Recoupment of Overpayments

Recoupment is required if the results of a utilization review indicate overpayment for services delivered, payment made for services not delivered, or payment made for services provided without preauthorization. The appropriate agency or agency designee notifies the provider in writing about the overpayment identified and explains the method of recoupment to be used.

Administrative Actions and Sanctions

The administrative actions or sanctions form a utilization review may result in one or more of the following being taken by the agency or agency's designee:

  1. Closure of the review with written notification to the provider.
  2. Discussion and interpretation of results of the review with the provider.
  3. Referral to the appropriate state licensing board or the Texas Office of the Inspector General.
  4. Any other remedies authorized by rule, regulation, statute, or contract.