SRC-CDH C.S.S.B. 30 75(R)BILL ANALYSIS
Senate Research CenterC.S.S.B. 30
By: Zaffirini
Health & Human Services
4-4-97
Committee Report (Substituted)
DIGEST
Texas spent more than $7.3 billion for Medicaid services and $1.3 billion
on financial assistance and food stamp programs in fiscal year 1995, yet
fraud may account for as much as 10 percent of all Medicaid, financial
assistance, and food stamp claims. Even if Texas loses only a fraction of
this amount to fraud, the loss represents a serious, ongoing drain of
public resources. Successful fraud control efforts demand strong referral
and detection programs, an effective investigative function, and
appropriate punishments.
This legislation provides a package of reforms intended to improve the
state's ability to combat fraudulent acts committed against publicly
funded programs. This bill will centralize and streamline fraud referral,
investigation, and prosecution efforts under the Health and Human Services
Commission's newly-created Office of Investigations and Enforcement;
ensure appropriate use of Medicaid-funded services and equipment; tighten
provider enrollment processes through the use of background checks and
on-site inspections; require health and human services agencies to use
advanced fraud-detection technologies based on the success of the
comptroller's Medicaid Fraud Detection project; add a state qui tam cause
of action to prosecute fraudulent Medicaid providers; provide additional
controls for fraud and abuse in Medicaid managed care; and enact stiffer
penalties for fraud, especially for those acts of fraud that harm
children.
PURPOSE
As proposed, C.S.S.B. 30 establishes fraud and improper payments under the
state Medicaid program and other welfare programs, creates a private cause
of action for false claims for certain government payments, and creates a
criminal offense while providing penalties.
RULEMAKING AUTHORITY
Rulemaking authority is granted to the Department of Human Services in
SECTIONS 1.01, 2.012.04, 3.01, 3.02, and 5.01 (Sections 22.0254(c),
32.024(t), 32.024(u), 32.0321(a), 32.0322(b), 32.039(u) and (v),
32.046(a), and 23.016, Human Resources Code); to the Health and Human
Services Commission (HHSC) in SECTION 1.05 (Section 531.047(a), Government
Code) and SECTION 2.06(a); to the secretary of state in SECTION 1.07(c);
to HHSC and each agency operating part of the state Medicaid program in
SECTION 2.07(c); and to the board of a state agency that operates part of
the Medicaid program in SECTION 4.06 (Section 36.005(b), Human Resources
Code) of this bill.
SECTION BY SECTION ANALYSIS
ARTICLE 1. GENERAL PROVISIONS RELATING TO WELFARE AGENCIES
SECTION 1.01. COLLECTION OF FOOD STAMP AND FINANCIAL ASSISTANCE PAYMENTS
MADE IN ERROR. (a) Amends Chapter 22, Human Resources Code, by adding
Sections 22.0251-22.0252, as follows:
Sec. 22.0251. TIMELY DETERMINATION OF OVERPAYMENTS. Requires the Texas
Department of Human Services (department), subject to the approval of the
commissioner of health and human services (commissioner), to record the
time taken to discover an error in making a grant; set progressive goals
for reducing the discovery time; and adopt a schedule to meet the goals
set. Sets forth the terms under which the department is required to
submit a progress report.
Sec. 22.0252. TELEPHONE COLLECTION PROGRAM. Sets forth the terms by
which the department is required to use the telephone to collect
reimbursement from a person who receives a benefit granted in error, and
submit a semiannual report.
Sec. 22.0253. PARTICIPATION IN FEDERAL TAX REFUND OFFSET PROGRAM.
Requires the department to participate in the Federal Tax Refund Offset
Program to attempt to recover benefits granted in error, and submit as
many claims as possible for offset against income tax returns.
Sec. 22.0254. PROSECUTION OF FRAUDULENT CLAIMS. Requires the department
to keep a record of the dispositions of referrals made by the department
to a district attorney concerning fraudulent claims for benefits. Sets
forth the terms by which the department is required to obtain status
information on each major fraudulent claim; request a written explanation
for each case referred in which the district attorney declines to
prosecute; and encourage the creation of a special welfare fraud unit in
each district attorney's office. Authorizes the department, by rule, to
define what constitutes a major fraudulent claim.
(b) Amends Chapter 22, Human Resources Code, by adding Section 22.0291,
as follows:
Sec. 22.0291. INFORMATION MATCHING SYSTEM RELATING TO IMMIGRANTS AND
FOREIGN VISITORS. Sets forth the terms by which the department is
required to use a computerized matching system relating to immigrants and
foreign visitors for the purpose of preventing individuals from unlawfully
receiving benefits administered by the department. Sets forth the terms
by which the department is authorized to enter into an agreement with the
Department of State of the United States and the United States Department
of Justice as necessary to implement this section, and by which the
department and federal agencies are required to protect the
confidentiality of shared information. Requires the department to submit
a semiannual report.
(c) Requires the department to begin operation of the telephone
collection program not later than January 1, 1998.
(d) Requires the department to submit the initial reports required by
Sections 22.0251(b) and 22.0291(e), Human Resources Code, not later than
January 1, 1998.
(e) Requires the department to submit the initial report required by
Section 22.0252(b), Human Resources Code, not later than September 1,
1998.
SECTION 1.02. USE OF EARNED FEDERAL FUNDS. Amends Chapter 22, Human
Resources Code, by adding Section 22.032, as follows:
Sec. 22.032. USE OF EARNED FEDERAL FUNDS. Authorizes the department,
subject to the General Appropriations Act, to use earned federal funds
derived from recovery of amounts paid or benefits granted by the
department as a result of fraud to pay the costs of the department's
activities relating to preventing fraud.
SECTION 1.03. PAYMENT OF MEDICAID CLAIMS. (a) Amends Chapter 32B, Human
Resources Code, by adding Sections 32.043 and 32.044, as follows:
Sec. 32.043. DUAL MEDICAID AND MEDICARE COVERAGE. Requires the
department to identify each individual receiving dual Medicaid and
Medicare coverage, and to analyze claims to ensure that payment is sought
first under the Medicare program to the extent allowed by law.
Sec. 32.044. MISDIRECTED BILLING. Requires the department to develop a
procedure for matching claims to determine alternative responsibility for
payment and ensuring that the appropriate entity bears the cost.
(b) Provides that this section takes effect on the first date that it may
take effect under Section 39, Article III, Texas Constitution.
SECTION 1.04. ENHANCED MEDICAID REIMBURSEMENT. (a) Amends Chapter 32B,
Human Resources Code, by adding Section 32.045, as follows:
Sec. 32.045. ENHANCED REIMBURSEMENT. Requires the department to develop
a procedure for identifying each service provided under the medical
assistance program for which the state is eligible to receive enhanced
reimbursement of costs from the federal government and ensuring that the
state seeks the highest level of federal reimbursement available.
