Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1930
                                Barcode 679970                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Judiciary (Bogdanoff) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (1) of section 316.066, Florida
    6  Statutes, is amended to read:
    7         316.066 Written reports of crashes.—
    8         (1)(a) A Florida Traffic Crash Report, Long Form, must is
    9  required to be completed and submitted to the department within
   10  10 days after completing an investigation is completed by the
   11  every law enforcement officer who in the regular course of duty
   12  investigates a motor vehicle crash:
   13         1. That resulted in death, or personal injury, or any
   14  indication of complaints of pain or discomfort by any of the
   15  parties or passengers involved in the crash;.
   16         2. That involved one or more passengers, other than the
   17  drivers of the vehicles, in any of the vehicles involved in the
   18  crash;
   19         3.2. That involved a violation of s. 316.061(1) or s.
   20  316.193; or.
   21         4.3. In which a vehicle was rendered inoperative to a
   22  degree that required a wrecker to remove it from traffic, if
   23  such action is appropriate, in the officer’s discretion.
   24         (b) In every crash for which a Florida Traffic Crash
   25  Report, Long Form, is not required by this section, the law
   26  enforcement officer may complete a short-form crash report or
   27  provide a short-form crash report to be completed by each party
   28  involved in the crash. Short-form crash reports prepared by the
   29  law enforcement officer shall be maintained by the officer’s
   30  agency.
   31         (c) The long-form and the short-form report must include:
   32         1. The date, time, and location of the crash.
   33         2. A description of the vehicles involved.
   34         3. The names and addresses of the parties involved.
   35         4. The names and addresses of all passengers in all
   36  vehicles involved in the crash, each clearly identified as being
   37  a passenger, and the identification of the vehicle in which they
   38  were a passenger.
   39         5.4. The names and addresses of witnesses.
   40         6.5. The name, badge number, and law enforcement agency of
   41  the officer investigating the crash.
   42         7.6. The names of the insurance companies for the
   43  respective parties involved in the crash.
   44         (d)(c) Each party to the crash must shall provide the law
   45  enforcement officer with proof of insurance, which must to be
   46  included in the crash report. If a law enforcement officer
   47  submits a report on the accident, proof of insurance must be
   48  provided to the officer by each party involved in the crash. Any
   49  party who fails to provide the required information commits a
   50  noncriminal traffic infraction, punishable as a nonmoving
   51  violation as provided in chapter 318, unless the officer
   52  determines that due to injuries or other special circumstances
   53  such insurance information cannot be provided immediately. If
   54  the person provides the law enforcement agency, within 24 hours
   55  after the crash, proof of insurance that was valid at the time
   56  of the crash, the law enforcement agency may void the citation.
   57         (e)(d) The driver of a vehicle that was in any manner
   58  involved in a crash resulting in damage to any vehicle or other
   59  property in an amount of $500 or more, which crash was not
   60  investigated by a law enforcement agency, shall, within 10 days
   61  after the crash, submit a written report of the crash to the
   62  department or traffic records center. The entity receiving the
   63  report may require witnesses of the crash crashes to render
   64  reports and may require any driver of a vehicle involved in a
   65  crash of which a written report must be made as provided in this
   66  section to file supplemental written reports if whenever the
   67  original report is deemed insufficient by the receiving entity.
   68         (f) The investigating law enforcement officer may testify
   69  at trial or provide a signed affidavit to confirm or supplement
   70  the information included on the long-form or short-form report.
   71         (e) Short-form crash reports prepared by law enforcement
   72  shall be maintained by the law enforcement officer’s agency.
   73         Section 2. Subsection (6) is added to section 400.991,
   74  Florida Statutes, to read:
   75         400.991 License requirements; background screenings;
   76  prohibitions.—
   77         (6) All forms that constitute part of the application for
   78  licensure or exemption from licensure under this part must
   79  contain the following statement:
   81         INSURANCE FRAUD NOTICE.—Submitting a false, misleading, or
   82  fraudulent application or other document when applying for
   83  licensure as a health care clinic, when seeking an exemption
   84  from licensure as a health care clinic, or when demonstrating
   85  compliance with part X of chapter 400, Florida Statutes, is a
   86  fraudulent insurance act, as defined in s. 626.989 or s.
   87  817.234, Florida Statutes, subject to investigation by the
   88  Division of Insurance Fraud, and is grounds for discipline by
   89  the appropriate licensing board of the Department of Health.
   90         Section 3. Section 626.9894, Florida Statutes, is created
   91  to read:
   92         626.9894Motor vehicle insurance fraud direct-support
   93  organization.—
   94         (1) DEFINITIONS.—As used in this section, the term:
   95         (a) “Division” means the Division of Insurance Fraud of the
   96  Department of Financial Services.
   97         (b) “Motor vehicle insurance fraud” means any act defined
   98  as a “fraudulent insurance act” under s. 626.989, which relates
   99  to the coverage of motor vehicle insurance as described in part
  100  XI of chapter 627.
  101         (c) “Organization” means the direct-support organization
  102  established under this section.
  103         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  104  direct-support organization, to be known as the “Automobile
  105  Insurance Fraud Strike Force,” whose sole purpose is to support
  106  the prosecution, investigation, and prevention of motor vehicle
  107  insurance fraud. The organization shall:
  108         (a) Be a not-for-profit corporation incorporated under
  109  chapter 617 and approved by the Department of State.
  110         (b) Be organized and operated to conduct programs and
  111  activities; to raise funds; to request and receive grants,
  112  gifts, and bequests of money; to acquire, receive, hold, invest,
  113  and administer, in its own name, securities, funds, objects of
  114  value, or other property, real or personal; and to make grants
  115  and expenditures to or for the direct or indirect benefit of the
  116  division, state attorneys’ offices, the statewide prosecutor,
  117  the Agency for Health Care Administration, and the Department of
  118  Health to the extent that such grants and expenditures are to be
  119  used exclusively to advance the purpose of prosecuting,
  120  investigating, or preventing motor vehicle insurance fraud.
  121  Grants and expenditures may include the cost of salaries or
  122  benefits of dedicated motor vehicle insurance fraud
  123  investigators, prosecutors, or support personnel if such grants
  124  and expenditures do not interfere with prosecutorial
  125  independence or otherwise create conflicts of interest which
  126  threaten the success of prosecutions.
  127         (c) Be determined by the division to operate in a manner
  128  that promotes the goals of laws relating to motor vehicle
  129  insurance fraud, that is in the best interest of the state, and
  130  that is in accordance with the adopted goals and mission of the
  131  division.
  132         (d) Use all of its grants and expenditures solely for the
  133  purpose of preventing and decreasing motor vehicle insurance
  134  fraud, and not for the purpose of lobbying as defined in s.
  135  11.045.
  136         (e) Be subject to an annual financial audit in accordance
  137  with s. 215.981.
  138         (3) CONTRACT.—The organization shall operate under written
  139  contract with the division. The contract must provide for:
  140         (a) Approval of the articles of incorporation and bylaws of
  141  the organization by the division.
  142         (b) Submission of an annual budget for the approval of the
  143  division. The budget must require the organization to minimize
  144  costs to the division and its members at all times by using
  145  existing personnel and property and allowing for telephonic
  146  meetings when appropriate.
  147         (c) Certification by the division that the direct-support
  148  organization is complying with the terms of the contract and in
  149  a manner consistent with the goals and purposes of the
  150  department and in the best interest of the state. Such
  151  certification must be made annually and reported in the official
  152  minutes of a meeting of the organization.
  153         (d) Allocation of funds to address motor vehicle insurance
  154  fraud.
  155         (e) Reversion of moneys and property held in trust by the
  156  organization for motor vehicle insurance fraud prosecution,
  157  investigation, and prevention to the division if the
  158  organization is no longer approved to operate for the department
  159  or if the organization ceases to exist, or to the state if the
  160  division ceases to exist.
  161         (f) Specific criteria to be used by the organization’s
  162  board of directors to evaluate the effectiveness of funding used
  163  to combat motor vehicle insurance fraud.
  164         (g) The fiscal year of the organization, which begins July
  165  1 of each year and ends June 30 of the following year.
  166         (h) Disclosure of the material provisions of the contract,
  167  and distinguishing between the department and the organization
  168  to donors of gifts, contributions, or bequests, including
  169  providing such disclosure on all promotional and fundraising
  170  publications.
  171         (4) BOARD OF DIRECTORS.—The board of directors of the
  172  organization shall consist of the following seven members:
  173         (a) The Chief Financial Officer, or designee, who shall
  174  serve as chair.
  175         (b) Two state attorneys, one of whom shall be appointed by
  176  the Chief Financial Officer and one of whom shall be appointed
  177  by the Attorney General.
  178         (c) Two representatives of motor vehicle insurers appointed
  179  by the Chief Financial Officer.
  180         (d) Two representatives of local law enforcement agencies,
  181  both of whom shall be appointed by the Chief Financial Officer.
  183         The officer who appointed a member of the board may remove
  184  that member for cause. The term of office of an appointed member
  185  expires at the same time as the term of the officer who
  186  appointed him or her or at such earlier time as the person
  187  ceases to be qualified.
  188         (5) USE OF PROPERTY.—The department may authorize, without
  189  charge, appropriate use of fixed property and facilities of the
  190  division by the organization, subject to this subsection.
  191         (a) The department may prescribe any condition with which
  192  the organization must comply in order to use the division’s
  193  property or facilities.
  194         (b) The department may not authorize the use of the
  195  division’s property or facilities if the organization does not
  196  provide equal membership and employment opportunities to all
  197  persons regardless of race, religion, sex, age, or national
  198  origin.
  199         (c) The department shall adopt rules prescribing the
  200  procedures by which the organization is governed and any
  201  conditions with which the organization must comply to use the
  202  division’s property or facilities.
  203         (6) CONTRIBUTIONS.—Any contributions made by an insurer to
  204  the organization shall be allowed as appropriate business
  205  expenses for all regulatory purposes.
  206         (7) DEPOSITORY.—Any moneys received by the organization may
  207  be held in a separate depository account in the name of the
  208  organization and subject to the provisions of the contract with
  209  the division.
  210         (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division
  211  receives proceeds from the organization, those proceeds shall be
  212  deposited into the Insurance Regulatory Trust Fund.
  213         Section 4. Subsection (3) is added to section 627.4137,
  214  Florida Statutes, to read:
  215         627.4137 Disclosure of certain information required.—
  216         (3)Any request made to a self-insured corporation pursuant
  217  to this section must be sent by certified mail to the registered
  218  agent of the disclosing entity.
  219         Section 5. Section 627.730, Florida Statutes, is amended to
  220  read:
  221         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  222  627.730-627.7407 627.730-627.7405 may be cited and known as the
  223  “Florida Motor Vehicle No-Fault Law.”
