This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:36 GMT
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.