About Texas HHSC OIG Exclusion Program

The Texas Health & Human Services Commissions (Commission) Office of Inspector General (OIG) works diligently to protect the health and welfare of Texas Medicaid and other HHS programs beneficiaries by preventing the participation of certain individuals and businesses. The OIG excludes individuals and entities affected by various legal authorities. A listing of all currently excluded parties is maintained by OIG and is called the List of Excluded Individuals/Entities by Texas OIG.

Bases for exclusion include convictions for program-related fraud and patient abuse, licensing board actions, U.S. Health & Human Services OIG (Medicare) exclusion actions, and "Permissive" exclusions as allowed by various legal authorities.

It is each provider's or person's responsibility to ensure that items or services furnished personally by, at the medical direction of, or on the prescription or order of an excluded person are not billed to the Titles V (Maternal and Child Health Services), XIX (Medicaid), XX (Block Grants for Social Services), and/or other HHS programs after the effective date of exclusion. This section applies regardless of whether an excluded person has obtained a program provider number or equivalent, either as an individual or as a member of a group, prior to being reinstated.

The effect of exclusion1 from Medicaid, Title V, and Title XX and other HHS programs is as follows:

• No payment will be made by these programs for any item or service furnished by the exclude person on or after the effective date of exclusion;
• The excluded person must neither personally nor through a clinic, group, corporation, or other association or entity, bill or otherwise request or receive payment for any Title V, XIX, or XX, or other HHS programs for items or services provided on or after the effective date of the exclusion. Exclusion also prevents the excluded person from providing any services pursuant to the Medicaid program, whether or not you directly request Medicaid program payment for such services;
• The excluded person must not assess care or order or prescribe services, directly or indirectly, to Title V, XIX, or XX, or other HHS programs recipients after the effective date of exclusion. A clinic, group, corporation, or other association or entity must not submit claims for any assessments, services or items provided by a person within such organization or entity who is excluded from participation, unless the services or supplies were provided before the effective date of exclusion;
• An entity that employs or otherwise associates with a person excluded from participation in Titles V, XIX, or XX, other HHS programs must not include within a cost report or any documents used to determine an individual payment rate, a statewide payment rate or a fee, the salary, fringe benefits, overhead, or any other costs associated with the person excluded;
• An order or prescription written before the exclusion effective date is valid for the duration of the order or prescription; and
• An order or prescription written before the exclusion effective date is valid for the duration of the order or prescription; and
• If, after the effective date of an exclusion, claims are submitted or are cause to be submitted for services or items furnished within the period of exclusion, administrative damages and/or penalties may be imposed.2

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Contact

To request contact with Sanctions Staff you may call the Texas Health & Human Services Commission, Office of Inspector General's main telephone number at:

Telephone Number:
(512) 491-2000

Fax Number:
(512) 491-2009

Mailing Address:
Texas Health & Human Services Commission
Office of Inspector General Sanctions Section: MC 1358
P.O. Box 85200
Austin, TX 78708-5200

To Obtain Documentation on Excluded Individuals or Entities:

If you have verified the identity of an excluded party and are seeking documentation of this action, you may submit a written request to the address listed above. Your request should include a copy of the LEIE page identifying the individual or entity. Requests without this information from the LEIE will be returned. In most instances, the only documentation available will be the exclusion notice, which notifies the party of the exclusion, its effect and information concerning appeal rights. It does not contain specific details regarding the basis for the exclusion. We recommend contacting an excluded individual or entity for additional information concerning any of these actions.