SECTION 310:657-29-2. Prohibited acts

(a)   No person may operate a Plan in Oklahoma, nor use the phrase "workplace medical plan," nor imply that it is a workplace medical plan, unless that person first obtains a certificate.

(b)   No Plan shall imply that certification qualifies the Plan to provide services except as authorized under the Act and OAC 310:657.

(c)   A Plan, its employees and agents shall not:

(1)   Pay claims reviewers based on reductions, unless the reductions are based on uniformly applied protocols designed to detect billing errors and duplicate charges;

(2)   Compel an injured worker or a provider to:

(A)   Accept less than the full settlement of a claim;

(B)   File suit to obtain full settlement;

(C)   Accept a lesser, interim figure as a premature final settlement; or

(3)   Knowingly misrepresent reimbursement criteria and time frames to employees, a provider, an insurer, an insured, or their representatives.

[Source: Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96; Amended at 14 Ok Reg 2264, eff 6-12-97; Amended at 23 Ok Reg 2404, eff 6-25-06]