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 3 - ADMINISTRATIVE ACTIONS AND SANCTIONS › Section 371.1703 - Termination of Enrollment or Cancellation of Contract

Current through Reg. 49, No. 28; July 12, 2024
(a) The OIG may terminate the enrollment or
					 cancel the contract of a person by debarment, suspension, revocation, or other
					 deactivation of participation, as appropriate. The OIG may terminate or cancel
					 a person's enrollment or contract if it determines that the person committed an
					 act for which a person is subject to administrative actions or
					 sanctions.
(b) When the OIG
					 establishes the following by prima facie evidence, the OIG must terminate or
					 cancel the enrollment or contract from the Medicaid program or any other HHS
					 program of:
(1) a provider or any person with
					 an ownership interest in the provider has been convicted of a criminal offense
					 related to that person's involvement with the Medicare, Medicaid, or CHIP
					 program in the last ten years;
(2)
					 a provider that is terminated or revoked for cause, excluded, or debarred under
					 Title XVIII of the Social Security Act or under the Medicaid program or CHIP
					 program of any other state;
(3) a
					 provider that fails to permit access to any and all provider locations for
					 unannounced or announced on-site inspections required during the provider
					 screening process as provided by rule;
(4) a provider when any person with an
					 ownership or control interest or who is an agent or managing employee of the
					 provider fails to submit timely and accurate information, including
					 fingerprints if required by CMS or state rule, and cooperate with any and all
					 screening methods required during the provider screening process as provided by
					 rule, statute, rule, or regulation;
(5) a provider that fails to submit sets of
					 fingerprints in a form and manner to be provided by rule;
(6) a person that fails to repay overpayments
					 under the Medicaid program or CHIP;
(7) a person that owns, controls, manages, or
					 is otherwise affiliated with and has financial, managerial, or administrative
					 influence over a provider who has been suspended or prohibited from
					 participating in Medicare, Medicaid, or CHIP;
(8) a provider that fails to identify or
					 disclose in the provider screening process for any HHS program:
(A) all persons with a direct or indirect
					 ownership or control interest, as defined by
					 RSA
					 455.101;
(B) all information required to be disclosed
					 in accordance with
					 RSA
					 1001.1101, 42 C.F.R. chapter 455, or other by
					 statute, rule, or regulation; or
(C) all agents or subcontractors of the
					 provider:
(i) if the provider or a person with
					 an ownership interest in the provider has an ownership interest in the agent or
					 subcontractor; or
(ii) if the
					 provider engages in a business transaction with the agent or subcontractor that
					 meets the criteria specified by
					 RSA
					 455.105; or
(9) a provider that has been excluded or
					 debarred from participation in a state or federally funded health care program
					 as a result of:
(A) a criminal conviction or
					 finding of civil or administrative liability for committing a fraudulent act,
					 theft, embezzlement, or other financial misconduct under a state or federally
					 funded health care program; or
(B)
					 a criminal conviction for committing an act under a state or federally funded
					 health care program that caused bodily injury to:
(i) a person who is 65 years of age or
					 older;
(ii) a person with a
					 disability; or
(iii) a person under
					 18 years of age.