1. (a) Offering, paying, soliciting, or receiving an improper inducement relating to medical benefit delivery is prohibited as are improper attempts to influence medical benefit delivery, including through the making of improper threats. This section applies to all participants in the workers' compensation system and their agents.

2. (b) The following specific acts will be deemed to be an improper inducement, influence or threat:

   1. (1) Intentionally, knowingly, or willfully soliciting or receiving any remuneration (including, but not limited to, any kickback, bribe, or rebate) in return for referring an injured employee (employee) to a person (either the person soliciting or receiving the inducement or another person):

      1. (A) for the furnishing or arranging for the furnishing of any item, treatment, or service constituting a medical benefit for which payment may be made in whole or in part under the Statute or Rules; or
      2. (B) in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, treatment or item constituting a medical benefit for which payment may be made in whole or in part under the Statute or Rules.

   2. (2) Intentionally, knowingly, or willfully offering or paying any remuneration (including, but not limited to, any kickback, bribe, or rebate) in return for referring an employee to a person (either the person offering or paying the inducement or another person):

      1. (A) for the furnishing or arranging for the furnishing of any item, treatment or service constituting a medical benefit for which payment may be made in whole or in part under the Statute or Rules; or
      2. (B) in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, treatment, or item constituting a medical benefit for which payment may be made in whole or in part under the Statute or Rules.
   3. (3) Except as provided by Texas Labor Code §408.0222, providing any financial incentive or promising or threatening to provide employee evaluation reports or other medical opinions that could enhance or reduce the employee's income benefits or affect the employee's work release status as an inducement to have the employee treat with or be evaluated by the provider or comply with the provider's proposed treatment.
   4. (4) Intentionally, knowingly, or willfully offering or soliciting an inducement in return for selecting a particular health care provider for the furnishing or arranging for the furnishing of any item, treatment, or service (including purchasing or leasing) for which payment may be made in whole or in part under the Statute or Rules; or intentionally, knowingly, or willfully offering or soliciting an inducement which may reasonably tend to cause a particular provider to be selected (excluding a convenience necessary to allow for the provision of health care, such as transportation to and from the provider's facility, translator services related to evaluation and treatment, providing claim filing forms or information on rights and responsibilities under the Statute and Rules, if generally available to all patients). Such inducement is improper whether offered directly or indirectly, overtly or covertly, in cash or in kind.
   5. (5) Intentionally, knowingly, or willfully making, presenting, filing, or threatening to make, present, or file any frivolous claim or assertion against a system participant, medical peer reviewer, or any other person performing duties arising under the Statute or Rules, with the commission or any licensing, certifying, regulatory, or investigatory body.
   6. (6) Intentionally, knowingly, or willfully making or causing to be made a threat against life, safety, or property directed to a system participant related to their performance of duties arising under the Statute or Rules.
3. (c) The exceptions that apply to subsections (b)(1) and (b)(2) of this section are those that apply to analogous provisions in Title 42, United States Code §1320a-7b(3). The exceptions shall apply to subsections (b)(1) and (b)(2).

4. (d) Nothing in this section prohibits an employer or carrier from offering employees an incentive to obtain health care from doctors within an insurance carrier network established under Texas Labor Code §408.0223. However, such incentives shall not:

   1. (1) limit the right of the employee to request the authority to select an alternate treating doctor under Texas Labor Code §408.023 (including to change to a doctor out of the network); or
   2. (2) require the employee to give up entitlement to or refund the incentive the employer or carrier offered or provided to the employee during the period that the employee's treating doctor was within the network.

Source Note:The provisions of this §180.25 adopted to be effective March 14, 2002, 27 TexReg 1817.