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Senate Study Bill 3165 - IntroducedA Bill ForAn Act 1relating to workers’ compensation and insurance fraud
2and other prohibited health service provider practices,
3providing appropriations and penalties, and including
4effective date and applicability provisions.
5BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 507F.1 Definitions.
2As used in this chapter, unless the context otherwise
3requires:
41. “Business entity” means a corporation, association,
5partnership, limited liability company, limited liability
6partnership, or other legal entity.
72. “Insurer” means a person entering into arrangements or
8contracts of insurance or reinsurance agreeing to perform any
9of the following acts:
10a. Pay or indemnify another as to loss from certain
11contingencies called risks, including through reinsurance.
12b. Pay or grant a specified amount or determinable benefit
13to another in connection with ascertainable risk contingencies.
14c. Pay an annuity to another.
15d. Act as surety.
163. “Statement” includes but is not limited to any notice,
17statement, proof of loss, receipt for payment, invoice,
18account, bill for services, diagnosis, prescription, hospital
19or physician record, X ray, test result, or other evidence of
20loss, injury, or expense.
21 Sec. 2. NEW SECTION. 507F.2 Purpose.
22A workers’ compensation fraud unit is created within the
23insurance fraud bureau within the insurance division. Upon a
24reasonable determination by the workers’ compensation fraud
25unit, by its own inquiries or as a result of complaints filed
26with the insurance fraud bureau or the workers’ compensation
27fraud unit, that a person has engaged in, is engaging in,
28or may be engaging in an act or practice that violates this
29chapter, the workers’ compensation fraud unit may administer
30oaths and affirmations, issue and serve subpoenas ordering the
31attendance of witnesses, collect evidence related to such act
32or practice, commence a suit, and prosecute a violation of this
33chapter.
34 Sec. 3. NEW SECTION. 507F.3 Workers’ compensation attorney
35fraud — penalty.
-1- 11. An attorney or an attorney’s agent who acts unilaterally
2without an attorney’s knowledge commits workers’ compensation
3attorney fraud if the person, for the purpose of obtaining any
4benefit under chapter 85, 85A, 85B, 86, or 87 for oneself or on
5behalf of another person, knowingly does any of the following:
6a. Presents or causes to be presented to an insurer any
7oral or written statement, knowing the statement contains false
8information concerning a material fact.
9b. Employs any deception device, scheme, or artifice to
10defraud.
11c. Misrepresents, conceals, or suppresses any material fact
12to defraud.
13d. Makes a false entry in, fabricates, alters, conceals, or
14destroys a document to defraud.
15e. Assists, abets, solicits, or conspires with another in
16committing a violation of this chapter.
172. An attorney or an attorney’s agent who commits workers’
18compensation attorney fraud is, upon conviction, guilty
19of a class “D” felony. An attorney convicted of workers’
20compensation attorney fraud shall forfeit the ability to
21collect any attorney fees not already collected and shall
22refund attorney fees already collected from the client who was
23the subject of the worker’s compensation attorney fraud, unless
24the client commits workers’ compensation benefit fraud, in
25which case the attorney fees shall be forfeited to the victim
26compensation fund established in section 915.94.
273. Fifty percent of the criminal penalty collected under
28this section shall be deposited in the workers’ compensation
29fraud penalty fund created in section 507F.9. Fifty percent
30of the criminal penalty collected under this section shall be
31deposited pursuant to section 602.8108.
32 Sec. 4. NEW SECTION. 507F.4 Workers’ compensation benefit
33fraud — penalty.
341. A person commits the offense of workers’ compensation
35benefit fraud if the person, for the purpose of obtaining any
-2-1benefit under chapter 85, 85A, 85B, 86, or 87 for oneself or on
2behalf of another person, knowingly does any of the following:
3a. Presents or causes to be presented to an insurer, any
4oral or written statement, knowing that such statement contains
5false information concerning a material fact.
6b. Misrepresents, conceals, or suppresses any material fact
7to defraud.
8c. Makes a false entry in, fabricates, alters, conceals, or
9destroys a document to defraud.
10d. Assists, abets, solicits, or conspires with another in
11committing a violation of this chapter.
122. A person who commits workers’ compensation benefit
13fraud is, upon conviction, guilty of a class “D” felony. Upon
14conviction of this offense, a person shall forfeit all right to
15compensation under chapters 85, 85A, and 85B for the alleged
16injury which is the subject matter of the conviction.
173. Fifty percent of the criminal penalty collected under
18this section shall be deposited in the workers’ compensation
19fraud penalty fund created in section 507F.9. Fifty percent
20of the criminal penalty collected under this section shall be
21deposited pursuant to section 602.8108.
22 Sec. 5. NEW SECTION. 507F.5 Workers’ compensation health
23service provider fraud — penalty.
241. A health service provider or a health service provider’s
25agent who acts unilaterally without a health service
26providers’s knowledge commits workers’ compensation health
27service provider fraud if the person, for the purpose of
28obtaining any benefit or payment under chapter 85, 85A, 85B,
2986, or 87 for oneself or on behalf of another person, knowingly
30does any of the following:
31a. Presents or causes to be presented to an insurer any
32oral or written statement, knowing that such statement contains
33false information concerning a material fact.
34b. Misrepresents, conceals, or suppresses any material fact
35to defraud.
-3- 1c. Makes a false entry in, fabricates, alters, conceals, or
2destroys a document to defraud.
3d. Bills for services not rendered, services rendered for
4a person other than the person identified on the bill, or
5services rendered for an injury or person not covered by the
6workers’ compensation laws.
7e. Assists, abets, solicits, or conspires with another in
8committing a violation of this chapter.
92. A health service provider or health service provider’s
10agent who commits workers’ compensation health service provider
11fraud is, upon conviction, guilty of a class “D” felony.
123. Fifty percent of the criminal penalty collected under
13this section shall be deposited in the workers’ compensation
14fraud penalty fund created in section 507F.9. Fifty percent
15of the criminal penalty collected under this section shall be
16deposited pursuant to section 602.8108.
17 Sec. 6. NEW SECTION. 507F.6 Workers’ compensation insurance
18carrier fraud — penalty.
191. An employee, agent, or contractor of an insurer commits
20workers’ compensation insurance carrier fraud if the person,
21for the purpose of obtaining any benefit or payment under
22chapter 85, 85A, 85B, 86, or 87 for oneself or on behalf of
23another person, knowingly does any of the following in the
24course of processing an insurance claim:
25a. Creates fraudulent claims and authorizes the payment of
26such claims to defraud the insurer.
