(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.
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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; amended to be effective May 1, 2016, 41 TexReg 2941 |