Fla. Admin. Code R. 69L-34.001 : DEPARTMENT OF FINANCIAL SERVICES — Division of Workers' Compensation —34 - Carrier Report of Health Care Provider Violations —34.001 - Definitions

As used in this Rule Chapter:

(1) "Carrier" is as defined in Section 440.13(1)(c), Florida Statutes (F.S.).
(2) "Division" means The Department of Financial Services Division of Workers' Compensation.
(3) "Health Care Provider" (hereinafter referred to as "Provider") is as defined in Section 440.13(1)(h), F.S., and includes those that consent to the jurisdiction of the Division pursuant to Section 440.13(3)(f), F.S.
(4) "Supportive Documentation" is defined as all documents and records that support an allegation of a violation pursuant to this Rule Chapter.
(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.
(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 440.13(4)(a) and (c), F.S., or pursuant to subsection 69L-7.602(4), F.A.C.; failing to refund an overpayment of reimbursement, pursuant to Section 440.13(11)(a), F.S.; collecting or receiving payment from an injured worker in violation of Section 440.13(14)(a), F.S.; failing to follow standards of care, pursuant to Section 440.13(16), F.S., including overutilization of services; or failing to properly bill medical services, pursuant to Rule 69L-7.602, F.A.C. Recommending treatment that would constitute overutilization, in and of itself, is not an instance of overutilization.
(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 69L-7.602, F.A.C., and the applicable reimbursement manual(s).

Fla. Admin. Code Ann. R. 69L-34.001

Rulemaking Authority 440.13(4)(c), (7)(e), 440.591 FS. Law Implemented 440.13, 440.13(1)(k) FS.
New 9-6-11.