S.F. _____ Section 1. NEW SECTION . 507F.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Business entity” means a corporation, association, 4 partnership, limited liability company, limited liability 5 partnership, or other legal entity. 6 2. “Insurer” means a person entering into arrangements or 7 contracts of insurance or reinsurance agreeing to perform any 8 of the following acts: 9 a. Pay or indemnify another as to loss from certain 10 contingencies called risks, including through reinsurance. 11 b. Pay or grant a specified amount or determinable benefit 12 to another in connection with ascertainable risk contingencies. 13 c. Pay an annuity to another. 14 d. Act as surety. 15 3. “Statement” includes but is not limited to any notice, 16 statement, proof of loss, receipt for payment, invoice, 17 account, bill for services, diagnosis, prescription, hospital 18 or physician record, X ray, test result, or other evidence of 19 loss, injury, or expense. 20 Sec. 2. NEW SECTION . 507F.2 Purpose. 21 A workers’ compensation fraud unit is created within the 22 insurance fraud bureau within the insurance division. Upon a 23 reasonable determination by the workers’ compensation fraud 24 unit, by its own inquiries or as a result of complaints filed 25 with the insurance fraud bureau or the workers’ compensation 26 fraud unit, that a person has engaged in, is engaging in, 27 or may be engaging in an act or practice that violates this 28 chapter, the workers’ compensation fraud unit may administer 29 oaths and affirmations, issue and serve subpoenas ordering the 30 attendance of witnesses, collect evidence related to such act 31 or practice, commence a suit, and prosecute a violation of this 32 chapter. 33 Sec. 3. NEW SECTION . 507F.3 Workers’ compensation attorney 34 fraud —— penalty. 35 -1- LSB 5360XC (13) 87 asf/rj 1/ 16

S.F. _____ 1. An attorney or an attorney’s agent who acts unilaterally 1 without an attorney’s knowledge commits workers’ compensation 2 attorney fraud if the person, for the purpose of obtaining any 3 benefit under chapter 85, 85A, 85B, 86, or 87 for oneself or on 4 behalf of another person, knowingly does any of the following: 5 a. Presents or causes to be presented to an insurer any 6 oral or written statement, knowing the statement contains false 7 information concerning a material fact. 8 b. Employs any deception device, scheme, or artifice to 9 defraud. 10 c. Misrepresents, conceals, or suppresses any material fact 11 to defraud. 12 d. Makes a false entry in, fabricates, alters, conceals, or 13 destroys a document to defraud. 14 e. Assists, abets, solicits, or conspires with another in 15 committing a violation of this chapter. 16 2. An attorney or an attorney’s agent who commits workers’ 17 compensation attorney fraud is, upon conviction, guilty 18 of a class “D” felony. An attorney convicted of workers’ 19 compensation attorney fraud shall forfeit the ability to 20 collect any attorney fees not already collected and shall 21 refund attorney fees already collected from the client who was 22 the subject of the worker’s compensation attorney fraud, unless 23 the client commits workers’ compensation benefit fraud, in 24 which case the attorney fees shall be forfeited to the victim 25 compensation fund established in section 915.94. 26 3. Fifty percent of the criminal penalty collected under 27 this section shall be deposited in the workers’ compensation 28 fraud penalty fund created in section 507F.9. Fifty percent 29 of the criminal penalty collected under this section shall be 30 deposited pursuant to section 602.8108. 31 Sec. 4. NEW SECTION . 507F.4 Workers’ compensation benefit 32 fraud —— penalty. 33 1. A person commits the offense of workers’ compensation 34 benefit fraud if the person, for the purpose of obtaining any 35 -2- LSB 5360XC (13) 87 asf/rj 2/ 16

