Florida Senate - 2011                             CS for SB 1930
       By the Committee on Banking and Insurance; and Senator Bogdanoff
       597-04386-11                                          20111930c1
    1                        A bill to be entitled                      
    2         An act relating to motor vehicle personal injury
    3         protection insurance; amending s. 316.066, F.S.;
    4         revising provisions relating to the contents of
    5         written reports of motor vehicle crashes; requiring
    6         short-form crash reports by a law enforcement officer
    7         to be maintained by the officer’s agency; authorizing
    8         the investigation officer to testify at trial or
    9         provide an affidavit concerning the content of the
   10         reports; amending s. 400.991, F.S.; requiring that an
   11         application for licensure as a mobile clinic include a
   12         statement regarding insurance fraud; creating s.
   13         626.9894, F.S.; providing definitions; authorizing the
   14         Division of Insurance Fraud to establish a direct
   15         support organization for the purpose of prosecuting,
   16         investigating, and preventing motor vehicle insurance
   17         fraud; providing requirements for the organization and
   18         the organization’s contract with the division;
   19         providing for a board of directors; authorizing the
   20         organization to use the division’s property and
   21         facilities subject to certain requirements;
   22         authorizing contributions from insurers; providing
   23         that any moneys received by the organization may be
   24         held in a separate depository account in the name of
   25         the organization; requiring the division to deposit
   26         certain proceeds into the Insurance Regulatory Trust
   27         Fund; amending s. 627.4137, F.S.; requiring a
   28         claimant’s request about insurance coverage to be
   29         appropriately served upon the disclosing entity;
   30         amending s. 627.730, F.S.; conforming a cross
   31         reference; amending s. 627.731, F.S.; providing
   32         legislative intent with respect to the Florida Motor
   33         Vehicle No-Fault Law; amending s. 627.732, F.S.;
   34         defining the terms “claimant,” “entity wholly owned,”
   35         and “no-fault law”; amending s. 627.736, F.S.;
   36         conforming a cross-reference; adding licensed
   37         acupuncturists to the list of practitioners authorized
   38         to provide, supervise, order, or prescribe services;
   39         requiring certain entities providing medical services
   40         to document that they meet required criteria; revising
   41         requirements relating to the form that must be
   42         submitted by providers; requiring an entity or clinic
   43         to file a new form within a specified period after the
   44         date of a change of ownership; revising provisions
   45         relating to when payment for a benefit is due;
   46         providing that an insurer’s failure to send certain
   47         specification or explanation does not waive other
   48         grounds for rejecting an invalid claim; authorizing an
   49         insurer to obtain evidence and assert any ground for
   50         adjusting or rejecting a claim; providing that the
   51         time period for paying a claim is tolled during the
   52         investigation of a fraudulent insurance act;
   53         specifying when benefits are not payable; preempting
   54         local lien laws with respect to payment of benefits to
   55         medical providers; providing that a claimant that
   56         violates certain provisions is not entitled to any
   57         payment, regardless of whether a portion of the claim
   58         may be legitimate; authorizing an insurer to recover
   59         payments and bring a cause of action to recover
   60         payments; providing that an insurer may deny any claim
   61         based on other evidence of fraud; forbidding a
   62         physician, hospital, clinic, or other medical
   63         institution that fails to comply with certain
   64         provisions from billing the injured person or the
   65         insured; providing that an insurer has a right to
   66         conduct reasonable investigations of claims;
   67         authorizing an insurer to require a claimant to
   68         provide certain records; requiring a records review to
   69         be conducted by the same type of practitioner as the
   70         medical provider whose records are being reviewed;
   71         specifying when the period for payment is tolled;
   72         authorizing an insurer to deny benefits if an insured,
   73         claimant, or medical provider fails to comply with
   74         certain provisions; revising the insurer’s
   75         reimbursement limitation; providing a limit on the
   76         amount of reimbursement if the insurance policy
   77         includes a schedule of charges; creating a rebuttable
   78         presumption that the insured did not receive the
   79         alleged treatment if the insured does not countersign
   80         the patient log; authorizing the insurer to deny a
   81         claim if the provider does not submit a properly
   82         completed statement or bill within a certain time;
   83         specifying requirements for furnishing the insured
   84         with notice of the amount of covered loss; deleting an
   85         obsolete provision; requiring the provider to provide
   86         copies of the patient log within a certain time if
   87         requested by the insurer; providing that failure to
   88         maintain a patient log renders the treatment unlawful
   89         and noncompensable; revising requirements relating to
   90         discovery; authorizing the insurer to conduct a
   91         physical review of the treatment location; requiring
   92         the insured and assignee to comply with certain
   93         provisions to recover benefits; requiring the provider
   94         to produce persons having the most knowledge in
   95         specified circumstances; requiring the insurer to pay
   96         reasonable compensation to the provider for attending
   97         the examination; requiring the insurer to request
   98         certain information before requesting an assignee to
   99         participate in an examination under oath; providing
  100         that an insurer that requests an examination under
  101         oath without a reasonable basis is engaging in an
  102         unfair and deceptive trade practice; providing that
  103         failure to appear for scheduled examinations
  104         establishes a rebuttable presumption that such failure
  105         was unreasonable; authorizing an insurer to contract
  106         with a preferred provider network; authorizing an
  107         insurer to provide a premium discount to an insured
  108         who selects a preferred provider; authorizing an
  109         insurance policy to not pay for nonemergency services
  110         performed by a nonpreferred provider in specified
  111         circumstances; authorizing an insurer to use a
  112         preferred provider network; revising requirements
  113         relating to demand letters in an action for benefits;
  114         specifying when a demand letter is defective;
  115         requiring a second demand letter under certain
  116         circumstances; deleting obsolete provisions; providing
  117         that a demand letter may not be used to request the
  118         production of claim documents or records from the
  119         insurer; amending s. 817.234, F.S.; providing that
  120         persons and business entities found guilty of
  121         insurance fraud lose their occupational and
  122         practitioner licenses for a certain period; providing
  123         civil penalties for fraudulent insurance claims;
  124         amending ss. 324.021, 456.057, and 627.7401, F.S.;
  125         conforming cross-references; providing an effective
  126         date.
  128  Be It Enacted by the Legislature of the State of Florida:
  130         Section 1. Subsection (1) of section 316.066, Florida
  131  Statutes, is amended to read:
  132         316.066 Written reports of crashes.—
  133         (1)(a) A Florida Traffic Crash Report, Long Form, must is
  134  required to be completed and submitted to the department within
  135  10 days after completing an investigation is completed by the
  136  every law enforcement officer who in the regular course of duty
  137  investigates a motor vehicle crash:
  138         1. That resulted in death, or personal injury, or any
  139  indication of complaints of pain or discomfort by any of the
  140  parties or passengers involved in the crash;.
  141         2. That involved one or more passengers, other than the
  142  drivers of the vehicles, in any of the vehicles involved in the
  143  crash;
  144         3.2. That involved a violation of s. 316.061(1) or s.
  145  316.193; or.
  146         4.3. In which a vehicle was rendered inoperative to a
  147  degree that required a wrecker to remove it from traffic, if
  148  such action is appropriate, in the officer’s discretion.
  149         (b) In every crash for which a Florida Traffic Crash
  150  Report, Long Form, is not required by this section, the law
  151  enforcement officer may complete a short-form crash report or
  152  provide a short-form crash report to be completed by each party
  153  involved in the crash. Short-form crash reports prepared by the
  154  law enforcement officer shall be maintained by the officer’s
  155  agency.
  156         (c) The long-form and the short-form report must include:
  157         1. The date, time, and location of the crash.
  158         2. A description of the vehicles involved.
  159         3. The names and addresses of the parties involved.
  160         4. The names and addresses of all passengers in all
  161  vehicles involved in the crash, each clearly identified as being
  162  a passenger and the identification of the vehicle in which they
  163  were a passenger.
  164         5.4. The names and addresses of witnesses.
  165         6.5. The name, badge number, and law enforcement agency of
  166  the officer investigating the crash.
  167         7.6. The names of the insurance companies for the
  168  respective parties involved in the crash.
  169         (d)(c) Each party to the crash must shall provide the law
  170  enforcement officer with proof of insurance, which must to be
  171  included in the crash report. If a law enforcement officer
  172  submits a report on the accident, proof of insurance must be
  173  provided to the officer by each party involved in the crash. Any
  174  party who fails to provide the required information commits a
  175  noncriminal traffic infraction, punishable as a nonmoving
  176  violation as provided in chapter 318, unless the officer
  177  determines that due to injuries or other special circumstances
  178  such insurance information cannot be provided immediately. If
  179  the person provides the law enforcement agency, within 24 hours
  180  after the crash, proof of insurance that was valid at the time
  181  of the crash, the law enforcement agency may void the citation.
  182         (e)(d) The driver of a vehicle that was in any manner
  183  involved in a crash resulting in damage to any vehicle or other
  184  property in an amount of $500 or more, which crash was not
  185  investigated by a law enforcement agency, shall, within 10 days
  186  after the crash, submit a written report of the crash to the
  187  department or traffic records center. The entity receiving the
  188  report may require witnesses of the crash crashes to render
  189  reports and may require any driver of a vehicle involved in a
  190  crash of which a written report must be made as provided in this
  191  section to file supplemental written reports if whenever the
  192  original report is deemed insufficient by the receiving entity.
  193         (f) The investigating law enforcement officer may testify
  194  at trial or provide a signed affidavit to confirm or supplement
  195  the information included on the long-form or short-form report.
  196         (e) Short-form crash reports prepared by law enforcement
  197  shall be maintained by the law enforcement officer’s agency.
  198         Section 2. Subsection (6) is added to section 400.991,
  199  Florida Statutes, to read:
  200         400.991 License requirements; background screenings;
  201  prohibitions.—
  202         (6) All forms that constitute part of the application for
  203  licensure or exemption from licensure under this part must
  204  contain the following statement:
  206         INSURANCE FRAUD NOTICE.—Submitting a false,
  207         misleading, or fraudulent application or other
  208         document when applying for licensure as a health care
  209         clinic, when seeking an exemption from licensure as a
  210         health care clinic, or when demonstrating compliance
  211         with part X of chapter 400, Florida Statutes, is a
  212         fraudulent insurance act, as defined in s. 626.989 or
  213         s. 817.234, Florida Statutes, subject to investigation
  214         by the Division of Insurance Fraud, and is grounds for
  215         discipline by the appropriate licensing board of the
  216         Florida Department of Health.
  217         Section 3. Section 626.9894, Florida Statutes, is created
  218  to read:
  219         626.9894Motor vehicle insurance fraud direct-support
  220  organization.—
  221         (1) DEFINITIONS.—As used in this section, the term:
  222         (a) “Division” means the Division of Insurance Fraud of the
  223  Department of Financial Services.
  224         (b) “Motor vehicle insurance fraud” means any act defined
  225  as a “fraudulent insurance act” under s. 626.989, which relates
  226  to the coverage of motor vehicle insurance as described in part
  227  XI of chapter 627.
  228         (c) “Organization” means the direct-support organization
  229  established under this section.
