Texas Insurance Code 1369.265 – Certain Audits Exempt From Deadlines
Current as of: 2024 | Check for updates
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Terms Used In Texas Insurance Code 1369.265
- Fraud: Intentional deception resulting in injury to another.
- Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005
A health benefit plan issuer or pharmacy benefit manager is not subject to the deadlines for sending a report under Sections 1369.263 and 1369.264 if, after reviewing claims data, written or oral statements of pharmacy staff, wholesalers, or others, or other investigative information, including patient referrals, anonymous reports, or postings on Internet websites, the plan issuer or pharmacy benefit manager suspects the audited pharmacist or pharmacy committed fraud or made an intentional misrepresentation related to the pharmacy business.