(b) Requires the Texas Department of Health (TDH) to identify and seek
reimbursement for all services provided under the state Medicaid program
for a certain period for which the state was eligible but did not receive
enhanced reimbursement of costs at a certain rate.
(c) Makes a conforming change.
SECTION 1.05. MINIMUM COLLECTION GOAL. (a) Amends Chapter 531B,
Government Code, by adding Section 531.047, as follows:
Sec. 531.047. MINIMUM COLLECTION GOAL. Requires HHSC, by rule, to set a
minimum goal for the department specifying the amount of benefits granted
in error that the department should recover. Sets forth the terms by
which the comptroller, if the department fails to meet the goal set under
Subsection (a), is required to reduce the department's general revenue
appropriations by a certain amount. Requires HHSC, the governor, and the
Legislative Budget Board to monitor the department's performance, and
requires the department to cooperate by providing information on request.
(b) Makes a conforming change.
SECTION 1.06. COMMISSION POWERS AND DUTIES RELATING TO WELFARE FRAUD. (a)
Amends Chapter 531, Government Code, by adding Subchapter C, as follows:
SUBCHAPTER C. MEDICAID AND OTHER WELFARE FRAUD, ABUSE, OR OVERCHARGES
Sec. 531.101. AWARD FOR REPORTING MEDICAID FRAUD, ABUSE, OR OVERCHARGES.
Sets forth the terms by which HHSC is authorized to grant an award to an
individual who reports activity constituting fraud, abuse of funds, or
overcharges; and determine the amount of an award. Provides that an
award under this section is subject to appropriation. Sets forth the
procedure for payment of, and appropriation of money for, an award.
Sec. 531.102. INVESTIGATIONS AND ENFORCEMENT OFFICE. Sets forth the
terms by which HHSC, through the office of investigations and enforcement,
is responsible for the investigation of fraud and the enforcement of state
law relating to the provision of health and human services. Requires HHSC
to set certain objectives, priorities, and performance standards for the
office; and train office staff to enable pursuit of priority Medicaid and
welfare fraud and abuse cases. Authorizes HHSC to require employees of
health and human services agencies to provide assistance to HHSC regarding
the investigation of fraud.
Sec. 531.103. INTERAGENCY COORDINATION. Establishes the conditions under
which HHSC and the office of the attorney general are required to enter
into a memorandum of understanding to implement procedures for processing
cases of suspected fraud, waste, or abuse; and jointly prepare and submit
a semiannual report. Provides that an exchange of information under this
section does not affect whether the information is subject to disclosure
under Chapter 552, Government Code.
Sec. 531.104. ASSISTING INVESTIGATIONS BY ATTORNEY GENERAL. Sets forth
the terms by which HHSC and the attorney general are required to execute a
memorandum of understanding under which HHSC shall provide investigative
support to the attorney general.
Sec. 531.105. FRAUD DETECTION TRAINING. Establishes the conditions by
which HHSC is required to implement a program to provide annual training
in identifying cases of fraud, waste, or abuse. Requires TDH and the
department, in cooperation with HHSC, to periodically set a goal of the
number of cases that each agency will attempt to identify and refer to
HHSC. Requires HHSC to include goal-related information in the report.
Sec. 531.106. LEARNING OR NEURAL NETWORK TECHNOLOGY. Requires HHSC to
use learning or neural network technology to identify and deter fraud;
contract with a private or public entity to develop and implement the
technology; require certain health and human services agencies to
participate; maintain all information necessary to apply the technology to
claims data covering a two-year period; and refer cases identified by the
technology to the appropriate office. Authorizes the commission to
require the entity it contracts with to install and operate the technology
at certain locations. Requires the data used for neural network
processing to be maintained as an independent subset for security
purposes.
Sec. 531.107. MEDICAID AND PUBLIC ASSISTANCE FRAUD OVERSIGHT TASK FORCE.
Provides that the Medicaid and Public Assistance Fraud Oversight Task
Force assists HHSC and the office of investigations and enforcement in
improving the efficiency of fraud investigations and collections. Sets
forth the composition, presiding officer, and meeting times of the task
force. Sets forth the compensation for a member's service on the task
force. Establishes the conditions under which the commission's office of
investigations and enforcement is required to provide certain information
to the task force.
Sec. 531.108. FRAUD PREVENTION. Requires the office of investigations
and enforcement to compile and disseminate accurate information and
statistics relating to fraud prevention and certain post-fraud referrals.
Sets forth the terms by which HHSC is required to publicize successful
fraud prosecutions; ensure the maintenance and promotion of a toll-free
hotline; develop a cost-effective method of identifying applicants for
public assistance in certain areas; verify automobile information used as
eligibility criteria; establish a computerized matching system to prevent
an incarcerated individual from illegally receiving benefits; and submit a
semiannual report.
Sec. 531.109. DISPOSITION OF FUNDS. Sets forth the disposition of funds
under this subchapter.
(b) Amends Section 22.028(c), Human Resources Code, to make a conforming
change.
(c) Sets forth the terms under which Section 531.104, Government Code,
takes effect.
(d) Sets forth the terms by which HHSC is required to award the contract
for the learning or neural network technology, and by which the contractor
is required to begin operations. Sets forth the terms by which the
commissioner is required to enter into an interagency agreement and
execute a memorandum of understanding with the comptroller.
(e) Requires HHSC to submit the initial report required by Section
531.108(e) not later than April 1, 1998.
(f) Provides that this article, in adding Section 531.101, Government
Code, conforms to a change in law made by Section 1, Chapter 444, Acts of
the 74th Legislature, Regular Session, 1995.
(g) Repealer: Section 16G, Article 4413(502), V.T.C.S., as added by
Section 1, Chapter 444, Acts of the 74th Legislature, Regular Session,
1997.
(h) Sets forth the terms by which this Act prevails over another Act of
the 75th Legislature.
(i) Repealer: Section 21.0145, Human Resources Code (Public Assistance
Fraud Oversight Task Force) and Section 22.027, Human Resources Code
(Fraud Prevention).
(j) Makes a conforming change.
SECTION 1.07. CONSOLIDATION OF STAFF. Sets forth the terms by which the
powers, duties, programs, funds, contracts, records, employees, and rules
or forms adopted by the department's utilization and assessment review
function or TDH's claims review and analysis group and policy and data
analysis group are transferred to HHSC. Provides that the secretary of
state is authorized to adopt rules as necessary to expedite the
implementation of this subsection. Makes application of this Act
prospective regarding the consolidation of investigations staff. Makes a
conforming change.
