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Florida Administrative Code (Last Updated: June 27, 2024) |
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69. Department of Financial Services |
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69L. Division of Workers' Compensation |
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69L-34. Carrier Report Of Health Care Provider Violations |
1As used in this rule chapter:
7(1) “Carrier” is as defined in section 14440.13(1)(c), 15Florida Statutes ( F.S.).
19(2) “Division” means The Department of Financial Services Division of Workers’ Compensation.
31(3) “Health Care Provider” (hereinafter referred to as “Provider”) is as defined in section 45440.13(1)(g), F.S., 47and includes those that consent to the jurisdiction of the Division pursuant to section 61440.13(3)(f), F.S.
63(4) “Supportive Documentation” is defined as all documents and records that support an allegation of a violation pursuant to this rule chapter.
85(5) “Verifiable delivery process” is defined as the ability to document a common carrier’s pick-up date or a United States Postal Services postmark date.
109(6) “Violation” is defined as a Provider’s non-compliance with chapter 440, F.S., and Division rules, which shall include: failing to submit medical records and reports pursuant to sections 137440.13(4)(a) 138and (c), F.S., or pursuant to subsection 14569L-7.710(4), 146F.A.C.; failing to refund an overpayment of reimbursement, pursuant to section 157440.13(11)(a), F.S.; 159collecting or receiving payment from an injured worker in violation of section 171440.13(13)(a), F.S.; 173failing to follow standards of care, pursuant to section 182440.13(15), F.S., 184including overutilization of services; or failing to properly bill medical services, pursuant to rule 19869L-7.710, 199F.A.C. Recommending treatment that would constitute overutilization, in and of itself, is not an instance of overutilization.
216(7) “Improper billing and billing errors” means the failure of a Provider to comply with the Division’s billing and reporting requirements pursuant to rule 24069L-7.710, 241F.A.C., and the applicable reimbursement manual(s).
247Rulemaking Authority 249440.13(4)(c), 250(7)(e), 251440.591 FS. 253Law Implemented 255440.13, 256440.13(1)(j) FS. 258History–New 9-6-11.
