1. (a) If the commissioner, through the commissioner's designated representative, believes that any person or entity conducting utilization review pursuant to this article is in violation of the Act or applicable regulations, the commissioner's designated representative shall notify the utilization review agent or insurance carrier of the alleged violation and may compel the production of any and all documents or other information as necessary to determine whether or not such violation has taken place.
2. (b) The commissioner's designated representative may initiate the proceedings under this section.
3. (c) Proceedings under this section are a contested case for the purpose of Government Code, Chapter 2001.

4. (d) If the commissioner determines that the utilization review agent, insurance carrier, or other person or entity conducting utilization review pursuant to this subchapter has violated or is violating any provision of this Act, the commissioner may:

   1. (1) impose sanctions under the Insurance Code, Article 1.10, §7;
   2. (2) issue a cease and desist order under the Insurance Code, Article 1.10A; or
   3. (3) assess administrative penalties under the Insurance Code, Article 1.10E.
5. (e) If the utilization review agent has violated or is violating any provisions of the Insurance Code other than the Act, or applicable rules of the department, sanctions may be imposed under the Insurance Code, Article 1.10 or 1.10A.
6. (f) The commission of fraudulent or deceptive acts or omissions in obtaining, attempting to obtain, or use of certification as a utilization review agent shall be a violation of the Act.

Source Note:The provisions of this §19.2017 adopted to be effective September 20, 1998, 23 TexReg 9560.