27b. Authorizes the payment of claims known by the employee,
28agent, or contractor to be fraudulent to assist, abet, solicit,
29or conspire with another to defraud the insurer.
302. An employee, agent, or contractor of an insurer who
31commits workers’ compensation insurance carrier fraud is, upon
32conviction, guilty of a class “D” felony.
333. Fifty percent of the criminal penalty collected under
34this section shall be deposited in the workers’ compensation
35fraud penalty fund created in section 507F.9. Fifty percent
-4-1of the criminal penalty collected under this section shall be
2deposited pursuant to section 602.8108.
3 Sec. 7. NEW SECTION. 507F.7 Workers’ compensation insurance
4coverage fraud — penalty.
51. A person commits the offense of workers’ compensation
6insurance coverage fraud if the person, in connection with
7any application or renewal of an insurance policy providing
8workers’ compensation insurance coverage or to avoid payment
9of or reduce premiums due for that coverage, for oneself or
10another, knowingly does any of the following:
11a. Presents or causes to be presented to an insurer, any
12oral or written statement, knowing that such statement contains
13false information concerning a material fact to defraud.
14b. Misrepresents, conceals, or suppresses any material fact
15to defraud.
16c. Makes a false entry in, fabricates, alters, conceals, or
17destroys a document to defraud.
182. A person who commits workers’ compensation insurance
19coverage fraud is, upon conviction, guilty of a class “D”
20felony.
213. Fifty percent of the criminal penalty collected under
22this section shall be deposited in the workers’ compensation
23fraud penalty fund created in section 507F.9. Fifty percent
24of the criminal penalty collected under this section shall be
25deposited pursuant to section 602.8108.
26 Sec. 8. NEW SECTION. 507F.8 Restitution.
27In addition to the criminal penalties established in this
28chapter, the court shall order a person who commits an offense
29under this chapter to pay restitution to persons aggrieved by
30the violation. Restitution shall be ordered in addition to a
31fine and the possibility of imprisonment, but not in lieu of a
32fine and the possibility of imprisonment.
33 Sec. 9. NEW SECTION. 507F.9 Fund created.
34A workers’ compensation fraud penalty fund is created in
35the state treasury as a separate fund under the control of
-5-1the commissioner of insurance for purposes of this chapter.
2All moneys deposited into the fund are appropriated to the
3insurance division of the department of commerce for the
4workers’ compensation fraud unit. Notwithstanding section
58.33, any balance in the fund on June 30 of each fiscal year
6shall not revert to the general fund of the state, but shall
7be available for purposes of this chapter in subsequent fiscal
8years. The commissioner of insurance may request additional
9full time equivalent positions as needed and the request shall
10be granted so long as sufficient funds are within the workers’
11compensation fraud penalty fund.
12 Sec. 10. NEW SECTION. 507F.10 Examination of information
13outside the state.
14As a unit within the insurance fraud bureau, the workers’
15compensation fraud unit, pursuant to section 507E.4, may obtain
16and examine any information that is related to enforcement of
17this chapter in possession of a person located outside the
18state.
19 Sec. 11. NEW SECTION. 507F.11 Confidentiality.
20As a unit within the insurance fraud bureau, all of the
21provisions of section 507E.5 shall apply to the workers’
22compensation fraud unit.
23 Sec. 12. NEW SECTION. 507F.12 Immunity from liability.
24A person is immune from civil liability for acts under this
25chapter if the person meets the requirements set forth in
26section 507E.7.
27 Sec. 13. NEW SECTION. 507F.13 Election of prosecution.
28If a person commits an offense under this chapter, the
29prosecuting attorney may elect to proceed under this chapter
30or any other law of this state.
31 Sec. 14. NEW SECTION. 507F.14 Prosecuting attorney status.
321. The workers’ compensation fraud unit shall employ at
33least one full-time prosecuting attorney. The prosecuting
34attorney, having specialized knowledge and training, shall
35in all counties in this state prosecute all criminal actions
-6-1which may be brought under this chapter in which the workers’
2compensation fraud unit may be interested, when, in the
3prosecuting attorney’s judgment, the interest of the unit
4requires such action.
52. The prosecuting attorney may request a county attorney
6to assist with or handle the prosecution of a criminal action
7which may be brought under this chapter.
83. The prosecuting attorney shall report to the
9commissioner of insurance.
10 Sec. 15. NEW SECTION. 507F.15 Law enforcement officer
11status.
12As a unit within the insurance fraud bureau, all of the
13provisions of section 507E.8 shall apply to the workers’
14compensation fraud unit.
15 Sec. 16. NEW SECTION. 507F.16 Limitation of actions.
16An information or indictment asserting a violation of this
17chapter shall be commenced within five years after the last
18date of its commission.
19 Sec. 17. NEW SECTION. 507F.17 Suspension of benefits.
20If a person is currently receiving or has a pending
21application for workers’ compensation benefits under chapter
2285, 85A, or 85B and the workers’ compensation fraud unit,
23after providing the person notice and opportunity to be heard,
24determines probable cause of a violation of this chapter by a
25person receiving benefits under chapter 85, 85A, or 85B, the
26workers’ compensation fraud unit shall notify the workers’
27compensation commissioner, who shall suspend benefits until the
28workers’ compensation fraud unit makes a final determination
29whether to charge a person with a violation of this chapter and
30commence prosecutorial action. If the workers’ compensation
31fraud unit’s final determination is to not prosecute, the
32workers’ compensation commissioner shall resume the person’s
33benefits. If the workers’ compensation fraud unit’s final
34determination is to prosecute, the person’s benefits shall
35remain suspended until the conclusion of the criminal
-7-1proceedings in district court.
2A person convicted of workers’ compensation fraud shall be
3prohibited from receiving benefits under chapters 85, 85A,
4and 85B for the particular claim or injury giving rise to the
5criminal action. If the person is acquitted or the charges
6are dismissed, the workers’ compensation fraud unit shall
7notify the workers’ compensation commissioner of such action
8and the commissioner shall resume the payment of any benefits
9previously suspended. A person whose benefits have been
10suspended and the payment of benefits resumed has the option to
11receive a back payment in a lump sum upon resumption of payment
12of benefits.
13 Sec. 18. NEW SECTION. 507F.18 Rulemaking authority.
14The commissioner of insurance may adopt rules pursuant to
15chapter 17A to administer this chapter.
