Public-domain · open source
OpenJurist

Tex. Lab. Code § 413.016

PAYMENTS IN VIOLATION OF MEDICAL POLICIES AND FEE GUIDELINES

Known as the Texas Workers' Compensation Act

The act spans §§ 401–419 (623 sections).

Applied in 3 court decisions — leading case Daughters of Charity Health Services of Waco v. Linnstaedter (2007)

Most recently applied in Vista Medical Center Hospital v. Texas Mutual Insurance Company (September 2013)

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff

How often courts cite this section

20052010201310
citing decisions per year

Court decisions citing this, by year. The dip in the last several years is a data-coverage gap, not a real trend — our corpus holds fewer opinions from the most recent years, so recent citations are undercounted.

(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.

Official source: Texas Constitution and Statutes. Reproduced from public-domain Texas statutes; confirm against the official source for the current text. Not legal advice.