8.6 Review Outcomes


Recoupment of Overpayments

Recoupment is required if the results of a utilization review indicate overpayment for services delivered, payment made for services not delivered, or payment made for services provided without preauthorization.

The agency notifies the provider in writing about the overpayment identified and explains the method of recoupment to be used.

Administrative Actions and Sanctions

The administrative actions or sanctions from a utilization review may result in one or more of the following being taken by the agency:

  1. Closure of the review with written notification to the provider.
  2. Discussion and interpretation of the results of the review with the provider.
  3. Referral to the appropriate state licensing board or to the Texas Office of the Inspector General.