S.F. _____ benefit under chapter 85, 85A, 85B, 86, or 87 for oneself or on 1 behalf of another person, knowingly does any of the following: 2 a. Presents or causes to be presented to an insurer, any 3 oral or written statement, knowing that such statement contains 4 false information concerning a material fact. 5 b. Misrepresents, conceals, or suppresses any material fact 6 to defraud. 7 c. Makes a false entry in, fabricates, alters, conceals, or 8 destroys a document to defraud. 9 d. Assists, abets, solicits, or conspires with another in 10 committing a violation of this chapter. 11 2. A person who commits workers’ compensation benefit 12 fraud is, upon conviction, guilty of a class “D” felony. Upon 13 conviction of this offense, a person shall forfeit all right to 14 compensation under chapters 85, 85A, and 85B for the alleged 15 injury which is the subject matter of the conviction. 16 3. Fifty percent of the criminal penalty collected under 17 this section shall be deposited in the workers’ compensation 18 fraud penalty fund created in section 507F.9. Fifty percent 19 of the criminal penalty collected under this section shall be 20 deposited pursuant to section 602.8108. 21 Sec. 5. NEW SECTION . 507F.5 Workers’ compensation health 22 service provider fraud —— penalty. 23 1. A health service provider or a health service provider’s 24 agent who acts unilaterally without a health service 25 providers’s knowledge commits workers’ compensation health 26 service provider fraud if the person, for the purpose of 27 obtaining any benefit or payment under chapter 85, 85A, 85B, 28 86, or 87 for oneself or on behalf of another person, knowingly 29 does any of the following: 30 a. Presents or causes to be presented to an insurer any 31 oral or written statement, knowing that such statement contains 32 false information concerning a material fact. 33 b. Misrepresents, conceals, or suppresses any material fact 34 to defraud. 35 -3- LSB 5360XC (13) 87 asf/rj 3/ 16

S.F. _____ c. Makes a false entry in, fabricates, alters, conceals, or 1 destroys a document to defraud. 2 d. Bills for services not rendered, services rendered for 3 a person other than the person identified on the bill, or 4 services rendered for an injury or person not covered by the 5 workers’ compensation laws. 6 e. Assists, abets, solicits, or conspires with another in 7 committing a violation of this chapter. 8 2. A health service provider or health service provider’s 9 agent who commits workers’ compensation health service provider 10 fraud is, upon conviction, guilty of a class “D” felony. 11 3. Fifty percent of the criminal penalty collected under 12 this section shall be deposited in the workers’ compensation 13 fraud penalty fund created in section 507F.9. Fifty percent 14 of the criminal penalty collected under this section shall be 15 deposited pursuant to section 602.8108. 16 Sec. 6. NEW SECTION . 507F.6 Workers’ compensation insurance 17 carrier fraud —— penalty. 18 1. An employee, agent, or contractor of an insurer commits 19 workers’ compensation insurance carrier fraud if the person, 20 for the purpose of obtaining any benefit or payment under 21 chapter 85, 85A, 85B, 86, or 87 for oneself or on behalf of 22 another person, knowingly does any of the following in the 23 course of processing an insurance claim: 24 a. Creates fraudulent claims and authorizes the payment of 25 such claims to defraud the insurer. 26 b. Authorizes the payment of claims known by the employee, 27 agent, or contractor to be fraudulent to assist, abet, solicit, 28 or conspire with another to defraud the insurer. 29 2. An employee, agent, or contractor of an insurer who 30 commits workers’ compensation insurance carrier fraud is, upon 31 conviction, guilty of a class “D” felony. 32 3. Fifty percent of the criminal penalty collected under 33 this section shall be deposited in the workers’ compensation 34 fraud penalty fund created in section 507F.9. Fifty percent 35 -4- LSB 5360XC (13) 87 asf/rj 4/ 16

