Bill Text: FL S1930 | 2011 | Regular Session | Comm Sub
Bill Title: Motor Vehicle Personal Injury Protection Insurance
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [S1930 Detail]
Download: Florida-2011-S1930-Comm_Sub.html
Florida Senate - 2011 CS for SB 1930 By the Committee on Banking and Insurance; and Senator Bogdanoff 597-04386-11 20111930c1 1 A bill to be entitled 2 An act relating to motor vehicle personal injury 3 protection insurance; amending s. 316.066, F.S.; 4 revising provisions relating to the contents of 5 written reports of motor vehicle crashes; requiring 6 short-form crash reports by a law enforcement officer 7 to be maintained by the officer’s agency; authorizing 8 the investigation officer to testify at trial or 9 provide an affidavit concerning the content of the 10 reports; amending s. 400.991, F.S.; requiring that an 11 application for licensure as a mobile clinic include a 12 statement regarding insurance fraud; creating s. 13 626.9894, F.S.; providing definitions; authorizing the 14 Division of Insurance Fraud to establish a direct 15 support organization for the purpose of prosecuting, 16 investigating, and preventing motor vehicle insurance 17 fraud; providing requirements for the organization and 18 the organization’s contract with the division; 19 providing for a board of directors; authorizing the 20 organization to use the division’s property and 21 facilities subject to certain requirements; 22 authorizing contributions from insurers; providing 23 that any moneys received by the organization may be 24 held in a separate depository account in the name of 25 the organization; requiring the division to deposit 26 certain proceeds into the Insurance Regulatory Trust 27 Fund; amending s. 627.4137, F.S.; requiring a 28 claimant’s request about insurance coverage to be 29 appropriately served upon the disclosing entity; 30 amending s. 627.730, F.S.; conforming a cross 31 reference; amending s. 627.731, F.S.; providing 32 legislative intent with respect to the Florida Motor 33 Vehicle No-Fault Law; amending s. 627.732, F.S.; 34 defining the terms “claimant,” “entity wholly owned,” 35 and “no-fault law”; amending s. 627.736, F.S.; 36 conforming a cross-reference; adding licensed 37 acupuncturists to the list of practitioners authorized 38 to provide, supervise, order, or prescribe services; 39 requiring certain entities providing medical services 40 to document that they meet required criteria; revising 41 requirements relating to the form that must be 42 submitted by providers; requiring an entity or clinic 43 to file a new form within a specified period after the 44 date of a change of ownership; revising provisions 45 relating to when payment for a benefit is due; 46 providing that an insurer’s failure to send certain 47 specification or explanation does not waive other 48 grounds for rejecting an invalid claim; authorizing an 49 insurer to obtain evidence and assert any ground for 50 adjusting or rejecting a claim; providing that the 51 time period for paying a claim is tolled during the 52 investigation of a fraudulent insurance act; 53 specifying when benefits are not payable; preempting 54 local lien laws with respect to payment of benefits to 55 medical providers; providing that a claimant that 56 violates certain provisions is not entitled to any 57 payment, regardless of whether a portion of the claim 58 may be legitimate; authorizing an insurer to recover 59 payments and bring a cause of action to recover 60 payments; providing that an insurer may deny any claim 61 based on other evidence of fraud; forbidding a 62 physician, hospital, clinic, or other medical 63 institution that fails to comply with certain 64 provisions from billing the injured person or the 65 insured; providing that an insurer has a right to 66 conduct reasonable investigations of claims; 67 authorizing an insurer to require a claimant to 68 provide certain records; requiring a records review to 69 be conducted by the same type of practitioner as the 70 medical provider whose records are being reviewed; 71 specifying when the period for payment is tolled; 72 authorizing an insurer to deny benefits if an insured, 73 claimant, or medical provider fails to comply with 74 certain provisions; revising the insurer’s 75 reimbursement limitation; providing a limit on the 76 amount of reimbursement if the insurance policy 77 includes a schedule of charges; creating a rebuttable 78 presumption that the insured did not receive the 79 alleged treatment if the insured does not countersign 80 the patient log; authorizing the insurer to deny a 81 claim if the provider does not submit a properly 82 completed statement or bill within a certain time; 83 specifying requirements for furnishing the insured 84 with notice of the amount of covered loss; deleting an 85 obsolete provision; requiring the provider to provide 86 copies of the patient log within a certain time if 87 requested by the insurer; providing that failure to 88 maintain a patient log renders the treatment unlawful 89 and noncompensable; revising requirements relating to 90 discovery; authorizing the insurer to conduct a 91 physical review of the treatment location; requiring 92 the insured and assignee to comply with certain 93 provisions to recover benefits; requiring the provider 94 to produce persons having the most knowledge in 95 specified circumstances; requiring the insurer to pay 96 reasonable compensation to the provider for attending 97 the examination; requiring the insurer to request 98 certain information before requesting an assignee to 99 participate in an examination under oath; providing 100 that an insurer that requests an examination under 101 oath without a reasonable basis is engaging in an 102 unfair and deceptive trade practice; providing that 103 failure to appear for scheduled examinations 104 establishes a rebuttable presumption that such failure 105 was unreasonable; authorizing an insurer to contract 106 with a preferred provider network; authorizing an 107 insurer to provide a premium discount to an insured 108 who selects a preferred provider; authorizing an 109 insurance policy to not pay for nonemergency services 110 performed by a nonpreferred provider in specified 111 circumstances; authorizing an insurer to use a 112 preferred provider network; revising requirements 113 relating to demand letters in an action for benefits; 114 specifying when a demand letter is defective; 115 requiring a second demand letter under certain 116 circumstances; deleting obsolete provisions; providing 117 that a demand letter may not be used to request the 118 production of claim documents or records from the 119 insurer; amending s. 817.234, F.S.; providing that 120 persons and business entities found guilty of 121 insurance fraud lose their occupational and 122 practitioner licenses for a certain period; providing 123 civil penalties for fraudulent insurance claims; 124 amending ss. 324.021, 456.057, and 627.7401, F.S.; 125 conforming cross-references; providing an effective 126 date. 127 128 Be It Enacted by the Legislature of the State of Florida: 129 130 Section 1. Subsection (1) of section 316.066, Florida 131 Statutes, is amended to read: 132 316.066 Written reports of crashes.— 133 (1)(a) A Florida Traffic Crash Report, Long Form, mustis134required tobe completed and submitted to the department within 135 10 days aftercompletingan investigation is completed by the 136everylaw enforcement officer who in the regular course of duty 137 investigates a motor vehicle crash: 138 1. That resulted in death,orpersonal injury, or any 139 indication of complaints of pain or discomfort by any of the 140 parties or passengers involved in the crash;.141 2. That involved one or more passengers, other than the 142 drivers of the vehicles, in any of the vehicles involved in the 143 crash; 144 3.2.That involved a violation of s. 316.061(1) or s. 145 316.193; or.146 4.3.In which a vehicle was rendered inoperative to a 147 degree that required a wrecker to remove it from traffic, if 148 such action is appropriate, in the officer’s discretion. 149 (b) In every crash for which a Florida Traffic Crash 150 Report, Long Form, is not required by this section, the law 151 enforcement officer may complete a short-form crash report or 152 provide a short-form crash report to be completed by each party 153 involved in the crash. Short-form crash reports prepared by the 154 law enforcement officer shall be maintained by the officer’s 155 agency. 156 (c) The long-form and the short-form report must include: 157 1. The date, time, and location of the crash. 158 2. A description of the vehicles involved. 159 3. The names and addresses of the parties involved. 160 4. The names and addresses of all passengers in all 161 vehicles involved in the crash, each clearly identified as being 162 a passenger and the identification of the vehicle in which they 163 were a passenger. 164 5.4.The names and addresses of witnesses. 165 6.5.The name, badge number, and law enforcement agency of 166 the officer investigating the crash. 167 7.6.The names of the insurance companies for the 168 respective parties involved in the crash. 169 (d)(c)Each party to the crash mustshallprovide the law 170 enforcement officer with proof of insurance, which musttobe 171 included in the crash report. If a law enforcement officer 172 submits a report on the accident, proof of insurance must be 173 provided to the officer by each party involved in the crash. Any 174 party who fails to provide the required information commits a 175 noncriminal traffic infraction, punishable as a nonmoving 176 violation as provided in chapter 318, unless the officer 177 determines that due to injuries or other special circumstances 178 such insurance information cannot be provided immediately. If 179 the person provides the law enforcement agency, within 24 hours 180 after the crash, proof of insurance that was valid at the time 181 of the crash, the law enforcement agency may void the citation. 182 (e)(d)The driver of a vehicle that was in any manner 183 involved in a crash resulting in damage to any vehicle or other 184 property in an amount of $500 or more,whichcrashwas not 185 investigated by a law enforcement agency, shall, within 10 days 186 after the crash, submit a written report of the crash to the 187 department or traffic records center. The entity receiving the 188 report may require witnesses of the crashcrashesto render 189 reports and may require any driver of a vehicle involved in a 190 crash of which a written report must be madeas provided in this191sectionto file supplemental written reports ifwheneverthe 192 original report is deemed insufficient by the receiving entity. 193 (f) The investigating law enforcement officer may testify 194 at trial or provide a signed affidavit to confirm or supplement 195 the information included on the long-form or short-form report. 196(e) Short-form crash reports prepared by law enforcement197shall be maintained by the law enforcement officer’s agency.198 Section 2. Subsection (6) is added to section 400.991, 199 Florida Statutes, to read: 200 400.991 License requirements; background screenings; 201 prohibitions.— 202 (6) All forms that constitute part of the application for 203 licensure or exemption from licensure under this part must 204 contain the following statement: 205 206 INSURANCE FRAUD NOTICE.—Submitting a false, 207 misleading, or fraudulent application or other 208 document when applying for licensure as a health care 209 clinic, when seeking an exemption from licensure as a 210 health care clinic, or when demonstrating compliance 211 with part X of chapter 400, Florida Statutes, is a 212 fraudulent insurance act, as defined in s. 626.989 or 213 s. 817.234, Florida Statutes, subject to investigation 214 by the Division of Insurance Fraud, and is grounds for 215 discipline by the appropriate licensing board of the 216 Florida Department of Health. 217 Section 3. Section 626.9894, Florida Statutes, is created 218 to read: 219 626.9894 Motor vehicle insurance fraud direct-support 220 organization.