HB 1117

1	A bill to be entitled
2	An act relating to Medicaid fraud; amending s. 499.067,
3	F.S.; requiring that the Department of Health deny,
4	revoke, suspend, or refuse to issue or renew a permit or
5	certificate of certain applicants, permittees, or
6	certificateholders that have been convicted of, or entered
7	a plea of guilty or nolo contendere to, regardless of
8	adjudication, a felony involving Medicaid fraud; amending
9	s. 624.418, F.S.; requiring that the Office of Insurance
10	Regulation deny, suspend, or revoke a certificate of
11	authority of a health insurer that has been convicted of,
12	or entered a plea of guilty or nolo contendere to,
13	regardless of adjudication, a felony involving Medicaid
14	fraud; defining the term "health insurer" for purposes of
15	penalties relating to Medicaid fraud; amending s.
16	626.6115, F.S.; requiring that the Department of Financial
17	Services deny, revoke, or suspend a health insurance
18	agency's license or refuse to issue or renew an
19	application for such a license if the business or
20	applicant has been convicted of, or entered a plea of
21	guilty or nolo contendere to, regardless of adjudication,
22	a felony involving Medicaid fraud; defining the term
23	"health insurance agency" for purposes of penalties
24	relating to Medicaid fraud; amending s. 641.45, F.S.;
25	requiring that the Office of Insurance Regulation deny,
26	revoke, or suspend a certificate of authority or refuse to
27	issue or renew an application for a certificate of
28	authority for certain prepaid health clinics or applicants
29	that have been convicted of, or entered a plea of guilty
30	or nolo contendere to, regardless of adjudication, a
31	felony involving Medicaid fraud; amending s. 641.52, F.S.;
32	providing for nonapplicability; requiring that the Agency
33	for Health Care Administration deny, revoke, or suspend a
34	health care provider certificate or refuse to issue or
35	renew an application for a health care provider
36	certificate for certain prepaid health clinics, health
37	maintenance organizations, or applicants that have been
38	convicted of, or entered a plea of guilty or nolo
39	contendere to, regardless of adjudication, a felony
40	involving Medicaid fraud; providing an effective date.
41
42	Be It Enacted by the Legislature of the State of Florida:
43
44	Section 1.  Subsection (8) is added to section 499.067,
45	Florida Statutes, to read:
46	499.067  Denial, suspension, or revocation of permit,
47	certification, or registration.-
48	(8)(a)  The department shall deny or refuse to issue a
49	permit or certificate to any applicant if the applicant has been
50	convicted of, or entered a plea of guilty or nolo contendere to,
51	regardless of adjudication, a felony under s. 409.920 or s.
52	409.9201, unless the conviction occurred more than 5 years
53	before the date of the application.
54	(b)  The department shall revoke, suspend, or refuse to
55	renew a permit or certificate to any permittee or
56	certificateholder if the permittee or certificateholder has been
57	convicted of, or entered a plea of guilty or nolo contendere to,
58	regardless of adjudication, a felony under s. 409.920 or s.
59	409.9201 on or after July 1, 2010, unless the conviction
60	occurred more than 5 years before the date of the application.
61	Section 2.  Subsection (4) is added to section 624.418,
62	Florida Statutes, to read:
63	624.418  Suspension, revocation of certificate of authority
64	for violations and special grounds.-
65	(4)(a)  The office shall revoke a health insurer's
66	certificate of authority if it finds that the insurer has been
67	convicted of, or entered a plea of guilty or nolo contendere to,
68	regardless of adjudication, a felony under s. 409.920 or s.
69	409.9201, unless the conviction occurred more than 5 years
70	before the date of the application.
71	(b)  As used in this subsection, the term "health insurer"
72	means any insurance company authorized to transact health
73	insurance in this state as defined in s. 624.603, a health
74	maintenance organization authorized to transact business in this
75	state pursuant to part I of chapter 641, or a prepaid health
76	clinic authorized to transact business in this state pursuant to
77	part II of chapter 641.
78	Section 3.  Section 626.6115, Florida Statutes, is amended
79	to read:
80	626.6115  Grounds for compulsory refusal, suspension, or
81	revocation of insurance agency license.-
82	(1)  The department shall deny, suspend, revoke, or refuse
83	to continue the license of any insurance agency if it finds, as
84	to any insurance agency or as to any majority owner, partner,
85	manager, director, officer, or other person who manages or
86	controls such agency, that any of the following applicable
87	grounds exist:
88	(a)(1)  Lack by the agency of one or more of the
89	qualifications for the license as specified in this code.
