SECTION 357.623. Recovery When Fraud Is Involved

(a) Decision to recover funds.

(1) Recovery of funds which are obtained through fraudulent means by a provider may be recommended by the prosecuting attorney or by an administrative determination by program staff.

(2) After a case is referred to the Fraud and Abuse Division, department staff may not attempt to recover funds without prior approval from the Fraud and Abuse Division. Vendor payments may be withheld to coincide with the investigation according to program procedures. If fraud cannot be determined or if the prosecuting attorney declines the case, the attorney general's unit returns the case to the department for administrative sanction or action.

(3) When provider fraud is suspected, the department makes no agreements for restitution. The decision regarding acceptance of restitution is left to the prosecuting attorney.

(4) The prosecuting attorney may decide to accept restitution payments before or after an indictment, or a court may order a repayment schedule upon conviction. Whether restitution is made instead of a prosecution or following a court order, all cashier's checks or money orders are made payable to the Texas Department of Human Services.

(5) The department or its agents are responsible for recoupment when referred cases do not result in prosecution. These cases are returned to the department's Fraud and Abuse Division to send to the appropriate division administrator for administrative action.

(b) Manner of repayment. When fraud is involved, repayment is arranged based on an administrative hearing, a recommendation by the district or county attorney, or a court order. Claims are collected in one lump sum whenever possible. If the provider is financially unable to pay the indebtedness in this manner, however, payment may be accepted in regular installments. Installment payments should be as large as possible. The claim should be liquidated within one year. Convicted providers should be ordered to make monthly or weekly payments.

Source Note: The provisions of this §357.623 adopted to be effective January 1, 1976; amended to be effective December 29, 1976, 1 TexReg 3515; amended to be effective March 1, 1979, 4 TexReg 555; amended to be effective February 29, 1980, 5 TexReg 529; amended to be effective July 1, 1986, 11 TexReg 2828; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013