HB 0967

1	A bill to be entitled
2	An act relating to insurance; amending s. 400.9935, F.S.;
3	requiring health care clinics to display signs displaying
4	certain information relating to insurance fraud;
5	authorizing compliance inspections by the Division of
6	Insurance Fraud; requiring clinics to allow inspection
7	access; amending s. 440.105, F.S.; providing criminal
8	penalties for employers who fail to provide required
9	workers' compensation coverage for employees under certain
10	circumstances; amending s. 624.15, F.S.; specifying
11	violations of department rule as misdemeanors; specifying
12	a violation of department emergency rules or orders as a
13	felony of the third degree; providing penalties; amending
14	s. 624.155, F.S.; providing that civil actions may be
15	brought against any person acting as an insurer without a
16	certificate of authority if damaged by such acting;
17	amending s. 626.112, F.S.; providing a criminal penalty
18	for transacting insurance without a license; amending s.
19	626.901, F.S.; clarifying nonapplication to certain
20	independently procured coverage of a prohibition against
21	representing or aiding an unauthorized insurer; amending
22	s. 626.938, F.S.; revising provisions requiring a report
23	and taxation of independently procured coverages;
24	specifying nonauthorization of independent procurement of
25	workers' compensation, life, or health insurance; amending
26	s. 626.989, F.S.; including self-insured entities
27	associated with the National Insurance Crime Bureau within
28	a list of entities required to report insurance fraud;
29	authorizing the division to adopt rules for standardized
30	reporting of fraudulent activity; amending s. 817.234,
31	F.S.; clarifying provisions specifying material omission
32	and insurance fraud; prohibiting scheming to create
33	documentation of a motor vehicle crash that did not occur;
34	providing a criminal penalty; amending s. 817.2361, F.S.;
35	providing that creating, presenting, or marketing
36	fraudulent proof of motor vehicle insurance is a felony of
37	the third degree; amending s. 817.50, F.S.; specifying
38	nonapplication of provisions specifying evidence of intent
39	to defraud to certain investigative actions taken by law
40	enforcement officers; amending s. 817.505, F.S.; providing
41	an additional patient brokering prohibition; revising a
42	definition; amending s. 843.08, F.S.; providing a criminal
43	penalty for falsely assuming or pretending to be an
44	officer of the Department of Financial Services; providing
45	severability; providing an effective date.
46
47	Be It Enacted by the Legislature of the State of Florida:
48
49	Section 1.  Subsection (13) is added to section 400.9935,
50	Florida Statutes, to read:
51	400.9935  Clinic responsibilities.--
52	(13)  The clinic shall display a sign in a conspicuous
53	location within the clinic readily visible to all patients
54	indicating that pursuant to s. 626.9892, the Department of
55	Financial Services may pay rewards of up to $25,000 to persons
56	providing information leading to the arrest and conviction of
57	persons committing crimes investigated by the Division of
58	Insurance Fraud arising from violations of s. 440.105, s.
59	624.15, s. 626.9541, s. 626.989, or s. 817.234. An authorized
60	employee of the Division of Insurance Fraud may make unannounced
61	inspections of clinics licensed pursuant to this part as
62	necessary to determine that the clinic is in compliance with
63	this subsection. A licensed clinic shall allow full and complete
64	access to the premises to such authorized employee of the
65	division who makes an inspection to determine compliance with
66	this subsection.
67	Section 2.  Subsection (4) of section 440.105, Florida
68	Statutes, is amended to read:
69	440.105  Prohibited activities; reports; penalties;
70	limitations.--
71	(4)  Unless otherwise specifically provided, whoever
72	violates any provision of this subsection commits insurance
73	fraud, punishable as provided in paragraph (f).
74	(a)  It shall be unlawful for any employer to knowingly:
75	1.  Present or cause to be presented any false, fraudulent,
76	or misleading oral or written statement to any person as
77	evidence of compliance with s. 440.38.
78	2.  Make a deduction from the pay of any employee entitled
79	to the benefits of this chapter for the purpose of requiring the
80	employee to pay any portion of premium paid by the employer to a
81	carrier or to contribute to a benefit fund or department
82	maintained by such employer for the purpose of providing
83	compensation or medical services and supplies as required by
84	this chapter.
85	3.  Fail to secure workers' payment of compensation
86	coverage if required to do so by this chapter.
