1 Tex. Admin. Code § 371.29 - Random Prepayment Review

The OIG may perform a random prepayment review of claims submitted by Medicaid providers for reimbursement to determine whether the claim involves fraud, waste, or abuse. Suspect claims identified through this process may result in:

(1) imposition of a recoupment of overpayments and/or other pertinent administrative sanctions or actions;

(2) initiation of a full fraud, waste, or abuse investigation;

(3) referral for criminal or civil investigation and prosecution;

(4) withholding payment of these claims for not more than five working days without notice to the provider for which claims were submitted.

Notes

1 Tex. Admin. Code § 371.29

The provisions of this §371.29 adopted to be effective January 9, 2005, 29 TexReg 12128; Amended by Texas Register, Volume 41, Number 17, April 22, 2016, TexReg 2942, eff. 5/1/2016