Florida Senate - 2009                             CS for SB 1986
       
       
       
       By the Committee on Health Regulation; and Senators Gaetz and
       Peaden
       
       
       
       588-03464A-09                                         20091986c1
    1                        A bill to be entitled                      
    2         An act relating to health care; providing legislative
    3         findings; designating Miami-Dade County as a health
    4         care fraud area of concern; amending s. 68.085, F.S.;
    5         allocating certain funds recovered under the Florida
    6         False Claims Act to fund rewards for persons who
    7         report and provide information relating to Medicaid
    8         fraud; amending s. 68.086, F.S.; providing that a
    9         defendant who prevails in an action under the Florida
   10         False Claims Act may be awarded attorney’s fees and
   11         costs against the person bringing the action under
   12         certain circumstances; amending s. 400.471, F.S.;
   13         prohibiting the Agency for Health Care Administration
   14         from renewing a license of a home health agency in
   15         certain counties if the agency has been sanctioned for
   16         certain misconduct; amending s. 400.474, F.S.;
   17         authorizing the Agency for Health Care Administration
   18         to deny, revoke, or suspend the license of or fine a
   19         home health agency that bills the Medicaid program for
   20         medically unnecessary services; amending s. 400.506,
   21         F.S.; exempting certain items from a prohibition
   22         against providing remuneration to certain persons by a
   23         nurse registry; amending s. 408.05, F.S.; requiring
   24         the Florida Center for Health Information and Policy
   25         Analysis to take certain actions to improve the
   26         prevention and detection of health care fraud through
   27         the use of technology; creating s. 408.8065;, F.S.;
   28         providing additional licensure requirements for home
   29         health agencies, home medical equipment providers, and
   30         health care clinics; imposing criminal penalties on a
   31         person who knowingly submits misleading information to
   32         the Agency for Health Care Administration in
   33         connection with applications for certain licenses;
   34         amending s. 408.810, F.S.; requiring certain licensees
   35         to provide clients with a description of Medicaid
   36         fraud and the statewide toll-free telephone number for
   37         the central Medicaid fraud hotline; amending s.
   38         408.815, F.S.; providing additional grounds to deny an
   39         application for a license; amending s. 409.905, F.S.;
   40         authorizing the Agency for Health Care Administration
   41         to require prior authorization of care based on
   42         utilization rates; requiring a home health agency to
   43         submit a plan of care and documentation of a
   44         recipient’s medical condition to the Agency for Health
   45         Care Administration when requesting prior
   46         authorization; prohibiting the Agency for Health Care
   47         Administration from paying for home health services
   48         unless specified requirements are satisfied; amending
   49         s. 409.912, F.S.; requiring the Agency for Health Care
   50         Administration to establish norms for the utilization
   51         of Medicaid services; requiring the agency to submit a
   52         report relating to the overutilization of Medicaid
   53         services; amending s. 409.913, F.S.; requiring that
   54         the annual report submitted by the Agency for Health
   55         Care Administration and the Medicaid Fraud Control
   56         Unit of the Department of Legal Affairs recommend
   57         changes necessary to prevent and detect Medicaid
   58         fraud; requiring the Agency for Health Care
   59         Administration to monitor patterns of overutilization
   60         of Medicaid services; requiring the agency to deny
   61         payment or require repayment for Medicaid services
   62         under certain circumstances; requiring the Agency for
   63         Health Care Administration to immediately terminate a
   64         Medicaid provider’s participation in the Medicaid
   65         program as a result of certain adjudications against
   66         the provider or certain affiliated persons; requiring
   67         the Agency for Health Care Administration to suspend
   68         or terminate a Medicaid provider’s participation in
   69         the Medicaid program if the provider or certain
   70         affiliated persons participating in the Medicaid
   71         program have been suspended or terminated by the
   72         Federal Government or another state; providing that a
   73         provider is subject to sanctions for violations of law
   74         as the result of actions or inactions of the provider
   75         or certain affiliated persons; requiring the Agency
   76         for Health Care Administration to use specified
   77         documents from a provider’s records to calculate an
   78         overpayment by the Medicaid program; prohibiting a
   79         provider from using certain documents or data as
   80         evidence when challenging a claim of overpayment by
   81         the Agency for Health Care Administration; requiring
   82         that the agency provide notice of certain
   83         administrative sanctions to other regulatory agencies
   84         within a specified period; requiring the Agency for
   85         Health Care Administration to withhold or deny
   86         Medicaid payments under certain circumstances;
   87         requiring the agency to terminate a provider’s
   88         participation in the Medicaid program if the provider
   89         fails to repay certain overpayments from the Medicaid
   90         program; requiring the agency to provide at least
   91         annually information on Medicaid fraud in an
   92         explanation of benefits letter; requiring the Agency
   93         for Health Care Administration to post a list on its
   94         website of Medicaid providers and affiliated persons
   95         of providers who have been terminated or sanctioned;
   96         amending s. 409.920, F.S.; defining the term “managed
   97         care organization”; providing criminal penalties and
   98         fines for Medicaid fraud; granting civil immunity to
   99         certain persons who report suspected Medicaid fraud;
  100         creating s. 409.9203, F.S.; authorizing the payment of
  101         rewards to persons who report and provide information
  102         relating to Medicaid fraud; amending s. 456.004, F.S.;
  103         requiring the Department of Health to work
  104         cooperatively with the Agency for Health Care
  105         Administration and the judicial system to recover
  106         overpayments by the Medicaid program; amending s.
  107         456.041, F.S.; requiring the Department of Health to
  108         include a statement in the practitioner profile if a
  109         practitioner has been terminated from participating in
  110         the Medicaid program; creating s. 456.0635, F.S.;
  111         prohibiting Medicaid fraud in the practice of health
  112         care professions; requiring the Department of Health
  113         or boards within the department to refuse to admit to
  114         exams and to deny licenses, permits, or certificates
  115         to certain persons who have engaged in certain acts;
  116         requiring health care practitioners to report
  117         allegations of Medicaid fraud; specifying that
  118         acceptance of the relinquishment of a license in
  119         anticipation of charges relating to Medicaid fraud
  120         constitutes permanent revocation of a license;
  121         amending s. 456.072, F.S.; creating additional grounds
  122         for the Department of Health to take disciplinary
  123         action against certain applicants or licensees for
  124         misconduct relating to a Medicaid program or to health
  125         care fraud; amending s. 456.074, F.S.; requiring the
  126         Department of Health to issue an emergency order
  127         suspending the license of a person who engages in
  128         certain criminal conduct relating to the Medicaid
  129         program; amending s. 465.022, F.S.; authorizing
  130         partnerships and corporations to obtain pharmacy
  131         permits; requiring applicants or certain persons
  132         affiliated with an applicant for a pharmacy permit to
  133         submit a set of fingerprints for a criminal history
  134         records check and pay the costs of the criminal
  135         history records check; amending s. 465.023, F.S.;
  136         requiring the Department of Health or the Board of
  137         Pharmacy to deny an application for a pharmacy permit
  138         or take disciplinary action against a permitee for
  139         certain misconduct by the applicant, licensee, or
  140         person affiliated with the applicant or licensee;
  141         amending s. 825.103, F.S.; redefining the term
  142         “exploitation of an elderly person or disabled adult”;
  143         amending s. 921.0022, F.S.; revising the severity
  144         level ranking of Medicaid fraud under the Criminal
  145         Punishment Code; creating a pilot project to monitor
  146         and verify the delivery of home health services and
  147         provide for electronic claims for home health
  148         services; requiring the Agency for Health Care
  149         Administration to issue a report evaluating the pilot
  150         project; creating a pilot project for home health care
  151         management in Miami-Dade County; amending ss. 400.0077
  152         and 430.608, F.S.; conforming cross-references to
  153         changes made by the act; providing an effective date.
  154  
  155  Be It Enacted by the Legislature of the State of Florida:
  156  
  157         Section 1. The Legislature finds that:
  158         (1) Immediate and proactive measures are necessary to
  159  prevent, reduce, and mitigate health care fraud, waste, and
  160  abuse and are essential to maintaining the integrity and
  161  financial viability of health care delivery systems, including
  162  those funded in whole or in part by the Medicare and Medicaid
  163  trust funds. Without these measures, health care delivery
  164  systems in this state will be depleted of necessary funds to
  165  deliver patient care, and taxpayers’ dollars will be devalued
  166  and not used for their intended purposes.
  167         (2) Sufficient justification exists for increased oversight
  168  of health care clinics, home health agencies, providers of home
  169  medical equipment, and other health care providers throughout
  170  the state, and in particular, in Miami-Dade County.
  171         (3) The state’s best interest is served by deterring health
  172  care fraud, abuse, and waste and identifying patterns of
  173  fraudulent or abusive Medicare and Medicaid activity early,
  174  especially in high-risk localities, such as Miami-Dade County,
  175  in order to prevent inappropriate expenditures of public funds
  176  and harm to the state’s residents.
  177         (4) The Legislature designates Miami-Dade County as a
  178  health care fraud crisis area for purposes of implementing
  179  increased scrutiny of home health agencies, home medical
  180  equipment providers, health care clinics, and other health care
  181  providers in Miami-Dade County in order to assist the state’s
  182  efforts to prevent Medicaid fraud, waste, and abuse in the
  183  county and throughout the state.
  184         Section 2. Section 68.085, Florida Statutes, is amended to
  185  read:
  186         68.085 Awards to plaintiffs bringing action.—
  187         (1) If the department proceeds with and prevails in an
  188  action brought by a person under this act, except as provided in
  189  subsection (2), the court shall order the distribution to the
  190  person of at least 15 percent but not more than 25 percent of
  191  the proceeds recovered under any judgment obtained by the
  192  department in an action under s. 68.082 or of the proceeds of
  193  any settlement of the claim, depending upon the extent to which
  194  the person substantially contributed to the prosecution of the
  195  action.
  196         (2) If the department proceeds with an action which the
  197  court finds to be based primarily on disclosures of specific
  198  information, other than that provided by the person bringing the
  199  action, relating to allegations or transactions in a criminal,
  200  civil, or administrative hearing; a legislative, administrative,
  201  inspector general, or auditor general report, hearing, audit, or
  202  investigation; or from the news media, the court may award such
  203  sums as it considers appropriate, but in no case more than 10
  204  percent of the proceeds recovered under a judgment or received
  205  in settlement of a claim under this act, taking into account the
  206  significance of the information and the role of the person
  207  bringing the action in advancing the case to litigation.
  208         (3) If the department does not proceed with an action under
  209  this section, the person bringing the action or settling the
  210  claim shall receive an amount which the court decides is
  211  reasonable for collecting the civil penalty and damages. The
  212  amount shall be not less than 25 percent and not more than 30
  213  percent of the proceeds recovered under a judgment rendered in
  214  an action under this act or in settlement of a claim under this
  215  act.
