The OIG may perform a random prepayment review of claims submitted by Medicaid providers for reimbursement to determine whether the claim involves fraud, waste, or abuse. Suspect claims identified through this process may result in:

1. (1) imposition of a recoupment of overpayments and/or other pertinent administrative sanctions or actions;
2. (2) initiation of a full fraud, waste, or abuse investigation;
3. (3) referral for criminal or civil investigation and prosecution;
4. (4) withholding payment of these claims for not more than five working days without notice to the provider for which claims were submitted.

Source Note:The provisions of this §371.29 adopted to be effective January 9, 2005, 29 TexReg 12128; amended to be effective May 1, 2016, 41 TexReg 2941.