SECTION 371.1715. Damages and Penalties

(a) The OIG may assess administrative penalties otherwise authorized by law on behalf of the commission or a health and human services agency.

(b) Any administrative penalties or damages assessed for violations related to health care items or services that are authorized or provided under federal law, including claims submitted by persons for payment under the Medicaid program, are determined as provided in Texas Human Resources Code, §32.039. The OIG will also follow the procedures for imposing penalties or damages in Texas Human Resources Code, §32.039, which include opportunities for a person subject to potential penalties or damages to have an informal review and an appeal, and apply the factors in accordance with §371.1603 of this subchapter (relating to Legal Basis and Scope).

(c) This rule shall not be construed to deny any person potentially subject to an administrative sanction imposed by the OIG, including administrative damages or penalties, the right to introduce mitigating evidence in a contested case proceeding. This rule also shall not be construed to deny the OIG the right to introduce any evidence supporting any of the factors described in §371.1603 of this subchapter (relating to Legal Basis and Scope) in a contested case proceeding in which the agency seeks to impose an administrative sanction, including administrative damages or penalties, upon a person.

(d) Due process.

(1) After service of a notice of preliminary report recommending the assessment of an administrative penalty, a person has a right to make a written request for an informal review not later than the tenth day after service of the notice.

(2) After receiving written notice of the results of an informal review, a person may make a written request for an administrative appeal hearing no later than ten days after the date of service of the notice.

Source Note: The provisions of this §371.1715 adopted to be effective October 14, 2012, 37 TexReg 7989; amended to be effective April 15, 2014, 39 TexReg 2833; amended to be effective May 1, 2016, 41 TexReg 2941; amended to be effective May 20, 2020, 45 TexReg 3259