Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 357 - HEARINGS
Subchapter O - RECOVERY OF BENEFITS WRONGFULLY RECEIVED
Section 357.621 - Department Responsibility

Universal Citation: 1 TX Admin Code ยง 357.621

Current through Reg. 49, No. 38; September 20, 2024

(a) The department or its agents are responsible for recovering from providers all payments made for services delivered or provided under fraudulent or abusive circumstances or through error or misunderstanding. At the department's discretion, overpayments may be collected in a lump sum or in installments. If collection is made through installments, the provider must comply with the payment plan established by the department for a reasonable length of time not to exceed 12 months.

(b) The department determines the need for individual provider participation or reinstatement. This determination is based on the following criteria:

(1) accessibility of other health care to the recipient population; and

(2) previous conduct of the provider during participation in the Medicare or Medicaid program in any state or any conduct or action for which a sanction as described in these sections could have been taken.

(c) The department or its agents recover overpayments made because of claims processing errors by the department or its agents.

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