16 Sec. 19. Section 85.27, subsections 3 and 4, Code 2018, are
17amended to read as follows:
183. A medical service provided under this chapter or
19chapter 85A or 85B shall not be billed at a rate higher than
20a health service provider’s standard retail rate for the
21medical service. A health service provider who bills and
22receives payment in excess of the health service provider’s
23standard rate for a medical service provided to treat a
24workers’ compensation injury shall reimburse the employer
25or insurance carrier which paid for the medical service for
26the excess payments received by the health service provider.
27Notwithstanding section 85.26, subsection 4, charges believed
28to be excessive or unnecessary may be referred by the
29employer, insurance carrier, or health service provider to the
30workers’ compensation commissioner for determination, and the
31commissioner may utilize the procedures provided in sections
3286.38 and 86.39, or set by rule, and conduct such inquiry as
33the commissioner deems necessary. Any health service provider
34charges not in dispute shall be paid directly to the health
35service provider prior to utilization of procedures provided
-8-1in sections 86.38 and 86.39 or set by rule. A health service
2provider rendering treatment to an employee whose injury is
3compensable under this section agrees to be bound by such
4charges as allowed by the workers’ compensation commissioner
5and shall not recover in law or equity any amount in excess of
6charges set by the commissioner. When a dispute under this
7chapter, chapter 85A, or chapter 85B regarding reasonableness
8of a fee for medical services arises between a health service
9provider and an employer or insurance carrier, the health
10service provider, employer, or insurance carrier shall not seek
11payment from the injured employee. A health service provider
12shall not seek payment for fees in dispute from the insurance
13carrier or employer until the commissioner finds, pursuant to
14informal dispute resolution procedures established by rule by
15the commissioner, that the disputed amount is reasonable. This
16section does not affect the responsibility of an insurance
17carrier or an employer to pay amounts not in dispute or a
18health service provider’s right to receive payment from an
19employee’s nonoccupational plan as provided in section 85.38,
20subsection 2.
214. For purposes of this section, the employer is obliged to
22furnish reasonable services and supplies to treat an injured
23employee, and has the right to choose the care. The employer
24retains the right to choose the employee’s care throughout the
25course of treatment for all services identified in subsection
261. The employer is not obliged to authorize a referral for
27care to a specific provider of services by an authorized
28treating medical provider and the employer has the right to
29choose any provider for the care. If the employer chooses the
30care, the employer shall hold the employee harmless for the
31cost of care until the employer notifies the employee that the
32employer is no longer authorizing all or any part of the care
33and the reason for the change in authorization. An employer
34is not liable for the cost of care that the employer arranges
35in response to a sudden emergency if the employee’s condition,
-9-1for which care was arranged, is not related to the employment.
2The treatment must be offered promptly and be reasonably
3suited to treat the injury without undue inconvenience to the
4employee. If the employee has reason to be dissatisfied with
5the care offered, the employee should communicate the basis of
6such dissatisfaction to the employer, in writing if requested,
7following which the employer and the employee may agree to
8alternate care reasonably suited to treat the injury. If the
9employer and employee cannot agree on such alternate care,
10the commissioner may, upon application and reasonable proofs
11of the necessity therefor, allow and order other care. In an
12emergency, the employee may choose the employee’s care at the
13employer’s expense, provided the employer or the employer’s
14agent cannot be reached immediately. An application made under
15this subsection shall be considered an original proceeding
16for purposes of commencement and contested case proceedings
17under section 85.26. The hearing shall be conducted pursuant
18to chapter 17A. Before a hearing is scheduled, the parties
19may choose a telephone hearing or an in-person hearing. A
20request for an in-person hearing shall be approved unless the
21in-person hearing would be impractical because of the distance
22between the parties to the hearing. The workers’ compensation
23commissioner shall issue a decision within ten working days of
24receipt of an application for alternate care made pursuant to a
25telephone hearing or within fourteen working days of receipt of
26an application for alternate care made pursuant to an in-person
27hearing. The employer shall notify an injured employee of the
28employee’s ability to contest the employer’s choice of care
29pursuant to this subsection.
30 Sec. 20. NEW SECTION. 85.37A Suspension of benefits for
31workers’ compensation fraud.
32Section 507F.17 requires the workers’ compensation
33commissioner to suspend a person’s benefits if the workers’
34compensation fraud unit has probable cause to believe that the
35person has violated chapter 507F.
-10-1 Sec. 21. NEW SECTION. 86.39A Criminal penalty for workers’
2compensation attorney fraud.
3Chapter 507F sets forth criminal penalties for engaging in
4workers’ compensation fraud, including but not limited to fraud
5committed by an attorney.
6 Sec. 22. NEW SECTION. 507E.2A Definition of insurer.
7As used in this chapter, unless the context otherwise
8requires, “insurer” means a person entering into arrangements or
9contracts of insurance or reinsurance agreeing to perform any
10of the following acts:
11a. Pay or indemnify another as to loss from certain
12contingencies called risks, including through reinsurance.
13b. Pay or grant a specified amount or determinable benefit
14to another in connection with ascertainable risk contingencies.
15c. Pay an annuity to another.
16d. Act as surety.
17 Sec. 23. Section 507E.6, Code 2018, is amended to read as
18follows:
19507E.6 Duties of insurer and fraud bureau.
201. An insurer which believes that a claim or application
21for insurance coverage is being made which is a violation of
22section 507E.3 or believes that a violation of 507E.3A has
23occurred, shall provide, within sixty days of the receipt
24of such claim or application becoming aware of a possible
25violation, written notification to the bureau of the claim or
26application suspected violation on a form prescribed by the
27bureau, including any additional information requested by the
28bureau related to the claim or application or the party making
29the claim or application.
302. The fraud bureau shall review each notification and
31determine whether further investigation is warranted.
323. If the bureau determines that further investigation
33is warranted, the bureau shall conduct an independent
34investigation of the facts surrounding the claim or application
35for insurance coverage notification to determine the extent,
-11-1if any, to which fraud occurred in the submission of the claim
2or application. If the notification pertains to workers’
3compensation insurance fraud, the bureau shall deliver the
4notice to the workers’ compensation fraud unit, which shall
5determine if an investigation and prosecution are warranted.
6Upon formal request made by the bureau, the insurer shall
7provide all additional information related to the notification
8within ten business days or a time period specifically
9identified by the bureau.
