Human Resources Code § 32.0291

The commission may review claims before payment to check for fraud or abuse, and may delay or hold payments in limited circumstances.

Jurisdiction: United States — Texas
Instrument: Code
Version: Undated source snapshot
Language: en
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claims review payment holds

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Provisions of Human Resources Code § 32.0291

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32.0291
Human Resources Code § 32.0291
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The commission may review claims before payment to check for fraud or abuse, and may delay or hold payments in limited circumstances.

Sec. 32.0291. PREPAYMENT REVIEWS AND PAYMENT HOLDS. (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 (d) Repealed by Acts 2013, 83rd Leg., R.S., Ch. 622, Sec. 6, eff.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. Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.103, eff. Sept. 1, 2003. Amended by: Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 4, eff. September 1, 2013. Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 5, eff. September 1, 2013. Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 6, eff. September 1, 2013. Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.101, eff. April 2, 2015. Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.81, eff. April 1, 2025.

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Human Resources Code § 32.0291

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Provisions of Human Resources Code § 32.0291

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