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F.S. 817.505 on Google Scholar

F.S. 817.505 on Casetext

Amendments to 817.505


The 2022 Florida Statutes (including 2022 Special Session A and 2023 Special Session B)
Title XLVI
CRIMES
Chapter 817
FRAUDULENT PRACTICES
View Entire Chapter
F.S. 817.505 Florida Statutes and Case Law
817.505 Patient brokering prohibited; exceptions; penalties.—
(1) It is unlawful for any person, including any health care provider or health care facility, to:
(a) Offer or pay a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of a patient or patronage to or from a health care provider or health care facility;
(b) Solicit or receive a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for referring a patient or patronage to or from a health care provider or health care facility;
(c) Solicit or receive a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for the acceptance or acknowledgment of treatment from a health care provider or health care facility; or
(d) Aid, abet, advise, or otherwise participate in the conduct prohibited under paragraph (a), paragraph (b), or paragraph (c).
(2) For the purposes of this section, the term:
(a) “Health care provider or health care facility” means any person or entity licensed, certified, or registered; required to be licensed, certified, or registered; or lawfully exempt from being required to be licensed, certified, or registered with the Agency for Health Care Administration or the Department of Health; any person or entity that has contracted with the Agency for Health Care Administration to provide goods or services to Medicaid recipients as provided under s. 409.907; a county health department established under part I of chapter 154; any community service provider contracting with the Department of Children and Families to furnish alcohol, drug abuse, or mental health services under part IV of chapter 394; any substance abuse service provider licensed under chapter 397; or any federally supported primary care program such as a migrant or community health center authorized under ss. 329 and 330 of the United States Public Health Services Act.
(b) “Health care provider network entity” means a corporation, partnership, or limited liability company owned or operated by two or more health care providers and organized for the purpose of entering into agreements with health insurers, health care purchasing groups, or the Medicare or Medicaid program.
(c) “Health insurer” means any insurance company authorized to transact health insurance in the state, any insurance company authorized to transact health insurance or casualty insurance in the state that is offering a minimum premium plan or stop-loss coverage for any person or entity providing health care benefits, any self-insurance plan as defined in s. 624.031, any health maintenance organization authorized to transact business in the state pursuant to part I of chapter 641, any prepaid health clinic authorized to transact business in the state pursuant to part II of chapter 641, any prepaid limited health service organization authorized to transact business in this state pursuant to chapter 636, any multiple-employer welfare arrangement authorized to transact business in the state pursuant to ss. 624.436-624.45, or any fraternal benefit society providing health benefits to its members as authorized pursuant to chapter 632.
(3) This section shall not apply to the following payment practices:
(a) Any discount, payment, waiver of payment, or payment practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or regulations promulgated thereunder.
(b) Any payment, compensation, or financial arrangement within a group practice as defined in s. 456.053, provided such payment, compensation, or arrangement is not to or from persons who are not members of the group practice.
(c) Payments to a health care provider or health care facility for professional consultation services.
(d) Commissions, fees, or other remuneration lawfully paid to insurance agents as provided under the insurance code.
(e) Payments by a health insurer who reimburses, provides, offers to provide, or administers health, mental health, or substance abuse goods or services under a health benefit plan.
(f) Payments to or by a health care provider or health care facility, or a health care provider network entity, that has contracted with a health insurer, a health care purchasing group, or the Medicare or Medicaid program to provide health, mental health, or substance abuse goods or services under a health benefit plan when such payments are for goods or services under the plan. However, nothing in this section affects whether a health care provider network entity is an insurer required to be licensed under the Florida Insurance Code.
(g) Insurance advertising gifts lawfully permitted under s. 626.9541(1)(m).
(h) Commissions or fees paid to a nurse registry licensed under s. 400.506 for referring persons providing health care services to clients of the nurse registry.
(i) Payments by a health care provider or health care facility to a health, mental health, or substance abuse information service that provides information upon request and without charge to consumers about providers of health care goods or services to enable consumers to select appropriate providers or facilities, provided that such information service:
1. Does not attempt through its standard questions for solicitation of consumer criteria or through any other means to steer or lead a consumer to select or consider selection of a particular health care provider or health care facility;
2. Does not provide or represent itself as providing diagnostic or counseling services or assessments of illness or injury and does not make any promises of cure or guarantees of treatment;
3. Does not provide or arrange for transportation of a consumer to or from the location of a health care provider or health care facility; and
4. Charges and collects fees from a health care provider or health care facility participating in its services that are set in advance, are consistent with the fair market value for those information services, and are not based on the potential value of a patient or patients to a health care provider or health care facility or of the goods or services provided by the health care provider or health care facility.
(j) Any activity permitted under s. 429.195(2).
(4)(a) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this section commits a felony of the third degree, punishable as provided in s. 775.082 or s. 775.084, and shall be ordered to pay a fine of $50,000.
(b) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this section, where the prohibited conduct involves 10 or more patients but fewer than 20 patients, commits a felony of the second degree, punishable as provided in s. 775.082 or s. 775.084, and shall be ordered to pay a fine of $100,000.
(c) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this section, where the prohibited conduct involves 20 or more patients, commits a felony of the first degree, punishable as provided in s. 775.082 or s. 775.084, and shall be ordered to pay a fine of $500,000.
(5) Notwithstanding the existence or pursuit of any other remedy, the Attorney General or the state attorney of the judicial circuit in which any part of the offense occurred may maintain an action for injunctive or other process to enforce the provisions of this section.
(6) The party bringing an action under this section may recover reasonable expenses in obtaining injunctive relief, including, but not limited to, investigative costs, court costs, reasonable attorney’s fees, witness costs, and deposition expenses.
(7) The provisions of this section are in addition to any other civil, administrative, or criminal actions provided by law and may be imposed against both corporate and individual defendants.
History.—s. 1, ch. 96-152; s. 226, ch. 97-101; s. 168, ch. 98-166; s. 297, ch. 99-8; s. 7, ch. 99-204; s. 228, ch. 2000-160; s. 19, ch. 2006-305; s. 37, ch. 2012-160; s. 302, ch. 2014-19; s. 4, ch. 2015-66; s. 24, ch. 2017-173; s. 11, ch. 2019-159; s. 6, ch. 2020-38.