  224         Section 6. Section 627.731, Florida Statutes, is amended to
  225  read:
  226         627.731 Purpose; legislative intent.—The purpose of the no
  227  fault law ss. 627.730-627.7405 is to provide for medical,
  228  surgical, funeral, and disability insurance benefits without
  229  regard to fault, and to require motor vehicle insurance securing
  230  such benefits, for motor vehicles required to be registered in
  231  this state and, with respect to motor vehicle accidents, a
  232  limitation on the right to claim damages for pain, suffering,
  233  mental anguish, and inconvenience.
  234         (1) The Legislature finds that automobile insurance fraud
  235  remains a major problem for state consumers and insurers.
  236  According to the National Insurance Crime Bureau, in recent
  237  years this state has been among those states that have the
  238  highest number of fraudulent and questionable claims.
  239         (2) The Legislature intends to balance the insured’s
  240  interest in prompt payment of valid claims for insurance
  241  benefits under the no-fault law with the public’s interest in
  242  reducing fraud, abuse, and overuse of the no-fault system. To
  243  that end, the Legislature intends that the investigation and
  244  prevention of fraudulent insurance acts in this state be
  245  enhanced, that additional sanctions for such acts be imposed,
  246  and that the no-fault law be revised to remove incentives for
  247  fraudulent insurance acts. The Legislature intends that the no
  248  fault law be construed according to the plain language of the
  249  statutory provisions, which are designed to meet these goals.
  250         (3) The Legislature intends that:
  251         (a) Insurers properly investigate claims, and as such, be
  252  allowed to obtain examinations under oath and sworn statements
  253  from any claimant seeking no-fault insurance benefits, and to
  254  request mental and physical examinations of persons seeking
  255  personal injury protection coverage or benefits.
  256         (b) Any false, misleading, or otherwise fraudulent activity
  257  associated with a claim renders any claim brought by a claimant
  258  engaging in such activity invalid. An insurer must be able to
  259  raise fraud as a defense to a claim for no-fault insurance
  260  benefits irrespective of any prior adjudication of guilt or
  261  determination of fraud by the Department of Financial Services.
  262         (c) Insurers toll the payment or denial of a claim, with
  263  respect to any portion of a claim for which the insurer has a
  264  reasonable belief that a fraudulent insurance act, as defined in
  265  s. 626.989, has been committed.
  266         (d) Insurers discover the names of all passengers involved
  267  in an automobile accident before paying claims or benefits
  268  pursuant to an insurance policy governed by the no-fault law. A
  269  rebuttable presumption must be established that a person was not
  270  involved in the event giving rise to the claim if that person’s
  271  name does not appear on the police report.
  272         (e) The insured’s interest in obtaining competent counsel
  273  must be balanced with the public’s interest in preventing a no
  274  fault system that encourages litigation by allowing for
  275  exorbitant attorney’s fees. Courts should limit attorney fee
  276  awards so as to eliminate the incentive for attorneys to
  277  manufacture unnecessary litigation.
  278         Section 7. Section 627.732, Florida Statutes, is reordered
  279  and amended to read:
  280         627.732 Definitions.—As used in the no-fault law ss.
  281  627.730-627.7405, the term:
  282         (1) “Broker” means any person not possessing a license
  283  under chapter 395, chapter 400, chapter 429, chapter 458,
  284  chapter 459, chapter 460, chapter 461, or chapter 641 who
  285  charges or receives compensation for any use of medical
  286  equipment and is not the 100-percent owner or the 100-percent
  287  lessee of such equipment. For purposes of this section, such
  288  owner or lessee may be an individual, a corporation, a
  289  partnership, or any other entity and any of its 100-percent
  290  owned affiliates and subsidiaries. For purposes of this
  291  subsection, the term “lessee” means a long-term lessee under a
  292  capital or operating lease, but does not include a part-time
  293  lessee. The term “broker” does not include a hospital or
  294  physician management company whose medical equipment is
  295  ancillary to the practices managed, a debt collection agency, or
  296  an entity that has contracted with the insurer to obtain a
  297  discounted rate for such services; or nor does the term include
  298  a management company that has contracted to provide general
  299  management services for a licensed physician or health care
  300  facility and whose compensation is not materially affected by
  301  the usage or frequency of usage of medical equipment or an
  302  entity that is 100-percent owned by one or more hospitals or
  303  physicians. The term “broker” does not include a person or
  304  entity that certifies, upon request of an insurer, that:
  305         (a) It is a clinic licensed under ss. 400.990-400.995;
  306         (b) It is a 100-percent owner of medical equipment; and
  307         (c) The owner’s only part-time lease of medical equipment
  308  for personal injury protection patients is on a temporary basis,
  309  not to exceed 30 days in a 12-month period, and such lease is
  310  solely for the purposes of necessary repair or maintenance of
  311  the 100-percent-owned medical equipment or pending the arrival
  312  and installation of the newly purchased or a replacement for the
  313  100-percent-owned medical equipment, or for patients for whom,
  314  because of physical size or claustrophobia, it is determined by
  315  the medical director or clinical director to be medically
  316  necessary that the test be performed in medical equipment that
  317  is open-style. The leased medical equipment may not cannot be
  318  used by patients who are not patients of the registered clinic
  319  for medical treatment of services. Any person or entity making a
  320  false certification under this subsection commits insurance
  321  fraud as defined in s. 817.234. However, the 30-day period
  322  provided in this paragraph may be extended for an additional 60
  323  days as applicable to magnetic resonance imaging equipment if
  324  the owner certifies that the extension otherwise complies with
  325  this paragraph.
  326         (10)(2) “Medically necessary” refers to a medical service
  327  or supply that a prudent physician would provide for the purpose
  328  of preventing, diagnosing, or treating an illness, injury,
  329  disease, or symptom in a manner that is:
  330         (a) In accordance with generally accepted standards of
  331  medical practice;
  332         (b) Clinically appropriate in terms of type, frequency,
  333  extent, site, and duration; and
  334         (c) Not primarily for the convenience of the patient,
  335  physician, or other health care provider.
  336         (11)(3) “Motor vehicle” means a any self-propelled vehicle
  337  with four or more wheels which is of a type both designed and
  338  required to be licensed for use on the highways of this state,
  339  and any trailer or semitrailer designed for use with such
  340  vehicle, and includes:
  341         (a) A “private passenger motor vehicle,” which is any motor
  342  vehicle that which is a sedan, station wagon, or jeep-type
  343  vehicle and, if not used primarily for occupational,
  344  professional, or business purposes, a motor vehicle of the
  345  pickup, panel, van, camper, or motor home type.
  346         (b) A “commercial motor vehicle,” which is any motor
  347  vehicle that which is not a private passenger motor vehicle.
  349         The term “motor vehicle” does not include a mobile home or
  350  any motor vehicle that which is used in mass transit, other than
  351  public school transportation, and designed to transport more
  352  than five passengers exclusive of the operator of the motor
  353  vehicle and that which is owned by a municipality, a transit
  354  authority, or a political subdivision of the state.
  355         (12)(4) “Named insured” means a person, usually the owner
  356  of a vehicle, identified in a policy by name as the insured
  357  under the policy.
  358         (13) “No-fault law” means the Florida Motor Vehicle No
  359  Fault Law codifed at ss. 627.730-627.7407.
  360         (14)(5) “Owner” means a person who holds the legal title to
  361  a motor vehicle; or, if in the event a motor vehicle is the
  362  subject of a security agreement or lease with an option to
  363  purchase with the debtor or lessee having the right to
  364  possession, then the debtor or lessee is shall be deemed the
  365  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  366         (16)(6) “Relative residing in the same household” means a
  367  relative of any degree by blood or by marriage who usually makes
  368  her or his home in the same family unit, whether or not
  369  temporarily living elsewhere.
  370         (2)(7) “Certify” means to swear or attest to being true or
  371  represented in writing.
  372         (3) “Claimant” means the person, organization, or entity
  373  seeking benefits, including all assignees.
  374         (4) “Entity wholly owned” means a proprietorship, group
  375  practice, partnership, or corporation that provides health care
  376  services rendered by licensed health care practitioners. In
  377  order to be wholly owned, licensed health care practitioners
  378  must be the business owners of all aspects of the business
  379  entity, including, but not limited to, being reflected as the
  380  business owners on the title or lease of the physical facility,
  381  filing taxes as the business owners, being account holders on
  382  the entity’s bank account, being listed as the principals on all
  383  incorporation documents required by this state, and having
  384  ultimate authority over all personnel and compensation decisions
  385  relating to the entity.
  386         (6)(8) “Immediate personal supervision,” as it relates to
  387  the performance of medical services by nonphysicians not in a
  388  hospital, means that an individual licensed to perform the
  389  medical service or provide the medical supplies must be present
  390  within the confines of the physical structure where the medical
  391  services are performed or where the medical supplies are
  392  provided such that the licensed individual can respond
  393  immediately to any emergencies if needed.
  394         (7)(9) “Incident,” with respect to services considered as
  395  incident to a physician’s professional service, for a physician
  396  licensed under chapter 458, chapter 459, chapter 460, or chapter
  397  461, if not furnished in a hospital, means such services that
  398  are must be an integral, even if incidental, part of a covered
  399  physician’s service.
  400         (8)(10) “Knowingly” means that a person, with respect to
  401  information, has actual knowledge of the information,; acts in
  402  deliberate ignorance of the truth or falsity of the
  403  information,; or acts in reckless disregard of the information.,
  404  and Proof of specific intent to defraud is not required.
  405         (9)(11) “Lawful” or “lawfully” means in substantial
  406  compliance with all relevant applicable criminal, civil, and
  407  administrative requirements of state and federal law related to
  408  the provision of medical services or treatment.
  409         (5)(12) “Hospital” means a facility that, at the time
  410  services or treatment were rendered, was licensed under chapter
  411  395.
  412         (15)(13) “Properly completed” means providing truthful,
  413  substantially complete, and substantially accurate responses as
  414  to all material elements of to each applicable request for
  415  information or statement by a means that may lawfully be
  416  provided and that complies with this section, or as agreed by
  417  the parties.
  418         (18)(14) “Upcoding” means submitting an action that submits
  419  a billing code that would result in payment greater in amount
  420  than would be paid using a billing code that accurately
  421  describes the services performed. The term does not include an
  422  otherwise lawful bill by a magnetic resonance imaging facility,
  423  which globally combines both technical and professional
  424  components, if the amount of the global bill is not more than
  425  the components if billed separately; however, payment of such a
  426  bill constitutes payment in full for all components of such
  427  service.
  428         (17)(15) “Unbundling” means submitting an action that
  429  submits a billing code that is properly billed under one billing
  430  code, but that has been separated into two or more billing
  431  codes, and would result in payment greater than the in amount
  432  that than would be paid using one billing code.
