- (a) Improper charges constitute a form of fraudulent and deceptive practice.
(b) Without limiting the definition of improper charges, the following may be considered improper:
- (1) Increasing charges when a patient utilizes a third-party payment program;
- (2) Reporting incorrect treatment dates for the purpose of obtaining payments;
- (3) Reporting charges for services not rendered;
- (4) Incorrectly reporting services rendered for the purpose of obtaining payment that is greater than that to which he or she is entitled;
(5)
- (A) Announcing to the public, individually or through advertising, marketing, or public relations efforts, prior to the rendition of services, that payment made by an insurance carrier or a third-party payer with copayment or deductible features will be accepted by the licensee as payment in full, or reduced payment, unless if, at the time the billing is made, licensee discloses such agreement, services rendered, and the amount billed for each service to both the patient and insurance carrier or third-party payer.
- (B) This disclosure must be made on the face of the statement, or on a label affixed to the statement, by type printed or stamped in legible characters of at least ten (10) points in height.
- (C) Provided, however, that this section shall not prohibit a discount, credit, or reduction of charges provided under an agreement between the holder of a license and:
(i) An insurance company, health service corporation, or health maintenance organization licensed under the laws of this state;
(ii) Governmental third-party payment program; or
- (iii) Self-insurance program organized, managed, or funded by a business entity for its own employees or labor organization for its members;
- (6) Raising fees for the purpose of overcoming the deductible provision of an insurance contract; and
(7)
- (A) Overutilization of practice.
- (B) This is construed to be treatment that is excessive in quality or quantity to the needs of the patient, it being recognized that individual patients require varying and specifically individual treatment programs.