Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. SB 1930
                                Barcode 328022                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  04/13/2011           .                                

       The Committee on Banking and Insurance (Bogdanoff) recommended
       the following:
    1         Senate Amendment to Amendment (243424) (with title
    2  amendment)
    4         Delete lines 3 - 30
    5  and insert:
    6         Delete everything after the enacting clause
    7  and insert:
    8         Section 1. Subsection (1) of section 316.066, Florida
    9  Statutes, is amended to read:
   10         316.066 Written reports of crashes.—
   11         (1)(a) A Florida Traffic Crash Report, Long Form, must is
   12  required to be completed and submitted to the department within
   13  10 days after completing an investigation is completed by the
   14  every law enforcement officer who in the regular course of duty
   15  investigates a motor vehicle crash:
   16         1. That resulted in death, or personal injury, or any
   17  indication of complaints of pain or discomfort by any of the
   18  parties or passengers involved in the crash;.
   19         2. That involved one or more passengers, other than the
   20  drivers of the vehicles, in any of the vehicles involved in the
   21  crash;
   22         3.2. That involved a violation of s. 316.061(1) or s.
   23  316.193; or.
   24         4.3. In which a vehicle was rendered inoperative to a
   25  degree that required a wrecker to remove it from traffic, if
   26  such action is appropriate, in the officer’s discretion.
   27         (b) In every crash for which a Florida Traffic Crash
   28  Report, Long Form, is not required by this section, the law
   29  enforcement officer may complete a short-form crash report or
   30  provide a short-form crash report to be completed by each party
   31  involved in the crash. Short-form crash reports prepared by the
   32  law enforcement officer shall be maintained by the officer’s
   33  agency.
   34         (c) The long-form and the short-form report must include:
   35         1. The date, time, and location of the crash.
   36         2. A description of the vehicles involved.
   37         3. The names and addresses of the parties involved.
   38         4. The names and addresses of all passengers in all
   39  vehicles involved in the crash, each clearly identified as being
   40  a passenger and the identification of the vehicle in which they
   41  were a passenger.
   42         5.4. The names and addresses of witnesses.
   43         6.5. The name, badge number, and law enforcement agency of
   44  the officer investigating the crash.
   45         7.6. The names of the insurance companies for the
   46  respective parties involved in the crash.
   47         (d)(c) Each party to the crash must shall provide the law
   48  enforcement officer with proof of insurance, which must to be
   49  included in the crash report. If a law enforcement officer
   50  submits a report on the accident, proof of insurance must be
   51  provided to the officer by each party involved in the crash. Any
   52  party who fails to provide the required information commits a
   53  noncriminal traffic infraction, punishable as a nonmoving
   54  violation as provided in chapter 318, unless the officer
   55  determines that due to injuries or other special circumstances
   56  such insurance information cannot be provided immediately. If
   57  the person provides the law enforcement agency, within 24 hours
   58  after the crash, proof of insurance that was valid at the time
   59  of the crash, the law enforcement agency may void the citation.
   60         (e)(d) The driver of a vehicle that was in any manner
   61  involved in a crash resulting in damage to any vehicle or other
   62  property in an amount of $500 or more, which crash was not
   63  investigated by a law enforcement agency, shall, within 10 days
   64  after the crash, submit a written report of the crash to the
   65  department or traffic records center. The entity receiving the
   66  report may require witnesses of the crash crashes to render
   67  reports and may require any driver of a vehicle involved in a
   68  crash of which a written report must be made as provided in this
   69  section to file supplemental written reports if whenever the
   70  original report is deemed insufficient by the receiving entity.
   71         (f) The investigating law enforcement officer may testify
   72  at trial or provide a signed affidavit to confirm or supplement
   73  the information included on the long-form or short-form report.
   74         (e) Short-form crash reports prepared by law enforcement
   75  shall be maintained by the law enforcement officer’s agency.
   76         Section 2. Subsection (6) is added to section 400.991,
   77  Florida Statutes, to read:
   78         400.991 License requirements; background screenings;
   79  prohibitions.—
   80         (6) All forms that constitute part of the application for
   81  licensure or exemption from licensure under this part must
   82  contain the following statement:
   84         INSURANCE FRAUD NOTICE.—Submitting a false,
   85         misleading, or fraudulent application or other
   86         document when applying for licensure as a health care
   87         clinic, when seeking an exemption from licensure as a
   88         health care clinic, or when demonstrating compliance
   89         with part X of chapter 400, Florida Statutes, is a
   90         fraudulent insurance act, as defined in s. 626.989 or
   91         s. 817.234, Florida Statutes, subject to investigation
   92         by the Division of Insurance Fraud, and is grounds for
   93         discipline by the appropriate licensing board of the
   94         Florida Department of Health.
   95         Section 3. Section 626.9894, Florida Statutes, is created
   96  to read:
   97         626.9894Motor vehicle insurance fraud direct-support
   98  organization.—
   99         (1) DEFINITIONS.—As used in this section, the term:
  100         (a) “Division” means the Division of Insurance Fraud of the
  101  Department of Financial Services.
  102         (b) “Motor vehicle insurance fraud” means any act defined
  103  as a “fraudulent insurance act” under s. 626.989, which relates
  104  to the coverage of motor vehicle insurance as described in part
  105  XI of chapter 627.
  106         (c) “Organization” means the direct-support organization
  107  established under this section.
  108         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  109  direct-support organization, to be known as the “Automobile
  110  Insurance Fraud Strike Force,” whose sole purpose is to support
  111  the prosecution, investigation, and prevention of motor vehicle
  112  insurance fraud. The organization shall:
  113         (a) Be a not-for-profit corporation incorporated under
  114  chapter 617 and approved by the Department of State.
  115         (b) Be organized and operated to conduct programs and
  116  activities; to raise funds; to request and receive grants,
  117  gifts, and bequests of money; to acquire, receive, hold, invest,
  118  and administer, in its own name, securities, funds, objects of
  119  value, or other property, real or personal; and to make grants
  120  and expenditures to or for the direct or indirect benefit of the
  121  division, state attorneys’ offices, the statewide prosecutor,
  122  the Agency for Health Care Administration, and the Department of
  123  Health to the extent that such grants and expenditures are to be
  124  used exclusively to advance the purpose of prosecuting,
  125  investigating, or preventing motor vehicle insurance fraud.
  126  Grants and expenditures may include the cost of salaries or
  127  benefits of dedicated motor vehicle insurance fraud
  128  investigators, prosecutors, or support personnel if such grants
  129  and expenditures do not interfere with prosecutorial
  130  independence or otherwise create conflicts of interest which
  131  threaten the success of prosecutions.
  132         (c) Be determined by the division to operate in a manner
  133  that promotes the goals of laws relating to motor vehicle
  134  insurance fraud, that is in the best interest of the state, and
  135  that is in accordance with the adopted goals and mission of the
  136  division.
  137         (d) Use all of its grants and expenditures solely for the
  138  purpose of preventing and decreasing motor vehicle insurance
  139  fraud, and not for the purpose of lobbying as defined in s.
  140  11.045.
  141         (e) Be subject to an annual financial audit in accordance
  142  with s. 215.981.
  143         (3) CONTRACT.—The organization shall operate under written
  144  contract with the division. The contract must provide for:
  145         (a) Approval of the articles of incorporation and bylaws of
  146  the organization by the division.
  147         (b) Submission of an annual budget for the approval of the
  148  division. The budget must require the organization to minimize
  149  costs to the division and its members at all times by using
  150  existing personnel and property and allowing for telephonic
  151  meetings when appropriate.
  152         (c) Certification by the division that the direct-support
  153  organization is complying with the terms of the contract and in
  154  a manner consistent with the goals and purposes of the
  155  department and in the best interest of the state. Such
  156  certification must be made annually and reported in the official
  157  minutes of a meeting of the organization.
  158         (d) Allocation of funds to address motor vehicle insurance
  159  fraud.
  160         (e) Reversion of moneys and property held in trust by the
  161  organization for motor vehicle insurance fraud prosecution,
  162  investigation, and prevention to the division if the
  163  organization is no longer approved to operate for the department
  164  or if the organization ceases to exist, or to the state if the
  165  division ceases to exist.
  166         (f) Specific criteria to be used by the organization’s
  167  board of directors to evaluate the effectiveness of funding used
  168  to combat motor vehicle insurance fraud.
  169         (g) The fiscal year of the organization, which begins July
  170  1 of each year and ends June 30 of the following year.
  171         (h) Disclosure of the material provisions of the contract,
  172  and distinguishing between the department and the organization
  173  to donors of gifts, contributions, or bequests, including
  174  providing such disclosure on all promotional and fundraising
  175  publications.
  176         (4) BOARD OF DIRECTORS.—The board of directors of the
  177  organization shall consist of the following seven members:
  178         (a) The Chief Financial Officer, or designee, who shall
  179  serve as chair.
  180         (b) Two state attorneys, one of whom shall be appointed by
  181  the Chief Financial Officer and one of whom shall be appointed
  182  by the Attorney General.
  183         (c) Two representatives of motor vehicle insurers appointed
  184  by the Chief Financial Officer.
  185         (d) Two representatives of local law enforcement agencies,
  186  both of whom shall be appointed by the Chief Financial Officer.
  188  The officer who appointed a member of the board may remove that
  189  member for cause. The term of office of an appointed member
  190  expires at the same time as the term of the officer who
  191  appointed him or her or at such earlier time as the person
  192  ceases to be qualified.
  193         (5) USE OF PROPERTY.—The department may authorize, without
  194  charge, appropriate use of fixed property and facilities of the
  195  division by the organization, subject to this subsection.
  196         (a) The department may prescribe any condition with which
  197  the organization must comply in order to use the division’s
  198  property or facilities.
  199         (b) The department may not authorize the use of the
  200  division’s property or facilities if the organization does not
  201  provide equal membership and employment opportunities to all
  202  persons regardless of race, religion, sex, age, or national
  203  origin.
  204         (c) The department shall adopt rules prescribing the
  205  procedures by which the organization is governed and any
  206  conditions with which the organization must comply to use the
  207  division’s property or facilities.
  208         (6) CONTRIBUTIONS.—Any contributions made by an insurer to
  209  the organization shall be allowed as appropriate business
  210  expenses for all regulatory purposes.
  211         (7) DEPOSITORY.—Any moneys received by the organization may
  212  be held in a separate depository account in the name of the
  213  organization and subject to the provisions of the contract with
  214  the division.
  215         (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division
  216  receives proceeds from the organization, those proceeds shall be
  217  deposited into the Insurance Regulatory Trust Fund.
