SECTION 357.581. Department Responsibility

(a) The Texas Department of Human Services is responsible for minimizing the opportunity for provider fraud and abuse as well as recipient fraud and abuse and for protecting recipients of federally funded health care programs from unsafe practitioners. The department takes appropriate action to protect recipients and the program when providers of services are suspected of committing fraud or abuse.

(b) All actions resulting in overpayment to a provider are not necessarily fraudulent. Some circumstances could result in the referral of a provider to the Medicaid Fraud Control Unit in the attorney general's office. Other circumstances would result in administrative action rather than referral for judicial action or criminal prosecution. These actions, or sanctions, range from a notice to the provider explaining his error to exclusion from the Medicaid Program.

Source Note: The provisions of this §357.581 adopted to be effective January 1, 1976; amended to be effective February 29, 1980, 5 TexReg 556; amended 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