Statutes updated from Official Statutes on: March 07, 2023
F.S. 817.505 on Google Scholar

F.S. 817.505 on Casetext

Amendments to 817.505


Arrestable Offenses / Crimes under Fla. Stat. 817.505
Level: Degree
Misdemeanor/Felony: First/Second/Third

817.505 4 - FRAUD - VIOLATE PATIENT BROKERING LAW - F: T

Civil Citations / Citable Offenses under S817.505
R or S next to points is Mandatory Revocation or Suspension

S817.505 PATIENT REFERRAL VIOLATION (or Brokering) Patient brokering prohibited; exceptions; penalties - Points on Drivers License: 0 R

Annotations, Discussions, Cases:

  1. State v. Rubio

    917 So. 2d 383 (Fla. Dist. Ct. App. 2005)   Cited 5 times
    The information did not charge the defendants with violating section 817.505(1)(a). Nevertheless, sections 817.505(1)(a) and 817.505(1)(b) are similar and both prohibit engaging in any split-fee arrangement involving patient referrals.
    PAGE 393

  2. Med. Mng. Group v. State Farm Auto

    811 So. 2d 705 (Fla. Dist. Ct. App. 2002)   Cited 5 times
    MMGO justifies this arrangement as a free enterprise commercial venture based on the common law right of assignment, claiming an assignment of the patient's right under his insurance policy and an assignment from Premier of its right to bill a commercially reasonable fee. We agree with the trial judge that the arrangement is nothing more than a fee-splitting scheme to compensate for MRI referrals prohibited by section 817.505, Florida Statutes.

  3. State v. Kigar

    279 So. 3d 217 (Fla. Dist. Ct. App. 2019)   1 Legal Analyses
    The 2019 version of section 817.505(3)(a) now uses slightly different and more specific language. Section 817.505(3)(a) now provides that section 817.505 shall not apply to any discount, payment, waiver of payment, or payment practice "expressly authorized by 42 U.S.C. s. 1320a-7b(b)(3) or regulations adopted thereunder." § 817.505(3)(a), Fla. Stat. (2019) (emphasis added).
    PAGE 218

  4. State Farm Mut. Auto. Ins. Co. v. Performance Orthapaedics & Neurosurgery, LLC

    315 F. Supp. 3d 1291 (S.D. Fla. 2018)   Cited 21 times   1 Legal Analyses
    The Patient Brokering and Anti-Kickback Statutes prohibit receipt of any kind of payment "directly or indirectly" for mere referral of a patient as well as any split-fee arrangement "in any form whatsoever." Fla. Stat. § 817.505 (1)(b). If the Patient Brokering and Anti-Kickback Statutes were violated, then the kickback or split fee was unlawful and Defendants are not entitled to the excess payment based on the referral or split-fee arrangement. See Gov't Emps. Ins. Co. v. Clear Vision Windshield Repair, LLC , No.16–cv–2077, 2017 WL 1196438, at *5 (M.D. Fla. Mar. 29, 2017) (finding that the "Plaintiffs' remedy is unjust enrichment" where defendants submitted fraudulent bills to an insurer after "the insureds assigned to Defendants the payment owed to the insureds under the insurance agreement"); Med. Mgmt. Group of Orlando, Inc. v. State Farm Mut. Auto. Ins. Co. , 811 So.2d 705, 706 (Fla. Dist. Ct. App. 2002) (affirming summary judgment ruling that defendant was not obligated to pay MRI charges that were illegal under section 817.505, and explaining "we agree with the trial judge that the arrangement is nothing more than a fee-splitting scheme to compensate for…
    PAGE 1308

  5. State v. Rubio

    967 So. 2d 768 (Fla. 2007)   Cited 11 times
    In this issue, the defendants argue that section 817.505, Florida Statutes (2002), which prohibits "patient brokering," is unconstitutional because it (1) is vague; (2) lacks a mens rea requirement; and (3) fails to impose a mens rea requirement of willfulness. Counts 56-129 charged the defendants with split-fee patient brokering, in violation of section 817.505(1)(b)-(c).
    PAGE 776

