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(8) PATTERN OR PRACTICE OF OVERUTILIZATION.
(b) If the department determines that a health care provider has engaged
in a pattern or practice of overutilization or a violation of this
chapter or rules adopted by the department, including a pattern or
practice of providing treatment in excess of the practice parameters or
protocols of treatment, it may impose one or more of the following
penalties:
1. An order of the department barring the provider from payment under
this chapter;
2. Deauthorization of care under review;
3. Denial of payment for care rendered in the future;
4. Decertification of a health care provider certified as an expert
medical advisor under subsection (9) or of a rehabilitation provider
certified under s.
440.49;
5. An administrative fine assessed by the department in an amount not to
exceed $5,000 per instance of overutilization or violation; and
6. Notification of and review by the appropriate licensing authority
pursuant to s.
440.106(3).
11) AUDITS.
(a) The department may investigate health care providers to
determine whether providers are complying with this chapter and with
rules adopted by the department, whether the providers are engaging
in overutilization, whether providers are engaging in improper
billing practices, and whether providers are adhering to practice
parameters and protocols established in accordance with this
chapter. If the department finds that a health care provider has
improperly billed, overutilized, or failed to comply with department
rules or the requirements of this chapter, including, but not
limited to, practice parameters and protocols established in
accordance with this chapter, it must notify the provider of its
findings and may determine that the health care
provider may not receive payment from the carrier or may impose
penalties as set forth in subsection (8) or other sections of this
chapter. If the health care provider has received payment from a
carrier for services that were improperly billed, that constitute
overutilization, or that were outside practice parameters or
protocols established in accordance with this chapter, it must
return those payments to the carrier. The department may assess a
penalty not to $500 for each overpayment that is not refunded within
30 days after notification of overpayment by the department or
carrier.
(13) REMOVAL OF PHYSICIANS FROM LISTS OF THOSE AUTHORIZED
TO RENDER MEDICAL CARE.
The department shall remove from the list of physicians or
facilities authorized to provide remedial treatment, care, and
attendance under this chapter the name of any physician or facility
found after reasonable investigation to have:
(a) Engaged in professional or other misconduct or incompetency in
connection with medical services rendered under this chapter;
(b) Exceeded the limits of his or her or its professional competence
in rendering medical care under this chapter, or to have made
materially false statements regarding his or her or its
qualifications in his or her application;
(c) Failed to transmit copies of medical reports to the employer or
carrier, or failed to submit full and truthful medical reports of
all his or her or its findings to the employer or carrier as
required under this chapter;
(d) Solicited, or employed another to solicit for himself or herself
or itself or for another, professional treatment, examination, or
care of an injured employee in connection with any claim under this
chapter;
(e) Refused to appear before, or to answer upon request of, the
department or any duly authorized officer of the state, any legal
question, or to produce any relevant book or paper concerning his or
her conduct under any authorization granted to him or her under this
chapter;
(f) Self-referred in violation of this chapter or other laws of this
state; or
(g) Engaged in a pattern of practice of overutilization or a
violation of this chapter or rules adopted by the department,
including failure to adhere to practice parameters and protocols
established in accordance with this chapter.
