended more than 15 years before the date of
 1572  the application;
 1573         (c)(b)Has been terminated for cause from the Florida
 1574  Medicaid program pursuant to s. 409.913, unless the applicant
 1575  has been in good standing with the Florida Medicaid program for
 1576  the most recent 5 years;
 1577         (d)(c)Has been terminated for cause, pursuant to the
 1578  appeals procedures established by the state or Federal
 1579  Government, from any other state Medicaid program or the federal
 1580  Medicare program, unless the applicant has been in good standing
 1581  with a state Medicaid program or the federal Medicare program
 1582  for the most recent 5 years and the termination occurred at
 1583  least 20 years before prior to the date of the application; or.
 1584         (e)Is currently listed on the United States Department of
 1585  Health and Human Services Office of Inspector General’s List of
 1586  Excluded Individuals and Entities.
 1587         (f) This subsection does not apply to applicants for
 1588  initial licensure or certification who were enrolled in an
 1589  educational or training program on or before July 1, 2009, which
 1590  was recognized by a board or, if there is no board, recognized
 1591  by the department, and who applied for licensure after July 1,
 1592  2009.
 1593         (3)Each board within the jurisdiction of the department,
 1594  or the department if there is no board, shall refuse to renew a
 1595  license, certificate, or registration of any applicant if the
 1596  candidate or applicant or any principal, officer, agent,
 1597  managing employee, or affiliated person of the applicant:
 1598         (a)Has been convicted of, or entered a plea of guilty or
 1599  nolo contendere to, regardless of adjudication, a felony under:
 1600  chapter 409, chapter 817, chapter 893, or a similar felony
 1601  offense committed in another state or jurisdiction since July 1,
 1602  2009.
 1603         (b)Has been convicted of, or entered a plea of guilty or
 1604  nolo contendere to, regardless of adjudication, a felony under
 1605  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
 1606  2009.
 1607         (c)Has been terminated for cause from the Florida Medicaid
 1608  program pursuant to s. 409.913, unless the applicant has been in
 1609  good standing with the Florida Medicaid program for the most
 1610  recent 5 years.
 1611         (d)Has been terminated for cause, pursuant to the appeals
 1612  procedures established by the state, from any other state
 1613  Medicaid program, unless the applicant has been in good standing
 1614  with a state Medicaid program for the most recent 5 years and
 1615  the termination occurred at least 20 years before the date of
 1616  the application.
 1617         (e)Is currently listed on the United States Department of
 1618  Health and Human Services Office of Inspector General’s List of
 1619  Excluded Individuals and Entities.
 1620         (f)For felonies in which the defendant entered a plea of
 1621  guilty or nolo contendere in an agreement with the court to
 1622  enter a pretrial intervention or drug diversion program, the
 1623  department shall not approve or deny the application for a
 1624  renewal of a license, certificate, or registration until the
 1625  final resolution of the case.
 1626         (4)(3) Licensed health care practitioners shall report
 1627  allegations of Medicaid fraud to the department, regardless of
 1628  the practice setting in which the alleged Medicaid fraud
 1629  occurred.
 1630         (5)(4) The acceptance by a licensing authority of a
 1631  candidate’s relinquishment of a license which is offered in
 1632  response to or anticipation of the filing of administrative
 1633  charges alleging Medicaid fraud or similar charges constitutes
 1634  the permanent revocation of the license.
 1635         (6)The department shall adopt rules to administer the
 1636  provisions of this section related to denial of licensure
 1637  renewal.
 1638         Section 13. Paragraph (kk) of subsection (1) of section
 1639  456.072, Florida Statutes, is amended to read:
 1640         456.072 Grounds for discipline; penalties; enforcement.—
 1641         (1) The following acts shall constitute grounds for which
 1642  the disciplinary actions specified in subsection (2) may be
 1643  taken:
 1644         (kk) Being terminated from the state Medicaid program
 1645  pursuant to s. 409.913 or, any other state Medicaid program, or
 1646  excluded from the federal Medicare program, unless eligibility
 1647  to participate in the program from which the practitioner was
 1648  terminated has been restored.
 1649         Section 14. Subsection (13) of section 456.073, Florida
 1650  Statutes, is amended to read:
 1651         456.073 Disciplinary proceedings.—Disciplinary proceedings
 1652  for each board shall be within the jurisdiction of the
 1653  department.
 1654         (13) Notwithstanding any provision of law to the contrary,
 1655  an administrative complaint against a licensee shall be filed
 1656  within 6 years after the time of the incident or occurrence
 1657  giving rise to the complaint against the licensee. If such
 1658  incident or occurrence involved fraud related to the Medicaid
 1659  program, criminal actions, diversion of controlled substances,
 1660  sexual misconduct, or impairment by the licensee, this
 1661  subsection does not apply to bar initiation of an investigation
 1662  or filing of an administrative complaint beyond the 6-year
 1663  timeframe. In those cases covered by this subsection in which it
 1664  can be shown that fraud, concealment, or intentional
 1665  misrepresentation of fact prevented the discovery of the
 1666  violation of law, the period of limitations is extended forward,
 1667  but in no event to exceed 12 years after the time of the
 1668  incident or occurrence.
 1669         Section 15. Subsection (1) of section 456.074, Florida
 1670  Statutes, is amended to read:
 1671         456.074 Certain health care practitioners; immediate
 1672  suspension of license.—
 1673         (1) The department shall issue an emergency order
 1674  suspending the license of any person licensed in a profession as
 1675  defined in this chapter under chapter 458, chapter 459, chapter
 1676  460, chapter 461, chapter 462, chapter 463, chapter 464, chapter
 1677  465, chapter 466, or chapter 484 who pleads guilty to, is
 1678  convicted or found guilty of, or who enters a plea of nolo
 1679  contendere to, regardless of adjudication, to:
 1680         (a) A felony under chapter 409, chapter 812, chapter 817,
 1681  or chapter 893, chapter 895, chapter 896, or under 21 U.S.C. ss.
 1682  801-970, or under 42 U.S.C. ss. 1395-1396; or
 1683         (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
 1684  285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
 1685  1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
 1686  Medicaid program.
 1687         Section 16. Paragraph (q) of subsection (2) of section
 1688  499.01, Florida Statutes, is amended to read:
 1689         499.01 Permits.—
 1690         (2) The following permits are established:
 1691         (q) Device manufacturer permit.—A device manufacturer
 1692  permit is required for any person that engages in the
 1693  manufacture, repackaging, or assembly of medical devices for
 1694  human use in this state, except that a permit is not required
 1695  if:
 1696         1. The person does not manufacture, repackage, or assemble
 1697  any medical devices or components for such devices, except those
 1698  devices or components which are exempt from registration
 1699  pursuant to s. 499.015(8); or
 1700         2. The person is engaged only in manufacturing,
 1701  repackaging, or assembling a medical device pursuant to a
 1702  practitioner’s order for a specific patient.
 1703         a.1. A manufacturer or repackager of medical devices in
 1704  this state must comply with all appropriate state and federal
 1705  good manufacturing practices and quality system rules.
 1706         b.2. The department shall adopt rules related to storage,
 1707  handling, and recordkeeping requirements for manufacturers of
 1708  medical devices for human use.
 1709         Section 17. This act shall take effect July 1, 2010.

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