  216         (4) Following any distributions under subsection (1),
  217  subsection (2), or subsection (3), the agency injured by the
  218  submission of a false or fraudulent claim shall be awarded an
  219  amount not to exceed its compensatory damages. If the action was
  220  based on a claim of funds from the state Medicaid program, 10
  221  percent of any remaining proceeds shall be deposited into the
  222  Legal Affairs Revolving Trust Fund to fund rewards for persons
  223  who report and provide information relating to Medicaid fraud
  224  pursuant to s. 409.9203. Any remaining proceeds, including civil
  225  penalties awarded under s. 68.082, shall be deposited in the
  226  General Revenue Fund.
  227         (5) Any payment under this section to the person bringing
  228  the action shall be paid only out of the proceeds recovered from
  229  the defendant.
  230         (6) Whether or not the department proceeds with the action,
  231  if the court finds that the action was brought by a person who
  232  planned and initiated the violation of s. 68.082 upon which the
  233  action was brought, the court may, to the extent the court
  234  considers appropriate, reduce the share of the proceeds of the
  235  action which the person would otherwise receive under this
  236  section, taking into account the role of the person in advancing
  237  the case to litigation and any relevant circumstances pertaining
  238  to the violation. If the person bringing the action is convicted
  239  of criminal conduct arising from his or her role in the
  240  violation of s. 68.082, the person shall be dismissed from the
  241  civil action and shall not receive any share of the proceeds of
  242  the action. Such dismissal shall not prejudice the right of the
  243  department to continue the action.
  244         Section 3. Section 68.086, Florida Statutes, is amended to
  245  read:
  246         68.086 Expenses; attorney’s fees and costs.—
  247         (1) If the department initiates an action under this act or
  248  assumes control of an action brought by a person under this act,
  249  the department shall be awarded its reasonable attorney’s fees,
  250  expenses, and costs.
  251         (2) If the court awards the person bringing the action
  252  proceeds under this act, the person shall also be awarded an
  253  amount for reasonable attorney’s fees and costs. Payment for
  254  reasonable attorney’s fees and costs shall be made from the
  255  recovered proceeds before the distribution of any award.
  256         (3) If the department does not proceed with an action under
  257  this act and the person bringing the action conducts the action
  258  defendant is the prevailing party, the court may shall award to
  259  the defendant its reasonable attorney’s fees and costs if the
  260  defendant prevails in the action and the court finds that the
  261  claim of against the person bringing the action was clearly
  262  frivolous, clearly vexatious, or brought primarily for purposes
  263  of harassment.
  264         (4) No liability shall be incurred by the state government,
  265  the affected agency, or the department for any expenses,
  266  attorney’s fees, or other costs incurred by any person in
  267  bringing or defending an action under this act.
  268         Section 4. Subsection (10) is added to section 400.471,
  269  Florida Statutes, to read:
  270         400.471 Application for license; fee.—
  271         (10) The agency may not issue a renewal license for a home
  272  health agency in any county having at least one licensed home
  273  health agency and that has more than one home health agency per
  274  5,000 persons, as indicated by the most recent population
  275  estimates published by the Legislature’s Office of Economic and
  276  Demographic Research, if the applicant or any controlling
  277  interest has been administratively sanctioned within the last
  278  calendar year by the agency for one or more of the following
  279  acts:
  280         (a) An intentional, reckless, or negligent act that
  281  materially affects the health or safety of a patient;
  282         (b) Knowingly providing home health services in an
  283  unlicensed assisted living facility or unlicensed adult family
  284  care home, unless the home health agency or employee reports the
  285  unlicensed facility or home to the agency within 72 hours after
  286  providing the services;
  287         (c) Preparing or maintaining fraudulent patient records,
  288  such as, but not limited to, charting ahead, recording vital
  289  signs or symptoms which were not personally obtained or observed
  290  by the home health agency’s staff at the time indicated,
  291  borrowing patients or patient records from other home health
  292  agencies to pass a survey or inspection, or falsifying
  293  signatures;
  294         (d) Failing to provide at least one service directly to a
  295  patient for a period of 60 days;
  296         (e) Demonstrating a pattern of falsifying documents
  297  relating to the training of home health aides or certified
  298  nursing assistants or demonstrating a pattern of falsifying
  299  health statements for staff who provide direct care to patients.
  300  A pattern may be demonstrated by a showing of at least three
  301  fraudulent entries or documents;
  302         (f) Demonstrating a pattern of billing any payor for
  303  services not provided. A pattern may be demonstrated by a
  304  showing of at least three billings for services not provided
  305  within a 12-month period;
  306         (g) Demonstrating a pattern of failing to provide a service
  307  specified in the home health agency’s written agreement with a
  308  patient or the patient’s legal representative, or the plan of
  309  care for that patient, unless a reduction in service is mandated
  310  by Medicare, Medicaid, or a state program or as provided in s.
  311  400.492(3). A pattern may be demonstrated by a showing of at
  312  least three incidents, regardless of the patient or service, in
  313  which the home health agency did not provide a service specified
  314  in a written agreement or plan of care during a 3-month period;
  315         (h) Giving remuneration to a case manager, discharge
  316  planner, facility-based staff member, or third-party vendor who
  317  is involved in the discharge planning process of a facility
  318  licensed under chapter 395 or this chapter from whom the home
  319  health agency receives referrals;
  320         (i) Giving cash, or its equivalent, to a Medicare or
  321  Medicaid beneficiary; or
  322         (j) Demonstrating a pattern of billing the Medicaid program
  323  for services to Medicaid recipients which are medically
  324  unnecessary. A pattern may be demonstrated by a showing of at
  325  least three fraudulent entries or documents.
  326         Section 5. Paragraph (l) is added to subsection (6) of
  327  section 400.474, Florida Statutes, to read:
  328         400.474 Administrative penalties.—
  329         (6) The agency may deny, revoke, or suspend the license of
  330  a home health agency and shall impose a fine of $5,000 against a
  331  home health agency that:
  332         (l) Demonstrates a pattern of billing the Medicaid program
  333  for services to Medicaid recipients that are medically
  334  unnecessary. A pattern may be demonstrated by a showing of at
  335  least three medically unnecessary services.
  336         Section 6. Paragraph (a) of subsection (15) of section
  337  400.506, Florida Statutes, is amended to read:
  338         400.506 Licensure of nurse registries; requirements;
  339  penalties.—
  340         (15)(a) The agency may deny, suspend, or revoke the license
  341  of a nurse registry and shall impose a fine of $5,000 against a
  342  nurse registry that:
  343         1. Provides services to residents in an assisted living
  344  facility for which the nurse registry does not receive fair
  345  market value remuneration.
  346         2. Provides staffing to an assisted living facility for
  347  which the nurse registry does not receive fair market value
  348  remuneration.
  349         3. Fails to provide the agency, upon request, with copies
  350  of all contracts with assisted living facilities which were
  351  executed within the last 5 years.
  352         4. Gives remuneration to a case manager, discharge planner,
  353  facility-based staff member, or third-party vendor who is
  354  involved in the discharge planning process of a facility
  355  licensed under chapter 395 or this chapter and from whom the
  356  nurse registry receives referrals. However, this subparagraph
  357  does not prohibit a nurse registry from providing promotional
  358  items or promotional products, food, or beverages. The
  359  cumulative value of these items may not exceed $50 for a single
  360  event. The cumulative value of these items may not exceed $100
  361  in a calendar year for all persons specified in this
  362  subparagraph who are affiliated with a facility.
  363         5. Gives remuneration to a physician, a member of the
  364  physician’s office staff, or an immediate family member of the
  365  physician, and the nurse registry received a patient referral in
  366  the last 12 months from that physician or the physician’s office
  367  staff. However, this subparagraph does not prohibit a nurse
  368  registry from providing promotional items or promotional
  369  products, food, or beverages. The cumulative value of these
  370  items may not exceed $50 for a single event. The cumulative
  371  value of these items may not exceed $100 in a calendar year for
  372  all persons specified in this subparagraph who are affiliated
  373  with a physician’s office.
  374         Section 7. Present subsections (4) through (9) of section
  375  408.05, Florida Statutes, are renumbered as subsections (5)
  376  through (10), respectively, and a new subsection (4) is added to
  377  that section, to read:
  378         408.05 Florida Center for Health Information and Policy
  379  Analysis.—
  380         (4) MEDICAID FRAUD DETECTION.—In order to improve the
  381  detection of health care fraud, use technology to prevent and
  382  detect fraud, and maximize the electronic exchange of health
  383  care fraud information, the center shall:
  384         (a) Compile, maintain, and publish on its website a
  385  detailed list of all state and federal databases that contain
  386  health care fraud information and update the list at least
  387  biannually;
  388         (b) Develop a strategic plan to connect all databases that
  389  contain health care fraud information to facilitate the
  390  electronic exchange of health information between the agency,
  391  the Department of Health, the Department of Law Enforcement, and
  392  the Attorney General’s Office. The plan must include recommended
  393  standard data formats, fraud identification strategies, and
  394  specifications for the technical interface between state and
  395  federal health care fraud databases;
  396         (c) Monitor innovations in health information technology,
  397  specifically as it pertains to Medicaid fraud prevention and
  398  detection; and
  399         (d) Periodically publish policy briefs that highlight
  400  available new technology to prevent or detect health care fraud
  401  and projects implemented by other states, the private sector, or
  402  the Federal Government which use technology to prevent or detect
  403  health care fraud.
  404         Section 8. Section 408.8065, Florida Statutes, is created
  405  to read:
  406         408.8065 Additional licensure requirements for home health
  407  agencies, home medical equipment providers, and health care
  408  clinics.—
  409         (1) An applicant for initial licensure, or initial
  410  licensure due to a change of ownership, as a home health agency,
  411  home medical equipment provider, or health care clinic shall:
  412         (a) Demonstrate financial ability to operate, as required
  413  under s. 408.810(8);
  414         (b)1. Submit pro forma financial statements, including a
  415  balance sheet and an income and expense statement, for the first
  416  year of operation which provides evidence that the applicant has
  417  sufficient assets, credit, and projected revenues to cover
  418  liabilities and expenses; or
  419         2. Demonstrate the financial ability to operate if the
  420  applicant’s assets, credit, and projected revenues do not meet
  421  or exceed projected liabilities and expenses; and
  422         (c) Submit a statement of the applicant’s estimated startup
  423  costs and sources of funds through the break-even point in
  424  operations demonstrating that the applicant has the ability to
  425  fund all startup costs. The statement must show that the
  426  applicant has a minimum amount of operating funds equal to 3
  427  months of average projected expenses. The applicant must provide
  428  documented proof that these funds will be available as needed.
  429  
  430  All documents required under this subsection must be prepared in
  431  accordance with generally accepted accounting principles and may
  432  be in a compilation form. The financial statements must be
  433  signed by a certified public accountant.
  434         (2) In addition to the penalties provided in s. 408.812,
  435  any person offering services requiring licensure under part III,
  436  part VII, or part X of chapter 400, who knowingly files a false
  437  or misleading license or license renewal application or who
  438  submits false or misleading information related to such
  439  application; and any person who violates or conspires to violate
  440  this section commits a felony of the third degree, punishable as
  441  provided in s. 775.082, s. 775.083, or s. 775.084.
  442         Section 9. Paragraph (a) of subsection (5) of section
  443  408.810, Florida Statutes, is amended to read:
  444         408.810 Minimum licensure requirements.—In addition to the
  445  licensure requirements specified in this part, authorizing
  446  statutes, and applicable rules, each applicant and licensee must
  447  comply with the requirements of this section in order to obtain
  448  and maintain a license.
