The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 1808
INTRODUCER: Senator Burton
SUBJECT: Refund of Overpayments Made by Patients
DATE: March 17, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Pre-meeting
2. AHS
3. RC
I. Summary:
SB 1808 requires specified health care practitioners to refund to a patient any overpayment made
by the patient no later than 30 days after the practitioner determines that such an overpayment
was made. Under the bill, if a practitioner fails to timely refund an overpayment after he or she
determines that an overpayment was made, it constitutes grounds for disciplinary action by the
applicable board, or the Department of Health if there is no board. The bill authorizes the board,
or the department if there is no board, to adopt rules to implement this provision.
The requirement to timely refund such an overpayment does not apply to overpayments made to
providers by commercial health insurers and health maintenance organizations.
The bill provides an effective date of January 1, 2026.
II. Present Situation:
Overpayments in Health Care
Circumstances such as miscalculations, duplicate payments, insurance coverage adjustments, and
coding errors can create occasional overpayments by patients to health care providers. When this
occurs, it is both ethical and legally required for the provider to return any excess funds to the
patient, although there is no statutory requirement that the overpayment be refunded by a certain
date.
For example, the following situations could lead to a health care provider collecting an
overpayment and subsequently refunding the overpayment to the patient:
REVISED: BILL: SB 1808 Page 2
Excess Patient Responsibility Collected
In some instances, a patient’s insurance benefits or deductibles may be miscalculated by either
the patient or the health care provider. For example, a clinic might initially collect a copayment
or deductible based on an estimate of services rendered. When the insurance claim is later
processed, the insurer might pay more than anticipated, resulting in an overpayment on the
patient’s account. In such cases, the provider is obligated to refund the excess amount to the
patient.
Duplicate Payments
Occasionally, patients or their family members may inadvertently make multiple payments for
the same service. This situation can occur when payment is mailed, then followed by an
electronic payment or when two different individuals in a household pay the same bill. Once the
provider’s accounting or billing system detects that the patient’s account has been paid more than
once for the same service, they may issue a refund of the additional payment.
Insurance Reconciliation Adjustments
After claims are submitted to an insurance company, subsequent policy adjustments or
retroactive changes to coverage may alter the final bill. For instance, if an insurance company
conducts an internal audit and determines that a greater portion of the claim should have been
covered, they might send an additional reimbursement to the provider. This supplemental
payment can create a credit on the patient’s account, thereby necessitating a refund of any
previously collected balance from the patient.
Billing or Coding Errors
In rare circumstances, mistakes in billing codes or modifiers lead to inaccurate charges on a
patient’s account. Such coding discrepancies may not be apparent until the insurance company or
the provider’s billing department conducts a review. Upon identifying a coding error—such as a
charge for a service that was not actually performed—the provider corrects the billing statement
and may refund any overpayment to the patient.
Coordination of Benefits Between Multiple Insurers
Patients sometimes have two or more sources of insurance coverage (e.g., primary and secondary
insurance plans). If both insurers remit payment and inadvertently exceed the cost of the service,
the health care provider may receive funds beyond what is contractually called for. Once this
overage is discovered, the overpayment may be refunded directly to the patient or appropriately
adjusted between the insurers.
State Regulation of Insurance
The Office of Insurance Regulation (OIR)
1
is responsible for all activities concerning health
maintenance organizations (HMOs), health insurers, and other risk-bearing entities, including
1
The OIR is a unit under the Financial Services Commission, which is composed of the Governor, the Attorney General, the
Chief Financial Officer, and the Commissioner of Agriculture. Commission members serve as the agency head for purposes
of rulemaking under ch. 120, F.S. See s. 20.121(3), F.S. BILL: SB 1808 Page 3
licensing, rates, policy forms, market conduct, claims, issuance of certificates of authority,
solvency, viatical settlements, premium financing, and administrative supervision, as provided
under the Florida Insurance Code.
2
To transact business in Florida, a health insurer or HMO must
obtain a certificate of authority from the OIR.
