BILL ANALYSIS
C.S.H.B. 1487
By: Counts (Montford)
Economic Development
05-18-95
Senate Committee Report (Substituted)
BACKGROUND
The 73rd Legislature, Regular Session, enacted Section 32.55, Penal
Code (Insurance Claim Fraud). The intention of Section 32.55 was
to counter the growing number and magnitude of accident insurance
fraud rings, which often included the involvement of unscrupulous
doctors, attorneys, physical therapists, runners, and law clerks
among the perpetrators. Section 32.55, however, was not included
in the revised Penal Code.
PURPOSE
As proposed, C.S.H.B. 1487 sets forth provisions relating to the
investigation, prosecution, and punishment of the offense of
insurance fraud.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not grant any
additional rulemaking authority to a state officer, institution, or
agency.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Title 7, Penal Code, by adding Chapter 35, as
follows:
CHAPTER 35. INSURANCE FRAUD
Sec. 35.01. DEFINITIONS. Defines "health care goods,"
"health care provider," "health care service," "insurer," and
"statement."
Sec. 35.02. INSURANCE FRAUD. (a) Provides that a person
commits an offense if, with intent to defraud or deceive an
insurer, the person causes to be prepared or presents to an
insurer in support of a claim for payment under a health or
property and casualty insurance policy a statement that the
person knows contains false or misleading information
concerning a matter that is material to the claim, and the
matter affects a person's right to a payment or the amount of
payment to which a person is entitled.
(b) Provides that a person commits an offense if, with
intent to defraud or deceive an insurer, the person
solicits, offers, pays, or receives a benefit in connection
with the furnishing of health care goods or services for
which a claim payment is submitted under a health or
property and casualty insurance policy.
(c) Provides that information concerning a matter that is
material to a claim for payment under an insurance policy
includes certain information.
(d) Sets forth a staggered schedule of offenses contingent
on the dollar amount of the fraudulent claim.
Sec. 35.03. AGGREGATION AND MULTIPLE OFFENSES. (a)
Authorizes the conduct to be considered as one offense and the
value of the claim aggregated in determining the
classification of the offense when separate claims in
violation of this chapter are communicated to an insurer or
group of insurers pursuant to one scheme or continuing course
of conduct. Prohibits Subsection (b) from applying if claims
are aggregated under this subsection.
(b) Authorizes the conduct to be considered as one offense
when three or more separate claims in violation of this
chapter are communicated to an insurer or group of insurers
pursuant to one scheme or continuing course of conduct.
Requires the classification of the offense to be one
category higher than the most serious single offense proven
from the separate claims, except that if the most serious
offense is a first degree felony, the offense is a first
degree felony. Prohibits this subsection from being applied
if claims are aggregated under Subsection (a).
Sec. 35.04. JURISDICTION OF ATTORNEY GENERAL. (a) Authorizes
the attorney general to offer to an attorney representing the
state in the prosecution of an offense under Section 35.02 the
investigative, technical, and litigation assistance of the
attorney general's office.
(b) Authorizes the attorney general to prosecute or assist
in the prosecution of an offense under Section 35.02 on
request of the attorney representing the state.
SECTION 2. Amends Article 2.12, Code of Criminal Procedure, to
provide that officers commissioned under the Texas High-Speed Rail
Act (Article 6674v.2, V.T.C.S.), and an investigator commissioned
by the commissioner of insurance (commissioner) under Article
1.10D, Insurance Code, are peace officers.
SECTION 3. Amends Article 59.01(2), Code of Criminal Procedure, to
redefine "contraband."
SECTION 4. Amends Section 2, Article 1.10D, Insurance Code, by
amending Subsections (b) and (e), and adding Subsections (f) and
(g), as follows:
(b) Authorizes the commissioner to make any necessary
investigation if the commissioner has reason to believe that
any person has engaged in or is engaging in an act or practice
that may constitute either a fraudulent insurance act, as
defined by Section 1(a)(2) of this article, or insurance fraud
under Section 35.02(a), Penal Code, or has committed or is
about to commit a fraudulent insurance act or insurance fraud.
Deletes a provision regarding allegations of fraud on the part
of a policyholder or claimant.
(e) Makes a conforming change.
(f) Authorizes the commissioner to employ investigators as the
commissioner considers necessary to enforce this article, and
to commission those investigators as peace officers. Requires
an investigator employed by the Texas Department of Insurance
(department) as a peace officer to meet the requirements for
peace officers imposed under Chapter 415, Government Code.
Requires the commissioner, if the commissioner elects to
commission peace officers, to appoint a chief investigator who
is commissioned as a peace officer and who is qualified by
training and experience in law enforcement to supervise,
direct, and administer the activities of the commissioned
investigators.
(g) Authorizes an investigator employed by the department to
request the assistance of local law enforcement officers in
conducting an investigation authorized by this article.
SECTION 5. Amends Section 1B(d), Article 6701h, V.T.C.S. (Texas
Motor Vehicle Safety-Responsibility Act), to make a nonsubstantive
change.
SECTION 6. Makes application of this Act prospective.
SECTION 7. Effective date: September 1, 1995.
SECTION 8. Emergency clause.