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Tex. Hum. Res. Code § 32.0291

PREPAYMENT REVIEWS AND PAYMENT HOLDS

Applied in 3 court decisions — leading case Janek v. Harlingen Family Dentistry, P.C. (2014)

Most recently applied in Texas Health & Human Services Commission & Office of Inspector General v. Antoine Dental Center (April 2016)

Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.103, eff

(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.

(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.

(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(d) Repealed by Acts 2013, 83rd Leg., R.S., Ch. 622, Sec. 6, eff.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.

Official source: Texas Constitution and Statutes. Reproduced from public-domain Texas statutes; confirm against the official source for the current text. Not legal advice.