  218         Section 4. Subsection (3) is added to section 627.4137,
  219  Florida Statutes, to read:
  220         627.4137 Disclosure of certain information required.—
  221         (3)Any request made to a self-insured corporation pursuant
  222  to this section shall be sent by certified mail to the
  223  registered agent of the disclosing entity.
  224         Section 5. Section 627.730, Florida Statutes, is amended to
  225  read:
  226         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  227  627.730-627.7407 627.730-627.7405 may be cited and known as the
  228  “Florida Motor Vehicle No-Fault Law.”
  229         Section 6. Section 627.731, Florida Statutes, is amended to
  230  read:
  231         627.731 Purpose; legislative intent.—The purpose of the no
  232  fault law ss. 627.730-627.7405 is to provide for medical,
  233  surgical, funeral, and disability insurance benefits without
  234  regard to fault, and to require motor vehicle insurance securing
  235  such benefits, for motor vehicles required to be registered in
  236  this state and, with respect to motor vehicle accidents, a
  237  limitation on the right to claim damages for pain, suffering,
  238  mental anguish, and inconvenience.
  239         (1) The Legislature finds that automobile insurance fraud
  240  remains a major problem for state consumers and insurers.
  241  According to the National Insurance Crime Bureau, in recent
  242  years this state has been among those states that have the
  243  highest number of fraudulent and questionable claims.
  244         (2) The Legislature intends to balance the insured’s
  245  interest in prompt payment of valid claims for insurance
  246  benefits under the no-fault law with the public’s interest in
  247  reducing fraud, abuse, and overuse of the no-fault system. To
  248  that end, the Legislature intends that the investigation and
  249  prevention of fraudulent insurance acts in this state be
  250  enhanced, that additional sanctions for such acts be imposed,
  251  and that the no-fault law be revised to remove incentives for
  252  fraudulent insurance acts. The Legislature intends that the no
  253  fault law be construed according to the plain language of the
  254  statutory provisions, which are designed to meet these goals.
  255         (3) The Legislature intends that:
  256         (a) Insurers properly investigate claims, and as such, be
  257  allowed to obtain examinations under oath and sworn statements
  258  from any claimant seeking no-fault insurance benefits, and to
  259  request mental and physical examinations of persons seeking
  260  personal injury protection coverage or benefits.
  261         (b) Any false, misleading, or otherwise fraudulent activity
  262  associated with a claim render the entire claim invalid. An
  263  insurer must be able to raise fraud as a defense to a claim for
  264  no-fault insurance benefits irrespective of any prior
  265  adjudication of guilt or determination of fraud by the
  266  Department of Financial Services.
  267         (c) Insurers toll the payment or denial of a claim, with
  268  respect to any portion of a claim for which the insurer has a
  269  reasonable belief that a fraudulent insurance act, as defined in
  270  s. 626.989, has been committed.
  271         (d) Insurers discover the names of all passengers involved
  272  in an automobile accident before paying claims or benefits
  273  pursuant to an insurance policy governed by the no-fault law. A
  274  rebuttable presumption must be established that a person was not
  275  involved in the event giving rise to the claim if that person’s
  276  name does not appear on the police report.
  277         (e) The insured’s interest in obtaining competent counsel
  278  must be balanced with the public’s interest in preventing a no
  279  fault system that encourages litigation by allowing for
  280  exorbitant attorney’s fees. Courts should limit attorney fee
  281  awards so as to eliminate the incentive for attorneys to
  282  manufacture unnecessary litigation.
  283         Section 7. Section 627.7311, Florida Statutes, is created
  284  to read:
  285         627.7311 Implementation of no-fault law.—The provisions,
  286  schedules, and procedures authorized under the no-fault law
  287  shall be implemented by insurers and have full force and effect
  288  regardless of their express inclusion in an insurance policy,
  289  and an insurer is not required to amend its policy to implement
  290  such provisions, schedules, or procedures.
  291         Section 8. Section 627.732, Florida Statutes, is reordered
  292  and amended to read:
  293         627.732 Definitions.—As used in the no-fault law ss.
  294  627.730-627.7405, the term:
  295         (1) “Broker” means any person not possessing a license
  296  under chapter 395, chapter 400, chapter 429, chapter 458,
  297  chapter 459, chapter 460, chapter 461, or chapter 641 who
  298  charges or receives compensation for any use of medical
  299  equipment and is not the 100-percent owner or the 100-percent
  300  lessee of such equipment. For purposes of this section, such
  301  owner or lessee may be an individual, a corporation, a
  302  partnership, or any other entity and any of its 100-percent
  303  owned affiliates and subsidiaries. For purposes of this
  304  subsection, the term “lessee” means a long-term lessee under a
  305  capital or operating lease, but does not include a part-time
  306  lessee. The term “broker” does not include a hospital or
  307  physician management company whose medical equipment is
  308  ancillary to the practices managed, a debt collection agency, or
  309  an entity that has contracted with the insurer to obtain a
  310  discounted rate for such services; or nor does the term include
  311  a management company that has contracted to provide general
  312  management services for a licensed physician or health care
  313  facility and whose compensation is not materially affected by
  314  the usage or frequency of usage of medical equipment or an
  315  entity that is 100-percent owned by one or more hospitals or
  316  physicians. The term “broker” does not include a person or
  317  entity that certifies, upon request of an insurer, that:
  318         (a) It is a clinic licensed under ss. 400.990-400.995;
  319         (b) It is a 100-percent owner of medical equipment; and
  320         (c) The owner’s only part-time lease of medical equipment
  321  for personal injury protection patients is on a temporary basis,
  322  not to exceed 30 days in a 12-month period, and such lease is
  323  solely for the purposes of necessary repair or maintenance of
  324  the 100-percent-owned medical equipment or pending the arrival
  325  and installation of the newly purchased or a replacement for the
  326  100-percent-owned medical equipment, or for patients for whom,
  327  because of physical size or claustrophobia, it is determined by
  328  the medical director or clinical director to be medically
  329  necessary that the test be performed in medical equipment that
  330  is open-style. The leased medical equipment may not cannot be
  331  used by patients who are not patients of the registered clinic
  332  for medical treatment of services. Any person or entity making a
  333  false certification under this subsection commits insurance
  334  fraud as defined in s. 817.234. However, the 30-day period
  335  provided in this paragraph may be extended for an additional 60
  336  days as applicable to magnetic resonance imaging equipment if
  337  the owner certifies that the extension otherwise complies with
  338  this paragraph.
  339         (9)(2) “Medically necessary” refers to a medical service or
  340  supply that a prudent physician would provide for the purpose of
  341  preventing, diagnosing, or treating an illness, injury, disease,
  342  or symptom in a manner that is:
  343         (a) In accordance with generally accepted standards of
  344  medical practice;
  345         (b) Clinically appropriate in terms of type, frequency,
  346  extent, site, and duration; and
  347         (c) Not primarily for the convenience of the patient,
  348  physician, or other health care provider.
  349         (10)(3) “Motor vehicle” means a any self-propelled vehicle
  350  with four or more wheels which is of a type both designed and
  351  required to be licensed for use on the highways of this state,
  352  and any trailer or semitrailer designed for use with such
  353  vehicle, and includes:
  354         (a) A “private passenger motor vehicle,” which is any motor
  355  vehicle that which is a sedan, station wagon, or jeep-type
  356  vehicle and, if not used primarily for occupational,
  357  professional, or business purposes, a motor vehicle of the
  358  pickup, panel, van, camper, or motor home type.
  359         (b) A “commercial motor vehicle,” which is any motor
  360  vehicle that which is not a private passenger motor vehicle.
  362  The term “motor vehicle” does not include a mobile home or any
  363  motor vehicle that which is used in mass transit, other than
  364  public school transportation, and designed to transport more
  365  than five passengers exclusive of the operator of the motor
  366  vehicle and that which is owned by a municipality, a transit
  367  authority, or a political subdivision of the state.
  368         (11)(4) “Named insured” means a person, usually the owner
  369  of a vehicle, identified in a policy by name as the insured
  370  under the policy.
  371         (12) “No-fault law” means the Florida Motor Vehicle No
  372  Fault Law codifed at ss. 627.730-627.7407.
  373         (13)(5) “Owner” means a person who holds the legal title to
  374  a motor vehicle; or, if in the event a motor vehicle is the
  375  subject of a security agreement or lease with an option to
  376  purchase with the debtor or lessee having the right to
  377  possession, then the debtor or lessee is shall be deemed the
  378  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  379         (15)(6) “Relative residing in the same household” means a
  380  relative of any degree by blood or by marriage who usually makes
  381  her or his home in the same family unit, whether or not
  382  temporarily living elsewhere.
  383         (2)(7) “Certify” means to swear or attest to being true or
  384  represented in writing.
  385         (3) “Claimant” means the person, organization, or entity
  386  seeking benefits, including all assignees.
  387         (5)(8) “Immediate personal supervision,” as it relates to
  388  the performance of medical services by nonphysicians not in a
  389  hospital, means that an individual licensed to perform the
  390  medical service or provide the medical supplies must be present
  391  within the confines of the physical structure where the medical
  392  services are performed or where the medical supplies are
  393  provided such that the licensed individual can respond
  394  immediately to any emergencies if needed.
  395         (6)(9) “Incident,” with respect to services considered as
  396  incident to a physician’s professional service, for a physician
  397  licensed under chapter 458, chapter 459, chapter 460, or chapter
  398  461, if not furnished in a hospital, means such services that
  399  are must be an integral, even if incidental, part of a covered
  400  physician’s service.
  401         (7)(10) “Knowingly” means that a person, with respect to
  402  information, has actual knowledge of the information,; acts in
  403  deliberate ignorance of the truth or falsity of the
  404  information,; or acts in reckless disregard of the information.,
  405  and Proof of specific intent to defraud is not required.
  406         (8)(11) “Lawful” or “lawfully” means in substantial
  407  compliance with all relevant applicable criminal, civil, and
  408  administrative requirements of state and federal law related to
  409  the provision of medical services or treatment.
  410         (4)(12) “Hospital” means a facility that, at the time
  411  services or treatment were rendered, was licensed under chapter
  412  395.
  413         (14)(13) “Properly completed” means providing truthful,
  414  substantially complete, and substantially accurate responses as
  415  to all material elements of to each applicable request for
  416  information or statement by a means that may lawfully be
  417  provided and that complies with this section, or as agreed by
  418  the parties.
