1 Tex. Admin. Code § 371.1711 - Recoupment of Overpayments and Debts
(a)
The OIG recovers overpayments made to providers within the Medicaid or other
HHS programs, whether the overpayment resulted from error by the provider, the
claims administrator, or an operating agency, misunderstanding, or a program
violation.
(b) Application. The OIG
may recoup from any person if it determines that the person committed an act
for which a person is subject to administrative actions or sanctions, including
the following:
(1) commits a program
violation that leads to the payment of an overpayment;
(2) has failed to pay a debt owed to Medicare
or to any Medicaid program as the result of fraudulent or abusive actions by a
person participating in such program;
(3) is affiliated with a person who commits a
program violation that leads to the payment of an overpayment;
(4) commits an act for which sanctions,
damages, penalties, or liability could be or are assessed by the OIG;
or
(5) who causes or receives an
overpayment.
(c) Notice
includes:
(1) the specific basis for the
overpayment or debt;
(2) a
description of facts and supporting evidence;
(3) a representative sample of any documents
that form the basis for the overpayment or debt;
(4) the extrapolation methodology,
information relating to the extrapolation methodology used as part of the
investigation, and the methods used to determine the overpayment or debt in
sufficient detail so that the extrapolation results may be demonstrated to be
statistically valid and are fully reproducible;
(5) the calculation of the overpayment or
debt amount;
(6) the amount of
damages and penalties, if applicable; and
(7) a description of administrative and
judicial due process remedies, including the provider's option to seek informal
resolution, the provider's right to seek a formal administrative appeal
hearing, or the provider's option to seek both.
(d) The person who is the subject of a
recoupment of overpayment or recoupment of a debt is responsible for payment of
all overpayment amounts or debts assessed.
Notes
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