Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. SB 1930
                                Barcode 100124                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/13/2011           .                                

       The Committee on Banking and Insurance (Bogdanoff) recommended
       the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (1) of section 316.066, Florida
    6  Statutes, is amended to read:
    7         316.066 Written reports of crashes.—
    8         (1)(a) A Florida Traffic Crash Report, Long Form, must is
    9  required to be completed and submitted to the department within
   10  10 days after completing an investigation is completed by the
   11  every law enforcement officer who in the regular course of duty
   12  investigates a motor vehicle crash:
   13         1. That resulted in death, or personal injury, or any
   14  indication of complaints of pain or discomfort by any of the
   15  parties or passengers involved in the crash;.
   16         2. That involved one or more passengers, other than the
   17  drivers of the vehicles, in any of the vehicles involved in the
   18  crash;
   19         3.2. That involved a violation of s. 316.061(1) or s.
   20  316.193; or.
   21         4.3. In which a vehicle was rendered inoperative to a
   22  degree that required a wrecker to remove it from traffic, if
   23  such action is appropriate, in the officer’s discretion.
   24         (b) In every crash for which a Florida Traffic Crash
   25  Report, Long Form, is not required by this section, the law
   26  enforcement officer may complete a short-form crash report or
   27  provide a short-form crash report to be completed by each party
   28  involved in the crash. Short-form crash reports prepared by the
   29  law enforcement officer shall be maintained by the officer’s
   30  agency.
   31         (c) The long-form and the short-form report must include:
   32         1. The date, time, and location of the crash.
   33         2. A description of the vehicles involved.
   34         3. The names and addresses of the parties involved.
   35         4. The names and addresses of all passengers in all
   36  vehicles involved in the crash, each clearly identified as being
   37  a passenger and the identification of the vehicle in which they
   38  were a passenger.
   39         5.4. The names and addresses of witnesses.
   40         6.5. The name, badge number, and law enforcement agency of
   41  the officer investigating the crash.
   42         7.6. The names of the insurance companies for the
   43  respective parties involved in the crash.
   44         (d)(c) Each party to the crash must shall provide the law
   45  enforcement officer with proof of insurance, which must to be
   46  included in the crash report. If a law enforcement officer
   47  submits a report on the accident, proof of insurance must be
   48  provided to the officer by each party involved in the crash. Any
   49  party who fails to provide the required information commits a
   50  noncriminal traffic infraction, punishable as a nonmoving
   51  violation as provided in chapter 318, unless the officer
   52  determines that due to injuries or other special circumstances
   53  such insurance information cannot be provided immediately. If
   54  the person provides the law enforcement agency, within 24 hours
   55  after the crash, proof of insurance that was valid at the time
   56  of the crash, the law enforcement agency may void the citation.
   57         (e)(d) The driver of a vehicle that was in any manner
   58  involved in a crash resulting in damage to any vehicle or other
   59  property in an amount of $500 or more, which crash was not
   60  investigated by a law enforcement agency, shall, within 10 days
   61  after the crash, submit a written report of the crash to the
   62  department or traffic records center. The entity receiving the
   63  report may require witnesses of the crash crashes to render
   64  reports and may require any driver of a vehicle involved in a
   65  crash of which a written report must be made as provided in this
   66  section to file supplemental written reports if whenever the
   67  original report is deemed insufficient by the receiving entity.
   68         (f) The investigating law enforcement officer may testify
   69  at trial or provide a signed affidavit to confirm or supplement
   70  the information included on the long-form or short-form report.
   71         (e) Short-form crash reports prepared by law enforcement
   72  shall be maintained by the law enforcement officer’s agency.
   73         Section 2. Subsection (6) is added to section 400.991,
   74  Florida Statutes, to read:
   75         400.991 License requirements; background screenings;
   76  prohibitions.—
   77         (6) All forms that constitute part of the application for
   78  licensure or exemption from licensure under this part must
   79  contain the following statement:
   81         INSURANCE FRAUD NOTICE.—Submitting a false,
   82         misleading, or fraudulent application or other
   83         document when applying for licensure as a health care
   84         clinic, when seeking an exemption from licensure as a
   85         health care clinic, or when demonstrating compliance
   86         with part X of chapter 400, Florida Statutes, is a
   87         fraudulent insurance act, as defined in s. 626.989 or
   88         s. 817.234, Florida Statutes, subject to investigation
   89         by the Division of Insurance Fraud, and is grounds for
   90         discipline by the appropriate licensing board of the
   91         Florida Department of Health.
   92         Section 3. Section 626.9894, Florida Statutes, is created
   93  to read:
   94         626.9894Motor vehicle insurance fraud direct-support
   95  organization.—
   96         (1) DEFINITIONS.—As used in this section, the term:
   97         (a) “Division” means the Division of Insurance Fraud of the
   98  Department of Financial Services.
   99         (b) “Motor vehicle insurance fraud” means any act defined
  100  as a “fraudulent insurance act” under s. 626.989, which relates
  101  to the coverage of motor vehicle insurance as described in part
  102  XI of chapter 627.
  103         (c) “Organization” means the direct-support organization
  104  established under this section.
  105         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  106  direct-support organization, to be known as the “Automobile
  107  Insurance Fraud Strike Force,” whose sole purpose is to support
  108  the prosecution, investigation, and prevention of motor vehicle
  109  insurance fraud. The organization shall:
  110         (a) Be a not-for-profit corporation incorporated under
  111  chapter 617 and approved by the Department of State.
  112         (b) Be organized and operated to conduct programs and
  113  activities; to raise funds; to request and receive grants,
  114  gifts, and bequests of money; to acquire, receive, hold, invest,
  115  and administer, in its own name, securities, funds, objects of
  116  value, or other property, real or personal; and to make grants
  117  and expenditures to or for the direct or indirect benefit of the
  118  division, state attorneys’ offices, the statewide prosecutor,
  119  the Agency for Health Care Administration, and the Department of
  120  Health to the extent that such grants and expenditures are to be
  121  used exclusively to advance the purpose of prosecuting,
  122  investigating, or preventing motor vehicle insurance fraud.
  123  Grants and expenditures may include the cost of salaries or
  124  benefits of dedicated motor vehicle insurance fraud
  125  investigators, prosecutors, or support personnel if such grants
  126  and expenditures do not interfere with prosecutorial
  127  independence or otherwise create conflicts of interest which
  128  threaten the success of prosecutions.
  129         (c) Be determined by the division to operate in a manner
  130  that promotes the goals of laws relating to motor vehicle
  131  insurance fraud, that is in the best interest of the state, and
  132  that is in accordance with the adopted goals and mission of the
  133  division.
  134         (d) Use all of its grants and expenditures solely for the
  135  purpose of preventing and decreasing motor vehicle insurance
  136  fraud, and not for the purpose of lobbying as defined in s.
  137  11.045.
  138         (e) Be subject to an annual financial audit in accordance
  139  with s. 215.981.
  140         (3) CONTRACT.—The organization shall operate under written
  141  contract with the division. The contract must provide for:
  142         (a) Approval of the articles of incorporation and bylaws of
  143  the organization by the division.
  144         (b) Submission of an annual budget for the approval of the
  145  division. The budget must require the organization to minimize
  146  costs to the division and its members at all times by using
  147  existing personnel and property and allowing for telephonic
  148  meetings when appropriate.
  149         (c) Certification by the division that the direct-support
  150  organization is complying with the terms of the contract and in
  151  a manner consistent with the goals and purposes of the
  152  department and in the best interest of the state. Such
  153  certification must be made annually and reported in the official
  154  minutes of a meeting of the organization.
  155         (d) Allocation of funds to address motor vehicle insurance
  156  fraud.
  157         (e) Reversion of moneys and property held in trust by the
  158  organization for motor vehicle insurance fraud prosecution,
  159  investigation, and prevention to the division if the
  160  organization is no longer approved to operate for the department
  161  or if the organization ceases to exist, or to the state if the
  162  division ceases to exist.
  163         (f) Specific criteria to be used by the organization’s
  164  board of directors to evaluate the effectiveness of funding used
  165  to combat motor vehicle insurance fraud.
  166         (g) The fiscal year of the organization, which begins July
  167  1 of each year and ends June 30 of the following year.
  168         (h) Disclosure of the material provisions of the contract,
  169  and distinguishing between the department and the organization
  170  to donors of gifts, contributions, or bequests, including
  171  providing such disclosure on all promotional and fundraising
  172  publications.
  173         (4) BOARD OF DIRECTORS.—The board of directors of the
  174  organization shall consist of the following seven members:
  175         (a) The Chief Financial Officer, or designee, who shall
  176  serve as chair.
  177         (b) Two state attorneys, one of whom shall be appointed by
  178  the Chief Financial Officer and one of whom shall be appointed
  179  by the Attorney General.
  180         (c) Two representatives of motor vehicle insurers appointed
  181  by the Chief Financial Officer.
  182         (d) Two representatives of local law enforcement agencies,
  183  both of whom shall be appointed by the Chief Financial Officer.
  185  The officer who appointed a member of the board may remove that
  186  member for cause. The term of office of an appointed member
  187  expires at the same time as the term of the officer who
  188  appointed him or her or at such earlier time as the person
  189  ceases to be qualified.
  190         (5) USE OF PROPERTY.—The department may authorize, without
  191  charge, appropriate use of fixed property and facilities of the
  192  division by the organization, subject to this subsection.
  193         (a) The department may prescribe any condition with which
  194  the organization must comply in order to use the division’s
  195  property or facilities.
  196         (b) The department may not authorize the use of the
  197  division’s property or facilities if the organization does not
  198  provide equal membership and employment opportunities to all
  199  persons regardless of race, religion, sex, age, or national
  200  origin.
  201         (c) The department shall adopt rules prescribing the
  202  procedures by which the organization is governed and any
  203  conditions with which the organization must comply to use the
  204  division’s property or facilities.
  205         (6) CONTRIBUTIONS.—Any contributions made by an insurer to
  206  the organization shall be allowed as appropriate business
  207  expenses for all regulatory purposes.
  208         (7) DEPOSITORY.—Any moneys received by the organization may
  209  be held in a separate depository account in the name of the
  210  organization and subject to the provisions of the contract with
  211  the division.
  212         (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division
  213  receives proceeds from the organization, those proceeds shall be
  214  deposited into the Insurance Regulatory Trust Fund.
  215         Section 4. Subsection (3) is added to section 627.4137,
  216  Florida Statutes, to read:
  217         627.4137 Disclosure of certain information required.—
  218         (3)Any request made to a self-insured corporation pursuant
  219  to this section shall be sent by certified mail to the
  220  registered agent of the disclosing entity.
