Section 371.1721 - Recoupment of Overpayments Identified by Inspection(a) Introduction. The OIG conducts inspections related to the provision and delivery of all health and human services in the state. The OIG may recover an overpayment identified in an inspection.(b) Records. (1) A person who receives a request for records and documentation for an OIG inspection must provide the records and documentation to the OIG within the time period requested by the OIG or 10 calendar days from the date of receipt of the request, whichever is later, except when OIG determines an element of surprise is critical to the inspection objective. When an element of surprise is critical, the person must provide the records and documentation to OIG when requested.(2) When requested, a person subject to an OIG inspection must submit a signed and notarized OIG-approved records affidavit that properly authenticates the records provided to OIG as business records pursuant to Texas Rules of Evidence Rule 803(6) and Rule 902(10).(3) Failure to produce requested records and affidavits may result in an OIG enforcement action under this chapter.(c) Inspection procedures. During an inspection, the OIG: (1) follows the Quality Standards for Inspection and Evaluation adopted by the Council of the Inspectors General on Integrity and Efficiency;(2) limits the scope covered to a five year period;(3) notifies the person subject to an inspection in writing of the impending inspection not later than the seventh calendar day before the first day of the site visit, if any, except when the OIG determines an element of surprise is critical to the inspection objective; and(4) permits the person subject to an inspection to produce documentation to address any finding found during an inspection by the date specified by the OIG.(d) Notice. (1) Draft inspection report. The OIG delivers the draft inspection report to the person subject to the inspection after field work is completed.(2) Final inspection report. The OIG delivers a final inspection report to the person subject to the inspection.(3) Electronic mail. OIG notices may be sent by electronic mail.(e) Final report. The final inspection report includes: (1) a statement of compliance with the Quality Standards for Inspection and Evaluation;(2) the management response, if provided, which may be summarized; and(3) any recommendations, findings, or overpayment amount.(f) Management response; overpayments; and due process. (1) Draft inspection report. A person who is the subject of a draft inspection report may provide a written management response. The OIG must receive the written management response by the date specified by the OIG. The OIG may revise the draft inspection report as needed to incorporate management responses, if provided, or other relevant considerations; or the OIG may issue a final report.(2) Final inspection report. A person who receives a final inspection report that includes an overpayment amount must: (A) pay the overpayment amount no later than 60 calendar days after receipt of the final inspection report;(B) timely request and execute a final payment plan agreement approved by the OIG; or(C) make a timely request to the OIG for an administrative hearing at the HHSC Appeals Division.(3) Request for payment plan agreement. A request for a final payment plan agreement must be in writing and received by the OIG no later than 15 calendar days after receipt of the final inspection report.(4) Request for administrative hearing appeal. A request for an appeal must be in writing and received by the OIG no later than 15 calendar days after receipt of the final inspection report. The request must: (A) be signed by the person or the person's attorney;(B) specify the issues, findings, or legal authority being challenged and the basis for each challenge;(C) for inspection findings that are not being challenged, state whether the person will remit payment no later than 60 calendar days after receipt of the final inspection report or seek a payment plan agreement; and(D) include a copy of the final inspection report.(5) Administrative hearing appeal. Upon timely receipt of a written request for appeal that meets the requirements in paragraph (4) of this subsection, the OIG notifies the HHSC Appeals Division of the person's hearing request. The appeal then proceeds pursuant to Chapter 357, Subchapter I of this title (relating to Hearings Under the Administrative Procedure Act).(g) Scope and effect. (1) A final inspection report becomes final and unappealable 30 calendar days after the person's receipt of the final inspection report, unless the OIG has received a timely and complete request for an appeal.(2) If the person has timely and completely requested an appeal, the contested amount of the overpayment becomes final 30 calendar days after the person receives written notice of the appeal results. Recovery of any overpayments at issue on appeal is not initiated until the appeal has been finally determined.(3) The effect of a final overpayment identified in a final inspection report is to create a final debt in favor of the State of Texas.(4) Failure to pay a delinquent debt may result in OIG collection efforts or enforcement action under this chapter.1 Tex. Admin. Code § 371.1721
Adopted by Texas Register, Volume 49, Number 51, December 20, 2024, TexReg 10331, eff. 12/26/2024