SF 1132

as introduced - 88th Legislature (2013 - 2014) Posted on 03/08/2013 10:07am

A bill for an act
relating to no-fault auto insurance; regulating certain unethical practices by health
care providers; regulating independent medical examinations; modifying the
criminal provision against a person employing, using, or acting as a capper, runner,
or steerer; amending Minnesota Statutes 2012, sections 65B.54, subdivision 6;
609.612; proposing coding for new law in Minnesota Statutes, chapter 65B.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2012, section 65B.54, subdivision 6, is amended to read:

Subd. 6.

Unethical practices.

(a) A licensed health care provider shall not initiate
direct contact, in person, over the telephone, or by other electronic means, with any person
who has suffered an injury arising out of the maintenance or use of an automobile, for the
purpose of influencing that person to receive treatment or to purchase any good or item
from the licensee or anyone associated with the licensee. This subdivision prohibits such
direct contact whether initiated by the licensee individually or on behalf of the licensee by
any employee, independent contractor, agent, or third party, including a capper, runner, or
steerer, as defined in section 609.612, subdivision 1, paragraph (c). This subdivision does
not apply when an injured person voluntarily initiates contact with a licensee.

(b) This subdivision does not prohibit licensees, or persons acting on their behalf,
from mailing advertising literature directly to such persons, so long as:

(1) the word "ADVERTISEMENT" appears clearly and conspicuously at the
beginning of the written materials;

(2) the name of the individual licensee appears clearly and conspicuously within
the written materials;

(3) the licensee is clearly identified as a licensed health care provider within the
written materials; and

(4) the licensee does not initiate, individually or through any employee, independent
contractor, agent, or third party, direct contact with the person after the written materials
are sent.

(c) This subdivision does not apply to:

(1) advertising that does not involve direct contact with specific prospective
patients, in public media such as telephone directories, professional directories, ads in
newspapers and other periodicals, radio or television ads, Web sites, billboards, mailed
or electronically transmitted communication, or similar media if such advertisements
comply with paragraph (d);

(2) general marketing practices, other than those described in clause (1), such as
giving lectures; participating in special events, trade shows, or meetings of organizations;
or making presentations relative to the benefits of a specific medical treatment;

(3) contact with friends or relatives, or statements made in a social setting;

(4) direct contact initiated by an ambulance service licensed under chapter 144E, a
medical response unit registered under section 144E.275, or by the emergency department
of a hospital licensed under chapter 144, for the purpose of rendering emergency care; or

(5) a situation in which the injured person:

(i) had a prior professional relationship with the licensee;

(ii) has selected that licensee as the licensee from whom the injured person receives
health care; or

(iii) has received treatment related to the accident from the licensee.

(d) For purposes of this paragraph, "legal name," for an individual means the
name under which an individual is licensed or registered as a health care professional in
Minnesota or an adjacent state, and for a business entity, a name under which the entity is
registered with the secretary of state in Minnesota or an adjacent state, so long as the name
does not include any misleading description of the nature of its health care practice; and
"health care provider" means an individual or business entity that provides new text begin , or through its
advertising appears, or could be interpreted to provide, new text end medical treatment new text begin or diagnosis new text end of
an injury new text begin , or referral for medical treatment or diagnosis of an injury new text end eligible as a medical
expense claim under this chapter. In addition to any laws governing, or rules adopted by, a
health care provider licensing board, any solicitation or advertisement new text begin that appears to be,
or could be interpreted to be, new text end for medical treatment new text begin or diagnosis new text end , or for referral for medical
treatment new text begin or diagnosis new text end , of an injury eligible for treatment under this chapter must:

(1) new text begin presumptively new text end be undertaken only by or at the direction of deleted text begin a deleted text end new text begin one or more duly
licensed new text end health care deleted text begin provider deleted text end new text begin providers as set forth in paragraph (f) new text end ;

(2) prominently display or reference the legal name of the new text begin directing new text end health care
deleted text begin provider deleted text end new text begin providers new text end ;

(3) display or reference the license type of the new text begin directing new text end health care deleted text begin provider
deleted text end new text begin providers new text end , or in the case of a health care provider that is a business entity deleted text begin , deleted text end new text begin : new text end

new text begin (i) new text end the license type of all of the owners of the health care provider new text begin ; and
new text end

new text begin (ii) if applicable, the fact that one or more of the owners is not licensed or registered
as a health care professional, new text end but need not include the names of the owners new text begin or health
care providers actually rendering the treatment or diagnostic procedures or receiving
the referral for the care new text end ;

(4) not contain any false, deceptive, or misleading information, or misrepresent the
services to be provided;