104. The bureau shall report any alleged violation of law
11disclosed by the investigation to the appropriate licensing
12agency or prosecuting authority having jurisdiction with
13respect to such violation.
14 Sec. 24. Section 507E.8, Code 2018, is amended to read as
15follows:
16507E.8 Law enforcement officer status.
171. Bureau investigators shall have the power and status
18of law enforcement officers who by the nature of their duties
19may be required to perform the duties of a peace officer when
20making arrests for criminal violations established as a result
21of their investigations pursuant to this chapter or chapter
22507F.
232. The general laws applicable to arrests by law enforcement
24officers of the state also apply to bureau investigators.
25Bureau investigators shall have the power to execute arrest
26warrants and search warrants for the same criminal violations,
27serve subpoenas issued for the examination, investigation, and
28trial of all offenses identified through their investigations,
29and arrest upon probable cause without warrant a person found
30in the act of committing a violation of the provisions of this
31chapter or chapter 507F.
32 Sec. 25. EFFECTIVE DATE. This Act, being deemed of
33immediate importance, takes effect upon enactment.
34 Sec. 26. APPLICABILITY. This Act applies on the effective
35date of this Act to acts of fraud or prohibited health service
-12-1providers’ practices committed on or after the effective date
2of this Act.
3EXPLANATION
4The inclusion of this explanation does not constitute agreement with
5the explanation’s substance by the members of the general assembly.
6This bill relates to workers’ compensation and insurance
7fraud and other prohibited health service provider practices.
8The bill creates new Code chapter 507F dedicated to workers’
9compensation fraud, codified following the existing insurance
10fraud Code chapter 507E.
11The bill establishes a workers’ compensation fraud unit
12(unit) within the insurance fraud bureau within the insurance
13division. The purpose of the unit is to investigate and
14prosecute workers’ compensation fraud. Unit investigators have
15the power and status of law enforcement officers. The bill
16requires the unit to employ at least one full-time prosecuting
17attorney to prosecute all criminal actions which may be brought
18under this Code chapter in which the unit may be interested,
19when, in the prosecuting attorney’s judgment, the interest of
20the unit requires such action.
21The bill provides an election of prosecution. If a person
22commits an offense under this Code chapter, the prosecuting
23attorney may elect to proceed under this Code chapter or any
24other law of this state. The prosecuting attorney may be the
25unit prosecuting attorney or a county attorney.
26The bill sets forth criminal penalties for engaging in
27workers’ compensation fraud, including fraud committed by
28employers, workers, insurers, health service providers,
29employees of insurers, and attorneys. Specifically, the bill
30penalizes as a class “D” felony the following forms of workers’
31compensation fraud: benefit fraud, insurance coverage fraud,
32health service provider fraud, insurance carrier fraud, and
33attorney fraud. The elements for each crime are enumerated in
34the bill. A class “D” felony is punishable by confinement for
35no more than five years and a fine of at least $750 but not
-13-1more than $7,500. The bill provides that in addition to any
2other applicable penalties, a court shall order a person to pay
3restitution to persons aggrieved by the violation, if a person
4commits an offense under this Code chapter. The bill requires
550 percent of the criminal penalty collected under this Code
6chapter to be deposited in a fund created in the bill. Moneys
7in the fund are appropriated to the insurance division of the
8department of commerce to the unit for the benefit of the
9workers’ compensation fraud unit.
10The new workers’ compensation fraud Code chapter
11incorporates by reference the following provisions from the
12insurance fraud Code chapter 507E: 507E.4 (examination of
13information outside the state), 507E.5 (confidentiality), and
14507E.7 (immunity from liability).
15The new Code chapter also defines insurer. “Insurer” means
16a person entering into arrangements or contracts of insurance
17or reinsurance agreeing to perform any of the following acts:
18pay or indemnify another as to loss from certain contingencies
19called risks, including through reinsurance; pay or grant
20a specified amount or determinable benefit to another in
21connection with ascertainable risk contingencies; pay an
22annuity to another; or act as surety.
23The new Code chapter limits commencement of actions
24for violations of the Code chapter to within five years of
25commission of workers’ compensation fraud.
26The new Code chapter provides for suspension of benefits
27if the workers’ compensation fraud unit determines there is
28probable cause, after providing a person notice and opportunity
29to be heard, that a violation of the new Code chapter has
30occurred by a person receiving benefits under Code chapter
3185, 85A, or 85B. The chapter provides for the suspension
32of benefits until a determination of no prosecution occurs
33or where a determination to prosecute is reached, until the
34conclusion of the criminal proceedings in district court. The
35bill provides that a person convicted of workers’ compensation
-14-1fraud shall be prohibited from receiving benefits under Code
2chapters 85, 85A, and 85B for the particular claim or injury
3giving rise to the criminal action. The bill provides that
4if the person is acquitted or the charges are dismissed, a
5person’s benefits will be resumed. The bill provides that a
6person has an option to receive a lump sum for back payment of
7benefits upon resumption of benefits.
8The new Code chapter grants the commissioner of insurance
9rulemaking authority.
10The bill amends Code chapter 507E to provide a definition of
11insurer. Insurer, for the purposes of that Code chapter, means
12the same as defined in new Code chapter 507F.
13The bill also amends Code section 507E.6 (duties of insurer)
14to provide for a process when an insurer alerts the insurance
15fraud bureau of workers’ compensation fraud. The bill provides
16that if the notification pertains to workers’ compensation
17insurance fraud, the insurance fraud bureau shall deliver the
18notice to the workers’ compensation fraud unit.
19The bill amends Code chapter 85 to provide that the employer
20retains the right to choose the employee’s physician throughout
21the course of treatment, including the choice of specialists.
22The employer is not obliged to authorize a referral for care
23with a specific provider of services.
24The bill amends Code chapter 85 to reference suspension of
25benefits under new Code chapter 507F.
26The bill amends Code chapter 86 to reference the criminal
27penalty for fraudulent attorney fees under new Code chapter
28507F.
29The bill also amends Code chapter 85 to provide that
30medical services provided under Code chapter 85, 85A, or 85B
31shall not be billed at a rate higher than the health service
32provider’s standard retail rate for that medical service. The
33bill provides that a health service provider who bills and
34receives payment in excess of the health service provider’s
35standard retail rate for medical services to treat a workers’
-15-1compensation-covered injury shall reimburse the company which
2paid for the medical services for the excess payments.
3The bill takes effect upon enactment and applies to acts
4of fraud or prohibited health service providers’ practices
5committed on or after enactment.