3
The Agency for Health Administration (agency)
regulates the quality of care provided by HMOs under part III of ch. 641, F.S. Prior to receiving
a certificate of authority from the OIR, an HMO must receive a Health Care Provider Certificate
from the agency.
4
As part of the certification process used by the agency, an HMO must provide
information to demonstrate that the HMO has the ability to provide quality of care consistent
with the prevailing standards of care.
5
Payment of Health Insurer and HMO Claims
The Florida Insurance Code
6
prescribes the rights and responsibilities of health care providers,
health insurers, and HMOs for the payment of claims. Florida’s prompt payment laws govern
payment of provider claims submitted to insurers and HMOs, including Medicaid managed care
plans, in accordance with ss. 627.6131, 627.662, and 641.3155, F.S., respectively.
7
The law
prescribes a protocol for specified providers to use for the submission of their claims to an
insurer or HMO, as well as a statutory process for insurers or HMOs to use for the payment or
denial of the claims.
Generally, if a health insurer or HMO determines it has made an overpayment to a provider, the
insurer’s or HMO’s claim for the overpayment must be submitted to the provider within
30 months after the applicable payment by the insurer or HMO.
8
A provider must pay, deny, or
contest the claim for overpayment of a health insurer or HMO within 40 days after receiving the
claim.
All contested claims for overpayment must be paid or denied within 120 days after the provider’s
receipt of the claim.
9
Failure to pay or deny the claim of overpayment within 140 days after
receipt creates an uncontestable obligation by the provider to pay the claim.
10
A claim for
overpayment is not permitted beyond 30 months after the health insurer’s or HMO’s applicable
payment to the provider, except that claims for overpayment may be sought beyond that time
from providers convicted of fraud pursuant to s. 817.234, F.S.
11
Section 627.6131(18), F.S., provides an exception to the period of 30 months for an insurer to
submit a claim for overpayment to a provider. Section 641.3155(16), F.S., provides the same
requirements for an HMO. All claims for overpayment submitted to a provider licensed under
chs. 458 (medical practice), 459 (osteopathic medicine), 460 (chiropractic medicine),
2
Section 20.121(3)(a), F.S.
3
Sections 624.401 and 641.49, F.S.
4
Section 641.495, F.S.
5
Id.
6
Pursuant to s. 624.01, F.S., chs. 624-632, 634, 635, 636, 641, 642, 648, and 651 constitute the “Florida Insurance Code.”
7
The prompt pay provisions apply to HMO contracts and major medical policies offered by individual and group insurers
licensed under ch. 624, F.S.
8
Section 627.6131(6), F.S., and s. 641.3155(5) F.S., for HMO provision.
9
Id.
10
Id.
11
Id. BILL: SB 1808 Page 4
461 (podiatric medicine), or 466 (dentistry), F.S., must be submitted to the provider within
12 months – not 30 months – after the health insurer’s or HMO’s applicable payment to the
provider. A claim for overpayment may not be permitted after 12 months except that claims for
overpayment may be sought beyond that time from providers convicted of fraud pursuant to
s. 817.234, F.S.
The Department of Health
The Legislature created the DOH to protect and promote the health of all residents and visitors in
the state.
12
The DOH is charged with the regulation of health practitioners for the preservation of
the health, safety, and welfare of the public. The Division of Medical Quality Assurance (MQA)
is responsible for the boards
13
and professions within the DOH.
14
The health care practitioners
licensed by the DOH include the following:
• Acupuncturists;
15
• Allopathic physicians, physician assistants, anesthesiologist assistants, and medical
assistants;
16
• Osteopathic physicians, physician assistants, and anesthesiologist assistants;
17
• Chiropractic physicians and physician assistants;
18
• Podiatric physicians;
19
• Naturopathic physicians;
20
• Optometrists;
21
• Autonomous advanced practice registered nurses, advanced practice registered nurses,
registered nurses, licensed practical nurses, and certified nursing assistants;
22
• Pharmacists, pharmacy interns, and pharmacy technicians;
23
• Dentists, dental hygienists, and dental laboratories;
24
• Midwives;
25
• Speech and language pathologists;
26
• Audiologists;
27
• Occupational therapists and occupational therapy assistants;
28
12
Section 20.43(1), F.S.
