TX SB1811

Prohibits health maintenance organizations (HMOs) and insurers from using extrapolation—a mathematical technique that estimates audit results for a larger group of claims based on a sample—when auditing physicians or providers

Requires any payment adjustments (additional payments to providers or refunds to insurers/HMOs) to be based on actual overpayments or underpayments, not estimated amounts from extrapolation

Exempts governmental health benefit plans from these restrictions, including the child health plan program (CHIP), children's health benefits plans, and Medicaid programs including managed care

Applies only to physician or provider contracts with insurers or HMOs entered into or renewed on or after the effective date

Takes effect September 1, 2025