  433         Section 8. Subsections (1) and (4) of section 627.736,
  434  Florida Statutes, are amended, subsections (5) through (16) of
  435  that section are redesignated as subsections (6) through (17),
  436  respectively, a new subsection (5) is added to that section,
  437  present subsection (5), paragraph (b) of present subsection (6),
  438  paragraph (b) of present subsection (7), and present subsections
  439  (8), (9), and (10) of that section are amended, to read:
  440         627.736 Required personal injury protection benefits;
  441  exclusions; priority; claims.—
  442         (1) REQUIRED BENEFITS.—Every insurance policy complying
  443  with the security requirements of s. 627.733 must shall provide
  444  personal injury protection to the named insured, relatives
  445  residing in the same household, persons operating the insured
  446  motor vehicle, passengers in such motor vehicle, and other
  447  persons struck by such motor vehicle and suffering bodily injury
  448  while not an occupant of a self-propelled vehicle, subject to
  449  the provisions of subsection (2) and paragraph (4)(h) (4)(e), to
  450  a limit of $10,000 for loss sustained by any such person as a
  451  result of bodily injury, sickness, disease, or death arising out
  452  of the ownership, maintenance, or use of a motor vehicle as
  453  follows:
  454         (a) Medical benefits.—Eighty percent of all reasonable
  455  expenses, charged pursuant to subsection (6), for medically
  456  necessary medical, surgical, X-ray, dental, and rehabilitative
  457  services, including prosthetic devices, and for medically
  458  necessary ambulance, hospital, and nursing services. However,
  459  the medical benefits shall provide reimbursement only for such
  460  services and care that are lawfully provided, supervised,
  461  ordered, or prescribed by a physician licensed under chapter 458
  462  or chapter 459, a dentist licensed under chapter 466, or a
  463  chiropractic physician licensed under chapter 460, or an
  464  acupuncturist licensed under chapter 457 exclusively to provide
  465  oriental medicine as defined in s. 457.102, or that are provided
  466  by any of the following persons or entities:
  467         1. A hospital or ambulatory surgical center licensed under
  468  chapter 395.
  469         2. A person or entity licensed under part III of chapter
  470  401 which ss. 401.2101-401.45 that provides emergency
  471  transportation and treatment.
  472         3. An entity wholly owned by one or more physicians
  473  licensed under chapter 458 or chapter 459, chiropractic
  474  physicians licensed under chapter 460, or dentists licensed
  475  under chapter 466 or by such practitioner or practitioners and
  476  the spouse, parent, child, or sibling of such that practitioner
  477  or those practitioners.
  478         4. An entity wholly owned, directly or indirectly, by a
  479  hospital or hospitals.
  480         5. A health care clinic licensed under part X of chapter
  481  400 which ss. 400.990-400.995 that is:
  482         a. Accredited by the Joint Commission on Accreditation of
  483  Healthcare Organizations, the American Osteopathic Association,
  484  the Commission on Accreditation of Rehabilitation Facilities, or
  485  the Accreditation Association for Ambulatory Health Care, Inc.;
  486  or
  487         b. A health care clinic that:
  488         (I) Has a medical director licensed under chapter 458,
  489  chapter 459, or chapter 460;
  490         (II) Has been continuously licensed for more than 3 years
  491  or is a publicly traded corporation that issues securities
  492  traded on an exchange registered with the United States
  493  Securities and Exchange Commission as a national securities
  494  exchange; and
  495         (III) Provides at least four of the following medical
  496  specialties:
  497         (A) General medicine.
  498         (B) Radiography.
  499         (C) Orthopedic medicine.
  500         (D) Physical medicine.
  501         (E) Physical therapy.
  502         (F) Physical rehabilitation.
  503         (G) Prescribing or dispensing outpatient prescription
  504  medication.
  505         (H) Laboratory services.
  507         If any services are provided by an entity or clinic
  508  described in subparagraph 3., subparagraph 4., or subparagraph
  509  5., the entity or clinic must provide the insurer at the initial
  510  submission of the claim with a form adopted by the Department of
  511  Financial Services which documents that the entity or clinic
  512  meets applicable criteria for such entity or clinic and includes
  513  a sworn statement or affidavit to that effect. Any change in
  514  ownership requires the filing of a new form within 10 days after
  515  the date of the change in ownership. If an insurer denies a
  516  claim based on failure to submit the proper form, the insurer
  517  must notify the provider, and the provider shall have 30 days
  518  after receipt of such notice to submit a properly completed
  519  form. If the provider fails to timely submit a properly
  520  completed claim, the insurer is not required to pay the claim.
  521  The Financial Services Commission shall adopt by rule the form
  522  that must be used by an insurer and a health care provider
  523  specified in subparagraph 3., subparagraph 4., or subparagraph
  524  5. to document that the health care provider meets the criteria
  525  of this paragraph, which rule must include a requirement for a
  526  sworn statement or affidavit.
  527         (b) Disability benefits.—Sixty percent of any loss of gross
  528  income and loss of earning capacity per individual from
  529  inability to work proximately caused by the injury sustained by
  530  the injured person, plus all expenses reasonably incurred in
  531  obtaining from others ordinary and necessary services in lieu of
  532  those that, but for the injury, the injured person would have
  533  performed without income for the benefit of his or her
  534  household. All disability benefits payable under this provision
  535  must shall be paid at least not less than every 2 weeks.
  536         (c) Death benefits.—Death benefits equal to the lesser of
  537  $5,000 or the remainder of unused personal injury protection
  538  benefits per individual. The insurer may pay such benefits to
  539  the executor or administrator of the deceased, to any of the
  540  deceased’s relatives by blood, or legal adoption, or connection
  541  by marriage, or to any person appearing to the insurer to be
  542  equitably entitled thereto.
  544         Only insurers writing motor vehicle liability insurance in
  545  this state may provide the required benefits of this section,
  546  and no such insurers may not insurer shall require the purchase
  547  of any other motor vehicle coverage other than the purchase of
  548  property damage liability coverage as required by s. 627.7275 as
  549  a condition for providing such required benefits. Insurers may
  550  not require that property damage liability insurance in an
  551  amount greater than $10,000 be purchased in conjunction with
  552  personal injury protection. Such insurers shall make benefits
  553  and required property damage liability insurance coverage
  554  available through normal marketing channels. An Any insurer
  555  writing motor vehicle liability insurance in this state who
  556  fails to comply with such availability requirement as a general
  557  business practice violates shall be deemed to have violated part
  558  IX of chapter 626, and such violation constitutes shall
  559  constitute an unfair method of competition or an unfair or
  560  deceptive act or practice involving the business of insurance.
  561  An; and any such insurer committing such violation is shall be
  562  subject to the penalties afforded in such part, as well as those
  563  that are which may be afforded elsewhere in the insurance code.
  564         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  565  the no-fault law are ss. 627.730-627.7405 shall be primary,
  566  except that benefits received under any workers’ compensation
  567  law shall be credited against the benefits provided by
  568  subsection (1) and are shall be due and payable as loss accrues,
  569  upon the receipt of reasonable proof of such loss and the amount
  570  of expenses and loss incurred which are covered by the policy
  571  issued under the no-fault law ss. 627.730-627.7405. If When the
  572  Agency for Health Care Administration provides, pays, or becomes
  573  liable for medical assistance under the Medicaid program related
  574  to injury, sickness, disease, or death arising out of the
  575  ownership, maintenance, or use of a motor vehicle, the benefits
  576  are under ss. 627.730-627.7405 shall be subject to the
  577  provisions of the Medicaid program.
  578         (a) An insurer may require written notice to be given as
  579  soon as practicable after an accident involving a motor vehicle
  580  with respect to which the policy affords the security required
  581  by the no-fault law ss. 627.730-627.7405.
  582         (b) Personal injury protection insurance benefits paid
  583  pursuant to this section are shall be overdue if not paid within
  584  30 days after the insurer is furnished written notice of the
  585  fact of a covered loss and of the amount of same. If such
  586  written notice is not furnished to the insurer as to the entire
  587  claim, any partial amount supported by written notice is overdue
  588  if not paid within 30 days after the such written notice is
  589  furnished to the insurer. Any part or all of the remainder of
  590  the claim that is subsequently supported by written notice is
  591  overdue if not paid within 30 days after such written notice is
  592  furnished to the insurer. For the purpose of calculating the
  593  extent to which benefits are overdue, payment shall be
  594  considered made on the date a draft or other valid instrument
  595  that is equivalent to payment is placed in the United States
  596  mail in a properly addressed, postpaid envelope, or, if not so
  597  posted, on the date of delivery.
  598         (c) If When an insurer pays only a portion of a claim or
  599  rejects a claim, the insurer shall provide at the time of the
  600  partial payment or rejection an itemized specification of each
  601  item that the insurer had reduced, omitted, or declined to pay
  602  and any information that the insurer desires the claimant to
  603  consider related to the medical necessity of the denied
  604  treatment or to explain the reasonableness of the reduced
  605  charge, provided that this does shall not limit the introduction
  606  of evidence at trial.; and The insurer must shall include the
  607  name and address of the person to whom the claimant should
  608  respond, and a claim number to be referenced in future
  609  correspondence, and a detailed description of the amount paid
  610  for each date of service. The insurer’s failure to send an
  611  itemized specification or explanation of benefits does not waive
  612  other grounds for rejecting an invalid claim.
  613         (d)A However, notwithstanding the fact that written notice
  614  has been furnished to the insurer, Any payment is shall not be
  615  deemed overdue if when the insurer has reasonable proof to
  616  establish that the insurer is not responsible for the payment.
  617  An insurer may obtain evidence and assert any ground for
  618  adjustment or rejection of a For the purpose of calculating the
  619  extent to which any benefits are overdue, payment shall be
  620  treated as being made on the date a draft or other valid
  621  instrument which is equivalent to payment was placed in the
  622  United States mail in a properly addressed, postpaid envelope
  623  or, if not so posted, on the date of delivery. This paragraph
  624  does not preclude or limit the ability of the insurer to assert
  625  that the claim that is was unrelated, was not medically
  626  necessary, or was unreasonable, or submitted that the amount of
  627  the charge was in excess of that permitted under, or in
  628  violation of, subsection (6) (5). Such assertion by the insurer
  629  may be made at any time, including after payment of the claim,
  630  or after the 30-day time period for payment set forth in this
  631  paragraph (b), or after the filing of a lawsuit.
  632         (e) The 30-day period for payment is tolled while the
  633  insurer investigates a fraudulent insurance act, as defined in
  634  s. 626.989, with respect to any portion of a claim for which the
  635  insurer has a reasonable belief that a fraudulent insurance act
  636  has been committed. The insurer must notify the claimant in
  637  writing that it is investigating a fraudulent insurance act
  638  within 30 days after the date it has a reasonable belief that
  639  such act has been committed. The insurer must pay or deny the
  640  claim, in full or in part, within 15 days after completion of
  641  its investigation. However, no payment is due to a claimant who
  642  has violated paragraph (k).