  419         (17)(14) “Upcoding” means submitting an action that submits
  420  a billing code that would result in payment greater in amount
  421  than would be paid using a billing code that accurately
  422  describes the services performed. The term does not include an
  423  otherwise lawful bill by a magnetic resonance imaging facility,
  424  which globally combines both technical and professional
  425  components, if the amount of the global bill is not more than
  426  the components if billed separately; however, payment of such a
  427  bill constitutes payment in full for all components of such
  428  service.
  429         (16)(15) “Unbundling” means submitting an action that
  430  submits a billing code that is properly billed under one billing
  431  code, but that has been separated into two or more billing
  432  codes, and would result in payment greater than the in amount
  433  that than would be paid using one billing code.
  434         Section 9. Subsections (1) and (4) of section 627.736,
  435  Florida Statutes, are amended, subsections (5) through (16) of
  436  that section are redesignated as subsections (6) through (17),
  437  respectively, a new subsection (5) is added to that section,
  438  present subsection (5), paragraph (b) of present subsection (6),
  439  paragraph (b) of present subsection (7), and present subsections
  440  (8), (9), and (10) of that section are amended, to read:
  441         627.736 Required personal injury protection benefits;
  442  exclusions; priority; claims.—
  443         (1) REQUIRED BENEFITS.—Every insurance policy complying
  444  with the security requirements of s. 627.733 must shall provide
  445  personal injury protection to the named insured, relatives
  446  residing in the same household, persons operating the insured
  447  motor vehicle, passengers in such motor vehicle, and other
  448  persons struck by such motor vehicle and suffering bodily injury
  449  while not an occupant of a self-propelled vehicle, subject to
  450  the provisions of subsection (2) and paragraph (4)(h) (4)(e), to
  451  a limit of $10,000 for loss sustained by any such person as a
  452  result of bodily injury, sickness, disease, or death arising out
  453  of the ownership, maintenance, or use of a motor vehicle as
  454  follows:
  455         (a) Medical benefits.—Eighty percent of all reasonable
  456  expenses, charged pursuant to subsection (6), for medically
  457  necessary medical, surgical, X-ray, dental, and rehabilitative
  458  services, including prosthetic devices, and for medically
  459  necessary ambulance, hospital, and nursing services. However,
  460  the medical benefits shall provide reimbursement only for such
  461  services and care that are lawfully provided, supervised,
  462  ordered, or prescribed by a physician licensed under chapter 458
  463  or chapter 459, a dentist licensed under chapter 466, or a
  464  chiropractic physician licensed under chapter 460 or that are
  465  provided by any of the following persons or entities:
  466         1. A hospital or ambulatory surgical center licensed under
  467  chapter 395.
  468         2. A person or entity licensed under part III of chapter
  469  401 which ss. 401.2101-401.45 that provides emergency
  470  transportation and treatment.
  471         3. An entity wholly owned by one or more physicians
  472  licensed under chapter 458 or chapter 459, chiropractic
  473  physicians licensed under chapter 460, or dentists licensed
  474  under chapter 466 or by such practitioner or practitioners and
  475  the spouse, parent, child, or sibling of such that practitioner
  476  or those practitioners.
  477         4. An entity wholly owned, directly or indirectly, by a
  478  hospital or hospitals.
  479         5. A health care clinic licensed under part X of chapter
  480  400 which ss. 400.990-400.995 that is:
  481         a. Accredited by the Joint Commission on Accreditation of
  482  Healthcare Organizations, the American Osteopathic Association,
  483  the Commission on Accreditation of Rehabilitation Facilities, or
  484  the Accreditation Association for Ambulatory Health Care, Inc.;
  485  or
  486         b. A health care clinic that:
  487         (I) Has a medical director licensed under chapter 458,
  488  chapter 459, or chapter 460;
  489         (II) Has been continuously licensed for more than 3 years
  490  or is a publicly traded corporation that issues securities
  491  traded on an exchange registered with the United States
  492  Securities and Exchange Commission as a national securities
  493  exchange; and
  494         (III) Provides at least four of the following medical
  495  specialties:
  496         (A) General medicine.
  497         (B) Radiography.
  498         (C) Orthopedic medicine.
  499         (D) Physical medicine.
  500         (E) Physical therapy.
  501         (F) Physical rehabilitation.
  502         (G) Prescribing or dispensing outpatient prescription
  503  medication.
  504         (H) Laboratory services.
  505         6. An acupuncturist licensed under chapter 457.
  507  If any services under this paragraph are provided by an entity
  508  or clinic described in subparagraph 3., subparagraph 4., or
  509  subparagraph 5., the entity or clinic must provide the insurer
  510  at the initial submission of the claim with a form adopted by
  511  the Department of Financial Services which documents that the
  512  entity or clinic meets applicable criteria for such entity or
  513  clinic and includes a sworn statement or affidavit to that
  514  effect. Any change in ownership requires the filing of a new
  515  form within 10 days after the date of the change in ownership.
  516  The Financial Services Commission shall adopt by rule the form
  517  that must be used by an insurer and a health care provider
  518  specified in subparagraph 3., subparagraph 4., or subparagraph
  519  5. to document that the health care provider meets the criteria
  520  of this paragraph, which rule must include a requirement for a
  521  sworn statement or affidavit.
  522         (b) Disability benefits.—Sixty percent of any loss of gross
  523  income and loss of earning capacity per individual from
  524  inability to work proximately caused by the injury sustained by
  525  the injured person, plus all expenses reasonably incurred in
  526  obtaining from others ordinary and necessary services in lieu of
  527  those that, but for the injury, the injured person would have
  528  performed without income for the benefit of his or her
  529  household. All disability benefits payable under this provision
  530  must shall be paid at least not less than every 2 weeks.
  531         (c) Death benefits.—Death benefits equal to the lesser of
  532  $5,000 or the remainder of unused personal injury protection
  533  benefits per individual. The insurer may pay such benefits to
  534  the executor or administrator of the deceased, to any of the
  535  deceased’s relatives by blood, or legal adoption, or connection
  536  by marriage, or to any person appearing to the insurer to be
  537  equitably entitled thereto.
  539  Only insurers writing motor vehicle liability insurance in this
  540  state may provide the required benefits of this section, and no
  541  such insurers may not insurer shall require the purchase of any
  542  other motor vehicle coverage other than the purchase of property
  543  damage liability coverage as required by s. 627.7275 as a
  544  condition for providing such required benefits. Insurers may not
  545  require that property damage liability insurance in an amount
  546  greater than $10,000 be purchased in conjunction with personal
  547  injury protection. Such insurers shall make benefits and
  548  required property damage liability insurance coverage available
  549  through normal marketing channels. An Any insurer writing motor
  550  vehicle liability insurance in this state who fails to comply
  551  with such availability requirement as a general business
  552  practice violates shall be deemed to have violated part IX of
  553  chapter 626, and such violation constitutes shall constitute an
  554  unfair method of competition or an unfair or deceptive act or
  555  practice involving the business of insurance. An; and any such
  556  insurer committing such violation is shall be subject to the
  557  penalties afforded in such part, as well as those that are which
  558  may be afforded elsewhere in the insurance code.
  559         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  560  the no-fault law are ss. 627.730-627.7405 shall be primary,
  561  except that benefits received under any workers’ compensation
  562  law shall be credited against the benefits provided by
  563  subsection (1) and are shall be due and payable as loss accrues,
  564  upon the receipt of reasonable proof of such loss and the amount
  565  of expenses and loss incurred which are covered by the policy
  566  issued under the no-fault law ss. 627.730-627.7405. If When the
  567  Agency for Health Care Administration provides, pays, or becomes
  568  liable for medical assistance under the Medicaid program related
  569  to injury, sickness, disease, or death arising out of the
  570  ownership, maintenance, or use of a motor vehicle, the benefits
  571  are under ss. 627.730-627.7405 shall be subject to the
  572  provisions of the Medicaid program.
  573         (a) An insurer may require written notice to be given as
  574  soon as practicable after an accident involving a motor vehicle
  575  with respect to which the policy affords the security required
  576  by the no-fault law ss. 627.730-627.7405.
  577         (b) Personal injury protection insurance benefits paid
  578  pursuant to this section are shall be overdue if not paid within
  579  30 days after the insurer is furnished written notice of the
  580  fact of a covered loss and of the amount of same. If such
  581  written notice is not furnished to the insurer as to the entire
  582  claim, any partial amount supported by written notice is overdue
  583  if not paid within 30 days after such written notice is
  584  furnished to the insurer. Any part or all of the remainder of
  585  the claim that is subsequently supported by written notice is
  586  overdue if not paid within 30 days after such written notice is
  587  furnished to the insurer.
  588         (c) If When an insurer pays only a portion of a claim or
  589  rejects a claim, the insurer shall provide at the time of the
  590  partial payment or rejection an itemized specification of each
  591  item that the insurer had reduced, omitted, or declined to pay
  592  and any information that the insurer desires the claimant to
  593  consider related to the medical necessity of the denied
  594  treatment or to explain the reasonableness of the reduced
  595  charge, provided that this does shall not limit the introduction
  596  of evidence at trial.; and The insurer must shall include the
  597  name and address of the person to whom the claimant should
  598  respond and a claim number to be referenced in future
  599  correspondence. An insurer’s failure to send an itemized
  600  specification or explanation of benefits does not waive other
  601  grounds for rejecting an invalid claim.
  602         (d)A However, notwithstanding the fact that written notice
  603  has been furnished to the insurer, Any payment is shall not be
  604  deemed overdue if when the insurer has reasonable proof to
  605  establish that the insurer is not responsible for the payment.
  606  An insurer may obtain evidence and assert any ground for
  607  adjustment or rejection of a For the purpose of calculating the
  608  extent to which any benefits are overdue, payment shall be
  609  treated as being made on the date a draft or other valid
  610  instrument which is equivalent to payment was placed in the
  611  United States mail in a properly addressed, postpaid envelope
  612  or, if not so posted, on the date of delivery. This paragraph
  613  does not preclude or limit the ability of the insurer to assert
  614  that the claim that is was unrelated, was not medically
  615  necessary, or was unreasonable, or submitted that the amount of
  616  the charge was in excess of that permitted under, or in
  617  violation of, subsection (6) (5). Such assertion by the insurer
  618  may be made at any time, including after payment of the claim,
  619  or after the 30-day time period for payment set forth in this
  620  paragraph (b), or after the filing of a lawsuit.
