Florida Statutes

Fla. Stat. § 641.3154 (2025)

Organization liability; provider billing prohibited.

✓ 2025 Florida Statutes — current through the 2025 Regular Session

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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.

Notes of Decisions

Cited in 7 cases, 2005–2010 · leading case: HEALTH OPTIONS v. Palmetto Pathology Servs., 983 So. 2d 608 (Fla. 3d DCA 2008).

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HEALTH OPTIONS v. Palmetto Pathology Servs., 983 So. 2d 608 (Fla. 3d DCA 2008). · cites it 6× “3155) or subsection 641.3154(1), Florida Statutes (2005).”

Found. Health v. WESTSIDE EKG ASSOC., 944 So. 2d 188 (Fla. 2006). · cites it 3× “For example, section 641.3154 states that an HMO "is liable for services rendered to an eligible subscriber by a provider if the provider follows the [HMO]'s authorization procedures and receives authorization," § 641.”

Westside EKG Assocs. v. Found. Health, 932 So. 2d 214 (Fla. 4th DCA 2005). · cites it 5× “See § 641.3154(4), Fla. Stat. Failure to allow providers to enforce the Act's prompt payment provisions, integral to the HMO contracts with subscribers, would render HMOs impervious to legal action, granting them exclusive access to the courts but confining service providers to…”

Martis v. Pekin Mem'l Hosp., Inc., 917 N.E.2d 598 (Ill. App. Ct. 2009). · cites it 2× “2d at 614 , citing Fla. Stat. Ann. § 641.3154 (1) (2005); Fla.”

Sheridan Healthcorp., Inc. v. Neighborhood Health P'ship, Inc., 459 F. Supp. 2d 1269 (S.D. Fla. 2006). · cites it 2× “Sheridan alleges that NHP's failure to pay Sheridan for services rendered to NHP members, in violation of Fla. Stat. § 641.3154 , and NHP's failure to pay Sheridan's "clean claims” that were filed electronically within a 120-day period, violate Fla.”

Joseph L. Riley Anesthesia Assocs. v. Stein, 27 So. 3d 140 (Fla. 5th DCA 2010). · cites it 12× “See § 641.3154, Fla. Stat. More specifically, section 641.”

Martis v. Pekin Mem'l Hosp. (Ill. App. Ct. 2009). “2d at 614 , citing Fla. Stat. Ann. §641.3154 (1) (2005); Fla.”

— 641.3154(1) — 2 cases

HEALTH OPTIONS v. Palmetto Pathology Servs., 983 So. 2d 608 (Fla. 3d DCA 2008). “3155) or subsection 641.3154(1), Florida Statutes (2005).”

Found. Health v. WESTSIDE EKG ASSOC., 944 So. 2d 188 (Fla. 2006). “For example, section 641.3154 states that an HMO "is liable for services rendered to an eligible subscriber by a provider if the provider follows the [HMO]'s authorization procedures and receives authorization," § 641.”

— 641.3154(2) — 2 cases

HEALTH OPTIONS v. Palmetto Pathology Servs., 983 So. 2d 608 (Fla. 3d DCA 2008). “3155) or subsection 641.3154(1), Florida Statutes (2005).”

— 641.3154(4) — 3 cases

Westside EKG Assocs. v. Found. Health, 932 So. 2d 214 (Fla. 4th DCA 2005). “See § 641.3154(4), Fla. Stat. Failure to allow providers to enforce the Act's prompt payment provisions, integral to the HMO contracts with subscribers, would render HMOs impervious to legal action, granting them exclusive access to the courts but confining service providers to…”

HEALTH OPTIONS v. Palmetto Pathology Servs., 983 So. 2d 608 (Fla. 3d DCA 2008). “3155) or subsection 641.3154(1), Florida Statutes (2005).”

Joseph L. Riley Anesthesia Assocs. v. Stein, 27 So. 3d 140 (Fla. 5th DCA 2010). “See § 641.3154, Fla. Stat. More specifically, section 641.”

— 641.3154(4)(b) — 1 case

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