— 221 (1) DEFINITIONS.—As used in this section, the term: 222 (a) “Division” means the Division of Insurance Fraud of the 223 Department of Financial Services. 224 (b) “Motor vehicle insurance fraud” means any act defined 225 as a “fraudulent insurance act” under s. 626.989, which relates 226 to the coverage of motor vehicle insurance as described in part 227 XI of chapter 627. 228 (c) “Organization” means the direct-support organization 229 established under this section. 230 (2) ORGANIZATION ESTABLISHED.—The division may establish a 231 direct-support organization, to be known as the “Automobile 232 Insurance Fraud Strike Force,” whose sole purpose is to support 233 the prosecution, investigation, and prevention of motor vehicle 234 insurance fraud. The organization shall: 235 (a) Be a not-for-profit corporation incorporated under 236 chapter 617 and approved by the Department of State. 237 (b) Be organized and operated to conduct programs and 238 activities; to raise funds; to request and receive grants, 239 gifts, and bequests of money; to acquire, receive, hold, invest, 240 and administer, in its own name, securities, funds, objects of 241 value, or other property, real or personal; and to make grants 242 and expenditures to or for the direct or indirect benefit of the 243 division, state attorneys’ offices, the statewide prosecutor, 244 the Agency for Health Care Administration, and the Department of 245 Health to the extent that such grants and expenditures are to be 246 used exclusively to advance the purpose of prosecuting, 247 investigating, or preventing motor vehicle insurance fraud. 248 Grants and expenditures may include the cost of salaries or 249 benefits of dedicated motor vehicle insurance fraud 250 investigators, prosecutors, or support personnel if such grants 251 and expenditures do not interfere with prosecutorial 252 independence or otherwise create conflicts of interest which 253 threaten the success of prosecutions. 254 (c) Be determined by the division to operate in a manner 255 that promotes the goals of laws relating to motor vehicle 256 insurance fraud, that is in the best interest of the state, and 257 that is in accordance with the adopted goals and mission of the 258 division. 259 (d) Use all of its grants and expenditures solely for the 260 purpose of preventing and decreasing motor vehicle insurance 261 fraud, and not for the purpose of lobbying as defined in s. 262 11.045. 263 (e) Be subject to an annual financial audit in accordance 264 with s. 215.981. 265 (3) CONTRACT.—The organization shall operate under written 266 contract with the division. The contract must provide for: 267 (a) Approval of the articles of incorporation and bylaws of 268 the organization by the division. 269 (b) Submission of an annual budget for the approval of the 270 division. The budget must require the organization to minimize 271 costs to the division and its members at all times by using 272 existing personnel and property and allowing for telephonic 273 meetings when appropriate. 274 (c) Certification by the division that the direct-support 275 organization is complying with the terms of the contract and in 276 a manner consistent with the goals and purposes of the 277 department and in the best interest of the state. Such 278 certification must be made annually and reported in the official 279 minutes of a meeting of the organization. 280 (d) Allocation of funds to address motor vehicle insurance 281 fraud. 282 (e) Reversion of moneys and property held in trust by the 283 organization for motor vehicle insurance fraud prosecution, 284 investigation, and prevention to the division if the 285 organization is no longer approved to operate for the department 286 or if the organization ceases to exist, or to the state if the 287 division ceases to exist. 288 (f) Specific criteria to be used by the organization’s 289 board of directors to evaluate the effectiveness of funding used 290 to combat motor vehicle insurance fraud. 291 (g) The fiscal year of the organization, which begins July 292 1 of each year and ends June 30 of the following year. 293 (h) Disclosure of the material provisions of the contract, 294 and distinguishing between the department and the organization 295 to donors of gifts, contributions, or bequests, including 296 providing such disclosure on all promotional and fundraising 297 publications. 298 (4) BOARD OF DIRECTORS.—The board of directors of the 299 organization shall consist of the following seven members: 300 (a) The Chief Financial Officer, or designee, who shall 301 serve as chair. 302 (b) Two state attorneys, one of whom shall be appointed by 303 the Chief Financial Officer and one of whom shall be appointed 304 by the Attorney General. 305 (c) Two representatives of motor vehicle insurers appointed 306 by the Chief Financial Officer. 307 (d) Two representatives of local law enforcement agencies, 308 both of whom shall be appointed by the Chief Financial Officer. 309 310 The officer who appointed a member of the board may remove that 311 member for cause. The term of office of an appointed member 312 expires at the same time as the term of the officer who 313 appointed him or her or at such earlier time as the person 314 ceases to be qualified. 315 (5) USE OF PROPERTY.—The department may authorize, without 316 charge, appropriate use of fixed property and facilities of the 317 division by the organization, subject to this subsection. 318 (a) The department may prescribe any condition with which 319 the organization must comply in order to use the division’s 320 property or facilities. 321 (b) The department may not authorize the use of the 322 division’s property or facilities if the organization does not 323 provide equal membership and employment opportunities to all 324 persons regardless of race, religion, sex, age, or national 325 origin. 326 (c) The department shall adopt rules prescribing the 327 procedures by which the organization is governed and any 328 conditions with which the organization must comply to use the 329 division’s property or facilities. 330 (6) CONTRIBUTIONS.—Any contributions made by an insurer to 331 the organization shall be allowed as appropriate business 332 expenses for all regulatory purposes. 333 (7) DEPOSITORY.—Any moneys received by the organization may 334 be held in a separate depository account in the name of the 335 organization and subject to the provisions of the contract with 336 the division. 337 (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division 338 receives proceeds from the organization, those proceeds shall be 339 deposited into the Insurance Regulatory Trust Fund. 340 Section 4. Subsection (3) is added to section 627.4137, 341 Florida Statutes, to read: 342 627.4137 Disclosure of certain information required.— 343 (3) Any request made to a self-insured corporation pursuant 344 to this section shall be sent by certified mail to the 345 registered agent of the disclosing entity. 346 Section 5. Section 627.730, Florida Statutes, is amended to 347 read: 348 627.730 Florida Motor Vehicle No-Fault Law.—Sections 349 627.730-627.7407627.730-627.7405may be cited and known as the 350 “Florida Motor Vehicle No-Fault Law.” 351 Section 6. Section 627.731, Florida Statutes, is amended to 352 read: 353 627.731 Purpose; legislative intent.—The purpose of the no 354 fault lawss.627.730-627.7405is to provide for medical, 355 surgical, funeral, and disability insurance benefits without 356 regard to fault, and to require motor vehicle insurance securing 357 such benefits, for motor vehicles required to be registered in 358 this state and, with respect to motor vehicle accidents, a 359 limitation on the right to claim damages for pain, suffering, 360 mental anguish, and inconvenience. 361 (1) The Legislature finds that automobile insurance fraud 362 remains a major problem for state consumers and insurers. 363 According to the National Insurance Crime Bureau, in recent 364 years this state has been among those states that have the 365 highest number of fraudulent and questionable claims. 366 (2) The Legislature intends to balance the insured’s 367 interest in prompt payment of valid claims for insurance 368 benefits under the no-fault law with the public’s interest in 369 reducing fraud, abuse, and overuse of the no-fault system. To 370 that end, the Legislature intends that the investigation and 371 prevention of fraudulent insurance acts in this state be 372 enhanced, that additional sanctions for such acts be imposed, 373 and that the no-fault law be revised to remove incentives for 374 fraudulent insurance acts. The Legislature intends that the no 375 fault law be construed according to the plain language of the 376 statutory provisions, which are designed to meet these goals. 377 (3) The Legislature intends that: 378 (a) Insurers properly investigate claims, and as such, be 379 allowed to obtain examinations under oath and sworn statements 380 from any claimant seeking no-fault insurance benefits, and to 381 request mental and physical examinations of persons seeking 382 personal injury protection coverage or benefits. 383 (b) Any false, misleading, or otherwise fraudulent activity 384 associated with a claim renders any claim brought by a claimant 385 engaging in such activity invalid. An insurer must be able to 386 raise fraud as a defense to a claim for no-fault insurance 387 benefits irrespective of any prior adjudication of guilt or 388 determination of fraud by the Department of Financial Services. 389 (c) Insurers toll the payment or denial of a claim, with 390 respect to any portion of a claim for which the insurer has a 391 reasonable belief that a fraudulent insurance act, as defined in 392 s. 626.989, has been committed. 393 (d) Insurers discover the names of all passengers involved 394 in an automobile accident before paying claims or benefits 395 pursuant to an insurance policy governed by the no-fault law. A 396 rebuttable presumption must be established that a person was not 397 involved in the event giving rise to the claim if that person’s 398 name does not appear on the police report. 399 (e) The insured’s interest in obtaining competent counsel 400 must be balanced with the public’s interest in preventing a no 401 fault system that encourages litigation by allowing for 402 exorbitant attorney’s fees. Courts should limit attorney fee 403 awards so as to eliminate the incentive for attorneys to 404 manufacture unnecessary litigation. 405 Section 7. Section 627.732, Florida Statutes, is reordered 406 and amended to read: 407 627.732 Definitions.