8000, Sanctions, Fraud and Abuse
Revision 13-0; Effective September 3, 2013
Rule: 40 Texas Administrative Code, Chapter 49, Subchapter F.
The Texas Health and Human Services Commission (HHSC) identifies and refers cases of suspected fraud or abuse of Medicare, Medicaid or social services program funding or resources to the Texas Health and Human Services Commission, Office of Inspector General (HHSC-OIG).
If directed to do so by the OIG, HHSC excludes from program reimbursement any provider agency that defrauds or abuses a Medicare or Medicaid program. HHSC suspends, in the event that the U.S. Department of Health and Human Services (HHS) directs the suspension, any recipient of Medicaid reimbursement who has been convicted of a crime related to the delivery of medical care or services under Medicare, Medicaid or social services programs.