  621         (e) The 30-day period for payment is tolled while the
  622  insurer investigates a fraudulent insurance act, as defined in
  623  s. 626.989, with respect to any portion of a claim for which the
  624  insurer has a reasonable belief that a fraudulent insurance act
  625  has been committed. The insurer must notify the claimant in
  626  writing that it is investigating a fraudulent insurance act
  627  within 30 days after the date it has a reasonable belief that
  628  such act has been committed. The insurer must pay or deny the
  629  claim, in full or in part, within 90 days after the date the
  630  written notice of the fact of a covered loss and of the amount
  631  of the loss was provided to the insurer. However, no payment is
  632  due to a claimant that has violated paragraph (k).
  633         (f)(c)Notwithstanding any local lien law, upon receiving
  634  notice of an accident that is potentially covered by personal
  635  injury protection benefits, the insurer must reserve $5,000 of
  636  personal injury protection benefits for payment to physicians
  637  licensed under chapter 458 or chapter 459 or dentists licensed
  638  under chapter 466 who provide emergency services and care, as
  639  defined in s. 395.002(9), or who provide hospital inpatient
  640  care. The amount required to be held in reserve may be used only
  641  to pay claims from such physicians or dentists until 30 days
  642  after the date the insurer receives notice of the accident.
  643  After the 30-day period, any amount of the reserve for which the
  644  insurer has not received notice of such a claim from a physician
  645  or dentist who provided emergency services and care or who
  646  provided hospital inpatient care may then be used by the insurer
  647  to pay other claims. The time periods specified in paragraph (b)
  648  for required payment of personal injury protection benefits are
  649  shall be tolled for the period of time that an insurer is
  650  required by this paragraph to hold payment of a claim that is
  651  not from a physician or dentist who provided emergency services
  652  and care or who provided hospital inpatient care to the extent
  653  that the personal injury protection benefits not held in reserve
  654  are insufficient to pay the claim. This paragraph does not
  655  require an insurer to establish a claim reserve for insurance
  656  accounting purposes.
  657         (g)(d) All overdue payments shall bear simple interest at
  658  the rate established under s. 55.03 or the rate established in
  659  the insurance contract, whichever is greater, for the year in
  660  which the payment became overdue, calculated from the date the
  661  insurer was furnished with written notice of the amount of
  662  covered loss. However, interest on a payment that is overdue
  663  pursuant to paragraph (e) shall be calculated from the date the
  664  insurer denies payment. Interest is shall be due at the time
  665  payment of the overdue claim is made.
  666         (h)(e) The insurer of the owner of a motor vehicle shall
  667  pay personal injury protection benefits for:
  668         1. Accidental bodily injury sustained in this state by the
  669  owner while occupying a motor vehicle, or while not an occupant
  670  of a self-propelled vehicle if the injury is caused by physical
  671  contact with a motor vehicle.
  672         2. Accidental bodily injury sustained outside this state,
  673  but within the United States of America or its territories or
  674  possessions or Canada, by the owner while occupying the owner’s
  675  motor vehicle.
  676         3. Accidental bodily injury sustained by a relative of the
  677  owner residing in the same household, under the circumstances
  678  described in subparagraph 1. or subparagraph 2. if, provided the
  679  relative at the time of the accident is domiciled in the owner’s
  680  household and is not himself or herself the owner of a motor
  681  vehicle with respect to which security is required under the no
  682  fault law ss. 627.730-627.7405.
  683         4. Accidental bodily injury sustained in this state by any
  684  other person while occupying the owner’s motor vehicle or, if a
  685  resident of this state, while not an occupant of a self
  686  propelled vehicle, if the injury is caused by physical contact
  687  with such motor vehicle if, provided the injured person is not
  688  himself or herself:
  689         a. The owner of a motor vehicle with respect to which
  690  security is required under the no-fault law ss. 627.730
  691  627.7405; or
  692         b. Entitled to personal injury benefits from the insurer of
  693  the owner or owners of such a motor vehicle.
  694         (i)(f) If two or more insurers are liable to pay personal
  695  injury protection benefits for the same injury to any one
  696  person, the maximum payable is shall be as specified in
  697  subsection (1), and any insurer paying the benefits is shall be
  698  entitled to recover from each of the other insurers an equitable
  699  pro rata share of the benefits paid and expenses incurred in
  700  processing the claim.
  701         (j)(g) It is a violation of the insurance code for an
  702  insurer to fail to timely provide benefits as required by this
  703  section with such frequency as to constitute a general business
  704  practice.
  705         (k)(h) Benefits are shall not be due or payable to a
  706  claimant who knowingly: or on the behalf of an insured person if
  707  that person has
  708         1. Submits a false or misleading statement, document,
  709  record, or bill;
  710         2. Submits false or misleading information; or
  711         3. Has otherwise committed or attempted to commit a
  712  fraudulent insurance act as defined in s. 626.989.
  714  A claimant that violates this paragraph is not entitled to any
  715  personal injury protection benefits or payment for any bills and
  716  services, regardless of whether a portion of the claim may be
  717  legitimate. However, a claimant that does not violate this
  718  paragraph may not be denied benefits solely due to a violation
  719  by another claimant.
  720         (l) Notwithstanding any remedies afforded by law, the
  721  insurer may recover from a claimant who violates paragraph (k)
  722  any sums previously paid to a claimant and may bring any
  723  available common law and statutory causes of action. A claimant
  724  has violated paragraph (k) committed, by a material act or
  725  omission, any insurance fraud relating to personal injury
  726  protection coverage under his or her policy, if the fraud is
  727  admitted to in a sworn statement by the insured or if it is
  728  established in a court of competent jurisdiction. Any insurance
  729  fraud voids shall void all coverage arising from the claim
  730  related to such fraud under the personal injury protection
  731  coverage of the claimant insured person who committed the fraud,
  732  irrespective of whether a portion of the insured person’s claim
  733  may be legitimate, and any benefits paid before prior to the
  734  discovery of the insured person’s insurance fraud is shall be
  735  recoverable by the insurer from the claimant person who
  736  committed insurance fraud in their entirety. The prevailing
  737  party is entitled to its costs and attorney’s fees in any action
  738  in which it prevails in an insurer’s action to enforce its right
  739  of recovery under this paragraph. This paragraph does not
  740  preclude or limit an insurer’s right to deny a claim based on
  741  other evidence of fraud or affect an insurer’s right to plead
  742  and prove a claim or defense of fraud under common law. If a
  743  physician, hospital, clinic, or other medical institution
  744  violates paragraph (k), the injured party is not liable for, and
  745  the physician, hospital, clinic, or other medical institution
  746  may not bill the insured for, charges that are unpaid because of
  747  failure to comply with paragraph (k). Any agreement requiring
  748  the injured person or insured to pay for such charges is
  749  unenforceable.
  750         (5) INSURER INVESTIGATIONS.—An insurer has the right and
  751  duty to conduct a reasonable investigation of a claim. In the
  752  course of the insurer’s investigation of a claim:
  753         (a) Any records review need not be based on a physical
  754  examination and may be obtained at any time, including after
  755  reduction or denial of the claim.
  756         1. The records review must be conducted by a practitioner
  757  within the same licensing chapter as the medical provider whose
  758  records are being reviewed unless the records review is
  759  performed by a physician licensed under chapter 458 or chapter
  760  459.
  761         2. The 30-day period for payment under paragraph (4)(b) is
  762  tolled from the date the insurer sends its request for treatment
  763  records to the date that the insurer receives the treatment
  764  records.
  765         3. The insured, claimant, or medical provider may impose a
  766  reasonable, cost-based fee that includes only the cost of
  767  copying and postage and not the cost of labor for copying.
  768         (b) In all circumstances, an insured seeking benefits under
  769  the no-fault law must comply with the terms of the policy, which
  770  includes, but is not limited to, submitting to examinations
  771  under oath. Compliance with this paragraph is a condition
  772  precedent to receiving benefits.
  773         (c) An insurer may deny benefits if the insured, claimant,
  774  or medical provider fails to:
  775         1. Cooperate in the insurer’s investigation;
  776         2. Commits a fraud or material misrepresentation; or
  777         3. Comply with this subsection.
  778         (d) The claimant may not file suit unless and until it
  779  complies with this subsection.
  781         (a)1. Any physician, hospital, clinic, or other person or
  782  institution lawfully rendering treatment to an injured person
  783  for a bodily injury covered by personal injury protection
  784  insurance may charge the insurer and injured party only a
  785  reasonable amount pursuant to this section for the services and
  786  supplies rendered, and the insurer providing such coverage may
  787  pay for such charges directly to such person or institution
  788  lawfully rendering such treatment, if the insured receiving such
  789  treatment or his or her guardian has countersigned the properly
  790  completed invoice, bill, or claim form approved by the office
  791  upon which such charges are to be paid for as having actually
  792  been rendered, to the best knowledge of the insured or his or
  793  her guardian. In no event, However, may such charges may not
  794  exceed the reimbursement schedule under this paragraph a charge
  795  be in excess of the amount the person or institution customarily
  796  charges for like services or supplies. With respect to a
  797  determination of whether a charge for a particular service,
  798  treatment, or otherwise is reasonable, consideration may be
  799  given to evidence of usual and customary charges and payments
  800  accepted by the provider involved in the dispute, and
  801  reimbursement levels in the community and various federal and
  802  state medical fee schedules applicable to automobile and other
  803  insurance coverages, and other information relevant to the
  804  reasonableness of the reimbursement for the service, treatment,
  805  or supply.
  806         1.2. The insurer shall may limit reimbursement to no more
  807  than 80 percent of the following schedule of maximum charges:
  808         a. For emergency transport and treatment by providers
  809  licensed under chapter 401, 200 percent of Medicare.
  810         b. For emergency services and care provided by a hospital
  811  licensed under chapter 395, 75 percent of the hospital’s usual
  812  and customary charges.
  813         c. For emergency services and care as defined by s.
  814  395.002(9) provided in a facility licensed under chapter 395
  815  rendered by a physician or dentist, and related hospital
  816  inpatient services rendered by a physician or dentist, the usual
  817  and customary charges in the community.
  818         d. For hospital inpatient services, other than emergency
  819  services and care, 200 percent of the Medicare Part A
  820  prospective payment applicable to the specific hospital
  821  providing the inpatient services.
  822         e. For hospital outpatient services, other than emergency
  823  services and care, 200 percent of the Medicare Part A Ambulatory
  824  Payment Classification for the specific hospital providing the
  825  outpatient services.
  826         f. For all other medical services, supplies, and care, 200
  827  percent of the allowable amount under the participating
  828  physicians schedule of Medicare Part B. For all other supplies
  829  and care, including durable medical equipment and care and
  830  services rendered by ambulatory surgical centers and clinical
  831  laboratories, 200 percent of the allowable amount under Medicare
  832  Part B. However, if such services, supplies, or care is not
  833  reimbursable under Medicare Part B, the insurer may limit
  834  reimbursement to 80 percent of the maximum reimbursable
  835  allowance under workers’ compensation, as determined under s.
