What is considered an unreasonable billed charge? What do you mean by material misrepresentation under fraud?
While the Department does not regulate the amount a physician or provider can charge for a particular service, it will remain alert to allegations of abuse in this area. In connection with these expressed concerns, the definition of billed charges states that, for purposes of the subchapter, billed charges must comply with all other applicable requirements of law, including Texas Health and Safety Code §311.0025, Texas Occupations Code §105.002, and Texas Insurance Code Chapter 552. In addition, physicians, providers, consumers, and carriers are encouraged to file complaints with the Department regarding allegations of fraudulent or unreasonable charges. The TDI Fraud Unit, when it believes there has been a violation of a law, refers such matters, as appropriate, to the Board of Medical Examiners, a district attorney’s office, the Office of the Attorney General or the federal government. Moreover, the Department has launched an aggressive education campaign to inform all stakeholders o
