Oklahoma Administrative Code (Last Updated: March 11, 2021) |
TITLE 310. Oklahoma State Department of Health |
Chapter 657. Certified Workplace Medical Plans |
Subchapter 29. Restricted and Prohibited Acts |
SECTION 310:657-29-2. Prohibited acts
Latest version.
- (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.