  836  440.13 and rules adopted thereunder which are in effect at the
  837  time such services, supplies, or care is provided. Services,
  838  supplies, or care that is not reimbursable under Medicare or
  839  workers’ compensation is not required to be reimbursed by the
  840  insurer.
  841         2.3. For purposes of subparagraph 1. 2., the applicable fee
  842  schedule or payment limitation under Medicare is the fee
  843  schedule or payment limitation in effect on January 1 of the
  844  year in which at the time the services, supplies, or care was
  845  rendered and for the area in which such services were rendered,
  846  which shall apply throughout the remainder of the year
  847  notwithstanding any subsequent changes made to the fee schedule
  848  or payment limitation, except that it may not be less than the
  849  allowable amount under the participating physicians schedule of
  850  Medicare Part B for 2007 for medical services, supplies, and
  851  care subject to Medicare Part B.
  852         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  853  any limitation on the number of treatments or other utilization
  854  limits that apply under Medicare or workers’ compensation. An
  855  insurer that applies the allowable payment limitations of
  856  subparagraph 1. 2. must reimburse a provider who lawfully
  857  provided care or treatment under the scope of his or her
  858  license, regardless of whether such provider is would be
  859  entitled to reimbursement under Medicare due to restrictions or
  860  limitations on the types or discipline of health care providers
  861  who may be reimbursed for particular procedures or procedure
  862  codes.
  863         4.5. If an insurer limits payment as authorized by
  864  subparagraph 1. 2., the person providing such services,
  865  supplies, or care may not bill or attempt to collect from the
  866  insured any amount in excess of such limits, except for amounts
  867  that are not covered by the insured’s personal injury protection
  868  coverage due to the coinsurance amount or maximum policy limits.
  869         (b)1. An insurer or insured is not required to pay a claim
  870  or charges:
  871         a. Made by a broker or by a person making a claim on behalf
  872  of a broker;
  873         b. For any service or treatment that was not lawful at the
  874  time rendered;
  875         c. To any person who knowingly submits a false or
  876  misleading statement relating to the claim or charges;
  877         d. With respect to A bill or statement that does not
  878  substantially meet the applicable requirements of paragraphs
  879  (c), paragraph (d), and (e);
  880         e. Except for emergency treatment and care, if the insured
  881  failed to countersign a billing form or patient log related to
  882  such claim or charges. Failure to submit a countersigned billing
  883  form or patient log creates a rebuttable presumption that the
  884  insured did not receive the alleged treatment. The insurer is
  885  not considered to have been furnished with notice of the subject
  886  treatment and loss until the insurer is able to verify that the
  887  insured received the alleged treatment. As used in this sub
  888  subparagraph, the term “countersigned” means a second or
  889  verifying signature, as on a previously signed document, and is
  890  not satisfied by the statement “signature on file” or any
  891  similar statement;
  892         f.e. For any treatment or service that is upcoded, or that
  893  is unbundled if when such treatment or services should be
  894  bundled, in accordance with paragraph (d). To facilitate prompt
  895  payment of lawful services, an insurer may change codes that it
  896  determines to have been improperly or incorrectly upcoded or
  897  unbundled, and may make payment based on the changed codes,
  898  without affecting the right of the provider to dispute the
  899  change by the insurer if, provided that before doing so, the
  900  insurer contacts must contact the health care provider and
  901  discusses discuss the reasons for the insurer’s change and the
  902  health care provider’s reason for the coding, or makes make a
  903  reasonable good faith effort to do so, as documented in the
  904  insurer’s file; and
  905         g.f. For medical services or treatment billed by a
  906  physician and not provided in a hospital unless such services
  907  are rendered by the physician or are incident to his or her
  908  professional services and are included on the physician’s bill,
  909  including documentation verifying that the physician is
  910  responsible for the medical services that were rendered and
  911  billed.
  912         2. The Department of Health, in consultation with the
  913  appropriate professional licensing boards, shall adopt, by rule,
  914  a list of diagnostic tests deemed not to be medically necessary
  915  for use in the treatment of persons sustaining bodily injury
  916  covered by personal injury protection benefits under this
  917  section. The initial list shall be adopted by January 1, 2004,
  918  and shall be revised from time to time as determined by the
  919  Department of Health, in consultation with the respective
  920  professional licensing boards. Inclusion of a test on the list
  921  must of invalid diagnostic tests shall be based on lack of
  922  demonstrated medical value and a level of general acceptance by
  923  the relevant provider community and may shall not be dependent
  924  for results entirely upon subjective patient response.
  925  Notwithstanding its inclusion on a fee schedule in this
  926  subsection, an insurer or insured is not required to pay any
  927  charges or reimburse claims for any invalid diagnostic test as
  928  determined by the Department of Health.
  929         (c)1. With respect to any treatment or service, other than
  930  medical services billed by a hospital or other provider for
  931  emergency services as defined in s. 395.002 or inpatient
  932  services rendered at a hospital-owned facility, the statement of
  933  charges must be furnished to the insurer by the provider and may
  934  not include, and the insurer is not required to pay, charges for
  935  treatment or services rendered more than 35 days before the
  936  postmark date or electronic transmission date of the statement,
  937  except for past due amounts previously billed on a timely basis
  938  under this paragraph, and except that, if the provider submits
  939  to the insurer a notice of initiation of treatment within 21
  940  days after its first examination or treatment of the claimant,
  941  the statement may include charges for treatment or services
  942  rendered up to, but not more than, 75 days before the postmark
  943  date of the statement. The injured party is not liable for, and
  944  the provider may shall not bill the injured party for, charges
  945  that are unpaid because of the provider’s failure to comply with
  946  this paragraph. Any agreement requiring the injured person or
  947  insured to pay for such charges is unenforceable.
  948         1.2. If, however, the insured fails to furnish the provider
  949  with the correct name and address of the insured’s personal
  950  injury protection insurer, the provider has 35 days from the
  951  date the provider obtains the correct information to furnish the
  952  insurer with a statement of the charges. The insurer is not
  953  required to pay for such charges unless the provider includes
  954  with the statement documentary evidence that was provided by the
  955  insured during the 35-day period demonstrating that the provider
  956  reasonably relied on erroneous information from the insured and
  957  either:
  958         a. A denial letter from the incorrect insurer; or
  959         b. Proof of mailing, which may include an affidavit under
  960  penalty of perjury, reflecting timely mailing to the incorrect
  961  address or insurer.
  962         2.3. For emergency services and care as defined in s.
  963  395.002 rendered in a hospital emergency department or for
  964  transport and treatment rendered by an ambulance provider
  965  licensed pursuant to part III of chapter 401, the provider is
  966  not required to furnish the statement of charges within the time
  967  periods established by this paragraph,; and the insurer is shall
  968  not be considered to have been furnished with notice of the
  969  amount of covered loss for purposes of paragraph (4)(b) until it
  970  receives a statement complying with paragraph (d), or copy
  971  thereof, which specifically identifies the place of service to
  972  be a hospital emergency department or an ambulance in accordance
  973  with billing standards recognized by the Centers for Medicare
  974  and Medicaid Services Health Care Finance Administration.
  975         3.4. Each notice of the insured’s rights under s. 627.7401
  976  must include the following statement in type no smaller than 12
  977  points:
  979         BILLING REQUIREMENTS.—Florida Statutes provide that
  980         with respect to any treatment or services, other than
  981         certain hospital and emergency services, the statement
  982         of charges furnished to the insurer by the provider
  983         may not include, and the insurer and the injured party
  984         are not required to pay, charges for treatment or
  985         services rendered more than 35 days before the
  986         postmark date of the statement, except for past due
  987         amounts previously billed on a timely basis, and
  988         except that, if the provider submits to the insurer a
  989         notice of initiation of treatment within 21 days after
  990         its first examination or treatment of the claimant,
  991         the first billing cycle statement may include charges
  992         for treatment or services rendered up to, but not more
  993         than, 75 days before the postmark date of the
  994         statement.
  996         (d) All statements and bills for medical services rendered
  997  by any physician, hospital, clinic, or other person or
  998  institution shall be submitted to the insurer on a properly
  999  completed Centers for Medicare and Medicaid Services (CMS) 1500
 1000  form, UB 92 forms, or any other standard form approved by the
 1001  office or adopted by the commission for purposes of this
 1002  paragraph. All billings for such services rendered by providers
 1003  must shall, to the extent applicable, follow the Physicians’
 1004  Current Procedural Terminology (CPT) or Healthcare Correct
 1005  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1006  year in which services are rendered and comply with the Centers
 1007  for Medicare and Medicaid Services (CMS) 1500 form instructions
 1008  and the American Medical Association Current Procedural
 1009  Terminology (CPT) Editorial Panel and Healthcare Correct
 1010  Procedural Coding System (HCPCS). All providers other than
 1011  hospitals shall include on the applicable claim form the
 1012  professional license number of the provider in the line or space
 1013  provided for “Signature of Physician or Supplier, Including
 1014  Degrees or Credentials.” In determining compliance with
 1015  applicable CPT and HCPCS coding, guidance shall be provided by
 1016  the Physicians’ Current Procedural Terminology (CPT) or the
 1017  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1018  for the year in which services were rendered, the Office of the
 1019  Inspector General (OIG), Physicians Compliance Guidelines, and
 1020  other authoritative treatises designated by rule by the Agency
 1021  for Health Care Administration. A No statement of medical
 1022  services may not include charges for medical services of a
 1023  person or entity that performed such services without possessing
 1024  the valid licenses required to perform such services. For
 1025  purposes of paragraph (4)(b), an insurer is shall not be
 1026  considered to have been furnished with notice of the amount of
 1027  covered loss or medical bills due unless the statements or bills
 1028  comply with this paragraph, and unless the statements or bills
 1029  are comply with this paragraph, and unless the statements or
 1030  bills are properly completed in their entirety as to all
 1031  material provisions, with all relevant information being
 1032  provided therein. If an insurer denies a claim due to a
 1033  provider’s failure to submit a properly completed form, the
 1034  insurer shall notify the provider as to the provisions that were
 1035  improperly completed, and the provider shall have 15 days after
 1036  the receipt of such notice to submit a properly completed form.
 1037  If the provider fails to comply with this requirement, the
 1038  insurer is not required to pay for the services that were billed
 1039  on the improperly completed form.
