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Florida Statute 641.3154 - Full Text and Legal Analysis
Florida Statute 641.3154 | Lawyer Caselaw & Research
Link to State of Florida Official Statute
F.S. 641.3154 Case Law from Google Scholar Google Search for Amendments to 641.3154

The 2025 Florida Statutes

Title XXXVII
INSURANCE
Chapter 641
HEALTH CARE SERVICE PROGRAMS
View Entire Chapter
F.S. 641.3154
641.3154 Organization liability; provider billing prohibited.
(1) If a health maintenance organization is liable for services rendered to a subscriber by a provider, regardless of whether a contract exists between the organization and the provider, the organization is liable for payment of fees to the provider and the subscriber is not liable for payment of fees to the provider.
(2) For purposes of this section, a health maintenance organization is liable for services rendered to an eligible subscriber by a provider if the provider follows the health maintenance organization’s authorization procedures and receives authorization for a covered service for an eligible subscriber, unless the provider provided information to the health maintenance organization with the willful intention to misinform the health maintenance organization.
(3) The liability of an organization for payment of fees for services is not affected by any contract the organization has with a third party for the functions of authorizing, processing, or paying claims.
(4) A provider or any representative of a provider, regardless of whether the provider is under contract with the health maintenance organization, may not collect or attempt to collect money from, maintain any action at law against, or report to a credit agency a subscriber of an organization for payment of services for which the organization is liable, if the provider in good faith knows or should know that the organization is liable. This prohibition applies during the pendency of any claim for payment made by the provider to the organization for payment of the services and any legal proceedings or dispute resolution process to determine whether the organization is liable for the services if the provider is informed that such proceedings are taking place. It is presumed that a provider does not know and should not know that an organization is liable unless:
(a) The provider is informed by the organization that it accepts liability;
(b) A court of competent jurisdiction determines that the organization is liable; or
(c) The agency issues a final order that the organization is required to pay for such services subsequent to a recommendation made by a resolution organization pursuant to s. 408.7057.
(5) An organization, the office, and the department shall report any suspected violation of this section by a health care practitioner to the Department of Health and by a facility to the agency, which shall take such action as authorized by law.
History.s. 2, ch. 2000-252; s. 11, ch. 2002-389; s. 1583, ch. 2003-261; s. 14, ch. 2004-297; s. 113, ch. 2018-24.

F.S. 641.3154 on Google Scholar

F.S. 641.3154 on CourtListener

Amendments to 641.3154


Annotations, Discussions, Cases:

Cases Citing Statute 641.3154

Total Results: 5

Foundation Health v. WESTSIDE EKG ASSOC.

944 So. 2d 188

Supreme Court of Florida | Filed: Oct 19, 2006 | Docket: 1649903

Cited 23 times | Published

HMOs established in the HMO Act. For example, section 641.3154 states that an HMO "is liable for services

Westside EKG Associates v. Foundation Health

932 So. 2d 214, 2005 WL 1026183

District Court of Appeal of Florida | Filed: May 4, 2005 | Docket: 1285378

Cited 9 times | Published

existence of parallel legal remedies. Furthermore, section 641.3154(4) provides: A provider . . ., regardless

HEALTH OPTIONS v. Palmetto Pathology Servs.

983 So. 2d 608, 2008 Fla. App. LEXIS 5506, 2008 WL 1733673

District Court of Appeal of Florida | Filed: Apr 16, 2008 | Docket: 1684694

Cited 8 times | Published

services, PPS was nonetheless prohibited (by section 641.3154(4), Florida Statutes (2007)) from directly

Sheridan Healthcorp., Inc. v. Neighborhood Health Partnership, Inc.

459 F. Supp. 2d 1269, 2006 U.S. Dist. LEXIS 76811, 2006 WL 3059883

District Court, S.D. Florida | Filed: Sep 22, 2006 | Docket: 107390

Cited 2 times | Published

rendered to NHP members, in violation of Fla. Stat. § 641.3154, and NHP's failure to pay Sheridan's "clean claims"

Joseph L. Riley Anesthesia Associates v. Stein

27 So. 3d 140, 2010 Fla. App. LEXIS 556, 2010 WL 322156

District Court of Appeal of Florida | Filed: Jan 29, 2010 | Docket: 1664799

Published

agree with the trial court that in light of section 641.3154, Florida Statutes (2007), the provider *142