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RULE §371.1305 Preliminary Investigation and Report

Published: 2015

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(a) OIG will determine whether it has sufficient information
and whether it has jurisdiction within 30 days of receipt of a complaint
or allegation of fraud, waste, or abuse; within 30 days of OIG having
reason to believe that fraud or abuse has occurred; or within 30 days
of OIG having identified possible questionable practices. If OIG has
jurisdiction and sufficient information to initiate an investigation,
OIG will conduct a preliminary investigation to determine whether
there is sufficient basis to warrant a full investigation. OIG may
also collaborate with federal or other state authorities in conducting
audits or investigations and in taking enforcement measures in response
to program violations.
  (1) After completing its preliminary investigation,
OIG may, at its discretion, initiate settlement discussions of an
administrative case with the person who is the subject of the investigation.
If the matter cannot reasonably be settled or if OIG determines that
further investigation is required before the propriety of settlement
or other enforcement can be evaluated, OIG may conduct a full investigation.

  (2) If, at any point during its investigation, OIG
determines that an overpayment resulted without wrongdoing, OIG may
refer the matter for routine payment correction by HHSC's fiscal agent
or an operating agency or may offer a payment plan.
(b) Once the preliminary investigation is completed,
OIG will review the allegations of fraud, abuse, or questionable practices,
and all facts and evidence relating to the allegation and will prepare
a preliminary report before the allegation of fraud or abuse will
proceed to a full investigation. The preliminary report will document
the following:
  (1) the allegation that is the basis of the report;
  (2) the evidence reviewed;
  (3) the procedures used to conduct the preliminary
investigation, if available;
  (4) the findings of the preliminary investigation;
  (5) whether a full investigation is warranted.
(c) OIG will also consider the factors listed in §371.1603(f)(1)
of this chapter (relating to Legal Basis and Scope).
(d) OIG will maintain a record of all allegations of
fraud or abuse against a provider containing the date each allegation
was received or identified and the source of the allegation, if available.
This record is confidential under Texas Government Code §531.1021(g)
and subject to Texas Government Code §531.1021(h).

Source Note: The provisions of this §371.1305 adopted to be effective April 15, 2014, 39 TexReg 2833