13
Under s. 456.001(1), F.S., “board” is defined as any board, commission, or other statutorily created entity, to the extent
such entity is authorized to exercise regulatory or rulemaking functions within the DOH or, in some cases, within the DOH
MQA.
14
Section 20.43(3)(g), F.S.
15
Chapter 457, F.S.
16
Chapter 458, F.S.
17
Chapter 459, F.S.
18
Chapter 460, F.S.
19
Chapter 461, F.S.
20
Chapter 462, F.S.
21
Chapter 463, F.S.
22
Chapter 464, F.S.
23
Chapter 465, F.S.
24
Chapter 466, F.S.
25
Chapter 467, F.S.
26
Part I, ch. 468, F.S.
27
Id.
28
Part III, ch. 468, F.S. BILL: SB 1808 Page 5
• Respiratory therapists;
29
• Dieticians and nutritionists;
30
• Athletic trainers;
31
• Orthotists, prosthetists, and pedorthists;
32
• Electrologists;
33
• Massage therapists;
34
• Clinical laboratory personnel;
35
• Medical physicists;
36
• Genetic counselors;
37
• Opticians;
38
• Hearing aid specialists;
39
• Physical therapists;
40
• Psychologists and school psychologists;
41
and
• Clinical social workers, mental health counselors, and marriage and family therapists.
42
Disciplinary Proceeding under Chapters 456 and 120, F.S.
Section 456.072, F.S., enumerates at least 45 specific acts that constitute grounds for disciplinary
action against licensed health care practitioners in Florida. In addition, each health care
practitioner’s respective practice act contains specific statutory provisions on prohibited acts,
disciplinary actions, grounds for discipline, and actions by the applicable board.
The DOH, on behalf of the boards, investigates any complaint that is filed against a health care
practitioner if the complaint is:
• In writing;
• Signed by the complainant;
43
and
• Legally sufficient.
44
29
Part V, ch. 468, F.S.
30
Part X, ch. 468, F.S.
31
Part XIII, ch. 468, F.S.
32
Part XIV, ch. 468, F.S.
33
Chapter 478, F.S.
34
Chapter 480, F.S.
35
Part I, ch. 483, F.S.
36
Part II, ch. 483, F.S.
37
Part III, ch. 483, F.S.
38
Part I, ch. 484, F.S.
39
Part II, ch. 484, F.S.
40
Chapter 486, F.S.
41
Chapter 490, F.S.
42
Chapter 491, F.S.
43
Section 456.073(1), F.S. The DOH may also investigate an anonymous complaint, or that of a confidential informant, if the
complaint is in writing and is legally sufficient, if the alleged violation of law or rules is substantial, and if the DOH has
reason to believe, after preliminary inquiry, that the violations alleged in the complaint are true.
44
Id. BILL: SB 1808 Page 6
A complaint is legally sufficient if it contains allegations of ultimate facts that, if true, show that
a regulated practitioner has violated:
• Chapter 456, F.S.;
• His or her practice act; or
• A rule of his or her board or the DOH.
45
The Consumer Services Unit receives the complaints and refers them to the closest Investigative
Services Unit (ISU) office. The ISU investigates complaints against health care practitioners.
46
Complaints that present an immediate threat to public safety are given priority; however, all
complaints are investigated as timely as possible. When the complaint is assigned to an
investigator, the complainant will be contacted and given the opportunity to provide additional
information. A thorough investigation will be conducted. The steps taken in the investigation are
determined by the specifics of the allegations, but generally include the following:
• Obtaining medical records, documents, and evidence;
• Locating and interviewing the complainant, the patient, the subject, and any witnesses; and
• Drafting and serving subpoenas for necessary information.
