SHARS providers must maintain and retain documentation and claims to fully document the services and supplies provided and delivered to a student with Texas Medicaid coverage. These documents and claims must be retained for the cessation of service plus seven years or until all audit questions, hearings, investigations, or court cases are resolved. The provider must be sure the requesting agency has given clear indication of the audit’s conclusion prior to releasing records from retention.
These records must be made available immediately at the time of the request by the HHSC OIG, the Office of the Attorney General (OAG) Medicaid Fraud Control Unit (MFCU) or Antitrust and Civil Medicaid Fraud Section, TMHP, DFPS, HHSC, DSHS, Texas Workforce Commission (TWC), U.S. Department of Health and Human Services (HHS), and any state or federal agency authorized to conduct compliance, regulatory, or program integrity functions on SHARS providers and services.
A copy of the claim without additional documentation will not meet this requirement. Unless a copy is acceptable to the requester, the provider is required to submit original documents. Requested records must be provided promptly and at no cost to the state or federal agency. The provider must provide immediate access to the provider’s premises and records for purposes of reviewing, examining, and securing custody of records, documents, electronic data, equipment, or other requested items, as determined necessary by the requestor.
Nothing in Medicaid policies will limit access otherwise authorized under state or federal law. If, in the opinion of the requestor, the documents are not provided as requested or the requestor suspects the documents may be altered or destroyed, this failure to comply may result in a payment hold on the provider’s Medicaid payments, recoupment of payments for all claims related to the missing records, contract cancellation, and/or exclusion from Texas Medicaid. If the provider places the required information in another entity’s records, such as a vendor, the provider is responsible for obtaining a copy of these requested records for use by the requesting state and federal agencies.
This Medicaid policy can be viewed in its entirety at: Texas Medicaid Providers Procedure Manual (TMPPM) Provider Responsibilities, January 2022 (1.7.3).