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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 358MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES
SUBCHAPTER ERIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS
RULE §358.605Fraud Referral and Restitution

(a) The Texas Health and Human Services Commission (HHSC) follows 42 CFR §§455.13 - 455.16 for issues governing fraud referral and restitution.

(b) HHSC evaluates a person's willful withholding of information for fraud, including:

  (1) willful misstatements, oral or written, made by the person or the person's authorized representative in response to oral or written questions from HHSC concerning the person's income, resources, or other circumstances that may affect the amounts of benefits, including understatements or omission of information about income and resources; and

  (2) willful failure by the person or the person's authorized representative to report changes in income, resources, or other circumstances that may affect the amount of benefits, if HHSC has clearly notified the person or the person's authorized representative of the person's obligation to report these changes.


Source Note: The provisions of this §358.605 adopted to be effective September 1, 2009, 34 TexReg 5497

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