  230         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  231  direct-support organization, to be known as the “Automobile
  232  Insurance Fraud Strike Force,” whose sole purpose is to support
  233  the prosecution, investigation, and prevention of motor vehicle
  234  insurance fraud. The organization shall:
  235         (a) Be a not-for-profit corporation incorporated under
  236  chapter 617 and approved by the Department of State.
  237         (b) Be organized and operated to conduct programs and
  238  activities; to raise funds; to request and receive grants,
  239  gifts, and bequests of money; to acquire, receive, hold, invest,
  240  and administer, in its own name, securities, funds, objects of
  241  value, or other property, real or personal; and to make grants
  242  and expenditures to or for the direct or indirect benefit of the
  243  division, state attorneys’ offices, the statewide prosecutor,
  244  the Agency for Health Care Administration, and the Department of
  245  Health to the extent that such grants and expenditures are to be
  246  used exclusively to advance the purpose of prosecuting,
  247  investigating, or preventing motor vehicle insurance fraud.
  248  Grants and expenditures may include the cost of salaries or
  249  benefits of dedicated motor vehicle insurance fraud
  250  investigators, prosecutors, or support personnel if such grants
  251  and expenditures do not interfere with prosecutorial
  252  independence or otherwise create conflicts of interest which
  253  threaten the success of prosecutions.
  254         (c) Be determined by the division to operate in a manner
  255  that promotes the goals of laws relating to motor vehicle
  256  insurance fraud, that is in the best interest of the state, and
  257  that is in accordance with the adopted goals and mission of the
  258  division.
  259         (d) Use all of its grants and expenditures solely for the
  260  purpose of preventing and decreasing motor vehicle insurance
  261  fraud, and not for the purpose of lobbying as defined in s.
  262  11.045.
  263         (e) Be subject to an annual financial audit in accordance
  264  with s. 215.981.
  265         (3) CONTRACT.—The organization shall operate under written
  266  contract with the division. The contract must provide for:
  267         (a) Approval of the articles of incorporation and bylaws of
  268  the organization by the division.
  269         (b) Submission of an annual budget for the approval of the
  270  division. The budget must require the organization to minimize
  271  costs to the division and its members at all times by using
  272  existing personnel and property and allowing for telephonic
  273  meetings when appropriate.
  274         (c) Certification by the division that the direct-support
  275  organization is complying with the terms of the contract and in
  276  a manner consistent with the goals and purposes of the
  277  department and in the best interest of the state. Such
  278  certification must be made annually and reported in the official
  279  minutes of a meeting of the organization.
  280         (d) Allocation of funds to address motor vehicle insurance
  281  fraud.
  282         (e) Reversion of moneys and property held in trust by the
  283  organization for motor vehicle insurance fraud prosecution,
  284  investigation, and prevention to the division if the
  285  organization is no longer approved to operate for the department
  286  or if the organization ceases to exist, or to the state if the
  287  division ceases to exist.
  288         (f) Specific criteria to be used by the organization’s
  289  board of directors to evaluate the effectiveness of funding used
  290  to combat motor vehicle insurance fraud.
  291         (g) The fiscal year of the organization, which begins July
  292  1 of each year and ends June 30 of the following year.
  293         (h) Disclosure of the material provisions of the contract,
  294  and distinguishing between the department and the organization
  295  to donors of gifts, contributions, or bequests, including
  296  providing such disclosure on all promotional and fundraising
  297  publications.
  298         (4) BOARD OF DIRECTORS.—The board of directors of the
  299  organization shall consist of the following seven members:
  300         (a) The Chief Financial Officer, or designee, who shall
  301  serve as chair.
  302         (b) Two state attorneys, one of whom shall be appointed by
  303  the Chief Financial Officer and one of whom shall be appointed
  304  by the Attorney General.
  305         (c) Two representatives of motor vehicle insurers appointed
  306  by the Chief Financial Officer.
  307         (d) Two representatives of local law enforcement agencies,
  308  both of whom shall be appointed by the Chief Financial Officer.
  310  The officer who appointed a member of the board may remove that
  311  member for cause. The term of office of an appointed member
  312  expires at the same time as the term of the officer who
  313  appointed him or her or at such earlier time as the person
  314  ceases to be qualified.
  315         (5) USE OF PROPERTY.—The department may authorize, without
  316  charge, appropriate use of fixed property and facilities of the
  317  division by the organization, subject to this subsection.
  318         (a) The department may prescribe any condition with which
  319  the organization must comply in order to use the division’s
  320  property or facilities.
  321         (b) The department may not authorize the use of the
  322  division’s property or facilities if the organization does not
  323  provide equal membership and employment opportunities to all
  324  persons regardless of race, religion, sex, age, or national
  325  origin.
  326         (c) The department shall adopt rules prescribing the
  327  procedures by which the organization is governed and any
  328  conditions with which the organization must comply to use the
  329  division’s property or facilities.
  330         (6) CONTRIBUTIONS.—Any contributions made by an insurer to
  331  the organization shall be allowed as appropriate business
  332  expenses for all regulatory purposes.
  333         (7) DEPOSITORY.—Any moneys received by the organization may
  334  be held in a separate depository account in the name of the
  335  organization and subject to the provisions of the contract with
  336  the division.
  337         (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division
  338  receives proceeds from the organization, those proceeds shall be
  339  deposited into the Insurance Regulatory Trust Fund.
  340         Section 4. Subsection (3) is added to section 627.4137,
  341  Florida Statutes, to read:
  342         627.4137 Disclosure of certain information required.—
  343         (3)Any request made to a self-insured corporation pursuant
  344  to this section shall be sent by certified mail to the
  345  registered agent of the disclosing entity.
  346         Section 5. Section 627.730, Florida Statutes, is amended to
  347  read:
  348         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  349  627.730-627.7407 627.730-627.7405 may be cited and known as the
  350  “Florida Motor Vehicle No-Fault Law.”
  351         Section 6. Section 627.731, Florida Statutes, is amended to
  352  read:
  353         627.731 Purpose; legislative intent.—The purpose of the no
  354  fault law ss. 627.730-627.7405 is to provide for medical,
  355  surgical, funeral, and disability insurance benefits without
  356  regard to fault, and to require motor vehicle insurance securing
  357  such benefits, for motor vehicles required to be registered in
  358  this state and, with respect to motor vehicle accidents, a
  359  limitation on the right to claim damages for pain, suffering,
  360  mental anguish, and inconvenience.
  361         (1) The Legislature finds that automobile insurance fraud
  362  remains a major problem for state consumers and insurers.
  363  According to the National Insurance Crime Bureau, in recent
  364  years this state has been among those states that have the
  365  highest number of fraudulent and questionable claims.
  366         (2) The Legislature intends to balance the insured’s
  367  interest in prompt payment of valid claims for insurance
  368  benefits under the no-fault law with the public’s interest in
  369  reducing fraud, abuse, and overuse of the no-fault system. To
  370  that end, the Legislature intends that the investigation and
  371  prevention of fraudulent insurance acts in this state be
  372  enhanced, that additional sanctions for such acts be imposed,
  373  and that the no-fault law be revised to remove incentives for
  374  fraudulent insurance acts. The Legislature intends that the no
  375  fault law be construed according to the plain language of the
  376  statutory provisions, which are designed to meet these goals.
  377         (3) The Legislature intends that:
  378         (a) Insurers properly investigate claims, and as such, be
  379  allowed to obtain examinations under oath and sworn statements
  380  from any claimant seeking no-fault insurance benefits, and to
  381  request mental and physical examinations of persons seeking
  382  personal injury protection coverage or benefits.
  383         (b) Any false, misleading, or otherwise fraudulent activity
  384  associated with a claim renders any claim brought by a claimant
  385  engaging in such activity invalid. An insurer must be able to
  386  raise fraud as a defense to a claim for no-fault insurance
  387  benefits irrespective of any prior adjudication of guilt or
  388  determination of fraud by the Department of Financial Services.
  389         (c) Insurers toll the payment or denial of a claim, with
  390  respect to any portion of a claim for which the insurer has a
  391  reasonable belief that a fraudulent insurance act, as defined in
  392  s. 626.989, has been committed.
  393         (d) Insurers discover the names of all passengers involved
  394  in an automobile accident before paying claims or benefits
  395  pursuant to an insurance policy governed by the no-fault law. A
  396  rebuttable presumption must be established that a person was not
  397  involved in the event giving rise to the claim if that person’s
  398  name does not appear on the police report.
  399         (e) The insured’s interest in obtaining competent counsel
  400  must be balanced with the public’s interest in preventing a no
  401  fault system that encourages litigation by allowing for
  402  exorbitant attorney’s fees. Courts should limit attorney fee
  403  awards so as to eliminate the incentive for attorneys to
  404  manufacture unnecessary litigation.
  405         Section 7. Section 627.732, Florida Statutes, is reordered
  406  and amended to read:
  407         627.732 Definitions.—As used in the no-fault law ss.