—As used in the no-fault lawss.408627.730-627.7405, the term: 409 (1) “Broker” means any person not possessing a license 410 under chapter 395, chapter 400, chapter 429, chapter 458, 411 chapter 459, chapter 460, chapter 461, or chapter 641 who 412 charges or receives compensation for any use of medical 413 equipment and is not the 100-percent owner or the 100-percent 414 lessee of such equipment. For purposes of this section, such 415 owner or lessee may be an individual, a corporation, a 416 partnership, or any other entity and any of its 100-percent 417 owned affiliates and subsidiaries. For purposes of this 418 subsection, the term “lessee” means a long-term lessee under a 419 capital or operating lease, but does not include a part-time 420 lessee. The term “broker” does not include a hospital or 421 physician management company whose medical equipment is 422 ancillary to the practices managed, a debt collection agency, or 423 an entity that has contracted with the insurer to obtain a 424 discounted rate for such services; ornor does the term include425 a management company that has contracted to provide general 426 management services for a licensed physician or health care 427 facility and whose compensation is not materially affected by 428 the usage or frequency of usage of medical equipment or an 429 entity that is 100-percent owned by one or more hospitals or 430 physicians. The term “broker” does not include a person or 431 entity that certifies, upon request of an insurer, that: 432 (a) It is a clinic licensed under ss. 400.990-400.995; 433 (b) It is a 100-percent owner of medical equipment; and 434 (c) The owner’s only part-time lease of medical equipment 435 for personal injury protection patients is on a temporary basis, 436 not to exceed 30 days in a 12-month period, and such lease is 437 solely for the purposes of necessary repair or maintenance of 438 the 100-percent-owned medical equipment or pending the arrival 439 and installation of the newly purchased or a replacement for the 440 100-percent-owned medical equipment, or for patients for whom, 441 because of physical size or claustrophobia, it is determined by 442 the medical director or clinical director to be medically 443 necessary that the test be performed in medical equipment that 444 is open-style. The leased medical equipment may notcannotbe 445 used by patients who are not patients of the registered clinic 446for medical treatment of services. Any person or entity making a 447 false certification under this subsection commits insurance 448 fraud as defined in s. 817.234. However, the 30-day period 449provided in this paragraphmay be extended for an additional 60 450 days as applicable to magnetic resonance imaging equipment if 451 the owner certifies that the extension otherwise complies with 452 this paragraph. 453 (10)(2)“Medically necessary” refers to a medical service 454 or supply that a prudent physician would provide for the purpose 455 of preventing, diagnosing, or treating an illness, injury, 456 disease, or symptom in a manner that is: 457 (a) In accordance with generally accepted standards of 458 medical practice; 459 (b) Clinically appropriate in terms of type, frequency, 460 extent, site, and duration; and 461 (c) Not primarily for the convenience of the patient, 462 physician, or other health care provider. 463 (11)(3)“Motor vehicle” means aanyself-propelled vehicle 464 with four or more wheels which is of a type both designed and 465 required to be licensed for use on the highways of this state, 466 and any trailer or semitrailer designed for use with such 467 vehicle, and includes: 468 (a) A “private passenger motor vehicle,” which is any motor 469 vehicle thatwhichis a sedan, station wagon, or jeep-type 470 vehicle and, if not used primarily for occupational, 471 professional, or business purposes, a motor vehicle of the 472 pickup, panel, van, camper, or motor home type. 473 (b) A “commercial motor vehicle,” which is any motor 474 vehicle thatwhichis not a private passenger motor vehicle. 475 476 The term“motor vehicle”does not include a mobile home or any 477 motor vehicle thatwhichis used in mass transit, other than 478 public school transportation, and designed to transport more 479 than five passengers exclusive of the operator of the motor 480 vehicle and thatwhichis owned by a municipality, a transit 481 authority, or a political subdivision of the state. 482 (12)(4)“Named insured” means a person, usually the owner 483 of a vehicle, identified in a policy by name as the insured 484 under the policy. 485 (13) “No-fault law” means the Florida Motor Vehicle No 486 Fault Law codifed at ss. 627.730-627.7407. 487 (14)(5)“Owner” means a person who holds the legal title to 488 a motor vehicle; or, ifin the eventa motor vehicle is the 489 subject of a security agreement or lease with an option to 490 purchase with the debtor or lessee having the right to 491 possession,thenthe debtor or lessee isshall bedeemed the 492 owner for the purposes of the no-fault lawss.627.730-627.7405. 493 (16)(6)“Relative residing in the same household” means a 494 relative of any degree by blood or by marriage who usually makes 495 her or his home in the same family unit, whether or not 496 temporarily living elsewhere. 497 (2)(7)“Certify” means to swear or attest to being true or 498 represented in writing. 499 (3) “Claimant” means the person, organization, or entity 500 seeking benefits, including all assignees. 501 (4) “Entity wholly owned” means a proprietorship, group 502 practice, partnership, or corporation that provides health care 503 services rendered by licensed health care practitioners. In 504 order to be wholly owned, licensed health care practitioners 505 must be the business owners of all aspects of the business 506 entity, including, but not limited to, being reflected as the 507 business owners on the title or lease of the physical facility, 508 filing taxes as the business owners, being account holders on 509 the entity’s bank account, being listed as the principals on all 510 incorporation documents required by this state, and having 511 ultimate authority over all personnel and compensation decisions 512 relating to the entity. 513 (6)(8)“Immediate personal supervision,” as it relates to 514 the performance of medical services by nonphysicians not in a 515 hospital, means that an individual licensed to perform the 516 medical service or provide the medical supplies must be present 517 within the confines of the physical structure where the medical 518 services are performed or where the medical supplies are 519 provided such that the licensed individual can respond 520 immediately to any emergencies if needed. 521 (7)(9)“Incident,” with respect to services considered as 522 incident to a physician’s professional service, for a physician 523 licensed under chapter 458, chapter 459, chapter 460, or chapter 524 461, if not furnished in a hospital, meanssuchservices that 525 aremust bean integral, even if incidental, part of a covered 526 physician’s service. 527 (8)(10)“Knowingly” means that a person, with respect to 528 information, has actual knowledge of the information,;acts in 529 deliberate ignorance of the truth or falsity of the 530 information,;or acts in reckless disregard of the information.,531andProof of specific intent to defraud is not required. 532 (9)(11)“Lawful” or “lawfully” means in substantial 533 compliance with all relevant applicable criminal, civil, and 534 administrative requirements of state and federal law related to 535 the provision of medical services or treatment. 536 (5)(12)“Hospital” means a facility that, at the time 537 services or treatment were rendered, was licensed under chapter 538 395. 539 (15)(13)“Properly completed” means providing truthful, 540 substantially complete, and substantially accurate responsesas541 to all material elements oftoeach applicable request for 542 information or statement by a means that may lawfully be 543 provided and that complies with this section, or as agreed by 544 the parties. 545 (18)(14)“Upcoding” means submittingan action that submits546 a billing code that would result in payment greater in amount 547 than would be paid using a billing code that accurately 548 describes the services performed. The term does not include an 549 otherwise lawful bill by a magnetic resonance imaging facility, 550 which globally combines both technical and professional 551 components, if the amount of the global bill is not more than 552 the components if billed separately; however, payment of such a 553 bill constitutes payment in full for all components of such 554 service. 555 (17)(15)“Unbundling” means submittingan action that556submitsa billing code that is properly billed under one billing 557 code, but that has been separated into two or more billing 558 codes,and would result in payment greater than theinamount 559 thatthanwould be paid using one billing code. 560 Section 8. Subsections (1) and (4) of section 627.736, 561 Florida Statutes, are amended, subsections (5) through (16) of 562 that section are redesignated as subsections (6) through (17), 563 respectively, a new subsection (5) is added to that section, 564 present subsection (5), paragraph (b) of present subsection (6), 565 paragraph (b) of present subsection (7), and present subsections 566 (8), (9), and (10) of that section are amended, to read: 567 627.736 Required personal injury protection benefits; 568 exclusions; priority; claims.— 569 (1) REQUIRED BENEFITS.—Every insurance policy complying 570 with the security requirements of s. 627.733 mustshallprovide 571 personal injury protection to the named insured, relatives 572 residing in the same household, persons operating the insured 573 motor vehicle, passengers in such motor vehicle, and other 574 persons struck by such motor vehicle and suffering bodily injury 575 while not an occupant of a self-propelled vehicle, subject to 576the provisions ofsubsection (2) and paragraph (4)(h)(4)(e),to 577 a limit of $10,000 for loss sustained byanysuch person as a 578 result of bodily injury, sickness, disease, or death arising out 579 of the ownership, maintenance, or use of a motor vehicle as 580 follows: 581 (a) Medical benefits.—Eighty percent of all reasonable 582 expenses, charged pursuant to subsection (6), for medically 583 necessary medical, surgical, X-ray, dental, and rehabilitative 584 services, including prosthetic devices, and for medically 585 necessary ambulance, hospital, and nursing services. However, 586 the medical benefitsshallprovide reimbursement only for such 587 services and care that are lawfully provided, supervised, 588 ordered, or prescribed by a physician licensed under chapter 458 589 or chapter 459, a dentist licensed under chapter 466,ora 590 chiropractic physician licensed under chapter 460, or an 591 acupuncturist licensed under chapter 457 exclusively to provide 592 oriental medicine as defined in s. 457.102, or that are provided 593 by any of the followingpersons or entities: 594 1. A hospital or ambulatory surgical center licensed under 595 chapter 395. 596 2. A person or entity licensed under part III of chapter 597 401 whichss.401.2101-401.45thatprovides emergency 598 transportation and treatment. 599 3. An entity wholly owned by one or more physicians 600 licensed under chapter 458 or chapter 459, chiropractic 601 physicians licensed under chapter 460, or dentists licensed 602 under chapter 466 or by suchpractitioner orpractitioners and 603 the spouse, parent, child, or sibling of suchthat practitioner604or thosepractitioners. 605 4. An entity wholly owned, directly or indirectly, by a 606 hospital or hospitals. 607 5. A health care clinic licensed under part X of chapter 608 400 whichss.400.990-400.995thatis: 609 a. Accredited by the Joint Commission on Accreditation of 610 Healthcare Organizations, the American Osteopathic Association, 611 the Commission on Accreditation of Rehabilitation Facilities, or 612 the Accreditation Association for Ambulatory Health Care, Inc.; 613 or 614 b. A health care clinic that: 615 (I) Has a medical director licensed under chapter 458, 616 chapter 459, or chapter 460; 617 (II) Has been continuously licensed for more than 3 years 618 or is a publicly traded corporation that issues securities 619 traded on an exchange registered with the United States 620 Securities and Exchange Commission as a national securities 621 exchange; and 622 (III) Provides at least four of the following medical 623 specialties: 624 (A) General medicine. 625 (B) Radiography. 626 (C) Orthopedic medicine. 627 (D) Physical medicine. 628 (E) Physical therapy. 629 (F) Physical rehabilitation. 630 (G) Prescribing or dispensing outpatient prescription 631 medication. 632 (H) Laboratory services. 633 634 If any services under this paragraph are provided by an entity 635 or clinic described in subparagraph 3., subparagraph 4., or 636 subparagraph 5., the entity or clinic must provide the insurer 637 at the initial submission of the claim with a form adopted by 638 the Department of Financial Services which documents that the 639 entity or clinic meets applicable criteria for such entity or 640 clinic and includes a sworn statement or affidavit to that 641 effect. Any change in ownership requires the filing of a new 642 form within 10 days after the date of the change in ownership. 