  449         (5)(a) On or before the first day services are provided to
  450  a client, a licensee must inform the client and his or her
  451  immediate family or representative, if appropriate, of the right
  452  to report:
  453         1. Complaints. The statewide toll-free telephone number for
  454  reporting complaints to the agency must be provided to clients
  455  in a manner that is clearly legible and must include the words:
  456  “To report a complaint regarding the services you receive,
  457  please call toll-free (phone number).”
  458         2. Abusive, neglectful, or exploitative practices. The
  459  statewide toll-free telephone number for the central abuse
  460  hotline must be provided to clients in a manner that is clearly
  461  legible and must include the words: “To report abuse, neglect,
  462  or exploitation, please call toll-free (phone number).”
  463         3. Medicaid fraud. A written description of Medicaid fraud
  464  in layman’s terms and the statewide toll-free telephone number
  465  for the central Medicaid fraud hotline must be provided to
  466  clients in a manner that is clearly legible and must include the
  467  words: “To report suspected Medicaid fraud, please call toll
  468  free (phone number).”
  469  
  470  The agency shall publish a minimum of a 90-day advance notice of
  471  a change in the toll-free telephone numbers.
  472         Section 10. Subsection (4) is added to section 408.815,
  473  Florida Statutes, to read:
  474         408.815 License or application denial; revocation.—
  475         (4) In addition to the grounds provided in authorizing
  476  statutes, the agency shall deny an application for a license or
  477  license renewal if the applicant or a person having a
  478  controlling interest in an applicant has been:
  479         (a) Convicted of, or enters a plea of guilty or nolo
  480  contendere to, regardless of adjudication, a felony under
  481  chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
  482  42 U.S.C. ss. 1395-1396; or
  483         (b) Terminated for cause, pursuant to the appeals
  484  procedures established by the state or Federal Government, from
  485  any state Medicaid program or the federal Medicare program.
  486         Section 11. Subsection (4) of section 409.905, Florida
  487  Statutes, is amended to read:
  488         409.905 Mandatory Medicaid services.—The agency may make
  489  payments for the following services, which are required of the
  490  state by Title XIX of the Social Security Act, furnished by
  491  Medicaid providers to recipients who are determined to be
  492  eligible on the dates on which the services were provided. Any
  493  service under this section shall be provided only when medically
  494  necessary and in accordance with state and federal law.
  495  Mandatory services rendered by providers in mobile units to
  496  Medicaid recipients may be restricted by the agency. Nothing in
  497  this section shall be construed to prevent or limit the agency
  498  from adjusting fees, reimbursement rates, lengths of stay,
  499  number of visits, number of services, or any other adjustments
  500  necessary to comply with the availability of moneys and any
  501  limitations or directions provided for in the General
  502  Appropriations Act or chapter 216.
  503         (4) HOME HEALTH CARE SERVICES.—The agency shall pay for
  504  nursing and home health aide services, supplies, appliances, and
  505  durable medical equipment, necessary to assist a recipient
  506  living at home. An entity that provides services pursuant to
  507  this subsection shall be licensed under part III of chapter 400.
  508  These services, equipment, and supplies, or reimbursement
  509  therefor, may be limited as provided in the General
  510  Appropriations Act and do not include services, equipment, or
  511  supplies provided to a person residing in a hospital or nursing
  512  facility.
  513         (a) In providing home health care services, the agency may
  514  require prior authorization of care based on diagnosis or
  515  utilization rates. The agency shall require prior authorization
  516  for visits for home health services that are not associated with
  517  a skilled nursing visit when the home health agency utilization
  518  rates exceed the state average by 50 percent or more. The home
  519  health agency must submit the recipient’s plan of care and
  520  documentation that supports the recipient’s diagnosis to the
  521  agency when requesting prior authorization.
  522         (b) The agency shall implement a comprehensive utilization
  523  management program that requires prior authorization of all
  524  private duty nursing services, an individualized treatment plan
  525  that includes information about medication and treatment orders,
  526  treatment goals, methods of care to be used, and plans for care
  527  coordination by nurses and other health professionals. The
  528  utilization management program shall also include a process for
  529  periodically reviewing the ongoing use of private duty nursing
  530  services. The assessment of need shall be based on a child’s
  531  condition, family support and care supplements, a family’s
  532  ability to provide care, and a family’s and child’s schedule
  533  regarding work, school, sleep, and care for other family
  534  dependents. When implemented, the private duty nursing
  535  utilization management program shall replace the current
  536  authorization program used by the Agency for Health Care
  537  Administration and the Children’s Medical Services program of
  538  the Department of Health. The agency may competitively bid on a
  539  contract to select a qualified organization to provide
  540  utilization management of private duty nursing services. The
  541  agency is authorized to seek federal waivers to implement this
  542  initiative.
  543         (c) The agency may not pay for home health services, unless
  544  the services are medically necessary, and:
  545         1. The services are ordered by a physician.
  546         2. The written prescription for the services is signed and
  547  dated by the recipient’s physician before the development of a
  548  plan of care and before any request requiring prior
  549  authorization.
  550         3. The physician ordering the services is not employed,
  551  under contract with, or otherwise affiliated with the home
  552  health agency rendering the services.
  553         4. The physician ordering the services has examined the
  554  recipient within the 30 days preceding the initial request for
  555  the services and biannually thereafter.
  556         5. The written prescription for the services includes the
  557  recipient’s acute or chronic medical condition or diagnosis; the
  558  home health service required, including the minimum skill level
  559  required to perform the service; and the frequency and duration
  560  of the services.
  561         6. The national provider identifier, Medicaid
  562  identification number, or medical practitioner license number of
  563  the physician ordering the services is listed on the written
  564  prescription for the services, the claim for home health
  565  reimbursement, and the prior authorization request.
  566         Section 12. Subsection (14) of section 409.912, Florida
  567  Statutes, is amended to read:
  568         409.912 Cost-effective purchasing of health care.—The
  569  agency shall purchase goods and services for Medicaid recipients
  570  in the most cost-effective manner consistent with the delivery
  571  of quality medical care. To ensure that medical services are
  572  effectively utilized, the agency may, in any case, require a
  573  confirmation or second physician’s opinion of the correct
  574  diagnosis for purposes of authorizing future services under the
  575  Medicaid program. This section does not restrict access to
  576  emergency services or poststabilization care services as defined
  577  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  578  shall be rendered in a manner approved by the agency. The agency
  579  shall maximize the use of prepaid per capita and prepaid
  580  aggregate fixed-sum basis services when appropriate and other
  581  alternative service delivery and reimbursement methodologies,
  582  including competitive bidding pursuant to s. 287.057, designed
  583  to facilitate the cost-effective purchase of a case-managed
  584  continuum of care. The agency shall also require providers to
  585  minimize the exposure of recipients to the need for acute
  586  inpatient, custodial, and other institutional care and the
  587  inappropriate or unnecessary use of high-cost services. The
  588  agency shall contract with a vendor to monitor and evaluate the
  589  clinical practice patterns of providers in order to identify
  590  trends that are outside the normal practice patterns of a
  591  provider’s professional peers or the national guidelines of a
  592  provider’s professional association. The vendor must be able to
  593  provide information and counseling to a provider whose practice
  594  patterns are outside the norms, in consultation with the agency,
  595  to improve patient care and reduce inappropriate utilization.
  596  The agency may mandate prior authorization, drug therapy
  597  management, or disease management participation for certain
  598  populations of Medicaid beneficiaries, certain drug classes, or
  599  particular drugs to prevent fraud, abuse, overuse, and possible
  600  dangerous drug interactions. The Pharmaceutical and Therapeutics
  601  Committee shall make recommendations to the agency on drugs for
  602  which prior authorization is required. The agency shall inform
  603  the Pharmaceutical and Therapeutics Committee of its decisions
  604  regarding drugs subject to prior authorization. The agency is
  605  authorized to limit the entities it contracts with or enrolls as
  606  Medicaid providers by developing a provider network through
  607  provider credentialing. The agency may competitively bid single
  608  source-provider contracts if procurement of goods or services
  609  results in demonstrated cost savings to the state without
  610  limiting access to care. The agency may limit its network based
  611  on the assessment of beneficiary access to care, provider
  612  availability, provider quality standards, time and distance
  613  standards for access to care, the cultural competence of the
  614  provider network, demographic characteristics of Medicaid
  615  beneficiaries, practice and provider-to-beneficiary standards,
  616  appointment wait times, beneficiary use of services, provider
  617  turnover, provider profiling, provider licensure history,
  618  previous program integrity investigations and findings, peer
  619  review, provider Medicaid policy and billing compliance records,
  620  clinical and medical record audits, and other factors. Providers
  621  shall not be entitled to enrollment in the Medicaid provider
  622  network. The agency shall determine instances in which allowing
  623  Medicaid beneficiaries to purchase durable medical equipment and
  624  other goods is less expensive to the Medicaid program than long
  625  term rental of the equipment or goods. The agency may establish
  626  rules to facilitate purchases in lieu of long-term rentals in
  627  order to protect against fraud and abuse in the Medicaid program
  628  as defined in s. 409.913. The agency may seek federal waivers
  629  necessary to administer these policies.
  630         (14)(a) The agency shall operate or contract for the
  631  operation of utilization management and incentive systems
  632  designed to encourage cost-effective use of services and to
  633  eliminate overutilization of Medicaid services that are
  634  medically unnecessary. The agency shall establish norms for the
  635  utilization of Medicaid services which are risk-adjusted for
  636  patient acuity. The agency shall also track Medicaid provider
  637  prescription and treatment patterns and develop treatment norms.
  638  Providers that demonstrate a pattern of submitting claims for
  639  medically unnecessary services shall be referred to the Medicaid
  640  program integrity unit for investigation. By February 1, 2010,
  641  the agency shall submit a report to the Governor, the President
  642  of the Senate, and the Speaker of the House of Representatives
  643  on the utilization of Medicaid services and the establishment of
  644  utilization norms in the Medicaid program. The report must
  645  include a definition of overutilization and gross
  646  overutilization of Medicaid services and recommendations to
  647  decrease the overutilization of Medicaid services in the
  648  Medicaid program.
  649         (b) The agency shall develop a procedure for determining
  650  whether health care providers and service vendors can provide
  651  the Medicaid program using a business case that demonstrates
  652  whether a particular good or service can offset the cost of
  653  providing the good or service in an alternative setting or
  654  through other means and therefore should receive a higher
  655  reimbursement. The business case must include, but need not be
  656  limited to:
  657         1. A detailed description of the good or service to be
  658  provided, a description and analysis of the agency’s current
  659  performance of the service, and a rationale documenting how
  660  providing the service in an alternative setting would be in the
  661  best interest of the state, the agency, and its clients.
  662         2. A cost-benefit analysis documenting the estimated
  663  specific direct and indirect costs, savings, performance
  664  improvements, risks, and qualitative and quantitative benefits
  665  involved in or resulting from providing the service. The cost
  666  benefit analysis must include a detailed plan and timeline
  667  identifying all actions that must be implemented to realize
  668  expected benefits. The Secretary of Health Care Administration
  669  shall verify that all costs, savings, and benefits are valid and
  670  achievable.