  221         Section 5. Section 627.730, Florida Statutes, is amended to
  222  read:
  223         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  224  627.730-627.7407 627.730-627.7405 may be cited and known as the
  225  “Florida Motor Vehicle No-Fault Law.”
  226         Section 6. Section 627.731, Florida Statutes, is amended to
  227  read:
  228         627.731 Purpose; legislative intent.—The purpose of the no
  229  fault law ss. 627.730-627.7405 is to provide for medical,
  230  surgical, funeral, and disability insurance benefits without
  231  regard to fault, and to require motor vehicle insurance securing
  232  such benefits, for motor vehicles required to be registered in
  233  this state and, with respect to motor vehicle accidents, a
  234  limitation on the right to claim damages for pain, suffering,
  235  mental anguish, and inconvenience.
  236         (1) The Legislature finds that automobile insurance fraud
  237  remains a major problem for state consumers and insurers.
  238  According to the National Insurance Crime Bureau, in recent
  239  years this state has been among those states that have the
  240  highest number of fraudulent and questionable claims.
  241         (2) The Legislature intends to balance the insured’s
  242  interest in prompt payment of valid claims for insurance
  243  benefits under the no-fault law with the public’s interest in
  244  reducing fraud, abuse, and overuse of the no-fault system. To
  245  that end, the Legislature intends that the investigation and
  246  prevention of fraudulent insurance acts in this state be
  247  enhanced, that additional sanctions for such acts be imposed,
  248  and that the no-fault law be revised to remove incentives for
  249  fraudulent insurance acts. The Legislature intends that the no
  250  fault law be construed according to the plain language of the
  251  statutory provisions, which are designed to meet these goals.
  252         (3) The Legislature intends that:
  253         (a) Insurers properly investigate claims, and as such, be
  254  allowed to obtain examinations under oath and sworn statements
  255  from any claimant seeking no-fault insurance benefits, and to
  256  request mental and physical examinations of persons seeking
  257  personal injury protection coverage or benefits.
  258         (b) Any false, misleading, or otherwise fraudulent activity
  259  associated with a claim renders any claim brought by a claimant
  260  engaging in such activity invalid. An insurer must be able to
  261  raise fraud as a defense to a claim for no-fault insurance
  262  benefits irrespective of any prior adjudication of guilt or
  263  determination of fraud by the Department of Financial Services.
  264         (c) Insurers toll the payment or denial of a claim, with
  265  respect to any portion of a claim for which the insurer has a
  266  reasonable belief that a fraudulent insurance act, as defined in
  267  s. 626.989, has been committed.
  268         (d) Insurers discover the names of all passengers involved
  269  in an automobile accident before paying claims or benefits
  270  pursuant to an insurance policy governed by the no-fault law. A
  271  rebuttable presumption must be established that a person was not
  272  involved in the event giving rise to the claim if that person’s
  273  name does not appear on the police report.
  274         (e) The insured’s interest in obtaining competent counsel
  275  must be balanced with the public’s interest in preventing a no
  276  fault system that encourages litigation by allowing for
  277  exorbitant attorney’s fees. Courts should limit attorney fee
  278  awards so as to eliminate the incentive for attorneys to
  279  manufacture unnecessary litigation.
  280         Section 7. Section 627.732, Florida Statutes, is reordered
  281  and amended to read:
  282         627.732 Definitions.—As used in the no-fault law ss.
  283  627.730-627.7405, the term:
  284         (1) “Broker” means any person not possessing a license
  285  under chapter 395, chapter 400, chapter 429, chapter 458,
  286  chapter 459, chapter 460, chapter 461, or chapter 641 who
  287  charges or receives compensation for any use of medical
  288  equipment and is not the 100-percent owner or the 100-percent
  289  lessee of such equipment. For purposes of this section, such
  290  owner or lessee may be an individual, a corporation, a
  291  partnership, or any other entity and any of its 100-percent
  292  owned affiliates and subsidiaries. For purposes of this
  293  subsection, the term “lessee” means a long-term lessee under a
  294  capital or operating lease, but does not include a part-time
  295  lessee. The term “broker” does not include a hospital or
  296  physician management company whose medical equipment is
  297  ancillary to the practices managed, a debt collection agency, or
  298  an entity that has contracted with the insurer to obtain a
  299  discounted rate for such services; or nor does the term include
  300  a management company that has contracted to provide general
  301  management services for a licensed physician or health care
  302  facility and whose compensation is not materially affected by
  303  the usage or frequency of usage of medical equipment or an
  304  entity that is 100-percent owned by one or more hospitals or
  305  physicians. The term “broker” does not include a person or
  306  entity that certifies, upon request of an insurer, that:
  307         (a) It is a clinic licensed under ss. 400.990-400.995;
  308         (b) It is a 100-percent owner of medical equipment; and
  309         (c) The owner’s only part-time lease of medical equipment
  310  for personal injury protection patients is on a temporary basis,
  311  not to exceed 30 days in a 12-month period, and such lease is
  312  solely for the purposes of necessary repair or maintenance of
  313  the 100-percent-owned medical equipment or pending the arrival
  314  and installation of the newly purchased or a replacement for the
  315  100-percent-owned medical equipment, or for patients for whom,
  316  because of physical size or claustrophobia, it is determined by
  317  the medical director or clinical director to be medically
  318  necessary that the test be performed in medical equipment that
  319  is open-style. The leased medical equipment may not cannot be
  320  used by patients who are not patients of the registered clinic
  321  for medical treatment of services. Any person or entity making a
  322  false certification under this subsection commits insurance
  323  fraud as defined in s. 817.234. However, the 30-day period
  324  provided in this paragraph may be extended for an additional 60
  325  days as applicable to magnetic resonance imaging equipment if
  326  the owner certifies that the extension otherwise complies with
  327  this paragraph.
  328         (9)(2) “Medically necessary” refers to a medical service or
  329  supply that a prudent physician would provide for the purpose of
  330  preventing, diagnosing, or treating an illness, injury, disease,
  331  or symptom in a manner that is:
  332         (a) In accordance with generally accepted standards of
  333  medical practice;
  334         (b) Clinically appropriate in terms of type, frequency,
  335  extent, site, and duration; and
  336         (c) Not primarily for the convenience of the patient,
  337  physician, or other health care provider.
  338         (10)(3) “Motor vehicle” means a any self-propelled vehicle
  339  with four or more wheels which is of a type both designed and
  340  required to be licensed for use on the highways of this state,
  341  and any trailer or semitrailer designed for use with such
  342  vehicle, and includes:
  343         (a) A “private passenger motor vehicle,” which is any motor
  344  vehicle that which is a sedan, station wagon, or jeep-type
  345  vehicle and, if not used primarily for occupational,
  346  professional, or business purposes, a motor vehicle of the
  347  pickup, panel, van, camper, or motor home type.
  348         (b) A “commercial motor vehicle,” which is any motor
  349  vehicle that which is not a private passenger motor vehicle.
  351  The term “motor vehicle” does not include a mobile home or any
  352  motor vehicle that which is used in mass transit, other than
  353  public school transportation, and designed to transport more
  354  than five passengers exclusive of the operator of the motor
  355  vehicle and that which is owned by a municipality, a transit
  356  authority, or a political subdivision of the state.
  357         (11)(4) “Named insured” means a person, usually the owner
  358  of a vehicle, identified in a policy by name as the insured
  359  under the policy.
  360         (12) “No-fault law” means the Florida Motor Vehicle No
  361  Fault Law codifed at ss. 627.730-627.7407.
  362         (13)(5) “Owner” means a person who holds the legal title to
  363  a motor vehicle; or, if in the event a motor vehicle is the
  364  subject of a security agreement or lease with an option to
  365  purchase with the debtor or lessee having the right to
  366  possession, then the debtor or lessee is shall be deemed the
  367  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  368         (15)(6) “Relative residing in the same household” means a
  369  relative of any degree by blood or by marriage who usually makes
  370  her or his home in the same family unit, whether or not
  371  temporarily living elsewhere.
  372         (2)(7) “Certify” means to swear or attest to being true or
  373  represented in writing.
  374         (3) “Claimant” means the person, organization, or entity
  375  seeking benefits, including all assignees.
  376         (5)(8) “Immediate personal supervision,” as it relates to
  377  the performance of medical services by nonphysicians not in a
  378  hospital, means that an individual licensed to perform the
  379  medical service or provide the medical supplies must be present
  380  within the confines of the physical structure where the medical
  381  services are performed or where the medical supplies are
  382  provided such that the licensed individual can respond
  383  immediately to any emergencies if needed.
  384         (6)(9) “Incident,” with respect to services considered as
  385  incident to a physician’s professional service, for a physician
  386  licensed under chapter 458, chapter 459, chapter 460, or chapter
  387  461, if not furnished in a hospital, means such services that
  388  are must be an integral, even if incidental, part of a covered
  389  physician’s service.
  390         (7)(10) “Knowingly” means that a person, with respect to
  391  information, has actual knowledge of the information,; acts in
  392  deliberate ignorance of the truth or falsity of the
  393  information,; or acts in reckless disregard of the information.,
  394  and Proof of specific intent to defraud is not required.
  395         (8)(11) “Lawful” or “lawfully” means in substantial
  396  compliance with all relevant applicable criminal, civil, and
  397  administrative requirements of state and federal law related to
  398  the provision of medical services or treatment.
  399         (4)(12) “Hospital” means a facility that, at the time
  400  services or treatment were rendered, was licensed under chapter
  401  395.
  402         (14)(13) “Properly completed” means providing truthful,
  403  substantially complete, and substantially accurate responses as
  404  to all material elements of to each applicable request for
  405  information or statement by a means that may lawfully be
  406  provided and that complies with this section, or as agreed by
  407  the parties.
  408         (17)(14) “Upcoding” means submitting an action that submits
  409  a billing code that would result in payment greater in amount
  410  than would be paid using a billing code that accurately
  411  describes the services performed. The term does not include an
  412  otherwise lawful bill by a magnetic resonance imaging facility,
  413  which globally combines both technical and professional
  414  components, if the amount of the global bill is not more than
  415  the components if billed separately; however, payment of such a
  416  bill constitutes payment in full for all components of such
  417  service.
  418         (16)(15) “Unbundling” means submitting an action that
  419  submits a billing code that is properly billed under one billing
  420  code, but that has been separated into two or more billing
  421  codes, and would result in payment greater than the in amount
  422  that than would be paid using one billing code.