  643         (f)(c)Except as otherwise provided under a local lien law
  644  applicable to a trauma center hospital that compensates
  645  physicians who provide emergency services and care or hospital
  646  inpatient services, upon receiving notice of an accident that is
  647  potentially covered by personal injury protection benefits, the
  648  insurer must reserve $5,000 of personal injury protection
  649  benefits for payment to physicians licensed under chapter 458 or
  650  chapter 459 or dentists licensed under chapter 466 who provide
  651  emergency services and care, as defined in s. 395.002(9), or who
  652  provide hospital inpatient care. The amount required to be held
  653  in reserve may be used only to pay claims from such physicians
  654  or dentists until 30 days after the date the insurer receives
  655  notice of the accident. After the 30-day period, any amount of
  656  the reserve for which the insurer has not received notice of
  657  such a claim from a physician or dentist who provided emergency
  658  services and care or who provided hospital inpatient care may
  659  then be used by the insurer to pay other claims. The time
  660  periods specified in paragraph (b) for required payment of
  661  personal injury protection benefits are shall be tolled for the
  662  period of time that an insurer is required by this paragraph to
  663  hold payment of a claim that is not from a physician or dentist
  664  who provided emergency services and care or who provided
  665  hospital inpatient care to the extent that the personal injury
  666  protection benefits not held in reserve are insufficient to pay
  667  the claim. This paragraph does not require an insurer to
  668  establish a claim reserve for insurance accounting purposes.
  669         (g)(d) All overdue payments shall bear simple interest at
  670  the rate established under s. 55.03 or the rate established in
  671  the insurance contract, whichever is greater, for the year in
  672  which the payment became overdue, calculated from the date the
  673  insurer was furnished with written notice of the amount of
  674  covered loss. Interest is shall be due at the time payment of
  675  the overdue claim is made. However, interest on a payment that
  676  is overdue pursuant to paragraph (e) shall be calculated from
  677  the date the payment is due pursuant to paragraph (b).
  678         (h)(e) The insurer of the owner of a motor vehicle shall
  679  pay personal injury protection benefits for:
  680         1. Accidental bodily injury sustained in this state by the
  681  owner while occupying a motor vehicle, or while not an occupant
  682  of a self-propelled vehicle if the injury is caused by physical
  683  contact with a motor vehicle.
  684         2. Accidental bodily injury sustained outside this state,
  685  but within the United States of America or its territories or
  686  possessions or Canada, by the owner while occupying the owner’s
  687  motor vehicle.
  688         3. Accidental bodily injury sustained by a relative of the
  689  owner residing in the same household, under the circumstances
  690  described in subparagraph 1. or subparagraph 2. if, provided the
  691  relative at the time of the accident is domiciled in the owner’s
  692  household and is not himself or herself the owner of a motor
  693  vehicle with respect to which security is required under the no
  694  fault law ss. 627.730-627.7405.
  695         4. Accidental bodily injury sustained in this state by any
  696  other person while occupying the owner’s motor vehicle or, if a
  697  resident of this state, while not an occupant of a self
  698  propelled vehicle, if the injury is caused by physical contact
  699  with such motor vehicle if, provided the injured person is not
  700  himself or herself:
  701         a. The owner of a motor vehicle with respect to which
  702  security is required under the no-fault law ss. 627.730
  703  627.7405; or
  704         b. Entitled to personal injury benefits from the insurer of
  705  the owner or owners of such a motor vehicle.
  706         (i)(f) If two or more insurers are liable to pay personal
  707  injury protection benefits for the same injury to any one
  708  person, the maximum payable is shall be as specified in
  709  subsection (1), and any insurer paying the benefits is shall be
  710  entitled to recover from each of the other insurers an equitable
  711  pro rata share of the benefits paid and expenses incurred in
  712  processing the claim.
  713         (j)(g) It is a violation of the insurance code for an
  714  insurer to fail to timely provide benefits as required by this
  715  section with such frequency as to constitute a general business
  716  practice.
  717         (k)(h) Benefits are shall not be due or payable to a
  718  claimant who knowingly: or on the behalf of an insured person if
  719  that person has
  720         1. Submits a false or misleading statement, document,
  721  record, or bill;
  722         2. Submits false or misleading information; or
  723         3. Has otherwise committed or attempted to commit a
  724  fraudulent insurance act as defined in s. 626.989.
  726  A claimant that violates this paragraph is not entitled to any
  727  personal injury protection benefits or reimbursement for any
  728  benefits provided, regardless of whether a portion of the claim
  729  may be legitimate. However, a medical provider that does not
  730  violate this paragraph may not be denied reimbursement for
  731  benefits provided solely due to violation by another medical
  732  provider.
  733         (l) Notwithstanding any remedies afforded by law, the
  734  insurer may recover from a claimant who violates paragraph (k)
  735  any sums previously paid to that claimant and may bring any
  736  available common law and statutory causes of action. A claimant
  737  has violated paragraph (k) committed, by a material act or
  738  omission, any insurance fraud relating to personal injury
  739  protection coverage under his or her policy, if the fraud is
  740  admitted to in a sworn statement by the insured or if it is
  741  established in a court of competent jurisdiction. Any insurance
  742  fraud voids shall void all coverage arising from the claim
  743  related to such fraud under the personal injury protection
  744  coverage of the claimant insured person who committed the fraud,
  745  irrespective of whether a portion of the insured person’s claim
  746  may be legitimate, and any benefits paid before prior to the
  747  discovery of the insured person’s insurance fraud is shall be
  748  recoverable by the insurer from the claimant person who
  749  committed insurance fraud in their entirety. The prevailing
  750  party is entitled to its costs and attorney’s fees in any action
  751  in which it prevails in an insurer’s action to enforce its right
  752  of recovery under this paragraph. This paragraph does not
  753  preclude or limit an insurer’s right to deny a claim based on
  754  other evidence of fraud or affect an insurer’s right to plead
  755  and prove a claim or defense of fraud under common law. If a
  756  physician, hospital, clinic, or other medical institution
  757  violates paragraph (k), the injured party is not liable for, and
  758  the physician, hospital, clinic, or other medical institution
  759  may not bill the insured for, charges that are unpaid because of
  760  failure to comply with paragraph (k). Any agreement requiring
  761  the injured person or insured to pay for such charges is
  762  unenforceable.
  763         (5) INSURER INVESTIGATIONS.—An insurer has the right and
  764  duty to conduct a reasonable investigation of a claim. In the
  765  course of the insurer’s investigation of a claim:
  766         (a) The insurer may require the insured, claimant, or
  767  medical provider to provide copies of the treatment and
  768  examination records. The records review need not be based on a
  769  physical examination and may be obtained at any time, including
  770  after reduction or denial of the claim.
  771         1. The 30-day period for payment under paragraph (4)(b) is
  772  tolled from the date the insurer sends its request for treatment
  773  records to the date that the insurer receives such records.
  774         2. A medical provider may impose a reasonable, cost-based
  775  fee that includes only the cost of copying and postage, but does
  776  not include the cost of labor for copying. The cost of copying
  777  may not exceed $1 per page for the first 25 pages and 25 cents
  778  per page for each page in excess of 25 pages. However, a medical
  779  provider may impose the reasonable costs of reproducing X rays
  780  and other special kinds of records, including the actual cost of
  781  the material and supplies used to duplicate the record, as well
  782  as the labor costs and overhead costs associated with such
  783  duplication.
  784         (b) In all circumstances, an insured seeking benefits under
  785  the no-fault law must comply with the terms of the policy, which
  786  includes, but is not limited to, submitting to examinations
  787  under oath. Compliance with this paragraph is a condition
  788  precedent to receiving benefits.
  789         (c) An insurer may deny benefits if the insured, claimant,
  790  or medical provider fails to:
  791         1. Cooperate in the insurer’s investigation;
  792         2. Commits a fraud or material misrepresentation; or
  793         3. Comply with this subsection.
  795         (a)1. Any physician, hospital, clinic, or other person or
  796  institution lawfully rendering treatment to an injured person
  797  for a bodily injury covered by personal injury protection
  798  insurance may charge the insurer and injured party only a
  799  reasonable amount pursuant to this section for the services and
  800  supplies rendered, and the insurer providing such coverage may
  801  pay for such charges directly to the such person or institution
  802  lawfully rendering such treatment, if the insured receiving such
  803  treatment or his or her guardian has countersigned the properly
  804  completed invoice, bill, or claim form approved by the office
  805  upon which such charges are to be paid for as having actually
  806  been rendered, to the best knowledge of the insured or his or
  807  her guardian. In no event, However, may such charges may not
  808  exceed a charge be in excess of the amount the person or
  809  institution customarily charges for like services or supplies.
  810  In determining With respect to a determination of whether a
  811  charge for a particular service, treatment, or otherwise is
  812  reasonable, consideration may be given to evidence of usual and
  813  customary charges and payments accepted by the provider involved
  814  in the dispute, and reimbursement levels in the community, and
  815  various federal and state medical fee schedules applicable to
  816  automobile and other insurance coverages, and other information
  817  relevant to the reasonableness of the reimbursement for the
  818  service, treatment, or supply.
  819         1.2. The insurer may limit reimbursement to 80 percent of
  820  the following schedule of maximum charges:
  821         a. For emergency transport and treatment by providers
  822  licensed under chapter 401, 200 percent of Medicare.
  823         b. For emergency services and care provided by a hospital
  824  licensed under chapter 395, 75 percent of the hospital’s usual
  825  and customary charges.
  826         c. For emergency services and care as defined by s.
  827  395.002(9) provided in a facility licensed under chapter 395
  828  rendered by a physician or dentist, and related hospital
  829  inpatient services rendered by a physician or dentist, the usual
  830  and customary charges in the community.
  831         d. For hospital inpatient services, other than emergency
  832  services and care, 200 percent of the Medicare Part A
  833  prospective payment applicable to the specific hospital
  834  providing the inpatient services.
  835         e. For hospital outpatient services, other than emergency
  836  services and care, 200 percent of the Medicare Part A Ambulatory
  837  Payment Classification for the specific hospital providing the
  838  outpatient services.
  839         f. For all other medical services, supplies, and care, 200
  840  percent of the allowable amount under the participating
  841  physicians schedule of Medicare Part B; for other supplies and
  842  care, including care and services rendered by ambulatory
  843  surgical centers and clinical laboratories, 200 percent of the
  844  allowable amount under Medicare Part B; and for durable medical
  845  equipment, the allowable amount under the Durable Medical
  846  Equipment, Prosthetics, Orthotics, and Supplies fee schedule
  847  under Medicare Part B. However, if such services, supplies, or
  848  care is not reimbursable under Medicare Part B, the insurer may
  849  limit reimbursement to 80 percent of the maximum reimbursable
  850  allowance under workers’ compensation, as determined under s.