87	a.  However, if an employer knowingly fails to secure
88	workers' compensation coverage for an employee as required by
89	this chapter, and such employee subsequently suffers a work-
90	related injury requiring hospitalization, the employer commits a
91	felony of the second degree, punishable as provided in s.
92	775.082, s. 775.083, or s. 775.084.
93	b.  However, if an employer knowingly fails to secure
94	workers' compensation coverage for an employee as required by
95	this chapter, and such employee subsequently suffers a work
96	related death, the employer commits a felony of the first
97	degree, punishable as provided in s. 775.082, s. 775.083, or s.
98	775.084.
99	(b)  It shall be unlawful for any person:
100	1.  To knowingly make, or cause to be made, any false,
101	fraudulent, or misleading oral or written statement for the
102	purpose of obtaining or denying any benefit or payment under
103	this chapter.
104	2.  To present or cause to be presented any written or oral
105	statement as part of, or in support of, a claim for payment or
106	other benefit pursuant to any provision of this chapter, knowing
107	that such statement contains any false, incomplete, or
108	misleading information concerning any fact or thing material to
109	such claim.
110	3.  To prepare or cause to be prepared any written or oral
111	statement that is intended to be presented to any employer,
112	insurance company, or self-insured program in connection with,
113	or in support of, any claim for payment or other benefit
114	pursuant to any provision of this chapter, knowing that such
115	statement contains any false, incomplete, or misleading
116	information concerning any fact or thing material to such claim.
117	4.  To knowingly assist, conspire with, or urge any person
118	to engage in activity prohibited by this section.
119	5.  To knowingly make any false, fraudulent, or misleading
120	oral or written statement, or to knowingly omit or conceal
121	material information, required by s. 440.185 or s. 440.381, for
122	the purpose of obtaining workers' compensation coverage or for
123	the purpose of avoiding, delaying, or diminishing the amount of
124	payment of any workers' compensation premiums.
125	6.  To knowingly misrepresent or conceal payroll,
126	classification of workers, or information regarding an
127	employer's loss history which would be material to the
128	computation and application of an experience rating modification
129	factor for the purpose of avoiding or diminishing the amount of
130	payment of any workers' compensation premiums.
131	7.  To knowingly present or cause to be presented any
132	false, fraudulent, or misleading oral or written statement to
133	any person as evidence of compliance with s. 440.38, as evidence
134	of eligibility for a certificate of exemption under s. 440.05.
135	8.  To knowingly violate a stop-work order issued by the
136	department pursuant to s. 440.107.
137	9.  To knowingly present or cause to be presented any
138	false, fraudulent, or misleading oral or written statement to
139	any person as evidence of identity for the purpose of obtaining
140	employment or filing or supporting a claim for workers'
141	compensation benefits.
142	(c)  It shall be unlawful for any physician licensed under
143	chapter 458, osteopathic physician licensed under chapter 459,
144	chiropractic physician licensed under chapter 460, podiatric
145	physician licensed under chapter 461, optometric physician
146	licensed under chapter 463, or any other practitioner licensed
147	under the laws of this state to knowingly and willfully assist,
148	conspire with, or urge any person to fraudulently violate any of
149	the provisions of this chapter.
150	(d)  It shall be unlawful for any person or governmental
151	entity licensed under chapter 395 to maintain or operate a
152	hospital in such a manner so that such person or governmental
153	entity knowingly and willfully allows the use of the facilities
154	of such hospital by any person, in a scheme or conspiracy to
155	fraudulently violate any of the provisions of this chapter.
156	(e)  It shall be unlawful for any attorney or other person,
157	in his or her individual capacity or in his or her capacity as a
158	public or private employee, or any firm, corporation,
159	partnership, or association, to knowingly assist, conspire with,
160	or urge any person to fraudulently violate any of the provisions
161	of this chapter.
162	(f)  If the monetary value of any violation of this
163	subsection:
164	1.  Is less than $20,000, the offender commits a felony of
165	the third degree, punishable as provided in s. 775.082, s.
166	775.083, or s. 775.084.
167	2.  Is $20,000 or more, but less than $100,000, the
168	offender commits a felony of the second degree, punishable as
169	provided in s. 775.082, s. 775.083, or s. 775.084.
170	3.  Is $100,000 or more, the offender commits a felony of
171	the first degree, punishable as provided in s. 775.082, s.
172	775.083, or s. 775.084.