643The Financial Services Commission shall adopt by rule the form644that must be used by an insurer and a health care provider645specified in subparagraph 3., subparagraph 4., or subparagraph6465. to document that the health care provider meets the criteria647of this paragraph, which rule must include a requirement for a648sworn statement or affidavit.649 (b) Disability benefits.—Sixty percent of any loss of gross 650 income and loss of earning capacity per individual from 651 inability to work proximately caused by the injury sustained by 652 the injured person, plus all expenses reasonably incurred in 653 obtaining from others ordinary and necessary services in lieu of 654 those that, but for the injury, the injured person would have 655 performed without income for the benefit of his or her 656 household. All disability benefits payable under this provision 657 mustshallbe paid at leastnot less thanevery 2 weeks. 658 (c) Death benefits.—Death benefits equal to the lesser of 659 $5,000 or the remainder of unused personal injury protection 660 benefits per individual. The insurer may pay such benefits to 661 the executor or administrator of the deceased, to any of the 662 deceased’s relatives by blood,orlegal adoption, orconnection663bymarriage, or to any person appearing to the insurer to be 664 equitably entitled thereto. 665 666 Only insurers writing motor vehicle liability insurance in this 667 state may provide the required benefits of this section, andno668 such insurers may notinsurer shallrequire the purchase of any 669 other motor vehicle coverage other than the purchase of property 670 damage liability coverage as required by s. 627.7275 as a 671 condition for providing suchrequiredbenefits. Insurers may not 672 require that property damage liability insurance in an amount 673 greater than $10,000 be purchased in conjunction with personal 674 injury protection. Such insurers shall make benefits and 675 required property damage liability insurance coverage available 676 through normal marketing channels. AnAnyinsurer writing motor 677 vehicle liability insurance in this state who fails to comply 678 with such availability requirement as a general business 679 practice violatesshall be deemed to have violatedpart IX of 680 chapter 626, and such violation constitutesshall constitutean 681 unfair method of competition or an unfair or deceptive act or 682 practice involving the business of insurance. An; and any such683 insurer committing such violation isshall besubject to the 684 penalties afforded in such part, as well as those that arewhich685may beafforded elsewhere in the insurance code. 686 (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under 687 the no-fault law aress.627.730-627.7405shall beprimary, 688 except that benefits received under any workers’ compensation 689 law shall be credited against the benefits provided by 690 subsection (1) and areshall bedue and payable as loss accrues,691 upon the receipt of reasonable proof of such loss and the amount 692 of expenses and loss incurred which are covered by the policy 693 issued under the no-fault lawss.627.730-627.7405. IfWhenthe 694 Agency for Health Care Administration provides, pays, or becomes 695 liable for medical assistance under the Medicaid program related 696 to injury, sickness, disease, or death arising out of the 697 ownership, maintenance, or use of a motor vehicle, the benefits 698 areunder ss.627.730-627.7405shall besubject to the 699 provisions of the Medicaid program. 700 (a) An insurer may require written notice to be given as 701 soon as practicable after an accident involving a motor vehicle 702 with respect to which the policy affords the security required 703 by the no-fault lawss.627.730-627.7405. 704 (b) Personal injury protection insurance benefits paid 705 pursuant to this section areshall beoverdue if not paid within 706 30 days after the insurer is furnished written notice of the 707 fact of a covered loss and of the amount of same. Ifsuch708 written notice is not furnished to the insurer as to the entire 709 claim, any partial amount supported by written notice is overdue 710 if not paid within 30 days after thesuchwritten notice is 711 furnished to the insurer. Any part or all of the remainder of 712 the claim that is subsequently supported by written notice is 713 overdue if not paid within 30 days aftersuchwritten notice is 714 furnished to the insurer. For the purpose of calculating the 715 extent to which benefits are overdue, payment shall be 716 considered made on the date a draft or other valid instrument 717 that is equivalent to payment is placed in the United States 718 mail in a properly addressed, postpaid envelope, or, if not so 719 posted, on the date of delivery. 720 (c) IfWhenan insurer pays only a portion of a claim or 721 rejects a claim, the insurer shall provide at the time of the 722 partial payment or rejection an itemized specification of each 723 item that the insurer had reduced, omitted, or declined to pay 724 and any information that the insurer desires the claimant to 725 consider related to the medical necessity of the denied 726 treatment or to explain the reasonableness of the reduced 727 charge, provided that this doesshallnot limit the introduction 728 of evidence at trial.; andThe insurer mustshallinclude the 729 name and address of the person to whom the claimant should 730 respond and a claim number to be referenced in future 731 correspondence. An insurer’s failure to send an itemized 732 specification or explanation of benefits does not waive other 733 grounds for rejecting an invalid claim. 734 (d) AHowever, notwithstanding the fact that written notice735has been furnished to the insurer, Anypayment isshallnotbe736deemedoverdue ifwhenthe insurer has reasonable proofto737establishthat the insurer is not responsible forthepayment. 738 An insurer may obtain evidence and assert any ground for 739 adjustment or rejection of aFor the purpose of calculating the740extent to which any benefits are overdue, payment shall be741treated as being made on the date a draft or other valid742instrument which is equivalent to payment was placed in the743United States mail in a properly addressed, postpaid envelope744or, if not so posted, on the date of delivery. This paragraph745does not preclude or limit the ability of the insurer to assert746that theclaim that iswasunrelated,wasnot medically 747 necessary,or wasunreasonable, or submittedthat the amount of748the charge was in excess of that permitted under, orin 749 violation of,subsection (6)(5). Such assertion by the insurer750may be madeat any time, including after payment of the claim, 751orafter the 30-daytimeperiod for payment set forth inthis752 paragraph (b), or after the filing of a lawsuit. 753 (e) The 30-day period for payment is tolled while the 754 insurer investigates a fraudulent insurance act, as defined in 755 s. 626.989, with respect to any portion of a claim for which the 756 insurer has a reasonable belief that a fraudulent insurance act 757 has been committed. The insurer must notify the claimant in 758 writing that it is investigating a fraudulent insurance act 759 within 30 days after the date it has a reasonable belief that 760 such act has been committed. The insurer must pay or deny the 761 claim, in full or in part, within 90 days after the date the 762 written notice of the fact of a covered loss and of the amount 763 of the loss was provided to the insurer. However, no payment is 764 due to a claimant that has violated paragraph (k). 765 (f)(c)Notwithstanding any local lien law, upon receiving 766 notice of an accident that is potentially covered by personal 767 injury protection benefits, the insurer must reserve $5,000 of 768 personal injury protection benefits for payment to physicians 769 licensed under chapter 458 or chapter 459 or dentists licensed 770 under chapter 466 who provide emergency services and care, as 771 defined in s. 395.002(9), or who provide hospital inpatient 772 care. The amount required to be held in reserve may be used only 773 to pay claims from such physicians or dentists until 30 days 774 after the date the insurer receives notice of the accident. 775 After the 30-day period, any amount of the reserve for which the 776 insurer has not received notice of suchaclaimfrom a physician777or dentist who provided emergency services and care or who778provided hospital inpatient caremaythenbe used by the insurer 779 to pay other claims. The time periods specified in paragraph (b) 780 forrequiredpayment of personal injury protection benefits are 781shall betolled for the period of time that an insurer is 782 requiredby this paragraphto hold payment of a claim that is 783 not from a physician or dentist who provided emergency services 784 and care or who provided hospital inpatient care to the extent 785 that the personal injury protection benefits not held in reserve 786 are insufficient to pay the claim. This paragraph does not 787 require an insurer to establish a claim reserve for insurance 788 accounting purposes. 789 (g)(d)All overdue paymentsshallbear simple interest at 790 the rate established under s. 55.03 or the rate established in 791 the insurance contract, whichever is greater, for the year in 792 which the payment became overdue, calculated from the date the 793 insurer was furnished with written notice of the amount of 794 covered loss. Interest isshall bedue at the time payment of 795 the overdue claim is made. However, interest on a payment that 796 is overdue pursuant to paragraph (e) shall be calculated from 797 the date the payment is due pursuant to paragraph (b). 798 (h)(e)The insurer of the owner of a motor vehicle shall 799 pay personal injury protection benefits for: 800 1. Accidental bodily injury sustained in this state by the 801 owner while occupying a motor vehicle, or while not an occupant 802 of a self-propelled vehicle if the injury is caused by physical 803 contact with a motor vehicle. 804 2. Accidental bodily injury sustained outside this state, 805 but within the United States of America or its territories or 806 possessions or Canada, by the owner while occupying the owner’s 807 motor vehicle. 808 3. Accidental bodily injury sustained by a relative of the 809 owner residing in the same household, under the circumstances 810 described in subparagraph 1. or subparagraph 2. if, providedthe 811 relative at the time of the accident is domiciled in the owner’s 812 household and is nothimself or herselfthe owner of a motor 813 vehicle with respect to which security is required under the no 814 fault lawss.627.730-627.7405. 815 4. Accidental bodily injury sustained in this state by any 816 other person while occupying the owner’s motor vehicle or, if a 817 resident of this state, while not an occupant of a self 818 propelled vehicle, if the injury is caused by physical contact 819 with such motor vehicle if, providedthe injured person is not 820himself or herself: 821 a. The owner of a motor vehicle with respect to which 822 security is required under the no-fault lawss.627.730823627.7405; or 824 b. Entitled to personal injury benefits from the insurer of 825 the owneror ownersof such a motor vehicle. 826 (i)(f)If two or more insurers are liable to pay personal 827 injury protection benefits for the same injury to any one 828 person, the maximum payable isshall beas specified in 829 subsection (1), and any insurer paying the benefits isshall be830 entitled to recover from each of the other insurers an equitable 831 pro rata share of the benefits paid and expenses incurred in 832 processing the claim. 833 (j)(g)It is a violation of the insurance code for an 834 insurer to fail to timely provide benefits as required by this 835 section with such frequency as to constitute a general business 836 practice. 837 (k)(h)Benefits areshallnotbedue or payable to a 838 claimant who knowingly:or on the behalf of an insured person if839that person has840 1. Submits a false or misleading statement, document, 841 record, or bill; 842 2. Submits false or misleading information; or 843 3. Has otherwise committed or attempted to commit a 844 fraudulent insurance act as defined in s. 626.989. 