Texas Government Code 544.0201 – Selection and Review of Medicaid Claims to Determine Resource Allocation
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 Medicaid reimbursement, including under the vendor drug program, for potential cases of fraud, waste, or abuse.
(b) In conducting the annual review of claims, the commission may directly contact a recipient by telephone, in person, or both to verify that the services for which a provider submitted a reimbursement claim were actually provided to the recipient.
Terms Used In Texas Government Code 544.0201
- 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 toward 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 only after the commission completes the prior year‘s annual review of claims.
Text of section effective on April 01, 2025