1. (a) The trustee, acting through the TRS Executive Director, may expel from participation in TRS-ActiveCare a participant who submits or causes to be submitted a false or fraudulent claim or enrollment application, or who has defrauded or attempted to defraud, any health benefits plan or pharmacy benefits plan offered under TRS-ActiveCare.
2. (b) Upon receipt of a complaint or upon its own motion, the TRS staff may file a petition for expulsion with the Executive Director. The Executive Director may docket the petition and refer the matter for a hearing by the State Office of Administrative Hearings.
3. (c) Following a hearing, the Executive Director may expel a person from participation in TRS-ActiveCare for a period of time not to exceed five years if the Executive Director finds that the person submitted or caused to be submitted a false or fraudulent claim or enrollment application or has defrauded or attempted to defraud any health benefits plan or pharmacy benefits plan offered under TRS-ActiveCare. Pursuant to the delegation of authority through this section, the order of the Executive Director is the final decision of TRS.

Source Note:The provisions of this §41.52 adopted to be effective December 26, 2002, 27 TexReg 12004; amended to be effective March 8, 2007, 32 TexReg 1092.