  423         Section 8. Subsections (1) and (4) of section 627.736,
  424  Florida Statutes, are amended, subsections (5) through (16) of
  425  that section are redesignated as subsections (6) through (17),
  426  respectively, a new subsection (5) is added to that section,
  427  present subsection (5), paragraph (b) of present subsection (6),
  428  paragraph (b) of present subsection (7), and present subsections
  429  (8), (9), and (10) of that section are amended, to read:
  430         627.736 Required personal injury protection benefits;
  431  exclusions; priority; claims.—
  432         (1) REQUIRED BENEFITS.—Every insurance policy complying
  433  with the security requirements of s. 627.733 must shall provide
  434  personal injury protection to the named insured, relatives
  435  residing in the same household, persons operating the insured
  436  motor vehicle, passengers in such motor vehicle, and other
  437  persons struck by such motor vehicle and suffering bodily injury
  438  while not an occupant of a self-propelled vehicle, subject to
  439  the provisions of subsection (2) and paragraph (4)(h) (4)(e), to
  440  a limit of $10,000 for loss sustained by any such person as a
  441  result of bodily injury, sickness, disease, or death arising out
  442  of the ownership, maintenance, or use of a motor vehicle as
  443  follows:
  444         (a) Medical benefits.—Eighty percent of all reasonable
  445  expenses, charged pursuant to subsection (6), for medically
  446  necessary medical, surgical, X-ray, dental, and rehabilitative
  447  services, including prosthetic devices, and for medically
  448  necessary ambulance, hospital, and nursing services. However,
  449  the medical benefits shall provide reimbursement only for such
  450  services and care that are lawfully provided, supervised,
  451  ordered, or prescribed by a physician licensed under chapter 458
  452  or chapter 459, a dentist licensed under chapter 466, or a
  453  chiropractic physician licensed under chapter 460, or an
  454  acupuncturist licensed under chapter 457 exclusively to provide
  455  oriental medicine as defined in s. 457.102, or that are provided
  456  by any of the following persons or entities:
  457         1. A hospital or ambulatory surgical center licensed under
  458  chapter 395.
  459         2. A person or entity licensed under part III of chapter
  460  401 which ss. 401.2101-401.45 that provides emergency
  461  transportation and treatment.
  462         3. An entity wholly owned by one or more physicians
  463  licensed under chapter 458 or chapter 459, chiropractic
  464  physicians licensed under chapter 460, or dentists licensed
  465  under chapter 466 or by such practitioner or practitioners and
  466  the spouse, parent, child, or sibling of such that practitioner
  467  or those practitioners.
  468         4. An entity wholly owned, directly or indirectly, by a
  469  hospital or hospitals.
  470         5. A health care clinic licensed under part X of chapter
  471  400 which ss. 400.990-400.995 that is:
  472         a. Accredited by the Joint Commission on Accreditation of
  473  Healthcare Organizations, the American Osteopathic Association,
  474  the Commission on Accreditation of Rehabilitation Facilities, or
  475  the Accreditation Association for Ambulatory Health Care, Inc.;
  476  or
  477         b. A health care clinic that:
  478         (I) Has a medical director licensed under chapter 458,
  479  chapter 459, or chapter 460;
  480         (II) Has been continuously licensed for more than 3 years
  481  or is a publicly traded corporation that issues securities
  482  traded on an exchange registered with the United States
  483  Securities and Exchange Commission as a national securities
  484  exchange; and
  485         (III) Provides at least four of the following medical
  486  specialties:
  487         (A) General medicine.
  488         (B) Radiography.
  489         (C) Orthopedic medicine.
  490         (D) Physical medicine.
  491         (E) Physical therapy.
  492         (F) Physical rehabilitation.
  493         (G) Prescribing or dispensing outpatient prescription
  494  medication.
  495         (H) Laboratory services.
  497  If any services under this paragraph are provided by an entity
  498  or clinic described in subparagraph 3., subparagraph 4., or
  499  subparagraph 5., the entity or clinic must provide the insurer
  500  at the initial submission of the claim with a form adopted by
  501  the Department of Financial Services which documents that the
  502  entity or clinic meets applicable criteria for such entity or
  503  clinic and includes a sworn statement or affidavit to that
  504  effect. Any change in ownership requires the filing of a new
  505  form within 10 days after the date of the change in ownership.
  506  The Financial Services Commission shall adopt by rule the form
  507  that must be used by an insurer and a health care provider
  508  specified in subparagraph 3., subparagraph 4., or subparagraph
  509  5. to document that the health care provider meets the criteria
  510  of this paragraph, which rule must include a requirement for a
  511  sworn statement or affidavit.
  512         (b) Disability benefits.—Sixty percent of any loss of gross
  513  income and loss of earning capacity per individual from
  514  inability to work proximately caused by the injury sustained by
  515  the injured person, plus all expenses reasonably incurred in
  516  obtaining from others ordinary and necessary services in lieu of
  517  those that, but for the injury, the injured person would have
  518  performed without income for the benefit of his or her
  519  household. All disability benefits payable under this provision
  520  must shall be paid at least not less than every 2 weeks.
  521         (c) Death benefits.—Death benefits equal to the lesser of
  522  $5,000 or the remainder of unused personal injury protection
  523  benefits per individual. The insurer may pay such benefits to
  524  the executor or administrator of the deceased, to any of the
  525  deceased’s relatives by blood, or legal adoption, or connection
  526  by marriage, or to any person appearing to the insurer to be
  527  equitably entitled thereto.
  529  Only insurers writing motor vehicle liability insurance in this
  530  state may provide the required benefits of this section, and no
  531  such insurers may not insurer shall require the purchase of any
  532  other motor vehicle coverage other than the purchase of property
  533  damage liability coverage as required by s. 627.7275 as a
  534  condition for providing such required benefits. Insurers may not
  535  require that property damage liability insurance in an amount
  536  greater than $10,000 be purchased in conjunction with personal
  537  injury protection. Such insurers shall make benefits and
  538  required property damage liability insurance coverage available
  539  through normal marketing channels. An Any insurer writing motor
  540  vehicle liability insurance in this state who fails to comply
  541  with such availability requirement as a general business
  542  practice violates shall be deemed to have violated part IX of
  543  chapter 626, and such violation constitutes shall constitute an
  544  unfair method of competition or an unfair or deceptive act or
  545  practice involving the business of insurance. An; and any such
  546  insurer committing such violation is shall be subject to the
  547  penalties afforded in such part, as well as those that are which
  548  may be afforded elsewhere in the insurance code.
  549         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  550  the no-fault law are ss. 627.730-627.7405 shall be primary,
  551  except that benefits received under any workers’ compensation
  552  law shall be credited against the benefits provided by
  553  subsection (1) and are shall be due and payable as loss accrues,
  554  upon the receipt of reasonable proof of such loss and the amount
  555  of expenses and loss incurred which are covered by the policy
  556  issued under the no-fault law ss. 627.730-627.7405. If When the
  557  Agency for Health Care Administration provides, pays, or becomes
  558  liable for medical assistance under the Medicaid program related
  559  to injury, sickness, disease, or death arising out of the
  560  ownership, maintenance, or use of a motor vehicle, the benefits
  561  are under ss. 627.730-627.7405 shall be subject to the
  562  provisions of the Medicaid program.
  563         (a) An insurer may require written notice to be given as
  564  soon as practicable after an accident involving a motor vehicle
  565  with respect to which the policy affords the security required
  566  by the no-fault law ss. 627.730-627.7405.
  567         (b) Personal injury protection insurance benefits paid
  568  pursuant to this section are shall be overdue if not paid within
  569  30 days after the insurer is furnished written notice of the
  570  fact of a covered loss and of the amount of same. If such
  571  written notice is not furnished to the insurer as to the entire
  572  claim, any partial amount supported by written notice is overdue
  573  if not paid within 30 days after the such written notice is
  574  furnished to the insurer. Any part or all of the remainder of
  575  the claim that is subsequently supported by written notice is
  576  overdue if not paid within 30 days after such written notice is
  577  furnished to the insurer. For the purpose of calculating the
  578  extent to which benefits are overdue, payment shall be
  579  considered made on the date a draft or other valid instrument
  580  that is equivalent to payment is placed in the United States
  581  mail in a properly addressed, postpaid envelope, or, if not so
  582  posted, on the date of delivery.
  583         (c) If When an insurer pays only a portion of a claim or
  584  rejects a claim, the insurer shall provide at the time of the
  585  partial payment or rejection an itemized specification of each
  586  item that the insurer had reduced, omitted, or declined to pay
  587  and any information that the insurer desires the claimant to
  588  consider related to the medical necessity of the denied
  589  treatment or to explain the reasonableness of the reduced
  590  charge, provided that this does shall not limit the introduction
  591  of evidence at trial.; and The insurer must shall include the
  592  name and address of the person to whom the claimant should
  593  respond and a claim number to be referenced in future
  594  correspondence. An insurer’s failure to send an itemized
  595  specification or explanation of benefits does not waive other
  596  grounds for rejecting an invalid claim.
  597         (d)A However, notwithstanding the fact that written notice
  598  has been furnished to the insurer, Any payment is shall not be
  599  deemed overdue if when the insurer has reasonable proof to
  600  establish that the insurer is not responsible for the payment.
  601  An insurer may obtain evidence and assert any ground for
  602  adjustment or rejection of a For the purpose of calculating the
  603  extent to which any benefits are overdue, payment shall be
  604  treated as being made on the date a draft or other valid
  605  instrument which is equivalent to payment was placed in the
  606  United States mail in a properly addressed, postpaid envelope
  607  or, if not so posted, on the date of delivery. This paragraph
  608  does not preclude or limit the ability of the insurer to assert
  609  that the claim that is was unrelated, was not medically
  610  necessary, or was unreasonable, or submitted that the amount of
  611  the charge was in excess of that permitted under, or in
  612  violation of, subsection (6) (5). Such assertion by the insurer
  613  may be made at any time, including after payment of the claim,
  614  or after the 30-day time period for payment set forth in this
  615  paragraph (b), or after the filing of a lawsuit.
  616         (e) The 30-day period for payment is tolled while the
  617  insurer investigates a fraudulent insurance act, as defined in
  618  s. 626.989, with respect to any portion of a claim for which the
  619  insurer has a reasonable belief that a fraudulent insurance act
  620  has been committed. The insurer must notify the claimant in
  621  writing that it is investigating a fraudulent insurance act
  622  within 30 days after the date it has a reasonable belief that
  623  such act has been committed. The insurer must pay or deny the
  624  claim, in full or in part, within 90 days after the date the
  625  written notice of the fact of a covered loss and of the amount
  626  of the loss was provided to the insurer. However, no payment is
  627  due to a claimant that has violated paragraph (k).
