Texas Administrative Code
Title 34 - PUBLIC FINANCE
Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS
Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS
Subchapter C - TEXAS SCHOOL EMPLOYEES GROUP HEALTH (TRS-ACTIVECARE)
Section 41.52 - Expulsion from TRS-ActiveCare
Current through Reg. 49, No. 38; September 20, 2024
(a) The trustee, acting through the executive director, may expel from participation in TRS-ActiveCare a participant who submits or causes to be submitted a false or fraudulent claim or enrollment application, or who has defrauded or attempted to defraud, any health benefits plan or pharmacy benefits plan offered under TRS-ActiveCare.
(b) Upon receipt of a complaint or upon its own motion, the TRS staff may file a petition for expulsion with the executive director. The executive director may docket the petition and refer the matter for an adjudicative hearing before the State Office of Administrative Hearings or otherwise as authorized by law. If a petition is docketed, the provisions of Chapter 43 of this title (relating to Contested Cases) shall apply to the proceeding.
(c) Following a hearing, the executive director may expel a person from participation in TRS-ActiveCare for a period of time not to exceed five years if the executive director finds that the person submitted or caused to be submitted a false or fraudulent claim or enrollment application or has defrauded or attempted to defraud any health benefits plan or pharmacy benefits plan offered under TRS-ActiveCare. Pursuant to the delegation of authority through this section, the order of the executive director is the final decision of TRS.