90	(b)(2)  Material misstatement, misrepresentation, or fraud
91	in obtaining the license or in attempting to obtain the license.
92	(c)(3)  Denial, suspension, or revocation of a license to
93	practice or conduct any regulated profession, business, or
94	vocation relating to the business of insurance by this state,
95	any other state, any nation, any possession or district of the
96	United States, any court, or any lawful agency thereof. However,
97	the existence of grounds for administrative action against a
98	licensed agency does not constitute grounds for action against
99	any other licensed agency, including an agency that owns, is
100	under common ownership with, or is owned by, in whole or in
101	part, the agency for which grounds for administrative action
102	exist.
103	(2)(a)  In addition to the grounds set forth in subsection
104	(1), the department shall deny, suspend, revoke, or refuse to
105	continue the license of any health insurance agency if it finds
106	that the health insurance agency or any majority owner, partner,
107	manager, director, officer, or other person who manages or
108	controls such agency has been convicted of, or entered a plea of
109	guilty or nolo contendere to, regardless of adjudication, a
110	felony under s. 409.920 or s. 409.9201, unless the conviction
111	occurred more than 5 years before the date of the application.
112	(b)  As used in this subsection, the term "health insurance
113	agency" means a business location at which an individual, firm,
114	partnership, corporation, association, or other entity, other
115	than an employee of the individual, firm, partnership,
116	corporation, association, or other entity and other than an
117	insurer as defined by s. 624.03 or an adjuster as defined in s.
118	626.015, engages in any activity or employs individuals to
119	engage in any activity that by law may be performed only by a
120	licensed health agent as defined in s. 626.015.
121	Section 4.  Subsection (4) is added to section 641.45,
122	Florida Statutes, to read:
123	641.45  Revocation or cancellation of certificate of
124	authority; suspension of authority to enroll new subscribers;
125	terms of suspension.-
126	(4)  The office shall deny, suspend, or revoke a prepaid
127	health clinic's certificate of authority or refuse to issue or
128	renew an application for a certificate of authority if it finds
129	that the prepaid health clinic or applicant has been convicted
130	of, or entered a plea of guilty or nolo contendere to,
131	regardless of adjudication, a felony under s. 409.920 or s.
132	409.9201, unless the conviction occurred more than 5 years
133	before the date of the application.
134	Section 5.  Subsection (5) of section 641.52, Florida
135	Statutes, is amended, and subsection (8) is added to that
136	section, to read:
137	641.52  Revocation of certificate; suspension of new
138	enrollment; suspension of the health care provider certificate;
139	administrative fine; notice of action to the office; penalty for
140	use of unlicensed providers.-
141	(5)  If the agency finds that one or more grounds exist for
142	the revocation or suspension of a certificate issued under this
143	part, the agency may, in lieu of such revocation or suspension,
144	impose a fine upon the organization. With respect to any
145	nonwillful violation, the fine may not exceed $2,500 per
146	violation. Such fines may not exceed an aggregate amount of
147	$25,000 for all nonwillful violations arising out of the same
148	action. With respect to any knowing and willful violation of a
149	lawful order or rule of the agency or a provision of this part,
150	the agency may impose a fine upon the organization in an amount
151	not to exceed $20,000 for each such violation. Such fines may
152	not exceed an aggregate amount of $250,000 for all knowing and
153	willful violations arising out of the same action. The agency
154	shall, by January 1, 1997, adopt by rule penalty categories that
155	specify varying ranges of fines for willful violations and for
156	nonwillful violations. This subsection does not apply to an
157	organization in which the agency has found that any ground set
158	forth in subsection (8) exists for the revocation or suspension
159	of a certificate issued under this part.
160	(8)  The agency shall deny, suspend, or revoke an
161	organization's health care provider certificate or refuse to
162	issue or renew an application for a health care provider
163	certificate if it finds that the organization or applicant has
164	been convicted of, or entered a plea of guilty or nolo
165	contendere to, regardless of adjudication, a felony under s.
166	409.920 or s. 409.9201, unless the conviction occurred more than
167	5 years before the date of the application.
168	Section 6.  This act shall take effect July 1, 2010.

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