Texas Workers' Compensation

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§ 42.25. Prohibited Practices

(a) The following, when committed knowingly or willfully, shall be deemed prohibited practices by health care providers, and may result in action by the board, including referral to professional grievance committees, licensing agencies, or the attorney general’s office:

(1) failing, neglecting, or refusing to observe and comply with the board’s rules;

(2) failing, neglecting, or refusing to submit complete, adequate, and detailed reports, when required, or to respond to requests by the carrier, the claimant or claimant’s representative, or the board for additional reports or other claim-related information. (See § 42.33(c) of this title (relating to Health Care Providers’ Reporting Requirements));

(3) submitting false or misleading reports, or colluding with other persons in the submission of false or misleading reports;

(4) submitting inaccurate or misleading bills;

(5) repeated overcharging;

(6) knowingly submitting a bill to an injured worker for treatment of a compensable injury or illness;

(7) charging or attempting to charge fees for required reports, handling fees, interest, or any surcharge whatsoever to an injured worker for treatment of a compensable injury or illness;

(8) persistently using contraindicated or hazardous treatment measures;

(9) repeated overutilization;

(10) using or prescribing narcotic, addictive, or dependency-inducing drugs for other than therapeutic purposes; or

(11) practicing after suspension or revocation of a provider’s practice privilege by the appropriate licensing agency, after conviction in any court of any offense involving moral turpitude, or after a declaration of mental incompetency by a court of competent jurisdiction.

(b) Written allegations of repeated overcharging (see subsection (a)(5) of this section), or repeated overutilization (see subsection (a)(9) of this section) shall be referred to appropriate regulatory agencies, pursuant to Texas Civil Statutes, Article 8306, § 7b(m). Allegations should be accompanied by appropriate documentation.

The provisions of this § 42.25 adopted to be effective October 20, 1988, 13 TexReg 4990.

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At a Glance:

Title:

§ 42.25. Prohibited Practices

Title:

Title 28. Insurance

Status:

Current

Usage:

Old Law Rule

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