  408  627.730-627.7405, the term:
  409         (1) “Broker” means any person not possessing a license
  410  under chapter 395, chapter 400, chapter 429, chapter 458,
  411  chapter 459, chapter 460, chapter 461, or chapter 641 who
  412  charges or receives compensation for any use of medical
  413  equipment and is not the 100-percent owner or the 100-percent
  414  lessee of such equipment. For purposes of this section, such
  415  owner or lessee may be an individual, a corporation, a
  416  partnership, or any other entity and any of its 100-percent
  417  owned affiliates and subsidiaries. For purposes of this
  418  subsection, the term “lessee” means a long-term lessee under a
  419  capital or operating lease, but does not include a part-time
  420  lessee. The term “broker” does not include a hospital or
  421  physician management company whose medical equipment is
  422  ancillary to the practices managed, a debt collection agency, or
  423  an entity that has contracted with the insurer to obtain a
  424  discounted rate for such services; or nor does the term include
  425  a management company that has contracted to provide general
  426  management services for a licensed physician or health care
  427  facility and whose compensation is not materially affected by
  428  the usage or frequency of usage of medical equipment or an
  429  entity that is 100-percent owned by one or more hospitals or
  430  physicians. The term “broker” does not include a person or
  431  entity that certifies, upon request of an insurer, that:
  432         (a) It is a clinic licensed under ss. 400.990-400.995;
  433         (b) It is a 100-percent owner of medical equipment; and
  434         (c) The owner’s only part-time lease of medical equipment
  435  for personal injury protection patients is on a temporary basis,
  436  not to exceed 30 days in a 12-month period, and such lease is
  437  solely for the purposes of necessary repair or maintenance of
  438  the 100-percent-owned medical equipment or pending the arrival
  439  and installation of the newly purchased or a replacement for the
  440  100-percent-owned medical equipment, or for patients for whom,
  441  because of physical size or claustrophobia, it is determined by
  442  the medical director or clinical director to be medically
  443  necessary that the test be performed in medical equipment that
  444  is open-style. The leased medical equipment may not cannot be
  445  used by patients who are not patients of the registered clinic
  446  for medical treatment of services. Any person or entity making a
  447  false certification under this subsection commits insurance
  448  fraud as defined in s. 817.234. However, the 30-day period
  449  provided in this paragraph may be extended for an additional 60
  450  days as applicable to magnetic resonance imaging equipment if
  451  the owner certifies that the extension otherwise complies with
  452  this paragraph.
  453         (10)(2) “Medically necessary” refers to a medical service
  454  or supply that a prudent physician would provide for the purpose
  455  of preventing, diagnosing, or treating an illness, injury,
  456  disease, or symptom in a manner that is:
  457         (a) In accordance with generally accepted standards of
  458  medical practice;
  459         (b) Clinically appropriate in terms of type, frequency,
  460  extent, site, and duration; and
  461         (c) Not primarily for the convenience of the patient,
  462  physician, or other health care provider.
  463         (11)(3) “Motor vehicle” means a any self-propelled vehicle
  464  with four or more wheels which is of a type both designed and
  465  required to be licensed for use on the highways of this state,
  466  and any trailer or semitrailer designed for use with such
  467  vehicle, and includes:
  468         (a) A “private passenger motor vehicle,” which is any motor
  469  vehicle that which is a sedan, station wagon, or jeep-type
  470  vehicle and, if not used primarily for occupational,
  471  professional, or business purposes, a motor vehicle of the
  472  pickup, panel, van, camper, or motor home type.
  473         (b) A “commercial motor vehicle,” which is any motor
  474  vehicle that which is not a private passenger motor vehicle.
  476  The term “motor vehicle” does not include a mobile home or any
  477  motor vehicle that which is used in mass transit, other than
  478  public school transportation, and designed to transport more
  479  than five passengers exclusive of the operator of the motor
  480  vehicle and that which is owned by a municipality, a transit
  481  authority, or a political subdivision of the state.
  482         (12)(4) “Named insured” means a person, usually the owner
  483  of a vehicle, identified in a policy by name as the insured
  484  under the policy.
  485         (13) “No-fault law” means the Florida Motor Vehicle No
  486  Fault Law codifed at ss. 627.730-627.7407.
  487         (14)(5) “Owner” means a person who holds the legal title to
  488  a motor vehicle; or, if in the event a motor vehicle is the
  489  subject of a security agreement or lease with an option to
  490  purchase with the debtor or lessee having the right to
  491  possession, then the debtor or lessee is shall be deemed the
  492  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  493         (16)(6) “Relative residing in the same household” means a
  494  relative of any degree by blood or by marriage who usually makes
  495  her or his home in the same family unit, whether or not
  496  temporarily living elsewhere.
  497         (2)(7) “Certify” means to swear or attest to being true or
  498  represented in writing.
  499         (3) “Claimant” means the person, organization, or entity
  500  seeking benefits, including all assignees.
  501         (4) “Entity wholly owned” means a proprietorship, group
  502  practice, partnership, or corporation that provides health care
  503  services rendered by licensed health care practitioners. In
  504  order to be wholly owned, licensed health care practitioners
  505  must be the business owners of all aspects of the business
  506  entity, including, but not limited to, being reflected as the
  507  business owners on the title or lease of the physical facility,
  508  filing taxes as the business owners, being account holders on
  509  the entity’s bank account, being listed as the principals on all
  510  incorporation documents required by this state, and having
  511  ultimate authority over all personnel and compensation decisions
  512  relating to the entity.
  513         (6)(8) “Immediate personal supervision,” as it relates to
  514  the performance of medical services by nonphysicians not in a
  515  hospital, means that an individual licensed to perform the
  516  medical service or provide the medical supplies must be present
  517  within the confines of the physical structure where the medical
  518  services are performed or where the medical supplies are
  519  provided such that the licensed individual can respond
  520  immediately to any emergencies if needed.
  521         (7)(9) “Incident,” with respect to services considered as
  522  incident to a physician’s professional service, for a physician
  523  licensed under chapter 458, chapter 459, chapter 460, or chapter
  524  461, if not furnished in a hospital, means such services that
  525  are must be an integral, even if incidental, part of a covered
  526  physician’s service.
  527         (8)(10) “Knowingly” means that a person, with respect to
  528  information, has actual knowledge of the information,; acts in
  529  deliberate ignorance of the truth or falsity of the
  530  information,; or acts in reckless disregard of the information.,
  531  and Proof of specific intent to defraud is not required.
  532         (9)(11) “Lawful” or “lawfully” means in substantial
  533  compliance with all relevant applicable criminal, civil, and
  534  administrative requirements of state and federal law related to
  535  the provision of medical services or treatment.
  536         (5)(12) “Hospital” means a facility that, at the time
  537  services or treatment were rendered, was licensed under chapter
  538  395.
  539         (15)(13) “Properly completed” means providing truthful,
  540  substantially complete, and substantially accurate responses as
  541  to all material elements of to each applicable request for
  542  information or statement by a means that may lawfully be
  543  provided and that complies with this section, or as agreed by
  544  the parties.
  545         (18)(14) “Upcoding” means submitting an action that submits
  546  a billing code that would result in payment greater in amount
  547  than would be paid using a billing code that accurately
  548  describes the services performed. The term does not include an
  549  otherwise lawful bill by a magnetic resonance imaging facility,
  550  which globally combines both technical and professional
  551  components, if the amount of the global bill is not more than
  552  the components if billed separately; however, payment of such a
  553  bill constitutes payment in full for all components of such
  554  service.
  555         (17)(15) “Unbundling” means submitting an action that
  556  submits a billing code that is properly billed under one billing
  557  code, but that has been separated into two or more billing
  558  codes, and would result in payment greater than the in amount
  559  that than would be paid using one billing code.
  560         Section 8. Subsections (1) and (4) of section 627.736,
  561  Florida Statutes, are amended, subsections (5) through (16) of
  562  that section are redesignated as subsections (6) through (17),
  563  respectively, a new subsection (5) is added to that section,
  564  present subsection (5), paragraph (b) of present subsection (6),
  565  paragraph (b) of present subsection (7), and present subsections
  566  (8), (9), and (10) of that section are amended, to read:
  567         627.736 Required personal injury protection benefits;
  568  exclusions; priority; claims.—
  569         (1) REQUIRED BENEFITS.—Every insurance policy complying
  570  with the security requirements of s. 627.733 must shall provide
  571  personal injury protection to the named insured, relatives
  572  residing in the same household, persons operating the insured
  573  motor vehicle, passengers in such motor vehicle, and other
  574  persons struck by such motor vehicle and suffering bodily injury
  575  while not an occupant of a self-propelled vehicle, subject to
  576  the provisions of subsection (2) and paragraph (4)(h) (4)(e), to
  577  a limit of $10,000 for loss sustained by any such person as a
  578  result of bodily injury, sickness, disease, or death arising out
  579  of the ownership, maintenance, or use of a motor vehicle as
  580  follows:
  581         (a) Medical benefits.—Eighty percent of all reasonable
  582  expenses, charged pursuant to subsection (6), for medically
  583  necessary medical, surgical, X-ray, dental, and rehabilitative
  584  services, including prosthetic devices, and for medically
  585  necessary ambulance, hospital, and nursing services. However,
  586  the medical benefits shall provide reimbursement only for such
  587  services and care that are lawfully provided, supervised,
  588  ordered, or prescribed by a physician licensed under chapter 458
  589  or chapter 459, a dentist licensed under chapter 466, or a
  590  chiropractic physician licensed under chapter 460, or an
  591  acupuncturist licensed under chapter 457 exclusively to provide
  592  oriental medicine as defined in s. 457.102, or that are provided
  593  by any of the following persons or entities:
  594         1. A hospital or ambulatory surgical center licensed under
  595  chapter 395.
  596         2. A person or entity licensed under part III of chapter
  597  401 which ss. 401.2101-401.45 that provides emergency
  598  transportation and treatment.
  599         3. An entity wholly owned by one or more physicians
  600  licensed under chapter 458 or chapter 459, chiropractic
  601  physicians licensed under chapter 460, or dentists licensed
  602  under chapter 466 or by such practitioner or practitioners and
  603  the spouse, parent, child, or sibling of such that practitioner
  604  or those practitioners.
  605         4. An entity wholly owned, directly or indirectly, by a
  606  hospital or hospitals.
  607         5. A health care clinic licensed under part X of chapter
  608  400 which ss. 400.990-400.995 that is:
  609         a. Accredited by the Joint Commission on Accreditation of
  610  Healthcare Organizations, the American Osteopathic Association,
  611  the Commission on Accreditation of Rehabilitation Facilities, or
  612  the Accreditation Association for Ambulatory Health Care, Inc.;
  613  or
  614         b. A health care clinic that:
  615         (I) Has a medical director licensed under chapter 458,
  616  chapter 459, or chapter 460;
  617         (II) Has been continuously licensed for more than 3 years
  618  or is a publicly traded corporation that issues securities
  619  traded on an exchange registered with the United States
  620  Securities and Exchange Commission as a national securities
  621  exchange; and
  622         (III) Provides at least four of the following medical
  623  specialties:
  624         (A) General medicine.
  625         (B) Radiography.
  626         (C) Orthopedic medicine.
  627         (D) Physical medicine.
  628         (E) Physical therapy.
  629         (F) Physical rehabilitation.
  630         (G) Prescribing or dispensing outpatient prescription
  631  medication.
  632         (H) Laboratory services.
  634  If any services under this paragraph are provided by an entity
  635  or clinic described in subparagraph 3., subparagraph 4., or
  636  subparagraph 5., the entity or clinic must provide the insurer
  637  at the initial submission of the claim with a form adopted by
  638  the Department of Financial Services which documents that the
  639  entity or clinic meets applicable criteria for such entity or
  640  clinic and includes a sworn statement or affidavit to that
  641  effect. Any change in ownership requires the filing of a new
  642  form within 10 days after the date of the change in ownership.