47
The ISU includes a staff of professional investigators and senior pharmacists who conduct
interviews, collect documents and evidence, prepare investigative reports for the Prosecution
Services Unit (PSU), and serve subpoenas and official orders for the DOH.
48
The PSU is responsible for providing legal services to the DOH in the regulation of all health
care boards and councils.
49
The PSU will review the investigative file and report from ISU and
recommend a course of action to the State Surgeon General (when an immediate threat to the
health, safety, and welfare of the people of Florida exists), the appropriate board’s probable
cause panel, or the DOH, if there is no board, which may include:
• Having the file reviewed by an expert;
• Issuing a closing order (CO);
• Filing an administrative complaint (AC); or
• Issuing an emergency order (ERO or ESO).
50
If the ISU investigative file received by the PSU does not pose an immediate threat to the health,
safety, and welfare of the people of Florida, then the PSU attorneys review the file and
determine, first, whether expert review is required and, then, whether to recommend to the
board’s probable cause panel:
• A CO;
• An AC; or
45
Id.
46
Department of Health, Licensing and Regulation, Enforcement, Administrative Complaint Process, Investigative Services,
available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-process/isu.html (last
visited March 14, 2025).
47
Id.
48
Id.
49
Department of Health, Licensing and Regulation, Enforcement, Administrative Complaint Process, Prosecution Services,
available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-process/psu.html (last
visited March 14, 2025).
50
Id. BILL: SB 1808 Page 7
• A Letter of Guidance (LOG).
51,52
A CO is recommended if the investigation and/or the expert opinion does not support the
allegation(s). The subject and the complainant are notified of the results. The complainant may
appeal the decision within sixty (60) days of notification by providing additional information for
consideration. Cases closed with no finding of probable cause are confidential and are not
available through a public records request.
53
An AC is recommended when the investigation and/or the expert opinion supports the
allegation(s). The subject is entitled to a copy of the complete case file prior to the probable
cause panel meeting. When an AC is filed with the agency clerk, the subject has the right to
choose one of the following options:
• An Administrative Hearing Involving Disputed Issues of Material Fact – The subject disputes
the facts in the AC and elects to have a hearing before the Division of Administrative
Hearings (DOAH). If this occurs, all parties may be asked to testify and the administrative
law judge will issue a recommended order that will then go to the board or the DOH for final
agency action.
• A Settlement/Stipulation/Consent Agreement – The subject enters into an agreement to be
presented before the board or the DOH. Terms of this agreement may impose penalties
negotiated between the subject or the subject’s attorney and the DOH’s attorney.
• A Hearing Not Involving Disputed Issues of Material Fact – The subject of the AC does not
dispute the facts. The subject elects to be heard before the board or the DOH. At that time,
the subject will be permitted to give oral and/or written evidence in mitigation or in
opposition to the recommended action by the DOH.
• Voluntary Relinquishment of License – The subject of the AC may elect to surrender his or
her license and to cease practice.
54
Final DOH action, including all of the above, as well as cases where the subject has failed to
respond to an AC, are presented before the applicable board, or the DOH if there is no board.
The subject may be required to appear. The complainant is notified of the date and location of
the hearing and may attend. If the subject is entitled to, and does, appeal the final decision, PSU
defends the final order before the appropriate appellate court.
55
When the applicable board, or the DOH if there is no board, finds a person guilty, it may enter an
order imposing a penalty listed in s. 456.072(2), F.S., which includes revocation, suspension, and
restriction of license, administrative fines not to exceed $10,000 per offense, reprimand,
probation, corrective action, and remedial education. It must also consider what sanctions are
necessary to protect the public or compensate the patient.
51
Section 456.073(2), F.S. The DOH may recommend a LOG in lieu of finding probable cause if the subject has not
previously been issued a LOG for a related offense.
52
Id.
53
Supra note 51.
54
Id.