  671         (c) If the agency determines that the increased
  672  reimbursement is cost-effective, the agency shall recommend a
  673  change in the reimbursement schedule for that particular good or
  674  service. If, within 12 months after implementing any rate change
  675  under this procedure, the agency determines that costs were not
  676  offset by the increased reimbursement schedule, the agency may
  677  revert to the former reimbursement schedule for the particular
  678  good or service.
  679         Section 13. Subsections (2), (7), (11), (13), (14), (15),
  680  (21), (22), (24), (25), (27), (30), (31), and (36) of section
  681  409.913, Florida Statutes, are amended, and subsection (37) is
  682  added to that section, to read:
  683         409.913 Oversight of the integrity of the Medicaid
  684  program.—The agency shall operate a program to oversee the
  685  activities of Florida Medicaid recipients, and providers and
  686  their representatives, to ensure that fraudulent and abusive
  687  behavior and neglect of recipients occur to the minimum extent
  688  possible, and to recover overpayments and impose sanctions as
  689  appropriate. Beginning January 1, 2003, and each year
  690  thereafter, the agency and the Medicaid Fraud Control Unit of
  691  the Department of Legal Affairs shall submit a joint report to
  692  the Legislature documenting the effectiveness of the state’s
  693  efforts to control Medicaid fraud and abuse and to recover
  694  Medicaid overpayments during the previous fiscal year. The
  695  report must describe the number of cases opened and investigated
  696  each year; the sources of the cases opened; the disposition of
  697  the cases closed each year; the amount of overpayments alleged
  698  in preliminary and final audit letters; the number and amount of
  699  fines or penalties imposed; any reductions in overpayment
  700  amounts negotiated in settlement agreements or by other means;
  701  the amount of final agency determinations of overpayments; the
  702  amount deducted from federal claiming as a result of
  703  overpayments; the amount of overpayments recovered each year;
  704  the amount of cost of investigation recovered each year; the
  705  average length of time to collect from the time the case was
  706  opened until the overpayment is paid in full; the amount
  707  determined as uncollectible and the portion of the uncollectible
  708  amount subsequently reclaimed from the Federal Government; the
  709  number of providers, by type, that are terminated from
  710  participation in the Medicaid program as a result of fraud and
  711  abuse; and all costs associated with discovering and prosecuting
  712  cases of Medicaid overpayments and making recoveries in such
  713  cases. The report must also document actions taken to prevent
  714  overpayments and the number of providers prevented from
  715  enrolling in or reenrolling in the Medicaid program as a result
  716  of documented Medicaid fraud and abuse and must include policy
  717  recommendations recommend changes necessary to prevent or
  718  recover overpayments and changes necessary to prevent and detect
  719  Medicaid fraud. All policy recommendations in the report must
  720  include a detailed fiscal analysis, including, but not limited
  721  to, implementation costs, estimated savings to the Medicaid
  722  program, and the return on investment. The agency must submit
  723  the policy recommendations and fiscal analyses in the report to
  724  the appropriate estimating conference, pursuant to s. 216.137,
  725  by February 15 of each year. The agency and the Medicaid Fraud
  726  Control Unit of the Department of Legal Affairs each must
  727  include detailed unit-specific performance standards,
  728  benchmarks, and metrics in the report, including projected costs
  729  savings to the state Medicaid program during the following
  730  fiscal year.
  731         (2) The agency shall conduct, or cause to be conducted by
  732  contract or otherwise, reviews, investigations, analyses,
  733  audits, or any combination thereof, to determine possible fraud,
  734  abuse, overpayment, or recipient neglect in the Medicaid program
  735  and shall report the findings of any overpayments in audit
  736  reports as appropriate. At least 5 percent of all audits shall
  737  be conducted on a random basis. As part of its ongoing fraud
  738  detection activities, the agency shall identify and monitor, by
  739  contract or otherwise, patterns of overutilization of Medicaid
  740  services based on state averages. The agency shall use the scope
  741  and frequency of services by diagnosis to establish utilization
  742  norms.
  743         (7) When presenting a claim for payment under the Medicaid
  744  program, a provider has an affirmative duty to supervise the
  745  provision of, and be responsible for, goods and services claimed
  746  to have been provided, to supervise and be responsible for
  747  preparation and submission of the claim, and to present a claim
  748  that is true and accurate and that is for goods and services
  749  that:
  750         (a) Have actually been furnished to the recipient by the
  751  provider prior to submitting the claim.
  752         (b) Are Medicaid-covered goods or services that are
  753  medically necessary.
  754         (c) Are of a quality comparable to those furnished to the
  755  general public by the provider’s peers.
  756         (d) Have not been billed in whole or in part to a recipient
  757  or a recipient’s responsible party, except for such copayments,
  758  coinsurance, or deductibles as are authorized by the agency.
  759         (e) Are provided in accord with applicable provisions of
  760  all Medicaid rules, regulations, handbooks, and policies and in
  761  accordance with federal, state, and local law.
  762         (f) Are documented by records made at the time the goods or
  763  services were provided, demonstrating the medical necessity for
  764  the goods or services rendered. Medicaid goods or services are
  765  excessive or not medically necessary unless both the medical
  766  basis and the specific need for them are fully and properly
  767  documented in the recipient’s medical record.
  768  
  769  The agency shall may deny payment or require repayment for goods
  770  or services that are not presented as required in this
  771  subsection.
  772         (11) The agency shall may deny payment or require repayment
  773  for inappropriate, medically unnecessary, or excessive goods or
  774  services from the person furnishing them, the person under whose
  775  supervision they were furnished, or the person causing them to
  776  be furnished.
  777         (13) The agency shall immediately may terminate
  778  participation of a Medicaid provider in the Medicaid program and
  779  may seek civil remedies or impose other administrative sanctions
  780  against a Medicaid provider, if the provider or any principal,
  781  officer, director, agent, managing employee, or affiliated
  782  person of the provider, or any partner or shareholder having an
  783  ownership interest in the provider equal to 5 percent or
  784  greater, has been:
  785         (a) Convicted of a criminal offense related to the delivery
  786  of any health care goods or services, including the performance
  787  of management or administrative functions relating to the
  788  delivery of health care goods or services;
  789         (b) Convicted of a criminal offense under federal law or
  790  the law of any state relating to the practice of the provider’s
  791  profession; or
  792         (c) Found by a court of competent jurisdiction to have
  793  neglected or physically abused a patient in connection with the
  794  delivery of health care goods or services.
  795  
  796  If the agency effects a termination under this subsection, the
  797  agency shall issue an immediate final order pursuant to s.
  798  120.569(2)(n).
  799         (14) If the provider or any principal, officer, director,
  800  agent, managing employee, or affiliated person of the provider,
  801  or any partner or shareholder having an ownership interest in
  802  the provider equal to 5 percent or greater, has been suspended
  803  or terminated from participation in the Medicaid program or the
  804  Medicare program by the Federal Government or any state, the
  805  agency must immediately suspend or terminate, as appropriate,
  806  the provider’s participation in this state’s the Florida
  807  Medicaid program for a period no less than that imposed by the
  808  Federal Government or any other state, and may not enroll such
  809  provider in this state’s the Florida Medicaid program while such
  810  foreign suspension or termination remains in effect. This
  811  sanction is in addition to all other remedies provided by law.
  812         (15) The agency shall may seek a any remedy provided by
  813  law, including, but not limited to, any remedy the remedies
  814  provided in subsections (13) and (16) and s. 812.035, if:
  815         (a) The provider’s license has not been renewed, or has
  816  been revoked, suspended, or terminated, for cause, by the
  817  licensing agency of any state;
  818         (b) The provider has failed to make available or has
  819  refused access to Medicaid-related records to an auditor,
  820  investigator, or other authorized employee or agent of the
  821  agency, the Attorney General, a state attorney, or the Federal
  822  Government;
  823         (c) The provider has not furnished or has failed to make
  824  available such Medicaid-related records as the agency has found
  825  necessary to determine whether Medicaid payments are or were due
  826  and the amounts thereof;
  827         (d) The provider has failed to maintain medical records
  828  made at the time of service, or prior to service if prior
  829  authorization is required, demonstrating the necessity and
  830  appropriateness of the goods or services rendered;
  831         (e) The provider is not in compliance with provisions of
  832  Medicaid provider publications that have been adopted by
  833  reference as rules in the Florida Administrative Code; with
  834  provisions of state or federal laws, rules, or regulations; with
  835  provisions of the provider agreement between the agency and the
  836  provider; or with certifications found on claim forms or on
  837  transmittal forms for electronically submitted claims that are
  838  submitted by the provider or authorized representative, as such
  839  provisions apply to the Medicaid program;
  840         (f) The provider or person who ordered or prescribed the
  841  care, services, or supplies has furnished, or ordered the
  842  furnishing of, goods or services to a recipient which are
  843  inappropriate, unnecessary, excessive, or harmful to the
  844  recipient or are of inferior quality;
  845         (g) The provider has demonstrated a pattern of failure to
  846  provide goods or services that are medically necessary;
  847         (h) The provider or an authorized representative of the
  848  provider, or a person who ordered or prescribed the goods or
  849  services, has submitted or caused to be submitted false or a
  850  pattern of erroneous Medicaid claims;
  851         (i) The provider or an authorized representative of the
  852  provider, or a person who has ordered or prescribed the goods or
  853  services, has submitted or caused to be submitted a Medicaid
  854  provider enrollment application, a request for prior
  855  authorization for Medicaid services, a drug exception request,
  856  or a Medicaid cost report that contains materially false or
  857  incorrect information;
  858         (j) The provider or an authorized representative of the
  859  provider has collected from or billed a recipient or a
  860  recipient’s responsible party improperly for amounts that should
  861  not have been so collected or billed by reason of the provider’s
  862  billing the Medicaid program for the same service;
  863         (k) The provider or an authorized representative of the
  864  provider has included in a cost report costs that are not
  865  allowable under a Florida Title XIX reimbursement plan, after
  866  the provider or authorized representative had been advised in an
  867  audit exit conference or audit report that the costs were not
  868  allowable;
  869         (l) The provider is charged by information or indictment
  870  with fraudulent billing practices. The sanction applied for this
  871  reason is limited to suspension of the provider’s participation
  872  in the Medicaid program for the duration of the indictment
  873  unless the provider is found guilty pursuant to the information
  874  or indictment;
  875         (m) The provider or a person who has ordered, or prescribed
  876  the goods or services is found liable for negligent practice
  877  resulting in death or injury to the provider’s patient;
  878         (n) The provider fails to demonstrate that it had available
  879  during a specific audit or review period sufficient quantities
  880  of goods, or sufficient time in the case of services, to support
  881  the provider’s billings to the Medicaid program;
  882         (o) The provider has failed to comply with the notice and
  883  reporting requirements of s. 409.907;
  884         (p) The agency has received reliable information of patient
  885  abuse or neglect or of any act prohibited by s. 409.920; or
  886         (q) The provider has failed to comply with an agreed-upon
  887  repayment schedule.