(5) not include any reference to the dollar amounts of the potential benefits under
this chapter new text begin if the reference could be reasonably interpreted to include an unconditional
right to the entirety of the benefits or a right of direct payment of the benefits to the injured
person or is in violation of clause (4) in any material respect new text end ; and

(6) not imply new text begin : new text end

new text begin (i) new text end endorsement by any law enforcement personnel or agency new text begin ; or
new text end

new text begin (ii) affiliation with, or participation by, one or more trauma centers or emergency
facilities where the implication is in violation of clause (4) in any material respect new text end .

new text begin (e) A health care provider that is a business entity may satisfy the requirements of
paragraph (d), clause (3), items (i) and (ii), with respect to its advertising by including the
required information in the comment field or other appropriate filed of its registration with
the applicable secretary of state, provided that (i) the contents of the field are published
online by the secretary and visible to the public and (ii) the applicable registration can
be readily determined from the advertising, either directly or through an assumed name
which is also registered with the secretary of state.
new text end

new text begin (f) An individual or business entity described in this paragraph that through its
advertising appears to provide for medical treatment or diagnosis, or for referral for
medical treatment or diagnosis, of any injury is presumed to be exercising, or attempting
to exercise, medical judgment and thereby in the practice of healing in this state under
section 146.01. This presumption may be rebutted with credible evidence including
without limit (1) copies of written contracts with one or more health care providers eligible
to receive referral where the contracts do not entail fees directly or indirectly based on the
number of referrals, or amount of benefits which may be associated with a referral, and do
not otherwise violate other applicable laws; (2) evidence that the greater number of health
care providers receiving the referrals are not owned to a substantial degree exclusively
by a single designated health care entity, or by a group of health care entities sharing
a material degree of common ownership; (3) evidence that the referrals for treatment
or diagnostic procedures focus primarily on assisting the patient or prospective patient
with the choice of health care provider and do not unconditionally or unduly persuade or
induce the patient or prospective patient to actually receive care absent an emergency;
and (4) evidence that health care providers eligible to receive such referrals comply with
section 609.612 with respect to such referrals.
new text end

deleted text begin (e) deleted text end new text begin (g) new text end A violation of this subdivision is grounds for the licensing authority to take
disciplinary action against the licensee, new text begin or against an individual or business entity acting
in the unauthorized practice of healing, new text end including revocation in appropriate cases.

new text begin (h) In any legal action against a state agency or official initiated or maintained under
this section, the state may recoup its attorney fees and costs with respect to any claim or
cause of action in which it prevails.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
new text end

Sec. 2.

Minnesota Statutes 2012, section 609.612, is amended to read:

609.612 EMPLOYMENT OF RUNNERS.

Subdivision 1.

Definitions.

(a) As used in this section, the following terms have
the meanings given.

new text begin (b) "Cash advance customer" means a person who agrees to receive a monetary sum
as a loan based on the prospect that a person either has or may have suffered an injury
arising out of the maintenance or use of an automobile.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end "Public media" means telephone directories, professional directories,
newspapers and other periodicals, radio and television, billboards, and mailed or
electronically transmitted written communications that do not involve in-person contact
with a specific prospective patient or client.

deleted text begin (c) deleted text end new text begin (d) new text end "Runner," "capper," or "steerer" means a person who for a pecuniary gain
directly procures or solicits prospective patients new text begin , clients, or cash advance customers,
new text end through telephonic, electronic, or written communication, or in-person contact, at the
direction of, deleted text begin or deleted text end in cooperation with, new text begin or for the benefit of, new text end a health care provider new text begin or attorney
new text end when the person knows or has reason to know that the provider's new text begin or attorney's new text end purpose
is to perform or obtain services or benefits new text begin for such patients, clients, or cash advance
customers new text end under or relating to a contract of motor vehicle insurance. The term runner,
capper, or steerer does not include a person who solicits or procures new text begin patients or new text end clients
either through public media, or new text begin in the case of providers new text end consistent with the requirements
of section 65B.54, subdivision 6.

Subd. 2.

Act constituting.