S.F. _____ of the criminal penalty collected under this section shall be 1 deposited pursuant to section 602.8108. 2 Sec. 7. NEW SECTION . 507F.7 Workers’ compensation insurance 3 coverage fraud —— penalty. 4 1. A person commits the offense of workers’ compensation 5 insurance coverage fraud if the person, in connection with 6 any application or renewal of an insurance policy providing 7 workers’ compensation insurance coverage or to avoid payment 8 of or reduce premiums due for that coverage, for oneself or 9 another, knowingly does any of the following: 10 a. Presents or causes to be presented to an insurer, any 11 oral or written statement, knowing that such statement contains 12 false information concerning a material fact to defraud. 13 b. Misrepresents, conceals, or suppresses any material fact 14 to defraud. 15 c. Makes a false entry in, fabricates, alters, conceals, or 16 destroys a document to defraud. 17 2. A person who commits workers’ compensation insurance 18 coverage fraud is, upon conviction, guilty of a class “D” 19 felony. 20 3. Fifty percent of the criminal penalty collected under 21 this section shall be deposited in the workers’ compensation 22 fraud penalty fund created in section 507F.9. Fifty percent 23 of the criminal penalty collected under this section shall be 24 deposited pursuant to section 602.8108. 25 Sec. 8. NEW SECTION . 507F.8 Restitution. 26 In addition to the criminal penalties established in this 27 chapter, the court shall order a person who commits an offense 28 under this chapter to pay restitution to persons aggrieved by 29 the violation. Restitution shall be ordered in addition to a 30 fine and the possibility of imprisonment, but not in lieu of a 31 fine and the possibility of imprisonment. 32 Sec. 9. NEW SECTION . 507F.9 Fund created. 33 A workers’ compensation fraud penalty fund is created in 34 the state treasury as a separate fund under the control of 35 -5- LSB 5360XC (13) 87 asf/rj 5/ 16

S.F. _____ the commissioner of insurance for purposes of this chapter. 1 All moneys deposited into the fund are appropriated to the 2 insurance division of the department of commerce for the 3 workers’ compensation fraud unit. Notwithstanding section 4 8.33, any balance in the fund on June 30 of each fiscal year 5 shall not revert to the general fund of the state, but shall 6 be available for purposes of this chapter in subsequent fiscal 7 years. The commissioner of insurance may request additional 8 full time equivalent positions as needed and the request shall 9 be granted so long as sufficient funds are within the workers’ 10 compensation fraud penalty fund. 11 Sec. 10. NEW SECTION . 507F.10 Examination of information 12 outside the state. 13 As a unit within the insurance fraud bureau, the workers’ 14 compensation fraud unit, pursuant to section 507E.4, may obtain 15 and examine any information that is related to enforcement of 16 this chapter in possession of a person located outside the 17 state. 18 Sec. 11. NEW SECTION . 507F.11 Confidentiality. 19 As a unit within the insurance fraud bureau, all of the 20 provisions of section 507E.5 shall apply to the workers’ 21 compensation fraud unit. 22 Sec. 12. NEW SECTION . 507F.12 Immunity from liability. 23 A person is immune from civil liability for acts under this 24 chapter if the person meets the requirements set forth in 25 section 507E.7. 26 Sec. 13. NEW SECTION . 507F.13 Election of prosecution. 27 If a person commits an offense under this chapter, the 28 prosecuting attorney may elect to proceed under this chapter 29 or any other law of this state. 30 Sec. 14. NEW SECTION . 507F.14 Prosecuting attorney status. 31 1. The workers’ compensation fraud unit shall employ at 32 least one full-time prosecuting attorney. The prosecuting 33 attorney, having specialized knowledge and training, shall 34 in all counties in this state prosecute all criminal actions 35 -6- LSB 5360XC (13) 87 asf/rj 6/ 16