  888  
  889  A provider is subject to sanctions for violations of this
  890  subsection as the result of actions or inactions of the provider
  891  or any principal, officer, director, agent, managing employee,
  892  or affiliated person of the provider, or any partner or
  893  shareholder having an ownership interest in the provider equal
  894  to 5 percent or greater.
  895         (21) When making a determination that an overpayment has
  896  occurred, the agency shall prepare and issue an audit report to
  897  the provider showing the calculation of overpayments. If the
  898  agency’s determination that an overpayment has occurred is based
  899  upon a review of the provider’s records, the calculation of the
  900  overpayment shall be based upon documentation created
  901  contemporaneously with the delivery of goods or rendering of
  902  services.
  903         (22) The audit report, supported by agency work papers,
  904  showing an overpayment to a provider constitutes evidence of the
  905  overpayment. A provider may not present or elicit testimony,
  906  either on direct examination or cross-examination in any court
  907  or administrative proceeding, regarding the purchase or
  908  acquisition by any means of drugs, goods, or supplies; sales or
  909  divestment by any means of drugs, goods, or supplies; or
  910  inventory of drugs, goods, or supplies, unless such acquisition,
  911  sales, divestment, or inventory is documented by written
  912  invoices, written inventory records, or other competent written
  913  documentary evidence maintained in the normal course of the
  914  provider’s business. Notwithstanding the applicable rules of
  915  discovery, all documentation that will be offered as evidence at
  916  an administrative hearing on a Medicaid overpayment must be
  917  exchanged by all parties at least 14 days before the
  918  administrative hearing or must be excluded from consideration.
  919  The documentation or data that a provider may rely upon or
  920  present as evidence that an overpayment has not occurred must be
  921  created contemporaneously with the delivery of goods or
  922  rendering of services, and must be made available to the agency
  923  before issuance of a final audit report.
  924         (24) If the agency imposes an administrative sanction
  925  pursuant to subsection (13), subsection (14), or subsection
  926  (15), except paragraphs (15)(e) and (o), upon any provider or
  927  any principal, officer, director, agent, managing employee, or
  928  affiliated person of the provider other person who is regulated
  929  by another state entity, the agency shall notify that other
  930  entity of the imposition of the sanction within 5 business days.
  931  Such notification must include the provider’s or person’s name
  932  and license number and the specific reasons for sanction.
  933         (25)(a) The agency shall may withhold Medicaid payments, in
  934  whole or in part, to a provider upon receipt of reliable
  935  evidence that the circumstances giving rise to the need for a
  936  withholding of payments involve fraud, willful
  937  misrepresentation, or abuse under the Medicaid program, or a
  938  crime committed while rendering goods or services to Medicaid
  939  recipients. If it is determined that fraud, willful
  940  misrepresentation, abuse, or a crime did not occur, the payments
  941  withheld must be paid to the provider within 14 days after such
  942  determination with interest at the rate of 10 percent a year.
  943  Any money withheld in accordance with this paragraph shall be
  944  placed in a suspended account, readily accessible to the agency,
  945  so that any payment ultimately due the provider shall be made
  946  within 14 days.
  947         (b) The agency shall may deny payment, or require
  948  repayment, if the goods or services were furnished, supervised,
  949  or caused to be furnished by a person who has been suspended or
  950  terminated from the Medicaid program or Medicare program by the
  951  Federal Government or any state.
  952         (c) Overpayments owed to the agency bear interest at the
  953  rate of 10 percent per year from the date of determination of
  954  the overpayment by the agency, and payment arrangements must be
  955  made at the conclusion of legal proceedings. A provider who does
  956  not enter into or adhere to an agreed-upon repayment schedule
  957  may be terminated by the agency for nonpayment or partial
  958  payment.
  959         (d) The agency, upon entry of a final agency order, a
  960  judgment or order of a court of competent jurisdiction, or a
  961  stipulation or settlement, may collect the moneys owed by all
  962  means allowable by law, including, but not limited to, notifying
  963  any fiscal intermediary of Medicare benefits that the state has
  964  a superior right of payment. Upon receipt of such written
  965  notification, the Medicare fiscal intermediary shall remit to
  966  the state the sum claimed.
  967         (e) The agency may institute amnesty programs to allow
  968  Medicaid providers the opportunity to voluntarily repay
  969  overpayments. The agency may adopt rules to administer such
  970  programs.
  971         (27) When the Agency for Health Care Administration has
  972  made a probable cause determination and alleged that an
  973  overpayment to a Medicaid provider has occurred, the agency,
  974  after notice to the provider, shall may:
  975         (a) Withhold, and continue to withhold during the pendency
  976  of an administrative hearing pursuant to chapter 120, any
  977  medical assistance reimbursement payments until such time as the
  978  overpayment is recovered, unless within 30 days after receiving
  979  notice thereof the provider:
  980         1. Makes repayment in full; or
  981         2. Establishes a repayment plan that is satisfactory to the
  982  Agency for Health Care Administration.
  983         (b) Withhold, and continue to withhold during the pendency
  984  of an administrative hearing pursuant to chapter 120, medical
  985  assistance reimbursement payments if the terms of a repayment
  986  plan are not adhered to by the provider.
  987         (30) The agency shall may terminate a provider’s
  988  participation in the Medicaid program if the provider fails to
  989  reimburse an overpayment that has been determined by final
  990  order, not subject to further appeal, within 35 days after the
  991  date of the final order, unless the provider and the agency have
  992  entered into a repayment agreement.
  993         (31) If a provider requests an administrative hearing
  994  pursuant to chapter 120, such hearing must be conducted within
  995  90 days following assignment of an administrative law judge,
  996  absent exceptionally good cause shown as determined by the
  997  administrative law judge or hearing officer. Upon issuance of a
  998  final order, the outstanding balance of the amount determined to
  999  constitute the overpayment shall become due. If a provider fails
 1000  to make payments in full, fails to enter into a satisfactory
 1001  repayment plan, or fails to comply with the terms of a repayment
 1002  plan or settlement agreement, the agency shall may withhold
 1003  medical assistance reimbursement payments until the amount due
 1004  is paid in full.
 1005         (36) At least three times a year, the agency shall provide
 1006  to each Medicaid recipient or his or her representative an
 1007  explanation of benefits in the form of a letter that is mailed
 1008  to the most recent address of the recipient on the record with
 1009  the Department of Children and Family Services. The explanation
 1010  of benefits must include the patient’s name, the name of the
 1011  health care provider and the address of the location where the
 1012  service was provided, a description of all services billed to
 1013  Medicaid in terminology that should be understood by a
 1014  reasonable person, and information on how to report
 1015  inappropriate or incorrect billing to the agency or other law
 1016  enforcement entities for review or investigation. At least once
 1017  a year, the letter also must include information on how to
 1018  report criminal Medicaid fraud, the Medicaid Fraud Control
 1019  Unit’s toll-free hotline number, and information about the
 1020  rewards available under s. 409.9203. The explanation of benefits
 1021  may not be mailed for Medicaid independent laboratory services
 1022  as described in s. 409.905(7) or for Medicaid certified match
 1023  services as described in ss. 409.9071 and 1011.70.
 1024         (37) The agency shall post on its website a current list of
 1025  each Medicaid provider, including any principal, officer,
 1026  director, agent, managing employee, or affiliated person of the
 1027  provider, or any partner or shareholder having an ownership
 1028  interest in the provider equal to 5 percent or greater, who has
 1029  been terminated from the Medicaid program or sanctioned under
 1030  this section. The list must be searchable by a variety of search
 1031  parameters and provide for the creation of formatted lists that
 1032  may be printed or imported into other applications, including
 1033  spreadsheets. The agency shall update the list at least monthly.
 1034         Section 14. Subsections (1) and (2) of section 409.920,
 1035  Florida Statutes, are amended, present subsections (8) and (9)
 1036  of that section are renumbered as subsections (9) and (10),
 1037  respectively, and a new subsection (8) is added to that section,
 1038  to read:
 1039         409.920 Medicaid provider fraud.—
 1040         (1) For the purposes of this section, the term:
 1041         (a) “Agency” means the Agency for Health Care
 1042  Administration.
 1043         (b) “Fiscal agent” means any individual, firm, corporation,
 1044  partnership, organization, or other legal entity that has
 1045  contracted with the agency to receive, process, and adjudicate
 1046  claims under the Medicaid program.
 1047         (c) “Item or service” includes:
 1048         1. Any particular item, device, medical supply, or service
 1049  claimed to have been provided to a recipient and listed in an
 1050  itemized claim for payment; or
 1051         2. In the case of a claim based on costs, any entry in the
 1052  cost report, books of account, or other documents supporting
 1053  such claim.
 1054         (d) “Knowingly” means that the act was done voluntarily and
 1055  intentionally and not because of mistake or accident. As used in
 1056  this section, the term “knowingly” also includes the word
 1057  “willfully” or “willful” which, as used in this section, means
 1058  that an act was committed voluntarily and purposely, with the
 1059  specific intent to do something that the law forbids, and that
 1060  the act was committed with bad purpose, either to disobey or
 1061  disregard the law.
 1062         (e) “Managed care organization” means a private insurance
 1063  carrier, health care cooperative or alliance, health maintenance
 1064  organization, insurer, organization, entity, association,
 1065  affiliation, or person that contracts with the agency to
 1066  provide, or is reimbursed by the agency for goods and services
 1067  provided, which are a required benefit of a state or federally
 1068  funded health care benefit program. The term includes a person
 1069  who provides or contracts to provide goods and services to a
 1070  managed care organization.
 1071         (2)(a) A person may not It is unlawful to:
 1072         1.(a) Knowingly make, cause to be made, or aid and abet in
 1073  the making of any false statement or false representation of a
 1074  material fact, by commission or omission, in any claim submitted
 1075  to the agency or its fiscal agent or a managed care organization
 1076  for payment.
 1077         2.(b) Knowingly make, cause to be made, or aid and abet in
 1078  the making of a claim for items or services that are not
 1079  authorized to be reimbursed by the Medicaid program.
 1080         3.(c) Knowingly charge, solicit, accept, or receive
 1081  anything of value, other than an authorized copayment from a
 1082  Medicaid recipient, from any source in addition to the amount
 1083  legally payable for an item or service provided to a Medicaid
 1084  recipient under the Medicaid program or knowingly fail to credit
 1085  the agency or its fiscal agent for any payment received from a
 1086  third-party source.
 1087         4.(d) Knowingly make or in any way cause to be made any
 1088  false statement or false representation of a material fact, by
 1089  commission or omission, in any document containing items of
 1090  income and expense that is or may be used by the agency to
 1091  determine a general or specific rate of payment for an item or
 1092  service provided by a provider.
 1093         5.(e) Knowingly solicit, offer, pay, or receive any
 1094  remuneration, including any kickback, bribe, or rebate, directly
 1095  or indirectly, overtly or covertly, in cash or in kind, in
 1096  return for referring an individual to a person for the
 1097  furnishing or arranging for the furnishing of any item or
 1098  service for which payment may be made, in whole or in part,
 1099  under the Medicaid program, or in return for obtaining,
 1100  purchasing, leasing, ordering, or arranging for or recommending,
 1101  obtaining, purchasing, leasing, or ordering any goods, facility,
 1102  item, or service, for which payment may be made, in whole or in
 1103  part, under the Medicaid program.