SECTION 1.08. USE OF PRIVATE COLLECTION AGENTS. Sets forth the terms
under which the department, with assistance from the Council on
Competitive Government, and subject to approval by the attorney general,
is required to use private collections agents to collect reimbursements
for benefits granted in error, and submit a progress and final report.
Requires the department, if approved by the attorney general, to ensure
that the collection agents are engaged in work not later than March 1,
1998.
SECTION 1.09. EXPEDITED FOOD STAMP DELIVERY; IMPACT ON FRAUDULENT CLAIMS.
Establishes the conditions by which the department is required to conduct
a study to determine the impact of one-day screening and service delivery
requirements on the level of fraud in the food stamp program, and submit a
report.
SECTION 1.10. STUDY ON COLLECTION OF ERRONEOUS FOOD STAMP OR FINANCIAL
ASSISTANCE BENEFITS THROUGH LIENS OR WAGE GARNISHMENT. Sets forth the
terms by which the department is required to conduct a study on collection
of erroneous food stamp or financial assistance benefits through liens or
wage garnishment, and submit a report.
SECTION 1.11. OPERATION RESTORE TRUST. Requires HHSC and the office of
the attorney general to cooperate with entities in other state
participating in "Operation Restore Trust" and share information. Defines
"Operation Restore Trust."
ARTICLE 2. MEDICAID SERVICE PROVIDERS
SECTION 2.01. AUTHORIZATION FOR AMBULANCE SERVICES. Amends Section
32.024, Human Resources Code, by adding Subsection (t), to establish the
conditions under which the department, by rule, is required to require a
physician, nursing facility, or other health care provider to obtain
authorization for non-emergency ambulance services. Requires HHSC and
each appropriate health and human services agency to adopt these rules not
later than January 1, 1998. Makes conforming changes.
SECTION 2.02. DURABLE MEDICAL EQUIPMENT. Amends Section 32.024, Human
Resources Code, by adding Subsection (u), to require the department, by
rule, to require a health care provider who arranges for durable medical
equipment for a child who receives medical assistance to ensure that the
child received the proper equipment, the equipment fit properly, the child
or the child's parent or guardian received the proper instruction; and to
make a notation in the child's medical records of the date on which the
requirements of Subdivision (1) are met. Requires HHSC and each
appropriate health and human services agency to adopt these rules not
later than January 1, 1998. Makes a conforming change.
SECTION 2.03. SURETY BOND. Amends Chapter 32B, Human Resources Code, by
adding Section 32.0321, as follows:
Sec. 32.0321. SURETY BOND. Authorizes the department, by rule, to
require each provider of medical assistance in a provider type that has
demonstrated significant potential for fraud or abuse to file a surety
bond.
SECTION 2.04. CRIMINAL HISTORY INFORMATION. (a) Amends Chapter 32B,
Human Resources Code, by adding Section 32.0322, as follows:
Sec. 32.0322. CRIMINAL HISTORY RECORD INFORMATION. Authorizes the
department to obtain the criminal history record information relating to a
provider or a person applying to enroll as a provider. Requires the
department, by rule, to establish criteria for revoking a provider's
enrollment or denying a person's application to enroll as a provider.
(b) Amends Chapter 411F, Government Code, by adding Section 411.132, as
follows:
Sec. 411.132. ACCESS TO CRIMINAL HISTORY RECORD INFORMATION; AGENCIES
OPERATING PART OF MEDICAL ASSISTANCE PROGRAM. Provides that HHSC or an
agency operating part of the medical assistance program is entitled to
obtain criminal history record information relating to a provider or a
person applying to enroll as a provider. Prohibits such information from
being released or disclosed except in certain circumstances.
SECTION 2.05. MANAGED CARE ORGANIZATIONS. (a) Amends Section 16A,
Article 4413(502), V.T.C.S., by amending Subsection (n) and adding
Subsections (o)-(t), to require a managed care organization that
contracts with the state to report information necessary to set rates,
detect fraud, neglect, and physical abuse, and ensure quality of care;
develop and submit a plan for preventing, detecting, and reporting fraud
and abuse; include standard provisions in each subcontract that affects
the delivery of or payment for Medicaid services; and submit the
subcontract and annual disclosure statements to HHSC. Requires the
operating agency to require each contract to contain certain provisions,
and to audit each managed care organization that contracts with the state.
Sets forth the terms by which an audited managed care organization is
responsible for paying the costs of the audit. Establishes the conditions
under which the operating agency and the Texas Department of Insurance are
required to enter into a memorandum of understanding. Defines "operating
agency."
(b) Amends Section 532.001, Government Code, as added by H.B. 1845 or
S.B. 898, Acts of the 75th Legislature, Regular Session, 1997, by adding
Subdivision (5), to define "operating agency."
(c) Amends Chapter 532B, Government Code as added by H.B. 1845 or S.B.
898, Acts of the 75th Legislature, Regular Session, 1997, by adding
Sections 532.112 and 532.113, as follows:
Sec. 532.112. DUTIES OF MANAGED CARE ORGANIZATION; CONTRACTUAL
PROVISIONS. Makes conforming changes.
Sec. 532.113. AUDITS; MEMORANDUM OF UNDERSTANDING. Makes conforming
changes.
(d) Requires TDH or the appropriate health and human services agency
operating part of the state Medicaid program to develop guidelines
applicable to a managed care organization's plan for preventing,
detecting, and reporting Medicaid fraud not later than November 1, 1997.
(e) Makes application of this Act prospective to November 1, 1997
regarding a managed care organization that enters into a contract with
HHSC.
(f) Makes application of this Act prospective regarding a contract.
(g) Sets forth those conditions which do not have to be met by a managed
care organization that contracts with the state before the effective date
of this section.
(h) Requires a managed care organization that renews a contract or
subcontract after the effective date to include all provisions required by
this section.
(i) Sets forth the terms under which Subsection (a) takes effect.
(j) Sets forth the terms under which Subsections (b) and (c) take
effect.
SECTION 2.06. PILOT PROGRAM; ON-SITE REVIEWS OF PROSPECTIVE PROVIDERS.
Sets forth the conditions under which HHSC shall, by rule, establish a
pilot program to reduce fraud by conducting on-site reviews of prospective
providers; may expand the program; and shall submit a report. Authorizes
HHSC to waive an on-site review of a prospective provider under certain
circumstances. Provides that this section expires September 1, 1999.
SECTION 2.07. DEVELOPMENT OF NEW PROVIDER CONTRACT. Sets forth the terms
by which HHSC is required to develop a new provider contract that contains
provisions designed to strengthen HHSC's ability to prevent provider
fraud. Establishes the conditions by which HHSC and each agency operating
part of the state Medicaid program, by rule, is required to require each
provider who enrolled in the program before the effective date of this
section to reenroll under the new contract.