-16-asf/rj
2and other prohibited health service provider practices,
3providing appropriations and penalties, and including
4effective date and applicability provisions.
5BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 507F.1 Definitions.
2As used in this chapter, unless the context otherwise
3requires:
41. “Business entity” means a corporation, association,
5partnership, limited liability company, limited liability
6partnership, or other legal entity.
72. “Insurer” means a person entering into arrangements or
8contracts of insurance or reinsurance agreeing to perform any
9of the following acts:
10a. Pay or indemnify another as to loss from certain
11contingencies called risks, including through reinsurance.
12b. Pay or grant a specified amount or determinable benefit
13to another in connection with ascertainable risk contingencies.
14c. Pay an annuity to another.
15d. Act as surety.
163. “Statement” includes but is not limited to any notice,
17statement, proof of loss, receipt for payment, invoice,
18account, bill for services, diagnosis, prescription, hospital
19or physician record, X ray, test result, or other evidence of
20loss, injury, or expense.
21 Sec. 2. NEW SECTION. 507F.2 Purpose.
22A workers’ compensation fraud unit is created within the
23insurance fraud bureau within the insurance division. Upon a
24reasonable determination by the workers’ compensation fraud
25unit, by its own inquiries or as a result of complaints filed
26with the insurance fraud bureau or the workers’ compensation
27fraud unit, that a person has engaged in, is engaging in,
28or may be engaging in an act or practice that violates this
29chapter, the workers’ compensation fraud unit may administer
30oaths and affirmations, issue and serve subpoenas ordering the
31attendance of witnesses, collect evidence related to such act
32or practice, commence a suit, and prosecute a violation of this
33chapter.
34 Sec. 3. NEW SECTION. 507F.3 Workers’ compensation attorney
35fraud — penalty.
-1- 11. An attorney or an attorney’s agent who acts unilaterally
2without an attorney’s knowledge commits workers’ compensation
3attorney fraud if the person, for the purpose of obtaining any
4benefit under chapter 85, 85A, 85B, 86, or 87 for oneself or on
5behalf of another person, knowingly does any of the following:
6a. Presents or causes to be presented to an insurer any
7oral or written statement, knowing the statement contains false
8information concerning a material fact.
9b. Employs any deception device, scheme, or artifice to
10defraud.
11c. Misrepresents, conceals, or suppresses any material fact
12to defraud.
13d. Makes a false entry in, fabricates, alters, conceals, or
14destroys a document to defraud.
15e. Assists, abets, solicits, or conspires with another in
16committing a violation of this chapter.
172. An attorney or an attorney’s agent who commits workers’
18compensation attorney fraud is, upon conviction, guilty
19of a class “D” felony. An attorney convicted of workers’
20compensation attorney fraud shall forfeit the ability to
21collect any attorney fees not already collected and shall
22refund attorney fees already collected from the client who was
23the subject of the worker’s compensation attorney fraud, unless
24the client commits workers’ compensation benefit fraud, in
25which case the attorney fees shall be forfeited to the victim
26compensation fund established in section 915.94.
273. Fifty percent of the criminal penalty collected under
28this section shall be deposited in the workers’ compensation
29fraud penalty fund created in section 507F.9. Fifty percent
30of the criminal penalty collected under this section shall be
31deposited pursuant to section 602.8108.
32 Sec. 4. NEW SECTION. 507F.4 Workers’ compensation benefit
33fraud — penalty.
341. A person commits the offense of workers’ compensation
35benefit fraud if the person, for the purpose of obtaining any
-2-1benefit under chapter 85, 85A, 85B, 86, or 87 for oneself or on
2behalf of another person, knowingly does any of the following:
3a. Presents or causes to be presented to an insurer, any
4oral or written statement, knowing that such statement contains
5false information concerning a material fact.
6b. Misrepresents, conceals, or suppresses any material fact
7to defraud.
8c. Makes a false entry in, fabricates, alters, conceals, or
9destroys a document to defraud.
10d. Assists, abets, solicits, or conspires with another in
11committing a violation of this chapter.
122. A person who commits workers’ compensation benefit
13fraud is, upon conviction, guilty of a class “D” felony. Upon
14conviction of this offense, a person shall forfeit all right to
15compensation under chapters 85, 85A, and 85B for the alleged
16injury which is the subject matter of the conviction.
173. Fifty percent of the criminal penalty collected under
18this section shall be deposited in the workers’ compensation
19fraud penalty fund created in section 507F.9. Fifty percent
20of the criminal penalty collected under this section shall be
21deposited pursuant to section 602.8108.
22 Sec. 5. NEW SECTION. 507F.5 Workers’ compensation health
23service provider fraud — penalty.
241. A health service provider or a health service provider’s
25agent who acts unilaterally without a health service
26providers’s knowledge commits workers’ compensation health
27service provider fraud if the person, for the purpose of
28obtaining any benefit or payment under chapter 85, 85A, 85B,
2986, or 87 for oneself or on behalf of another person, knowingly
30does any of the following:
31a. Presents or causes to be presented to an insurer any
32oral or written statement, knowing that such statement contains
33false information concerning a material fact.
34b. Misrepresents, conceals, or suppresses any material fact
35to defraud.
-3- 1c. Makes a false entry in, fabricates, alters, conceals, or
2destroys a document to defraud.
3d. Bills for services not rendered, services rendered for
4a person other than the person identified on the bill, or
5services rendered for an injury or person not covered by the
6workers’ compensation laws.
7e. Assists, abets, solicits, or conspires with another in
8committing a violation of this chapter.
92. A health service provider or health service provider’s
10agent who commits workers’ compensation health service provider
11fraud is, upon conviction, guilty of a class “D” felony.
123. Fifty percent of the criminal penalty collected under
13this section shall be deposited in the workers’ compensation
14fraud penalty fund created in section 507F.9. Fifty percent
15of the criminal penalty collected under this section shall be
16deposited pursuant to section 602.8108.
17 Sec. 6. NEW SECTION. 507F.6 Workers’ compensation insurance
18carrier fraud — penalty.
191. An employee, agent, or contractor of an insurer commits
20workers’ compensation insurance carrier fraud if the person,
21for the purpose of obtaining any benefit or payment under
22chapter 85, 85A, 85B, 86, or 87 for oneself or on behalf of
23another person, knowingly does any of the following in the
24course of processing an insurance claim:
25a. Creates fraudulent claims and authorizes the payment of
26such claims to defraud the insurer.
