Tex. Codes » Human Resources Code · TITLE 2. HUMAN SERVICES AND PROTECTIVE SERVICES IN GENERAL · SUBTITLE C. ASSISTANCE PROGRAMS · CHAPTER 32. MEDICAL ASSISTANCE PROGRAM
Texas Codes

Tex. Hum. Res. Code § 32.0291 (2026)

Prepayment Reviews And Payment Holds

✓ current as of May 2026
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Sec. 32.0291. PREPAYMENT REVIEWS AND PAYMENT HOLDS. (a) Notwithstanding any other law, the commission may:

(1) perform a prepayment review of a claim for reimbursement under the medical assistance program to determine whether the claim involves fraud or abuse; and

(2) as necessary to perform that review, withhold payment of the claim for not more than five working days without notice to the person submitting the claim.

(b) Subject to Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544, Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.

(c) A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544, Government Code, including the notice requirements under Section 544.0302.

(d) Repealed by Acts 2013, 83rd Leg., R.S., Ch. 622, Sec. 6, eff. September 1, 2013.

Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.103, eff. Sept. 1, 2003.

Amended by:

Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 4, eff. September 1, 2013.

Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 5, eff. September 1, 2013.

Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 6, eff. September 1, 2013.

Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.101, eff. April 2, 2015.

Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.81, eff. April 1, 2025.