SECTION 2.08. COMPETITIVE PROCESS FOR OBTAINING DURABLE MEDICAL
EQUIPMENT. Requires TDH to develop a process for selecting providers of
durable medical equipment and supplies, and requires HHSC to submit an
amendment to the state's Medicaid plan authorizing implementation of the
process developed by TDH by a certain date. Makes a conforming change.
SECTION 2.09. REVIEW OF SERVICE PROVIDER BILLING PRACTICES. Sets forth
the terms by which TDH is required to refer each identified improper
billing practice to HHSC's office of investigations and enforcement, and
to require the entity that administers the state Medicaid program to
modify the entity's claims processing, monitoring procedures, and computer
technology to prevent improper billing. Makes a conforming change.
ARTICLE 3. ADMINISTRATIVE PENALTIES AND SANCTIONS RELATING TO MEDICAID
FRAUD
SECTION 3.01. ADMINISTRATIVE PENALTIES. (a) Amends Section 32.039,
Human Resources Code, as follows:
Sec. 32.039. New heading: DAMAGES AND PENALTIES. Defines "claim,"
"managed care organization," and "managed care plan." Provides that a
person commits a violation if the person presents to the department a
claim that contains a statement or representation that the person knows to
be false; or is a managed care organization that fails to provide a
required health care benefit or service, fails to provide certain required
information, or engages in a fraudulent activity in connection with
enrollment of, or marketing to, an individual eligible for medical
assistance. Replaces all references to "false claim" with "violation."
Sets forth the penalty for a violation under Subsection (b). Sets forth
the terms by which a person is required to file a petition for judicial
review, and may stay enforcement of the penalty. Deletes the existing
provisions regarding judicial review. Sets forth the terms by which a
person found liable for a violation under Subsection (c) is prohibited
from providing health care services for a certain period. Authorizes the
department, by rule, to provide for an extended period of ineligibility.
(b) Makes application of this Act prospective regarding a violation.
SECTION 3.02. SANCTIONS APPLICABLE TO VENDOR DRUG PROGRAM. Amends
Chapter 32B, Human Resources Code, by adding Section 32.046, as follows:
Sec. 32.046. VENDOR DRUG PROGRAM; SANCTIONS AND PENALTIES. Requires the
department to adopt rules governing sanctions and penalties that apply to
a provider in the vendor drug program who submits an improper claim for
reimbursement; and to notify each provider in the program that the
provider is subject to sanctions and penalties.
SECTION 3.03. PROHIBITION OF CERTAIN PERSONS CONVICTED OF FRAUD. Amends
Chapter 32B, Human Resources Code, by adding Section 32.047, as follows:
Sec. 32.047. PROHIBITION OF CERTAIN HEALTH CARE SERVICE PROVIDERS. Sets
forth the terms under which a person is permanently prohibited from
providing or arranging to provide health care services.
SECTION 3.04. DEDUCTIONS FROM LOTTERY WINNINGS. (a) Amends Sections
466.407(a) and (c), Government Code, to require the executive director to
deduct a certain amount from the winnings of a person determined to be
delinquent in the payment of a tax or other money collected by the
comptroller, rather than the state treasurer; or delinquent in reimbursing
the department for a benefit granted in error. Includes the department
among the entities required to provide the executive director with a
report of persons who have been determined to be delinquent.
(b) Requires the department to implement the change in law made by this
section not later than January 1, 1998. Prohibits the department from
seeking recovery through lottery prize deduction of an amount of a benefit
granted in error to a person.
(c) Sets forth the terms by which the executive director of the Texas
Lottery Commission is required to deduct erroneous amounts from lottery
prizes.
ARTICLE 4. CIVIL REMEDIES RELATING TO MEDICAID FRAUD AND CREATION OF
CRIMINAL OFFENSE
SECTION 4.01. REDESIGNATION. (a) Amends Chapter 36, Human Resources
Code, by designating Sections 36.001, 36.002, and 36.007-36.012 as
Subchapter A; renumbering Sections 36.007-36.012 as Sections
36.003-36.008, respectively, and adding a subchapter heading, as follows:
SUBCHAPTER A. GENERAL PROVISIONS
(b) Amends Chapter 36, Human Resources Code, by designating Sections
36.003-36.006 as Subchapter B, renumbering those sections as Sections
36.051-36.054, respectively, and adding a subchapter heading, as follows:
SUBCHAPTER B. ACTION BY ATTORNEY GENERAL
SECTION 4.02. DEFINITIONS. Amends Section 36.001, Human Resources Code,
by amending Subdivisions (5)-(11) and adding Subdivision (12), to define
"managed care organization" and to redefine "provider." Makes conforming
changes.
SECTION 4.03. UNLAWFUL ACTS RELATING TO MANAGED CARE ORGANIZATION. Amends
Section 36.002, Human Resources Code, to set forth the terms by which a
managed care organization engages in unlawful acts.
SECTION 4.04. APPLICABLE PENALTIES AND CONFORMING AMENDMENT. Amends
Section 36.004, Human Resources Code, as renumbered by this article as
Section 36.052, by amending Subsections (a) and (e), to make conforming
changes.
SECTION 4.05. CONFORMING AMENDMENT. Amends Section 36.005, Human
Resources Code, as renumbered by this Act as Section 36.053, by amending
Subsection (b), to make a conforming change.
SECTION 4.06. ADDITIONAL SANCTIONS FOR MEDICAID FRAUD. Amends Section
36.009, Human Resources Code, as renumbered by this article as Section
36.005, to establish the conditions under which certain provider
agreements, permits, licenses, and certifications are required and
authorized to be suspended or revoked for an unlawful act. Sets forth the
terms by which a person found liable under Section 32.052 is prohibited
from providing health care services for a certain period. Authorizes the
board of a state agency that operates part of the Medicaid program, by
rule, to extend the ineligibility period longer than 10 years.
SECTION 4.07. AUTHORITY OF ATTORNEY GENERAL. (a) Amends Chapter 36B,
Human Resources Code, by adding Section 36.055, as follows:
Sec. 36.055. ATTORNEY GENERAL AS RELATOR IN FEDERAL ACTION. Establishes
the conditions under which the attorney general is authorized to bring an
action as relator regarding an act in connection with the Medicaid program
for which a person may be held liable.
(b) Sets forth the terms by which the attorney general is required to
develop strategies to increase state recoveries and report the results of
the office's effort to the legislature.