S.F. _____ which may be brought under this chapter in which the workers’ 1 compensation fraud unit may be interested, when, in the 2 prosecuting attorney’s judgment, the interest of the unit 3 requires such action. 4 2. The prosecuting attorney may request a county attorney 5 to assist with or handle the prosecution of a criminal action 6 which may be brought under this chapter. 7 3. The prosecuting attorney shall report to the 8 commissioner of insurance. 9 Sec. 15. NEW SECTION . 507F.15 Law enforcement officer 10 status. 11 As a unit within the insurance fraud bureau, all of the 12 provisions of section 507E.8 shall apply to the workers’ 13 compensation fraud unit. 14 Sec. 16. NEW SECTION . 507F.16 Limitation of actions. 15 An information or indictment asserting a violation of this 16 chapter shall be commenced within five years after the last 17 date of its commission. 18 Sec. 17. NEW SECTION . 507F.17 Suspension of benefits. 19 If a person is currently receiving or has a pending 20 application for workers’ compensation benefits under chapter 21 85, 85A, or 85B and the workers’ compensation fraud unit, 22 after providing the person notice and opportunity to be heard, 23 determines probable cause of a violation of this chapter by a 24 person receiving benefits under chapter 85, 85A, or 85B, the 25 workers’ compensation fraud unit shall notify the workers’ 26 compensation commissioner, who shall suspend benefits until the 27 workers’ compensation fraud unit makes a final determination 28 whether to charge a person with a violation of this chapter and 29 commence prosecutorial action. If the workers’ compensation 30 fraud unit’s final determination is to not prosecute, the 31 workers’ compensation commissioner shall resume the person’s 32 benefits. If the workers’ compensation fraud unit’s final 33 determination is to prosecute, the person’s benefits shall 34 remain suspended until the conclusion of the criminal 35 -7- LSB 5360XC (13) 87 asf/rj 7/ 16

S.F. _____ proceedings in district court. 1 A person convicted of workers’ compensation fraud shall be 2 prohibited from receiving benefits under chapters 85, 85A, 3 and 85B for the particular claim or injury giving rise to the 4 criminal action. If the person is acquitted or the charges 5 are dismissed, the workers’ compensation fraud unit shall 6 notify the workers’ compensation commissioner of such action 7 and the commissioner shall resume the payment of any benefits 8 previously suspended. A person whose benefits have been 9 suspended and the payment of benefits resumed has the option to 10 receive a back payment in a lump sum upon resumption of payment 11 of benefits. 12 Sec. 18. NEW SECTION . 507F.18 Rulemaking authority. 13 The commissioner of insurance may adopt rules pursuant to 14 chapter 17A to administer this chapter. 15 Sec. 19. Section 85.27, subsections 3 and 4, Code 2018, are 16 amended to read as follows: 17 3. A medical service provided under this chapter or 18 chapter 85A or 85B shall not be billed at a rate higher than 19 a health service provider’s standard retail rate for the 20 medical service. A health service provider who bills and 21 receives payment in excess of the health service provider’s 22 standard rate for a medical service provided to treat a 23 workers’ compensation injury shall reimburse the employer 24 or insurance carrier which paid for the medical service for 25 the excess payments received by the health service provider. 26 Notwithstanding section 85.26, subsection 4 , charges believed 27 to be excessive or unnecessary may be referred by the 28 employer, insurance carrier, or health service provider to the 29 workers’ compensation commissioner for determination, and the 30 commissioner may utilize the procedures provided in sections 31 86.38 and 86.39 , or set by rule, and conduct such inquiry as 32 the commissioner deems necessary. Any health service provider 33 charges not in dispute shall be paid directly to the health 34 service provider prior to utilization of procedures provided 35 -8- LSB 5360XC (13) 87 asf/rj 8/ 16

S.F. _____ in sections 86.38 and 86.39 or set by rule. A health service 1 provider rendering treatment to an employee whose injury is 2 compensable under this section agrees to be bound by such 3 charges as allowed by the workers’ compensation commissioner 4 and shall not recover in law or equity any amount in excess of 5 charges set by the commissioner. When a dispute under this 6 chapter , chapter 85A , or chapter 85B regarding reasonableness 7 of a fee for medical services arises between a health service 8 provider and an employer or insurance carrier, the health 9 service provider, employer, or insurance carrier shall not seek 10 payment from the injured employee. A health service provider 11 shall not seek payment for fees in dispute from the insurance 12 carrier or employer until the commissioner finds, pursuant to 13 informal dispute resolution procedures established by rule by 14 the commissioner, that the disputed amount is reasonable. This 15 section does not affect the responsibility of an insurance 16 carrier or an employer to pay amounts not in dispute or a 17 health service provider’s right to receive payment from an 18 employee’s nonoccupational plan as provided in section 85.38, 19 subsection 2 . 20 4. For purposes of this section , the employer is obliged to 21 furnish reasonable services and supplies to treat an injured 22 employee, and has the right to choose the care. The employer 23 retains the right to choose the employee’s care throughout the 24 course of treatment for all services identified in subsection 25 1. The employer is not obliged to authorize a referral for 26 care to a specific provider of services by an authorized 27 treating medical provider and the employer has the right to 28 choose any provider for the care. If the employer chooses the 29 care, the employer shall hold the employee harmless for the 30 cost of care until the employer notifies the employee that the 31 employer is no longer authorizing all or any part of the care 32 and the reason for the change in authorization. An employer 33 is not liable for the cost of care that the employer arranges 34 in response to a sudden emergency if the employee’s condition, 35 -9- LSB 5360XC (13) 87 asf/rj 9/ 16

