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 357.623 - Recovery When Fraud Is Involved
Universal Citation: 1 TX Admin Code ยง 357.623
Current through Reg. 49, No. 38; September 20, 2024
(a) Decision to recover funds.
(1) Recovery of
funds which are obtained through fraudulent means by a provider may be
recommended by the prosecuting attorney or by an administrative determination
by program staff.
(2) After a case
is referred to the Fraud and Abuse Division, department staff may not attempt
to recover funds without prior approval from the Fraud and Abuse Division.
Vendor payments may be withheld to coincide with the investigation according to
program procedures. If fraud cannot be determined or if the prosecuting
attorney declines the case, the attorney general's unit returns the case to the
department for administrative sanction or action.
(3) When provider fraud is suspected, the
department makes no agreements for restitution. The decision regarding
acceptance of restitution is left to the prosecuting attorney.
(4) The prosecuting attorney may decide to
accept restitution payments before or after an indictment, or a court may order
a repayment schedule upon conviction. Whether restitution is made instead of a
prosecution or following a court order, all cashier's checks or money orders
are made payable to the Texas Department of Human Services.
(5) The department or its agents are
responsible for recoupment when referred cases do not result in prosecution.
These cases are returned to the department's Fraud and Abuse Division to send
to the appropriate division administrator for administrative action.
(b) Manner of repayment. When fraud is involved, repayment is arranged based on an administrative hearing, a recommendation by the district or county attorney, or a court order. Claims are collected in one lump sum whenever possible. If the provider is financially unable to pay the indebtedness in this manner, however, payment may be accepted in regular installments. Installment payments should be as large as possible. The claim should be liquidated within one year. Convicted providers should be ordered to make monthly or weekly payments.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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