SECTION 4.08. CIVIL ACTION BY PRIVATE PERSON FOR MEDICAID FRAUD. Amends
Chapter 36, Human Resources Code, by adding Subchapter C, as follows:
SUBCHAPTER C. ACTION BY PRIVATE PERSONS
Sec. 36.101. ACTION BY PRIVATE PERSON AUTHORIZED. Sets forth the terms
by which a person is authorized to bring a civil action for a violation of
Section 36.002 for the person and the state in the name of the state.
Sec. 36.102. INITIATION OF ACTION. Sets forth the terms by which a
person is required to initiate an action under this subchapter.
Sec. 36.103. ANSWER BY DEFENDANT. Sets forth the terms by which a
defendant is required to file an answer to a petition.
Sec. 36.104. STATE'S DECISION TO CONTINUE ACTION. Requires the state to
proceed with the action or notify the court that the state declines to
take over the action by a certain date.
Sec. 36.105. REPRESENTATION OF STATE BY PRIVATE ATTORNEY. Authorizes the
attorney general to contract with a private attorney to represent the
state in an action.
Sec. 36.106. INTERVENTION BY OTHER PARTIES PROHIBITED. Prohibits a
person other than the state from intervening or bringing a related action
based on the facts underlying a pending action.
Sec. 36.107. RIGHTS OF PARTIES IF STATE CONTINUES ACTION. Sets forth the
rights of the parties to an action if the state proceeds with the action.
Sec. 36.108. RIGHTS OF PARTIES IF STATE DOES NOT CONTINUE ACTION. Sets
forth the rights of the parties to an action if the state elects not to
proceed with the action.
Sec. 36.109. STAY OF CERTAIN DISCOVERY. Sets forth the terms by which
the court is authorized to stay the discovery for a certain period under
certain circumstances.
Sec. 36.110. PURSUIT OF ALTERNATE REMEDY BY STATE. Authorizes the state
to pursue the state's claim through any alternate remedy available to the
state, notwithstanding Section 36.101. Establishes the rights of the
person bringing the action if an alternate remedy is pursued in another
proceeding. Sets forth the terms under which a finding of fact or
conclusion of law is final and conclusive.
Sec. 36.111. AWARD TO PRIVATE PLAINTIFF. Sets forth the terms by which
the person bringing an action or settling a claim is entitled to an award
in a certain amount; and by which the court is authorized to award a
certain amount. Defines "proceeds of the action."
Sec. 36.112. REDUCTION OF AWARD. Sets forth the terms by which the court
may reduce the share of the proceeds of an action the person would
otherwise receive under Section 36.111, and is required to dismiss the
person from the civil action, under certain circumstances. Prohibits the
person from receiving any share of the proceeds in certain situations.
Sec. 36.113. AWARD TO DEFENDANT FOR FRIVOLOUS ACTION OR ACTION BROUGHT
FOR PURPOSES OF HARASSMENT. Establishes the conditions under which the
court is authorized to award the defendant reasonable attorney's fees and
expenses if the defendant prevails in the action and the court finds that
the claim was frivolous, vexatious, or brought for purposes of harassment.
Provides that Chapter 105, Civil Practice and Remedies Code, applies in an
action with which the state proceeds.
Sec. 36.114. CERTAIN ACTIONS BARRED. Prohibits a person from bringing an
action under certain circumstances. Defines "original source."
Sec. 36.115. STATE NOT LIABLE FOR CERTAIN EXPENSES. Provides that the
state is not liable for expenses that a person incurs in bringing an
action under this section.
Sec. 36.116. RETALIATION BY EMPLOYER AGAINST PERSON BRINGING SUIT
PROHIBITED. Establishes the terms by which a person who is discharged,
demoted, suspended, harassed, or discriminated against by the person's
employer because of a lawful act taken by the person in furtherance of an
action under this subchapter is entitled to reinstatement with the same
seniority status and a certain amount of back pay and compensation.
Authorizes a person to bring an action for the relief provided in this
section.
Sec. 36.117. ATTORNEY GENERAL COMPENSATION. Authorizes the office of the
attorney general to retain a reasonable portion of recoveries under this
subchapter, not to exceed amounts specified in the General Appropriations
Act, for the administration of this subchapter.
SECTION 4.09. CRIMINAL OFFENSE AND REVOCATION OF CERTAIN LICENSES. (a)
Amends Chapter 36, Human Resources Code, by adding Subchapter D, as
follows:
SUBCHAPTER D. CRIMINAL PENALTIES AND REVOCATION OF CERTAIN OCCUPATIONAL
LICENSES
Sec. 36.131. CRIMINAL OFFENSE. Provides that a person commits an offense
if the person commits an unlawful act under Section 36.002, ranging from a
Class C misdemeanor to a first degree felony, depending on the value of
the payment or benefit provided. Provides that if conduct constituting an
offense also constitutes an offense under another provision of law,
including a provision in the Penal Code, an actor may be prosecuted under
either this section or the other provision. Sets forth the terms by which
payments or benefits provided as a result of one scheme or continuing
course of conduct are authorized to be considered as one offense, and
aggregated in determining the grade of the offense.
Sec. 36.132. REVOCATION OF LICENSES. Defines "license" and "licensing
authority." Sets forth the terms by which a licensing authority is
required to revoke a license if the person is convicted of a felony under
Section 36.131.
SECTION 4.10. APPLICATION. Makes application of this Act prospective
regarding a violation.
ARTICLE 5. SUSPENSION OF LICENSES
SECTION 5.01. SUSPENSION OF LICENSES. (a) Amends Title 2B, Human
Resources Code, by adding Chapter 23, as follows:
CHAPTER 23. SUSPENSION OF DRIVER'S OR RECREATIONAL LICENSE FOR FAILURE TO
REIMBURSE DEPARTMENT
Sec. 23.001. DEFINITIONS. Defines "license" and "order suspending a
license."
Sec. 23.002. LICENSING AUTHORITIES SUBJECT TO CHAPTER. Defines
"licensing authority."
Sec. 23.003. SUSPENSION OF LICENSE. Sets forth the terms by which the
department is authorized to issue an order suspending a license of certain
persons.
Sec. 23.004. INITIATION OF PROCEEDING. Sets forth the terms by which the
department is authorized to initiate a proceeding to suspend a person's
license. Requires the commissioner to render a final decision in the
proceeding.
Sec. 23.005. CONTENTS OF PETITION. Set forth the contents of a petition
for license suspension.
Sec. 23.006. NOTICE. Requires the department to give certain notices and
a form requesting a hearing to the person named in the petition on
initiating a proceeding under Section 23.004.
Sec. 23.007. HEARING ON PETITION TO SUSPEND LICENSE. Sets forth the
procedure regarding a hearing on a petition to suspend a license.