S.F. _____ for which care was arranged, is not related to the employment. 1 The treatment must be offered promptly and be reasonably 2 suited to treat the injury without undue inconvenience to the 3 employee. If the employee has reason to be dissatisfied with 4 the care offered, the employee should communicate the basis of 5 such dissatisfaction to the employer, in writing if requested, 6 following which the employer and the employee may agree to 7 alternate care reasonably suited to treat the injury. If the 8 employer and employee cannot agree on such alternate care, 9 the commissioner may, upon application and reasonable proofs 10 of the necessity therefor, allow and order other care. In an 11 emergency, the employee may choose the employee’s care at the 12 employer’s expense, provided the employer or the employer’s 13 agent cannot be reached immediately. An application made under 14 this subsection shall be considered an original proceeding 15 for purposes of commencement and contested case proceedings 16 under section 85.26 . The hearing shall be conducted pursuant 17 to chapter 17A . Before a hearing is scheduled, the parties 18 may choose a telephone hearing or an in-person hearing. A 19 request for an in-person hearing shall be approved unless the 20 in-person hearing would be impractical because of the distance 21 between the parties to the hearing. The workers’ compensation 22 commissioner shall issue a decision within ten working days of 23 receipt of an application for alternate care made pursuant to a 24 telephone hearing or within fourteen working days of receipt of 25 an application for alternate care made pursuant to an in-person 26 hearing. The employer shall notify an injured employee of the 27 employee’s ability to contest the employer’s choice of care 28 pursuant to this subsection . 29 Sec. 20. NEW SECTION . 85.37A Suspension of benefits for 30 workers’ compensation fraud. 31 Section 507F.17 requires the workers’ compensation 32 commissioner to suspend a person’s benefits if the workers’ 33 compensation fraud unit has probable cause to believe that the 34 person has violated chapter 507F. 35 -10- LSB 5360XC (13) 87 asf/rj 10/ 16

S.F. _____ Sec. 21. NEW SECTION . 86.39A Criminal penalty for workers’ 1 compensation attorney fraud. 2 Chapter 507F sets forth criminal penalties for engaging in 3 workers’ compensation fraud, including but not limited to fraud 4 committed by an attorney. 5 Sec. 22. NEW SECTION . 507E.2A Definition of insurer. 6 As used in this chapter, unless the context otherwise 7 requires, “insurer” means a person entering into arrangements or 8 contracts of insurance or reinsurance agreeing to perform any 9 of the following acts: 10 a. Pay or indemnify another as to loss from certain 11 contingencies called risks, including through reinsurance. 12 b. Pay or grant a specified amount or determinable benefit 13 to another in connection with ascertainable risk contingencies. 14 c. Pay an annuity to another. 15 d. Act as surety. 16 Sec. 23. Section 507E.6, Code 2018, is amended to read as 17 follows: 18 507E.6 Duties of insurer and fraud bureau . 19 1. An insurer which believes that a claim or application 20 for insurance coverage is being made which is a violation of 21 section 507E.3 or believes that a violation of 507E.3A has 22 occurred, shall provide, within sixty days of the receipt 23 of such claim or application becoming aware of a possible 24 violation , written notification to the bureau of the claim or 25 application suspected violation on a form prescribed by the 26 bureau , including any additional information requested by the 27 bureau related to the claim or application or the party making 28 the claim or application . 29 2. The fraud bureau shall review each notification and 30 determine whether further investigation is warranted. 31 3. If the bureau determines that further investigation 32 is warranted, the bureau shall conduct an independent 33 investigation of the facts surrounding the claim or application 34 for insurance coverage notification to determine the extent, 35 -11- LSB 5360XC (13) 87 asf/rj 11/ 16