  643  The Financial Services Commission shall adopt by rule the form
  644  that must be used by an insurer and a health care provider
  645  specified in subparagraph 3., subparagraph 4., or subparagraph
  646  5. to document that the health care provider meets the criteria
  647  of this paragraph, which rule must include a requirement for a
  648  sworn statement or affidavit.
  649         (b) Disability benefits.—Sixty percent of any loss of gross
  650  income and loss of earning capacity per individual from
  651  inability to work proximately caused by the injury sustained by
  652  the injured person, plus all expenses reasonably incurred in
  653  obtaining from others ordinary and necessary services in lieu of
  654  those that, but for the injury, the injured person would have
  655  performed without income for the benefit of his or her
  656  household. All disability benefits payable under this provision
  657  must shall be paid at least not less than every 2 weeks.
  658         (c) Death benefits.—Death benefits equal to the lesser of
  659  $5,000 or the remainder of unused personal injury protection
  660  benefits per individual. The insurer may pay such benefits to
  661  the executor or administrator of the deceased, to any of the
  662  deceased’s relatives by blood, or legal adoption, or connection
  663  by marriage, or to any person appearing to the insurer to be
  664  equitably entitled thereto.
  666  Only insurers writing motor vehicle liability insurance in this
  667  state may provide the required benefits of this section, and no
  668  such insurers may not insurer shall require the purchase of any
  669  other motor vehicle coverage other than the purchase of property
  670  damage liability coverage as required by s. 627.7275 as a
  671  condition for providing such required benefits. Insurers may not
  672  require that property damage liability insurance in an amount
  673  greater than $10,000 be purchased in conjunction with personal
  674  injury protection. Such insurers shall make benefits and
  675  required property damage liability insurance coverage available
  676  through normal marketing channels. An Any insurer writing motor
  677  vehicle liability insurance in this state who fails to comply
  678  with such availability requirement as a general business
  679  practice violates shall be deemed to have violated part IX of
  680  chapter 626, and such violation constitutes shall constitute an
  681  unfair method of competition or an unfair or deceptive act or
  682  practice involving the business of insurance. An; and any such
  683  insurer committing such violation is shall be subject to the
  684  penalties afforded in such part, as well as those that are which
  685  may be afforded elsewhere in the insurance code.
  686         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  687  the no-fault law are ss. 627.730-627.7405 shall be primary,
  688  except that benefits received under any workers’ compensation
  689  law shall be credited against the benefits provided by
  690  subsection (1) and are shall be due and payable as loss accrues,
  691  upon the receipt of reasonable proof of such loss and the amount
  692  of expenses and loss incurred which are covered by the policy
  693  issued under the no-fault law ss. 627.730-627.7405. If When the
  694  Agency for Health Care Administration provides, pays, or becomes
  695  liable for medical assistance under the Medicaid program related
  696  to injury, sickness, disease, or death arising out of the
  697  ownership, maintenance, or use of a motor vehicle, the benefits
  698  are under ss. 627.730-627.7405 shall be subject to the
  699  provisions of the Medicaid program.
  700         (a) An insurer may require written notice to be given as
  701  soon as practicable after an accident involving a motor vehicle
  702  with respect to which the policy affords the security required
  703  by the no-fault law ss. 627.730-627.7405.
  704         (b) Personal injury protection insurance benefits paid
  705  pursuant to this section are shall be overdue if not paid within
  706  30 days after the insurer is furnished written notice of the
  707  fact of a covered loss and of the amount of same. If such
  708  written notice is not furnished to the insurer as to the entire
  709  claim, any partial amount supported by written notice is overdue
  710  if not paid within 30 days after the such written notice is
  711  furnished to the insurer. Any part or all of the remainder of
  712  the claim that is subsequently supported by written notice is
  713  overdue if not paid within 30 days after such written notice is
  714  furnished to the insurer. For the purpose of calculating the
  715  extent to which benefits are overdue, payment shall be
  716  considered made on the date a draft or other valid instrument
  717  that is equivalent to payment is placed in the United States
  718  mail in a properly addressed, postpaid envelope, or, if not so
  719  posted, on the date of delivery.
  720         (c) If When an insurer pays only a portion of a claim or
  721  rejects a claim, the insurer shall provide at the time of the
  722  partial payment or rejection an itemized specification of each
  723  item that the insurer had reduced, omitted, or declined to pay
  724  and any information that the insurer desires the claimant to
  725  consider related to the medical necessity of the denied
  726  treatment or to explain the reasonableness of the reduced
  727  charge, provided that this does shall not limit the introduction
  728  of evidence at trial.; and The insurer must shall include the
  729  name and address of the person to whom the claimant should
  730  respond and a claim number to be referenced in future
  731  correspondence. An insurer’s failure to send an itemized
  732  specification or explanation of benefits does not waive other
  733  grounds for rejecting an invalid claim.
  734         (d)A However, notwithstanding the fact that written notice
  735  has been furnished to the insurer, Any payment is shall not be
  736  deemed overdue if when the insurer has reasonable proof to
  737  establish that the insurer is not responsible for the payment.
  738  An insurer may obtain evidence and assert any ground for
  739  adjustment or rejection of a For the purpose of calculating the
  740  extent to which any benefits are overdue, payment shall be
  741  treated as being made on the date a draft or other valid
  742  instrument which is equivalent to payment was placed in the
  743  United States mail in a properly addressed, postpaid envelope
  744  or, if not so posted, on the date of delivery. This paragraph
  745  does not preclude or limit the ability of the insurer to assert
  746  that the claim that is was unrelated, was not medically
  747  necessary, or was unreasonable, or submitted that the amount of
  748  the charge was in excess of that permitted under, or in
  749  violation of, subsection (6) (5). Such assertion by the insurer
  750  may be made at any time, including after payment of the claim,
  751  or after the 30-day time period for payment set forth in this
  752  paragraph (b), or after the filing of a lawsuit.
  753         (e) The 30-day period for payment is tolled while the
  754  insurer investigates a fraudulent insurance act, as defined in
  755  s. 626.989, with respect to any portion of a claim for which the
  756  insurer has a reasonable belief that a fraudulent insurance act
  757  has been committed. The insurer must notify the claimant in
  758  writing that it is investigating a fraudulent insurance act
  759  within 30 days after the date it has a reasonable belief that
  760  such act has been committed. The insurer must pay or deny the
  761  claim, in full or in part, within 90 days after the date the
  762  written notice of the fact of a covered loss and of the amount
  763  of the loss was provided to the insurer. However, no payment is
  764  due to a claimant that has violated paragraph (k).
  765         (f)(c)Notwithstanding any local lien law, upon receiving
  766  notice of an accident that is potentially covered by personal
  767  injury protection benefits, the insurer must reserve $5,000 of
  768  personal injury protection benefits for payment to physicians
  769  licensed under chapter 458 or chapter 459 or dentists licensed
  770  under chapter 466 who provide emergency services and care, as
  771  defined in s. 395.002(9), or who provide hospital inpatient
  772  care. The amount required to be held in reserve may be used only
  773  to pay claims from such physicians or dentists until 30 days
  774  after the date the insurer receives notice of the accident.
  775  After the 30-day period, any amount of the reserve for which the
  776  insurer has not received notice of such a claim from a physician
  777  or dentist who provided emergency services and care or who
  778  provided hospital inpatient care may then be used by the insurer
  779  to pay other claims. The time periods specified in paragraph (b)
  780  for required payment of personal injury protection benefits are
  781  shall be tolled for the period of time that an insurer is
  782  required by this paragraph to hold payment of a claim that is
  783  not from a physician or dentist who provided emergency services
  784  and care or who provided hospital inpatient care to the extent
  785  that the personal injury protection benefits not held in reserve
  786  are insufficient to pay the claim. This paragraph does not
  787  require an insurer to establish a claim reserve for insurance
  788  accounting purposes.
  789         (g)(d) All overdue payments shall bear simple interest at
  790  the rate established under s. 55.03 or the rate established in
  791  the insurance contract, whichever is greater, for the year in
  792  which the payment became overdue, calculated from the date the
  793  insurer was furnished with written notice of the amount of
  794  covered loss. Interest is shall be due at the time payment of
  795  the overdue claim is made. However, interest on a payment that
  796  is overdue pursuant to paragraph (e) shall be calculated from
  797  the date the payment is due pursuant to paragraph (b).
  798         (h)(e) The insurer of the owner of a motor vehicle shall
  799  pay personal injury protection benefits for:
  800         1. Accidental bodily injury sustained in this state by the
  801  owner while occupying a motor vehicle, or while not an occupant
  802  of a self-propelled vehicle if the injury is caused by physical
  803  contact with a motor vehicle.
  804         2. Accidental bodily injury sustained outside this state,
  805  but within the United States of America or its territories or
  806  possessions or Canada, by the owner while occupying the owner’s
  807  motor vehicle.
  808         3. Accidental bodily injury sustained by a relative of the
  809  owner residing in the same household, under the circumstances
  810  described in subparagraph 1. or subparagraph 2. if, provided the
  811  relative at the time of the accident is domiciled in the owner’s
  812  household and is not himself or herself the owner of a motor
  813  vehicle with respect to which security is required under the no
  814  fault law ss. 627.730-627.7405.
  815         4. Accidental bodily injury sustained in this state by any
  816  other person while occupying the owner’s motor vehicle or, if a
  817  resident of this state, while not an occupant of a self
  818  propelled vehicle, if the injury is caused by physical contact
  819  with such motor vehicle if, provided the injured person is not
  820  himself or herself:
  821         a. The owner of a motor vehicle with respect to which
  822  security is required under the no-fault law ss. 627.730
  823  627.7405; or
  824         b. Entitled to personal injury benefits from the insurer of
  825  the owner or owners of such a motor vehicle.
  826         (i)(f) If two or more insurers are liable to pay personal
  827  injury protection benefits for the same injury to any one
  828  person, the maximum payable is shall be as specified in
  829  subsection (1), and any insurer paying the benefits is shall be
  830  entitled to recover from each of the other insurers an equitable
  831  pro rata share of the benefits paid and expenses incurred in
  832  processing the claim.
  833         (j)(g) It is a violation of the insurance code for an
  834  insurer to fail to timely provide benefits as required by this
  835  section with such frequency as to constitute a general business
  836  practice.
