1-1 By: Harris of Tarrant, Moncrief, Zaffirini S.B. No. 208
1-2 (In the Senate - Filed January 29, 1993; February 1, 1993,
1-3 read first time and referred to Committee on Economic Development;
1-4 March 16, 1993, rereferred to Committee on Health and Human
1-5 Services; March 18, 1993, reported favorably, as amended, by the
1-6 following vote: Yeas 8, Nays 0; March 18, 1993, sent to printer.)
1-7 COMMITTEE VOTE
1-8 Yea Nay PNV Absent
1-9 Zaffirini x
1-10 Ellis x
1-11 Madla x
1-12 Moncrief x
1-13 Nelson x
1-14 Patterson x
1-15 Shelley x
1-16 Truan x
1-17 Wentworth x
1-18 COMMITTEE AMENDMENT NO. 1 By: Moncrief
1-19 Amend S.B. 208 in Section 1, in Subsection (a), Section
1-20 32.55, Penal Code (page 1, line 32), strike "an insurance policy"
1-21 and substitute "a health insurance policy."
1-22 A BILL TO BE ENTITLED
1-23 AN ACT
1-24 relating to the offense of insurance claim fraud; providing a
1-25 criminal penalty.
1-26 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-27 SECTION 1. Subchapter D, Chapter 32, Penal Code, is amended
1-28 by adding Section 32.55 to read as follows:
1-29 Sec. 32.55. INSURANCE CLAIM FRAUD. (a) A person commits an
1-30 offense if the person, with intent to injure, defraud, or deceive
1-31 an insurer, prepares or presents to an insurer in support of a
1-32 claim for payment under an insurance policy a statement that the
1-33 person knows:
1-34 (1) contains false or misleading information
1-35 concerning a matter that is material to the claim; or
1-36 (2) conceals or fails to disclose a material fact that
1-37 affects:
1-38 (A) a person's right to a payment; or
1-39 (B) the amount of a payment to which a person is
1-40 entitled.
1-41 (b) A person commits an offense if the person, with the
1-42 intent to injure, defraud, or deceive an insurer, solicits, offers,
1-43 pays, or receives a benefit in connection with the furnishing of
1-44 health care goods or services for which payment is sought under an
1-45 insurance policy.
1-46 (c) For the purposes of Subsection (a) of this section,
1-47 information concerning a matter that is material to a claim for
1-48 payment under an insurance policy includes information concerning:
1-49 (1) whether health care goods or services were
1-50 medically necessary under professionally accepted standards;
1-51 (2) whether health care goods or services were
1-52 provided;
1-53 (3) the nature of the health care goods or services
1-54 provided;
1-55 (4) the date on which health care goods or services
1-56 were provided;
1-57 (5) the medical record of goods or services provided;
1-58 (6) the condition treated or diagnosis made; or
1-59 (7) the identity of the provider or the recipient of
1-60 health care goods or services.
1-61 (d) Except as provided by Subsection (e) of this section, an
1-62 offense under this section is:
1-63 (1) a Class C misdemeanor if the value of the claim is
1-64 less than $20;
1-65 (2) a Class B misdemeanor if:
1-66 (A) the value of the claim is $20 or more but
1-67 less than $200; or
1-68 (B) the value of the claim is less than $20 and
2-1 the actor has been previously convicted of a misdemeanor under this
2-2 section;
2-3 (3) a Class A misdemeanor if the value of the claim is
2-4 $200 or more but less than $750;
2-5 (4) a felony of the third degree if:
2-6 (A) the value of the claim is $750 or more but
2-7 less than $20,000; or
2-8 (B) the value of the claim is less than $750 and
2-9 the actor has been previously convicted of a misdemeanor two or
2-10 more times under this section;
2-11 (5) a felony of the second degree if the value of the
2-12 claim is $20,000 or more but less than $100,000; or
2-13 (6) a felony of the first degree if:
2-14 (A) the value of the claim is $100,000 or more;
2-15 (B) the value of the claim is less than $100,000
2-16 and the actor has been previously convicted of a felony under this
2-17 section; or
2-18 (C) the value of the claim is less than $100,000
2-19 and the commission of the offense placed a person at risk of death
2-20 or serious bodily injury.
