A provider's violation or non-compliance with federal and or
state Medicaid laws, rules and regulations, rules under this chapter,
or Case Management and Pregnant Women policies and procedures may
result in one or more of the following actions taken by the department.
(1) Notification to the Medicaid claims administrator
through HHSC that the department has terminated the case management
provider. Providers will receive written notice of termination. Providers
who are terminated will not be approved if they reapply.
(2) Suspension of a provider in accordance with the
department's policies and procedures. Providers will receive written
notice of suspension.
(3) Probation of a provider in accordance with the
department's policies and procedures. Providers will receive written
notice of probation.
(4) Reprimand of a provider in accordance with the
department's policies and procedures. Providers will receive written
notice of reprimand.
(5) Report and referral to the appropriate professional
licensure entity.
(6) Report and referral to HHSC Office of Inspector
General.
(7) Report to a law enforcement agency.
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