55
Supra note 48. BILL: SB 1808 Page 8
III. Effect of Proposed Changes:
Section 1 of the bill creates a new s. 456.0625, F.S., to require specified health care
practitioners
56
to refund the amount of any overpayment made to the health care practitioner by a
patient no later than 30 days after the date that the health care practitioner determines that the
overpayment was made. The health care practitioner would need to refund the full amount of the
overpayment to satisfy this requirement. The following health care practitioners would be subject
to this new requirement:
• Allopathic physicians, physician assistants, anesthesiologist assistants, and medical
assistants;
57
• Osteopathic physicians, physician assistants, and anesthesiologist assistants;
58
• Chiropractic physicians and physician assistants;
59
• Podiatric physicians;
60
• Naturopathic physicians;
61
• Optometrists;
62
• Autonomous advanced practice registered nurses, advanced practice registered nurses,
registered nurses, licensed practical nurses, and certified nursing assistants;
63
• Pharmacists, pharmacy interns, and pharmacy technicians;
64
• Dentists, dental hygienists, and dental laboratories;
65
• Midwives;
66
• Electrologists;
67
• Clinical laboratory personnel;
68
• Medical physicists;
69
• Genetic counselors;
70
• Opticians;
71
56
Health care practitioners required to follow new section 456.0625 are more narrowly defined than health care practitioners
as the term is defined for chapter 456 in s. 456.001(4), F.S. Because of their exclusion from the list in subsection (1), the
following practitioners are not required by the bill to follow this section, acupuncturists licensed under ch. 467, speech-
language pathologists and audiologists licensed under part I of ch. 468, nursing home administrators licensed under part II of
ch. 468, occupational therapists and occupational therapy assistants licensed under part III of ch. 468, respiratory therapists
licensed under part V of ch. 468, dietitians and nutritionists licensed under part X of ch. 468, athletic trainers licensed under
part XIII of ch. 468, orthotists, pedorthists, and prosthetists licensed under part XIV of ch. 468, massage therapists licensed
under ch. 480, and hearing aid specialists licensed under part II of ch. 484.
57
Chapter 458, F.S.
58
Chapter 459, F.S.
59
Chapter 460, F.S.
60
Chapter 461, F.S.
61
Chapter 462, F.S.
62
Chapter 463, F.S.
63
Chapter 464, F.S.
64
Chapter 465, F.S.
65
Chapter 466, F.S.
66
Chapter 467, F.S.
67
Chapter 478, F.S.
68
Part I, ch. 483, F.S.
69
Part II, ch. 483, F.S.
70
Part III, ch. 483, F.S.
71
Part I, ch. 484, F.S. BILL: SB 1808 Page 9
• Physical therapists;
72
• Psychologists and school psychologists;
73
and
• Clinical social workers, mental health counselors, and marriage and family therapists.
74
The bill’s requirement for timely refund of an overpayment would not apply to overpayments
made to providers by commercial health insurers subject to s. 627.6131, F.S., or to health
maintenance organizations subject to s. 641.3155, F.S.
A violation of new s. 456.072, F.S., would constitute grounds for disciplinary action under the
practitioner’s practice act and under s. 456.072, F.S., as amended in section 2 of the bill.
Section 2 of the bill amends s. 456.072(1), F.S. to add failure to comply with new section
456.072, F.S., as created in section 1 of the bill, to the list of grounds for discipline. If the board,
or the department when there is no board, finds any person guilty of this new ground for
discipline, it may discipline the health care practitioner with disciplinary actions specified in
s. 456.072(2), F.S.
Section 3 of the bill provides an effective date of January 1, 2026.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
72
Chapter 486, F.S.
73
Chapter 490, F.S.
74
Chapter 491, F.S. BILL: SB 1808 Page 10
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
This bill may result in a loss of improper revenue for providers who fail to check for or
refund overpayments.
C. Government Sector Impact:
While the bill provides an additional ground for discipline for specified health care
practitioners, section 456.072, F.S., gives the DOH authority to recover costs related to
the investigation and prosecution of disciplinary cases. A disciplined practitioner would
be responsible to pay his or her own costs.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
The bill creates section 456.0625 of the Florida Statutes.
The bill substantially amends section 456.072 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.