Texas Government Code 531.109 – Selection and Review of Claims
Current as of: 2024 | Check for updates
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(a) The commission shall annually select and review a random, statistically valid sample of all claims for reimbursement under Medicaid, including under the vendor drug program, for potential cases of fraud, waste, or abuse.
(b) In conducting the annual review of claims under Subsection (a), the commission may directly contact a recipient by telephone or in person, or both, to verify that the services for which a claim for reimbursement was submitted by a provider were actually provided to the recipient.
Terms Used In Texas Government Code 531.109
- Allegation: something that someone says happened.
- 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
- Year: means 12 consecutive months. See Texas Government Code 311.005
(c) Based on the results of the annual review of claims, the commission shall determine the types of claims at which commission resources for fraud and abuse detection should be primarily directed.
(d) Absent an allegation of fraud, waste, or abuse, the commission may conduct an annual review of claims under this section only after the commission has completed the prior year‘s annual review of claims.
Text of section effective until April 01, 2025