  628         (f)(c)Notwithstanding any local lien law, upon receiving
  629  notice of an accident that is potentially covered by personal
  630  injury protection benefits, the insurer must reserve $5,000 of
  631  personal injury protection benefits for payment to physicians
  632  licensed under chapter 458 or chapter 459 or dentists licensed
  633  under chapter 466 who provide emergency services and care, as
  634  defined in s. 395.002(9), or who provide hospital inpatient
  635  care. The amount required to be held in reserve may be used only
  636  to pay claims from such physicians or dentists until 30 days
  637  after the date the insurer receives notice of the accident.
  638  After the 30-day period, any amount of the reserve for which the
  639  insurer has not received notice of such a claim from a physician
  640  or dentist who provided emergency services and care or who
  641  provided hospital inpatient care may then be used by the insurer
  642  to pay other claims. The time periods specified in paragraph (b)
  643  for required payment of personal injury protection benefits are
  644  shall be tolled for the period of time that an insurer is
  645  required by this paragraph to hold payment of a claim that is
  646  not from a physician or dentist who provided emergency services
  647  and care or who provided hospital inpatient care to the extent
  648  that the personal injury protection benefits not held in reserve
  649  are insufficient to pay the claim. This paragraph does not
  650  require an insurer to establish a claim reserve for insurance
  651  accounting purposes.
  652         (g)(d) All overdue payments shall bear simple interest at
  653  the rate established under s. 55.03 or the rate established in
  654  the insurance contract, whichever is greater, for the year in
  655  which the payment became overdue, calculated from the date the
  656  insurer was furnished with written notice of the amount of
  657  covered loss. Interest is shall be due at the time payment of
  658  the overdue claim is made. However, interest on a payment that
  659  is overdue pursuant to paragraph (e) shall be calculated from
  660  the date the payment is due pursuant to paragraph (b).
  661         (h)(e) The insurer of the owner of a motor vehicle shall
  662  pay personal injury protection benefits for:
  663         1. Accidental bodily injury sustained in this state by the
  664  owner while occupying a motor vehicle, or while not an occupant
  665  of a self-propelled vehicle if the injury is caused by physical
  666  contact with a motor vehicle.
  667         2. Accidental bodily injury sustained outside this state,
  668  but within the United States of America or its territories or
  669  possessions or Canada, by the owner while occupying the owner’s
  670  motor vehicle.
  671         3. Accidental bodily injury sustained by a relative of the
  672  owner residing in the same household, under the circumstances
  673  described in subparagraph 1. or subparagraph 2. if, provided the
  674  relative at the time of the accident is domiciled in the owner’s
  675  household and is not himself or herself the owner of a motor
  676  vehicle with respect to which security is required under the no
  677  fault law ss. 627.730-627.7405.
  678         4. Accidental bodily injury sustained in this state by any
  679  other person while occupying the owner’s motor vehicle or, if a
  680  resident of this state, while not an occupant of a self
  681  propelled vehicle, if the injury is caused by physical contact
  682  with such motor vehicle if, provided the injured person is not
  683  himself or herself:
  684         a. The owner of a motor vehicle with respect to which
  685  security is required under the no-fault law ss. 627.730
  686  627.7405; or
  687         b. Entitled to personal injury benefits from the insurer of
  688  the owner or owners of such a motor vehicle.
  689         (i)(f) If two or more insurers are liable to pay personal
  690  injury protection benefits for the same injury to any one
  691  person, the maximum payable is shall be as specified in
  692  subsection (1), and any insurer paying the benefits is shall be
  693  entitled to recover from each of the other insurers an equitable
  694  pro rata share of the benefits paid and expenses incurred in
  695  processing the claim.
  696         (j)(g) It is a violation of the insurance code for an
  697  insurer to fail to timely provide benefits as required by this
  698  section with such frequency as to constitute a general business
  699  practice.
  700         (k)(h) Benefits are shall not be due or payable to a
  701  claimant who knowingly: or on the behalf of an insured person if
  702  that person has
  703         1. Submits a false or misleading statement, document,
  704  record, or bill;
  705         2. Submits false or misleading information; or
  706         3. Has otherwise committed or attempted to commit a
  707  fraudulent insurance act as defined in s. 626.989.
  709  A claimant that violates this paragraph is not entitled to any
  710  personal injury protection benefits or payment for any bills and
  711  services, regardless of whether a portion of the claim may be
  712  legitimate. However, a claimant that does not violate this
  713  paragraph may not be denied benefits solely due to a violation
  714  by another claimant.
  715         (l) Notwithstanding any remedies afforded by law, the
  716  insurer may recover from a claimant who violates paragraph (k)
  717  any sums previously paid to that claimant and may bring any
  718  available common law and statutory causes of action. A claimant
  719  has violated paragraph (k) committed, by a material act or
  720  omission, any insurance fraud relating to personal injury
  721  protection coverage under his or her policy, if the fraud is
  722  admitted to in a sworn statement by the insured or if it is
  723  established in a court of competent jurisdiction. Any insurance
  724  fraud voids shall void all coverage arising from the claim
  725  related to such fraud under the personal injury protection
  726  coverage of the claimant insured person who committed the fraud,
  727  irrespective of whether a portion of the insured person’s claim
  728  may be legitimate, and any benefits paid before prior to the
  729  discovery of the insured person’s insurance fraud is shall be
  730  recoverable by the insurer from the claimant person who
  731  committed insurance fraud in their entirety. The prevailing
  732  party is entitled to its costs and attorney’s fees in any action
  733  in which it prevails in an insurer’s action to enforce its right
  734  of recovery under this paragraph. This paragraph does not
  735  preclude or limit an insurer’s right to deny a claim based on
  736  other evidence of fraud or affect an insurer’s right to plead
  737  and prove a claim or defense of fraud under common law. If a
  738  physician, hospital, clinic, or other medical institution
  739  violates paragraph (k), the injured party is not liable for, and
  740  the physician, hospital, clinic, or other medical institution
  741  may not bill the insured for, charges that are unpaid because of
  742  failure to comply with paragraph (k). Any agreement requiring
  743  the injured person or insured to pay for such charges is
  744  unenforceable.
  745         (5) INSURER INVESTIGATIONS.—An insurer has the right and
  746  duty to conduct a reasonable investigation of a claim. In the
  747  course of the insurer’s investigation of a claim:
  748         (a) The insurer may require the insured, claimant, or
  749  medical provider to provide copies of the treatment and
  750  examination records. Any records review need not be based on a
  751  physical examination and may be obtained at any time, including
  752  after reduction or denial of the claim.
  753         1. The records review must be conducted by a practitioner
  754  within the same licensing chapter as the medical provider whose
  755  records are being reviewed.
  756         2. The 30-day period for payment under paragraph (4)(b) is
  757  tolled from the date the insurer sends its request for treatment
  758  records to the date that the insurer receives the treatment
  759  records.
  760         3. The insured, claimant, or medical provider may impose a
  761  reasonable, cost-based fee that includes only the cost of
  762  copying and postage. The cost of copying may not exceed 15 cents
  763  per one-sided copy or 20 cents per two-sided copy and may not
  764  include the cost of labor for copying.
  765         (b) In all circumstances, an insured seeking benefits under
  766  the no-fault law must comply with the terms of the policy, which
  767  includes, but is not limited to, submitting to examinations
  768  under oath. Compliance with this paragraph is a condition
  769  precedent to receiving benefits.
  770         (c) An insurer may deny benefits if the insured, claimant,
  771  or medical provider fails to:
  772         1. Cooperate in the insurer’s investigation;
  773         2. Commits a fraud or material misrepresentation; or
  774         3. Comply with this subsection.
  776         (a)1. Any physician, hospital, clinic, or other person or
  777  institution lawfully rendering treatment to an injured person
  778  for a bodily injury covered by personal injury protection
  779  insurance may charge the insurer and injured party only a
  780  reasonable amount pursuant to this section for the services and
  781  supplies rendered, and the insurer providing such coverage may
  782  pay for such charges directly to the such person or institution
  783  lawfully rendering such treatment, if the insured receiving such
  784  treatment or his or her guardian has countersigned the properly
  785  completed invoice, bill, or claim form approved by the office
  786  upon which such charges are to be paid for as having actually
  787  been rendered, to the best knowledge of the insured or his or
  788  her guardian. In no event, However, may such charges may not
  789  exceed a charge be in excess of the amount the person or
  790  institution customarily charges for like services or supplies.
  791  In determining With respect to a determination of whether a
  792  charge for a particular service, treatment, or otherwise is
  793  reasonable, consideration may be given to evidence of usual and
  794  customary charges and payments accepted by the provider involved
  795  in the dispute, and reimbursement levels in the community, and
  796  various federal and state medical fee schedules applicable to
  797  automobile and other insurance coverages, and other information
  798  relevant to the reasonableness of the reimbursement for the
  799  service, treatment, or supply. However, such charges may not
  800  exceed the reimbursement schedule under this paragraph.
  801         1.2. The insurer may limit reimbursement to no more than 80
  802  percent of the following schedule of maximum charges:
  803         a. For emergency transport and treatment by providers
  804  licensed under chapter 401, 200 percent of Medicare.
  805         b. For emergency services and care provided by a hospital
  806  licensed under chapter 395, 75 percent of the hospital’s usual
  807  and customary charges.
  808         c. For emergency services and care as defined by s.
  809  395.002(9) provided in a facility licensed under chapter 395
  810  rendered by a physician or dentist, and related hospital
  811  inpatient services rendered by a physician or dentist, the usual
  812  and customary charges in the community.
  813         d. For hospital inpatient services, other than emergency
  814  services and care, 200 percent of the Medicare Part A
  815  prospective payment applicable to the specific hospital
  816  providing the inpatient services.
  817         e. For hospital outpatient services, other than emergency
  818  services and care, 200 percent of the Medicare Part A Ambulatory
  819  Payment Classification for the specific hospital providing the
  820  outpatient services.
  821         f. For all other medical services, supplies, and care, 200
  822  percent of the allowable amount under the participating
  823  physicians schedule of Medicare Part B. For all other supplies
  824  and care, including durable medical equipment and care and
  825  services rendered by ambulatory surgical centers and clinical
  826  laboratories, 200 percent of the allowable amount under Medicare
  827  Part B. However, if such services, supplies, or care is not
  828  reimbursable under Medicare Part B, the insurer may limit
  829  reimbursement to 80 percent of the maximum reimbursable
  830  allowance under workers’ compensation, as determined under s.