  851  440.13 and rules adopted thereunder which are in effect at the
  852  time such services, supplies, or care is provided. Services,
  853  supplies, or care that is not reimbursable under Medicare or
  854  workers’ compensation is not required to be reimbursed by the
  855  insurer.
  856         2.3. For purposes of subparagraph 1. 2., the applicable fee
  857  schedule or payment limitation under Medicare is the fee
  858  schedule or payment limitation in effect on January 1 of the
  859  year in which at the time the services, supplies, or care was
  860  rendered and for the area in which such services were rendered,
  861  which shall apply throughout the remainder of the year
  862  notwithstanding any subsequent changes made to the fee schedule
  863  or payment limitation, except that it may not be less than the
  864  allowable amount under the participating physicians schedule of
  865  Medicare Part B for 2007 for medical services, supplies, and
  866  care subject to Medicare Part B.
  867         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  868  any limitation on the number of treatments or other utilization
  869  limits that apply under Medicare or workers’ compensation. An
  870  insurer that applies the allowable payment limitations of
  871  subparagraph 1. 2. must reimburse a provider who lawfully
  872  provided care or treatment under the scope of his or her
  873  license, regardless of whether such provider is would be
  874  entitled to reimbursement under Medicare due to restrictions or
  875  limitations on the types or discipline of health care providers
  876  who may be reimbursed for particular procedures or procedure
  877  codes.
  878         4.5. If an insurer limits payment as authorized by
  879  subparagraph 1. 2., the person providing such services,
  880  supplies, or care may not bill or attempt to collect from the
  881  insured any amount in excess of such limits, except for amounts
  882  that are not covered by the insured’s personal injury protection
  883  coverage due to the coinsurance amount or maximum policy limits.
  884         5. If a provider submits a charge for an amount less than
  885  the amount allowed under subparagraphs 1. and 2., the insurer
  886  may pay the amount of the charge submitted.
  887         6. Effective January 1, 2012, an insurer may limit
  888  reimbursement to the amounts stated in this paragraph only if
  889  the insurance policy provides notice that the insurer may limit
  890  reimbursement pursuant to the schedule of charges specified in
  891  this paragraph. Policy provisions approved by the office satisfy
  892  this requirement.
  893         (b)1. An insurer or insured is not required to pay a claim
  894  or charges:
  895         a. Made by a broker or by a person making a claim on behalf
  896  of a broker;
  897         b. For any service or treatment that was not lawful at the
  898  time rendered;
  899         c. To any person who knowingly submits a false or
  900  misleading statement relating to the claim or charges;
  901         d. With respect to a bill or statement that does not
  902  substantially meet the applicable requirements of paragraphs
  903  (c), paragraph (d), and (e);
  904         e. Except for services provided by a hospital licensed
  905  pursuant to chapter 395, for physician or other provider
  906  services or treatment provided within that hospital, if the
  907  insured failed to countersign a billing form or patient log
  908  related to such claim or charges. Failure to submit a
  909  countersigned billing form or patient log creates a rebuttable
  910  presumption that the insured did not receive the alleged
  911  treatment. The insurer is not considered to have been furnished
  912  with notice of the loss and treatment until the insurer is able
  913  to verify that the insured received the alleged treatment. If an
  914  insurer denies a claim based on failure to submit a
  915  countersigned billing form or patient log, the insurer must
  916  notify the provider, and the provider shall have 30 days after
  917  receipt of such notice to submit a properly countersigned
  918  billing form or patient log. If the provider fails to comply
  919  with this requirement, the insurer is not required to pay the
  920  claim. As used in this sub-subparagraph, the term
  921  “countersigned” means a second or verifying signature, as on a
  922  previously signed document, and is not satisfied by the
  923  statement “signature on file” or similar statement;
  924         f.e. For any treatment or service that is upcoded, or that
  925  is unbundled if when such treatment or services should be
  926  bundled, in accordance with paragraph (d). To facilitate prompt
  927  payment of lawful services, an insurer may change codes that it
  928  determines to have been improperly or incorrectly upcoded or
  929  unbundled, and may make payment based on the changed codes,
  930  without affecting the right of the provider to dispute the
  931  change by the insurer if, provided that before doing so, the
  932  insurer contacts must contact the health care provider and
  933  discusses discuss the reasons for the insurer’s change and the
  934  health care provider’s reason for the coding, or makes make a
  935  reasonable good faith effort to do so, as documented in the
  936  insurer’s file; and
  937         g.f. For medical services or treatment billed by a
  938  physician and not provided in a hospital unless such services
  939  are rendered by the physician or are incident to his or her
  940  professional services and are included on the physician’s bill,
  941  including documentation verifying that the physician is
  942  responsible for the medical services that were rendered and
  943  billed.
  944         2. The Department of Health, in consultation with the
  945  appropriate professional licensing boards, shall adopt, by rule,
  946  a list of diagnostic tests deemed not to be medically necessary
  947  for use in the treatment of persons sustaining bodily injury
  948  covered by personal injury protection benefits under this
  949  section. The initial list shall be adopted by January 1, 2004,
  950  and shall be revised from time to time as determined by the
  951  Department of Health, in consultation with the respective
  952  professional licensing boards. Inclusion of a test on the list
  953  must of invalid diagnostic tests shall be based on lack of
  954  demonstrated medical value and a level of general acceptance by
  955  the relevant provider community and may shall not be dependent
  956  for results entirely upon subjective patient response.
  957  Notwithstanding its inclusion on a fee schedule in this
  958  subsection, an insurer or insured is not required to pay any
  959  charges or reimburse claims for any invalid diagnostic test as
  960  determined by the Department of Health.
  961         (c)1. With respect to any treatment or service, other than
  962  medical services billed by a hospital or other provider for
  963  emergency services as defined in s. 395.002 or inpatient
  964  services rendered at a hospital-owned facility, the statement of
  965  charges must be furnished to the insurer by the provider and may
  966  not include, and the insurer is not required to pay, charges for
  967  treatment or services rendered more than 35 days before the
  968  postmark date or electronic transmission date of the statement,
  969  except for past due amounts previously billed on a timely basis
  970  under this paragraph, and except that, if the provider submits
  971  to the insurer a notice of initiation of treatment within 21
  972  days after its first examination or treatment of the claimant,
  973  the statement may include charges for treatment or services
  974  rendered up to, but not more than, 75 days before the postmark
  975  date of the statement. The injured party is not liable for, and
  976  the provider may shall not bill the injured party for, charges
  977  that are unpaid because of the provider’s failure to comply with
  978  this paragraph. Any agreement requiring the injured person or
  979  insured to pay for such charges is unenforceable.
  980         1.2. If, however, the insured fails to furnish the provider
  981  with the correct name and address of the insured’s personal
  982  injury protection insurer, the provider has 35 days from the
  983  date the provider obtains the correct information to furnish the
  984  insurer with a statement of the charges. The insurer is not
  985  required to pay for such charges unless the provider includes
  986  with the statement documentary evidence that was provided by the
  987  insured during the 35-day period demonstrating that the provider
  988  reasonably relied on erroneous information from the insured and
  989  either:
  990         a. A denial letter from the incorrect insurer; or
  991         b. Proof of mailing, which may include an affidavit under
  992  penalty of perjury, reflecting timely mailing to the incorrect
  993  address or insurer.
  994         2.3. For emergency services and care as defined in s.
  995  395.002 rendered in a hospital emergency department or for
  996  transport and treatment rendered by an ambulance provider
  997  licensed pursuant to part III of chapter 401, the provider is
  998  not required to furnish the statement of charges within the time
  999  periods established by this paragraph,; and the insurer is shall
 1000  not be considered to have been furnished with notice of the
 1001  amount of covered loss for purposes of paragraph (4)(b) until it
 1002  receives a statement complying with paragraph (d), or copy
 1003  thereof, which specifically identifies the place of service to
 1004  be a hospital emergency department or an ambulance in accordance
 1005  with billing standards recognized by the Centers for Medicare
 1006  and Medicaid Services Health Care Finance Administration.
 1007         3.4. Each notice of the insured’s rights under s. 627.7401
 1008  must include the following statement in type no smaller than 12
 1009  points:
 1011         BILLING REQUIREMENTS.—Florida Statutes provide that with
 1012  respect to any treatment or services, other than certain
 1013  hospital and emergency services, the statement of charges
 1014  furnished to the insurer by the provider may not include, and
 1015  the insurer and the injured party are not required to pay,
 1016  charges for treatment or services rendered more than 35 days
 1017  before the postmark date of the statement, except for past due
 1018  amounts previously billed on a timely basis, and except that, if
 1019  the provider submits to the insurer a notice of initiation of
 1020  treatment within 21 days after its first examination or
 1021  treatment of the claimant, the first billing cycle statement may
 1022  include charges for treatment or services rendered up to, but
 1023  not more than, 75 days before the postmark date of the
 1024  statement.
 1026         (d) All statements and bills for medical services rendered
 1027  by any physician, hospital, clinic, or other person or
 1028  institution shall be submitted to the insurer on a properly
 1029  completed Centers for Medicare and Medicaid Services (CMS) 1500
 1030  form, UB 92 forms, or any other standard form approved by the
 1031  office or adopted by the commission for purposes of this
 1032  paragraph. All billings for such services rendered by providers
 1033  must shall, to the extent applicable, follow the Physicians’
 1034  Current Procedural Terminology (CPT) or Healthcare Correct
 1035  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1036  year in which services are rendered and comply with the Centers
 1037  for Medicare and Medicaid Services (CMS) 1500 form instructions
 1038  and the American Medical Association Current Procedural
 1039  Terminology (CPT) Editorial Panel and Healthcare Correct
 1040  Procedural Coding System (HCPCS). All providers other than
 1041  hospitals shall include on the applicable claim form the
 1042  professional license number of the provider in the line or space
 1043  provided for “Signature of Physician or Supplier, Including
 1044  Degrees or Credentials.” In determining compliance with
 1045  applicable CPT and HCPCS coding, guidance shall be provided by
 1046  the Physicians’ Current Procedural Terminology (CPT) or the
 1047  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1048  for the year in which services were rendered, the Office of the
 1049  Inspector General (OIG), Physicians Compliance Guidelines, and
 1050  other authoritative treatises designated by rule by the Agency
 1051  for Health Care Administration. A No statement of medical
 1052  services may not include charges for medical services of a
 1053  person or entity that performed such services without possessing
 1054  the valid licenses required to perform such services. For
 1055  purposes of paragraph (4)(b), an insurer is shall not be
 1056  considered to have been furnished with notice of the amount of
 1057  covered loss or medical bills due unless the statements or bills
 1058  comply with this paragraph, and unless the statements or bills
 1059  are comply with this paragraph, and unless the statements or
 1060  bills are properly completed in their entirety as to all
 1061  material provisions, with all relevant information being
 1062  provided therein. If an insurer denies a claim due to a
 1063  provider’s failure to submit a properly completed statement or
 1064  bill, the insurer shall notify the provider as to the provisions
 1065  that were improperly completed, and the provider shall have 30
 1066  days after the receipt of such notice to submit a properly
 1067  completed statement or bill. If the provider fails to comply
 1068  with this requirement, the insurer is not required to pay for
 1069  improperly billed services.
