1. (a) Medicaid and other Health and Human Services (HHS) program integrity requires that appropriate and medically necessary covered health care and social services be delivered safely by qualified active providers to eligible recipients in exchange for payment rates and fees established by law, rule, or contract established prior to the delivery of services.
2. (b) All services billed must be provided by providers who are enrolled as a provider and have signed a contract or provider agreement unless program rules permit the provider to bill for the services of other qualified persons. Regardless of payment methodology, program requirements, established through federal and state statutes, federal regulations, administrative rules, program rules, policies, procedures and manuals, and official explanations of those rules, policies, procedures and manuals, prescribe and govern the appropriate delivery of, and payment for, health care services and items within Medicaid and other health and human services programs.
3. (c) Chapter 531.102(a) of the Texas Government Code mandates that the Health and Human Services Commission (the Commission), through the Commission's Office of Inspector General (the Inspector General), is the state agency responsible for investigating fraud and abuse in Medicaid and other HHS programs. In addition, the Inspector General is responsible for the enforcement of state law relating to the provision of health and human services in Medicaid and other HHS programs.

Source Note:The provisions of this §371.1 adopted to be effective January 9, 2005, 29 TexReg 12128.