  831  440.13 and rules adopted thereunder which are in effect at the
  832  time such services, supplies, or care is provided. Services,
  833  supplies, or care that is not reimbursable under Medicare or
  834  workers’ compensation is not required to be reimbursed by the
  835  insurer.
  836         2.3. For purposes of subparagraph 1. 2., the applicable fee
  837  schedule or payment limitation under Medicare is the fee
  838  schedule or payment limitation in effect on January 1 of the
  839  year in which at the time the services, supplies, or care was
  840  rendered and for the area in which such services were rendered,
  841  which shall apply throughout the remainder of the year
  842  notwithstanding any subsequent changes made to the fee schedule
  843  or payment limitation, except that it may not be less than the
  844  allowable amount under the participating physicians schedule of
  845  Medicare Part B for 2007 for medical services, supplies, and
  846  care subject to Medicare Part B.
  847         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  848  any limitation on the number of treatments or other utilization
  849  limits that apply under Medicare or workers’ compensation. An
  850  insurer that applies the allowable payment limitations of
  851  subparagraph 1. 2. must reimburse a provider who lawfully
  852  provided care or treatment under the scope of his or her
  853  license, regardless of whether such provider is would be
  854  entitled to reimbursement under Medicare due to restrictions or
  855  limitations on the types or discipline of health care providers
  856  who may be reimbursed for particular procedures or procedure
  857  codes.
  858         4.5. If an insurer limits payment as authorized by
  859  subparagraph 1. 2., the person providing such services,
  860  supplies, or care may not bill or attempt to collect from the
  861  insured any amount in excess of such limits, except for amounts
  862  that are not covered by the insured’s personal injury protection
  863  coverage due to the coinsurance amount or maximum policy limits.
  864         5. Effective January 1, 2012, an insurer may limit
  865  reimbursement pursuant to this paragraph only if the insurance
  866  policy includes the schedule of charges specified in this
  867  paragraph.
  868         (b)1. An insurer or insured is not required to pay a claim
  869  or charges:
  870         a. Made by a broker or by a person making a claim on behalf
  871  of a broker;
  872         b. For any service or treatment that was not lawful at the
  873  time rendered;
  874         c. To any person who knowingly submits a false or
  875  misleading statement relating to the claim or charges;
  876         d. With respect to a bill or statement that does not
  877  substantially meet the applicable requirements of paragraphs
  878  (c), paragraph (d), and (e);
  879         e. Except for emergency treatment and care, if the insured
  880  failed to countersign a billing form or patient log related to
  881  such claim or charges. Failure to submit a countersigned billing
  882  form or patient log creates a rebuttable presumption that the
  883  insured did not receive the alleged treatment. The insurer is
  884  not considered to have been furnished with notice of the subject
  885  treatment and loss until the insurer is able to verify that the
  886  insured received the alleged treatment. As used in this sub
  887  subparagraph, the term “countersigned” means a second or
  888  verifying signature, as on a previously signed document, and is
  889  not satisfied by the statement “signature on file” or any
  890  similar statement;
  891         f.e. For any treatment or service that is upcoded, or that
  892  is unbundled if when such treatment or services should be
  893  bundled, in accordance with paragraph (d). To facilitate prompt
  894  payment of lawful services, an insurer may change codes that it
  895  determines to have been improperly or incorrectly upcoded or
  896  unbundled, and may make payment based on the changed codes,
  897  without affecting the right of the provider to dispute the
  898  change by the insurer if, provided that before doing so, the
  899  insurer contacts must contact the health care provider and
  900  discusses discuss the reasons for the insurer’s change and the
  901  health care provider’s reason for the coding, or makes make a
  902  reasonable good faith effort to do so, as documented in the
  903  insurer’s file; and
  904         g.f. For medical services or treatment billed by a
  905  physician and not provided in a hospital unless such services
  906  are rendered by the physician or are incident to his or her
  907  professional services and are included on the physician’s bill,
  908  including documentation verifying that the physician is
  909  responsible for the medical services that were rendered and
  910  billed.
  911         2. The Department of Health, in consultation with the
  912  appropriate professional licensing boards, shall adopt, by rule,
  913  a list of diagnostic tests deemed not to be medically necessary
  914  for use in the treatment of persons sustaining bodily injury
  915  covered by personal injury protection benefits under this
  916  section. The initial list shall be adopted by January 1, 2004,
  917  and shall be revised from time to time as determined by the
  918  Department of Health, in consultation with the respective
  919  professional licensing boards. Inclusion of a test on the list
  920  must of invalid diagnostic tests shall be based on lack of
  921  demonstrated medical value and a level of general acceptance by
  922  the relevant provider community and may shall not be dependent
  923  for results entirely upon subjective patient response.
  924  Notwithstanding its inclusion on a fee schedule in this
  925  subsection, an insurer or insured is not required to pay any
  926  charges or reimburse claims for any invalid diagnostic test as
  927  determined by the Department of Health.
  928         (c)1. With respect to any treatment or service, other than
  929  medical services billed by a hospital or other provider for
  930  emergency services as defined in s. 395.002 or inpatient
  931  services rendered at a hospital-owned facility, the statement of
  932  charges must be furnished to the insurer by the provider and may
  933  not include, and the insurer is not required to pay, charges for
  934  treatment or services rendered more than 35 days before the
  935  postmark date or electronic transmission date of the statement,
  936  except for past due amounts previously billed on a timely basis
  937  under this paragraph, and except that, if the provider submits
  938  to the insurer a notice of initiation of treatment within 21
  939  days after its first examination or treatment of the claimant,
  940  the statement may include charges for treatment or services
  941  rendered up to, but not more than, 75 days before the postmark
  942  date of the statement. The injured party is not liable for, and
  943  the provider may shall not bill the injured party for, charges
  944  that are unpaid because of the provider’s failure to comply with
  945  this paragraph. Any agreement requiring the injured person or
  946  insured to pay for such charges is unenforceable.
  947         1.2. If, however, the insured fails to furnish the provider
  948  with the correct name and address of the insured’s personal
  949  injury protection insurer, the provider has 35 days from the
  950  date the provider obtains the correct information to furnish the
  951  insurer with a statement of the charges. The insurer is not
  952  required to pay for such charges unless the provider includes
  953  with the statement documentary evidence that was provided by the
  954  insured during the 35-day period demonstrating that the provider
  955  reasonably relied on erroneous information from the insured and
  956  either:
  957         a. A denial letter from the incorrect insurer; or
  958         b. Proof of mailing, which may include an affidavit under
  959  penalty of perjury, reflecting timely mailing to the incorrect
  960  address or insurer.
  961         2.3. For emergency services and care as defined in s.
  962  395.002 rendered in a hospital emergency department or for
  963  transport and treatment rendered by an ambulance provider
  964  licensed pursuant to part III of chapter 401, the provider is
  965  not required to furnish the statement of charges within the time
  966  periods established by this paragraph,; and the insurer is shall
  967  not be considered to have been furnished with notice of the
  968  amount of covered loss for purposes of paragraph (4)(b) until it
  969  receives a statement complying with paragraph (d), or copy
  970  thereof, which specifically identifies the place of service to
  971  be a hospital emergency department or an ambulance in accordance
  972  with billing standards recognized by the Centers for Medicare
  973  and Medicaid Services Health Care Finance Administration.
  974         3.4. Each notice of the insured’s rights under s. 627.7401
  975  must include the following statement in type no smaller than 12
  976  points:
  978         BILLING REQUIREMENTS.—Florida Statutes provide that
  979         with respect to any treatment or services, other than
  980         certain hospital and emergency services, the statement
  981         of charges furnished to the insurer by the provider
  982         may not include, and the insurer and the injured party
  983         are not required to pay, charges for treatment or
  984         services rendered more than 35 days before the
  985         postmark date of the statement, except for past due
  986         amounts previously billed on a timely basis, and
  987         except that, if the provider submits to the insurer a
  988         notice of initiation of treatment within 21 days after
  989         its first examination or treatment of the claimant,
  990         the first billing cycle statement may include charges
  991         for treatment or services rendered up to, but not more
  992         than, 75 days before the postmark date of the
  993         statement.
  995         (d) All statements and bills for medical services rendered
  996  by any physician, hospital, clinic, or other person or
  997  institution shall be submitted to the insurer on a properly
  998  completed Centers for Medicare and Medicaid Services (CMS) 1500
  999  form, UB 92 forms, or any other standard form approved by the
 1000  office or adopted by the commission for purposes of this
 1001  paragraph. All billings for such services rendered by providers
 1002  must shall, to the extent applicable, follow the Physicians’
 1003  Current Procedural Terminology (CPT) or Healthcare Correct
 1004  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1005  year in which services are rendered and comply with the Centers
 1006  for Medicare and Medicaid Services (CMS) 1500 form instructions
 1007  and the American Medical Association Current Procedural
 1008  Terminology (CPT) Editorial Panel and Healthcare Correct
 1009  Procedural Coding System (HCPCS). All providers other than
 1010  hospitals shall include on the applicable claim form the
 1011  professional license number of the provider in the line or space
 1012  provided for “Signature of Physician or Supplier, Including
 1013  Degrees or Credentials.” In determining compliance with
 1014  applicable CPT and HCPCS coding, guidance shall be provided by
 1015  the Physicians’ Current Procedural Terminology (CPT) or the
 1016  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1017  for the year in which services were rendered, the Office of the
 1018  Inspector General (OIG), Physicians Compliance Guidelines, and
 1019  other authoritative treatises designated by rule by the Agency
 1020  for Health Care Administration. A No statement of medical
 1021  services may not include charges for medical services of a
 1022  person or entity that performed such services without possessing
 1023  the valid licenses required to perform such services. For
 1024  purposes of paragraph (4)(b), an insurer is shall not be
 1025  considered to have been furnished with notice of the amount of
 1026  covered loss or medical bills due unless the statements or bills
 1027  comply with this paragraph, and unless the statements or bills
 1028  are comply with this paragraph, and unless the statements or
 1029  bills are properly completed in their entirety as to all
 1030  material provisions, with all relevant information being
 1031  provided therein. If an insurer denies a claim due to a
 1032  provider’s failure to submit a properly completed statement or
 1033  bill, the insurer shall notify the provider as to the provisions
 1034  that were improperly completed, and the provider shall have 15
 1035  days after the receipt of such notice to submit a properly
 1036  completed statement or bill. If the provider fails to comply
 1037  with this requirement, the insurer is not required to pay for
 1038  improperly billed services.