 1070         (e)1. At the initial treatment or service provided, each
 1071  physician, other licensed professional, clinic, or other medical
 1072  institution providing medical services upon which a claim for
 1073  personal injury protection benefits is based shall require an
 1074  insured person, or his or her guardian, to execute a disclosure
 1075  and acknowledgment form, which reflects at a minimum that:
 1076         a. The insured, or his or her guardian, must countersign
 1077  the form attesting to the fact that the services set forth
 1078  therein were actually rendered. Listing CPT codes or other
 1079  coding on the disclosure and acknowledgment form does not
 1080  satisfy this requirement;
 1081         b. The insured, or his or her guardian, has both the right
 1082  and affirmative duty to confirm that the services were actually
 1083  rendered;
 1084         c. The insured, or his or her guardian, was not solicited
 1085  by any person to seek any services from the medical provider;
 1086         d. The physician, other licensed professional, clinic, or
 1087  other medical institution rendering services for which payment
 1088  is being claimed explained the services to the insured or his or
 1089  her guardian; and
 1090         e. If the insured notifies the insurer in writing of a
 1091  billing error, the insured may be entitled to a certain
 1092  percentage of a reduction in the amounts paid by the insured’s
 1093  motor vehicle insurer.
 1094         2. The physician, other licensed professional, clinic, or
 1095  other medical institution rendering services for which payment
 1096  is being claimed has the affirmative duty to explain the
 1097  services rendered to the insured, or his or her guardian, so
 1098  that the insured, or his or her guardian, countersigns the form
 1099  with informed consent.
 1100         3. Countersignature by the insured, or his or her guardian,
 1101  is not required for the reading of diagnostic tests or other
 1102  services that are of such a nature that they are not required to
 1103  be performed in the presence of the insured.
 1104         4. The licensed medical professional rendering treatment
 1105  for which payment is being claimed must sign, by his or her own
 1106  hand, the form complying with this paragraph.
 1107         5. An insurer is not considered to have been furnished with
 1108  notice of the amount of a covered loss or medical bills unless
 1109  the original completed disclosure and acknowledgment form is
 1110  shall be furnished to the insurer pursuant to paragraph (4)(b)
 1111  and sub-subparagraph 1.a. The disclosure and acknowledgement
 1112  form may not be electronically furnished. A disclosure and
 1113  acknowledgement form that does not meet the minimum requirements
 1114  of sub-subparagraph 1.a. does not provide an insurer with notice
 1115  of the amount of a covered loss or medical bills due.
 1116         6. This disclosure and acknowledgment form is not required
 1117  for services billed by a provider for emergency services as
 1118  defined in s. 395.002, for emergency services and care as
 1119  defined in s. 395.002 rendered in a hospital emergency
 1120  department, for inpatient hospital services, or for transport
 1121  and treatment rendered by an ambulance provider licensed
 1122  pursuant to part III of chapter 401.
 1123         7. The Financial Services Commission shall adopt, by rule,
 1124  a standard disclosure and acknowledgment form to that shall be
 1125  used to fulfill the requirements of this paragraph, effective 90
 1126  days after such form is adopted and becomes final. The
 1127  commission shall adopt a proposed rule by October 1, 2003. Until
 1128  the rule is final, the provider may use a form of its own which
 1129  otherwise complies with the requirements of this paragraph.
 1130         8. As used in this paragraph, the term “countersigned” or
 1131  “countersignature” means a second or verifying signature, as on
 1132  a previously signed document, and is not satisfied by the
 1133  statement “signature on file” or any similar statement.
 1134         9. The requirements of this paragraph apply only with
 1135  respect to the initial treatment or service of the insured by a
 1136  provider. For subsequent treatments or service, the provider
 1137  must maintain a patient log signed by the patient, in
 1138  chronological order by date of service, that is consistent with
 1139  the services being rendered to the patient as claimed. Listing
 1140  CPT codes or other coding on the patient log does not satisfy
 1141  this requirement. The provider must provide copies of the
 1142  patient log to the insurer within 30 days after receiving a
 1143  written request from the insurer. Failure to maintain a patient
 1144  log renders the treatment unlawful and noncompensable. The
 1145  requirements of this subparagraph for maintaining a patient log
 1146  signed by the patient may be met by a hospital that maintains
 1147  medical records as required by s. 395.3025 and applicable rules
 1148  and makes such records available to the insurer upon request.
 1149         (f) Upon written notification by any person, an insurer
 1150  shall investigate any claim of improper billing by a physician
 1151  or other medical provider. The insurer shall determine if the
 1152  insured was properly billed for only those services and
 1153  treatments that the insured actually received. If the insurer
 1154  determines that the insured has been improperly billed, the
 1155  insurer shall notify the insured, the person making the written
 1156  notification, and the provider of its findings and shall reduce
 1157  the amount of payment to the provider by the amount determined
 1158  to be improperly billed. If a reduction is made due to such
 1159  written notification by any person, the insurer shall pay to the
 1160  person 20 percent of the amount of the reduction, up to $500. If
 1161  the provider is arrested due to the improper billing, then the
 1162  insurer shall pay to the person 40 percent of the amount of the
 1163  reduction, up to $500.
 1164         (g) An insurer may not systematically downcode with the
 1165  intent to deny reimbursement otherwise due. Such action
 1166  constitutes a material misrepresentation under s.
 1167  626.9541(1)(i)2.
 1169  DISPUTES.—
 1170         (b) Every physician, hospital, clinic, or other medical
 1171  institution providing, before or after bodily injury upon which
 1172  a claim for personal injury protection insurance benefits is
 1173  based, any products, services, or accommodations in relation to
 1174  that or any other injury, or in relation to a condition claimed
 1175  to be connected with that or any other injury, shall, if
 1176  requested to do so by the insurer against whom the claim has
 1177  been made, permit the insurer or the insurer’s representative to
 1178  conduct an onsite physical review and examination of the
 1179  treatment location, treatment apparatuses, diagnostic devices,
 1180  and any other medical equipment used for the services rendered
 1181  in any location, other than a hospital licensed pursuant to
 1182  chapter 395, within 10 days after the insurer’s request, and
 1183  furnish forthwith a written report of the history, condition,
 1184  treatment, dates, and costs of such treatment of the injured
 1185  person and why the items identified by the insurer were
 1186  reasonable in amount and medically necessary, together with a
 1187  sworn statement that the treatment or services rendered were
 1188  reasonable and necessary with respect to the bodily injury
 1189  sustained and identifying which portion of the expenses for such
 1190  treatment or services was incurred as a result of such bodily
 1191  injury, and produce forthwith, and permit the inspection and
 1192  copying of, his or her or its records regarding such history,
 1193  condition, treatment, dates, and costs of treatment if; provided
 1194  that this does shall not limit the introduction of evidence at
 1195  trial. Such sworn statement must shall read as follows: “Under
 1196  penalty of perjury, I declare that I have read the foregoing,
 1197  and the facts alleged are true, to the best of my knowledge and
 1198  belief.” A No cause of action for violation of the physician
 1199  patient privilege or invasion of the right of privacy may not be
 1200  brought shall be permitted against any physician, hospital,
 1201  clinic, or other medical institution complying with the
 1202  provisions of this section. The person requesting such records
 1203  and such sworn statement shall pay all reasonable costs
 1204  connected therewith.
 1205         1. If an insurer makes a written request for documentation
 1206  or information under this paragraph within 30 days after having
 1207  received notice of the amount of a covered loss under paragraph
 1208  (4)(a), the amount or the partial amount that which is the
 1209  subject of the insurer’s inquiry is shall become overdue if the
 1210  insurer does not pay in accordance with paragraph (4)(b) or
 1211  within 10 days after the insurer’s receipt of the requested
 1212  documentation or information, whichever occurs later. For
 1213  purposes of this subparagraph paragraph, the term “receipt”
 1214  includes, but is not limited to, inspection and copying pursuant
 1215  to this paragraph. An Any insurer that requests documentation or
 1216  information pertaining to reasonableness of charges or medical
 1217  necessity under this paragraph without a reasonable basis for
 1218  such requests as a general business practice is engaging in an
 1219  unfair trade practice under the insurance code.
 1220         2. If an insured seeking to recover benefits pursuant to
 1221  the no-fault law assigns the contractual right to those benefits
 1222  or payment of those benefits to any person or entity, the
 1223  assignee must comply with the terms of the policy. In all
 1224  circumstances, the assignee is obligated to cooperate under the
 1225  policy, which includes, but is not limited to, participating in
 1226  an examination under oath. Examinations under oath may be
 1227  recorded by audio, video, court reporter, or any combination
 1228  thereof. Compliance with this paragraph is a condition precedent
 1229  to recovery of benefits pursuant to the no-fault law.
 1230         a. If an insurer requests an examination under oath of a
 1231  medical provider, the provider must produce the persons having
 1232  the most knowledge of the issues identified by the insurer in
 1233  the request for the examination. Before the commencement of the
 1234  examination under oath, the insurer must pay the medical
 1235  provider reasonable compensation for attending the examination.
 1236  Such compensation shall be based upon a good faith estimate of
 1237  the time required to conduct the examination under oath. If
 1238  additional time is necessary, the insurer must provide
 1239  compensation to the medical provider for the time that exceeds
 1240  the good faith estimate within 15 days after the examination if
 1241  the provider completes the examination. The medical provider may
 1242  have an attorney present at the examination under oath to
 1243  provide advice and counsel at the provider’s own expense.
 1244         b. Before requesting that an assignee participate in an
 1245  examination under oath, the insurer must send a written request
 1246  to the assignee requesting all information that the insurer
 1247  believes is necessary to process the claim and relevant to the
 1248  services rendered, including the information contemplated under
 1249  this subparagraph. All claimants must produce and allow for the
 1250  inspection of all documents requested by the insurer which are
 1251  relevant to the services rendered and reasonably obtainable by
 1252  the claimant.
 1253         c. An insurer that, as a general practice, requests
 1254  examinations under oath of an assignee without a reasonable
 1255  basis is engaging in an unfair and deceptive trade practice.
 1257  REPORTS.—
 1258         (b) If requested by the person examined, a party causing an
 1259  examination to be made shall deliver to him or her a copy of
 1260  every written report concerning the examination rendered by an
 1261  examining physician, at least one of which reports must set out
 1262  the examining physician’s findings and conclusions in detail.
