All codes › Government Code › Title 4

Chapter 544

Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services

Subchapter A. General Provisions

544.0001 Definitions 544.0002 Reference to Office of Investigations and Enforcement 544.0003 Authority of State Agency or Governmental Entity Not Limited

Subchapter B. Health and Human Services Commission: Administrative Provisions

544.0051 Coordination with Office of Attorney General; Annual Report 544.0052 Rules Regarding Enforcement and Punitive Actions 544.0053 Provision of Information to Pharmacy Subject to Audit; Informal Hearing on Audit Findings 544.0054 Records of Allegations of Fraud or Abuse 544.0055 Record and Confidentiality of Informal Resolution Meetings 544.0056 Expunction of Child's Chemical Dependency Diagnosis in Certain Records

Subchapter C. Office of Inspector General: General Provisions

544.0101 Appointment of Inspector General; Term 544.0102 Commission Powers and Duties Related to Office of Inspector General 544.0103 Office of Inspector General: General Powers and Duties 544.0104 Employment of Medical Director 544.0105 Employment of Dental Director 544.0106 Procurement of Qualified Expert on Behalf of Office of Inspector General 544.0107 Employment of Peace Officers 544.0108 Investigative Process Review 544.0109 Performance Audits and Coordination of Audit Activities 544.01091 Performance and Financial Audits of Local Behavioral Health Authorities and Local Mental Health Authorities 544.0110 Reports on Audits, Inspections, and Investigations 544.0111 Compliance with Federal Coding Guidelines 544.0112 Hospital Utilization Reviews and Audits: Provider Education Process 544.0113 Program Exclusions 544.0114 Report 544.0115 Permitted Disclosure of Certain Information

Subchapter D. Medicaid Provider Criminal History Record Information and Eligibility

544.0151 Definitions 544.0152 Exchange of Criminal History Record Information Between Participating Agencies 544.0153 Provider Eligibility for Medicaid Participation: Criminal History Record Information 544.0154 Monitoring of Certain Federal Databases 544.0155 Period for Determining Provider Eligibility for Medicaid

Subchapter E. Prevention and Detection of Fraud, Waste, and Abuse

544.0202 Duties Related to Fraud Prevention 544.0203 Fraud, Waste, and Abuse Detection Training 544.0204 Health and Human Services Agency Medicaid Fraud, Waste, and Abuse Detection Goal 544.0205 Award for Reporting Medicaid Fraud, Abuse, or Overcharges

Subchapter F. Investigation of Fraud, Waste, Abuse, and Overcharges

544.0251 Claims Criteria Requiring Commencement of Investigation 544.0252 Circumstances Requiring Commencement of Preliminary Investigation of Alleged Fraud or Abuse 544.0253 Conduct of Preliminary Investigation of Alleged Fraud or Abuse 544.0254 Finding of Certain Medicaid Fraud or Abuse Following Preliminary Investigation: Criminal Referral or Full Investigation 544.0255 Immediate Criminal Referral under Certain Circumstances 544.0256 Continuation of Payment Hold Following Referral to Law Enforcement Agency 544.0257 Completion of Full Investigation of Alleged Medicaid Fraud or Abuse 544.0258 Memorandum of Understanding for Assisting Attorney General Investigations Related to Medicaid 544.0259 Subpoenas

Subchapter G. Payment Holds

544.0301 Imposition of Payment Hold 544.0302 Notice 544.0303 Expedited Administrative Hearing 544.0304 Informal Resolution 544.0305 Website Posting

Subchapter H. Managed Care Organization Prevention and Investigation of Fraud and Abuse

544.0351 Applicability of Subchapter 544.0352 Special Investigative Unit or Contracted Entity to Investigate Fraud and Abuse 544.0353 Fraud and Abuse Prevention Plan 544.0354 Assistance and Oversight by Office of Inspector General 544.0355 Rules

Subchapter I. Financial Assistance Fraud

544.0401 Definition 544.0402 False or Misleading Information Related to Financial Assistance Eligibility 544.0403 Commission Action Following Determination of Violation 544.0404 Ineligibility for Financial Assistance Following Violation; Right to Appeal 544.0405 Household Eligibility for Financial Assistance Not Affected 544.0406 Rules

Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges

544.0451 Learning, Neural Network, or Other Technology Relating to Medicaid 544.0452 Medicaid Fraud Investigation Tracking System 544.0453 Medicaid Fraud Detection Technology 544.0454 Data Matching Against Federal Felon List 544.0455 Electronic Data Matching 544.0456 Methods to Reduce Fraud, Waste, and Abuse in Certain Public Assistance Programs

Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges

544.0501 Recovery Monitoring System 544.0502 Payment Recovery Efforts by Certain Persons; Retention of Recovered Amounts 544.0503 Process for Managed Care Organizations to Recoup Overpayments Related to Electronic Visit Verification Transactions 544.0504 Recovery Audit Contractors 544.0505 Annual Report on Certain Fraud and Abuse Recoveries 544.0506 Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt 544.0507 Appeal of Determination to Recoup Overpayment or Debt