Whoever employs, uses, or acts as a runner, capper, or
steerer is guilty of a felony and may be sentenced to imprisonment for not more than
three years or to a payment of a fine of not more than $6,000, or both. Charges for any
services rendered by a health care provider, who violated this section in regard to the
person for whom such services were rendered, are noncompensable and unenforceable
as a matter of law.

new text begin Subd. 3. new text end

new text begin Investigation and prosecution costs. new text end

new text begin In any investigation or prosecution
by the state, nothing shall prohibit an insurer from providing the financial resources
necessary for conducting the investigation and prosecution.
new text end

new text begin Subd. 4. new text end

new text begin Whistle-blowers. new text end

new text begin (a) Without limiting an insurer's right of full recovery
of proceeds paid for services deemed noncompensable under subdivision 2, the court
may also award those sums deemed appropriate, but in no case more than 25 percent of
proceeds to be recovered or saved by the insurer with respect to a particular runner, capper,
or steerer, to a qualified person or entity (herein, "informant") who provides the primary
specific evidence or information in support of one or more violations under this section,
taking into account the significance of the evidence or information. For the purposes of
this subdivision, "informant" shall not include any person or entity bringing an action
under this section or acting on behalf of the news media.
new text end

new text begin (b) An insurer may elect to reimburse, including on a prepayment basis or otherwise,
reasonable out-of-pocket costs of an actual or potential informant which is incurred or
likely to be incurred in the course of preparing and disclosing the information. The
out-of-pocket costs shall include without limit any applicable attorney fees associated with
the preparation and disclosure of the information by the informant.
new text end

new text begin (c) An actual or potential informant may place conditions on the use and disclosure of
the information. The conditions may include without limit confidentiality as to the identity
of the informant, as well as the nature of any reimbursement terms, restrictions on the scope
of individuals and entities with whom the insurer may properly disclose the information,
assistance in the determination of the scope of the insurer's investigation or efforts to
prosecute, and other conditions relating to the use and disclosure of the information.
new text end

new text begin (d) Unless otherwise requested by the informant, all information provided by an
informant, including any restriction on use and disclosure, if presented in court, shall be
examined in a confidential, in camera proceeding, unless the informant requests a hearing
in open court and the court determines that a public hearing is necessary to the public
interest and the proper administration of justice.
new text end

new text begin (e) In the absence of actual malice, no person or entity furnishing, disclosing, or
requesting such information under this section shall be subject to civil liability for libel,
slander, or any other cause of action arising from the furnishing, disclosing, or requesting
of such information. A person or entity against whom any action is brought who is found
to be immune from liability under this section may recover reasonable attorney fees and
costs from the person or party who brought the action. This section does not abrogate or
modify in any way any common law or statutory privilege or immunity enjoyed by any
person or entity. Without limiting the terms of this subdivision:
new text end

new text begin (1) an insurer shall be permitted to notify any change of representation or treating
health care provider to state and federal agencies, prior attorneys of record, and prior
treating providers of record, and to discuss the change with such persons or entities; and
new text end

new text begin (2) an insurer shall be permitted to request an explanation of circumstances of
change of treating provider and attorney to the subsequent treating provider and attorney;
notwithstanding the foregoing: (i) the payment of any benefits relating to the patient shall
not be suspended or conditioned upon the failure of the subsequent treating provider or
attorney to respond to the request or provide such explanation; and (ii) the request shall
clearly and conspicuously state that the payment of benefits shall not be suspended or
conditioned upon a response or explanation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective on July 1, 2013.
new text end

Sec. 3.

new text begin [65B.515] INDEPENDENT MEDICAL EXAMINATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Insurance fraud. new text end

new text begin The requirements of section 60A.951, subdivision
4, applies to an independent medical examination or examination under oath requested by
a reparation obligor relating to medical treatment or diagnosis of an injury eligible as a
medical expense claim under this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Claims practices. new text end

new text begin The requirements of section 72A.201, subdivision
4, relating standards for claim filing and handling applies to the filing and handling of
any claims for benefits under this chapter. For the purposes of this subdivision, a health
care provider who submits a claim to a reparation obligor relating to medical treatment
or diagnosis of an injury eligible as a medical expanse claim under this chapter shall
constitute a claimant.
new text end

new text begin Subd. 3. new text end

new text begin Payment suspension or denial; transcript. new text end

new text begin In the event a reparation
obligor requests an independent medical examination or examination under oath as set
forth in this section, and either suspends or denies payment of a medical expense claim
under this chapter, the reparation obligor shall provide to the claimants a full copy of
the transcript of the examination under oath or the report of the independent medical
examination as applicable along with written notice of the suspension or denial.
new text end

new text begin Subd. 4. new text end

new text begin Failure to comply; payment suspension or denial prohibited. new text end

new text begin Without
abrogating or modifying in any way any other law of this state, in the event that a
reparation obligor does not comply with the requirements of subdivision 2 or 3, the
reparation obligor shall be prohibited from suspending or denying payments contrary to
the requirements of section 65B.54.
new text end

new text begin Subd. 5. new text end

new text begin Licensing action. new text end

new text begin A violation of subdivision 1 by a health care provider
who performs an independent medical examination is grounds for the licensing authority
to take disciplinary action against the licensee, including revocation in appropriate cases.
new text end