27b. Authorizes the payment of claims known by the employee,
28agent, or contractor to be fraudulent to assist, abet, solicit,
29or conspire with another to defraud the insurer.
302. An employee, agent, or contractor of an insurer who
31commits workers’ compensation insurance carrier fraud is, upon
32conviction, guilty of a class “D” felony.
333. Fifty percent of the criminal penalty collected under
34this section shall be deposited in the workers’ compensation
35fraud penalty fund created in section 507F.9. Fifty percent
-4-1of the criminal penalty collected under this section shall be
2deposited pursuant to section 602.8108.
3 Sec. 7. NEW SECTION. 507F.7 Workers’ compensation insurance
4coverage fraud — penalty.
51. A person commits the offense of workers’ compensation
6insurance coverage fraud if the person, in connection with
7any application or renewal of an insurance policy providing
8workers’ compensation insurance coverage or to avoid payment
9of or reduce premiums due for that coverage, for oneself or
10another, knowingly does any of the following:
11a. Presents or causes to be presented to an insurer, any
12oral or written statement, knowing that such statement contains
13false information concerning a material fact to defraud.
14b. Misrepresents, conceals, or suppresses any material fact
15to defraud.
16c. Makes a false entry in, fabricates, alters, conceals, or
17destroys a document to defraud.
182. A person who commits workers’ compensation insurance
19coverage fraud is, upon conviction, guilty of a class “D”
20felony.
213. Fifty percent of the criminal penalty collected under
22this section shall be deposited in the workers’ compensation
23fraud penalty fund created in section 507F.9. Fifty percent
24of the criminal penalty collected under this section shall be
25deposited pursuant to section 602.8108.
26 Sec. 8. NEW SECTION. 507F.8 Restitution.
27In addition to the criminal penalties established in this
28chapter, the court shall order a person who commits an offense
29under this chapter to pay restitution to persons aggrieved by
30the violation. Restitution shall be ordered in addition to a
31fine and the possibility of imprisonment, but not in lieu of a
32fine and the possibility of imprisonment.
33 Sec. 9. NEW SECTION. 507F.9 Fund created.
34A workers’ compensation fraud penalty fund is created in
35the state treasury as a separate fund under the control of
-5-1the commissioner of insurance for purposes of this chapter.
2All moneys deposited into the fund are appropriated to the
3insurance division of the department of commerce for the
4workers’ compensation fraud unit. Notwithstanding section
58.33, any balance in the fund on June 30 of each fiscal year
6shall not revert to the general fund of the state, but shall
7be available for purposes of this chapter in subsequent fiscal
8years. The commissioner of insurance may request additional
9full time equivalent positions as needed and the request shall
10be granted so long as sufficient funds are within the workers’
11compensation fraud penalty fund.
12 Sec. 10. NEW SECTION. 507F.10 Examination of information
13outside the state.
14As a unit within the insurance fraud bureau, the workers’
15compensation fraud unit, pursuant to section 507E.4, may obtain
16and examine any information that is related to enforcement of
17this chapter in possession of a person located outside the
18state.
19 Sec. 11. NEW SECTION. 507F.11 Confidentiality.
20As a unit within the insurance fraud bureau, all of the
21provisions of section 507E.5 shall apply to the workers’
22compensation fraud unit.
23 Sec. 12. NEW SECTION. 507F.12 Immunity from liability.
24A person is immune from civil liability for acts under this
25chapter if the person meets the requirements set forth in
26section 507E.7.
27 Sec. 13. NEW SECTION. 507F.13 Election of prosecution.
28If a person commits an offense under this chapter, the
29prosecuting attorney may elect to proceed under this chapter
30or any other law of this state.
31 Sec. 14. NEW SECTION. 507F.14 Prosecuting attorney status.
321. The workers’ compensation fraud unit shall employ at
33least one full-time prosecuting attorney. The prosecuting
34attorney, having specialized knowledge and training, shall
35in all counties in this state prosecute all criminal actions
-6-1which may be brought under this chapter in which the workers’
2compensation fraud unit may be interested, when, in the
3prosecuting attorney’s judgment, the interest of the unit
4requires such action.
52. The prosecuting attorney may request a county attorney
6to assist with or handle the prosecution of a criminal action
7which may be brought under this chapter.
83. The prosecuting attorney shall report to the
9commissioner of insurance.
10 Sec. 15. NEW SECTION. 507F.15 Law enforcement officer
11status.
12As a unit within the insurance fraud bureau, all of the
13provisions of section 507E.8 shall apply to the workers’
14compensation fraud unit.
15 Sec. 16. NEW SECTION. 507F.16 Limitation of actions.
16An information or indictment asserting a violation of this
17chapter shall be commenced within five years after the last
18date of its commission.
19 Sec. 17. NEW SECTION. 507F.17 Suspension of benefits.
20If a person is currently receiving or has a pending
21application for workers’ compensation benefits under chapter
2285, 85A, or 85B and the workers’ compensation fraud unit,
23after providing the person notice and opportunity to be heard,
24determines probable cause of a violation of this chapter by a
25person receiving benefits under chapter 85, 85A, or 85B, the
26workers’ compensation fraud unit shall notify the workers’
27compensation commissioner, who shall suspend benefits until the
28workers’ compensation fraud unit makes a final determination
29whether to charge a person with a violation of this chapter and
30commence prosecutorial action. If the workers’ compensation
31fraud unit’s final determination is to not prosecute, the
32workers’ compensation commissioner shall resume the person’s
33benefits. If the workers’ compensation fraud unit’s final
34determination is to prosecute, the person’s benefits shall
35remain suspended until the conclusion of the criminal
-7-1proceedings in district court.
2A person convicted of workers’ compensation fraud shall be
3prohibited from receiving benefits under chapters 85, 85A,
4and 85B for the particular claim or injury giving rise to the
5criminal action. If the person is acquitted or the charges
6are dismissed, the workers’ compensation fraud unit shall
7notify the workers’ compensation commissioner of such action
8and the commissioner shall resume the payment of any benefits
9previously suspended. A person whose benefits have been
10suspended and the payment of benefits resumed has the option to
11receive a back payment in a lump sum upon resumption of payment
12of benefits.
13 Sec. 18. NEW SECTION. 507F.18 Rulemaking authority.
14The commissioner of insurance may adopt rules pursuant to
15chapter 17A to administer this chapter.