2-21 (e) An offense under this section is, if the actor is a
2-22 health care practitioner:
2-23 (1) a felony of the third degree if the value of the
2-24 claim is less than $20,000;
2-25 (2) a felony of the second degree if the value of the
2-26 claim is $20,000 or more but less than $100,000; or
2-27 (3) a felony of the first degree if:
2-28 (A) the value of the claim is $100,000 or more;
2-29 (B) the value of the claim is less than $100,000
2-30 and the actor has been previously convicted of an offense under
2-31 this section; or
2-32 (C) the value of the claim is less than $100,000
2-33 and the commission of the offense placed a person at risk of death
2-34 or serious bodily injury.
2-35 (f) In this section:
2-36 (1) "Insurer" means any person who does business as an
2-37 insurer in this state, including an insurer that is not authorized
2-38 to do business in this state. The term includes a health
2-39 maintenance organization, a company subject to Chapter 20,
2-40 Insurance Code, and an organization that is self-insured and that
2-41 provides health care benefits to its employees.
2-42 (2) "Health care practitioner" means a person who
2-43 renders or causes to be rendered health care or mental health care
2-44 services and who is entitled to payment under a health insurance
2-45 policy. The term includes:
2-46 (A) any person who may be selected by an insured
2-47 or a beneficiary under Article 21.52, Insurance Code; and
2-48 (B) an officer, employee, or agent of an
2-49 organization that renders health care or mental health care
2-50 services.
2-51 (3) "Statement" means any written representation of
2-52 fact, including a notice, proof of loss, bill of lading, receipt
2-53 for payment, invoice, account, estimate of property damages, bill
2-54 for services, diagnosis, prescription, medical record, X-ray, test
2-55 result, or other evidence of loss, injury, or expense. A statement
2-56 may be computer-generated.
2-57 SECTION 2. The change in law made by Section 32.55, Penal
2-58 Code, as added by this Act, applies only to the punishment for an
2-59 offense committed on or after the effective date of this Act. For
2-60 the purpose of this section, an offense is committed before the
2-61 effective date of this Act if any element of the offense occurs
2-62 before the effective date. An offense committed before the
2-63 effective date of this Act is covered by the law in effect when the
2-64 offense was committed, and the former law is continued in effect
2-65 for this purpose.
2-66 SECTION 3. This Act takes effect September 1, 1993.
2-67 SECTION 4. The importance of this legislation and the
2-68 crowded condition of the calendars in both houses create an
2-69 emergency and an imperative public necessity that the
2-70 constitutional rule requiring bills to be read on three several
3-1 days in each house be suspended, and this rule is hereby suspended.
3-2 * * * * *
3-3 Austin,
3-4 Texas
3-5 March 18, 1993
3-6 Hon. Bob Bullock
3-7 President of the Senate
3-8 Sir:
3-9 We, your Committee on Health and Human Services to which was
3-10 referred S.B. No. 208, have had the same under consideration, and I
3-11 am instructed to report it back to the Senate with the
3-12 recommendation that it do pass, as amended, and be printed.
3-13 Zaffirini,
3-14 Chairman
3-15 * * * * *
3-16 WITNESSES
3-17 FOR AGAINST ON
3-18 ___________________________________________________________________
3-19 Name: Dan Morales x
3-20 Representing: State of Texas
3-21 City: Austin
3-22 -------------------------------------------------------------------
3-23 Name: Dr. Charles Arnold x
3-24 Representing: Self
3-25 City: San Antonio
3-26 -------------------------------------------------------------------
3-27 Name: David F. Briones, M.D. x
3-28 Representing: TSPP & TMA
3-29 City: El Paso
3-30 -------------------------------------------------------------------
3-31 Name: Ben Marroquin x
3-32 Representing: MHMR
3-33 City: Austin
3-34 -------------------------------------------------------------------
3-35 Name: Joe Woods x
3-36 Representing: State Bd of Insurance
3-37 City: Austin
3-38 -------------------------------------------------------------------
3-39 Name: Rhonda Myron x
3-40 Representing: Tx Dept of Insurance
3-41 City: Austin
3-42 -------------------------------------------------------------------
3-43 Name: Caroline Scott x
3-44 Representing: Tx Dept of Insurance
3-45 City: Austin
3-46 -------------------------------------------------------------------
3-47 Name: Kevin O'Hanlon x
3-48 Representing: TEA
3-49 City: Austin
3-50 -------------------------------------------------------------------