Section 4915. Prohibited practices

Latest version.

An external appeal agent shall not, with
  respect to external appeal activities, permit or provide compensation or
  anything of value to its employees, agents, or contractors based on:
    1.  either  a percentage of the amount by which a claim is reduced for
  payment or the number of claims or the cost of services  for  which  the
  person has denied authorization or payment; or
    2.  any  other  method  that  encourages  the  upholding of an adverse
  determination.

                    
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