  837         (k)(h) Benefits are shall not be due or payable to a
  838  claimant who knowingly: or on the behalf of an insured person if
  839  that person has
  840         1. Submits a false or misleading statement, document,
  841  record, or bill;
  842         2. Submits false or misleading information; or
  843         3. Has otherwise committed or attempted to commit a
  844  fraudulent insurance act as defined in s. 626.989.
  846  A claimant that violates this paragraph is not entitled to any
  847  personal injury protection benefits or payment for any bills and
  848  services, regardless of whether a portion of the claim may be
  849  legitimate. However, a claimant that does not violate this
  850  paragraph may not be denied benefits solely due to a violation
  851  by another claimant.
  852         (l) Notwithstanding any remedies afforded by law, the
  853  insurer may recover from a claimant who violates paragraph (k)
  854  any sums previously paid to that claimant and may bring any
  855  available common law and statutory causes of action. A claimant
  856  has violated paragraph (k) committed, by a material act or
  857  omission, any insurance fraud relating to personal injury
  858  protection coverage under his or her policy, if the fraud is
  859  admitted to in a sworn statement by the insured or if it is
  860  established in a court of competent jurisdiction. Any insurance
  861  fraud voids shall void all coverage arising from the claim
  862  related to such fraud under the personal injury protection
  863  coverage of the claimant insured person who committed the fraud,
  864  irrespective of whether a portion of the insured person’s claim
  865  may be legitimate, and any benefits paid before prior to the
  866  discovery of the insured person’s insurance fraud is shall be
  867  recoverable by the insurer from the claimant person who
  868  committed insurance fraud in their entirety. The prevailing
  869  party is entitled to its costs and attorney’s fees in any action
  870  in which it prevails in an insurer’s action to enforce its right
  871  of recovery under this paragraph. This paragraph does not
  872  preclude or limit an insurer’s right to deny a claim based on
  873  other evidence of fraud or affect an insurer’s right to plead
  874  and prove a claim or defense of fraud under common law. If a
  875  physician, hospital, clinic, or other medical institution
  876  violates paragraph (k), the injured party is not liable for, and
  877  the physician, hospital, clinic, or other medical institution
  878  may not bill the insured for, charges that are unpaid because of
  879  failure to comply with paragraph (k). Any agreement requiring
  880  the injured person or insured to pay for such charges is
  881  unenforceable.
  882         (5) INSURER INVESTIGATIONS.—An insurer has the right and
  883  duty to conduct a reasonable investigation of a claim. In the
  884  course of the insurer’s investigation of a claim:
  885         (a) The insurer may require the insured, claimant, or
  886  medical provider to provide copies of the treatment and
  887  examination records. Any records review need not be based on a
  888  physical examination and may be obtained at any time, including
  889  after reduction or denial of the claim.
  890         1. The records review must be conducted by a practitioner
  891  within the same licensing chapter as the medical provider whose
  892  records are being reviewed.
  893         2. The 30-day period for payment under paragraph (4)(b) is
  894  tolled from the date the insurer sends its request for treatment
  895  records to the date that the insurer receives the treatment
  896  records.
  897         3. A medical provider may impose a reasonable, cost-based
  898  fee that includes only the cost of copying and postage, but does
  899  not include the cost of labor for copying. The cost of copying
  900  may not exceed $1 per page for the first 25 pages and 25 cents
  901  per page for each page in excess of 25 pages. However, a medical
  902  provider may impose the reasonable costs of reproducing X rays
  903  and other special kinds of records, including the actual cost of
  904  the material and supplies used to duplicate the record, as well
  905  as the labor costs and overhead costs associated with such
  906  duplication.
  907         (b) In all circumstances, an insured seeking benefits under
  908  the no-fault law must comply with the terms of the policy, which
  909  includes, but is not limited to, submitting to examinations
  910  under oath. Compliance with this paragraph is a condition
  911  precedent to receiving benefits.
  912         (c) An insurer may deny benefits if the insured, claimant,
  913  or medical provider fails to:
  914         1. Cooperate in the insurer’s investigation;
  915         2. Commits a fraud or material misrepresentation; or
  916         3. Comply with this subsection.
  918         (a)1. Any physician, hospital, clinic, or other person or
  919  institution lawfully rendering treatment to an injured person
  920  for a bodily injury covered by personal injury protection
  921  insurance may charge the insurer and injured party only a
  922  reasonable amount pursuant to this section for the services and
  923  supplies rendered, and the insurer providing such coverage may
  924  pay for such charges directly to the such person or institution
  925  lawfully rendering such treatment, if the insured receiving such
  926  treatment or his or her guardian has countersigned the properly
  927  completed invoice, bill, or claim form approved by the office
  928  upon which such charges are to be paid for as having actually
  929  been rendered, to the best knowledge of the insured or his or
  930  her guardian. In no event, However, may such charges may not
  931  exceed a charge be in excess of the amount the person or
  932  institution customarily charges for like services or supplies.
  933  In determining With respect to a determination of whether a
  934  charge for a particular service, treatment, or otherwise is
  935  reasonable, consideration may be given to evidence of usual and
  936  customary charges and payments accepted by the provider involved
  937  in the dispute, and reimbursement levels in the community, and
  938  various federal and state medical fee schedules applicable to
  939  automobile and other insurance coverages, and other information
  940  relevant to the reasonableness of the reimbursement for the
  941  service, treatment, or supply.
  942         1.2. The insurer may limit reimbursement to no more than 80
  943  percent of the following schedule of maximum charges:
  944         a. For emergency transport and treatment by providers
  945  licensed under chapter 401, 200 percent of Medicare.
  946         b. For emergency services and care provided by a hospital
  947  licensed under chapter 395, 75 percent of the hospital’s usual
  948  and customary charges.
  949         c. For emergency services and care as defined by s.
  950  395.002(9) provided in a facility licensed under chapter 395
  951  rendered by a physician or dentist, and related hospital
  952  inpatient services rendered by a physician or dentist, the usual
  953  and customary charges in the community.
  954         d. For hospital inpatient services, other than emergency
  955  services and care, 200 percent of the Medicare Part A
  956  prospective payment applicable to the specific hospital
  957  providing the inpatient services.
  958         e. For hospital outpatient services, other than emergency
  959  services and care, 200 percent of the Medicare Part A Ambulatory
  960  Payment Classification for the specific hospital providing the
  961  outpatient services.
  962         f. For all other medical services, supplies, and care, 200
  963  percent of the allowable amount under the participating
  964  physicians schedule of Medicare Part B. For all other supplies
  965  and care, including durable medical equipment and care and
  966  services rendered by ambulatory surgical centers and clinical
  967  laboratories, 200 percent of the allowable amount under Medicare
  968  Part B. However, if such services, supplies, or care is not
  969  reimbursable under Medicare Part B, the insurer may limit
  970  reimbursement to 80 percent of the maximum reimbursable
  971  allowance under workers’ compensation, as determined under s.
  972  440.13 and rules adopted thereunder which are in effect at the
  973  time such services, supplies, or care is provided. Services,
  974  supplies, or care that is not reimbursable under Medicare or
  975  workers’ compensation is not required to be reimbursed by the
  976  insurer.
  977         2.3. For purposes of subparagraph 1. 2., the applicable fee
  978  schedule or payment limitation under Medicare is the fee
  979  schedule or payment limitation in effect on January 1 of the
  980  year in which at the time the services, supplies, or care was
  981  rendered and for the area in which such services were rendered,
  982  which shall apply throughout the remainder of the year
  983  notwithstanding any subsequent changes made to the fee schedule
  984  or payment limitation, except that it may not be less than the
  985  allowable amount under the participating physicians schedule of
  986  Medicare Part B for 2007 for medical services, supplies, and
  987  care subject to Medicare Part B.
  988         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  989  any limitation on the number of treatments or other utilization
  990  limits that apply under Medicare or workers’ compensation. An
  991  insurer that applies the allowable payment limitations of
  992  subparagraph 1. 2. must reimburse a provider who lawfully
  993  provided care or treatment under the scope of his or her
  994  license, regardless of whether such provider is would be
  995  entitled to reimbursement under Medicare due to restrictions or
  996  limitations on the types or discipline of health care providers
  997  who may be reimbursed for particular procedures or procedure
  998  codes.
  999         4.5. If an insurer limits payment as authorized by
 1000  subparagraph 1. 2., the person providing such services,
 1001  supplies, or care may not bill or attempt to collect from the
 1002  insured any amount in excess of such limits, except for amounts
 1003  that are not covered by the insured’s personal injury protection
 1004  coverage due to the coinsurance amount or maximum policy limits.
 1005         5. Effective January 1, 2012, an insurer may limit
 1006  reimbursement pursuant to this paragraph only if the insurance
 1007  policy includes the schedule of charges specified in this
 1008  paragraph.
 1009         (b)1. An insurer or insured is not required to pay a claim
 1010  or charges:
 1011         a. Made by a broker or by a person making a claim on behalf
 1012  of a broker;
 1013         b. For any service or treatment that was not lawful at the
 1014  time rendered;
 1015         c. To any person who knowingly submits a false or
 1016  misleading statement relating to the claim or charges;
 1017         d. With respect to a bill or statement that does not
 1018  substantially meet the applicable requirements of paragraphs
 1019  (c), paragraph (d), and (e);
 1020         e. Except for emergency treatment and care, if the insured
 1021  failed to countersign a billing form or patient log related to
 1022  such claim or charges. Failure to submit a countersigned billing
 1023  form or patient log creates a rebuttable presumption that the
 1024  insured did not receive the alleged treatment. The insurer is
 1025  not considered to have been furnished with notice of the subject
 1026  treatment and loss until the insurer is able to verify that the
 1027  insured received the alleged treatment. As used in this sub
 1028  subparagraph, the term “countersigned” means a second or
 1029  verifying signature, as on a previously signed document, and is
 1030  not satisfied by the statement “signature on file” or any
 1031  similar statement;
 1032         f.e. For any treatment or service that is upcoded, or that
 1033  is unbundled if when such treatment or services should be
 1034  bundled, in accordance with paragraph (d). To facilitate prompt
 1035  payment of lawful services, an insurer may change codes that it
 1036  determines to have been improperly or incorrectly upcoded or
 1037  unbundled, and may make payment based on the changed codes,
 1038  without affecting the right of the provider to dispute the
 1039  change by the insurer if, provided that before doing so, the
 1040  insurer contacts must contact the health care provider and
 1041  discusses discuss the reasons for the insurer’s change and the
 1042  health care provider’s reason for the coding, or makes make a
 1043  reasonable good faith effort to do so, as documented in the
 1044  insurer’s file; and
 1045         g.f. For medical services or treatment billed by a
 1046  physician and not provided in a hospital unless such services
 1047  are rendered by the physician or are incident to his or her
 1048  professional services and are included on the physician’s bill,
 1049  including documentation verifying that the physician is
 1050  responsible for the medical services that were rendered and
 1051  billed.