 1040         (e)1. At the initial treatment or service provided, each
 1041  physician, other licensed professional, clinic, or other medical
 1042  institution providing medical services upon which a claim for
 1043  personal injury protection benefits is based shall require an
 1044  insured person, or his or her guardian, to execute a disclosure
 1045  and acknowledgment form, which reflects at a minimum that:
 1046         a. The insured, or his or her guardian, must countersign
 1047  the form attesting to the fact that the services set forth
 1048  therein were actually rendered. The services shall be described
 1049  and listed on the disclosure and acknowledgement form in words
 1050  readable by the insured. If the insured cannot read, the
 1051  provider should verify, under penalty of perjury, that the
 1052  services listed on the form were verbally explained to the
 1053  insured before the insured signs the form. Listing CPT codes or
 1054  other coding on the disclosure and acknowledgment form does not
 1055  satisfy this requirement;
 1056         b. The insured, or his or her guardian, has both the right
 1057  and affirmative duty to confirm that the services were actually
 1058  rendered;
 1059         c. The insured, or his or her guardian, was not solicited
 1060  by any person to seek any services from the medical provider;
 1061         d. The physician, other licensed professional, clinic, or
 1062  other medical institution rendering services for which payment
 1063  is being claimed explained the services to the insured or his or
 1064  her guardian; and
 1065         e. If the insured notifies the insurer in writing of a
 1066  billing error, the insured may be entitled to a certain
 1067  percentage of a reduction in the amounts paid by the insured’s
 1068  motor vehicle insurer.
 1069         2. The physician, other licensed professional, clinic, or
 1070  other medical institution rendering services for which payment
 1071  is being claimed has the affirmative duty to explain the
 1072  services rendered to the insured, or his or her guardian, so
 1073  that the insured, or his or her guardian, countersigns the form
 1074  with informed consent.
 1075         3. Countersignature by the insured, or his or her guardian,
 1076  is not required for the reading of diagnostic tests or other
 1077  services that are of such a nature that they are not required to
 1078  be performed in the presence of the insured.
 1079         4. The licensed medical professional rendering treatment
 1080  for which payment is being claimed must sign, by his or her own
 1081  hand, the form complying with this paragraph.
 1082         5. An insurer is not considered to have been furnished with
 1083  notice of the amount of a covered loss or medical bills unless
 1084  the original completed disclosure and acknowledgment form is
 1085  shall be furnished to the insurer pursuant to paragraph (4)(b)
 1086  and sub-subparagraph 1.a. The disclosure and acknowledgement
 1087  form may not be electronically furnished. A disclosure and
 1088  acknowledgement form that does not meet the minimum requirements
 1089  of sub-subparagraph 1.a. does not provide an insurer with notice
 1090  of the amount of a covered loss or medical bills due.
 1091         6. This disclosure and acknowledgment form is not required
 1092  for services billed by a provider for emergency services as
 1093  defined in s. 395.002, for emergency services and care as
 1094  defined in s. 395.002 rendered in a hospital emergency
 1095  department, or for transport and treatment rendered by an
 1096  ambulance provider licensed pursuant to part III of chapter 401.
 1097         7. The Financial Services Commission shall adopt, by rule,
 1098  a standard disclosure and acknowledgment form to that shall be
 1099  used to fulfill the requirements of this paragraph, effective 90
 1100  days after such form is adopted and becomes final. The
 1101  commission shall adopt a proposed rule by October 1, 2003. Until
 1102  the rule is final, the provider may use a form of its own which
 1103  otherwise complies with the requirements of this paragraph.
 1104         8. As used in this paragraph, the term “countersigned” or
 1105  “countersignature” means a second or verifying signature, as on
 1106  a previously signed document, and is not satisfied by the
 1107  statement “signature on file” or any similar statement.
 1108         9. The requirements of this paragraph apply only with
 1109  respect to the initial treatment or service of the insured by a
 1110  provider. For subsequent treatments or service, the provider
 1111  must maintain a patient log signed by the patient, in
 1112  chronological order by date of service, which describes the
 1113  treatment rendered in a language readable by the insured that is
 1114  consistent with the services being rendered to the patient as
 1115  claimed. Listing CPT codes or other coding on the patient log
 1116  does not satisfy this requirement. The provider must provide
 1117  copies of the patient log to the insurer within 30 days after
 1118  receiving a written request from the insurer. Failure to
 1119  maintain a patient log renders the treatment unlawful and
 1120  noncompensable. The requirements of this subparagraph for
 1121  maintaining a patient log signed by the patient may be met by a
 1122  hospital that maintains medical records as required by s.
 1123  395.3025 and applicable rules and makes such records available
 1124  to the insurer upon request.
 1125         (f) Upon written notification by any person, an insurer
 1126  shall investigate any claim of improper billing by a physician
 1127  or other medical provider. The insurer shall determine if the
 1128  insured was properly billed for only those services and
 1129  treatments that the insured actually received. If the insurer
 1130  determines that the insured has been improperly billed, the
 1131  insurer shall notify the insured, the person making the written
 1132  notification, and the provider of its findings and shall reduce
 1133  the amount of payment to the provider by the amount determined
 1134  to be improperly billed. If a reduction is made due to such
 1135  written notification by any person, the insurer shall pay to the
 1136  person 20 percent of the amount of the reduction, up to $500. If
 1137  the provider is arrested due to the improper billing, then the
 1138  insurer shall pay to the person 40 percent of the amount of the
 1139  reduction, up to $500.
 1140         (g) An insurer may not systematically downcode with the
 1141  intent to deny reimbursement otherwise due. Such action
 1142  constitutes a material misrepresentation under s.
 1143  626.9541(1)(i)2.
 1145  DISPUTES.—
 1146         (b) Every physician, hospital, clinic, or other medical
 1147  institution providing, before or after bodily injury upon which
 1148  a claim for personal injury protection insurance benefits is
 1149  based, any products, services, or accommodations in relation to
 1150  that or any other injury, or in relation to a condition claimed
 1151  to be connected with that or any other injury, shall, if
 1152  requested to do so by the insurer against whom the claim has
 1153  been made, permit the insurer or the insurer’s representative to
 1154  conduct an onsite physical review and examination of the
 1155  treatment location, treatment apparatuses, diagnostic devices,
 1156  and any other medical equipment used for the services rendered
 1157  within 10 days after the insurer’s request, and furnish
 1158  forthwith a written report of the history, condition, treatment,
 1159  dates, and costs of such treatment of the injured person and why
 1160  the items identified by the insurer were reasonable in amount
 1161  and medically necessary, together with a sworn statement that
 1162  the treatment or services rendered were reasonable and necessary
 1163  with respect to the bodily injury sustained and identifying
 1164  which portion of the expenses for such treatment or services was
 1165  incurred as a result of such bodily injury, and produce
 1166  forthwith, and permit the inspection and copying of, his or her
 1167  or its records regarding such history, condition, treatment,
 1168  dates, and costs of treatment if; provided that this does shall
 1169  not limit the introduction of evidence at trial. Such sworn
 1170  statement must shall read as follows: “Under penalty of perjury,
 1171  I declare that I have read the foregoing, and the facts alleged
 1172  are true, to the best of my knowledge and belief.” A No cause of
 1173  action for violation of the physician-patient privilege or
 1174  invasion of the right of privacy may not be brought shall be
 1175  permitted against any physician, hospital, clinic, or other
 1176  medical institution complying with the provisions of this
 1177  section. The person requesting such records and such sworn
 1178  statement shall pay all reasonable costs connected therewith.
 1179         1. If an insurer makes a written request for documentation
 1180  or information under this paragraph within 30 days after having
 1181  received notice of the amount of a covered loss under paragraph
 1182  (4)(a), the amount or the partial amount that which is the
 1183  subject of the insurer’s inquiry is shall become overdue if the
 1184  insurer does not pay in accordance with paragraph (4)(b) or
 1185  within 10 days after the insurer’s receipt of the requested
 1186  documentation or information, whichever occurs later. For
 1187  purposes of this subparagraph paragraph, the term “receipt”
 1188  includes, but is not limited to, inspection and copying pursuant
 1189  to this paragraph. An Any insurer that requests documentation or
 1190  information pertaining to reasonableness of charges or medical
 1191  necessity under this paragraph without a reasonable basis for
 1192  such requests as a general business practice is engaging in an
 1193  unfair trade practice under the insurance code.
 1194         2. If an insured seeking to recover benefits pursuant to
 1195  the no-fault law assigns the contractual right to those benefits
 1196  or payment of those benefits to any person or entity, the
 1197  assignee must comply with the terms of the policy. In all
 1198  circumstances, the assignee is obligated to cooperate under the
 1199  policy, which includes, but is not limited to, participating in
 1200  an examination under oath. Examinations under oath may be
 1201  recorded by audio, video, court reporter, or any combination
 1202  thereof. Compliance with this paragraph is a condition precedent
 1203  to recovery of benefits pursuant to the no-fault law.
 1204         a. If an insurer requests an examination under oath of a
 1205  medical provider, the provider must produce the persons having
 1206  the most knowledge of the issues identified by the insurer in
 1207  the request for examination under oath. All claimants must
 1208  produce and provide for inspection all documents requested by
 1209  the insurer which are reasonably obtainable by the claimant.
 1210         b. Before requesting that an assignee participate in an
 1211  examination under oath, the insurer must send a written request
 1212  to the assignee requesting all information that the insurer
 1213  believes is necessary to process the claim, including the
 1214  information contemplated under this subparagraph.
 1215         c. An insurer that, as a general practice, requests
 1216  examinations under oath of an assignee without a reasonable
 1217  basis is engaging in an unfair and deceptive trade practice.
 1219  REPORTS.—
 1220         (b) If requested by the person examined, a party causing an
 1221  examination to be made shall deliver to him or her a copy of
 1222  every written report concerning the examination rendered by an
 1223  examining physician, at least one of which reports must set out
 1224  the examining physician’s findings and conclusions in detail.
 1225  After such request and delivery, the party causing the
 1226  examination to be made is entitled, upon request, to receive
 1227  from the person examined every written report available to him
 1228  or her or his or her representative concerning any examination,
 1229  previously or thereafter made, of the same mental or physical
 1230  condition. By requesting and obtaining a report of the
 1231  examination so ordered, or by taking the deposition of the
 1232  examiner, the person examined waives any privilege he or she may
 1233  have, in relation to the claim for benefits, regarding the
 1234  testimony of every other person who has examined, or may
 1235  thereafter examine, him or her in respect to the same mental or
 1236  physical condition. If a person fails to appear for unreasonably
 1237  refuses to submit to an examination, the personal injury
 1238  protection carrier is not required to pay no longer liable for
 1239  subsequent personal injury protection benefits incurred after
 1240  the date of the first requested examination until the insured
 1241  appears for the examination. Failure to appear for two scheduled
 1242  examinations raises a rebuttable presumption that such failure
 1243  was unreasonable. Submission to an examination is a condition
 1244  precedent to the recovery of benefits.
