(a) The division shall order a refund of charges paid to a health care provider in
excess of those allowed by the medical policies or fee guidelines. The division shall also refer the health care provider alleged to have violated
this subtitle to the division of compliance and practices. 1
(b) If the division determines that an insurance carrier has paid medical charges
that are inconsistent with the medical policies or fee guidelines adopted by the commissioner,
the division shall investigate the potential violation. If the insurance carrier reduced a charge of a health care provider that was within
the guidelines, the insurance carrier shall be directed to submit the difference to
the provider unless the reduction is in accordance with an agreement between the health
care provider and the insurance carrier.
A reference to the division of compliance and practices of the former Texas Workers'
Compensation Commission means the division of workers' compensation of the Texas Department
of Insurance pursuant to V.T.C.A., Labor Code § 402.0215 and Acts 2005, 79th Leg.,
ch. 265, § 8.019(b).
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