Texas Administrative Code › 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 B - OFFICE OF INSPECTOR GENERAL › Section 371.23 - Surety Bond

Current through Reg. 49, No. 28; July 12, 2024
(a) The OIG may
				  require each provider of medical assistance in the Medicaid program, in a
				  provider type that has demonstrated significant potential for fraud, waste, or
				  abuse, to file with the OIG a surety bond in a reasonable amount. The amount of
				  the surety bond may not exceed the maximum amount allowed by state or federal
				  law, plus the maximum amount of penalties allowed by state and federal
				  law.
(b) The OIG requires a
				  provider of medical assistance or person to file, with the OIG, a surety bond
				  in a reasonable amount if the OIG identifies acts or behavior that indicate
				  suspected fraud, waste, or abuse involving criminal conduct relating to the
				  provider's services under the program that indicates the need for protection
				  against potential future acts of fraud, waste, or abuse. The amount of the
				  surety bond shall not exceed the maximum amount allowed by state or federal
				  law, plus the maximum amount of penalties allowed by state and federal
				  law.
(c) The surety bond required
				  of a provider or person, by the OIG, under subsections (a) and (b) of this
				  section must be payable to HHSC to compensate HHSC for damages resulting from,
				  or penalties or fines imposed in connection with, an act of fraud, waste, or
				  abuse committed by the provider or person under the program.
(d) The OIG may require a provider of medical
				  assistance or person to file with the OIG a surety bond in an amount and manner
				  specified by the OIG. A surety bond may be required if the OIG identifies acts
				  or behavior that indicate suspected fraud, waste, or abuse that involves
				  criminal conduct that relates to the provider's services under the program and
				  that indicate the need for protection against potential loss of recoupment of
				  overpayments, penalties, damages, or other debts assessed against the provider
				  by the OIG, due to potential default of the provider or failure of the provider
				  to reimburse the OIG assessed amounts. Among other reasons, a surety bond may
				  be imposed in connection with a settlement agreement, a provisional,
				  probationary, or closed end contract, or as a condition of
				  reinstatement.
(e) Subject to
				  subsection (f) or (g) of this section, the OIG may require each provider of
				  medical assistance that establishes a resident's trust fund account to post a
				  surety bond to secure the account. The bond must be payable to HHSC to
				  compensate residents of the bonded provider for trust funds that are lost,
				  stolen, or otherwise unaccounted for if the provider does not repay any
				  deficiency in a resident's trust fund account to the person legally entitled to
				  receive the funds.
(f) For that
				  portion of a case involving a resident's trust fund accounts, the OIG does not
				  require the amount of a surety bond posted for a single facility provider under
				  subsection (e) of this section to exceed the average of the total average
				  monthly balance of all of the provider's resident trust fund accounts for the
				  12-month period preceding the bond issuance or renewal date. This limitation
				  does not apply to any type of violations other than resident trust fund
				  accounts.
(g) If an employee of a
				  provider of medical assistance is responsible for the loss of funds in a
				  resident's trust fund account, the resident, the resident's family, and the
				  resident's legal representative are not obligated to make any payments to the
				  provider that would have been made out of the trust fund had the loss not
				  occurred.
(h) Failure by a provider
				  or person to post a surety bond timely and as required by the OIG may result in
				  imposition of any of the administrative actions or sanctions and/or imposition
				  of damages and penalties, as specified in Subchapter G of this chapter
				  (relating to Administrative Actions and Sanctions).
(i) Surety bonds required by the OIG are
				  considered administrative actions. Administrative actions are further described
				  in §
										RSA
				  371.1701 of this chapter (relating to
				  Administrative Actions) .