Tex. Lab. Code § 413.016 · Subchapter B. MEDICAL SERVICES AND FEES
PAYMENTS IN VIOLATION OF MEDICAL POLICIES AND FEE GUIDELINES.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(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.
(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.
Notes and commentary — not statutory text
History
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.239, eff. September 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/LA/htm/LA.413.htm
- Text hash
- sha256 b543397724b149719202836a1b2e6487cc8b99d9406d8b7e0d4a746e80f76b28
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Cited by 2 provisions
Provisions in this library whose text cites Tex. Lab. Code § 413.016. Each shows the citation as that text prints it.
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.