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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371 - MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER F - INVESTIGATIONS
SECTION/RULE §371.1312 - Recipient Investigations
Chapter Review Date 08/08/2023

(a) The OIG may consider the following factors when opening and prioritizing recipient cases for the efficient management of the OIG's workload:(1) the highest potential for recovery;(2) applicable federal timeliness requirements;(3) initial screening information obtained to support the allegation raised in the complaint;(4) whether allegations in the complaint are violations of applicable agency policy, law or regulations; and(5) any other relevant information or analysis the OIG deems appropriate.(b) The OIG may consider the following factors in determining whether to close a recipient investigation:(1) the investigation has been open for 180 days or longer, unless the OIG determines that more time is needed to complete the investigation;(2) information or evidence to substantiate the complaint is unavailable or unobtainable;(3) evidence regarding the subject of the complaint does not support the allegations raised in the complaint;(4) an investigation, audit, inspection, or other review regarding the complaint already exists; or(5) any other relevant information or analysis the OIG deems appropriate.

Source Note: The provisions of this §371.1312 adopted to be effective July 23, 2019, 44 TexReg 3628.

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