| (a) Definition. In the context of this subchapter,
the term vendor hold means detaining accrued vendor payments from
the effective date of the hold until the release date.
(b) Reasons for placing a pharmacy provider on vendor
hold are as follows:
(1) violation of the provisions of the pharmacy provider
agreements and/or amendments;
(2) failure to pay, within the allotted period of time,
the amount of restitution as revealed by an audit of the pharmacy
provider;
(3) a request by the Office of Inspector General or
the Office of Attorney General, pursuant to an investigation of a
pharmacy provider for possible fraud;
(4) failure to file a required cost report according
to applicable instructions and within the prescribed time period;
(5) failure to allow access to financial and other
records in accordance with §354.1807 of this division (relating
to Access to Records); or
(6) a credible allegation of fraud, as defined in 42
CFR §455.2.
(c) HHSC will lift a vendor hold when it determines
that the reason for the placement of the vendor hold is no longer
present.
(1) A vendor hold placed due to a violation of a pharmacy
provider agreement and/or amendments, as described in subsection (b)(1)
of this section, will be lifted when the provider proves to be compliant
with the pharmacy provider agreements and/or amendments.
(2) A vendor hold placed due to a failure to pay restitution
within the allotted time period, as described in subsection (b)(2)
of this section, will be lifted when restitution is paid in full.
(3) A vendor hold placed pursuant to an investigation
of fraud, as described in subsection (b)(3) of this section, will
be lifted when the investigation of possible fraud ends. If fraud
is found, however, the pharmacy provider's participation in the Medicaid
program will be terminated.
(4) A vendor hold placed due to a pharmacy provider's
failure to file a required cost report, as described in subsection
(b)(4) of this section, remains in effect until all cost-reporting
deficiencies are corrected. If the cost reporting deficiencies are
not corrected within three months following the due date of the report,
the pharmacy provider's agreement may be cancelled. The pharmacy provider
is notified of agreement cancellation when this action is taken. Notice
is considered to have been made as of the date of delivery to the
United States Postal Service.
(5) A vendor hold placed due to a pharmacy provider's
failure to allow access to financial and other records, as described
in subsection (b)(5) of this section, remains in effect until access
to the requested records is allowed. If access to the requested records
is not provided within 31 days of the refusal, the pharmacy provider's
agreement may be cancelled. The pharmacy provider is notified of agreement
cancellation when the action is taken.
(6) A vendor hold placed due to a credible allegation
of fraud, as described in subsection (b)(6) of this subsection, will
be lifted when the investigation of the fraud allegation ends. If
fraud is found, however, the pharmacy provider's participation in
the Medicaid program will be terminated.
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