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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER GADMINISTRATIVE ACTIONS AND SANCTIONS
DIVISION 1GENERAL PROVISIONS
RULE §371.1617Finality and Collections

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

  (1) expiration of 30 calendar days after receipt of the notice of final sanction or notice of a payment hold if no timely request for appeal of imposition of the sanction is received by OIG;

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

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

(b) The effect of a final sanction resulting in recoupment, restricted reimbursement, assessment of damages, penalties, recoupment of audit overpayments, or other financial recovery is to create a final debt in favor of the State of Texas. 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 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 will be 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) OIG may, at its sole discretion, agree to suspend any vendor holds pending negotiations of payment plan terms.

(e) When a debt is delinquent, 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 OIG as potentially subject to recovery due to the person's fraud 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.


Source Note: The provisions of this §371.1617 adopted to be effective October 14, 2012, 37 TexReg 7989; amended to be effective April 15, 2014, 39 TexReg 2833

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