Current through Reg. 47, No. 249; December 28, 2021
The Division is authorized to conduct an investigation of an alleged violation
based upon any of the following results:
An audit of medical bill data filed with the Division; or
(c) A combination of paragraphs (a) and (b)
(2) The Carrier
and the Provider shall submit to the Division, within forty-five (45) days of
receipt of a document request from the Division, all additional documentation
requested by the Division as a part of its investigation. If any of the
requested documentation is not included in the Carrier's or the Provider's
response to the Division's document request, the Carrier or the Provider shall
submit a specific written explanation as to the reason(s) the documentation was
(3) If either the
Carrier or the Provider fails to timely submit the requested documentation or
specific written explanation as to the reason the additional documentation can
not be provided, the Division, in its exclusive jurisdiction pursuant to
F.S., is authorized to close the investigation or issue its findings based on
the documentation filed with the Referral Form and any responses appurtenant
thereto that were timely received.
(4) The Division shall not issue a penalty
for violations under this Rule Chapter except following an investigation
pursuant to this rule; however, if the Division finds a Provider has engaged in
a violation, administrative penalties, fines or other sanctions shall be issued
in accordance with Section 440.13(8), (11), and (13), F.S.
Fla. Admin. Code Ann. R.
FS. Law Implemented
(8), (11), (13) FS.