Sec. 23.008. ORDER SUSPENDING LICENSE. Sets forth the procedure by which
the department is required to render an order suspending a license, is
authorized to stay such an order, and is prohibited from rendering an
order.
Sec. 23.009. DEFAULT ORDER. Requires the department to consider the
allegations of the petition for suspension to be admitted, and render an
order suspending a license if the person fails to respond to the notice,
request a hearing, or appear at the hearing.
Sec. 23.010. REVIEW OF FINAL ADMINISTRATIVE ORDER. Provides that an
order issued by the department is a final agency decision and subject to
review as provided by Chapter 2001, Government Code.
Sec. 23.011. ACTION BY LICENSING AUTHORITY. Requires a licensing
authority to take certain actions on receipt of a final order suspending a
license, and prohibits other actions. Sets forth the terms by which a
person who continues to engage in the licensed activity after the
implementation of the order is liable for certain civil and criminal
penalties. Establishes that the denial or suspension of a driver's license
is governed by this chapter and not by Title 7B, Transportation Code.
Sec. 23.012. MOTION TO REVOKE STAY. Sets forth the terms under which the
department is authorized to file a motion to revoke the stay of an order
suspending a license, and is required to revoke the stay and render a
final order suspending a license under certain circumstances.
Sec. 23.013. VACATING OR STAYING ORDER SUSPENDING A LICENSE. Sets forth
the terms by which the department is authorized to render an order
vacating or staying an order suspending a license. Sets forth the terms
by which on receipt of such an order, the licensing authority is required
to reinstate and return the affected license to the person.
Sec. 23.014. FEE BY LICENSING AUTHORITY. Authorizes a licensing
authority to charge a fee to a person who is the subject of an order
suspending a license.
Sec. 23.015. COOPERATION BETWEEN LICENSING AUTHORITIES AND DEPARTMENT.
Sets forth the terms by which the department is authorized to request
certain information from each licensing authority, and by which a
licensing authority is required to provide the information. Authorizes
the department to enter into a cooperative agreement with a licensing
authority to administer this chapter.
Sec. 23.016. RULES, FORMS, AND PROCEDURES. Requires the department, by
rule, to prescribe forms and procedures for the implementation of this
chapter.
(b) Requires the department to take all action necessary to implement the
change in law made by this article not later than January 1, 1998.
Prohibits the department from suspending a license because of a person's
failure to reimburse the department for a benefit granted in error before
September 1, 1997.
ARTICLE 6. MEASUREMENT OF FRAUD
SECTION 6.01. HEALTH CARE FRAUD STUDY. (a) Amends Chapter 403B,
Government Code, by adding Section 403.026, as follows:
Sec. 403.026. HEALTH CARE FRAUD STUDY. Sets forth the terms by which the
comptroller is required to conduct a study each biennium to determine the
number and type of fraudulent claims for benefits submitted. Establishes
the conditions under which the comptroller and certain state agencies are
required to cooperate and may enter into a memorandum of understanding.
Requires the comptroller to report the results of the study in a certain
manner.
(b) Requires the comptroller to complete the initial study required by
Section 403.026, Government Code, not later than December 1, 1998.
SECTION 6.02. COMPILATION OF STATISTICS. Amends Chapter 531B, Government
Code, by adding Section 531.0215, as follows:
Sec. 531.0215. COMPILATION OF STATISTICS RELATING TO FRAUD. Requires
HHSC and each health and human services agency that administers a part of
the state Medicaid program to maintain statistics on fraudulent claims for
benefits.
(b) Amends Chapter 501C, Labor Code, by adding Section 501.0431, as
follows:
Sec. 501.0431. COMPILATION OF STATISTICS RELATING TO FRAUD. Requires the
director to maintain statistics on fraudulent claims for medical benefits.
(c) Amends Section 17(a), Article 3.50-2, V.T.C.S. (Texas Employees
Uniform Group Insurance Benefits Act), to require the trustee to maintain
statistics on fraudulent claims for benefits under this Act.
ARTICLE 7. GENERAL FALSE CLAIMS
SECTION 7.01. GENERAL FALSE CLAIMS ACT. (a) Amends Title 10F,
Government Code, by adding Chapter 2259, as follows:
CHAPTER 2259. FALSE CLAIMS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 2259.001. DEFINITIONS. Defines "claim," "government contractor,"
"governmental entity," "local governmental entity," "managing official,"
and "prosecuting authority."
Sec. 2259.002. PROHIBITED ACTS. Prohibits a person from presenting a
false claim for payment or approval to certain persons; making or using a
false record or statement to obtain payment or approval of a false claim;
conspiring to defraud a governmental entity or contractor; delivering less
property than the amount of property for which the person receives a
receipt; making or delivering a receipt falsely representing the amount
of property delivered; buying or accepting as a pledge of an obligation or
debt public property from unauthorized persons; making or using a false
record or statement to conceal, avoid, or decrease an obligation to pay or
transmit money or property; accepting the benefits from a false claim made
by any person; or causing an act described by Subdivisions (1) through (8)
to be committed by another person.
SUBCHAPTER B. LIABILITY FOR VIOLATIONS
Sec. 2259.011. LIABILITY FOR KNOWING VIOLATION. Establishes the terms by
which a court that finds that a person knowingly violated Section 2259.002
is required to award the affected governmental entity certain costs and
damages, and is authorized to reduce the amount of exemplary damages
awarded under Subsection (a)(2). Establishes the conditions under which a
person knowingly violates Section 2259.002.
Sec. 2259.012. CIVIL PENALTY. Sets forth the terms by which the court is
authorized to award the affected governmental entity a civil penalty of
not more than $10,000 for each false claim, with certain exceptions.
Sec. 2259.013. LIABILITY JOINT AND SEVERAL; PROPORTIONATE RESPONSIBILITY
INAPPLICABLE. Provides that liability is joint and several for a
violation committed by more than one person. Establishes that Chapter 33,
Civil Practice and Remedies Code, does not apply to an action brought
under this chapter.
Sec. 2259.014. EXCEPTIONS. Prohibits a court from awarding exemplary
damages and attorney's fees and costs or a civil penalty against a person
if the total actual damages resulting from all violations for which
damages are being assessed against the person is less than $500.
Sec. 2259.015. DEPOSIT OF MONEY. Sets forth the terms by which money
collected on behalf of a governmental entity is required to be deposited
to the credit of the general revenue fund of the state or of the local
governmental entity, as appropriate.
Sec. 2259.016. LIMITATIONS. Requires an action, subject to Subsection
(b), to be brought not later than the third anniversary of the date on
which the violation was discovered by certain persons. Prohibits an
action from being brought after the 10th anniversary of the date on which
the violation was committed.
