34 Tex. Admin. Code § 41.52 - Expulsion from TRS-ActiveCare
(a) The trustee,
acting through the executive director, may expel from participation in
TRS-ActiveCare a participant who submits or causes to be submitted a false or
fraudulent claim or enrollment application, or who has defrauded or attempted
to defraud, any health benefits plan or pharmacy benefits plan offered under
TRS-ActiveCare.
(b) Upon receipt of
a complaint or upon its own motion, the TRS staff may file a petition for
expulsion with the executive director. The executive director may docket the
petition and refer the matter for an adjudicative hearing before the State
Office of Administrative Hearings or otherwise as authorized by law. If a
petition is docketed, the provisions of Chapter 43 of this title (relating to
Contested Cases) shall apply to the proceeding.
(c) Following a hearing, the executive
director may expel a person from participation in TRS-ActiveCare for a period
of time not to exceed five years if the executive director finds that the
person submitted or caused to be submitted a false or fraudulent claim or
enrollment application or has defrauded or attempted to defraud any health
benefits plan or pharmacy benefits plan offered under TRS-ActiveCare. Pursuant
to the delegation of authority through this section, the order of the executive
director is the final decision of TRS.
Notes
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