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 G - ADMINISTRATIVE ACTIONS AND SANCTIONS › Division 2 - GROUNDS FOR ENFORCEMENT › Section 371.1665 - Cost Report Violations

Current through Reg. 49, No. 28; July 12, 2024
A person is subject to administrative actions or
						sanctions if the person:
(1) reports
					 costs of non-covered or non-chargeable health care or administrative services,
					 supplies, equipment, or other unallowable expenses in a cost report;
(2) incorrectly apportions or allocates costs
					 in a cost report;
(3) reports costs
					 of unallowable health care or administrative services, supplies, or equipment
					 as allowable costs in a cost report;
(4) reports costs of health care services,
					 supplies, or equipment that were not delivered to the recipient;
(5) reports costs of administrative services,
					 supplies, or equipment that were not actually incurred;
(6) engages in an arrangement between
					 providers and employees, related parties, independent contractors, suppliers,
					 and/or others that appear to be designed to overstate the costs to the program
					 through any device (such as commissions or fee splitting) or to siphon off or
					 conceal illegal profits;
(7)
					 reports costs in a cost report that were not incurred, that were incurred at a
					 discount or lesser cost than that which was reported, or that were attributable
					 to non-program activities, other enterprises, or personal expenses;
(8) manipulates or falsifies statistics that
					 result in overstatement of costs or avoidance of recoupment, including
					 incorrectly reporting square footage, hours worked, revenues received, or units
					 of service delivered;
(9) claims
					 bad debts without first attempting to collect payment;
(10) depreciates assets that have been fully
					 depreciated or sold, or uses an incorrect basis for depreciation;
(11) affiliates with, retains, or employs a
					 person excluded from participation in Medicare, Medicaid, or other HHS program
					 and includes the salary, fringe, overhead, or any other costs associated with
					 the excluded person within a cost report or any documents used to determine a
					 person's payment rate, a statewide payment rate, or a fee;
(12) reports a cost above the cost actually
					 paid to a related party;
(13)
					 reports a damage, cost, or penalty collected by the OIG as an allowable expense
					 in a cost report;
(14) minimizes or
					 understates profits on a cost report;
(15) manipulates or understates profits on a
					 cost report in a manner that reduces the experience rebate that would have been
					 owing to the state;
(16)
					 manipulates or falsifies supporting documentation related to a cost report,
					 including the use of market data rather than actual expenses; or
(17) manipulates or falsifies any cost report
					 supporting documentation including medical loss statistics, annual statements,
					 encounter data, cash disbursement journal entries, or annual reports.