Sec. 2259.017. APPLICATION OF LAW GOVERNING EXEMPLARY DAMAGES. Provides
that Chapter 41, Civil Practice and Remedies Code, does not apply to
exemplary damages awarded under Section 2259.011 or to the civil penalty
awarded under Section 2259.012.
SUBCHAPTER C. ATTORNEY GENERAL ACTION
Sec. 2259.021. ATTORNEY GENERAL INVESTIGATION. Requires the attorney
general to investigate alleged violations of Section 2259.002 involving
state funds. Authorizes the attorney general, if the attorney general
finds that a person has violated Section 2259.002, to bring an action
under Subchapter B against the person.
Sec. 2259.022. AFFECTED LOCAL GOVERNMENTAL ENTITY. Sets forth the terms
by which if the attorney general brings an action under Subchapter B on
certain claims, the attorney general is required to provide a copy of the
complaint to the appropriate prosecuting authority, and the prosecuting
authority is authorized to intervene in the action.
SUBCHAPTER D. ACTION BROUGHT BY PROSECUTING AUTHORITY
Sec. 2259.031. PROSECUTING AUTHORITY INVESTIGATION. Requires a
prosecuting authority to investigate alleged violations of Section
2259.002 involving funds belonging to a local governmental entity and to
bring an action under certain circumstances.
Sec. 2259.032. ATTORNEY GENERAL. Sets forth the terms by which, if the
prosecuting authority brings an action on certain claims, the prosecuting
authority is required to provide a copy of the complaint to the attorney
general. Requires the attorney general to notify the court of certain
information after receiving the copy of the complaint. Sets forth the
terms by which the prosecuting authority is authorized to continue as a
party in the action, and is authorized to conduct the action.
SUBCHAPTER E. PRIVATE CAUSE OF ACTION
Sec. 2259.041. PRIVATE ACTION. Sets forth the terms by which a person is
authorized to bring a civil action for a violation of Section 2259.002.
Sec. 2259.042. SERVICE OF PETITION. Sets forth the terms by which a
person who brings an action is required to serve a copy of the petition in
the action on certain persons.
Sec. 2259.043. INTERVENTION. Establishes the conditions under which the
attorney general or the prosecuting authority is authorized to assume
responsibility for prosecution in an action involving certain funds. Sets
forth the terms by which the prosecuting authority is authorized to enter
an appearance and proceed as a party in the action, or enter an
appearance, depending on whether the attorney general assumes, or does not
assume, primary responsibility for prosecution of the action.
Sec. 2259.044. AWARD TO PRIVATE PARTY IF GOVERNMENT PROSECUTES ACTION.
Establishes the conditions under which the court is required to determine
the amount to award a person if the government prosecutes the action.
Sec. 2259.045. AWARD TO PRIVATE PARTY IF GOVERNMENT DOES NOT PROSECUTE
ACTION. Sets forth the terms by which the court is required to determine
the amount to award a person if the government does not prosecute an
action.
Sec. 2259.046. REDUCTION OF AWARD. Sets forth the terms by which the
court is authorized to reduce the share of the settlement or judgment the
person would otherwise receive, and is required to dismiss the person from
the civil action, so that the person may not receive any share of the
settlement or judgment.
SUBCHAPTER F. INTERFERENCE WITH DISCLOSURE BY EMPLOYEES
Sec. 2259.051. RIGHT TO DISCLOSE INFORMATION AND PARTICIPATE IN ACTION.
Sets forth the terms by which a person is entitled to disclose certain
information and participate in certain actions regarding an alleged
violation of Section 2259.002 or an action filed or to be filed under this
chapter.
Sec. 2259.052. PROHIBITED CONDUCT BY EMPLOYER. Prohibits an employer
from adopting or enforcing a rule or policy that prevents an employee from
exercising the employee's rights under Section 2259.051, or discriminating
against an employee because the employee has exercised the employee's
rights under Section 2259.051. Provides that an employer who violates
Subsection (a) is liable to the employee for certain damages and costs.
Prohibits an employee from recovering under Subsection (b) unless certain
conditions are met. Provides that this section does not apply to an
employer who is subject to Chapter 554, Government Code.
(b) Makes application of this Act prospective regarding an action.
ARTICLE 8. WAIVERS; EFFECTIVE DATE; EMERGENCY
SECTION 8.01. WAIVERS. Sets forth the terms by which a state agency is
required to request a waiver or authorization for implementation of a
provision.
SECTION 8.02. Effective date: September 1, 1997, except as otherwise
provided by this Act.
SECTION 8.03. Emergency clause.
SUMMARY OF COMMITTEE CHANGES
Changes the relating clause to include provisions regarding fraud and
improper payments under other welfare programs and the creation of private
cause of action for false claims for certain government payments. Deletes
the reference to "Medicaid fraud."
SECTION 1.01.
Amends Section 22.0251, Human Resources Code, to change the heading to
read, "TIMELY DETERMINATION OF OVERPAYMENTS." Deletes the date by which
the department must submit its semiannual report. Authorizes the report
to be consolidated with certain other reports.
Amends Section 22.0254, Human Resources Code, to delete the provision
requiring the district attorney to cooperate in providing information
requested by the department. Authorizes, rather than requires, the
department, by rule, to define what constitutes a major fraudulent claim.
Amends Section 22.0291, Human Resources Code, to change the heading to
read, "INFORMATION MATCHING SYSTEM RELATING TO IMMIGRANTS AND FOREIGN
VISITORS." Sets forth the terms by which the department is authorized to
enter into an agreement with the Department of State of the United States
and the United States Department of Justice relating to immigrants and
foreign visitors, and is required to use a computerized matching system
relating to the same. Deletes the previous provisions regarding an
embassy information matching system.
SECTION 1.02.
Adds Section 22.032, Human Resources Code, to authorize the department to
use earned federal funds to pay the costs of the department's activities
relating to preventing fraud.
SECTION 1.03.
Amends Section 32.043, Human Resources Code, to require the department to
analyze claims to ensure that payment is sought first under the Medicare
program to the extent allowed by law, rather than to ensure that payment
is not made under the medical assistance program if the service is covered
under Medicare.
Deletes the provision requiring HHSC to submit an amendment authorizing
the state to limit payment under the state Medicaid program for a person
entitled to dual Medicaid and Medicare coverage.
SECTION 1.06.
Replaces references to "welfare fraud, misuse, or overcharges" with
"welfare fraud, abuse, or overcharges."
Amends Section 531.102, Government Code, to authorize HHSC to require
employees of health and human services agencies to provide assistance to
HHSC in connection with the investigation of fraud.
Amends Section 531.103, Government Code, to provide that an exchange of
information between the office of the attorney general and HHSC or a
health and human services agency does not affect whether the information
is subject to disclosure. Changes the terms under which HHSC and the
office of the attorney general are required to submit a semiannual report.
