| (a) The trustee, acting through the executive director,
may expel from participation in TRS-ActiveCare a participant who submits
or causes to be submitted a false or fraudulent claim or enrollment
application, or who has defrauded or attempted to defraud, any health
benefits plan or pharmacy benefits plan offered under TRS-ActiveCare.
(b) Upon receipt of a complaint or upon its own motion,
the TRS staff may file a petition for expulsion with the executive
director. The executive director may docket the petition and refer
the matter for an adjudicative hearing before the State Office of
Administrative Hearings or otherwise as authorized by law. If a petition
is docketed, the provisions of Chapter 43 of this title (relating
to Contested Cases) shall apply to the proceeding.
(c) Following a hearing, the executive director may
expel a person from participation in TRS-ActiveCare for a period of
time not to exceed five years if the executive director finds that
the person submitted or caused to be submitted a false or fraudulent
claim or enrollment application or has defrauded or attempted to defraud
any health benefits plan or pharmacy benefits plan offered under TRS-ActiveCare.
Pursuant to the delegation of authority through this section, the
order of the executive director is the final decision of TRS.
|
| Source Note: The provisions of this §41.52 adopted to be effective December 26, 2002, 27 TexReg 12004; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective December 22, 2014, 39 TexReg 10029 |
