(a) If the health care services provided to an injured employee are determined by the insurance carrier to be inappropriate, the insurance carrier shall:
(1) notify the health care provider in writing of the carrier’s decision; and
(2) demand a refund by the health care provider of the portion of payment on the claim that was received by the health care provider for the inappropriate services.
(b) The health care provider may appeal the insurance carrier’s determination under Subsection (a). The health care provider must file an appeal under this subsection with the insurance carrier not later than the 45th day after the date of the insurance carrier’s request for the refund. The insurance carrier must act on the appeal not later than the 45th day after the date on which the provider files the appeal.
(c) A health care provider shall reimburse the insurance carrier for payments received by the provider for inappropriate charges not later than the 45th day after the date of the carrier’s notice. The failure by the health care provider to timely remit payment to the carrier constitutes an administrative violation.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), § 3.0895, eff. September 1, 2005.