78th Texas Legislature, Regular Session, House Bill 1743, Chapter 257 Page: 1 of 21
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CHAPTER 257 H.B. No. 1743
1 AN ACT
2 relating to prevention of fraud and abuse under the medical
3 assistance program; creating an offense.
4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
5 SECTION 1i. Subchapter B, Chapter 32, Human Resources Code,
6 is amended by adding Section 32.0291 to read as follows:
7 Sec. 32:0291. PREPAYMENT REVIEWS AND POSTPAYMENT HOLDS.
8 (a) Notwithstanding any other law, the department may:
9 (1) perform a prepayment review of a claim for
10 reimbursement under the medical assistance program to determine
11 whether the claim involves fraud or abuse; and
12 (2) as necessary to perform that review, withhold
13 payment of the claim for not more than five working days without
14 notice to the person submitting the claim.
15 (b) Notwithstanding any other law, the department may
16 impose a postpayment hold on payment of future claims submitted by a
17 provider if the department has reliable evidence that the provider
18 has committed fraud or wilful misrepresentation regarding a claim
19 for reimbursement under the medical assistance program. The
20 department must notify the provider of the postpayment hold not
21 later than the fifth working day after the date the hold is imposed.
22 (c) On timely written request by a provider subject to a
23 postpayment hold under Subsection (b), the department shall file a
24 request with the State Office of Administrative Hearings for an
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Texas. Legislature. House of Representatives. 78th Texas Legislature, Regular Session, House Bill 1743, Chapter 257, legislative document, June 18, 2003; [Austin, Texas]. (texashistory.unt.edu/ark:/67531/metapth158257/m1/1/: accessed May 28, 2017), University of North Texas Libraries, The Portal to Texas History, texashistory.unt.edu; crediting UNT Libraries Government Documents Department.