Texas Administrative Code (Last Updated: March 27,2024) |
TITLE 1. ADMINISTRATION |
PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION |
CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY |
SUBCHAPTER F. INVESTIGATIONS |
SECTION 371.1312. Recipient Investigations
Latest version.
-
(a) The OIG may consider the following factors when opening and prioritizing recipient cases for the efficient management of the OIG's workload: (1) the highest potential for recovery; (2) applicable federal timeliness requirements; (3) initial screening information obtained to support the allegation raised in the complaint; (4) whether allegations in the complaint are violations of applicable agency policy, law or regulations; and (5) any other relevant information or analysis the OIG deems appropriate. (b) The OIG may consider the following factors in determining whether to close a recipient investigation: (1) the investigation has been open for 180 days or longer, unless the OIG determines that more time is needed to complete the investigation; (2) information or evidence to substantiate the complaint is unavailable or unobtainable; (3) evidence regarding the subject of the complaint does not support the allegations raised in the complaint; (4) an investigation, audit, inspection, or other review regarding the complaint already exists; or (5) any other relevant information or analysis the OIG deems appropriate. Source Note: The provisions of this §371.1312 adopted to be effective July 23, 2019, 44 TexReg 3628