 1039         (e)1. At the initial treatment or service provided, each
 1040  physician, other licensed professional, clinic, or other medical
 1041  institution providing medical services upon which a claim for
 1042  personal injury protection benefits is based shall require an
 1043  insured person, or his or her guardian, to execute a disclosure
 1044  and acknowledgment form, which reflects at a minimum that:
 1045         a. The insured, or his or her guardian, must countersign
 1046  the form attesting to the fact that the services set forth
 1047  therein were actually rendered. Listing CPT codes or other
 1048  coding on the disclosure and acknowledgment form does not
 1049  satisfy this requirement;
 1050         b. The insured, or his or her guardian, has both the right
 1051  and affirmative duty to confirm that the services were actually
 1052  rendered;
 1053         c. The insured, or his or her guardian, was not solicited
 1054  by any person to seek any services from the medical provider;
 1055         d. The physician, other licensed professional, clinic, or
 1056  other medical institution rendering services for which payment
 1057  is being claimed explained the services to the insured or his or
 1058  her guardian; and
 1059         e. If the insured notifies the insurer in writing of a
 1060  billing error, the insured may be entitled to a certain
 1061  percentage of a reduction in the amounts paid by the insured’s
 1062  motor vehicle insurer.
 1063         2. The physician, other licensed professional, clinic, or
 1064  other medical institution rendering services for which payment
 1065  is being claimed has the affirmative duty to explain the
 1066  services rendered to the insured, or his or her guardian, so
 1067  that the insured, or his or her guardian, countersigns the form
 1068  with informed consent.
 1069         3. Countersignature by the insured, or his or her guardian,
 1070  is not required for the reading of diagnostic tests or other
 1071  services that are of such a nature that they are not required to
 1072  be performed in the presence of the insured.
 1073         4. The licensed medical professional rendering treatment
 1074  for which payment is being claimed must sign, by his or her own
 1075  hand, the form complying with this paragraph.
 1076         5. An insurer is not considered to have been furnished with
 1077  notice of the amount of a covered loss or medical bills unless
 1078  the original completed disclosure and acknowledgment form is
 1079  shall be furnished to the insurer pursuant to paragraph (4)(b)
 1080  and sub-subparagraph 1.a. The disclosure and acknowledgement
 1081  form may not be electronically furnished. A disclosure and
 1082  acknowledgement form that does not meet the minimum requirements
 1083  of sub-subparagraph 1.a. does not provide an insurer with notice
 1084  of the amount of a covered loss or medical bills due.
 1085         6. This disclosure and acknowledgment form is not required
 1086  for services billed by a provider for emergency services as
 1087  defined in s. 395.002, for emergency services and care as
 1088  defined in s. 395.002 rendered in a hospital emergency
 1089  department, or for transport and treatment rendered by an
 1090  ambulance provider licensed pursuant to part III of chapter 401.
 1091         7. The Financial Services Commission shall adopt, by rule,
 1092  a standard disclosure and acknowledgment form to that shall be
 1093  used to fulfill the requirements of this paragraph, effective 90
 1094  days after such form is adopted and becomes final. The
 1095  commission shall adopt a proposed rule by October 1, 2003. Until
 1096  the rule is final, the provider may use a form of its own which
 1097  otherwise complies with the requirements of this paragraph.
 1098         8. As used in this paragraph, the term “countersigned” or
 1099  “countersignature” means a second or verifying signature, as on
 1100  a previously signed document, and is not satisfied by the
 1101  statement “signature on file” or any similar statement.
 1102         9. The requirements of this paragraph apply only with
 1103  respect to the initial treatment or service of the insured by a
 1104  provider. For subsequent treatments or service, the provider
 1105  must maintain a patient log signed by the patient, in
 1106  chronological order by date of service, that is consistent with
 1107  the services being rendered to the patient as claimed. Listing
 1108  CPT codes or other coding on the patient log does not satisfy
 1109  this requirement. The provider must provide copies of the
 1110  patient log to the insurer within 30 days after receiving a
 1111  written request from the insurer. Failure to maintain a patient
 1112  log renders the treatment unlawful and noncompensable. The
 1113  requirements of this subparagraph for maintaining a patient log
 1114  signed by the patient may be met by a hospital that maintains
 1115  medical records as required by s. 395.3025 and applicable rules
 1116  and makes such records available to the insurer upon request.
 1117         (f) Upon written notification by any person, an insurer
 1118  shall investigate any claim of improper billing by a physician
 1119  or other medical provider. The insurer shall determine if the
 1120  insured was properly billed for only those services and
 1121  treatments that the insured actually received. If the insurer
 1122  determines that the insured has been improperly billed, the
 1123  insurer shall notify the insured, the person making the written
 1124  notification, and the provider of its findings and shall reduce
 1125  the amount of payment to the provider by the amount determined
 1126  to be improperly billed. If a reduction is made due to such
 1127  written notification by any person, the insurer shall pay to the
 1128  person 20 percent of the amount of the reduction, up to $500. If
 1129  the provider is arrested due to the improper billing, then the
 1130  insurer shall pay to the person 40 percent of the amount of the
 1131  reduction, up to $500.
 1132         (g) An insurer may not systematically downcode with the
 1133  intent to deny reimbursement otherwise due. Such action
 1134  constitutes a material misrepresentation under s.
 1135  626.9541(1)(i)2.
 1137  DISPUTES.—
 1138         (b) Every physician, hospital, clinic, or other medical
 1139  institution providing, before or after bodily injury upon which
 1140  a claim for personal injury protection insurance benefits is
 1141  based, any products, services, or accommodations in relation to
 1142  that or any other injury, or in relation to a condition claimed
 1143  to be connected with that or any other injury, shall, if
 1144  requested to do so by the insurer against whom the claim has
 1145  been made, permit the insurer or the insurer’s representative to
 1146  conduct an onsite physical review and examination of the
 1147  treatment location, treatment apparatuses, diagnostic devices,
 1148  and any other medical equipment used for the services rendered
 1149  within 10 days after the insurer’s request, and furnish
 1150  forthwith a written report of the history, condition, treatment,
 1151  dates, and costs of such treatment of the injured person and why
 1152  the items identified by the insurer were reasonable in amount
 1153  and medically necessary, together with a sworn statement that
 1154  the treatment or services rendered were reasonable and necessary
 1155  with respect to the bodily injury sustained and identifying
 1156  which portion of the expenses for such treatment or services was
 1157  incurred as a result of such bodily injury, and produce
 1158  forthwith, and permit the inspection and copying of, his or her
 1159  or its records regarding such history, condition, treatment,
 1160  dates, and costs of treatment if; provided that this does shall
 1161  not limit the introduction of evidence at trial. Such sworn
 1162  statement must shall read as follows: “Under penalty of perjury,
 1163  I declare that I have read the foregoing, and the facts alleged
 1164  are true, to the best of my knowledge and belief.” A No cause of
 1165  action for violation of the physician-patient privilege or
 1166  invasion of the right of privacy may not be brought shall be
 1167  permitted against any physician, hospital, clinic, or other
 1168  medical institution complying with the provisions of this
 1169  section. The person requesting such records and such sworn
 1170  statement shall pay all reasonable costs connected therewith.
 1171         1. If an insurer makes a written request for documentation
 1172  or information under this paragraph within 30 days after having
 1173  received notice of the amount of a covered loss under paragraph
 1174  (4)(a), the amount or the partial amount that which is the
 1175  subject of the insurer’s inquiry is shall become overdue if the
 1176  insurer does not pay in accordance with paragraph (4)(b) or
 1177  within 10 days after the insurer’s receipt of the requested
 1178  documentation or information, whichever occurs later. For
 1179  purposes of this subparagraph paragraph, the term “receipt”
 1180  includes, but is not limited to, inspection and copying pursuant
 1181  to this paragraph. An Any insurer that requests documentation or
 1182  information pertaining to reasonableness of charges or medical
 1183  necessity under this paragraph without a reasonable basis for
 1184  such requests as a general business practice is engaging in an
 1185  unfair trade practice under the insurance code.
 1186         2. If an insured seeking to recover benefits pursuant to
 1187  the no-fault law assigns the contractual right to those benefits
 1188  or payment of those benefits to any person or entity, the
 1189  assignee must comply with the terms of the policy. In all
 1190  circumstances, the assignee is obligated to cooperate under the
 1191  policy, which includes, but is not limited to, participating in
 1192  an examination under oath. Examinations under oath may be
 1193  recorded by audio, video, court reporter, or any combination
 1194  thereof. Compliance with this paragraph is a condition precedent
 1195  to recovery of benefits pursuant to the no-fault law.
 1196         a. If an insurer requests an examination under oath of a
 1197  medical provider, the provider must produce the persons having
 1198  the most knowledge of the issues identified by the insurer in
 1199  the request for examination under oath. All claimants must
 1200  produce and allow for the inspection all documents requested by
 1201  the insurer which are relevant to the services rendered and
 1202  reasonably obtainable by the claimant. The insurer must pay the
 1203  medical provider reasonable compensation for attending the
 1204  examination under oath; however, expert witness fees are not
 1205  reasonable compensation. The medical provider may have an
 1206  attorney present at the examination under oath at the provider’s
 1207  own expense.
 1208         b. Before requesting that an assignee participate in an
 1209  examination under oath, the insurer must send a written request
 1210  to the assignee requesting all information that the insurer
 1211  believes is necessary to process the claim and relevant to the
 1212  services rendered, including the information contemplated under
 1213  this subparagraph.
 1214         c. An insurer that, as a general practice, requests
 1215  examinations under oath of an assignee without a reasonable
 1216  basis is engaging in an unfair and deceptive trade practice.
 1218  REPORTS.—
 1219         (b) If requested by the person examined, a party causing an
 1220  examination to be made shall deliver to him or her a copy of
 1221  every written report concerning the examination rendered by an
 1222  examining physician, at least one of which reports must set out
 1223  the examining physician’s findings and conclusions in detail.
 1224  After such request and delivery, the party causing the
 1225  examination to be made is entitled, upon request, to receive
 1226  from the person examined every written report available to him
 1227  or her or his or her representative concerning any examination,
 1228  previously or thereafter made, of the same mental or physical
 1229  condition. By requesting and obtaining a report of the
 1230  examination so ordered, or by taking the deposition of the
 1231  examiner, the person examined waives any privilege he or she may
 1232  have, in relation to the claim for benefits, regarding the
 1233  testimony of every other person who has examined, or may
 1234  thereafter examine, him or her in respect to the same mental or
 1235  physical condition. If a person fails to appear for unreasonably
 1236  refuses to submit to an examination, the personal injury
 1237  protection carrier is not required to pay no longer liable for
 1238  subsequent personal injury protection benefits incurred after
 1239  the date of the first requested examination until the insured
 1240  appears for the examination. Failure to appear for two scheduled
 1241  examinations raises a rebuttable presumption that such failure
 1242  was unreasonable. Submission to an examination is a condition
 1243  precedent to the recovery of benefits.
