Florida Regulations 69L-34.005

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§ 69L-34.005 Referral Investigation.

(1) The Division is authorized to conduct an investigation of an alleged violation based upon any of the following results:

(a) An audit of medical bill data filed with the Division; or

(b) The receipt of a completed Referral Form, DFS-F6-DWC-2000 HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-00278" http://www.flrules.org/Gateway/reference.asp?No=Ref-00278 (Effective: August 2011), and all Supportive Documentation; or

(c) A combination of paragraphs (a) and (b) above.

(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 not included.

(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 Section 440.13(11)(c), 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.

Rulemaking Authority 440.13(4)(c), (7)(e), 440.591 FS. Law Implemented 440.13(1), (8), (11), (13) FS. History-New 9-6-11.