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 G - ADMINISTRATIVE ACTIONS AND SANCTIONS
Division 1 - GENERAL PROVISIONS
Section 371.1617 - Finality and Collections

Universal Citation: 1 TX Admin Code § 371.1617

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

(a) Unless otherwise provided in this subchapter, a sanction becomes final upon any of the following events:

(1) expiration of 30 calendar days after service of the notice of final sanction if no request for appeal of imposition of the sanction is received by the OIG by the 30th calendar day after service ;

(2) execution of a settlement agreement with the OIG; or

(3) a final order entered by the Executive Commissioner or his designee after an administrative hearing.

(b) The effect of a final sanction resulting in recoupment, assessment of damages, penalties, recoupment of audit overpayments, or other financial recovery is to create a final debt in favor of the State . Within 30 days after the date on which the sanction becomes final, the person must:

(1) pay the amount of the overpayment, assessment of damages, penalties, or other costs;

(2) negotiate and execute a payment plan, the terms of which are granted at the sole discretion of the OIG; or

(3) file a petition for judicial review contesting the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(c) If a final payment plan agreement is not executed by all parties or full restitution is not received within 30 calendar days after finality, the debt is delinquent and one or more vendor holds may be placed on the provider's payment claims and account by HHSC, the Medicaid/CHIP division, the state Comptroller, the OAG Collection Division, or any other state agency with authority to interrupt payments in satisfaction of a debt to the state.

(d) The OIG may, at its sole discretion, agree to suspend any vendor holds pending negotiations of payment plan terms.

(e) When a debt is delinquent, the OIG may collect funds owed. Collection methods may include:

(1) placing the person on prepayment or postpayment hold. Funds withheld by a payment hold may be used to satisfy any portion of an unpaid assessment of overpayments, damages, or penalties;

(2) using a collection agency;

(3) collecting from Medicare for Medicaid debts;

(4) requesting the State Comptroller to place a hold on all state voucher revenue for the person from all state agencies;

(5) requesting the OAG's Collection Division to file suit in district court or engage in other collection efforts;

(6) requesting the OAG to seek an injunction prohibiting the person from disposing of an asset(s) identified by the OIG as potentially subject to recovery due to the person's fraud, waste, or abuse;

(7) applying any funds derived from forfeited asset(s), after offsetting any expenses attributable to the sale of those assets; and

(8) receiving and reporting credit information on a person with outstanding debts.

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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