 1245  FEES.—With respect to any dispute under the provisions of ss.
 1246  627.730-627.7405 between the insured and the insurer under the
 1247  no-fault law, or between an assignee of an insured’s rights and
 1248  the insurer, the provisions of s. 627.428 shall apply, except as
 1249  provided in subsections (11) and (16) (10) and (15).
 1250         (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and
 1251  enter into contracts with preferred licensed health care
 1252  providers for the benefits described in this section, referred
 1253  to in this section as “preferred providers,” which include shall
 1254  include health care providers licensed under chapter 457,
 1255  chapter chapters 458, chapter 459, chapter 460, chapter 461, or
 1256  chapter and 463.
 1257         (a) The insurer may provide an option to an insured to use
 1258  a preferred provider at the time of purchase of the policy for
 1259  personal injury protection benefits, if the requirements of this
 1260  subsection are met. However, if the insurer offers a preferred
 1261  provider option, it must also offer a nonpreferred provider
 1262  policy. If the insured elects to use a provider who is not a
 1263  preferred provider, whether the insured purchased a preferred
 1264  provider policy or a nonpreferred provider policy, the medical
 1265  benefits provided by the insurer must shall be as required by
 1266  this section.
 1267         (b) If the insured elects the to use a provider who is a
 1268  preferred provider option, the insurer may pay medical benefits
 1269  in excess of the benefits required by this section and may waive
 1270  or lower the amount of any deductible that applies to such
 1271  medical benefits. As an alternative, or in addition to such
 1272  benefits, waiver, or reduction, the insurer may provide an
 1273  actuarially appropriate premium discount as specified in an
 1274  approved rate filing to an insured who selects the preferred
 1275  provider option. If the preferred provider option provides a
 1276  premium discount, the insured forfeits the premium discount
 1277  effective on the date that the insured elects to use a provider
 1278  who is not a preferred provider and who renders nonemergency
 1279  services, unless there is no member of the preferred provider
 1280  network located within 15 miles of the insured’s place of
 1281  residence whose scope of practice includes the required
 1282  services, or unless the nonemergency services are rendered in
 1283  the emergency room of a hospital licensed under chapter 395. If
 1284  the insurer offers a preferred provider policy to a policyholder
 1285  or applicant, it must also offer a nonpreferred provider policy.
 1286         (c) The insurer shall provide each insured policyholder
 1287  with a current roster of preferred providers in the county in
 1288  which the insured resides at the time of purchasing purchase of
 1289  such policy, and shall make such list available for public
 1290  inspection during regular business hours at the insurer’s
 1291  principal office of the insurer within the state. The insurer
 1292  may contract with a health insurer to use an existing preferred
 1293  provider network to implement the preferred provider option. All
 1294  providers and entities that are eligible to receive
 1295  reimbursement pursuant to paragraph (1)(a) may provide services
 1296  through a preferred provider network. Any other arrangement is
 1297  subject to the approval of the Office of Insurance Regulation.
 1298         (11)(10) DEMAND LETTER.—
 1299         (a) As a condition precedent to filing any action for
 1300  benefits under this section, the claimant filing suit must
 1301  provide the insurer must be provided with written notice of an
 1302  intent to initiate litigation. Such notice may not be sent until
 1303  the claim is overdue, including any additional time the insurer
 1304  has to pay the claim pursuant to paragraph (4)(b). A premature
 1305  demand letter is defective and cannot be cured unless the court
 1306  first abates the action or the claimant first voluntarily
 1307  dismisses the action.
 1308         (b) The notice required notice must shall state that it is
 1309  a “demand letter under s. 627.736(10)” and shall state with
 1310  specificity:
 1311         1. The name of the insured upon which such benefits are
 1312  being sought, including a copy of the assignment giving rights
 1313  to the claimant if the claimant is not the insured.
 1314         2. The claim number or policy number upon which such claim
 1315  was originally submitted to the insurer.
 1316         3. To the extent applicable, the name of any medical
 1317  provider who rendered to an insured the treatment, services,
 1318  accommodations, or supplies that form the basis of such claim;
 1319  and an itemized statement specifying each exact amount, the date
 1320  of treatment, service, or accommodation, and the type of benefit
 1321  claimed to be due. A completed form satisfying the requirements
 1322  of paragraph (6)(5)(d) or the lost-wage statement previously
 1323  submitted may be used as the itemized statement. To the extent
 1324  that the demand involves an insurer’s withdrawal of payment
 1325  under paragraph (7)(a) for future treatment not yet rendered,
 1326  the claimant shall attach a copy of the insurer’s notice
 1327  withdrawing such payment and an itemized statement of the type,
 1328  frequency, and duration of future treatment claimed to be
 1329  reasonable and medically necessary.
 1330         (c) Each notice required by this subsection must be
 1331  delivered to the insurer by United States certified or
 1332  registered mail, return receipt requested. Such postal costs
 1333  shall be reimbursed by the insurer if so requested by the
 1334  claimant in the notice, when the insurer pays the claim. Such
 1335  notice must be sent to the person and address specified by the
 1336  insurer for the purposes of receiving notices under this
 1337  subsection. Each licensed insurer, whether domestic, foreign, or
 1338  alien, shall file with the office designation of the name and
 1339  address of the person to whom notices must pursuant to this
 1340  subsection shall be sent which the office shall make available
 1341  on its Internet website. The name and address on file with the
 1342  office pursuant to s. 624.422 shall be deemed the authorized
 1343  representative to accept notice pursuant to this subsection if
 1344  in the event no other designation has been made.
 1345         (d) If, within 30 days after receipt of notice by the
 1346  insurer, the overdue claim specified in the notice is paid by
 1347  the insurer together with applicable interest and a penalty of
 1348  10 percent of the overdue amount paid by the insurer, subject to
 1349  a maximum penalty of $250, no action may be brought against the
 1350  insurer. If the demand involves an insurer’s withdrawal of
 1351  payment under paragraph (7)(a) for future treatment not yet
 1352  rendered, no action may be brought against the insurer if,
 1353  within 30 days after its receipt of the notice, the insurer
 1354  mails to the person filing the notice a written statement of the
 1355  insurer’s agreement to pay for such treatment in accordance with
 1356  the notice and to pay a penalty of 10 percent, subject to a
 1357  maximum penalty of $250, when it pays for such future treatment
 1358  in accordance with the requirements of this section. To the
 1359  extent the insurer determines not to pay any amount demanded,
 1360  the penalty is shall not be payable in any subsequent action.
 1361  For purposes of this subsection, payment or the insurer’s
 1362  agreement is shall be treated as being made on the date a draft
 1363  or other valid instrument that is equivalent to payment, or the
 1364  insurer’s written statement of agreement, is placed in the
 1365  United States mail in a properly addressed, postpaid envelope,
 1366  or if not so posted, on the date of delivery. The insurer is not
 1367  obligated to pay any attorney’s fees if the insurer pays the
 1368  claim or mails its agreement to pay for future treatment within
 1369  the time prescribed by this subsection.
 1370         (e) The applicable statute of limitation for an action
 1371  under this section shall be tolled for a period of 30 business
 1372  days by the mailing of the notice required by this subsection.
 1373         (f)A demand letter that does not meet the minimum
 1374  requirements set forth in this subsection or that is sent during
 1375  the pendency of the lawsuit is defective. A defective demand
 1376  letter cannot be cured unless the court first abates the action
 1377  or the claimant first voluntarily dismisses the action.
 1378         (g)(f)An Any insurer making a general business practice of
 1379  not paying valid claims until receipt of the notice required by
 1380  this subsection is engaging in an unfair trade practice under
 1381  the insurance code.
 1382         (h) If the insurer pays in response to a demand letter and
 1383  the claimant disputes the amount paid, the claimant must send a
 1384  second demand letter by certified or registered mail stating the
 1385  exact amount that the claimant believes the insurer owes and why
 1386  the claimant believes the amount paid is incorrect. The insurer
 1387  has an additional 10 days after receipt of the second letter to
 1388  issue any additional payment that is owed. The purpose of this
 1389  provision is to avoid unnecessary litigation over miscalculated
 1390  payments.
 1391         (i) Demand letters may not be used to request the
 1392  production of claim documents or other records from the insurer.
 1393         Section 9. Paragraph (c) of subsection (7), and subsections
 1394  (10) through (12) of section 817.234, Florida Statutes, are
 1395  amended to read:
 1396         817.234 False and fraudulent insurance claims.—
 1397         (7)
 1398         (c) An insurer, or any person acting at the direction of or
 1399  on behalf of an insurer, may not change an opinion in a mental
 1400  or physical report prepared under s. 627.736(8) 627.736(7) or
 1401  direct the physician preparing the report to change such
 1402  opinion; however, this provision does not preclude the insurer
 1403  from calling to the attention of the physician errors of fact in
 1404  the report based upon information in the claim file. Any person
 1405  who violates this paragraph commits a felony of the third
 1406  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1407  775.084.
 1408         (10) As used in this section, the term “insurer” means any
 1409  insurer, health maintenance organization, self-insurer, self
 1410  insurance fund, or other similar entity or person regulated
 1411  under chapter 440 or chapter 641 or by the Office of Insurance
 1412  Regulation under the Florida Insurance Code.
 1413         (10)(11) If the value of any property involved in a
 1414  violation of this section:
 1415         (a) Is less than $20,000, the offender commits a felony of
 1416  the third degree, punishable as provided in s. 775.082, s.
 1417  775.083, or s. 775.084.
 1418         (b) Is $20,000 or more, but less than $100,000, the
 1419  offender commits a felony of the second degree, punishable as
 1420  provided in s. 775.082, s. 775.083, or s. 775.084.
 1421         (c) Is $100,000 or more, the offender commits a felony of
 1422  the first degree, punishable as provided in s. 775.082, s.
 1423  775.083, or s. 775.084.
 1424         (11) In addition to any criminal liability, a person
 1425  convicted of violating any provision of this section for the
 1426  purpose of receiving insurance proceeds from a motor vehicle
 1427  insurance contract is subject to a civil penalty.