845 846 A claimant that violates this paragraph is not entitled to any 847 personal injury protection benefits or payment for any bills and 848 services, regardless of whether a portion of the claim may be 849 legitimate. However, a claimant that does not violate this 850 paragraph may not be denied benefits solely due to a violation 851 by another claimant. 852 (l) Notwithstanding any remedies afforded by law, the 853 insurer may recover from a claimant who violates paragraph (k) 854 any sums previously paid to that claimant and may bring any 855 available common law and statutory causes of action. A claimant 856 has violated paragraph (k)committed, by a material act or857omission, any insurance fraud relating to personal injury858protection coverage under his or her policy,if the fraud is 859 admitted to in a sworn statementby the insuredorif it is860 established in a court of competent jurisdiction. Any insurance 861 fraud voidsshall voidall coverage arising from the claim 862 related tosuch fraud under the personal injury protection863coverage ofthe claimantinsured personwho committed the fraud, 864 irrespective of whether a portion of the insured person’s claim 865 may be legitimate, and any benefits paid beforeprior tothe 866 discovery of theinsured person’s insurancefraud isshall be867 recoverable by the insurer from the claimantpersonwho 868 committed insurance fraud in their entirety. The prevailing 869 party is entitled to its costs and attorney’s fees in any action 870 in which it prevails in an insurer’s action to enforce its right 871 of recovery under this paragraph. This paragraph does not 872 preclude or limit an insurer’s right to deny a claim based on 873 other evidence of fraud or affect an insurer’s right to plead 874 and prove a claim or defense of fraud under common law. If a 875 physician, hospital, clinic, or other medical institution 876 violates paragraph (k), the injured party is not liable for, and 877 the physician, hospital, clinic, or other medical institution 878 may not bill the insured for, charges that are unpaid because of 879 failure to comply with paragraph (k). Any agreement requiring 880 the injured person or insured to pay for such charges is 881 unenforceable. 882 (5) INSURER INVESTIGATIONS.—An insurer has the right and 883 duty to conduct a reasonable investigation of a claim. In the 884 course of the insurer’s investigation of a claim: 885 (a) The insurer may require the insured, claimant, or 886 medical provider to provide copies of the treatment and 887 examination records. Any records review need not be based on a 888 physical examination and may be obtained at any time, including 889 after reduction or denial of the claim. 890 1. The records review must be conducted by a practitioner 891 within the same licensing chapter as the medical provider whose 892 records are being reviewed. 893 2. The 30-day period for payment under paragraph (4)(b) is 894 tolled from the date the insurer sends its request for treatment 895 records to the date that the insurer receives the treatment 896 records. 897 3. A medical provider may impose a reasonable, cost-based 898 fee that includes only the cost of copying and postage, but does 899 not include the cost of labor for copying. The cost of copying 900 may not exceed $1 per page for the first 25 pages and 25 cents 901 per page for each page in excess of 25 pages. However, a medical 902 provider may impose the reasonable costs of reproducing X rays 903 and other special kinds of records, including the actual cost of 904 the material and supplies used to duplicate the record, as well 905 as the labor costs and overhead costs associated with such 906 duplication. 907 (b) In all circumstances, an insured seeking benefits under 908 the no-fault law must comply with the terms of the policy, which 909 includes, but is not limited to, submitting to examinations 910 under oath. Compliance with this paragraph is a condition 911 precedent to receiving benefits. 912 (c) An insurer may deny benefits if the insured, claimant, 913 or medical provider fails to: 914 1. Cooperate in the insurer’s investigation; 915 2. Commits a fraud or material misrepresentation; or 916 3. Comply with this subsection. 917 (6)(5)CHARGES FOR TREATMENT OF INJURED PERSONS.— 918 (a)1.Any physician, hospital, clinic, or other person or 919 institution lawfully rendering treatment to an injured person 920 for a bodily injury covered by personal injury protection 921 insurance may charge the insurer and injured party only a 922 reasonable amount pursuant to this section for the services and 923 supplies rendered, and the insurer providingsuchcoverage may 924 pay for such charges directly to thesuchperson or institution 925 lawfully rendering such treatment,if the insured receiving such 926 treatment or his or her guardian has countersigned the properly 927 completed invoice, bill, or claim form approved by the office 928 upon which such charges are to be paid for as having actually 929 been rendered, to the best knowledge of the insured or his or 930 her guardian.In no event,However,maysuch charges may not 931 exceeda charge be in excess ofthe amount the person or 932 institution customarily charges for like services or supplies. 933 In determiningWith respect to a determination ofwhether a 934 charge for a particular service, treatment, or otherwise is 935 reasonable, consideration may be given to evidence of usual and 936 customary charges and payments accepted by the provider involved 937 in the dispute,andreimbursement levels in the community,and938 various federal and state medical fee schedules applicable to 939 automobile and other insurance coverages, and other information 940 relevant to the reasonableness of the reimbursement for the 941 service, treatment, or supply. 942 1.2.The insurer may limit reimbursement to no more than 80 943 percent of the following schedule of maximum charges: 944 a. For emergency transport and treatment by providers 945 licensed under chapter 401, 200 percent of Medicare. 946 b. For emergency services and care provided by a hospital 947 licensed under chapter 395, 75 percent of the hospital’s usual 948 and customary charges. 949 c. For emergency services and care as defined by s. 950 395.002(9)provided in a facility licensed under chapter 395 951 rendered by a physician or dentist, and related hospital 952 inpatient services rendered by a physician or dentist, the usual 953 and customary charges in the community. 954 d. For hospital inpatient services, other than emergency 955 services and care, 200 percent of the Medicare Part A 956 prospective payment applicable to the specific hospital 957 providing the inpatient services. 958 e. For hospital outpatient services, other than emergency 959 services and care, 200 percent of the Medicare Part A Ambulatory 960 Payment Classification for the specific hospital providing the 961 outpatient services. 962 f. For all other medical services,supplies, and care,200 963 percent of the allowable amount under the participating 964 physicians schedule of Medicare Part B. For all other supplies 965 and care, including durable medical equipment and care and 966 services rendered by ambulatory surgical centers and clinical 967 laboratories, 200 percent of the allowable amount under Medicare 968 Part B. However, if such services, supplies, or care is not 969 reimbursable under Medicare Part B, the insurer may limit 970 reimbursement to 80 percent of the maximum reimbursable 971 allowance under workers’ compensation, as determined under s. 972 440.13 and rules adopted thereunder which are in effect at the 973 time such services, supplies, or care is provided. Services, 974 supplies, or care that is not reimbursable under Medicare or 975 workers’ compensation is not required to be reimbursed by the 976 insurer. 977 2.3.For purposes of subparagraph 1.2., the applicable fee 978 schedule or payment limitation under Medicare is the fee 979 schedule or payment limitation in effect on January 1 of the 980 year in whichat the timethe services, supplies, or care was 981 rendered and for the area in which such services were rendered, 982 which shall apply throughout the remainder of the year 983 notwithstanding any subsequent changes made to the fee schedule 984 or payment limitation, except that it may not be less than the 985 allowable amount under the participating physicians schedule of 986 Medicare Part B for 2007 for medical services, supplies, and 987 care subject to Medicare Part B. 988 3.4.Subparagraph 1.2.does not allow the insurer to apply 989 any limitation on the number of treatments or other utilization 990 limits that apply under Medicare or workers’ compensation. An 991 insurer that applies the allowable payment limitations of 992 subparagraph 1.2.must reimburse a provider who lawfully 993 provided care or treatment under the scope of his or her 994 license,regardless of whether such provider iswould be995 entitled to reimbursement under Medicare due to restrictions or 996 limitations on the types or discipline of health care providers 997 who may be reimbursed for particular procedures or procedure 998 codes. 999 4.5.If an insurer limits payment as authorized by 1000 subparagraph 1.2., the person providing such services, 1001 supplies, or care may not bill or attempt to collect from the 1002 insured any amount in excess of such limits, except for amounts 1003 that are not covered by the insured’s personal injury protection 1004 coverage due to the coinsurance amount or maximum policy limits. 1005 5. Effective January 1, 2012, an insurer may limit 1006 reimbursement pursuant to this paragraph only if the insurance 1007 policy includes the schedule of charges specified in this 1008 paragraph. 1009 (b)1. An insurer or insured is not required to pay a claim 1010 or charges: 1011 a. Made by a broker or by a person making a claim on behalf 1012 of a broker; 1013 b. For any service or treatment that was not lawful at the 1014 time rendered; 1015 c. To any person who knowingly submits a false or 1016 misleading statement relating to the claim or charges; 1017 d. With respect to a bill or statement that does not 1018substantiallymeet theapplicablerequirements of paragraphs 1019 (c),paragraph(d), and (e); 1020 e. Except for emergency treatment and care, if the insured 1021 failed to countersign a billing form or patient log related to 1022 such claim or charges. Failure to submit a countersigned billing 1023 form or patient log creates a rebuttable presumption that the 1024 insured did not receive the alleged treatment. The insurer is 1025 not considered to have been furnished with notice of the subject 1026 treatment and loss until the insurer is able to verify that the 1027 insured received the alleged treatment. As used in this sub 1028 subparagraph, the term “countersigned” means a second or 1029 verifying signature, as on a previously signed document, and is 1030 not satisfied by the statement “signature on file” or any 1031 similar statement; 1032 f.e.For any treatment or service that is upcoded, or that 1033 is unbundled ifwhensuch treatment or services should be 1034 bundled, in accordance with paragraph (d). To facilitate prompt 1035 payment of lawful services, an insurer may change codes that it 1036 determines to have been improperly or incorrectly upcoded or 1037 unbundled, and may make payment based on the changed codes, 1038 without affecting the right of the provider to dispute the 1039 change by the insurer if, provided thatbefore doing so, the 1040 insurer contactsmust contactthe health care provider and 1041 discussesdiscussthe reasons for the insurer’s change and the 1042 health care provider’s reason for the coding, or makesmakea 1043 reasonable good faith effort to do so, as documented in the 1044 insurer’s file; and 1045 g.f.For medical services or treatment billed by a 1046 physician and not provided in a hospital unless such services 1047 are rendered by the physician or are incident to his or her 1048 professional services and are included on the physician’s bill, 1049 including documentation verifying that the physician is 1050 responsible for the medical services that were rendered and 1051 billed. 