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 371.1669 - Self-Dealing

Current through Reg. 49, No. 28; July 12, 2024
A person is subject to administrative actions or
						sanctions if the person:
(1) rebates
					 or accepts a fee or a part of a fee or charge for a Medicaid or other HHS
					 program patient referral;
(2)
					 solicits recipients or causes recipients to be solicited, through offers of
					 transportation or otherwise, for the purpose of claiming payment related to
					 those recipients;
(3) knowingly
					 offers to pay or agrees to accept, directly or indirectly, overtly or covertly,
					 any remuneration in cash or in kind to or from another for securing or
					 soliciting a patient or patronage for or from a person licensed, certified, or
					 registered by a state health care regulatory agency or HHS agency;
(4) knowingly offers to pay or agrees to
					 accept, directly or indirectly, overtly or covertly, any remuneration in cash
					 or in kind to or from another for securing or soliciting a patient or patronage
					 for or from a person licensed, certified, or registered by a state health care
					 regulatory agency, subject to the exceptions enumerated in Chapter 102, Texas
					 Occupations Code;
(5) solicits or
					 receives, directly or indirectly, overtly or covertly, any remuneration,
					 including any kickback, bribe, or rebate, in cash or in kind for referring an
					 individual to a person for the furnishing of, or for arranging the furnishing
					 of, any item or service for which payment may be made, in whole or in part,
					 under the Medicaid or other HHS program, provided that this paragraph does not
					 prohibit the referral of a patient to another practitioner within a
					 multispecialty group or university medical services research and development
					 plan (practice plan) for medically necessary services;
(6) solicits or receives, directly or
					 indirectly, overtly or covertly, any remuneration, including any kickback,
					 bribe, or rebate, in cash or in kind for purchasing, leasing, or ordering, or
					 arranging for or recommending the purchasing, leasing, or ordering of, any
					 good, facility, service, or item for which payment may be made, in whole or in
					 part, under the Medicaid or other HHS program;
(7) offers or pays, directly or indirectly,
					 overtly or covertly, any remuneration, including any kickback, bribe, or
					 rebate, in cash or in kind to induce a person to refer an individual to another
					 person for the furnishing of, or for arranging the furnishing of, any item or
					 service for which payment may be made, in whole or in part, under the Medicaid
					 or other HHS program, provided that this paragraph does not prohibit the
					 referral of a patient to another practitioner within a multispecialty group or
					 university medical services research and development plan (practice plan) for
					 medically necessary services;
(8)
					 offers or pays, directly or indirectly, overtly or covertly, any remuneration,
					 including any kickback, bribe, or rebate, in cash or in kind to induce a person
					 to purchase, lease, or order, or arrange for or recommend the purchase, lease,
					 or order of, any good, facility, service, or item for which payment may be
					 made, in whole or in part, under the Medicaid or other HHS program;
(9) provides, offers, or receives an
					 inducement in a manner or for a purpose not otherwise prohibited by this
					 section or §
											RSA
					 102.001, Texas Occupations Code, to or from a
					 person, including a recipient, provider, employee or agent of a provider,
					 third-party vendor, or public servant, for the purpose of influencing or being
					 influenced in a decision regarding:
(A)
					 selection of a provider or receipt of a good or service under the Medicaid or
					 other HHS program;
(B) the use of
					 goods or services provided under the Medicaid or other HHS program;
					 or
(C) the inclusion or exclusion
					 of goods or services available under the Medicaid program;