 1104         6.(f) Knowingly submit false or misleading information or
 1105  statements to the Medicaid program for the purpose of being
 1106  accepted as a Medicaid provider.
 1107         7.(g) Knowingly use or endeavor to use a Medicaid
 1108  provider’s identification number or a Medicaid recipient’s
 1109  identification number to make, cause to be made, or aid and abet
 1110  in the making of a claim for items or services that are not
 1111  authorized to be reimbursed by the Medicaid program.
 1112         (b)1. A person who violates this subsection and receives or
 1113  endeavors to receive anything of value of:
 1114         a. Ten thousand dollars or less commits a felony of the
 1115  third degree, punishable as provided in s. 775.082, s. 775.083,
 1116  or s. 775.084.
 1117         b. More than $10,000, but less than $50,000, commits a
 1118  felony of the second degree, punishable as provided in s.
 1119  775.082, s. 775.083, or s. 775.084.
 1120         c. Fifty thousand dollars or more commits a felony of the
 1121  first degree, punishable as provided in s. 775.082, s. 775.083,
 1122  or s. 775.084.
 1123         2. The value of separate funds, goods, or services that a
 1124  person received or attempted to receive pursuant to a scheme or
 1125  course of conduct may be aggregated in determining the degree of
 1126  the offense.
 1127         3. In addition to the sentence authorized by law, a person
 1128  who is convicted of a violation of this subsection shall pay a
 1129  fine in an amount equal to five times the pecuniary gain
 1130  unlawfully received or the loss incurred by the Medicaid program
 1131  or managed care organization, whichever is greater.
 1132         (8) A person who provides the state, any state agency, any
 1133  of the state’s political subdivisions, or any agency of the
 1134  state’s political subdivisions with information about fraud or
 1135  suspected fraud by a Medicaid provider, including a managed care
 1136  organization, is immune from civil liability for providing the
 1137  information unless the person acted with knowledge that the
 1138  information was false or with reckless disregard for the truth
 1139  or falsity of the information.
 1140         Section 15. Section 409.9203, Florida Statutes, is created
 1141  to read:
 1142         409.9203 Rewards for reporting Medicaid fraud.—
 1143         (1) The Department of Law Enforcement or director of the
 1144  Medicaid Fraud Control Unit shall, subject to availability of
 1145  funds, pay a reward to a person who furnishes original
 1146  information relating to and reports a violation of the state’s
 1147  Medicaid fraud laws, unless the person declines the reward, if
 1148  the information and report:
 1149         (a) Is made to the Office of the Attorney General, the
 1150  Agency for Health Care Administration, the Department of Health,
 1151  or the Department of Law Enforcement;
 1152         (b) Relates to criminal fraud upon Medicaid funds or a
 1153  criminal violation of Medicaid laws by another person; and
 1154         (c) Leads to a recovery of a fine, penalty, or forfeiture
 1155  of property.
 1156         (2) The reward may not exceed the lesser of 25 percent of
 1157  the amount recovered or $500,000 in a single case.
 1158         (3) The reward shall be paid from the Legal Affairs
 1159  Revolving Trust Fund from moneys collected pursuant to s.
 1160  68.085.
 1161         (4) A person who receives a reward pursuant to this section
 1162  is not eligible to receive any funds pursuant to the Florida
 1163  False Claims Act for Medicaid fraud for which a reward is
 1164  received pursuant to this section.
 1165         Section 16. Subsection (11) is added to section 456.004,
 1166  Florida Statutes, to read:
 1167         456.004 Department; powers and duties.—The department, for
 1168  the professions under its jurisdiction, shall:
 1169         (11) Work cooperatively with the Agency for Health Care
 1170  Administration and the judicial system to recover Medicaid
 1171  overpayments by the Medicaid program. The department shall
 1172  investigate and prosecute health care practitioners who have not
 1173  remitted amounts owed to the state for an overpayment from the
 1174  Medicaid program pursuant to a final order, judgment, or
 1175  stipulation or settlement.
 1176         Section 17. Present subsections (6) through (10) of section
 1177  456.041, Florida Statutes, are renumbered as subsections (7)
 1178  through (11), respectively, and a new subsection (6) is added to
 1179  that section, to read:
 1180         456.041 Practitioner profile; creation.—
 1181         (6) The Department of Health shall provide in each
 1182  practitioner profile for every physician or advanced registered
 1183  nurse practitioner terminated from participating in the Medicaid
 1184  program, pursuant to s. 409.913, or sanctioned by the Medicaid
 1185  program a statement that the practitioner has been terminated
 1186  from participating in the Florida Medicaid program or sanctioned
 1187  by the Medicaid program.
 1188         Section 18. Section 456.0635, Florida Statutes, is created
 1189  to read:
 1190         456.0635 Medicaid fraud; disqualification for license,
 1191  certificate, or registration.—
 1192         (1) Medicaid fraud in the practice of a health care
 1193  profession is prohibited.
 1194         (2) Each board within the jurisdiction of the department,
 1195  or the department if there is no board, shall refuse to admit a
 1196  candidate to any examination and refuse to issue or renew a
 1197  license, certificate, or registration to any applicant if the
 1198  candidate or applicant or any principle, officer, agent,
 1199  managing employee, or affiliated person of the applicant, has
 1200  been:
 1201         (a) Convicted of, or entered a plea of guilty or nolo
 1202  contendere to, regardless of adjudication, a felony under
 1203  chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
 1204  42 U.S.C. ss. 1395-1396; or
 1205         (b) Terminated for cause, pursuant to the appeals
 1206  procedures established by the state or Federal Government, from
 1207  any state Medicaid program or the federal Medicare program.
 1208         (3) Licensed health care practitioners shall report
 1209  allegations of Medicaid fraud to the department, regardless of
 1210  the practice setting in which the alleged Medicaid fraud
 1211  occurred.
 1212         (4) The acceptance by a licensing authority of a
 1213  candidate’s relinquishment of a license which is offered in
 1214  response to or anticipation of the filing of administrative
 1215  charges alleging Medicaid fraud or similar charges constitutes
 1216  the permanent revocation of the license.
 1217         Section 19. Paragraphs (ii), (jj), (kk), and (ll) are added
 1218  to subsection (1) of section 456.072, Florida Statutes, to read:
 1219         456.072 Grounds for discipline; penalties; enforcement.—
 1220         (1) The following acts shall constitute grounds for which
 1221  the disciplinary actions specified in subsection (2) may be
 1222  taken:
 1223         (ii) Being convicted of, or entering a plea of guilty or
 1224  nolo contendere to, any misdemeanor or felony, regardless of
 1225  adjudication, under 18 U.S.C. s. 669, ss. 285-287, s. 371, s.
 1226  1001, s. 1035, s. 1341, s. 1343, s. 1347, s. 1349, or s. 1518,
 1227  or 42 U.S.C. ss. 1320a-7b, relating to the Medicaid program.
 1228         (jj) Failing to remit the sum owed to the state for an
 1229  overpayment from the Medicaid program pursuant to a final order,
 1230  judgment, or stipulation or settlement.
 1231         (kk) Being terminated from the state Medicaid program
 1232  pursuant to s. 409.913, any other state Medicaid program, or the
 1233  federal Medicare program.
 1234         (ll) Being convicted of, or entering a plea of guilty or
 1235  nolo contendere to, any misdemeanor or felony, regardless of
 1236  adjudication, a crime in any jurisdiction which relates to
 1237  health care fraud.
 1238         Section 20. Subsection (1) of section 456.074, Florida
 1239  Statutes, is amended to read:
 1240         456.074 Certain health care practitioners; immediate
 1241  suspension of license.—
 1242         (1) The department shall issue an emergency order
 1243  suspending the license of any person licensed under chapter 458,
 1244  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
 1245  chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
 1246  guilty to, is convicted or found guilty of, or who enters a plea
 1247  of nolo contendere to, regardless of adjudication, to:
 1248         (a) A felony under chapter 409, chapter 817, or chapter 893
 1249  or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-1396;
 1250  or.
 1251         (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
 1252  285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
 1253  1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
 1254  Medicaid program.
 1255         Section 21. Subsections (2) and (3) of section 465.022,
 1256  Florida Statutes, are amended to read:
 1257         465.022 Pharmacies; general requirements; fees.—
 1258         (2) A pharmacy permit shall be issued only to a person who
 1259  is at least 18 years of age, a partnership whose partners are
 1260  all at least 18 years of age, or to a corporation that which is
 1261  registered pursuant to chapter 607 or chapter 617 whose
 1262  officers, directors, and shareholders are at least 18 years of
 1263  age and have an ownership interest of 5 percent or greater.
 1264         (3) Any person, partnership, or corporation before engaging
 1265  in the operation of a pharmacy shall file with the board a sworn
 1266  application on forms provided by the department.
 1267         (a) An application for a pharmacy permit must include a set
 1268  of fingerprints from each person having an ownership interest of
 1269  5 percent or greater and from any person who, directly or
 1270  indirectly, manages, oversees, or controls the operation of the
 1271  applicant, including officers and members of the board of
 1272  directors of an applicant that is a corporation. The applicant
 1273  must provide payment in the application for the cost of state
 1274  and national criminal history records checks.
 1275         1. For corporations having more than $100 million of
 1276  business taxable assets in this state, the department shall
 1277  require each person who will be directly involved in the
 1278  management and operation of the pharmacy to submit a set of
 1279  fingerprints.
 1280         2. A representative of a corporation described in
 1281  subparagraph 1. satisfies the requirement to submit a set of his
 1282  or her fingerprints if the fingerprints are on file with a state
 1283  agency and available to the department.
 1284         (b) The department shall submit the fingerprints provided
 1285  by the applicant to the Department of Law Enforcement for a
 1286  state criminal history records check. The Department of Law
 1287  Enforcement shall forward the fingerprints to the Federal Bureau
 1288  of Investigation for a national criminal history records check.
