The Florida Division of Workers’ Compensation (DWC) holds payers accountable for repeated or unreasonable denials or reductions of medical bill payments without valid cause.
To enforce accountability, the DWC may:
- Order Full Payment: The DWC can compel the payer to pay the provider's bill in full.
- Impose Fines: A fine of up to $5,000 can be levied for each instance of improper denial or reduction.
- Award Costs and Fees: The state may award the healthcare provider costs, including reasonable attorney's fees, for pursuing the petition.
Florida |
Statute/Rule |
Statute |
|
Section |
440.13 Medical Services and Supplies; Penalty for Violations; Limitations |
Subsection Text |
440.20 (7) (f) Any carrier that engages in a pattern or practice of arbitrarily or unreasonably disallowing or reducing payments to health care providers may be subject to one or more of the following penalties imposed by the department: 1. Repayment of the appropriate amount to the health care provider. 2. An administrative fine assessed by the department in an amount not to exceed $5,000 per instance of improperly disallowing or reducing payments. 3. Award of the health care provider’s costs, including a reasonable attorney fee, for prosecuting the petition. |
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