173	Section 3.  Section 624.15, Florida Statutes, is amended to
174	read:
175	624.15  General penalty.--
176	(1)  Each willful violation of this code or department rule
177	as to which a greater penalty is not provided by another
178	provision of this code, department rule, or by other applicable
179	laws of this state is a misdemeanor of the second degree and is,
180	in addition to any prescribed applicable denial, suspension, or
181	revocation of certificate of authority, license, or permit,
182	punishable as provided in s. 775.082 or s. 775.083. Each
183	instance of such violation shall be considered a separate
184	offense.
185	(2)  Each willful violation of an emergency rule or order
186	adopted or issued by the department is a felony of the third
187	degree and, in addition to any prescribed applicable denial,
188	suspension, or revocation of a certificate of authority,
189	license, or permit, is punishable as provided in s. 775.082, s.
190	775.083, or s. 775.084. Each instance of such violation shall be
191	considered a separate offense.
192	Section 4.  Subsection (2) of section 624.155, Florida
193	Statutes, is amended to read:
194	624.155  Civil remedy.--
195	(2)  Any party may bring a civil action against any person
196	acting as an unauthorized insurer without a certificate of
197	authority if such party is damaged by a violation of s. 624.401
198	by that person the unauthorized insurer.
199	Section 5.  Subsection (9) is added to section 626.112,
200	Florida Statutes, to read:
201	626.112  License and appointment required; agents, customer
202	representatives, adjusters, insurance agencies, service
203	representatives, managing general agents.--
204	(9)  Any person who transacts insurance or otherwise
205	engages in insurance activities in this state without a license
206	in violation of this section commits a felony of the third
207	degree, punishable as provided in s. 775.082, s. 775.083, or s.
208	775.084.
209	Section 6.  Paragraph (d) of subsection (4) of section
210	626.901, Florida Statutes, is amended to read:
211	626.901  Representing or aiding unauthorized insurer
212	prohibited.--
213	(4)  This section does not apply to:
214	(d)  Independently procured coverage written pursuant to s.
215	626.938, which is not solicited, marketed, negotiated, or sold
216	within this state.
217	Section 7.  Subsections (1), (2), and (9) of section
218	626.938, Florida Statutes, are amended to read:
219	626.938  Report and tax of independently procured
220	coverages.--
221	(1)  Every insured who resides in this state and procures
222	or causes to be procured or continues or renews insurance from
223	another state or country with an unauthorized foreign or alien
224	insurer legitimately licensed in that jurisdiction, or any self-
225	insurer who resides in this state and so procures or continues
226	excess loss, catastrophe, or other insurance, upon a subject of
227	insurance resident, located, or to be performed within this
228	state, other than insurance procured through a surplus lines
229	agent pursuant to the Surplus Lines Law of this state or
230	exempted from tax under s. 626.932(4), shall, within 30 days
231	after the date such insurance was so procured, continued, or
232	renewed, file a report of the same with the Florida Surplus
233	Lines Service Office in writing and upon forms designated by the
234	Florida Surplus Lines Service Office and furnished to such an
235	insured upon request, or in a computer readable format as
236	determined by the Florida Surplus Lines Service Office. The
237	report shall show the name and address of the insured or
238	insureds, the name and address of the insurer, the subject of
239	the insurance, a general description of the coverage, the amount
240	of premium currently charged therefor, and such additional
241	pertinent information as is reasonably requested by the Florida
242	Surplus Lines Service Office.
243	(2)  Any insurance in an unauthorized insurer legitimately
244	licensed in another state or country procured through
245	solicitations, negotiations, or an application, in whole or in
246	part occurring or made outside within or from within this state,
247	or for which premiums in whole or in part are remitted directly
248	or indirectly from within this state, shall be deemed to be
249	insurance procured, continued, or renewed in this state within
250	the intent of subsection (1).
251	(9)  This section does not authorize independent
252	procurement of workers' compensation insurance, apply as to life
253	insurance, or health insurance.