 1289         Section 22. Subsection (1) of section 465.023, Florida
 1290  Statutes, is amended to read:
 1291         465.023 Pharmacy permittee; disciplinary action.—
 1292         (1) The department or the board shall deny an application
 1293  for a pharmacy permit, may revoke or suspend the permit of any
 1294  pharmacy permittee, and may fine, place on probation, or
 1295  otherwise discipline any pharmacy permittee if an affiliated
 1296  person, partner, officer, director, or agent of an applicant or
 1297  permittee who has:
 1298         (a) Obtained a permit by misrepresentation or fraud or
 1299  through an error of the department or the board;
 1300         (b) Attempted to procure, or has procured, a permit for any
 1301  other person by making, or causing to be made, any false
 1302  representation;
 1303         (c) Violated any of the requirements of this chapter or any
 1304  of the rules of the Board of Pharmacy; of chapter 499, known as
 1305  the “Florida Drug and Cosmetic Act”; of 21 U.S.C. ss. 301-392,
 1306  known as the “Federal Food, Drug, and Cosmetic Act”; of 21
 1307  U.S.C. ss. 821 et seq., known as the Comprehensive Drug Abuse
 1308  Prevention and Control Act; or of chapter 893;
 1309         (d) Been convicted or found guilty, regardless of
 1310  adjudication, of a felony or any other crime involving moral
 1311  turpitude in any of the courts of this state, of any other
 1312  state, or of the United States; or
 1313         (e) Been convicted or disciplined by a regulatory agency of
 1314  the Federal Government or a regulatory agency of another state
 1315  for any offense that would constitute a violation of this
 1316  chapter;
 1317         (f) Been convicted of, or entered a plea of guilty or nolo
 1318  contendere to, regardless of adjudication, a crime in any
 1319  jurisdiction which relates to the practice of, or the ability to
 1320  practice, the profession of pharmacy;
 1321         (g) Been convicted of, or entered a plea of guilty or nolo
 1322  contendere to, regardless of adjudication, a crime in any
 1323  jurisdiction which relates to health care fraud; or
 1324         (h)(e) Dispensed any medicinal drug based upon a
 1325  communication that purports to be a prescription as defined by
 1326  s. 465.003(14) or s. 893.02 when the pharmacist knows or has
 1327  reason to believe that the purported prescription is not based
 1328  upon a valid practitioner-patient relationship that includes a
 1329  documented patient evaluation, including history and a physical
 1330  examination adequate to establish the diagnosis for which any
 1331  drug is prescribed and any other requirement established by
 1332  board rule under chapter 458, chapter 459, chapter 461, chapter
 1333  463, chapter 464, or chapter 466.
 1334         Section 23. Section 825.103, Florida Statutes, is amended
 1335  to read:
 1336         825.103 Exploitation of an elderly person or disabled
 1337  adult; penalties.—
 1338         (1) “Exploitation of an elderly person or disabled adult”
 1339  means:
 1340         (a) Knowingly, by deception or intimidation, obtaining or
 1341  using, or endeavoring to obtain or use, an elderly person’s or
 1342  disabled adult’s funds, assets, or property with the intent to
 1343  temporarily or permanently deprive the elderly person or
 1344  disabled adult of the use, benefit, or possession of the funds,
 1345  assets, or property, or to benefit someone other than the
 1346  elderly person or disabled adult, by a person who:
 1347         1. Stands in a position of trust and confidence with the
 1348  elderly person or disabled adult; or
 1349         2. Has a business relationship with the elderly person or
 1350  disabled adult; or
 1351         (b) Obtaining or using, endeavoring to obtain or use, or
 1352  conspiring with another to obtain or use an elderly person’s or
 1353  disabled adult’s funds, assets, or property with the intent to
 1354  temporarily or permanently deprive the elderly person or
 1355  disabled adult of the use, benefit, or possession of the funds,
 1356  assets, or property, or to benefit someone other than the
 1357  elderly person or disabled adult, by a person who knows or
 1358  reasonably should know that the elderly person or disabled adult
 1359  lacks the capacity to consent; or.
 1360         (c) Breach of a fiduciary duty to an elderly person or
 1361  disabled adult by the person’s guardian or agent under a power
 1362  of attorney which results in an unauthorized appropriation,
 1363  sale, or transfer of property.
 1364         (2)(a) If the funds, assets, or property involved in the
 1365  exploitation of the elderly person or disabled adult is valued
 1366  at $100,000 or more, the offender commits a felony of the first
 1367  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1368  775.084.
 1369         (b) If the funds, assets, or property involved in the
 1370  exploitation of the elderly person or disabled adult is valued
 1371  at $20,000 or more, but less than $100,000, the offender commits
 1372  a felony of the second degree, punishable as provided in s.
 1373  775.082, s. 775.083, or s. 775.084.
 1374         (c) If the funds, assets, or property involved in the
 1375  exploitation of an elderly person or disabled adult is valued at
 1376  less than $20,000, the offender commits a felony of the third
 1377  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1378  775.084.
 1379         Section 24. Paragraphs (g) and (i) of subsection (3) of
 1380  section 921.0022, Florida Statutes, are amended to read:
 1381         921.0022 Criminal Punishment Code; offense severity ranking
 1382  chart.—
 1383         (3) OFFENSE SEVERITY RANKING CHART
 1384         (g) LEVEL 7
 1385  FloridaStatute     FelonyDegree               Description               
 1386  316.027(1)(b)      1st      Accident involving death, failure to stop; leaving scene.
 1387  316.193(3)(c)2.    3rd      DUI resulting in serious bodily injury.  
 1388  316.1935(3)(b)     1st      Causing serious bodily injury or death to another person; driving at high speed or with wanton disregard for safety while fleeing or attempting to elude law enforcement officer who is in a patrol vehicle with siren and lights activated.
 1389  327.35(3)(c)2.     3rd      Vessel BUI resulting in serious bodily injury.
 1390  402.319(2)         2nd      Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.
 1391  409.920(2)(b)1.a.  3rd      Medicaid provider fraud; $10,000 or less.
 1392  409.920(2)(b)1.b.  2nd      Medicaid provider fraud; more than $10,000, but less than $50,000.
 1393  456.065(2)         3rd      Practicing a health care profession without a license.
 1394  456.065(2)         2nd      Practicing a health care profession without a license which results in serious bodily injury.
 1395  458.327(1)         3rd      Practicing medicine without a license.   
 1396  459.013(1)         3rd      Practicing osteopathic medicine without a license.
 1397  460.411(1)         3rd      Practicing chiropractic medicine without a license.
 1398  461.012(1)         3rd      Practicing podiatric medicine without a license.
 1399  462.17             3rd      Practicing naturopathy without a license.
 1400  463.015(1)         3rd      Practicing optometry without a license.  
 1401  464.016(1)         3rd      Practicing nursing without a license.    
 1402  465.015(2)         3rd      Practicing pharmacy without a license.   
 1403  466.026(1)         3rd      Practicing dentistry or dental hygiene without a license.
 1404  467.201            3rd      Practicing midwifery without a license.  
 1405  468.366            3rd      Delivering respiratory care services without a license.
 1406  483.828(1)         3rd      Practicing as clinical laboratory personnel without a license.
 1407  483.901(9)         3rd      Practicing medical physics without a license.
 1408  484.013(1)(c)      3rd      Preparing or dispensing optical devices without a prescription.
 1409  484.053            3rd      Dispensing hearing aids without a license.
 1410  494.0018(2)        1st      Conviction of any violation of ss. 494.001-494.0077 in which the total money and property unlawfully obtained exceeded $50,000 and there were five or more victims.
 1411  560.123(8)(b)1.    3rd      Failure to report currency or payment instruments exceeding $300 but less than $20,000 by a money services business.
 1412  560.125(5)(a)      3rd      Money services business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.
 1413  655.50(10)(b)1.    3rd      Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.
 1414  775.21(10)(a)      3rd      Sexual predator; failure to register; failure to renew driver’s license or identification card; other registration violations.
 1415  775.21(10)(b)      3rd      Sexual predator working where children regularly congregate.
 1416  775.21(10)(g)      3rd      Failure to report or providing false information about a sexual predator; harbor or conceal a sexual predator.
 1417  782.051(3)         2nd      Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.
 1418  782.07(1)          2nd      Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).
 1419  782.071            2nd      Killing of a human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).
 1420  782.072            2nd      Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).
 1421  784.045(1)(a)1.    2nd      Aggravated battery; intentionally causing great bodily harm or disfigurement.
 1422  784.045(1)(a)2.    2nd      Aggravated battery; using deadly weapon. 
 1423  784.045(1)(b)      2nd      Aggravated battery; perpetrator aware victim pregnant.
 1424  784.048(4)         3rd      Aggravated stalking; violation of injunction or court order.
 1425  784.048(7)         3rd      Aggravated stalking; violation of court order.
 1426  784.07(2)(d)       1st      Aggravated battery on law enforcement officer.
 1427  784.074(1)(a)      1st      Aggravated battery on sexually violent predators facility staff.
 1428  784.08(2)(a)       1st      Aggravated battery on a person 65 years of age or older.
 1429  784.081(1)         1st      Aggravated battery on specified official or employee.
 1430  784.082(1)         1st      Aggravated battery by detained person on visitor or other detainee.
 1431  784.083(1)         1st      Aggravated battery on code inspector.    
 1432  790.07(4)          1st      Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).
 1433  790.16(1)          1st      Discharge of a machine gun under specified circumstances.
 1434  790.165(2)         2nd      Manufacture, sell, possess, or deliver hoax bomb.
 1435  790.165(3)         2nd      Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.
 1436  790.166(3)         2nd      Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.
 1437  790.166(4)         2nd      Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.
 1438  790.23             1st,PBL  Possession of a firearm by a person who qualifies for the penalty enhancements provided for in s. 874.04.
 1439  794.08(4)          3rd      Female genital mutilation; consent by a parent, guardian, or a person in custodial authority to a victim younger than 18 years of age.
 1440  796.03             2nd      Procuring any person under 16 years for prostitution.
 1441  800.04(5)(c)1.     2nd      Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.
 1442  800.04(5)(c)2.     2nd      Lewd or lascivious molestation; victim 12 years of age or older but less than 16 years; offender 18 years or older.
 1443  806.01(2)          2nd      Maliciously damage structure by fire or explosive.
 1444  810.02(3)(a)       2nd      Burglary of occupied dwelling; unarmed; no assault or battery.
 1445  810.02(3)(b)       2nd      Burglary of unoccupied dwelling; unarmed; no assault or battery.
 1446  810.02(3)(d)       2nd      Burglary of occupied conveyance; unarmed; no assault or battery.
 1447  810.02(3)(e)       2nd      Burglary of authorized emergency vehicle.
 1448  812.014(2)(a)1.    1st      Property stolen, valued at $100,000 or more or a semitrailer deployed by a law enforcement officer; property stolen while causing other property damage; 1st degree grand theft.
 1449  812.014(2)(b)2.    2nd      Property stolen, cargo valued at less than $50,000, grand theft in 2nd degree.
 1450  812.014(2)(b)3.    2nd      Property stolen, emergency medical equipment; 2nd degree grand theft.
 1451  812.014(2)(b)4.    2nd      Property stolen, law enforcement equipment from authorized emergency vehicle.
 1452  812.0145(2)(a)     1st      Theft from person 65 years of age or older; $50,000 or more.
 1453  812.019(2)         1st      Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.
 1454  812.131(2)(a)      2nd      Robbery by sudden snatching.             
 1455  812.133(2)(b)      1st      Carjacking; no firearm, deadly weapon, or other weapon.
 1456  817.234(8)(a)      2nd      Solicitation of motor vehicle accident victims with intent to defraud.
 1457  817.234(9)         2nd      Organizing, planning, or participating in an intentional motor vehicle collision.
 1458  817.234(11)(c)     1st      Insurance fraud; property value $100,000 or more.
 1459  817.2341(2)(b) & (3)(b)1st      Making false entries of material fact or false statements regarding property values relating to the solvency of an insuring entity which are a significant cause of the insolvency of that entity.
 1460  825.102(3)(b)      2nd      Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.