1052 2. The Department of Health, in consultation with the 1053 appropriate professional licensing boards, shall adopt, by rule, 1054 a list of diagnostic tests deemed not to be medically necessary 1055 for use in the treatment of persons sustaining bodily injury 1056 covered by personal injury protection benefits under this 1057 section. Theinitiallistshall be adopted by January 1, 2004,1058andshall be revised from time to time as determined by the 1059 Department of Health, in consultation with the respective 1060 professional licensing boards. Inclusion of a test on the list 1061 mustof invalid diagnostic tests shallbe based on lack of 1062 demonstrated medical value and a level of general acceptance by 1063 the relevant provider community and mayshallnot be dependent 1064 for results entirely upon subjective patient response. 1065 Notwithstanding its inclusion on a fee schedule in this 1066 subsection, an insurer or insured is not required to pay any 1067 charges or reimburse claims for any invalid diagnostic test as 1068 determined by the Department of Health. 1069 (c)1.With respect to any treatment or service, other than 1070 medical services billed by a hospital or other provider for 1071 emergency services as defined in s. 395.002 or inpatient 1072 services rendered at a hospital-owned facility, the statement of 1073 charges must be furnished to the insurer by the provider and may 1074 not include, and the insurer is not required to pay, charges for 1075 treatment or services rendered more than 35 days before the 1076 postmark date or electronic transmission date of the statement, 1077 except for past due amounts previously billed on a timely basis 1078 under this paragraph, and except that, if the provider submits 1079 to the insurer a notice of initiation of treatment within 21 1080 days after its first examination or treatment of the claimant, 1081 the statement may include charges for treatment or services 1082 rendered up to, but not more than, 75 days before the postmark 1083 date of the statement. The injured party is not liable for, and 1084 the provider mayshallnot bill the injured party for, charges 1085 that are unpaid because of the provider’s failure to comply with 1086 this paragraph. Any agreement requiring the injured person or 1087 insured to pay for such charges is unenforceable. 1088 1.2.If, however,the insured fails to furnish the provider 1089 with the correct name and address of the insured’s personal 1090 injury protection insurer, the provider has 35 days from the 1091 date the provider obtains the correct information to furnish the 1092 insurer with a statement of the charges. The insurer is not 1093 required to pay for such charges unless the provider includes 1094 with the statement documentary evidence that was provided by the 1095 insured during the 35-day period demonstrating that the provider 1096 reasonably relied on erroneous information from the insured and 1097 either: 1098 a. A denial letter from the incorrect insurer; or 1099 b. Proof of mailing, which may include an affidavit under 1100 penalty of perjury, reflecting timely mailing to the incorrect 1101 address or insurer. 1102 2.3.For emergency services and care as defined in s. 1103 395.002 rendered in a hospital emergency department or for 1104 transport and treatment rendered by an ambulance provider 1105 licensed pursuant to part III of chapter 401, the provider is 1106 not required to furnish the statement of charges within the time 1107 periods established by this paragraph,;and the insurer isshall1108 notbeconsidered to have been furnished with notice of the 1109 amount of covered loss for purposes of paragraph (4)(b) until it 1110 receives a statement complying with paragraph (d), or copy 1111 thereof, which specifically identifies the place of service to 1112 be a hospital emergency department or an ambulance in accordance 1113 with billing standards recognized by the Centers for Medicare 1114 and Medicaid ServicesHealth Care Finance Administration. 1115 3.4.Each notice of the insured’s rights under s. 627.7401 1116 must include the following statement in type no smaller than 12 1117 points: 1118 1119 BILLING REQUIREMENTS.—Florida Statutes provide that 1120 with respect to any treatment or services, other than 1121 certain hospital and emergency services, the statement 1122 of charges furnished to the insurer by the provider 1123 may not include, and the insurer and the injured party 1124 are not required to pay, charges for treatment or 1125 services rendered more than 35 days before the 1126 postmark date of the statement, except for past due 1127 amounts previously billed on a timely basis, and 1128 except that, if the provider submits to the insurer a 1129 notice of initiation of treatment within 21 days after 1130 its first examination or treatment of the claimant, 1131 the first billing cycle statement may include charges 1132 for treatment or services rendered up to, but not more 1133 than, 75 days before the postmark date of the 1134 statement. 1135 1136 (d) All statements and bills for medical services rendered 1137 by any physician, hospital, clinic, or other person or 1138 institution shall be submitted to the insurer on a properly 1139 completed Centers for Medicare and Medicaid Services (CMS) 1500 1140 form, UB 92 forms, or any other standard form approved by the 1141 office or adopted by the commission for purposes of this 1142 paragraph. All billings for such services rendered by providers 1143 mustshall, to the extent applicable, follow the Physicians’ 1144 Current Procedural Terminology (CPT) or Healthcare Correct 1145 Procedural Coding System (HCPCS), or ICD-9 in effect for the 1146 year in which services are rendered and comply with theCenters1147for Medicare and Medicaid Services (CMS)1500 form instructions 1148 and the American Medical Association Current Procedural 1149 Terminology (CPT) Editorial Panel and Healthcare Correct 1150 Procedural Coding System (HCPCS). All providers other than 1151 hospitals shall include on the applicable claim form the 1152 professional license number of the provider in the line or space 1153 provided for “Signature of Physician or Supplier, Including 1154 Degrees or Credentials.” In determining compliance with 1155 applicable CPT and HCPCS coding, guidance shall be provided by 1156 the Physicians’ Current Procedural Terminology (CPT) or the 1157 Healthcare Correct Procedural Coding System (HCPCS) in effect 1158 for the year in which services were rendered, the Office of the 1159 Inspector General(OIG), Physicians Compliance Guidelines, and 1160 other authoritative treatises designated by rule by the Agency 1161 for Health Care Administration. ANostatement of medical 1162 services may not include charges for medical services of a 1163 person or entity that performed such services without possessing 1164 the valid licenses required to perform such services. For 1165 purposes of paragraph (4)(b), an insurer isshallnotbe1166 considered to have been furnished with notice of the amount of 1167 covered loss or medical bills due unless the statements or bills 1168 comply with this paragraph, and unless the statements or bills 1169 arecomply with this paragraph, and unless the statements or1170bills areproperly completed in their entirety as to all 1171 material provisions, with all relevant information being 1172 provided therein. If an insurer denies a claim due to a 1173 provider’s failure to submit a properly completed statement or 1174 bill, the insurer shall notify the provider as to the provisions 1175 that were improperly completed, and the provider shall have 15 1176 days after the receipt of such notice to submit a properly 1177 completed statement or bill. If the provider fails to comply 1178 with this requirement, the insurer is not required to pay for 1179 improperly billed services. 1180 (e)1. At the initial treatment or service provided, each 1181 physician, other licensed professional, clinic, or other medical 1182 institution providing medical services upon which a claim for 1183 personal injury protection benefits is based shall require an 1184 insured person, or his or her guardian, to execute a disclosure 1185 and acknowledgment form, which reflects at a minimum that: 1186 a. The insured, or his or her guardian, must countersign 1187 the form attesting to the fact that the services set forth 1188 therein were actually rendered. Listing CPT codes or other 1189 coding on the disclosure and acknowledgment form does not 1190 satisfy this requirement; 1191 b. The insured, or his or her guardian, has both the right 1192 and affirmative duty to confirm that the services were actually 1193 rendered; 1194 c. The insured, or his or her guardian, was not solicited 1195 by any person to seek any services from the medical provider; 1196 d. The physician, other licensed professional, clinic, or 1197 other medical institution rendering services for which payment 1198 is being claimed explained the services to the insured or his or 1199 her guardian; and 1200 e. If the insured notifies the insurer in writing of a 1201 billing error, the insured may be entitled to a certain 1202 percentage of a reduction in the amounts paid by the insured’s 1203 motor vehicle insurer. 1204 2. The physician, other licensed professional, clinic, or 1205 other medical institution rendering services for which payment 1206 is being claimed has the affirmative duty to explain the 1207 services rendered to the insured, or his or her guardian, so 1208 that the insured, or his or her guardian, countersigns the form 1209 with informed consent. 1210 3. Countersignature by the insured, or his or her guardian, 1211 is not required for the reading of diagnostic tests or other 1212 services that are of such a nature that they are not required to 1213 be performed in the presence of the insured. 1214 4. The licensed medical professional rendering treatment 1215 for which payment is being claimed must sign, by his or her own 1216 hand, the form complying with this paragraph. 1217 5. An insurer is not considered to have been furnished with 1218 notice of the amount of a covered loss or medical bills unless 1219 the original completed disclosure and acknowledgment form is 1220shall befurnished to the insurer pursuant to paragraph (4)(b) 1221 and sub-subparagraph 1.a. The disclosure and acknowledgement 1222 form may not be electronically furnished. A disclosure and 1223 acknowledgement form that does not meet the minimum requirements 1224 of sub-subparagraph 1.a. does not provide an insurer with notice 1225 of the amount of a covered loss or medical bills due. 1226 6. This disclosure and acknowledgment form is not required 1227 for services billed by a provider for emergency services as 1228 defined in s. 395.002, for emergency services and care as 1229 defined in s. 395.002 rendered in a hospital emergency 1230 department, or for transport and treatment rendered by an 1231 ambulance provider licensed pursuant to part III of chapter 401. 1232 7. The Financial Services Commission shall adopt,by rule,1233 a standard disclosure and acknowledgment form tothat shallbe 1234 used to fulfill the requirements of this paragraph, effective 901235days after such form is adopted and becomes final.The1236commission shall adopt a proposed rule by October 1, 2003. Until1237the rule is final, the provider may use a form of its own which1238otherwise complies with the requirements of this paragraph.1239 8. As used in this paragraph, the term “countersigned” or 1240 “countersignature” means a second or verifying signature, as on 1241 a previously signed document, and is not satisfied by the 1242 statement “signature on file” or any similar statement. 