  6. Prosper v. Allstate

    964 So. 2d 763 (Fla. Dist. Ct. App. 2007)   Cited 1 times
    Prosper contends that section 817.505, Florida Statutes (2002), was held unconstitutional by the Florida Supreme Court in State v. Harden, 938 So.2d 480 (Fla. 2006). In Harden, the supreme court held that Florida's Medicaid anti-kickback statute, section 409.920(2)(e), Florida Statutes (2000), was preempted by the federal anti-kickback statute. 938 So.2d at 493. Prosper asserts that Harden held section 817.505(1)(b) unconstitutional by implication. In Rubio, the Fifth District contrasted section 817.505 from section 409.920 on the grounds that section 817.505 contained a "safe harbor" provision that provided it did not apply to payment practices not prohibited by federal law. See § 817.505(3)(a), Fla. Stat. (2002). Our supreme court recently adopted the Fifth District's reasoning and upheld the constitutionality of the statute. State v. Rubio, No. SC06-157, ___ So.2d ___, 2007 WL 2002586 (Fla. July 12, 2007). The prohibitions against fee splitting and patient brokering of section 817.505(1)(b) were correctly applied to the present case.
    PAGE 764

  7. State Farm Mut. Auto. Ins. Co. v. Performance Orthopaedics & Neurosurgery, LLC

    278 F. Supp. 3d 1307 (S.D. Fla. 2017)   Cited 30 times
    Specifically, Plaintiff asserts that Defendants' conduct violates Florida Statutes §§ 817.505 (Patient Brokering Statute), 456.054 (Anti–Kickback Statute), 395.0185 (Anti–Rebate Statute) and 817.234 (Insurance Fraud). See Amended Complaint (ECF No. 56) ¶¶ 9, 51, 123–130.
    PAGE 1326

  8. Gold, Vann White v. Friedenstab

    831 So. 2d 692 (Fla. Dist. Ct. App. 2002)   Cited 16 times
    Although we agree with the trial court that the 1997 service agreement contained illegal provisions, issues of fact remain as to the severability of those provisions. First, the trial court correctly determined that the 1997 service agreement was illegal in that it provides for fee splitting. Phycor's duties included developing and implementing a public relations program, administering managed care contracts, and providing ancillary services, as approved by the policy board. Although there is no evidence that the public relations and marketing duties resulted in increased business for the P.A., the agreement, itself, impermissibly provided for payment of a percentage of the revenue the management services and practice enhancement would generate and, thus, constituted an indirect method of fees for patient referral in violation of sections 458.331 and 817.505, Florida Statutes (2001). See Crow v. Agency for Health Care Admin., 669 So.2d 1160 (Fla. 5th DCA 1996) (holding that salary based on a percentage of previous year's revenue and a year-end bonus based on current year's revenues would each be in violation of the prohibition on fee-splitting). Florida Statutes §…
    PAGE 694

  9. United States v. Hill

    No. 17-13545 (11th Cir. Aug. 1, 2018)
    In October 2014 Berry recruited Hill, another service member stationed at MacDill, to work for Team Cream. Hill signed a Centurion marketing agreement under which he would receive 15% of Centurion's profit for each cream prescription that was filled as a result of his marketing efforts. That agreement required Centurion representatives "to conduct all of [their] business activities and operations in conformity with all state, local and federal laws and regulations." It further specified that: "Marketing representative acknowledges that he/she has read and understands the requirements and limitations provided in Florida [Statute] § 817.505, attached hereto as Exhibit 'A.'" That statute makes it unlawful to pay people "in cash or in kind" to "induce the referral of a patient or patronage to or from a health care provider" or solicit such a payment "in return for referring a patient or patronage to or from a health care provider." Fla. Stat. § 817.505( 1)(a)- (b). In November 2014 Centurion sent Hill an email reminder about complying with § 817.505. The subject line read "WE HAVE A NO TOLERANCE POLICY!" and the content stated that "[i]f it is brought to…
    PAGE 5

  10. Nationwide Mutual Co. v. Ft. Myers Total Rehab Ctr.

    657 F. Supp. 2d 1279 (M.D. Fla. 2009)   Cited 39 times
    An insurer shall have a cause of action against any person convicted of, or who, regardless of adjudication of guilt, pleads guilty or nolo contendere to insurance fraud under s. 817.234, patient brokering under s. 817.505, or kickbacks under s. 456.054, associated with a claim for personal injury protection benefits in accordance with this section. An insurer prevailing in an action brought under this subsection may recover compensatory, consequential, and punitive damages subject to the requirements and limitations of part II of chapter 768, and attorney's fees and costs incurred in litigating a cause of action against any person convicted of, or who, regardless of adjudication of guilt, pleads guilty or nolo contendere to insurance fraud under s. 817.234, patient brokering under s. 817.505, or kickbacks under s. 456.054, associated with a claim for personal injury protection benefits in accordance with this section.
    PAGE 7