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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 FINVESTIGATIONS
RULE §371.1312Recipient Investigations

(a) The OIG may consider the following factors when opening and prioritizing recipient cases for the efficient management of the OIG's workload:

  (1) the highest potential for recovery;

  (2) applicable federal timeliness requirements;

  (3) initial screening information obtained to support the allegation raised in the complaint;

  (4) whether allegations in the complaint are violations of applicable agency policy, law or regulations; and

  (5) any other relevant information or analysis the OIG deems appropriate.

(b) The OIG may consider the following factors in determining whether to close a recipient investigation:

  (1) the investigation has been open for 180 days or longer, unless the OIG determines that more time is needed to complete the investigation;

  (2) information or evidence to substantiate the complaint is unavailable or unobtainable;

  (3) evidence regarding the subject of the complaint does not support the allegations raised in the complaint;

  (4) an investigation, audit, inspection, or other review regarding the complaint already exists; or

  (5) any other relevant information or analysis the OIG deems appropriate.


Source Note: The provisions of this §371.1312 adopted to be effective July 23, 2019, 44 TexReg 3628

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