1243 9. The requirements of this paragraph apply only with 1244 respect to the initial treatment or service of the insured by a 1245 provider. For subsequent treatments or service, the provider 1246 must maintain a patient log signed by the patient, in 1247 chronological order by date of service, that is consistent with 1248 the services being rendered to the patient as claimed. Listing 1249 CPT codes or other coding on the patient log does not satisfy 1250 this requirement. The provider must provide copies of the 1251 patient log to the insurer within 30 days after receiving a 1252 written request from the insurer. Failure to maintain a patient 1253 log renders the treatment unlawful and noncompensable. The 1254 requirementsof this subparagraphfor maintaining a patient log 1255 signed by the patient may be met by a hospital that maintains 1256 medical records as required by s. 395.3025 and applicable rules 1257 and makes such records available to the insurer upon request. 1258 (f) Upon written notification by any person, an insurer 1259 shall investigate any claim of improper billing by a physician 1260 or other medical provider. The insurer shall determine if the 1261 insured was properly billed for only those services and 1262 treatments that the insured actually received. If the insurer 1263 determines that the insured has been improperly billed, the 1264 insurer shall notify the insured, the person making the written 1265 notification, and the provider of its findings andshallreduce 1266 the amount of payment to the provider by the amount determined 1267 to be improperly billed. If a reduction is made due to such 1268 written notification by any person, the insurer shall pay to the 1269 person 20 percent of the amount of the reduction, up to $500. If 1270 the provider is arrested due to the improper billing,thenthe 1271 insurer shall pay to the person 40 percent of the amount of the 1272 reduction, up to $500. 1273 (g) An insurer may not systematically downcode with the 1274 intent to deny reimbursement otherwise due. Such action 1275 constitutes a material misrepresentation under s. 1276 626.9541(1)(i)2. 1277 (7)(6)DISCOVERY OF FACTS ABOUT AN INJURED PERSON; 1278 DISPUTES.— 1279 (b) Every physician, hospital, clinic, or other medical 1280 institution providing, before or after bodily injury upon which 1281 a claim for personal injury protection insurance benefits is 1282 based, any products, services, or accommodations in relation to 1283 that or any other injury, or in relation to a condition claimed 1284 to be connected with that or any other injury, shall, if 1285 requested to do so by the insurer against whom the claim has 1286 been made, permit the insurer or the insurer’s representative to 1287 conduct an onsite physical review and examination of the 1288 treatment location, treatment apparatuses, diagnostic devices, 1289 and any other medical equipment used for the services rendered 1290 within 10 days after the insurer’s request, and furnish 1291forthwitha written report of the history, condition, treatment, 1292 dates, and costs of such treatment of the injured person and why 1293 the items identified by the insurer were reasonable in amount 1294 and medically necessary, together with a sworn statement that 1295 the treatment or services rendered were reasonable and necessary 1296 with respect to the bodily injury sustained and identifying 1297 which portion of the expenses for such treatment or services was 1298 incurred as a result of such bodily injury, and produce 1299 forthwith, and permit the inspection and copying of, his or her 1300 or its records regarding such history, condition, treatment, 1301 dates, and costs of treatment if; provided thatthis doesshall1302 not limit the introduction of evidence at trial. Such sworn 1303 statement mustshallread as follows: “Under penalty of perjury, 1304 I declare that I have read the foregoing, and the facts alleged 1305 are true, to the best of my knowledge and belief.” ANocause of 1306 action for violation of the physician-patient privilege or 1307 invasion of the right of privacy may not be broughtshall be1308permittedagainst any physician, hospital, clinic, or other 1309 medical institution complying withthe provisions ofthis 1310 section. The person requesting such records and such sworn 1311 statement shall pay all reasonable costs connected therewith. 1312 1. If an insurer makes a written request for documentation 1313 or information under this paragraph within 30 days after having 1314 received notice of the amount of a covered loss under paragraph 1315 (4)(a), the amount or the partial amount thatwhichis the 1316 subject of the insurer’s inquiry isshall becomeoverdue if the 1317 insurer does not pay in accordance with paragraph (4)(b) or 1318 within 10 days after the insurer’s receipt of the requested 1319 documentation or information, whichever occurs later. For 1320 purposes of this subparagraphparagraph, the term “receipt” 1321 includes, but is not limited to, inspection and copying pursuant 1322 to this paragraph. AnAnyinsurer that requests documentation or 1323 information pertaining to reasonableness of charges or medical 1324 necessity under this paragraph without a reasonable basis for 1325 such requests as a general business practice is engaging in an 1326 unfair trade practice under the insurance code. 1327 2. If an insured seeking to recover benefits pursuant to 1328 the no-fault law assigns the contractual right to those benefits 1329 or payment of those benefits to any person or entity, the 1330 assignee must comply with the terms of the policy. In all 1331 circumstances, the assignee is obligated to cooperate under the 1332 policy, which includes, but is not limited to, participating in 1333 an examination under oath. Examinations under oath may be 1334 recorded by audio, video, court reporter, or any combination 1335 thereof. Compliance with this paragraph is a condition precedent 1336 to recovery of benefits pursuant to the no-fault law. 1337 a. If an insurer requests an examination under oath of a 1338 medical provider, the provider must produce the persons having 1339 the most knowledge of the issues identified by the insurer in 1340 the request for examination under oath. All claimants must 1341 produce and allow for the inspection all documents requested by 1342 the insurer which are relevant to the services rendered and 1343 reasonably obtainable by the claimant. The insurer must pay the 1344 medical provider reasonable compensation for attending the 1345 examination under oath; however, expert witness fees are not 1346 reasonable compensation. The medical provider may have an 1347 attorney present at the examination under oath at the provider’s 1348 own expense. 1349 b. Before requesting that an assignee participate in an 1350 examination under oath, the insurer must send a written request 1351 to the assignee requesting all information that the insurer 1352 believes is necessary to process the claim and relevant to the 1353 services rendered, including the information contemplated under 1354 this subparagraph. 1355 c. An insurer that, as a general practice, requests 1356 examinations under oath of an assignee without a reasonable 1357 basis is engaging in an unfair and deceptive trade practice. 1358 (8)(7)MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; 1359 REPORTS.— 1360 (b) If requested by the person examined, a party causing an 1361 examination to be made shall deliver to him or her a copy of 1362 every written report concerning the examination rendered by an 1363 examining physician, at least one of which reports must set out 1364 the examining physician’s findings and conclusions in detail. 1365 After such request and delivery, the party causing the 1366 examination to be made is entitled, upon request, to receive 1367 from the person examined every written report available to him 1368 or her or his or her representative concerning any examination, 1369 previously or thereafter made, of the same mental or physical 1370 condition. By requesting and obtaining a report of the 1371 examination so ordered, or by taking the deposition of the 1372 examiner, the person examined waives any privilege he or she may 1373 have, in relation to the claim for benefits, regarding the 1374 testimony of every other person who has examined, or may 1375 thereafter examine, him or her in respect to the same mental or 1376 physical condition. If a person fails to appear forunreasonably1377refuses to submit toan examination, the personal injury 1378 protection carrier is not required to payno longer liablefor 1379subsequentpersonal injury protection benefits incurred after 1380 the date of the first requested examination until the insured 1381 appears for the examination. Failure to appear for two scheduled 1382 examinations raises a rebuttable presumption that such failure 1383 was unreasonable. Submission to an examination is a condition 1384 precedent to the recovery of benefits. 1385 (9)(8)APPLICABILITY OF PROVISION REGULATING ATTORNEY’S 1386 FEES.—With respect to any disputeunder the provisions of ss.1387627.730-627.7405between the insured and the insurer under the 1388 no-fault law, or between an assignee of an insured’s rights and 1389 the insurer, the provisions of s. 627.428shallapply, except as 1390 provided in subsections (11) and (16)(10) and (15). 1391 (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and 1392 enter into contracts with preferredlicensed health care1393 providers for the benefits described in this section,referred1394to in this section as “preferred providers,”which includeshall1395includehealth care providers licensed under chapter 457, 1396 chapterchapters458, chapter 459, chapter 460, chapter 461, or 1397 chapterand463. 1398 (a) The insurer may provide an option to an insured to use 1399 a preferred provider at the time of purchase of the policy for 1400 personal injury protection benefits,if the requirements of this 1401 subsection are met. However, if the insurer offers a preferred 1402 provider option, it must also offer a nonpreferred provider 1403 policy. If the insured elects to use a provider who is not a 1404 preferred provider, whether the insured purchased a preferred 1405 provider policy or a nonpreferred provider policy, the medical 1406 benefits provided by the insurer mustshallbe as required by 1407 this section. 1408 (b) If the insured elects theto use a provider who is a1409 preferred provider option, the insurer may pay medical benefits 1410 in excess of the benefits required by this section and may waive 1411 or lower the amount of any deductible that applies to such 1412 medical benefits. As an alternative, or in addition to such 1413 benefits, waiver, or reduction, the insurer may provide an 1414 actuarially appropriate premium discount as specified in an 1415 approved rate filing to an insured who selects the preferred 1416 provider option. If the preferred provider option provides a 1417 premium discount, the insured forfeits the premium discount 1418 effective on the date that the insured elects to use a provider 1419 who is not a preferred provider and who renders nonemergency 1420 services, unless there is no member of the preferred provider 1421 network located within 15 miles of the insured’s place of 1422 residence whose scope of practice includes the required 1423 services, or unless the nonemergency services are rendered in 1424 the emergency room of a hospital licensed under chapter 395.If1425the insurer offers a preferred provider policy to a policyholder1426or applicant, it must also offer a nonpreferred provider policy.1427 (c) The insurer shall provide each insuredpolicyholder1428 with a current roster of preferred providers in the county in 1429 which the insured resides at the time of purchasingpurchase of1430 such policy, andshallmake such list available for public 1431 inspection during regular business hours at the insurer’s 1432 principal officeof the insurerwithin the state. The insurer 1433 may contract with a health insurer to use an existing preferred 1434 provider network to implement the preferred provider option. All 1435 providers and entities that are eligible to receive 1436 reimbursement pursuant to paragraph (1)(a) may provide services 1437 through a preferred provider network. Any other arrangement is 1438 subject to the approval of the Office of Insurance Regulation. 