New Payment Hold and Overpayment Procedures

The OIG procedures for payment holds and overpayments are based on Senate Bill 207, 84th Regular Session, which took effect September 1, 2015.

A "payment hold" means the temporary denial of reimbursement under the Medicaid program for items or services furnished by a specified provider. The OIG imposes this administrative sanction in order to compel the production of records or when the OIG determines that a credible allegation of fraud exists.

For purposes of a payment hold, a “credible allegation of fraud” is an allegation of fraud that the OIG verifies has indicia of reliability after reviewing all allegations, facts and evidence. In addition, the OIG must determine that continuing to pay the provider would present an ongoing significant financial risk to the state and a threat to the integrity of the Medicaid program.

For more details on the payment hold process, please watch this video.