16 Sec. 19. Section 85.27, subsections 3 and 4, Code 2018, are
17amended to read as follows:
183. A medical service provided under this chapter or
19chapter 85A or 85B shall not be billed at a rate higher than
20a health service provider’s standard retail rate for the
21medical service. A health service provider who bills and
22receives payment in excess of the health service provider’s
23standard rate for a medical service provided to treat a
24workers’ compensation injury shall reimburse the employer
25or insurance carrier which paid for the medical service for
26the excess payments received by the health service provider.
27Notwithstanding section 85.26, subsection 4, charges believed
28to be excessive or unnecessary may be referred by the
29employer, insurance carrier, or health service provider to the
30workers’ compensation commissioner for determination, and the
31commissioner may utilize the procedures provided in sections
3286.38 and 86.39, or set by rule, and conduct such inquiry as
33the commissioner deems necessary. Any health service provider
34charges not in dispute shall be paid directly to the health
35service provider prior to utilization of procedures provided
-8-1in sections 86.38 and 86.39 or set by rule. A health service
2provider rendering treatment to an employee whose injury is
3compensable under this section agrees to be bound by such
4charges as allowed by the workers’ compensation commissioner
5and shall not recover in law or equity any amount in excess of
6charges set by the commissioner. When a dispute under this
7chapter, chapter 85A, or chapter 85B regarding reasonableness
8of a fee for medical services arises between a health service
9provider and an employer or insurance carrier, the health
10service provider, employer, or insurance carrier shall not seek
11payment from the injured employee. A health service provider
12shall not seek payment for fees in dispute from the insurance
13carrier or employer until the commissioner finds, pursuant to
14informal dispute resolution procedures established by rule by
15the commissioner, that the disputed amount is reasonable. This
16section does not affect the responsibility of an insurance
17carrier or an employer to pay amounts not in dispute or a
18health service provider’s right to receive payment from an
19employee’s nonoccupational plan as provided in section 85.38,
20subsection 2.
214. For purposes of this section, the employer is obliged to
22furnish reasonable services and supplies to treat an injured
23employee, and has the right to choose the care. The employer
24retains the right to choose the employee’s care throughout the
25course of treatment for all services identified in subsection
261. The employer is not obliged to authorize a referral for
27care to a specific provider of services by an authorized
28treating medical provider and the employer has the right to
29choose any provider for the care. If the employer chooses the
30care, the employer shall hold the employee harmless for the
31cost of care until the employer notifies the employee that the
32employer is no longer authorizing all or any part of the care
33and the reason for the change in authorization. An employer
34is not liable for the cost of care that the employer arranges
35in response to a sudden emergency if the employee’s condition,
-9-1for which care was arranged, is not related to the employment.
2The treatment must be offered promptly and be reasonably
3suited to treat the injury without undue inconvenience to the
4employee. If the employee has reason to be dissatisfied with
5the care offered, the employee should communicate the basis of
6such dissatisfaction to the employer, in writing if requested,
7following which the employer and the employee may agree to
8alternate care reasonably suited to treat the injury. If the
9employer and employee cannot agree on such alternate care,
10the commissioner may, upon application and reasonable proofs
11of the necessity therefor, allow and order other care. In an
12emergency, the employee may choose the employee’s care at the
13employer’s expense, provided the employer or the employer’s
14agent cannot be reached immediately. An application made under
15this subsection shall be considered an original proceeding
16for purposes of commencement and contested case proceedings
17under section 85.26. The hearing shall be conducted pursuant
18to chapter 17A. Before a hearing is scheduled, the parties
19may choose a telephone hearing or an in-person hearing. A
20request for an in-person hearing shall be approved unless the
21in-person hearing would be impractical because of the distance
22between the parties to the hearing. The workers’ compensation
23commissioner shall issue a decision within ten working days of
24receipt of an application for alternate care made pursuant to a
25telephone hearing or within fourteen working days of receipt of
26an application for alternate care made pursuant to an in-person
27hearing. The employer shall notify an injured employee of the
28employee’s ability to contest the employer’s choice of care
29pursuant to this subsection.
30 Sec. 20. NEW SECTION. 85.37A Suspension of benefits for
31workers’ compensation fraud.
32Section 507F.17 requires the workers’ compensation
33commissioner to suspend a person’s benefits if the workers’
34compensation fraud unit has probable cause to believe that the
35person has violated chapter 507F.
-10-1 Sec. 21. NEW SECTION. 86.39A Criminal penalty for workers’
2compensation attorney fraud.
3Chapter 507F sets forth criminal penalties for engaging in
4workers’ compensation fraud, including but not limited to fraud
5committed by an attorney.
6 Sec. 22. NEW SECTION. 507E.2A Definition of insurer.
7As used in this chapter, unless the context otherwise
8requires, “insurer” means a person entering into arrangements or
9contracts of insurance or reinsurance agreeing to perform any
10of the following acts:
11a. Pay or indemnify another as to loss from certain
12contingencies called risks, including through reinsurance.
13b. Pay or grant a specified amount or determinable benefit
14to another in connection with ascertainable risk contingencies.
15c. Pay an annuity to another.
16d. Act as surety.
17 Sec. 23. Section 507E.6, Code 2018, is amended to read as
18follows:
19507E.6 Duties of insurer and fraud bureau.
201. An insurer which believes that a claim or application
21for insurance coverage is being made which is a violation of
22section 507E.3 or believes that a violation of 507E.3A has
23occurred, shall provide, within sixty days of the receipt
24of such claim or application becoming aware of a possible
25violation, written notification to the bureau of the claim or
26application suspected violation on a form prescribed by the
27bureau, including any additional information requested by the
28bureau related to the claim or application or the party making
29the claim or application.
302. The fraud bureau shall review each notification and
31determine whether further investigation is warranted.
323. If the bureau determines that further investigation
33is warranted, the bureau shall conduct an independent
34investigation of the facts surrounding the claim or application
35for insurance coverage notification to determine the extent,
-11-1if any, to which fraud occurred in the submission of the claim
2or application. If the notification pertains to workers’
3compensation insurance fraud, the bureau shall deliver the
4notice to the workers’ compensation fraud unit, which shall
5determine if an investigation and prosecution are warranted.
6Upon formal request made by the bureau, the insurer shall
7provide all additional information related to the notification
8within ten business days or a time period specifically
9identified by the bureau.
104. The bureau shall report any alleged violation of law
11disclosed by the investigation to the appropriate licensing
12agency or prosecuting authority having jurisdiction with
13respect to such violation.
