Texas Human Resources Code 32.0291 – Prepayment Reviews and Payment Holds
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(a) Notwithstanding any other law, the commission may:
(1) perform a prepayment review of a claim for reimbursement under the medical assistance program to determine whether the claim involves fraud or abuse; and
(2) as necessary to perform that review, withhold payment of the claim for not more than five working days without notice to the person submitting the claim.
Text of subsection effective until April 01, 2025
(b) Subject to § 531.102, Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.
Text of subsection effective on April 01, 2025
Terms Used In Texas Human Resources Code 32.0291
- Fraud: Intentional deception resulting in injury to another.
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
(b) Subject to Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544, Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.
Text of subsection effective until April 01, 2025
(c) A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under § 531.102, Government Code, including the notice requirements under Subsection (g) of that section.
Text of subsection effective on April 01, 2025
(c) A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544, Government Code, including the notice requirements under Section 544.0302.
(d) Repealed by Acts 2013, 83rd Leg., R.S., Ch. 622, Sec. 6, eff. September 1, 2013.