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3.2.6 Suspected Cases of Provider Fraud and Abuse
HHSC is responsible for minimizing the opportunity for provider fraud and abuse. HHSC takes appropriate action to protect clients and the CSHCN Services Program when providers of services are suspected of committing fraud or abuse. HHSC is responsible for establishing criteria to identify cases of possible fraud and abuse and recouping all overpayments to a provider. Some circumstances may result in referring a provider for legal evaluation and possible prosecution while other circumstances may result in administrative sanctions.
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