W. Va. Code R. § 85-20-69

Current through Register Vol. XLI, No. 37, September 13, 2024

Section 85-20-69 - Violation and Penalties:

Without limiting the general nature of various statutes respecting criminal fraud, and by way of illustration and not in limitation, the following are deemed unlawful acts and practices:

a. Billing for services not actually performed;

b. Billing for expenses not actually incurred;

c. Billing services on dates other than the date on which they were actually performed;

d. Offering consideration of any kind, including gifts, services or gratuities to Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, employees in exchange for or as a past reward for referring cases to the provider;

e. Failing to close claims at the earliest practicable date when the injured worker can no longer benefit from such services;

f. Providing false information in any statement to the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, or forging or falsifying any record required to be kept by these Rules or any other statute or rule governing providers; and g. "Rolling in" unreimbursable time or expenses by adding hours for billable time or expenses.

All providers and employers shall retain for five (5) years and provide to the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, on request and without a subpoena hard copies of the source underlying any bill, invoice, report, etc. submitted to the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, by electronic or other means.

W. Va. Code R. § 85-20-69