 1461  825.103(2)(b)      2nd      Exploiting an elderly person or disabled adult and property is valued at $20,000 or more, but less than $100,000.
 1462  827.03(3)(b)       2nd      Neglect of a child causing great bodily harm, disability, or disfigurement.
 1463  827.04(3)          3rd      Impregnation of a child under 16 years of age by person 21 years of age or older.
 1464  837.05(2)          3rd      Giving false information about alleged capital felony to a law enforcement officer.
 1465  838.015            2nd      Bribery.                                 
 1466  838.016            2nd      Unlawful compensation or reward for official behavior.
 1467  838.021(3)(a)      2nd      Unlawful harm to a public servant.       
 1468  838.22             2nd      Bid tampering.                           
 1469  847.0135(3)        3rd      Solicitation of a child, via a computer service, to commit an unlawful sex act.
 1470  847.0135(4)        2nd      Traveling to meet a minor to commit an unlawful sex act.
 1471  872.06             2nd      Abuse of a dead human body.              
 1472  874.10             1st,PBL  Knowingly initiates, organizes, plans, finances, directs, manages, or supervises criminal gang-related activity.
 1473  893.13(1)(c)1.     1st      Sell, manufacture, or deliver cocaine (or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4.) within 1,000 feet of a child care facility, school, or state, county, or municipal park or publicly owned recreational facility or community center.
 1474  893.13(1)(e)1.     1st      Sell, manufacture, or deliver cocaine or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4., within 1,000 feet of property used for religious services or a specified business site.
 1475  893.13(4)(a)       1st      Deliver to minor cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs).
 1476  893.135(1)(a)1.    1st      Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.
 1477  893.135(1)(b)1.a.  1st      Trafficking in cocaine, more than 28 grams, less than 200 grams.
 1478  893.135(1)(c)1.a.  1st      Trafficking in illegal drugs, more than 4 grams, less than 14 grams.
 1479  893.135(1)(d)1.    1st      Trafficking in phencyclidine, more than 28 grams, less than 200 grams.
 1480  893.135(1)(e)1.    1st      Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.
 1481  893.135(1)(f)1.    1st      Trafficking in amphetamine, more than 14 grams, less than 28 grams.
 1482  893.135(1)(g)1.a.  1st      Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.
 1483  893.135(1)(h)1.a.  1st      Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.
 1484  893.135(1)(j)1.a.  1st      Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.
 1485  893.135(1)(k)2.a.  1st      Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.
 1486  893.1351(2)        2nd      Possession of place for trafficking in or manufacturing of controlled substance.
 1487  896.101(5)(a)      3rd      Money laundering, financial transactions exceeding $300 but less than $20,000.
 1488  896.104(4)(a)1.    3rd      Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.
 1489  943.0435(4)(c)     2nd      Sexual offender vacating permanent residence; failure to comply with reporting requirements.
 1490  943.0435(8)        2nd      Sexual offender; remains in state after indicating intent to leave; failure to comply with reporting requirements.
 1491  943.0435(9)(a)     3rd      Sexual offender; failure to comply with reporting requirements.
 1492  943.0435(13)       3rd      Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
 1493  943.0435(14)       3rd      Sexual offender; failure to report and reregister; failure to respond to address verification.
 1494  944.607(9)         3rd      Sexual offender; failure to comply with reporting requirements.
 1495  944.607(10)(a)     3rd      Sexual offender; failure to submit to the taking of a digitized photograph.
 1496  944.607(12)        3rd      Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
 1497  944.607(13)        3rd      Sexual offender; failure to report and reregister; failure to respond to address verification.
 1498  985.4815(10)       3rd      Sexual offender; failure to submit to the taking of a digitized photograph.
 1499  985.4815(12)       3rd      Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
 1500  985.4815(13)       3rd      Sexual offender; failure to report and reregister; failure to respond to address verification.
 1501         (i) LEVEL 9
 1502  FloridaStatute     FelonyDegree       Description        
 1503  316.193(3)(c)3.b.  1st      DUI manslaughter; failing to render aid or give information.
 1504  327.35(3)(c)3.b.            1st                       BUI manslaughter; failing to render aid or give information.
 1505  409.920(2)(b)1.c.           1st                       Medicaid provider fraud; $50,000 or more.
 1506  499.0051(9)        1st                               Knowing sale or purchase of contraband prescription drugs resulting in great bodily harm.
 1507  560.123(8)(b)3.    1st      Failure to report currency or payment instruments totaling or exceeding $100,000 by money transmitter.
 1508  560.125(5)(c)      1st      Money transmitter business by unauthorized person, currency, or payment instruments totaling or exceeding $100,000.
 1509  655.50(10)(b)3.    1st      Failure to report financial transactions totaling or exceeding $100,000 by financial institution.
 1510  775.0844           1st      Aggravated white collar crime.
 1511  782.04(1)          1st      Attempt, conspire, or solicit to commit premeditated murder.
 1512  782.04(3)          1st,PBL  Accomplice to murder in connection with arson, sexual battery, robbery, burglary, and other specified felonies.
 1513  782.051(1)         1st      Attempted felony murder while perpetrating or attempting to perpetrate a felony enumerated in s. 782.04(3).
 1514  782.07(2)          1st      Aggravated manslaughter of an elderly person or disabled adult.
 1515  787.01(1)(a)1.     1st,PBL  Kidnapping; hold for ransom or reward or as a shield or hostage.
 1516  787.01(1)(a)2.     1st,PBL  Kidnapping with intent to commit or facilitate commission of any felony.
 1517  787.01(1)(a)4.     1st,PBL  Kidnapping with intent to interfere with performance of any governmental or political function.
 1518  787.02(3)(a)       1st      False imprisonment; child under age 13; perpetrator also commits aggravated child abuse, sexual battery, or lewd or lascivious battery, molestation, conduct, or exhibition.
 1519  790.161            1st      Attempted capital destructive device offense.
 1520  790.166(2)         1st,PBL  Possessing, selling, using, or attempting to use a weapon of mass destruction.
 1521  794.011(2)         1st      Attempted sexual battery; victim less than 12 years of age.
 1522  794.011(2)         Life     Sexual battery; offender younger than 18 years and commits sexual battery on a person less than 12 years.
 1523  794.011(4)         1st      Sexual battery; victim 12 years or older, certain circumstances.
 1524  794.011(8)(b)      1st      Sexual battery; engage in sexual conduct with minor 12 to 18 years by person in familial or custodial authority.
 1525  794.08(2)          1st      Female genital mutilation; victim younger than 18 years of age.
 1526  800.04(5)(b)       Life     Lewd or lascivious molestation; victim less than 12 years; offender 18 years or older.
 1527  812.13(2)(a)       1st,PBL  Robbery with firearm or other deadly weapon.
 1528  812.133(2)(a)      1st,PBL  Carjacking; firearm or other deadly weapon.
 1529  812.135(2)(b)      1st      Home-invasion robbery with weapon.
 1530  817.568(7)         2nd,PBL  Fraudulent use of personal identification information of an individual under the age of 18 by his or her parent, legal guardian, or person exercising custodial authority.
 1531  827.03(2)          1st      Aggravated child abuse.   
 1532  847.0145(1)        1st      Selling, or otherwise transferring custody or control, of a minor.
 1533  847.0145(2)        1st      Purchasing, or otherwise obtaining custody or control, of a minor.
 1534  859.01             1st      Poisoning or introducing bacteria, radioactive materials, viruses, or chemical compounds into food, drink, medicine, or water with intent to kill or injure another person.
 1535  893.135            1st      Attempted capital trafficking offense.
 1536  893.135(1)(a)3.    1st      Trafficking in cannabis, more than 10,000 lbs.
 1537  893.135(1)(b)1.c.  1st      Trafficking in cocaine, more than 400 grams, less than 150 kilograms.
 1538  893.135(1)(c)1.c.  1st      Trafficking in illegal drugs, more than 28 grams, less than 30 kilograms.
 1539  893.135(1)(d)1.c.  1st      Trafficking in phencyclidine, more than 400 grams.
 1540  893.135(1)(e)1.c.  1st      Trafficking in methaqualone, more than 25 kilograms.
 1541  893.135(1)(f)1.c.  1st      Trafficking in amphetamine, more than 200 grams.
 1542  893.135(1)(h)1.c.  1st      Trafficking in gamma-hydroxybutyric acid (GHB), 10 kilograms or more.
 1543  893.135(1)(j)1.c.  1st      Trafficking in 1,4-Butanediol, 10 kilograms or more.
 1544  893.135(1)(k)2.c.  1st      Trafficking in Phenethylamines, 400 grams or more.
 1545  896.101(5)(c)      1st      Money laundering, financial instruments totaling or exceeding $100,000.
 1546  896.104(4)(a)3.    1st      Structuring transactions to evade reporting or registration requirements, financial transactions totaling or exceeding $100,000.
 1547         Section 25. Pilot project to monitor home health services.
 1548  The Agency for Health Care Administration shall develop and
 1549  implement a home health agency monitoring pilot project in
 1550  Miami-Dade County by January 1, 2010. The agency shall contract
 1551  with a vendor to verify the utilization and delivery of home
 1552  health services and provide an electronic billing interface for
 1553  home health services. The contract must require the creation of
 1554  a program to submit claims electronically for the delivery of
 1555  home health services. The program must verify telephonically
 1556  visits for the delivery of home health services using voice
 1557  biometrics. The agency may seek amendments to the Medicaid state
 1558  plan and waivers of federal laws, as necessary, to implement the
 1559  pilot project. Notwithstanding s. 287.057(5)(f), Florida
 1560  Statutes, the agency must award the contract through the
 1561  competitive solicitation process. The agency shall submit a
 1562  report to the Governor, the President of the Senate, and the
 1563  Speaker of the House of Representatives evaluating the pilot
 1564  project by February 1, 2011.
 1565         Section 26. Pilot project for home health care management.
 1566  The Agency for Health Care Administration shall implement a
 1567  comprehensive care management pilot project for home health
 1568  services by January 1, 2010, which includes face-to-face
 1569  assessments by a nurse licensed pursuant to chapter 464, Florida
 1570  Statutes, consultation with physicians ordering services to
 1571  substantiate the medical necessity for services, and on-site or
 1572  desk reviews of recipients’ medical records in Miami-Dade
 1573  County. The agency may enter into a contract with a qualified
 1574  organization to implement the pilot project. The agency may seek
 1575  amendments to the Medicaid state plan and waivers of federal
 1576  laws, as necessary, to implement the pilot project.
 1577         Section 27. Subsection (6) of section 400.0077, Florida
 1578  Statutes, is amended to read:
 1579         400.0077 Confidentiality.—
 1580         (6) This section does not limit the subpoena power of the
 1581  Attorney General pursuant to s. 409.920(10)(b) s. 409.920(9)(b).
 1582         Section 28. Subsection (2) of section 430.608, Florida
 1583  Statutes, is amended to read:
 1584         430.608 Confidentiality of information.—
 1585         (2) This section does not, however, limit the subpoena
 1586  authority of the Medicaid Fraud Control Unit of the Department
 1587  of Legal Affairs pursuant to s. 409.920(10)(b) s. 409.920(9)(b).
 1588         Section 29. This act shall take effect July 1, 2009.