S.F. _____ if any, to which fraud occurred in the submission of the claim 1 or application . If the notification pertains to workers’ 2 compensation insurance fraud, the bureau shall deliver the 3 notice to the workers’ compensation fraud unit, which shall 4 determine if an investigation and prosecution are warranted. 5 Upon formal request made by the bureau, the insurer shall 6 provide all additional information related to the notification 7 within ten business days or a time period specifically 8 identified by the bureau. 9 4. The bureau shall report any alleged violation of law 10 disclosed by the investigation to the appropriate licensing 11 agency or prosecuting authority having jurisdiction with 12 respect to such violation. 13 Sec. 24. Section 507E.8, Code 2018, is amended to read as 14 follows: 15 507E.8 Law enforcement officer status. 16 1. Bureau investigators shall have the power and status 17 of law enforcement officers who by the nature of their duties 18 may be required to perform the duties of a peace officer when 19 making arrests for criminal violations established as a result 20 of their investigations pursuant to this chapter or chapter 21 507F . 22 2. The general laws applicable to arrests by law enforcement 23 officers of the state also apply to bureau investigators. 24 Bureau investigators shall have the power to execute arrest 25 warrants and search warrants for the same criminal violations, 26 serve subpoenas issued for the examination, investigation, and 27 trial of all offenses identified through their investigations, 28 and arrest upon probable cause without warrant a person found 29 in the act of committing a violation of the provisions of this 30 chapter or chapter 507F . 31 Sec. 25. EFFECTIVE DATE. This Act, being deemed of 32 immediate importance, takes effect upon enactment. 33 Sec. 26. APPLICABILITY. This Act applies on the effective 34 date of this Act to acts of fraud or prohibited health service 35 -12- LSB 5360XC (13) 87 asf/rj 12/ 16

S.F. _____ providers’ practices committed on or after the effective date 1 of this Act. 2 EXPLANATION 3 The inclusion of this explanation does not constitute agreement with 4 the explanation’s substance by the members of the general assembly. 5 This bill relates to workers’ compensation and insurance 6 fraud and other prohibited health service provider practices. 7 The bill creates new Code chapter 507F dedicated to workers’ 8 compensation fraud, codified following the existing insurance 9 fraud Code chapter 507E. 10 The bill establishes a workers’ compensation fraud unit 11 (unit) within the insurance fraud bureau within the insurance 12 division. The purpose of the unit is to investigate and 13 prosecute workers’ compensation fraud. Unit investigators have 14 the power and status of law enforcement officers. The bill 15 requires the unit to employ at least one full-time prosecuting 16 attorney to prosecute all criminal actions which may be brought 17 under this Code chapter in which the unit may be interested, 18 when, in the prosecuting attorney’s judgment, the interest of 19 the unit requires such action. 20 The bill provides an election of prosecution. If a person 21 commits an offense under this Code chapter, the prosecuting 22 attorney may elect to proceed under this Code chapter or any 23 other law of this state. The prosecuting attorney may be the 24 unit prosecuting attorney or a county attorney. 25 The bill sets forth criminal penalties for engaging in 26 workers’ compensation fraud, including fraud committed by 27 employers, workers, insurers, health service providers, 28 employees of insurers, and attorneys. Specifically, the bill 29 penalizes as a class “D” felony the following forms of workers’ 30 compensation fraud: benefit fraud, insurance coverage fraud, 31 health service provider fraud, insurance carrier fraud, and 32 attorney fraud. The elements for each crime are enumerated in 33 the bill. A class “D” felony is punishable by confinement for 34 no more than five years and a fine of at least $750 but not 35 -13- LSB 5360XC (13) 87 asf/rj 13/ 16