 1052         2. The Department of Health, in consultation with the
 1053  appropriate professional licensing boards, shall adopt, by rule,
 1054  a list of diagnostic tests deemed not to be medically necessary
 1055  for use in the treatment of persons sustaining bodily injury
 1056  covered by personal injury protection benefits under this
 1057  section. The initial list shall be adopted by January 1, 2004,
 1058  and shall be revised from time to time as determined by the
 1059  Department of Health, in consultation with the respective
 1060  professional licensing boards. Inclusion of a test on the list
 1061  must of invalid diagnostic tests shall be based on lack of
 1062  demonstrated medical value and a level of general acceptance by
 1063  the relevant provider community and may shall not be dependent
 1064  for results entirely upon subjective patient response.
 1065  Notwithstanding its inclusion on a fee schedule in this
 1066  subsection, an insurer or insured is not required to pay any
 1067  charges or reimburse claims for any invalid diagnostic test as
 1068  determined by the Department of Health.
 1069         (c)1. With respect to any treatment or service, other than
 1070  medical services billed by a hospital or other provider for
 1071  emergency services as defined in s. 395.002 or inpatient
 1072  services rendered at a hospital-owned facility, the statement of
 1073  charges must be furnished to the insurer by the provider and may
 1074  not include, and the insurer is not required to pay, charges for
 1075  treatment or services rendered more than 35 days before the
 1076  postmark date or electronic transmission date of the statement,
 1077  except for past due amounts previously billed on a timely basis
 1078  under this paragraph, and except that, if the provider submits
 1079  to the insurer a notice of initiation of treatment within 21
 1080  days after its first examination or treatment of the claimant,
 1081  the statement may include charges for treatment or services
 1082  rendered up to, but not more than, 75 days before the postmark
 1083  date of the statement. The injured party is not liable for, and
 1084  the provider may shall not bill the injured party for, charges
 1085  that are unpaid because of the provider’s failure to comply with
 1086  this paragraph. Any agreement requiring the injured person or
 1087  insured to pay for such charges is unenforceable.
 1088         1.2. If, however, the insured fails to furnish the provider
 1089  with the correct name and address of the insured’s personal
 1090  injury protection insurer, the provider has 35 days from the
 1091  date the provider obtains the correct information to furnish the
 1092  insurer with a statement of the charges. The insurer is not
 1093  required to pay for such charges unless the provider includes
 1094  with the statement documentary evidence that was provided by the
 1095  insured during the 35-day period demonstrating that the provider
 1096  reasonably relied on erroneous information from the insured and
 1097  either:
 1098         a. A denial letter from the incorrect insurer; or
 1099         b. Proof of mailing, which may include an affidavit under
 1100  penalty of perjury, reflecting timely mailing to the incorrect
 1101  address or insurer.
 1102         2.3. For emergency services and care as defined in s.
 1103  395.002 rendered in a hospital emergency department or for
 1104  transport and treatment rendered by an ambulance provider
 1105  licensed pursuant to part III of chapter 401, the provider is
 1106  not required to furnish the statement of charges within the time
 1107  periods established by this paragraph,; and the insurer is shall
 1108  not be considered to have been furnished with notice of the
 1109  amount of covered loss for purposes of paragraph (4)(b) until it
 1110  receives a statement complying with paragraph (d), or copy
 1111  thereof, which specifically identifies the place of service to
 1112  be a hospital emergency department or an ambulance in accordance
 1113  with billing standards recognized by the Centers for Medicare
 1114  and Medicaid Services Health Care Finance Administration.
 1115         3.4. Each notice of the insured’s rights under s. 627.7401
 1116  must include the following statement in type no smaller than 12
 1117  points:
 1119         BILLING REQUIREMENTS.—Florida Statutes provide that
 1120         with respect to any treatment or services, other than
 1121         certain hospital and emergency services, the statement
 1122         of charges furnished to the insurer by the provider
 1123         may not include, and the insurer and the injured party
 1124         are not required to pay, charges for treatment or
 1125         services rendered more than 35 days before the
 1126         postmark date of the statement, except for past due
 1127         amounts previously billed on a timely basis, and
 1128         except that, if the provider submits to the insurer a
 1129         notice of initiation of treatment within 21 days after
 1130         its first examination or treatment of the claimant,
 1131         the first billing cycle statement may include charges
 1132         for treatment or services rendered up to, but not more
 1133         than, 75 days before the postmark date of the
 1134         statement.
 1136         (d) All statements and bills for medical services rendered
 1137  by any physician, hospital, clinic, or other person or
 1138  institution shall be submitted to the insurer on a properly
 1139  completed Centers for Medicare and Medicaid Services (CMS) 1500
 1140  form, UB 92 forms, or any other standard form approved by the
 1141  office or adopted by the commission for purposes of this
 1142  paragraph. All billings for such services rendered by providers
 1143  must shall, to the extent applicable, follow the Physicians’
 1144  Current Procedural Terminology (CPT) or Healthcare Correct
 1145  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1146  year in which services are rendered and comply with the Centers
 1147  for Medicare and Medicaid Services (CMS) 1500 form instructions
 1148  and the American Medical Association Current Procedural
 1149  Terminology (CPT) Editorial Panel and Healthcare Correct
 1150  Procedural Coding System (HCPCS). All providers other than
 1151  hospitals shall include on the applicable claim form the
 1152  professional license number of the provider in the line or space
 1153  provided for “Signature of Physician or Supplier, Including
 1154  Degrees or Credentials.” In determining compliance with
 1155  applicable CPT and HCPCS coding, guidance shall be provided by
 1156  the Physicians’ Current Procedural Terminology (CPT) or the
 1157  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1158  for the year in which services were rendered, the Office of the
 1159  Inspector General (OIG), Physicians Compliance Guidelines, and
 1160  other authoritative treatises designated by rule by the Agency
 1161  for Health Care Administration. A No statement of medical
 1162  services may not include charges for medical services of a
 1163  person or entity that performed such services without possessing
 1164  the valid licenses required to perform such services. For
 1165  purposes of paragraph (4)(b), an insurer is shall not be
 1166  considered to have been furnished with notice of the amount of
 1167  covered loss or medical bills due unless the statements or bills
 1168  comply with this paragraph, and unless the statements or bills
 1169  are comply with this paragraph, and unless the statements or
 1170  bills are properly completed in their entirety as to all
 1171  material provisions, with all relevant information being
 1172  provided therein. If an insurer denies a claim due to a
 1173  provider’s failure to submit a properly completed statement or
 1174  bill, the insurer shall notify the provider as to the provisions
 1175  that were improperly completed, and the provider shall have 15
 1176  days after the receipt of such notice to submit a properly
 1177  completed statement or bill. If the provider fails to comply
 1178  with this requirement, the insurer is not required to pay for
 1179  improperly billed services.
 1180         (e)1. At the initial treatment or service provided, each
 1181  physician, other licensed professional, clinic, or other medical
 1182  institution providing medical services upon which a claim for
 1183  personal injury protection benefits is based shall require an
 1184  insured person, or his or her guardian, to execute a disclosure
 1185  and acknowledgment form, which reflects at a minimum that:
 1186         a. The insured, or his or her guardian, must countersign
 1187  the form attesting to the fact that the services set forth
 1188  therein were actually rendered. Listing CPT codes or other
 1189  coding on the disclosure and acknowledgment form does not
 1190  satisfy this requirement;
 1191         b. The insured, or his or her guardian, has both the right
 1192  and affirmative duty to confirm that the services were actually
 1193  rendered;
 1194         c. The insured, or his or her guardian, was not solicited
 1195  by any person to seek any services from the medical provider;
 1196         d. The physician, other licensed professional, clinic, or
 1197  other medical institution rendering services for which payment
 1198  is being claimed explained the services to the insured or his or
 1199  her guardian; and
 1200         e. If the insured notifies the insurer in writing of a
 1201  billing error, the insured may be entitled to a certain
 1202  percentage of a reduction in the amounts paid by the insured’s
 1203  motor vehicle insurer.
 1204         2. The physician, other licensed professional, clinic, or
 1205  other medical institution rendering services for which payment
 1206  is being claimed has the affirmative duty to explain the
 1207  services rendered to the insured, or his or her guardian, so
 1208  that the insured, or his or her guardian, countersigns the form
 1209  with informed consent.
 1210         3. Countersignature by the insured, or his or her guardian,
 1211  is not required for the reading of diagnostic tests or other
 1212  services that are of such a nature that they are not required to
 1213  be performed in the presence of the insured.
 1214         4. The licensed medical professional rendering treatment
 1215  for which payment is being claimed must sign, by his or her own
 1216  hand, the form complying with this paragraph.
 1217         5. An insurer is not considered to have been furnished with
 1218  notice of the amount of a covered loss or medical bills unless
 1219  the original completed disclosure and acknowledgment form is
 1220  shall be furnished to the insurer pursuant to paragraph (4)(b)
 1221  and sub-subparagraph 1.a. The disclosure and acknowledgement
 1222  form may not be electronically furnished. A disclosure and
 1223  acknowledgement form that does not meet the minimum requirements
 1224  of sub-subparagraph 1.a. does not provide an insurer with notice
 1225  of the amount of a covered loss or medical bills due.
 1226         6. This disclosure and acknowledgment form is not required
 1227  for services billed by a provider for emergency services as
 1228  defined in s. 395.002, for emergency services and care as
 1229  defined in s. 395.002 rendered in a hospital emergency
 1230  department, or for transport and treatment rendered by an
 1231  ambulance provider licensed pursuant to part III of chapter 401.
 1232         7. The Financial Services Commission shall adopt, by rule,
 1233  a standard disclosure and acknowledgment form to that shall be
 1234  used to fulfill the requirements of this paragraph, effective 90
 1235  days after such form is adopted and becomes final. The
 1236  commission shall adopt a proposed rule by October 1, 2003. Until
 1237  the rule is final, the provider may use a form of its own which
 1238  otherwise complies with the requirements of this paragraph.
 1239         8. As used in this paragraph, the term “countersigned” or
 1240  “countersignature” means a second or verifying signature, as on
 1241  a previously signed document, and is not satisfied by the
 1242  statement “signature on file” or any similar statement.