1439 (11)(10)DEMAND LETTER.— 1440 (a) As a condition precedent to filing any action for 1441 benefits under this section, the claimant filing suit must 1442 provide the insurermust be providedwith written notice of an 1443 intent to initiate litigation. Such notice may not be sent until 1444 the claim is overdue, including any additional time the insurer 1445 has to pay the claim pursuant to paragraph (4)(b). A premature 1446 demand letter is defective and cannot be cured unless the court 1447 first abates the action or the claimant first voluntarily 1448 dismisses the action. 1449 (b) Thenoticerequired notice mustshallstate that it is 1450 a “demand letter under s. 627.736(10)” andshallstate with 1451 specificity: 1452 1. The name of the insured upon which such benefits are 1453 being sought, including a copy of the assignment giving rights 1454 to the claimant if the claimant is not the insured. 1455 2. The claim number or policy number upon which such claim 1456 was originally submitted to the insurer. 1457 3. To the extent applicable, the name of any medical 1458 provider who rendered to an insured the treatment, services, 1459 accommodations, or supplies that form the basis of such claim; 1460 and an itemized statement specifying each exact amount, the date 1461 of treatment, service, or accommodation, and the type of benefit 1462 claimed to be due. A completed form satisfying the requirements 1463 of paragraph (6)(5)(d) or the lost-wage statement previously 1464 submitted may be used as the itemized statement.To the extent1465that the demand involves an insurer’s withdrawal of payment1466under paragraph (7)(a) for future treatment not yet rendered,1467the claimant shall attach a copy of the insurer’s notice1468withdrawing such payment and an itemized statement of the type,1469frequency, and duration of future treatment claimed to be1470reasonable and medically necessary.1471 (c) Each notice required by this subsection must be 1472 delivered to the insurer by United States certified or 1473 registered mail, return receipt requested. Such postal costs 1474 shall be reimbursed by the insurer ifsorequested by the 1475 claimant in the notice,when the insurer pays the claim. Such 1476 notice must be sent to the person and address specified by the 1477 insurer for the purposes of receiving notices under this 1478 subsection. Each licensed insurer, whether domestic, foreign, or 1479 alien, shall file with the office designation of the name and 1480 address of the person to whom notices mustpursuant to this1481subsection shallbe sent which the office shall make available 1482 on its Internet website. The name and address on file with the 1483 office pursuant to s. 624.422 shall be deemed the authorized 1484 representative to accept notice pursuant to this subsection if 1485in the eventno other designation has been made. 1486 (d) If, within 30 days after receipt of notice by the 1487 insurer, the overdue claim specified in the notice is paid by 1488 the insurer together with applicable interest and a penalty of 1489 10 percent of the overdue amount paid by the insurer, subject to 1490 a maximum penalty of $250, no action may be brought against the 1491 insurer. Ifthe demand involves an insurer’s withdrawal of1492payment under paragraph (7)(a) for future treatment not yet1493rendered, no action may be brought against the insurer if,1494within 30 days after its receipt of the notice, the insurer1495mails to the person filing the notice a written statement of the1496insurer’s agreement to pay for such treatment in accordance with1497the notice and to pay a penalty of 10 percent, subject to a1498maximum penalty of $250, when it pays for such future treatment1499in accordance with the requirements of this section. To the1500extentthe insurer determines not to pay any amount demanded, 1501 the penalty isshallnotbepayable in any subsequent action. 1502 For purposes of this subsection, payment or the insurer’s 1503 agreement isshall betreated as being made on the date a draft 1504 or other valid instrument that is equivalent to payment, or the 1505 insurer’s written statement of agreement, is placed in the 1506 United States mail in a properly addressed, postpaid envelope, 1507 or if not so posted, on the date of delivery. The insurer is not 1508 obligated to pay any attorney’s fees if the insurer pays the 1509 claim or mails its agreement to pay for future treatment within 1510 the time prescribed by this subsection. 1511 (e) The applicable statute of limitation for an action 1512 under this section shall be tolled fora period of30 business 1513 days by the mailing of the notice required by this subsection. 1514 (f) A demand letter that does not meet the minimum 1515 requirements set forth in this subsection or that is sent during 1516 the pendency of the lawsuit is defective. A defective demand 1517 letter cannot be cured unless the court first abates the action 1518 or the claimant first voluntarily dismisses the action. 1519 (g)(f)AnAnyinsurer making a general business practice of 1520 not paying valid claims until receipt of the notice required by 1521 this subsection is engaging in an unfair trade practice under 1522 the insurance code. 1523 (h) If the insurer pays in response to a demand letter and 1524 the claimant disputes the amount paid, the claimant must send a 1525 second demand letter by certified or registered mail stating the 1526 exact amount that the claimant believes the insurer owes and why 1527 the claimant believes the amount paid is incorrect. The insurer 1528 has an additional 10 days after receipt of the second letter to 1529 issue any additional payment that is owed. The purpose of this 1530 provision is to avoid unnecessary litigation over miscalculated 1531 payments. 1532 (i) Demand letters may not be used to request the 1533 production of claim documents or other records from the insurer. 1534 Section 9. Subsection (10) of section 817.234, Florida 1535 Statutes, is amended, present subsection (12) of that section is 1536 renumbered as subsection (13) and amended, and a new subsection 1537 (12) is added to that section, to read: 1538 817.234 False and fraudulent insurance claims.— 1539 (10)(a) Any person who owns an business entity eligible for 1540 reimbursement under s. 627.736(1) and who is found guilty of 1541 insurance fraud under this section shall lose his or her 1542 occupational license for such entity for 5 years and may not 1543 receive reimbursement for personal injury protection benefits 1544 for 10 years. 1545 (b) Any licensed health care practitioner found guilty of 1546 insurance fraud under this section shall lose his or her license 1547 to practice for 5 years and may not receive reimbursement for 1548 personal injury protection benefits for 10 years.As used in1549this section, the term “insurer” means any insurer, health1550maintenance organization, self-insurer, self-insurance fund, or1551other similar entity or person regulated under chapter 440 or1552chapter 641 or by the Office of Insurance Regulation under the1553Florida Insurance Code.1554 (12) In addition to any criminal liability, a person 1555 convicted of violating any provision of this section for the 1556 purpose of receiving insurance proceeds from a motor vehicle 1557 insurance contract is subject to a civil penalty. 1558 (a) Except for a violation of subsection (9), the civil 1559 penalty shall be: 1560 1. A fine up to $5,000 for a first offense. 1561 2. A fine greater than $5,000, but not to exceed $10,000, 1562 for a second offense. 1563 3. A fine greater than $10,000, but not to exceed $15,000, 1564 for a third or subsequent offense. 1565 (b) The civil penalty for a violation of subsection (9) 1566 must be at least $15,000, but may not exceed $50,000. 1567 (c) The civil penalty shall be paid to the Insurance 1568 Regulatory Trust Fund within the Department of Financial 1569 Services and used by the department for the investigation and 1570 prosecution of insurance fraud. 1571 (d) This subsection does not prohibit a state attorney from 1572 entering into a written agreement in which the person charged 1573 with the violation does not admit to or deny the charges but 1574 consents to payment of the civil penalty. 1575 (13)(12)As used in this section, the term: 1576 (a) “Insurer” means any insurer, health maintenance 1577 organization, self-insurer, self-insurance fund, or similar 1578 entity or person regulated under chapter 440 or chapter 641 or 1579 by the Office of Insurance Regulation under the Florida 1580 Insurance Code. 1581 (b)(a)“Property” means property as defined in s. 812.012. 1582 (c)(b)“Value” has the same meaningmeans valueas provided 1583definedin s. 812.012. 1584 Section 10. Subsection (1) of section 324.021, Florida 1585 Statutes, is amended to read: 1586 324.021 Definitions; minimum insurance required.—The 1587 following words and phrases when used in this chapter shall, for 1588 the purpose of this chapter, have the meanings respectively 1589 ascribed to them in this section, except in those instances 1590 where the context clearly indicates a different meaning: 1591 (1) MOTOR VEHICLE.—Every self-propelled vehicle thatwhich1592 is designed and required to be licensed for use upon a highway, 1593 including trailers and semitrailers designed for use with such 1594 vehicles, except traction engines, road rollers, farm tractors, 1595 power shovels, and well drillers, and every vehicle thatwhich1596 is propelled by electric power obtained from overhead wires but 1597 not operated upon rails, but not including any bicycle or moped. 1598 However, the term does“motor vehicle” shallnot include aany1599 motor vehicle as defined in s. 627.732(3)ifwhenthe owner of 1600 such vehicle has complied with the no-fault lawrequirements of1601ss.627.730-627.7405, inclusive, unless the provisions of s. 1602 324.051 apply; and, in such case, the applicable proof of 1603 insurance provisions of s. 320.02 apply. 1604 Section 11. Paragraph (k) of subsection (2) of section 1605 456.057, Florida Statutes, is amended to read: 1606 456.057 Ownership and control of patient records; report or 1607 copies of records to be furnished.— 1608 (2) As used in this section, the terms “records owner,” 1609 “health care practitioner,” and “health care practitioner’s 1610 employer” do not include any of the following persons or 1611 entities; furthermore, the following persons or entities are not 1612 authorized to acquire or own medical records, but are authorized 1613 under the confidentiality and disclosure requirements of this 1614 section to maintain those documents required by the part or 1615 chapter under which they are licensed or regulated: 1616 (k) Persons or entities practicing under s. 627.736(8) 1617627.736(7). 1618 Section 12. Paragraph (b) of subsection (1) of section 1619 627.7401, Florida Statutes, is amended to read: 1620 627.7401 Notification of insured’s rights.— 1621 (1) The commission, by rule, shall adopt a form for the 1622 notification of insureds of their right to receive personal 1623 injury protection benefits under theFlorida Motor Vehicleno 1624 fault law. Such notice shall include: 1625 (b) An advisory informing insureds that: 1626 1. Pursuant to s. 626.9892, the Department of Financial 1627 Services may pay rewards of up to $25,000 to persons providing 1628 information leading to the arrest and conviction of persons 1629 committing crimes investigated by the Division of Insurance 1630 Fraud arising from violations of s. 440.105, s. 624.15, s. 1631 626.9541, s. 626.989, or s. 817.234. 1632 2. Pursuant to s. 627.736(6)(e)1.627.736(5)(e)1., if the 1633 insured notifies the insurer of a billing error, the insured may 1634 be entitled to a certain percentage of a reduction in the amount 1635 paid by the insured’s motor vehicle insurer. 1636 Section 13. This act shall take effect July 1, 2011.