Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 371 - MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
Subchapter B - OFFICE OF INSPECTOR GENERAL
Section 371.29 - Random Prepayment Review
Universal Citation: 1 TX Admin Code § 371.29
Current through Reg. 50, No. 13; March 28, 2025
The OIG may perform a random prepayment review of claims submitted by Medicaid providers for reimbursement to determine whether the claim involves fraud, waste, or abuse. Suspect claims identified through this process may result in:
(1) imposition of a recoupment of overpayments and/or other pertinent administrative sanctions or actions;
(2) initiation of a full fraud, waste, or abuse investigation;
(3) referral for criminal or civil investigation and prosecution;
(4) withholding payment of these claims for not more than five working days without notice to the provider for which claims were submitted.
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