Notes of Decisions
Cited in 7 cases, 2014–2016 · leading case: Janek v. Harlingen Fam. Dentistry, P.C., 451 S.W.3d 97 (Tex. App. 2014).
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Janek v. Harlingen Fam. Dentistry, P.C., 451 S.W.3d 97 (Tex. App. 2014). · cites it 3× “Tex. Hum. Res.Code § 32.0291(b). In a SOAH hearing on a payment hold, HHSC must make a prima facie showing that the evidence relied on in imposing the hold is relevant, credible, and material to the issue of fraud or willful misrepresentation.”
Harlingen Fam. Dentistry, P.C. v. Texas Health & Human Servs. Comm'n, 452 S.W.3d 479 (Tex. App. 2014). “Laws 611 , 690 (emphasis added) (amended 2013) (current version at Tex. Hum. Res. Code § 32.0291(b)). The plain language of these statutes authorized HHSC to impose a payment hold if it had “reliable evidence that the provider has committed fraud or wilful misrepresentation” and…”
Texas Health & Human Servs. Comm'n & Off. of Inspector Gen. v. Antoine Dental Ctr., 487 S.W.3d 776 (Tex. App. 2016). · cites it 2× “Laws 611 , 690 (amended 2013) (current version at Tex. Hum. Res. Code § 32.0291(b)). On April 4, 2012, based on Evans’ report, the HHSC-OIG sent the Clinic a notice of payment hold on all future claims.”
Pharmserv, Inc. v. Texas Health & Human Servs. Comm'n Off. of the Inspector Gen. of the Texas Health & Human Servs. Comm'n Kyle Janek, in His Off. Capacity as Comm'r of Texas Health & Human Servs. Comm'n (Tex. App. 2015). · cites it 10× “12 See Former Tex. Hum. Res. Code § 32.0291; 1 Tex. Admin.”
Texas Health & Human Servs. Comm'n & Off. of Inspector Gen. v. Antoine Dental Ctr. (Tex. Crim. App. 2015). · cites it 7× “21 Tex. Hum. Res. Code § 32.0291(b).........”
Harlingen Fam. Dentistry, P.C. & Trueblood Dental Assocs., P.A. v. Texas Health & Human Servs. Comm'n & Off. of the Inspector Gen. (Tex. App. 2014). “Laws 611 , 690 (emphasis added) (amended 2013) (current version at Tex. Hum. Res. Code § 32.0291(b)). The plain language of these statutes authorized HHSC to impose a payment hold if it had “reliable evidence that the provider has committed fraud or wilful misrepresentation” and…”
Pharmserv, Inc. v. Texas Health & Human Servs. Comm'n Off. of the Inspector Gen. of the Texas Health & Human Servs. Comm'n Kyle Janek, in His Off. Capacity as Comm'r of Texas Health & Human Servs. Comm'n (Tex. App. 2015). “1203, and Section 16 (see yellow highlighting) 2 INDEX OF AUTHORITIES Statutes Tex. Hum. Res. Code §32.0291 ............”
— Tex. Hum. Res. Code § 32.0291(a)(1) — 1 case
Pharmserv, Inc. v. Texas Health & Human Servs. Comm'n Off. of the Inspector Gen. of the Texas Health & Human Servs. Comm'n Kyle Janek, in His Off. Capacity as Comm'r of Texas Health & Human Servs. Comm'n (Tex. App. 2015). “12 See Former Tex. Hum. Res. Code § 32.0291; 1 Tex. Admin.”
— Tex. Hum. Res. Code § 32.0291(b) — 6 cases
Harlingen Fam. Dentistry, P.C. v. Texas Health & Human Servs. Comm'n, 452 S.W.3d 479 (Tex. App. 2014). “Laws 611 , 690 (emphasis added) (amended 2013) (current version at Tex. Hum. Res. Code § 32.0291(b)). The plain language of these statutes authorized HHSC to impose a payment hold if it had “reliable evidence that the provider has committed fraud or wilful misrepresentation” and…”
Janek v. Harlingen Fam. Dentistry, P.C., 451 S.W.3d 97 (Tex. App. 2014). “Tex. Hum. Res.Code § 32.0291(b). In a SOAH hearing on a payment hold, HHSC must make a prima facie showing that the evidence relied on in imposing the hold is relevant, credible, and material to the issue of fraud or willful misrepresentation.”
Texas Health & Human Servs. Comm'n & Off. of Inspector Gen. v. Antoine Dental Ctr., 487 S.W.3d 776 (Tex. App. 2016). “Laws 611 , 690 (amended 2013) (current version at Tex. Hum. Res. Code § 32.0291(b)). On April 4, 2012, based on Evans’ report, the HHSC-OIG sent the Clinic a notice of payment hold on all future claims.”
Pharmserv, Inc. v. Texas Health & Human Servs. Comm'n Off. of the Inspector Gen. of the Texas Health & Human Servs. Comm'n Kyle Janek, in His Off. Capacity as Comm'r of Texas Health & Human Servs. Comm'n (Tex. App. 2015). “12 See Former Tex. Hum. Res. Code § 32.0291; 1 Tex. Admin.”
Texas Health & Human Servs. Comm'n & Off. of Inspector Gen. v. Antoine Dental Ctr. (Tex. Crim. App. 2015). “21 Tex. Hum. Res. Code § 32.0291(b).........”
— Tex. Hum. Res. Code § 32.0291(c) — 4 cases
Janek v. Harlingen Fam. Dentistry, P.C., 451 S.W.3d 97 (Tex. App. 2014). “Tex. Hum. Res.Code § 32.0291(b). In a SOAH hearing on a payment hold, HHSC must make a prima facie showing that the evidence relied on in imposing the hold is relevant, credible, and material to the issue of fraud or willful misrepresentation.”
Texas Health & Human Servs. Comm'n & Off. of Inspector Gen. v. Antoine Dental Ctr., 487 S.W.3d 776 (Tex. App. 2016). “Laws 611 , 690 (amended 2013) (current version at Tex. Hum. Res. Code § 32.0291(b)). On April 4, 2012, based on Evans’ report, the HHSC-OIG sent the Clinic a notice of payment hold on all future claims.”
Pharmserv, Inc. v. Texas Health & Human Servs. Comm'n Off. of the Inspector Gen. of the Texas Health & Human Servs. Comm'n Kyle Janek, in His Off. Capacity as Comm'r of Texas Health & Human Servs. Comm'n (Tex. App. 2015). “12 See Former Tex. Hum. Res. Code § 32.0291; 1 Tex. Admin.”
Texas Health & Human Servs. Comm'n & Off. of Inspector Gen. v. Antoine Dental Ctr. (Tex. Crim. App. 2015). “21 Tex. Hum. Res. Code § 32.0291(b).........”
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