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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 357HEARINGS
SUBCHAPTER MFRAUD OR ABUSE INVOLVING MEDICAL PROVIDERS
RULE §357.585Grounds for Fraud Referral and Administrative Sanction

  (37) committing an act described in the Social Security Act, §1128A or §1128B.

  (38) meeting any of the conditions specified in §79.2112(f) or (g) of this title (relating to Administrative Sanctions or Actions);

  (39) failing to fully and accurately make any disclosure required by the Social Security Act, §1124 or §1126.

  (40) failing to disclose information about the ownership of a subcontractor with whom the person has had business transactions in an amount exceeding $25,000 during the previous 12 months or about any significant business transactions (as defined by HHS) with any wholly-owned supplier or subcontractor during the previous five years;

  (41) failing, as a hospital, to comply substantially with a corrective action required under the Social Security Act, §1886(f)(2)(B);

  (42) defaulting on repayments of scholarship obligations or items relating to health profession education made or secured, in whole or in part, by HHS when HHS has taken all reasonable steps available to HHS to secure repayment.

  (43) developing false source documents or failing to sign source documents, to retain supporting documentation, or to comply with the provisions or requirements of the department pertaining to electronic claims submittal.


Source Note: The provisions of this §357.585 adopted to be effective July 1, 1986, 11 TexReg 2825; 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

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