 1243         9. The requirements of this paragraph apply only with
 1244  respect to the initial treatment or service of the insured by a
 1245  provider. For subsequent treatments or service, the provider
 1246  must maintain a patient log signed by the patient, in
 1247  chronological order by date of service, that is consistent with
 1248  the services being rendered to the patient as claimed. Listing
 1249  CPT codes or other coding on the patient log does not satisfy
 1250  this requirement. The provider must provide copies of the
 1251  patient log to the insurer within 30 days after receiving a
 1252  written request from the insurer. Failure to maintain a patient
 1253  log renders the treatment unlawful and noncompensable. The
 1254  requirements of this subparagraph for maintaining a patient log
 1255  signed by the patient may be met by a hospital that maintains
 1256  medical records as required by s. 395.3025 and applicable rules
 1257  and makes such records available to the insurer upon request.
 1258         (f) Upon written notification by any person, an insurer
 1259  shall investigate any claim of improper billing by a physician
 1260  or other medical provider. The insurer shall determine if the
 1261  insured was properly billed for only those services and
 1262  treatments that the insured actually received. If the insurer
 1263  determines that the insured has been improperly billed, the
 1264  insurer shall notify the insured, the person making the written
 1265  notification, and the provider of its findings and shall reduce
 1266  the amount of payment to the provider by the amount determined
 1267  to be improperly billed. If a reduction is made due to such
 1268  written notification by any person, the insurer shall pay to the
 1269  person 20 percent of the amount of the reduction, up to $500. If
 1270  the provider is arrested due to the improper billing, then the
 1271  insurer shall pay to the person 40 percent of the amount of the
 1272  reduction, up to $500.
 1273         (g) An insurer may not systematically downcode with the
 1274  intent to deny reimbursement otherwise due. Such action
 1275  constitutes a material misrepresentation under s.
 1276  626.9541(1)(i)2.
 1278  DISPUTES.—
 1279         (b) Every physician, hospital, clinic, or other medical
 1280  institution providing, before or after bodily injury upon which
 1281  a claim for personal injury protection insurance benefits is
 1282  based, any products, services, or accommodations in relation to
 1283  that or any other injury, or in relation to a condition claimed
 1284  to be connected with that or any other injury, shall, if
 1285  requested to do so by the insurer against whom the claim has
 1286  been made, permit the insurer or the insurer’s representative to
 1287  conduct an onsite physical review and examination of the
 1288  treatment location, treatment apparatuses, diagnostic devices,
 1289  and any other medical equipment used for the services rendered
 1290  within 10 days after the insurer’s request, and furnish
 1291  forthwith a written report of the history, condition, treatment,
 1292  dates, and costs of such treatment of the injured person and why
 1293  the items identified by the insurer were reasonable in amount
 1294  and medically necessary, together with a sworn statement that
 1295  the treatment or services rendered were reasonable and necessary
 1296  with respect to the bodily injury sustained and identifying
 1297  which portion of the expenses for such treatment or services was
 1298  incurred as a result of such bodily injury, and produce
 1299  forthwith, and permit the inspection and copying of, his or her
 1300  or its records regarding such history, condition, treatment,
 1301  dates, and costs of treatment if; provided that this does shall
 1302  not limit the introduction of evidence at trial. Such sworn
 1303  statement must shall read as follows: “Under penalty of perjury,
 1304  I declare that I have read the foregoing, and the facts alleged
 1305  are true, to the best of my knowledge and belief.” A No cause of
 1306  action for violation of the physician-patient privilege or
 1307  invasion of the right of privacy may not be brought shall be
 1308  permitted against any physician, hospital, clinic, or other
 1309  medical institution complying with the provisions of this
 1310  section. The person requesting such records and such sworn
 1311  statement shall pay all reasonable costs connected therewith.
 1312         1. If an insurer makes a written request for documentation
 1313  or information under this paragraph within 30 days after having
 1314  received notice of the amount of a covered loss under paragraph
 1315  (4)(a), the amount or the partial amount that which is the
 1316  subject of the insurer’s inquiry is shall become overdue if the
 1317  insurer does not pay in accordance with paragraph (4)(b) or
 1318  within 10 days after the insurer’s receipt of the requested
 1319  documentation or information, whichever occurs later. For
 1320  purposes of this subparagraph paragraph, the term “receipt”
 1321  includes, but is not limited to, inspection and copying pursuant
 1322  to this paragraph. An Any insurer that requests documentation or
 1323  information pertaining to reasonableness of charges or medical
 1324  necessity under this paragraph without a reasonable basis for
 1325  such requests as a general business practice is engaging in an
 1326  unfair trade practice under the insurance code.
 1327         2. If an insured seeking to recover benefits pursuant to
 1328  the no-fault law assigns the contractual right to those benefits
 1329  or payment of those benefits to any person or entity, the
 1330  assignee must comply with the terms of the policy. In all
 1331  circumstances, the assignee is obligated to cooperate under the
 1332  policy, which includes, but is not limited to, participating in
 1333  an examination under oath. Examinations under oath may be
 1334  recorded by audio, video, court reporter, or any combination
 1335  thereof. Compliance with this paragraph is a condition precedent
 1336  to recovery of benefits pursuant to the no-fault law.
 1337         a. If an insurer requests an examination under oath of a
 1338  medical provider, the provider must produce the persons having
 1339  the most knowledge of the issues identified by the insurer in
 1340  the request for examination under oath. All claimants must
 1341  produce and allow for the inspection all documents requested by
 1342  the insurer which are relevant to the services rendered and
 1343  reasonably obtainable by the claimant. The insurer must pay the
 1344  medical provider reasonable compensation for attending the
 1345  examination under oath; however, expert witness fees are not
 1346  reasonable compensation. The medical provider may have an
 1347  attorney present at the examination under oath at the provider’s
 1348  own expense.
 1349         b. Before requesting that an assignee participate in an
 1350  examination under oath, the insurer must send a written request
 1351  to the assignee requesting all information that the insurer
 1352  believes is necessary to process the claim and relevant to the
 1353  services rendered, including the information contemplated under
 1354  this subparagraph.
 1355         c. An insurer that, as a general practice, requests
 1356  examinations under oath of an assignee without a reasonable
 1357  basis is engaging in an unfair and deceptive trade practice.
 1359  REPORTS.—
 1360         (b) If requested by the person examined, a party causing an
 1361  examination to be made shall deliver to him or her a copy of
 1362  every written report concerning the examination rendered by an
 1363  examining physician, at least one of which reports must set out
 1364  the examining physician’s findings and conclusions in detail.
 1365  After such request and delivery, the party causing the
 1366  examination to be made is entitled, upon request, to receive
 1367  from the person examined every written report available to him
 1368  or her or his or her representative concerning any examination,
 1369  previously or thereafter made, of the same mental or physical
 1370  condition. By requesting and obtaining a report of the
 1371  examination so ordered, or by taking the deposition of the
 1372  examiner, the person examined waives any privilege he or she may
 1373  have, in relation to the claim for benefits, regarding the
 1374  testimony of every other person who has examined, or may
 1375  thereafter examine, him or her in respect to the same mental or
 1376  physical condition. If a person fails to appear for unreasonably
 1377  refuses to submit to an examination, the personal injury
 1378  protection carrier is not required to pay no longer liable for
 1379  subsequent personal injury protection benefits incurred after
 1380  the date of the first requested examination until the insured
 1381  appears for the examination. Failure to appear for two scheduled
 1382  examinations raises a rebuttable presumption that such failure
 1383  was unreasonable. Submission to an examination is a condition
 1384  precedent to the recovery of benefits.
 1386  FEES.—With respect to any dispute under the provisions of ss.
 1387  627.730-627.7405 between the insured and the insurer under the
 1388  no-fault law, or between an assignee of an insured’s rights and
 1389  the insurer, the provisions of s. 627.428 shall apply, except as
 1390  provided in subsections (11) and (16) (10) and (15).
 1391         (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and
 1392  enter into contracts with preferred licensed health care
 1393  providers for the benefits described in this section, referred
 1394  to in this section as “preferred providers,” which include shall
 1395  include health care providers licensed under chapter 457,
 1396  chapter chapters 458, chapter 459, chapter 460, chapter 461, or
 1397  chapter and 463.
 1398         (a) The insurer may provide an option to an insured to use
 1399  a preferred provider at the time of purchase of the policy for
 1400  personal injury protection benefits, if the requirements of this
 1401  subsection are met. However, if the insurer offers a preferred
 1402  provider option, it must also offer a nonpreferred provider
 1403  policy. If the insured elects to use a provider who is not a
 1404  preferred provider, whether the insured purchased a preferred
 1405  provider policy or a nonpreferred provider policy, the medical
 1406  benefits provided by the insurer must shall be as required by
 1407  this section.
 1408         (b) If the insured elects the to use a provider who is a
 1409  preferred provider option, the insurer may pay medical benefits
 1410  in excess of the benefits required by this section and may waive
 1411  or lower the amount of any deductible that applies to such
 1412  medical benefits. As an alternative, or in addition to such
 1413  benefits, waiver, or reduction, the insurer may provide an
 1414  actuarially appropriate premium discount as specified in an
 1415  approved rate filing to an insured who selects the preferred
 1416  provider option. If the preferred provider option provides a
 1417  premium discount, the insured forfeits the premium discount
 1418  effective on the date that the insured elects to use a provider
 1419  who is not a preferred provider and who renders nonemergency
 1420  services, unless there is no member of the preferred provider
 1421  network located within 15 miles of the insured’s place of
 1422  residence whose scope of practice includes the required
 1423  services, or unless the nonemergency services are rendered in
 1424  the emergency room of a hospital licensed under chapter 395. If
 1425  the insurer offers a preferred provider policy to a policyholder
 1426  or applicant, it must also offer a nonpreferred provider policy.
 1427         (c) The insurer shall provide each insured policyholder
 1428  with a current roster of preferred providers in the county in
 1429  which the insured resides at the time of purchasing purchase of
 1430  such policy, and shall make such list available for public
 1431  inspection during regular business hours at the insurer’s
 1432  principal office of the insurer within the state. The insurer
 1433  may contract with a health insurer to use an existing preferred
 1434  provider network to implement the preferred provider option. All
 1435  providers and entities that are eligible to receive
 1436  reimbursement pursuant to paragraph (1)(a) may provide services
 1437  through a preferred provider network. Any other arrangement is
 1438  subject to the approval of the Office of Insurance Regulation.
 1439         (11)(10) DEMAND LETTER.—
 1440         (a) As a condition precedent to filing any action for
 1441  benefits under this section, the claimant filing suit must
 1442  provide the insurer must be provided with written notice of an
 1443  intent to initiate litigation. Such notice may not be sent until
 1444  the claim is overdue, including any additional time the insurer
 1445  has to pay the claim pursuant to paragraph (4)(b). A premature
 1446  demand letter is defective and cannot be cured unless the court
 1447  first abates the action or the claimant first voluntarily
 1448  dismisses the action.