 1246  FEES.—With respect to any dispute under the provisions of ss.
 1247  627.730-627.7405 between the insured and the insurer under the
 1248  no-fault law, or between an assignee of an insured’s rights and
 1249  the insurer, the provisions of s. 627.428 shall apply, except as
 1250  provided in subsections (11) and (16) (10) and (15).
 1251         (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and
 1252  enter into contracts with preferred licensed health care
 1253  providers for the benefits described in this section, referred
 1254  to in this section as “preferred providers,” which include shall
 1255  include health care providers licensed under chapter 457,
 1256  chapter chapters 458, chapter 459, chapter 460, chapter 461, or
 1257  chapter and 463.
 1258         (a) The insurer may provide an option to an insured to use
 1259  a preferred provider at the time of purchase of the policy for
 1260  personal injury protection benefits, if the requirements of this
 1261  subsection are met. However, if the insurer offers a preferred
 1262  provider option, it must also offer a nonpreferred provider
 1263  policy. If the insured elects to use a provider who is not a
 1264  preferred provider, whether the insured purchased a preferred
 1265  provider policy or a nonpreferred provider policy, the medical
 1266  benefits provided by the insurer shall be as required by this
 1267  section.
 1268         (b) If the insured elects the to use a provider who is a
 1269  preferred provider option, the insurer may pay medical benefits
 1270  in excess of the benefits required by this section and may waive
 1271  or lower the amount of any deductible that applies to such
 1272  medical benefits. As an alternative, or in addition to such
 1273  benefits, waiver, or reduction, the insurer may provide an
 1274  actuarially appropriate premium discount as specified in an
 1275  approved rate filing to an insured who selects the preferred
 1276  provider option. If the preferred provider option provides a
 1277  premium discount, the policy may provide that charges for
 1278  nonemergency services provided within this state are payable
 1279  only if performed by members of the preferred provider network
 1280  unless there is no member of the preferred provider network
 1281  located within 15 miles of the insured’s place of residence
 1282  whose scope of practice includes the required services, or
 1283  unless the nonemergency services are rendered in the emergency
 1284  room of a hospital licensed under chapter 395. If the insurer
 1285  offers a preferred provider policy to a policyholder or
 1286  applicant, it must also offer a nonpreferred provider policy.
 1287         (c) The insurer shall provide each insured policyholder
 1288  with a current roster of preferred providers in the county in
 1289  which the insured resides at the time of purchasing purchase of
 1290  such policy, and shall make such list available for public
 1291  inspection during regular business hours at the insurer’s
 1292  principal office of the insurer within the state. The insurer
 1293  may contract with a health insurer for the right to use an
 1294  existing preferred provider network to implement the preferred
 1295  provider option. Any other arrangement is subject to the
 1296  approval of the Office of Insurance Regulation.
 1297         (11)(10) DEMAND LETTER.—
 1298         (a) As a condition precedent to filing any action for
 1299  benefits under this section, the claimant filing suit must
 1300  provide the insurer must be provided with written notice of an
 1301  intent to initiate litigation. Such notice may not be sent until
 1302  the claim is overdue, including any additional time the insurer
 1303  has to pay the claim pursuant to paragraph (4)(b). A premature
 1304  demand letter is defective and cannot be cured unless the court
 1305  first abates the action or the claimant first voluntarily
 1306  dismisses the action.
 1307         (b) The notice required notice must shall state that it is
 1308  a “demand letter under s. 627.736(10)” and shall state with
 1309  specificity:
 1310         1. The name of the insured upon which such benefits are
 1311  being sought, including a copy of the assignment giving rights
 1312  to the claimant if the claimant is not the insured.
 1313         2. The claim number or policy number upon which such claim
 1314  was originally submitted to the insurer.
 1315         3. To the extent applicable, the name of any medical
 1316  provider who rendered to an insured the treatment, services,
 1317  accommodations, or supplies that form the basis of such claim;
 1318  and an itemized statement specifying each exact amount, the date
 1319  of treatment, service, or accommodation, and the type of benefit
 1320  claimed to be due. A completed form satisfying the requirements
 1321  of paragraph (6)(5)(d) or the lost-wage statement previously
 1322  submitted may be used as the itemized statement. To the extent
 1323  that the demand involves an insurer’s withdrawal of payment
 1324  under paragraph (7)(a) for future treatment not yet rendered,
 1325  the claimant shall attach a copy of the insurer’s notice
 1326  withdrawing such payment and an itemized statement of the type,
 1327  frequency, and duration of future treatment claimed to be
 1328  reasonable and medically necessary.
 1329         (c) Each notice required by this subsection must be
 1330  delivered to the insurer by United States certified or
 1331  registered mail, return receipt requested. Such postal costs
 1332  shall be reimbursed by the insurer if so requested by the
 1333  claimant in the notice, when the insurer pays the claim. Such
 1334  notice must be sent to the person and address specified by the
 1335  insurer for the purposes of receiving notices under this
 1336  subsection. Each licensed insurer, whether domestic, foreign, or
 1337  alien, shall file with the office designation of the name and
 1338  address of the person to whom notices must pursuant to this
 1339  subsection shall be sent which the office shall make available
 1340  on its Internet website. The name and address on file with the
 1341  office pursuant to s. 624.422 shall be deemed the authorized
 1342  representative to accept notice pursuant to this subsection if
 1343  in the event no other designation has been made.
 1344         (d) If, within 30 days after receipt of notice by the
 1345  insurer, the overdue claim specified in the notice is paid by
 1346  the insurer together with applicable interest and a penalty of
 1347  10 percent of the overdue amount paid by the insurer, subject to
 1348  a maximum penalty of $250, no action may be brought against the
 1349  insurer. If the demand involves an insurer’s withdrawal of
 1350  payment under paragraph (7)(a) for future treatment not yet
 1351  rendered, no action may be brought against the insurer if,
 1352  within 30 days after its receipt of the notice, the insurer
 1353  mails to the person filing the notice a written statement of the
 1354  insurer’s agreement to pay for such treatment in accordance with
 1355  the notice and to pay a penalty of 10 percent, subject to a
 1356  maximum penalty of $250, when it pays for such future treatment
 1357  in accordance with the requirements of this section. To the
 1358  extent the insurer determines not to pay any amount demanded,
 1359  the penalty is shall not be payable in any subsequent action.
 1360  For purposes of this subsection, payment or the insurer’s
 1361  agreement is shall be treated as being made on the date a draft
 1362  or other valid instrument that is equivalent to payment, or the
 1363  insurer’s written statement of agreement, is placed in the
 1364  United States mail in a properly addressed, postpaid envelope,
 1365  or if not so posted, on the date of delivery. The insurer is not
 1366  obligated to pay any attorney’s fees if the insurer pays the
 1367  claim or mails its agreement to pay for future treatment within
 1368  the time prescribed by this subsection.
 1369         (e) The applicable statute of limitation for an action
 1370  under this section shall be tolled for a period of 30 business
 1371  days by the mailing of the notice required by this subsection.
 1372         (f)A demand letter that does not meet the minimum
 1373  requirements set forth in this subsection or that is sent during
 1374  the pendency of the lawsuit is defective. A defective demand
 1375  letter cannot be cured unless the court first abates the action
 1376  or the claimant first voluntarily dismisses the action.
 1377         (g)(f)An Any insurer making a general business practice of
 1378  not paying valid claims until receipt of the notice required by
 1379  this subsection is engaging in an unfair trade practice under
 1380  the insurance code.
 1381         (h) If the insurer pays in response to a demand letter and
 1382  the claimant disputes the amount paid, the claimant must send a
 1383  second demand letter by certified or registered mail stating the
 1384  exact amount that the claimant believes the insurer owes and why
 1385  the claimant believes the amount paid is incorrect. The insurer
 1386  has an additional 10 days after receipt of the second letter to
 1387  issue any additional payment that is owed. The purpose of this
 1388  provision is to avoid unnecessary litigation over miscalculated
 1389  payments.
 1390         (i) Demand letters may not be used to request the
 1391  production of claim documents or other records from the insurer.
 1392         Section 10. Paragraph (c) of subsection (7), and
 1393  subsections (10) through (12) of section 817.234, Florida
 1394  Statutes, are amended to read:
 1395         817.234 False and fraudulent insurance claims.—
 1396         (7)
 1397         (c) An insurer, or any person acting at the direction of or
 1398  on behalf of an insurer, may not change an opinion in a mental
 1399  or physical report prepared under s. 627.736(8) 627.736(7) or
 1400  direct the physician preparing the report to change such
 1401  opinion; however, this provision does not preclude the insurer
 1402  from calling to the attention of the physician errors of fact in
 1403  the report based upon information in the claim file. Any person
 1404  who violates this paragraph commits a felony of the third
 1405  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1406  775.084.
 1407         (10) As used in this section, the term “insurer” means any
 1408  insurer, health maintenance organization, self-insurer, self
 1409  insurance fund, or other similar entity or person regulated
 1410  under chapter 440 or chapter 641 or by the Office of Insurance
 1411  Regulation under the Florida Insurance Code.
 1412         (10)(11) If the value of any property involved in a
 1413  violation of this section:
 1414         (a) Is less than $20,000, the offender commits a felony of
 1415  the third degree, punishable as provided in s. 775.082, s.
 1416  775.083, or s. 775.084.
 1417         (b) Is $20,000 or more, but less than $100,000, the
 1418  offender commits a felony of the second degree, punishable as
 1419  provided in s. 775.082, s. 775.083, or s. 775.084.
 1420         (c) Is $100,000 or more, the offender commits a felony of
 1421  the first degree, punishable as provided in s. 775.082, s.
 1422  775.083, or s. 775.084.
 1423         (11) In addition to any criminal liability, a person
 1424  convicted of violating any provision of this section for the
 1425  purpose of receiving insurance proceeds from a motor vehicle
 1426  insurance contract is subject to a civil penalty.
 1427         (a) Except for a violation of subsection (9), the civil
 1428  penalty shall be:
 1429         1. A fine up to $5,000 for a first offense.
 1430         2. A fine greater than $5,000, but not to exceed $10,000,
 1431  for a second offense.
