(a) A complaint relating to a mediation may be filed
by a mediator with the Board against a facility-based physician for
bad faith mediation. Conduct constituting bad faith mediation includes:
(1) failing to participate in a mediation;
(2) failing to provide information the mediator believes
is necessary to facilitate an agreement; or
(3) failing to designate a representative participating
in the mediation with full authority to enter into any mediated agreement.
(b) If the enrollee is not satisfied with a mediated
agreement, the enrollee may file a complaint with the Board against
a facility-based physician for improper billing reached under Chapter
1467 of the Insurance Code.
(c) Investigations.
(1) All complaints shall be investigated pursuant to
Chapter 179 of this title (relating to Investigations) and referred
to an informal settlement conference if appropriate.
(2) In accordance with §311.0025 of the Health
and Safety Code, the Board shall not open investigations relating
to complaints of a single instance of improper billing, but shall
open investigations on facility-based physicians who are alleged to
have engaged in improper billing in multiple instances.
(d) Penalties.
(1) Bad Faith Mediation. Except for good cause shown,
on a report of a mediator and appropriate proof of bad faith mediation,
the Board shall impose an administrative penalty.
(2) Improper Billing. If the Board determines that
a facility-based physician has engaged in improper billing practices,
the Board shall impose sanctions consistent with §190.14 of this
title (relating to Disciplinary Sanction Guidelines).
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Source Note: The provisions of this §187.88 adopted to be effective May 2, 2010, 35 TexReg 3279; amended to be effective January 20, 2014, 39 TexReg 284; amended to be effective February 21, 2016, 41 TexReg 1119 |