A person is subject to administrative actions or sanctions
if the person:
(1) rebates or accepts a fee or a part of a fee or
charge for a Medicaid or other HHS program patient referral;
(2) solicits recipients or causes recipients to be
solicited, through offers of transportation or otherwise, for the
purpose of claiming payment related to those recipients;
(3) knowingly offers to pay or agrees to accept, directly
or indirectly, overtly or covertly, any remuneration in cash or in
kind to or from another for securing or soliciting a patient or patronage
for or from a person licensed, certified, or registered by a state
health care regulatory agency or HHS agency;
(4) knowingly offers to pay or agrees to accept, directly
or indirectly, overtly or covertly, any remuneration in cash or in
kind to or from another for securing or soliciting a patient or patronage
for or from a person licensed, certified, or registered by a state
health care regulatory agency, subject to the exceptions enumerated
in Chapter 102, Texas Occupations Code;
(5) solicits or receives, directly or indirectly, overtly
or covertly, any remuneration, including any kickback, bribe, or rebate,
in cash or in kind for referring an individual to a person for the
furnishing of, or for arranging the furnishing of, any item or service
for which payment may be made, in whole or in part, under the Medicaid
or other HHS program, provided that this paragraph does not prohibit
the referral of a patient to another practitioner within a multispecialty
group or university medical services research and development plan
(practice plan) for medically necessary services;
(6) solicits or receives, directly or indirectly, overtly
or covertly, any remuneration, including any kickback, bribe, or rebate,
in cash or in kind for purchasing, leasing, or ordering, or arranging
for or recommending the purchasing, leasing, or ordering of, any good,
facility, service, or item for which payment may be made, in whole
or in part, under the Medicaid or other HHS program;
(7) offers or pays, directly or indirectly, overtly
or covertly, any remuneration, including any kickback, bribe, or rebate,
in cash or in kind to induce a person to refer an individual to another
person for the furnishing of, or for arranging the furnishing of,
any item or service for which payment may be made, in whole or in
part, under the Medicaid or other HHS program, provided that this
paragraph does not prohibit the referral of a patient to another practitioner
within a multispecialty group or university medical services research
and development plan (practice plan) for medically necessary services;
(8) offers or pays, directly or indirectly, overtly
or covertly, any remuneration, including any kickback, bribe, or rebate,
in cash or in kind to induce a person to purchase, lease, or order,
or arrange for or recommend the purchase, lease, or order of, any
good, facility, service, or item for which payment may be made, in
whole or in part, under the Medicaid or other HHS program;
(9) provides, offers, or receives an inducement in
a manner or for a purpose not otherwise prohibited by this section
or §102.001, Texas Occupations Code, to or from a person, including
a recipient, provider, employee or agent of a provider, third-party
vendor, or public servant, for the purpose of influencing or being
influenced in a decision regarding:
(A) selection of a provider or receipt of a good or
service under the Medicaid or other HHS program;
(B) the use of goods or services provided under the
Medicaid or other HHS program; or
(C) the inclusion or exclusion of goods or services
available under the Medicaid program;
(10) is a physician and refers a Medicaid or other
HHS program recipient to an entity with which the physician has a
financial relationship for the furnishing of designated health services,
payment for which would be denied under Title XVIII (Medicare) pursuant
to 42 U.S.C. §1395nn, §1396b(s) (Stark I, II, and III),
the federal Anti-Kickback Statute, the Affordable Care Act, or other
state or federal law prohibiting self-dealing or self-referral;
(11) engages in marketing services in violation of §531.02115
of the Texas Government Code, program rules, or contract and has not
received prior authorization from the program for the marketing campaign;
or
(12) fails to disclose documentation of financial relationships
necessary to establish compliance with §1877 and §1903(s)
of the Social Security Act or 42 C.F.R. §§411.350 - .389
(Stark I, II, and III), the federal Anti-Kickback Statute, the Affordable
Care Act, or other state or federal law prohibiting self-dealing or
self-referral.
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