Government Code § 544.0052

Sec. 544.0052. RULES REGARDING ENFORCEMENT AND PUNITIVE ACTIONS. (a) The executive commissioner, in consultation with the office of inspector general, shall adopt rules establishing criteria for determining enforcement and punitive actions regarding a provider who violated state law, program rules, or the provider's Medicaid provider agreement. (b) The rules must include: (1) direction for categorizing provider violations according to the nature of the violation and for scaling resulting enforcement actions, taking into consideration: (A) the seriousness of the violation; (B) the prevalence of errors by the provider; (C) the financial or other harm to this state or recipients resulting or potentially resulting from those errors; and (D) mitigating factors the office of inspector general determines appropriate; and (2) a specific list of potential penalties, including the amount of the penalties, for fraud and other Medicaid violations. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.