 1263  After such request and delivery, the party causing the
 1264  examination to be made is entitled, upon request, to receive
 1265  from the person examined every written report available to him
 1266  or her or his or her representative concerning any examination,
 1267  previously or thereafter made, of the same mental or physical
 1268  condition. By requesting and obtaining a report of the
 1269  examination so ordered, or by taking the deposition of the
 1270  examiner, the person examined waives any privilege he or she may
 1271  have, in relation to the claim for benefits, regarding the
 1272  testimony of every other person who has examined, or may
 1273  thereafter examine, him or her in respect to the same mental or
 1274  physical condition. If a person fails to appear for unreasonably
 1275  refuses to submit to an examination, the personal injury
 1276  protection carrier is not required to pay no longer liable for
 1277  subsequent personal injury protection benefits incurred after
 1278  the date of the first requested examination until the insured
 1279  appears for the examination. Failure to appear for two scheduled
 1280  examinations raises a rebuttable presumption that such failure
 1281  was unreasonable. Submission to an examination is a condition
 1282  precedent to the recovery of benefits.
 1284  FEES.—With respect to any dispute under the provisions of ss.
 1285  627.730-627.7405 between the insured and the insurer under the
 1286  no-fault law, or between an assignee of an insured’s rights and
 1287  the insurer, the provisions of s. 627.428 shall apply, except as
 1288  provided in subsections (11) and (16) (10) and (15).
 1289         (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and
 1290  enter into contracts with preferred licensed health care
 1291  providers for the benefits described in this section, referred
 1292  to in this section as “preferred providers,” which include shall
 1293  include health care providers licensed under chapter 457,
 1294  chapter chapters 458, chapter 459, chapter 460, chapter 461, or
 1295  chapter and 463.
 1296         (a) The insurer may provide an option to an insured to use
 1297  a preferred provider at the time of purchase of the policy for
 1298  personal injury protection benefits, if the requirements of this
 1299  subsection are met. However, if the insurer offers a preferred
 1300  provider option, it must also offer a nonpreferred provider
 1301  policy. If the insured elects to use a provider who is not a
 1302  preferred provider, whether the insured purchased a preferred
 1303  provider policy or a nonpreferred provider policy, the medical
 1304  benefits provided by the insurer must shall be as required by
 1305  this section.
 1306         (b) If the insured elects the to use a provider who is a
 1307  preferred provider option, the insurer may pay medical benefits
 1308  in excess of the benefits required by this section and may waive
 1309  or lower the amount of any deductible that applies to such
 1310  medical benefits. As an alternative, or in addition to such
 1311  benefits, waiver, or reduction, the insurer may provide an
 1312  actuarially appropriate premium discount as specified in an
 1313  approved rate filing to an insured who selects the preferred
 1314  provider option. If the preferred provider option provides a
 1315  premium discount, the insured forfeits the premium discount
 1316  effective on the date that the insured elects to use a provider
 1317  who is not a preferred provider and who renders nonemergency
 1318  services, unless there is no member of the preferred provider
 1319  network located within 15 miles of the insured’s place of
 1320  residence whose scope of practice includes the required
 1321  services, or unless the nonemergency services are rendered in
 1322  the emergency room of a hospital licensed under chapter 395. If
 1323  the insurer offers a preferred provider policy to a policyholder
 1324  or applicant, it must also offer a nonpreferred provider policy.
 1325         (c) The insurer shall provide each insured policyholder
 1326  with a current roster of preferred providers in the county in
 1327  which the insured resides at the time of purchasing purchase of
 1328  such policy, and shall make such list available for public
 1329  inspection during regular business hours at the insurer’s
 1330  principal office of the insurer within the state. The insurer
 1331  may contract with a health insurer to use an existing preferred
 1332  provider network to implement the preferred provider option. All
 1333  providers and entities that are eligible to receive
 1334  reimbursement pursuant to paragraph (1)(a) may provide services
 1335  through a preferred provider network. Any other arrangement is
 1336  subject to the approval of the Office of Insurance Regulation.
 1337         (11)(10) DEMAND LETTER.—
 1338         (a) As a condition precedent to filing any action for
 1339  benefits under this section, the claimant filing suit must
 1340  provide the insurer must be provided with written notice of an
 1341  intent to initiate litigation. Such notice may not be sent until
 1342  the claim is overdue, including any additional time the insurer
 1343  has to pay the claim pursuant to paragraph (4)(b). A premature
 1344  demand letter is defective and cannot be cured unless the court
 1345  first abates the action or the claimant first voluntarily
 1346  dismisses the action.
 1347         (b) The notice required notice must shall state that it is
 1348  a “demand letter under s. 627.736(10)” and shall state with
 1349  specificity:
 1350         1. The name of the insured upon which such benefits are
 1351  being sought, including a copy of the assignment giving rights
 1352  to the claimant if the claimant is not the insured.
 1353         2. The claim number or policy number upon which such claim
 1354  was originally submitted to the insurer.
 1355         3. To the extent applicable, the name of any medical
 1356  provider who rendered to an insured the treatment, services,
 1357  accommodations, or supplies that form the basis of such claim;
 1358  and an itemized statement specifying each exact amount, the date
 1359  of treatment, service, or accommodation, and the type of benefit
 1360  claimed to be due. A completed form satisfying the requirements
 1361  of paragraph (6)(5)(d) or the lost-wage statement previously
 1362  submitted may be used as the itemized statement. To the extent
 1363  that the demand involves an insurer’s withdrawal of payment
 1364  under paragraph (7)(a) for future treatment not yet rendered,
 1365  the claimant shall attach a copy of the insurer’s notice
 1366  withdrawing such payment and an itemized statement of the type,
 1367  frequency, and duration of future treatment claimed to be
 1368  reasonable and medically necessary.
 1369         (c) Each notice required by this subsection must be
 1370  delivered to the insurer by United States certified or
 1371  registered mail, return receipt requested. Such postal costs
 1372  shall be reimbursed by the insurer if so requested by the
 1373  claimant in the notice, when the insurer pays the claim. Such
 1374  notice must be sent to the person and address specified by the
 1375  insurer for the purposes of receiving notices under this
 1376  subsection. Each licensed insurer, whether domestic, foreign, or
 1377  alien, shall file with the office designation of the name and
 1378  address of the person to whom notices must pursuant to this
 1379  subsection shall be sent which the office shall make available
 1380  on its Internet website. The name and address on file with the
 1381  office pursuant to s. 624.422 shall be deemed the authorized
 1382  representative to accept notice pursuant to this subsection if
 1383  in the event no other designation has been made.
 1384         (d) If, within 30 days after receipt of notice by the
 1385  insurer, the overdue claim specified in the notice is paid by
 1386  the insurer together with applicable interest and a penalty of
 1387  10 percent of the overdue amount paid by the insurer, subject to
 1388  a maximum penalty of $250, no action may be brought against the
 1389  insurer. If the demand involves an insurer’s withdrawal of
 1390  payment under paragraph (7)(a) for future treatment not yet
 1391  rendered, no action may be brought against the insurer if,
 1392  within 30 days after its receipt of the notice, the insurer
 1393  mails to the person filing the notice a written statement of the
 1394  insurer’s agreement to pay for such treatment in accordance with
 1395  the notice and to pay a penalty of 10 percent, subject to a
 1396  maximum penalty of $250, when it pays for such future treatment
 1397  in accordance with the requirements of this section. To the
 1398  extent the insurer determines not to pay any amount demanded,
 1399  the penalty is shall not be payable in any subsequent action.
 1400  For purposes of this subsection, payment or the insurer’s
 1401  agreement is shall be treated as being made on the date a draft
 1402  or other valid instrument that is equivalent to payment, or the
 1403  insurer’s written statement of agreement, is placed in the
 1404  United States mail in a properly addressed, postpaid envelope,
 1405  or if not so posted, on the date of delivery. The insurer is not
 1406  obligated to pay any attorney’s fees if the insurer pays the
 1407  claim or mails its agreement to pay for future treatment within
 1408  the time prescribed by this subsection.
 1409         (e) The applicable statute of limitation for an action
 1410  under this section shall be tolled for a period of 30 business
 1411  days by the mailing of the notice required by this subsection.
 1412         (f)A demand letter that does not meet the minimum
 1413  requirements set forth in this subsection or that is sent during
 1414  the pendency of the lawsuit is defective. A defective demand
 1415  letter cannot be cured unless the court first abates the action
 1416  or the claimant first voluntarily dismisses the action.
 1417         (g)(f)An Any insurer making a general business practice of
 1418  not paying valid claims until receipt of the notice required by
 1419  this subsection is engaging in an unfair trade practice under
 1420  the insurance code.
 1421         (h) If the insurer pays in response to a demand letter and
 1422  the claimant disputes the amount paid, the claimant must send a
 1423  second demand letter by certified or registered mail stating the
 1424  exact amount that the claimant believes the insurer owes and why
 1425  the claimant believes the amount paid is incorrect. The insurer
 1426  has an additional 10 days after receipt of the second letter to
 1427  issue any additional payment that is owed. The purpose of this
 1428  provision is to avoid unnecessary litigation over miscalculated
 1429  payments.
 1430         (i) Demand letters may not be used to request the
 1431  production of claim documents or other records from the insurer.
 1432         Section 9. Subsection (10) of section 817.234, Florida
 1433  Statutes, is amended, present subsection (12) of that section is
 1434  renumbered as subsection (13) and amended, and a new subsection
 1435  (12) is added to that section, to read:
 1436         817.234 False and fraudulent insurance claims.—
 1437         (10)(a) Any person who owns an business entity eligible for
 1438  reimbursement under s. 627.736(1) and who is found guilty of
 1439  insurance fraud under this section shall lose his or her
 1440  occupational license for such entity for 5 years and may not
 1441  receive reimbursement for personal injury protection benefits
 1442  for 10 years.
 1443         (b) Any licensed health care practitioner found guilty of
 1444  insurance fraud under this section shall lose his or her license
 1445  to practice for 5 years and may not receive reimbursement for
 1446  personal injury protection benefits for 10 years. As used in
 1447  this section, the term “insurer” means any insurer, health
 1448  maintenance organization, self-insurer, self-insurance fund, or
 1449  other similar entity or person regulated under chapter 440 or
 1450  chapter 641 or by the Office of Insurance Regulation under the
 1451  Florida Insurance Code.
 1452         (12) In addition to any criminal liability, a person
 1453  convicted of violating any provision of this section for the
 1454  purpose of receiving insurance proceeds from a motor vehicle
 1455  insurance contract is subject to a civil penalty.
 1456         (a) Except for a violation of subsection (9), the civil
 1457  penalty shall be:
 1458         1. A fine up to $5,000 for a first offense.
 1459         2. A fine greater than $5,000, but not to exceed $10,000,
 1460  for a second offense.