S.F. _____ more than $7,500. The bill provides that in addition to any 1 other applicable penalties, a court shall order a person to pay 2 restitution to persons aggrieved by the violation, if a person 3 commits an offense under this Code chapter. The bill requires 4 50 percent of the criminal penalty collected under this Code 5 chapter to be deposited in a fund created in the bill. Moneys 6 in the fund are appropriated to the insurance division of the 7 department of commerce to the unit for the benefit of the 8 workers’ compensation fraud unit. 9 The new workers’ compensation fraud Code chapter 10 incorporates by reference the following provisions from the 11 insurance fraud Code chapter 507E: 507E.4 (examination of 12 information outside the state), 507E.5 (confidentiality), and 13 507E.7 (immunity from liability). 14 The new Code chapter also defines insurer. “Insurer” means 15 a person entering into arrangements or contracts of insurance 16 or reinsurance agreeing to perform any of the following acts: 17 pay or indemnify another as to loss from certain contingencies 18 called risks, including through reinsurance; pay or grant 19 a specified amount or determinable benefit to another in 20 connection with ascertainable risk contingencies; pay an 21 annuity to another; or act as surety. 22 The new Code chapter limits commencement of actions 23 for violations of the Code chapter to within five years of 24 commission of workers’ compensation fraud. 25 The new Code chapter provides for suspension of benefits 26 if the workers’ compensation fraud unit determines there is 27 probable cause, after providing a person notice and opportunity 28 to be heard, that a violation of the new Code chapter has 29 occurred by a person receiving benefits under Code chapter 30 85, 85A, or 85B. The chapter provides for the suspension 31 of benefits until a determination of no prosecution occurs 32 or where a determination to prosecute is reached, until the 33 conclusion of the criminal proceedings in district court. The 34 bill provides that a person convicted of workers’ compensation 35 -14- LSB 5360XC (13) 87 asf/rj 14/ 16

S.F. _____ fraud shall be prohibited from receiving benefits under Code 1 chapters 85, 85A, and 85B for the particular claim or injury 2 giving rise to the criminal action. The bill provides that 3 if the person is acquitted or the charges are dismissed, a 4 person’s benefits will be resumed. The bill provides that a 5 person has an option to receive a lump sum for back payment of 6 benefits upon resumption of benefits. 7 The new Code chapter grants the commissioner of insurance 8 rulemaking authority. 9 The bill amends Code chapter 507E to provide a definition of 10 insurer. Insurer, for the purposes of that Code chapter, means 11 the same as defined in new Code chapter 507F. 12 The bill also amends Code section 507E.6 (duties of insurer) 13 to provide for a process when an insurer alerts the insurance 14 fraud bureau of workers’ compensation fraud. The bill provides 15 that if the notification pertains to workers’ compensation 16 insurance fraud, the insurance fraud bureau shall deliver the 17 notice to the workers’ compensation fraud unit. 18 The bill amends Code chapter 85 to provide that the employer 19 retains the right to choose the employee’s physician throughout 20 the course of treatment, including the choice of specialists. 21 The employer is not obliged to authorize a referral for care 22 with a specific provider of services. 23 The bill amends Code chapter 85 to reference suspension of 24 benefits under new Code chapter 507F. 25 The bill amends Code chapter 86 to reference the criminal 26 penalty for fraudulent attorney fees under new Code chapter 27 507F. 28 The bill also amends Code chapter 85 to provide that 29 medical services provided under Code chapter 85, 85A, or 85B 30 shall not be billed at a rate higher than the health service 31 provider’s standard retail rate for that medical service. The 32 bill provides that a health service provider who bills and 33 receives payment in excess of the health service provider’s 34 standard retail rate for medical services to treat a workers’ 35 -15- LSB 5360XC (13) 87 asf/rj 15/ 16