254	Section 8.  Subsection (6) of section 626.989, Florida
255	Statutes, is amended to read:
256	626.989  Investigation by department or Division of
257	Insurance Fraud; compliance; immunity; confidential information;
258	reports to division; division investigator's power of arrest.--
259	(6)  Any person, other than an insurer, agent, or other
260	person licensed under the code, or an employee thereof, having
261	knowledge or who believes that a fraudulent insurance act or any
262	other act or practice which, upon conviction, constitutes a
263	felony or a misdemeanor under the code, or under s. 817.234, is
264	being or has been committed may send to the Division of
265	Insurance Fraud a report or information pertinent to such
266	knowledge or belief and such additional information relative
267	thereto as the department may request. However, any professional
268	practitioner licensed or regulated by the Department of Business
269	and Professional Regulation, except as otherwise provided by
270	law, any medical review committee as defined in s. 766.101, any
271	private medical review committee, any self-insured entity
272	contracting or associated with the National Insurance Crime
273	Bureau, and any insurer, agent, or other person licensed under
274	the code, or an employee thereof, having knowledge or who
275	believes that a fraudulent insurance act or any other act or
276	practice which, upon conviction, constitutes a felony or a
277	misdemeanor under the code, or under s. 817.234, is being or has
278	been committed shall send to the Division of Insurance Fraud a
279	report or information pertinent to such knowledge or belief and
280	such additional information relative thereto as the department
281	may require. The Division of Insurance Fraud shall review such
282	information or reports and select such information or reports
283	as, in its judgment, may require further investigation. It shall
284	then cause an independent examination of the facts surrounding
285	such information or report to be made to determine the extent,
286	if any, to which a fraudulent insurance act or any other act or
287	practice which, upon conviction, constitutes a felony or a
288	misdemeanor under the code, or under s. 817.234, is being
289	committed. The Division of Insurance Fraud shall report any
290	alleged violations of law which its investigations disclose to
291	the appropriate licensing agency and state attorney or other
292	prosecuting agency having jurisdiction with respect to any such
293	violation, as provided in s. 624.310. If prosecution by the
294	state attorney or other prosecuting agency having jurisdiction
295	with respect to such violation is not begun within 60 days of
296	the division's report, the state attorney or other prosecuting
297	agency having jurisdiction with respect to such violation shall
298	inform the division of the reasons for the lack of prosecution.
299	The division may adopt rules which set forth requirements for
300	the manner in which suspected fraudulent activity shall be
301	reported to the division through the use of a standard referral
302	form.
303	Section 9.  Paragraph (a) of subsection (7) and subsection
304	(9) of section 817.234, Florida Statutes, are amended to read:
305	817.234  False and fraudulent insurance claims.--
306	(7)(a)  It shall constitute a material omission and
307	insurance fraud, punishable as provided in subsection (11), for
308	any service physician or other provider, other than a hospital,
309	to engage in a general business practice of billing amounts as
310	its usual and customary charge, if such provider has agreed with
311	the insured patient or intends to waive deductibles or
312	copayments, or does not for any other reason intend to collect
313	the total amount of such charge. With respect to a determination
314	as to whether a service physician or other provider has engaged
315	in such general business practice, consideration shall be given
316	to evidence of whether the service physician or other provider
317	made a good faith attempt to collect such deductible or
318	copayment. This paragraph does not apply to physicians or other
319	providers who waive deductibles or copayments or reduce their
320	bills as part of a bodily injury settlement or verdict.
321	(9)  A person may not organize, plan, or knowingly
322	participate in an intentional motor vehicle crash or a scheme to
323	create documentation of a motor vehicle crash that did not occur
324	for the purpose of making motor vehicle tort claims or claims
325	for personal injury protection benefits as required by s.
326	627.736. Any person who violates this subsection commits a
327	felony of the second degree, punishable as provided in s.
328	775.082, s. 775.083, or s. 775.084. A person who is convicted of
329	a violation of this subsection shall be sentenced to a minimum
330	term of imprisonment of 2 years.
331	Section 10.  Section 817.2361, Florida Statutes, is amended
332	to read:
333	817.2361  False or fraudulent proof of motor vehicle
334	insurance card.--Any person who, with intent to deceive any
335	other person, creates, markets, or presents a false or
336	fraudulent proof of motor vehicle insurance card commits a
337	felony of the third degree, punishable as provided in s.
338	775.082, s. 775.083, or s. 775.084.
