Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 357 - HEARINGS
Subchapter M - FRAUD OR ABUSE INVOLVING MEDICAL PROVIDERS
Section 357.581 - Department Responsibility
Current through Reg. 49, No. 38; September 20, 2024
(a) The Texas Department of Human Services is responsible for minimizing the opportunity for provider fraud and abuse as well as recipient fraud and abuse and for protecting recipients of federally funded health care programs from unsafe practitioners. The department takes appropriate action to protect recipients and the program when providers of services are suspected of committing fraud or abuse.
(b) All actions resulting in overpayment to a provider are not necessarily fraudulent. Some circumstances could result in the referral of a provider to the Medicaid Fraud Control Unit in the attorney general's office. Other circumstances would result in administrative action rather than referral for judicial action or criminal prosecution. These actions, or sanctions, range from a notice to the provider explaining his error to exclusion from the Medicaid Program.
