Texas Administrative Code

Texas Administrative Code

TITLE 1	ADMINISTRATION
PART 15	TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 357	HEARINGS
SUBCHAPTER O	RECOVERY OF BENEFITS WRONGFULLY RECEIVED
RULE §357.621	Department Responsibility

(a) The department or its agents are responsible for recovering from providers all payments made for services delivered or provided under fraudulent or abusive circumstances or through error or misunderstanding. At the department's discretion, overpayments may be collected in a lump sum or in installments. If collection is made through installments, the provider must comply with the payment plan established by the department for a reasonable length of time not to exceed 12 months.

(b) The department determines the need for individual provider participation or reinstatement. This determination is based on the following criteria:

(1) accessibility of other health care to the recipient population; and

(2) previous conduct of the provider during participation in the Medicare or Medicaid program in any state or any conduct or action for which a sanction as described in these sections could have been taken.

(c) The department or its agents recover overpayments made because of claims processing errors by the department or its agents.

Source Note: The provisions of this §357.621 adopted to be effective July 1, 1986, 11 TexReg 2828; amended to be effective December 15, 1988, 13 TexReg 5828; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013