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Senate Bill 563 |
Senate Author: Janek |
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Effective: 9-1-05 |
House Sponsor: Delisi |
Senate Bill 563 amends provisions of the Human Resources Code, Government Code, Penal Code, and Civil Practice and Remedies Code relating to the prevention of Medicaid fraud and establishes several criminal offenses ranging from a Class C misdemeanor to a first degree felony for actions that constitute Medicaid fraud. The bill broadens the definition of "provider" to include a manufacturer or distributor of a product for which the Medicaid program provides reimbursement, defines what constitutes a culpable mental state with respect to a person acting "knowingly" in committing certain unlawful acts and amends provisions related to conduct that constitutes those acts, and includes provisions relating to prohibitions against the release and disclosure of certain information and documentary material by the office of the attorney general. Senate Bill 563 authorizes the executive commissioner of the Health and Human Services Commission (HHSC) to grant an exemption to the 10-year period of ineligibility for a provider under the Medicaid program found liable for an unlawful act if enforcing the period of ineligibility is found to be harmful to the program or a beneficiary of the program and extends the period by which the state may elect to intervene and proceed with respect to certain action filed by a private person. The bill requires HHSC to implement the Medicaid fraud reduction pilot program statewide if it is determined to be cost‑effective and to adopt a plan for the implementation to be phased in.