14 Sec. 24. Section 507E.8, Code 2018, is amended to read as
15follows:
16507E.8 Law enforcement officer status.
171. Bureau investigators shall have the power and status
18of law enforcement officers who by the nature of their duties
19may be required to perform the duties of a peace officer when
20making arrests for criminal violations established as a result
21of their investigations pursuant to this chapter or chapter
22507F.
232. The general laws applicable to arrests by law enforcement
24officers of the state also apply to bureau investigators.
25Bureau investigators shall have the power to execute arrest
26warrants and search warrants for the same criminal violations,
27serve subpoenas issued for the examination, investigation, and
28trial of all offenses identified through their investigations,
29and arrest upon probable cause without warrant a person found
30in the act of committing a violation of the provisions of this
31chapter or chapter 507F.
32 Sec. 25. EFFECTIVE DATE. This Act, being deemed of
33immediate importance, takes effect upon enactment.
34 Sec. 26. APPLICABILITY. This Act applies on the effective
35date of this Act to acts of fraud or prohibited health service
-12-1providers’ practices committed on or after the effective date
2of this Act.
3EXPLANATION
4The inclusion of this explanation does not constitute agreement with
5the explanation’s substance by the members of the general assembly.
6This bill relates to workers’ compensation and insurance
7fraud and other prohibited health service provider practices.
8The bill creates new Code chapter 507F dedicated to workers’
9compensation fraud, codified following the existing insurance
10fraud Code chapter 507E.
11The bill establishes a workers’ compensation fraud unit
12(unit) within the insurance fraud bureau within the insurance
13division. The purpose of the unit is to investigate and
14prosecute workers’ compensation fraud. Unit investigators have
15the power and status of law enforcement officers. The bill
16requires the unit to employ at least one full-time prosecuting
17attorney to prosecute all criminal actions which may be brought
18under this Code chapter in which the unit may be interested,
19when, in the prosecuting attorney’s judgment, the interest of
20the unit requires such action.
21The bill provides an election of prosecution. If a person
22commits an offense under this Code chapter, the prosecuting
23attorney may elect to proceed under this Code chapter or any
24other law of this state. The prosecuting attorney may be the
25unit prosecuting attorney or a county attorney.
26The bill sets forth criminal penalties for engaging in
27workers’ compensation fraud, including fraud committed by
28employers, workers, insurers, health service providers,
29employees of insurers, and attorneys. Specifically, the bill
30penalizes as a class “D” felony the following forms of workers’
31compensation fraud: benefit fraud, insurance coverage fraud,
32health service provider fraud, insurance carrier fraud, and
33attorney fraud. The elements for each crime are enumerated in
34the bill. A class “D” felony is punishable by confinement for
35no more than five years and a fine of at least $750 but not
-13-1more than $7,500. The bill provides that in addition to any
2other applicable penalties, a court shall order a person to pay
3restitution to persons aggrieved by the violation, if a person
4commits an offense under this Code chapter. The bill requires
550 percent of the criminal penalty collected under this Code
6chapter to be deposited in a fund created in the bill. Moneys
7in the fund are appropriated to the insurance division of the
8department of commerce to the unit for the benefit of the
9workers’ compensation fraud unit.
10The new workers’ compensation fraud Code chapter
11incorporates by reference the following provisions from the
12insurance fraud Code chapter 507E: 507E.4 (examination of
13information outside the state), 507E.5 (confidentiality), and
14507E.7 (immunity from liability).
15The new Code chapter also defines insurer. “Insurer” means
16a person entering into arrangements or contracts of insurance
17or reinsurance agreeing to perform any of the following acts:
18pay or indemnify another as to loss from certain contingencies
19called risks, including through reinsurance; pay or grant
20a specified amount or determinable benefit to another in
21connection with ascertainable risk contingencies; pay an
22annuity to another; or act as surety.
23The new Code chapter limits commencement of actions
24for violations of the Code chapter to within five years of
25commission of workers’ compensation fraud.
26The new Code chapter provides for suspension of benefits
27if the workers’ compensation fraud unit determines there is
28probable cause, after providing a person notice and opportunity
29to be heard, that a violation of the new Code chapter has
30occurred by a person receiving benefits under Code chapter
3185, 85A, or 85B. The chapter provides for the suspension
32of benefits until a determination of no prosecution occurs
33or where a determination to prosecute is reached, until the
34conclusion of the criminal proceedings in district court. The
35bill provides that a person convicted of workers’ compensation
-14-1fraud shall be prohibited from receiving benefits under Code
2chapters 85, 85A, and 85B for the particular claim or injury
3giving rise to the criminal action. The bill provides that
4if the person is acquitted or the charges are dismissed, a
5person’s benefits will be resumed. The bill provides that a
6person has an option to receive a lump sum for back payment of
7benefits upon resumption of benefits.
8The new Code chapter grants the commissioner of insurance
9rulemaking authority.
10The bill amends Code chapter 507E to provide a definition of
11insurer. Insurer, for the purposes of that Code chapter, means
12the same as defined in new Code chapter 507F.
13The bill also amends Code section 507E.6 (duties of insurer)
14to provide for a process when an insurer alerts the insurance
15fraud bureau of workers’ compensation fraud. The bill provides
16that if the notification pertains to workers’ compensation
17insurance fraud, the insurance fraud bureau shall deliver the
18notice to the workers’ compensation fraud unit.
19The bill amends Code chapter 85 to provide that the employer
20retains the right to choose the employee’s physician throughout
21the course of treatment, including the choice of specialists.
22The employer is not obliged to authorize a referral for care
23with a specific provider of services.
24The bill amends Code chapter 85 to reference suspension of
25benefits under new Code chapter 507F.
26The bill amends Code chapter 86 to reference the criminal
27penalty for fraudulent attorney fees under new Code chapter
28507F.
29The bill also amends Code chapter 85 to provide that
30medical services provided under Code chapter 85, 85A, or 85B
31shall not be billed at a rate higher than the health service
32provider’s standard retail rate for that medical service. The
33bill provides that a health service provider who bills and
34receives payment in excess of the health service provider’s
35standard retail rate for medical services to treat a workers’
-15-1compensation-covered injury shall reimburse the company which
2paid for the medical services for the excess payments.
3The bill takes effect upon enactment and applies to acts
4of fraud or prohibited health service providers’ practices
5committed on or after enactment.
-16-asf/rj