339	Section 11.  Subsection (2) of section 817.50, Florida
340	Statutes, is amended to read:
341	817.50  Fraudulently obtaining goods, services, etc., from
342	a health care provider.--
343	(2)  If any person gives to any health care provider in
344	this state a false or fictitious name or a false or fictitious
345	address or assigns to any health care provider the proceeds of
346	any health maintenance contract or insurance contract, then
347	knowing that such contract is no longer in force, is invalid, or
348	is void for any reason, such action shall be prima facie
349	evidence of the intent of such person to defraud the health care
350	provider. However, this subsection does not apply to
351	investigative actions taken by law enforcement officers for law
352	enforcement purposes in the course of their official duties.
353	Section 12.  Subsection (1) and paragraph (a) of subsection
354	(2) of section 817.505, Florida Statutes, are amended to read:
355	817.505  Patient brokering prohibited; exceptions;
356	penalties.--
357	(1)  It is unlawful for any person, including any health
358	care provider or health care facility, to:
359	(a)  Offer or pay any commission, bonus, rebate, kickback,
360	or bribe, directly or indirectly, in cash or in kind, or engage
361	in any split-fee arrangement, in any form whatsoever, to induce
362	the referral of patients or patronage to or from a health care
363	provider or health care facility;
364	(b)  Solicit or receive any commission, bonus, rebate,
365	kickback, or bribe, directly or indirectly, in cash or in kind,
366	or engage in any split-fee arrangement, in any form whatsoever,
367	in return for referring patients or patronage to or from a
368	health care provider or health care facility; or
369	(c)  Solicit or receive any commission, bonus, rebate,
370	kickback, or bribe, directly or indirectly, in cash or in kind,
371	or engage in any split-fee arrangement, in any form whatsoever,
372	in return for the acceptance or acknowledgement of treatment
373	from a health care provider or health care facility; or
374	(d)(c)  Aid, abet, advise, or otherwise participate in the
375	conduct prohibited under paragraph (a), or paragraph (b), or
376	paragraph (c).
377	(2)  For the purposes of this section, the term:
378	(a)  "Health care provider or health care facility" means
379	any person or entity licensed, certified, or registered;
380	required to be licensed, certified, or registered; or lawfully
381	exempt from being required to be licensed, certified, or
382	registered with the Agency for Health Care Administration; any
383	person or entity that has contracted with the Agency for Health
384	Care Administration to provide goods or services to Medicaid
385	recipients as provided under s. 409.907; a county health
386	department established under part I of chapter 154; any
387	community service provider contracting with the Department of
388	Children and Family Services to furnish alcohol, drug abuse, or
389	mental health services under part IV of chapter 394; any
390	substance abuse service provider licensed under chapter 397; or
391	any federally supported primary care program such as a migrant
392	or community health center authorized under ss. 329 and 330 of
393	the United States Public Health Services Act.
394	Section 13.  Section 843.08, Florida Statutes, is amended
395	to read:
396	843.08  Falsely personating officer, etc.--A person who
397	falsely assumes or pretends to be a sheriff, officer of the
398	Florida Highway Patrol, officer of the Fish and Wildlife
399	Conservation Commission, officer of the Department of
400	Environmental Protection, officer of the Department of
401	Transportation, officer of the Department of Financial Services,
402	officer of the Department of Corrections, correctional probation
403	officer, deputy sheriff, state attorney or assistant state
404	attorney, statewide prosecutor or assistant statewide
405	prosecutor, state attorney investigator, coroner, police
406	officer, lottery special agent or lottery investigator, beverage
407	enforcement agent, or watchman, or any member of the Parole
408	Commission and any administrative aide or supervisor employed by
409	the commission, or any personnel or representative of the
410	Department of Law Enforcement, and takes upon himself or herself
411	to act as such, or to require any other person to aid or assist
412	him or her in a matter pertaining to the duty of any such
413	officer, commits a felony of the third degree, punishable as
414	provided in s. 775.082, s. 775.083, or s. 775.084; however, a
415	person who falsely personates any such officer during the course
416	of the commission of a felony commits a felony of the second
417	degree, punishable as provided in s. 775.082, s. 775.083, or s.
418	775.084; except that if the commission of the felony results in
419	the death or personal injury of another human being, the person
420	commits a felony of the first degree, punishable as provided in
421	s. 775.082, s. 775.083, or s. 775.084.
422	Section 14.  If any provision of this act or the
423	application thereof to any person or circumstance is held
424	invalid, the invalidity does not affect other provisions or
425	applications of the act which can be given effect without the
426	invalid provision or application, and to this end, the
427	provisions of this act are declared severable.
428	Section 15.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.