 1461         3. A fine greater than $10,000, but not to exceed $15,000,
 1462  for a third or subsequent offense.
 1463         (b) The civil penalty for a violation of subsection (9)
 1464  must be at least $15,000, but may not exceed $50,000.
 1465         (c) The civil penalty shall be paid to the Insurance
 1466  Regulatory Trust Fund within the Department of Financial
 1467  Services and used by the department for the investigation and
 1468  prosecution of insurance fraud.
 1469         (d) This subsection does not prohibit a state attorney from
 1470  entering into a written agreement in which the person charged
 1471  with the violation does not admit to or deny the charges but
 1472  consents to payment of the civil penalty.
 1473         (13)(12) As used in this section, the term:
 1474         (a) “Insurer” means any insurer, health maintenance
 1475  organization, self-insurer, self-insurance fund, or similar
 1476  entity or person regulated under chapter 440 or chapter 641 or
 1477  by the Office of Insurance Regulation under the Florida
 1478  Insurance Code.
 1479         (b)(a) “Property” means property as defined in s. 812.012.
 1480         (c)(b) “Value” has the same meaning means value as provided
 1481  defined in s. 812.012.
 1482         Section 10. Subsection (1) of section 324.021, Florida
 1483  Statutes, is amended to read:
 1484         324.021 Definitions; minimum insurance required.—The
 1485  following words and phrases when used in this chapter shall, for
 1486  the purpose of this chapter, have the meanings respectively
 1487  ascribed to them in this section, except in those instances
 1488  where the context clearly indicates a different meaning:
 1489         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1490  is designed and required to be licensed for use upon a highway,
 1491  including trailers and semitrailers designed for use with such
 1492  vehicles, except traction engines, road rollers, farm tractors,
 1493  power shovels, and well drillers, and every vehicle that which
 1494  is propelled by electric power obtained from overhead wires but
 1495  not operated upon rails, but not including any bicycle or moped.
 1496  However, the term does “motor vehicle” shall not include a any
 1497  motor vehicle as defined in s. 627.732(3) if when the owner of
 1498  such vehicle has complied with the no-fault law requirements of
 1499  ss. 627.730-627.7405, inclusive, unless the provisions of s.
 1500  324.051 apply; and, in such case, the applicable proof of
 1501  insurance provisions of s. 320.02 apply.
 1502         Section 11. Paragraph (k) of subsection (2) of section
 1503  456.057, Florida Statutes, is amended to read:
 1504         456.057 Ownership and control of patient records; report or
 1505  copies of records to be furnished.—
 1506         (2) As used in this section, the terms “records owner,”
 1507  “health care practitioner,” and “health care practitioner’s
 1508  employer” do not include any of the following persons or
 1509  entities; furthermore, the following persons or entities are not
 1510  authorized to acquire or own medical records, but are authorized
 1511  under the confidentiality and disclosure requirements of this
 1512  section to maintain those documents required by the part or
 1513  chapter under which they are licensed or regulated:
 1514         (k) Persons or entities practicing under s. 627.736(8)
 1515  627.736(7).
 1516         Section 12. Paragraph (b) of subsection (1) of section
 1517  627.7401, Florida Statutes, is amended to read:
 1518         627.7401 Notification of insured’s rights.—
 1519         (1) The commission, by rule, shall adopt a form for the
 1520  notification of insureds of their right to receive personal
 1521  injury protection benefits under the Florida Motor Vehicle no
 1522  fault law. Such notice shall include:
 1523         (b) An advisory informing insureds that:
 1524         1. Pursuant to s. 626.9892, the Department of Financial
 1525  Services may pay rewards of up to $25,000 to persons providing
 1526  information leading to the arrest and conviction of persons
 1527  committing crimes investigated by the Division of Insurance
 1528  Fraud arising from violations of s. 440.105, s. 624.15, s.
 1529  626.9541, s. 626.989, or s. 817.234.
 1530         2. Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
 1531  insured notifies the insurer of a billing error, the insured may
 1532  be entitled to a certain percentage of a reduction in the amount
 1533  paid by the insured’s motor vehicle insurer.
 1534         Section 13. This act shall take effect July 1, 2011.
 1537  ================= T I T L E  A M E N D M E N T ================
 1538         And the title is amended as follows:
 1539         Delete everything before the enacting clause
 1540  and insert:
 1541                        A bill to be entitled                      
 1542         An act relating to motor vehicle personal injury
 1543         protection insurance; amending s. 316.066, F.S.;
 1544         revising provisions relating to the contents of
 1545         written reports of motor vehicle crashes; requiring
 1546         short-form crash reports by a law enforcement officer
 1547         to be maintained by the officer’s agency; authorizing
 1548         the investigating officer to testify at trial or
 1549         provide an affidavit concerning the content of the
 1550         reports; amending s. 400.991, F.S.; requiring that an
 1551         application for licensure as a mobile clinic include a
 1552         statement regarding insurance fraud; creating s.
 1553         626.9894, F.S.; providing definitions; authorizing the
 1554         Division of Insurance Fraud to establish a direct
 1555         support organization for the purpose of prosecuting,
 1556         investigating, and preventing motor vehicle insurance
 1557         fraud; providing requirements for the organization and
 1558         the organization’s contract with the division;
 1559         providing for a board of directors; authorizing the
 1560         organization to use the division’s property and
 1561         facilities subject to certain requirements;
 1562         authorizing contributions from insurers; providing
 1563         that any moneys received by the organization may be
 1564         held in a separate depository account in the name of
 1565         the organization; requiring the division to deposit
 1566         certain proceeds into the Insurance Regulatory Trust
 1567         Fund; amending s. 627.4137, F.S.; requiring a
 1568         claimant’s request about insurance coverage to be
 1569         appropriately served upon the disclosing entity;
 1570         amending s. 627.730, F.S.; conforming a cross
 1571         reference; amending s. 627.731, F.S.; providing
 1572         legislative intent with respect to the Florida Motor
 1573         Vehicle No-Fault Law; amending s. 627.732, F.S.;
 1574         defining the terms “claimant,” “entity wholly owned,”
 1575         and “no-fault law”; amending s. 627.736, F.S.;
 1576         conforming a cross-reference; adding licensed
 1577         acupuncturists to the list of practitioners authorized
 1578         to provide, supervise, order, or prescribe services;
 1579         requiring certain entities providing medical services
 1580         to document that they meet required criteria; revising
 1581         requirements relating to the claim form that must be
 1582         submitted by certain providers; requiring an entity or
 1583         clinic to file a new form within a specified period
 1584         after the date of a change of ownership; specifying
 1585         the time period for submitting a properly completed
 1586         claim; revising provisions relating to when payment
 1587         for a benefit is due; providing that an insurer’s
 1588         failure to send certain specification or explanation
 1589         of benefits does not waive other grounds for rejecting
 1590         an invalid claim; authorizing an insurer to obtain
 1591         evidence and assert any ground for adjusting or
 1592         rejecting a claim; providing that the time period for
 1593         paying a claim is tolled during the investigation of a
 1594         fraudulent insurance act; specifying when benefits are
 1595         not payable; providing an exception for trauma centers
 1596         covered by a local lien law from the requirement for
 1597         an insurer to set aside a certain amount for the
 1598         payment of benefits to medical providers; providing
 1599         that a claimant that violates certain provisions is
 1600         not entitled to any payment, regardless of whether a
 1601         portion of the claim may be legitimate; authorizing an
 1602         insurer to recover payments and bring a cause of
 1603         action to recover payments; providing that an insurer
 1604         may deny any claim based on other evidence of fraud;
 1605         forbidding a physician, hospital, clinic, or other
 1606         medical institution that fails to comply with certain
 1607         provisions from billing the injured person or the
 1608         insured; providing that an insurer has a right to
 1609         conduct reasonable investigations of claims;
 1610         authorizing an insurer to require a claimant to
 1611         provide certain records; specifying when the period
 1612         for payment is tolled; authorizing an insurer to deny
 1613         benefits if an insured, claimant, or medical provider
 1614         fails to comply with certain provisions; revising
 1615         insurer reimbursement limitations; authorizing an
 1616         insurer to pay the amount billed if less than the
 1617         amount allowed; providing a limit on the amount of
 1618         reimbursement if the insurance policy includes a
 1619         schedule of charges; authorizing an insurer to not pay
 1620         certain claims if the insured failed to countersign
 1621         the billing form or patient log; creating a rebuttable
 1622         presumption that the insured did not receive the
 1623         alleged treatment if the insured does not countersign
 1624         the billing form or patient log; providing a procedure
 1625         for correcting such failure; authorizing the insurer
 1626         to deny a claim if the provider does not submit a
 1627         properly completed statement or bill within a certain
 1628         time; specifying requirements for furnishing the
 1629         insured with notice of the amount of covered loss;
 1630         deleting an obsolete provision; requiring the provider
 1631         to provide copies of the patient log within a certain
 1632         time if requested by the insurer; providing that
 1633         failure to maintain a patient log renders the
 1634         treatment unlawful and noncompensable; revising
 1635         requirements relating to discovery; authorizing the
 1636         insurer to conduct a physical review of the treatment
 1637         location; providing an exception for hospitals;
 1638         requiring the insured and assignee to comply with
 1639         certain provisions to recover benefits; requiring the
 1640         provider to produce persons having the most knowledge
 1641         in specified circumstances; requiring the insurer to
 1642         pay reasonable compensation to the provider for
 1643         attending the examination; requiring the insurer to
 1644         request certain information before requesting an
 1645         assignee to participate in an examination under oath;
 1646         providing that an insurer that requests an examination
 1647         under oath without a reasonable basis is engaging in
 1648         an unfair and deceptive trade practice; providing that
 1649         failure to appear for scheduled examinations
 1650         establishes a rebuttable presumption that such failure
 1651         was unreasonable; authorizing an insurer to contract
 1652         with a preferred provider network; authorizing an
 1653         insurer to provide a premium discount to an insured
 1654         who selects a preferred provider; authorizing an
 1655         insurance policy to not pay for nonemergency services
 1656         performed by a nonpreferred provider in specified
 1657         circumstances; authorizing an insurer to use a
 1658         preferred provider network; revising requirements
 1659         relating to demand letters in an action for benefits;
 1660         specifying when a demand letter is defective;
 1661         requiring a second demand letter under certain
 1662         circumstances; deleting obsolete provisions; providing
 1663         that a demand letter may not be used to request the
 1664         production of claim documents or records from the
 1665         insurer; amending s. 817.234, F.S.; providing that
 1666         persons and business entities found guilty of
 1667         insurance fraud lose their occupational and
 1668         practitioner licenses for a certain period; providing
 1669         civil penalties for fraudulent insurance claims;
 1670         amending ss. 324.021, 456.057, and 627.7401, F.S.;
 1671         conforming cross-references; providing an effective
 1672         date.