 1432         3. A fine greater than $10,000, but not to exceed $15,000,
 1433  for a third or subsequent offense.
 1434         (b) The civil penalty for a violation of subsection (9)
 1435  must be at least $15,000, but may not exceed $50,000.
 1436         (c) The civil penalty shall be paid to the Insurance
 1437  Regulatory Trust Fund within the Department of Financial
 1438  Services and used by the department for the investigation and
 1439  prosecution of insurance fraud.
 1440         (d) This subsection does not prohibit a state attorney from
 1441  entering into a written agreement in which the person charged
 1442  with the violation does not admit to or deny the charges but
 1443  consents to payment of the civil penalty.
 1444         (12) As used in this section, the term:
 1445         (a) “Insurer” means any insurer, health maintenance
 1446  organization, self-insurer, self-insurance fund, or similar
 1447  entity or person regulated under chapter 440 or chapter 641 or
 1448  by the Office of Insurance Regulation under the Florida
 1449  Insurance Code.
 1450         (b)(a) “Property” means property as defined in s. 812.012.
 1451         (c)(b) “Value” has the same meaning means value as defined
 1452  in s. 812.012.
 1453         Section 11. Subsection (1) of section 324.021, Florida
 1454  Statutes, is amended to read:
 1455         324.021 Definitions; minimum insurance required.—The
 1456  following words and phrases when used in this chapter shall, for
 1457  the purpose of this chapter, have the meanings respectively
 1458  ascribed to them in this section, except in those instances
 1459  where the context clearly indicates a different meaning:
 1460         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1461  is designed and required to be licensed for use upon a highway,
 1462  including trailers and semitrailers designed for use with such
 1463  vehicles, except traction engines, road rollers, farm tractors,
 1464  power shovels, and well drillers, and every vehicle that which
 1465  is propelled by electric power obtained from overhead wires but
 1466  not operated upon rails, but not including any bicycle or moped.
 1467  However, the term does “motor vehicle” shall not include a any
 1468  motor vehicle as defined in s. 627.732(3) if when the owner of
 1469  such vehicle has complied with the no-fault law requirements of
 1470  ss. 627.730-627.7405, inclusive, unless the provisions of s.
 1471  324.051 apply; and, in such case, the applicable proof of
 1472  insurance provisions of s. 320.02 apply.
 1473         Section 12. Paragraph (k) of subsection (2) of section
 1474  456.057, Florida Statutes, is amended to read:
 1475         456.057 Ownership and control of patient records; report or
 1476  copies of records to be furnished.—
 1477         (2) As used in this section, the terms “records owner,”
 1478  “health care practitioner,” and “health care practitioner’s
 1479  employer” do not include any of the following persons or
 1480  entities; furthermore, the following persons or entities are not
 1481  authorized to acquire or own medical records, but are authorized
 1482  under the confidentiality and disclosure requirements of this
 1483  section to maintain those documents required by the part or
 1484  chapter under which they are licensed or regulated:
 1485         (k) Persons or entities practicing under s. 627.736(8)
 1486  627.736(7).
 1487         Section 13. Paragraph (b) of subsection (1) of section
 1488  627.7401, Florida Statutes, is amended to read:
 1489         627.7401 Notification of insured’s rights.—
 1490         (1) The commission, by rule, shall adopt a form for the
 1491  notification of insureds of their right to receive personal
 1492  injury protection benefits under the Florida Motor Vehicle no
 1493  fault law. Such notice shall include:
 1494         (b) An advisory informing insureds that:
 1495         1. Pursuant to s. 626.9892, the Department of Financial
 1496  Services may pay rewards of up to $25,000 to persons providing
 1497  information leading to the arrest and conviction of persons
 1498  committing crimes investigated by the Division of Insurance
 1499  Fraud arising from violations of s. 440.105, s. 624.15, s.
 1500  626.9541, s. 626.989, or s. 817.234.
 1501         2. Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
 1502  insured notifies the insurer of a billing error, the insured may
 1503  be entitled to a certain percentage of a reduction in the amount
 1504  paid by the insured’s motor vehicle insurer.
 1505         Section 14. This act shall take effect July 1, 2011.
 1507  ================= T I T L E  A M E N D M E N T ================
 1508         And the title is amended as follows:
 1509         Delete lines 34 - 39
 1510  and insert:
 1511         Delete everything before the enacting clause
 1512  and insert:
 1513                        A bill to be entitled                      
 1514         An act relating to motor vehicle personal injury
 1515         protection insurance; amending s. 316.066, F.S.;
 1516         revising provisions relating to the contents of
 1517         written reports of motor vehicle crashes; requiring
 1518         short-form crash reports by a law enforcement officer
 1519         to be maintained by the officer’s agency; authorizing
 1520         the investigation officer to testify at trial or
 1521         provide an affidavit concerning the content of the
 1522         reports; amending s. 400.991, F.S.; requiring that an
 1523         application for licensure as a mobile clinic include a
 1524         statement regarding insurance fraud; creating s.
 1525         626.9894, F.S.; providing definitions; authorizing the
 1526         Division of Insurance Fraud to establish a direct
 1527         support organization for the purpose of prosecuting,
 1528         investigating, and preventing motor vehicle insurance
 1529         fraud; providing requirements for the organization and
 1530         the organization’s contract with the division;
 1531         providing for a board of directors; authorizing the
 1532         organization to use the division’s property and
 1533         facilities subject to certain requirements;
 1534         authorizing contributions from insurers; providing
 1535         that any moneys received by the organization may be
 1536         held in a separate depository account in the name of
 1537         the organization; requiring the division to deposit
 1538         certain proceeds into the Insurance Regulatory Trust
 1539         Fund; amending s. 627.4137, F.S.; requiring a
 1540         claimant’s request about insurance coverage to be
 1541         appropriately served upon the disclosing entity;
 1542         amending s. 627.730, F.S.; conforming a cross
 1543         reference; amending s. 627.731, F.S.; providing
 1544         legislative intent with respect to the Florida Motor
 1545         Vehicle No-Fault Law; creating s. 627.7311, F.S.;
 1546         requiring the provisions, schedules, and procedures of
 1547         the no-fault law to be implemented by insurers
 1548         regardless of whether they are expressly stated in the
 1549         policy; amending s. 627.732, F.S.; defining the terms
 1550         “claimant” and “no-fault law”; amending s. 627.736,
 1551         F.S.; conforming a cross-reference; adding
 1552         acupuncturists to the list of authorized
 1553         practitioners; requiring certain entities providing
 1554         medical services to document that they meet required
 1555         criteria; revising requirements relating to the form
 1556         that must be submitted by providers; requiring an
 1557         entity or clinic to file a new form within a specified
 1558         period after the date of a change of ownership;
 1559         revising provisions relating to when payment for a
 1560         benefit is due; providing that an insurer’s failure to
 1561         send certain specification or explanation does not
 1562         waive other grounds for rejecting an invalid claim;
 1563         authorizing an insurer to obtain evidence and assert
 1564         any ground for adjusting or rejecting a claim;
 1565         providing that the time period for paying a claim is
 1566         tolled during the investigation of a fraudulent
 1567         insurance act; specifying when benefits are not
 1568         payable; preempting local lien laws with respect to
 1569         payment of benefits to medical providers; providing
 1570         that a claimant that violates certain provisions is
 1571         not entitled to any payment, regardless of whether a
 1572         portion of the claim may be legitimate; authorizing an
 1573         insurer to recover payments and bring a cause of
 1574         action to recover payments; providing that an insurer
 1575         may deny any claim based on other evidence of fraud;
 1576         forbidding a physician, hospital, clinic, or other
 1577         medical institution that fails to comply with certain
 1578         provisions from billing the injured person or the
 1579         insured; providing that an insurer has a right to
 1580         conduct reasonable investigations of claims;
 1581         authorizing an insurer to require a claimant to
 1582         provide certain records; requiring a records review to
 1583         be conducted by the same type of practitioner as the
 1584         medical provider whose records are being reviewed or
 1585         by a physician; specifying when the period for payment
 1586         is tolled; authorizing an insurer to deny benefits if
 1587         an insured, claimant, or medical provider fails to
 1588         comply with certain provisions; forbidding the
 1589         claimant from filing suit unless the claimant complies
 1590         with the act; revising the insurer’s reimbursement
 1591         limitation; providing a limit on the amount of
 1592         reimbursement; creating a rebuttable presumption that
 1593         the insured did not receive the alleged treatment if
 1594         the insured does not countersign the patient log;
 1595         authorizing the insurer to deny a claim if the
 1596         provider does not properly complete the required form
 1597         within a certain time; requiring the provider to
 1598         ensure that the insured understands the services being
 1599         provided; specifying requirements for furnishing the
 1600         insured with notice of the amount of covered loss;
 1601         deleting an obsolete provision; requiring the provider
 1602         to provide copies of the patient log within a certain
 1603         time if requested by the insurer; providing that
 1604         failure to maintain a patient log renders the
 1605         treatment unlawful and noncompensable; revising
 1606         requirements relating to discovery; authorizing the
 1607         insurer to conduct a physical review of the treatment
 1608         location; requiring the insured and assignee to comply
 1609         with certain provisions to recover benefits; requiring
 1610         the provider to produce persons having the most
 1611         knowledge in specified circumstances; requiring the
 1612         insurer to request certain information before
 1613         requesting an assignee to participate in an
 1614         examination under oath; providing that an insurer that
 1615         requests an examination under oath without a
 1616         reasonable basis is engaging in an unfair and
 1617         deceptive trade practice; providing that failure to
 1618         appear for scheduled examinations establishes a
 1619         rebuttable presumption that such failure was
 1620         unreasonable; authorizing an insurer to contract with
 1621         a preferred provider network; authorizing an insurer
 1622         to provide a premium discount to an insured who
 1623         selects a preferred provider; authorizing an insurance
 1624         policy to not pay for nonemergency services performed
 1625         by a nonpreferred provider in specified circumstances;
 1626         authorizing an insurer to contract with a health
 1627         insurer in specified circumstances; revising
 1628         requirements relating to demand letters in an action
 1629         for benefits; specifying when a demand letter is
 1630         defective; requiring a second demand letter under
 1631         certain circumstances; deleting obsolete provisions;
 1632         providing that a demand letter may not be used to
 1633         request the production of claim documents or records
 1634         from the insurer; amending s. 817.234, F.S.;
 1635         conforming a cross-reference; providing civil
 1636         penalties for fraudulent insurance claims; amending
 1637         ss. 324.021, 456.057, and 627.7401, F.S.; conforming
 1638         cross-references; providing an effective date.