Texas § 1369.266 RECOUPMENT AND INTEREST CHARGED AFTER AUDIT.

Texas Statutes

§ 1369.266 — RECOUPMENT AND INTEREST CHARGED AFTER AUDIT.

Texas § 1369.266

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Bluebook

Tex. Insurance Code Code Ann. § 1369.266 (2026).

Text

Sec. 1369.266. RECOUPMENT AND INTEREST CHARGED AFTER AUDIT.

(a)If an audit under this subchapter is conducted, the health benefit plan issuer or pharmacy benefit manager:

(1)may recoup from the pharmacist or pharmacy an amount based only on a final audit report; and

(2)may not accrue or assess interest on an amount due until the date the pharmacist or pharmacy receives the final audit report under Section 1369.264 .

(b)The limitations on recoupment and interest accrual or assessment under Subsection (a) do not apply to a health benefit plan issuer or pharmacy benefit manager that, 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 w

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Sec. 1369.266. RECOUPMENT AND INTEREST CHARGED AFTER AUDIT. (a) If an audit under this subchapter is conducted, the health benefit plan issuer or pharmacy benefit manager:
(1) may recoup from the pharmacist or pharmacy an amount based only on a final audit report; and
(2) may not accrue or assess interest on an amount due until the date the pharmacist or pharmacy receives the final audit report under Section 1369.264 .
(b) The limitations on recoupment and interest accrual or assessment under Subsection (a) do not apply to a health benefit plan issuer or pharmacy benefit manager that, 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, suspects the audited pharmacist or pharmacy committed fraud or made an intentional misrepresentation related to the pharmacy business.