 1449         (b) The notice required notice must shall state that it is
 1450  a “demand letter under s. 627.736(10)” and shall state with
 1451  specificity:
 1452         1. The name of the insured upon which such benefits are
 1453  being sought, including a copy of the assignment giving rights
 1454  to the claimant if the claimant is not the insured.
 1455         2. The claim number or policy number upon which such claim
 1456  was originally submitted to the insurer.
 1457         3. To the extent applicable, the name of any medical
 1458  provider who rendered to an insured the treatment, services,
 1459  accommodations, or supplies that form the basis of such claim;
 1460  and an itemized statement specifying each exact amount, the date
 1461  of treatment, service, or accommodation, and the type of benefit
 1462  claimed to be due. A completed form satisfying the requirements
 1463  of paragraph (6)(5)(d) or the lost-wage statement previously
 1464  submitted may be used as the itemized statement. To the extent
 1465  that the demand involves an insurer’s withdrawal of payment
 1466  under paragraph (7)(a) for future treatment not yet rendered,
 1467  the claimant shall attach a copy of the insurer’s notice
 1468  withdrawing such payment and an itemized statement of the type,
 1469  frequency, and duration of future treatment claimed to be
 1470  reasonable and medically necessary.
 1471         (c) Each notice required by this subsection must be
 1472  delivered to the insurer by United States certified or
 1473  registered mail, return receipt requested. Such postal costs
 1474  shall be reimbursed by the insurer if so requested by the
 1475  claimant in the notice, when the insurer pays the claim. Such
 1476  notice must be sent to the person and address specified by the
 1477  insurer for the purposes of receiving notices under this
 1478  subsection. Each licensed insurer, whether domestic, foreign, or
 1479  alien, shall file with the office designation of the name and
 1480  address of the person to whom notices must pursuant to this
 1481  subsection shall be sent which the office shall make available
 1482  on its Internet website. The name and address on file with the
 1483  office pursuant to s. 624.422 shall be deemed the authorized
 1484  representative to accept notice pursuant to this subsection if
 1485  in the event no other designation has been made.
 1486         (d) If, within 30 days after receipt of notice by the
 1487  insurer, the overdue claim specified in the notice is paid by
 1488  the insurer together with applicable interest and a penalty of
 1489  10 percent of the overdue amount paid by the insurer, subject to
 1490  a maximum penalty of $250, no action may be brought against the
 1491  insurer. If the demand involves an insurer’s withdrawal of
 1492  payment under paragraph (7)(a) for future treatment not yet
 1493  rendered, no action may be brought against the insurer if,
 1494  within 30 days after its receipt of the notice, the insurer
 1495  mails to the person filing the notice a written statement of the
 1496  insurer’s agreement to pay for such treatment in accordance with
 1497  the notice and to pay a penalty of 10 percent, subject to a
 1498  maximum penalty of $250, when it pays for such future treatment
 1499  in accordance with the requirements of this section. To the
 1500  extent the insurer determines not to pay any amount demanded,
 1501  the penalty is shall not be payable in any subsequent action.
 1502  For purposes of this subsection, payment or the insurer’s
 1503  agreement is shall be treated as being made on the date a draft
 1504  or other valid instrument that is equivalent to payment, or the
 1505  insurer’s written statement of agreement, is placed in the
 1506  United States mail in a properly addressed, postpaid envelope,
 1507  or if not so posted, on the date of delivery. The insurer is not
 1508  obligated to pay any attorney’s fees if the insurer pays the
 1509  claim or mails its agreement to pay for future treatment within
 1510  the time prescribed by this subsection.
 1511         (e) The applicable statute of limitation for an action
 1512  under this section shall be tolled for a period of 30 business
 1513  days by the mailing of the notice required by this subsection.
 1514         (f)A demand letter that does not meet the minimum
 1515  requirements set forth in this subsection or that is sent during
 1516  the pendency of the lawsuit is defective. A defective demand
 1517  letter cannot be cured unless the court first abates the action
 1518  or the claimant first voluntarily dismisses the action.
 1519         (g)(f)An Any insurer making a general business practice of
 1520  not paying valid claims until receipt of the notice required by
 1521  this subsection is engaging in an unfair trade practice under
 1522  the insurance code.
 1523         (h) If the insurer pays in response to a demand letter and
 1524  the claimant disputes the amount paid, the claimant must send a
 1525  second demand letter by certified or registered mail stating the
 1526  exact amount that the claimant believes the insurer owes and why
 1527  the claimant believes the amount paid is incorrect. The insurer
 1528  has an additional 10 days after receipt of the second letter to
 1529  issue any additional payment that is owed. The purpose of this
 1530  provision is to avoid unnecessary litigation over miscalculated
 1531  payments.
 1532         (i) Demand letters may not be used to request the
 1533  production of claim documents or other records from the insurer.
 1534         Section 9. Subsection (10) of section 817.234, Florida
 1535  Statutes, is amended, present subsection (12) of that section is
 1536  renumbered as subsection (13) and amended, and a new subsection
 1537  (12) is added to that section, to read:
 1538         817.234 False and fraudulent insurance claims.—
 1539         (10)(a) Any person who owns an business entity eligible for
 1540  reimbursement under s. 627.736(1) and who is found guilty of
 1541  insurance fraud under this section shall lose his or her
 1542  occupational license for such entity for 5 years and may not
 1543  receive reimbursement for personal injury protection benefits
 1544  for 10 years.
 1545         (b) Any licensed health care practitioner found guilty of
 1546  insurance fraud under this section shall lose his or her license
 1547  to practice for 5 years and may not receive reimbursement for
 1548  personal injury protection benefits for 10 years. As used in
 1549  this section, the term “insurer” means any insurer, health
 1550  maintenance organization, self-insurer, self-insurance fund, or
 1551  other similar entity or person regulated under chapter 440 or
 1552  chapter 641 or by the Office of Insurance Regulation under the
 1553  Florida Insurance Code.
 1554         (12) In addition to any criminal liability, a person
 1555  convicted of violating any provision of this section for the
 1556  purpose of receiving insurance proceeds from a motor vehicle
 1557  insurance contract is subject to a civil penalty.
 1558         (a) Except for a violation of subsection (9), the civil
 1559  penalty shall be:
 1560         1. A fine up to $5,000 for a first offense.
 1561         2. A fine greater than $5,000, but not to exceed $10,000,
 1562  for a second offense.
 1563         3. A fine greater than $10,000, but not to exceed $15,000,
 1564  for a third or subsequent offense.
 1565         (b) The civil penalty for a violation of subsection (9)
 1566  must be at least $15,000, but may not exceed $50,000.
 1567         (c) The civil penalty shall be paid to the Insurance
 1568  Regulatory Trust Fund within the Department of Financial
 1569  Services and used by the department for the investigation and
 1570  prosecution of insurance fraud.
 1571         (d) This subsection does not prohibit a state attorney from
 1572  entering into a written agreement in which the person charged
 1573  with the violation does not admit to or deny the charges but
 1574  consents to payment of the civil penalty.
 1575         (13)(12) As used in this section, the term:
 1576         (a) “Insurer” means any insurer, health maintenance
 1577  organization, self-insurer, self-insurance fund, or similar
 1578  entity or person regulated under chapter 440 or chapter 641 or
 1579  by the Office of Insurance Regulation under the Florida
 1580  Insurance Code.
 1581         (b)(a) “Property” means property as defined in s. 812.012.
 1582         (c)(b) “Value” has the same meaning means value as provided
 1583  defined in s. 812.012.
 1584         Section 10. Subsection (1) of section 324.021, Florida
 1585  Statutes, is amended to read:
 1586         324.021 Definitions; minimum insurance required.—The
 1587  following words and phrases when used in this chapter shall, for
 1588  the purpose of this chapter, have the meanings respectively
 1589  ascribed to them in this section, except in those instances
 1590  where the context clearly indicates a different meaning:
 1591         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1592  is designed and required to be licensed for use upon a highway,
 1593  including trailers and semitrailers designed for use with such
 1594  vehicles, except traction engines, road rollers, farm tractors,
 1595  power shovels, and well drillers, and every vehicle that which
 1596  is propelled by electric power obtained from overhead wires but
 1597  not operated upon rails, but not including any bicycle or moped.
 1598  However, the term does “motor vehicle” shall not include a any
 1599  motor vehicle as defined in s. 627.732(3) if when the owner of
 1600  such vehicle has complied with the no-fault law requirements of
 1601  ss. 627.730-627.7405, inclusive, unless the provisions of s.
 1602  324.051 apply; and, in such case, the applicable proof of
 1603  insurance provisions of s. 320.02 apply.
 1604         Section 11. Paragraph (k) of subsection (2) of section
 1605  456.057, Florida Statutes, is amended to read:
 1606         456.057 Ownership and control of patient records; report or
 1607  copies of records to be furnished.—
 1608         (2) As used in this section, the terms “records owner,”
 1609  “health care practitioner,” and “health care practitioner’s
 1610  employer” do not include any of the following persons or
 1611  entities; furthermore, the following persons or entities are not
 1612  authorized to acquire or own medical records, but are authorized
 1613  under the confidentiality and disclosure requirements of this
 1614  section to maintain those documents required by the part or
 1615  chapter under which they are licensed or regulated:
 1616         (k) Persons or entities practicing under s. 627.736(8)
 1617  627.736(7).
 1618         Section 12. Paragraph (b) of subsection (1) of section
 1619  627.7401, Florida Statutes, is amended to read:
 1620         627.7401 Notification of insured’s rights.—
 1621         (1) The commission, by rule, shall adopt a form for the
 1622  notification of insureds of their right to receive personal
 1623  injury protection benefits under the Florida Motor Vehicle no
 1624  fault law. Such notice shall include:
 1625         (b) An advisory informing insureds that:
 1626         1. Pursuant to s. 626.9892, the Department of Financial
 1627  Services may pay rewards of up to $25,000 to persons providing
 1628  information leading to the arrest and conviction of persons
 1629  committing crimes investigated by the Division of Insurance
 1630  Fraud arising from violations of s. 440.105, s. 624.15, s.
 1631  626.9541, s. 626.989, or s. 817.234.
 1632         2. Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
 1633  insured notifies the insurer of a billing error, the insured may
 1634  be entitled to a certain percentage of a reduction in the amount
 1635  paid by the insured’s motor vehicle insurer.
 1636         Section 13. This act shall take effect July 1, 2011.