A person is subject to administrative actions or sanctions
if the person:
(1) requests payment from a recipient for services
or items delivered within the Medicaid or other HHS program when payment
for the services was recouped by Medicaid or another HHS program for
any reason;
(2) requests payment from recipients for services or
items furnished, directed, ordered, or prescribed by an excluded person
without first:
(A) informing the recipient, before delivery of the
item or service, that those services are not reimbursable by the Medicaid
or other HHS program; and
(B) obtaining and retaining, before delivery of the
item or service, a written signed consent from the recipient indicating
that the recipient understands he or she is responsible for payment
for the services and that the services or items are still desired;
(3) misapplies, misuses, embezzles, converts, steals,
or fails to promptly release upon a valid request, or fails to keep
detailed receipts of expenditures relating to any funds or other property
in trust for a Medicaid or other HHS program recipient;
(4) causes or permits the embezzlement, misuse, misapplication,
improper withholding, conversion, or misappropriation of Medicaid
or Medicaid-related funds:
(A) while the Medicaid provider is bankrupt, in receivership,
or insolvent;
(B) rendering the Medicaid provider insolvent by such
act; or
(C) deepening or contributing to the insolvency of
the Medicaid provider by such act;
(5) requests payment from a recipient for services
or items delivered within the Medicaid or other HHS program for any
amount that exceeds the amount Medicaid or other HHS program paid
for such services or items, with the exception of any cost-sharing
authorized by the program;
(6) markets, offers, supplies, or sells confidential
information, including recipient names, Medicaid recipient identification
numbers, and other recipient information, for a use that is not expressly
authorized by a Medicaid or other HHS program;
(7) discloses a recipient's protected health information
to any person in exchange for direct or indirect remuneration, except
that a person may disclose a recipient's protected health information:
(A) to a covered entity as defined by §181.001
of the Texas Health and Safety Code or to a covered entity as that
term is defined by §602.001 of the Texas Insurance Code for the
purpose of:
(i) treatment;
(ii) payment;
(iii) health care operations; or
(iv) performing an insurance or health maintenance
organization function as described by §602.053 of the Texas Insurance
Code; or
(B) as otherwise authorized by state or federal law.
|
