1. (a) Any of the following acts by a service provider constitutes a violation for which the service provider is subject to subsection (b) of this section:

   1. (1) submitting charges for services that were not rendered;
   2. (2) administering improper, unreasonable, or medically unnecessary treatment or service;
   3. (3) failing or refusing to timely file required reports or records upon request;
   4. (4) making unnecessary referrals for service;
   5. (5) violating the fee guidelines as established by the Texas Workers' Compensation Commission; or
   6. (6) failure to comply with any provision of the Texas Administrative Code, Title 1, Part III, Chapter 61, or Tex. Code Crim. Proc. Chapter 56.
2. (b) A service provider that commits any of the violations in subsection (a) of this section is subject to a reduction or denial of payments, and any other applicable penalties allowed by law.
3. (c) The OAG shall award compensation for out of state health care services, except for acute trauma care as provided in subsection (d) of this section, according to the Texas Workers' Compensation Commission medical fee guidelines.
4. (d) Under the Texas Workers' Compensation Commission medical fee guidelines, reimbursements for acute trauma care shall be paid at a fair and reasonable amount. The OAG has determined that a fair and reasonable amount under this provision is the maximum allowable reimbursement under the Medicare program or the amount billed, whichever is less.
5. (e) To maximize efficiency, bills submitted by service providers for $5.00 or less will not be processed. Service providers are encouraged to combine bills of $5.00 or less to ensure payment can be made.

Source Note:The provisions of this §61.507 adopted to be effective December 15, 2002, 27 TexReg 11513; amended to be effective May 8, 2005, 30 TexReg 2491.