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 F - INVESTIGATIONS
Section 371.1312 - Recipient Investigations
Universal Citation: 1 TX Admin Code ยง 371.1312
Current through Reg. 49, No. 38; September 20, 2024
(a) The OIG may consider the following factors when opening and prioritizing recipient cases for the efficient management of the OIG's workload:
(1) the highest potential for recovery;
(2) applicable federal timeliness
requirements;
(3) initial screening
information obtained to support the allegation raised in the
complaint;
(4) whether allegations
in the complaint are violations of applicable agency policy, law or
regulations; and
(5) any other
relevant information or analysis the OIG deems appropriate.
(b) The OIG may consider the following factors in determining whether to close a recipient investigation:
(1) the investigation has been open for 180
days or longer, unless the OIG determines that more time is needed to complete
the investigation;
(2) information
or evidence to substantiate the complaint is unavailable or
unobtainable;
(3) evidence
regarding the subject of the complaint does not support the allegations raised
in the complaint;
(4) an
investigation, audit, inspection, or other review regarding the complaint
already exists; or
(5) any other
relevant information or analysis the OIG deems appropriate.
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