 1428         (a) Except for a violation of subsection (9), the civil
 1429  penalty shall be:
 1430         1. A fine up to $5,000 for a first offense.
 1431         2. A fine greater than $5,000, but not to exceed $10,000,
 1432  for a second offense.
 1433         3. A fine greater than $10,000, but not to exceed $15,000,
 1434  for a third or subsequent offense.
 1435         (b) The civil penalty for a violation of subsection (9)
 1436  must be at least $15,000, but may not exceed $50,000.
 1437         (c) The civil penalty shall be paid to the Insurance
 1438  Regulatory Trust Fund within the Department of Financial
 1439  Services and used by the department for the investigation and
 1440  prosecution of insurance fraud.
 1441         (d) This subsection does not prohibit a state attorney from
 1442  entering into a written agreement in which the person charged
 1443  with the violation does not admit to or deny the charges but
 1444  consents to payment of the civil penalty.
 1445         (12) As used in this section, the term:
 1446         (a) “Insurer” means any insurer, health maintenance
 1447  organization, self-insurer, self-insurance fund, or similar
 1448  entity or person regulated under chapter 440 or chapter 641 or
 1449  by the Office of Insurance Regulation under the Florida
 1450  Insurance Code.
 1451         (b)(a) “Property” means property as defined in s. 812.012.
 1452         (c)(b) “Value” has the same meaning means value as defined
 1453  in s. 812.012.
 1454         Section 10. Subsection (1) of section 324.021, Florida
 1455  Statutes, is amended to read:
 1456         324.021 Definitions; minimum insurance required.—The
 1457  following words and phrases when used in this chapter shall, for
 1458  the purpose of this chapter, have the meanings respectively
 1459  ascribed to them in this section, except in those instances
 1460  where the context clearly indicates a different meaning:
 1461         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1462  is designed and required to be licensed for use upon a highway,
 1463  including trailers and semitrailers designed for use with such
 1464  vehicles, except traction engines, road rollers, farm tractors,
 1465  power shovels, and well drillers, and every vehicle that which
 1466  is propelled by electric power obtained from overhead wires but
 1467  not operated upon rails, but not including any bicycle or moped.
 1468  However, the term does “motor vehicle” shall not include a any
 1469  motor vehicle as defined in s. 627.732(3) if when the owner of
 1470  such vehicle has complied with the no-fault law requirements of
 1471  ss. 627.730-627.7405, inclusive, unless the provisions of s.
 1472  324.051 apply; and, in such case, the applicable proof of
 1473  insurance provisions of s. 320.02 apply.
 1474         Section 11. Paragraph (k) of subsection (2) of section
 1475  456.057, Florida Statutes, is amended to read:
 1476         456.057 Ownership and control of patient records; report or
 1477  copies of records to be furnished.—
 1478         (2) As used in this section, the terms “records owner,”
 1479  “health care practitioner,” and “health care practitioner’s
 1480  employer” do not include any of the following persons or
 1481  entities; furthermore, the following persons or entities are not
 1482  authorized to acquire or own medical records, but are authorized
 1483  under the confidentiality and disclosure requirements of this
 1484  section to maintain those documents required by the part or
 1485  chapter under which they are licensed or regulated:
 1486         (k) Persons or entities practicing under s. 627.736(8)
 1487  627.736(7).
 1488         Section 12. Paragraph (b) of subsection (1) of section
 1489  627.7401, Florida Statutes, is amended to read:
 1490         627.7401 Notification of insured’s rights.—
 1491         (1) The commission, by rule, shall adopt a form for the
 1492  notification of insureds of their right to receive personal
 1493  injury protection benefits under the Florida Motor Vehicle no
 1494  fault law. Such notice shall include:
 1495         (b) An advisory informing insureds that:
 1496         1. Pursuant to s. 626.9892, the Department of Financial
 1497  Services may pay rewards of up to $25,000 to persons providing
 1498  information leading to the arrest and conviction of persons
 1499  committing crimes investigated by the Division of Insurance
 1500  Fraud arising from violations of s. 440.105, s. 624.15, s.
 1501  626.9541, s. 626.989, or s. 817.234.
 1502         2. Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
 1503  insured notifies the insurer of a billing error, the insured may
 1504  be entitled to a certain percentage of a reduction in the amount
 1505  paid by the insured’s motor vehicle insurer.
 1506         Section 13. This act shall take effect July 1, 2011.
 1508  ================= T I T L E  A M E N D M E N T ================
 1509         And the title is amended as follows:
 1510         Delete everything before the enacting clause
 1511  and insert:
 1512                        A bill to be entitled                      
 1513         An act relating to motor vehicle personal injury
 1514         protection insurance; amending s. 316.066, F.S.;
 1515         revising provisions relating to the contents of
 1516         written reports of motor vehicle crashes; requiring
 1517         short-form crash reports by a law enforcement officer
 1518         to be maintained by the officer’s agency; authorizing
 1519         the investigation officer to testify at trial or
 1520         provide an affidavit concerning the content of the
 1521         reports; amending s. 400.991, F.S.; requiring that an
 1522         application for licensure as a mobile clinic include a
 1523         statement regarding insurance fraud; creating s.
 1524         626.9894, F.S.; providing definitions; authorizing the
 1525         Division of Insurance Fraud to establish a direct
 1526         support organization for the purpose of prosecuting,
 1527         investigating, and preventing motor vehicle insurance
 1528         fraud; providing requirements for the organization and
 1529         the organization’s contract with the division;
 1530         providing for a board of directors; authorizing the
 1531         organization to use the division’s property and
 1532         facilities subject to certain requirements;
 1533         authorizing contributions from insurers; providing
 1534         that any moneys received by the organization may be
 1535         held in a separate depository account in the name of
 1536         the organization; requiring the division to deposit
 1537         certain proceeds into the Insurance Regulatory Trust
 1538         Fund; amending s. 627.4137, F.S.; requiring a
 1539         claimant’s request about insurance coverage to be
 1540         appropriately served upon the disclosing entity;
 1541         amending s. 627.730, F.S.; conforming a cross
 1542         reference; amending s. 627.731, F.S.; providing
 1543         legislative intent with respect to the Florida Motor
 1544         Vehicle No-Fault Law; amending s. 627.732, F.S.;
 1545         defining the terms “claimant” and “no-fault law”;
 1546         amending s. 627.736, F.S.; conforming a cross
 1547         reference; adding licensed acupuncturists to the list
 1548         of practitioners authorized to provide, supervise,
 1549         order, or prescribe services; requiring certain
 1550         entities providing medical services to document that
 1551         they meet required criteria; revising requirements
 1552         relating to the form that must be submitted by
 1553         providers; requiring an entity or clinic to file a new
 1554         form within a specified period after the date of a
 1555         change of ownership; revising provisions relating to
 1556         when payment for a benefit is due; providing that an
 1557         insurer’s failure to send certain specification or
 1558         explanation does not waive other grounds for rejecting
 1559         an invalid claim; authorizing an insurer to obtain
 1560         evidence and assert any ground for adjusting or
 1561         rejecting a claim; providing that the time period for
 1562         paying a claim is tolled during the investigation of a
 1563         fraudulent insurance act; specifying when benefits are
 1564         not payable; preempting local lien laws with respect
 1565         to payment of benefits to medical providers; providing
 1566         that a claimant that violates certain provisions is
 1567         not entitled to any payment, regardless of whether a
 1568         portion of the claim may be legitimate; authorizing an
 1569         insurer to recover payments and bring a cause of
 1570         action to recover payments; providing that an insurer
 1571         may deny any claim based on other evidence of fraud;
 1572         forbidding a physician, hospital, clinic, or other
 1573         medical institution that fails to comply with certain
 1574         provisions from billing the injured person or the
 1575         insured; providing that an insurer has a right to
 1576         conduct reasonable investigations of claims;
 1577         authorizing an insurer to require a claimant to
 1578         provide certain records; requiring a records review to
 1579         be conducted by the same type of practitioner as the
 1580         medical provider whose records are being reviewed;
 1581         specifying when the period for payment is tolled;
 1582         authorizing an insurer to deny benefits if an insured,
 1583         claimant, or medical provider fails to comply with
 1584         certain provisions; revising the insurer’s
 1585         reimbursement limitation; providing a limit on the
 1586         amount of reimbursement if the insurance policy
 1587         includes a schedule of charges; creating a rebuttable
 1588         presumption that the insured did not receive the
 1589         alleged treatment if the insured does not countersign
 1590         the patient log; authorizing the insurer to deny a
 1591         claim if the provider does not submit a properly
 1592         completed statement or bill within a certain time;
 1593         specifying requirements for furnishing the insured
 1594         with notice of the amount of covered loss; deleting an
 1595         obsolete provision; requiring the provider to provide
 1596         copies of the patient log within a certain time if
 1597         requested by the insurer; providing that failure to
 1598         maintain a patient log renders the treatment unlawful
 1599         and noncompensable; revising requirements relating to
 1600         discovery; authorizing the insurer to conduct a
 1601         physical review of the treatment location; requiring
 1602         the insured and assignee to comply with certain
 1603         provisions to recover benefits; requiring the provider
 1604         to produce persons having the most knowledge in
 1605         specified circumstances; requiring the insurer to pay
 1606         reasonable compensation to the provider for attending
 1607         the examination; requiring the insurer to request
 1608         certain information before requesting an assignee to
 1609         participate in an examination under oath; providing
 1610         that an insurer that requests an examination under
 1611         oath without a reasonable basis is engaging in an
 1612         unfair and deceptive trade practice; providing that
 1613         failure to appear for scheduled examinations
 1614         establishes a rebuttable presumption that such failure
 1615         was unreasonable; authorizing an insurer to contract
 1616         with a preferred provider network; authorizing an
 1617         insurer to provide a premium discount to an insured
 1618         who selects a preferred provider; authorizing an
 1619         insurance policy to not pay for nonemergency services
 1620         performed by a nonpreferred provider in specified
 1621         circumstances; authorizing an insurer to use a
 1622         preferred provider network; revising requirements
 1623         relating to demand letters in an action for benefits;
 1624         specifying when a demand letter is defective;
 1625         requiring a second demand letter under certain
 1626         circumstances; deleting obsolete provisions; providing
 1627         that a demand letter may not be used to request the
 1628         production of claim documents or records from the
 1629         insurer; amending s. 817.234, F.S.; conforming a
 1630         cross-reference; providing civil penalties for
 1631         fraudulent insurance claims; amending ss. 324.021,
 1632         456.057, and 627.7401, F.S.; conforming cross
 1633         references; providing an effective date.