Amends Section 531.106, Government Code, to authorize HHSC to require the
entity it contracts with to install and operate the learning or neural
network technology at certain locations. Requires the data used for
neural network processing to be maintained as an independent subset,
rather than requiring the technology to be capable of operating
independently.
Amends Section 531.107, Government Code, to replace references to "public
assistance fraud oversight task force" with "Medicaid and public
assistance fraud oversight task force." Changes the composition of the
task force.
Amends Section 531.108, Government Code, to require HHSC to ensure that a
toll-free hotline is maintained and promoted, either by HHSC or an agency,
rather than requiring HHSC to establish a toll-free hotline. Deletes the
provision requiring HHSC to submit a report to HHSC.
Requires HHSC to award the contract for the learning or neural network
technology and the contractor to begin operations not later than January
1, 1998, rather than September 1, 1997.
Requires HHSC to submit the initial report not later than April 1, 1998,
rather than September 1, 1997.
SECTION 1.07.
Changes the section heading to read, "CONSOLIDATION OF STAFF."
Replaces references to "the department's office of inspector general" with
"the department's utilization and assessment review function."
Replaces all references to "TDH's policy and analysis group" with "TDH's
claims review and analysis group and policy and data analysis group."
Deletes former SECTION 1.07.
SECTION 1.08.
Requires the department, subject to approval by the attorney general, to
use private collection agents to collect reimbursements for benefits
granted in error.
SECTION 2.01.
Amends Section 32.024, Human Resources Code, to require the rules to
provide that a request for authorization must be evaluated based on the
recipient's medical needs and may be granted for a certain length of time;
and a person denied payment for services rendered because a request for
prior authorization was denied is entitled to appeal the denial of payment
to the department.
SECTION 2.02.
Amends Section 32.024, Human Resources Code, to change the terms by which
the department, by rule, is required to require a health care provider who
arranges for durable medical equipment to ensure, rather than certify,
that the child or the parent's child or guardian receives instruction, and
to make a notation in the child's medical records of the date on which the
requirements are met. Deletes the provision requiring the department to
develop a certification form.
Deletes former SECTION 2.05.
SECTION 2.05.
Amends Section 16A, Article 4413(502), V.T.C.S., to require a managed care
organization that contracts with the state, rather than with HHSC, to
provide benefits or services to Medicaid eligible individuals to report
certain information, including information necessary to detect neglect and
physical abuse; develop and submit to the operating agency for approval by
HHSC, rather than to HHSC, a plan for preventing and reporting fraud and
abuse; and include standard provisions developed by the operating agency,
rather than HHSC, in each subcontract. Requires the operating agency,
rather than HHSC, to require that each contract contain certain
provisions, to audit managed care organizations, and to enter into a
memorandum of understanding with the Texas Department of Insurance.
Defines "operating agency."
Amends Section 532.001, Government Code, by adding Subdivision (5), to
define "operating agency."
Requires TDH or the appropriate health and human services agency, rather
than HHSC, to develop guidelines applicable to a managed care
organization's plan for preventing, detecting, and reporting Medicaid
fraud.
Provides that Subsection (a) takes effect only if neither H.B. 1845 nor
S.B. 898, Acts of the 75th Legislature, Regular Session, 1997, take
effect, rather than only if the Act of the 75th Legislature, Regular
Session, 1997, relating to nonsubstantive additions to and corrections in
enacted codes, does not take effect.
SECTION 2.06.
Requires the pilot program to provide for random on-site reviews, and
authorizes HHSC to waive an on-site review under certain conditions.
SECTION 2.08.
Changes the heading to read, "COMPETITIVE PROCESS FOR OBTAINING DURABLE
MEDICAL EQUIPMENT." Sets forth the terms by which TDH is required to
develop a process for selecting providers of durable medical equipment and
supplies, and by which HHSC is required to submit an amendment to the
state's Medicaid plan authorizing implementation of the process by a
certain date, rather than requiring HHSC to submit an amendment
authorizing TDH to select and use a preferred vendor for durable medical
equipment.
SECTION 2.09.
Requires TDH to refer each identified improper billing practice to HHSC's
office of investigations and enforcement.
SECTION 3.01.
Amends Section 32.039, Human Resources Code, to replace the reference to a
"medically necessary health care benefit or service" with a "health care
benefit or service."
Provides that Subsection (u), regarding persons prohibited from providing
health care services under the medical assistance program, does not apply
to a person who operates a nursing facility.
SECTION 4.06.
Amends Section 36.005, Human Resources Code, to change the terms by which
certain entities are required to suspend or revoke a provider agreement,
permit, license, or certification, and are authorized to suspend or revoke
the same, except in the case of a person who operates a nursing facility.
Deletes former SECTION 4.07.
SECTION 4.08.
Amends Section 36.117, Human Resources Code, to authorize the office of
the attorney general to retain a reasonable portion of recoveries for the
administration of this subchapter.
SECTION 4.09.
Amends the heading of Subchapter D to read, "CRIMINAL PENALTIES AND
REVOCATION OF CERTAIN OCCUPATIONAL LICENSES."
Amends Section 36.131, Human Resources Code, to authorize the actor, if
conduct constituting an offense under this section also constitutes an
offense under another provision of law, including a provision in the Penal
Code, to be prosecuted under either. Sets forth the terms by which when
multiple payments or benefits are provided as a result of one scheme or
continuing course of conduct, the conduct may be considered as one offense
and the amounts of payments or benefits aggregated in determining the
grade of the offense.
Adds Section 36.132, Human Resources Code, to define "license" and
"licensing authority." Sets forth the terms by which a licensing authority
is required to revoke a license issued by the authority to a person if the
person is convicted of a felony under Section 36.131.
Deletes the provision amending Section 4.01(b), Article 4495b, V.T.C.S.
SECTION 5.01.
Amends the heading for Chapter 23 to read, "SUSPENSION OF DRIVER'S OR
RECREATIONAL LICENSE FOR FAILURE TO REIMBURSE DEPARTMENT."
SECTION 7.01.
Adds Chapter 2259A, Government Code, to define "claim," "government
contractor," "governmental contractor," "governmental entity," "local
governmental entity," "managing official," and "prosecuting authority."
Prohibits a person from performing certain acts regarding a false claim
for payment or approval to a government entity or contractor.
Adds Chapter 2259B, Government Code, to set forth liabilities for
violations of Section 2259.002, including civil penalties, joint and
several liability, exceptions, limitations, and the deposit of money
collected.
Adds Chapter 2259C, Government Code, to establish the action taken by the
attorney general in investigating and bringing an action against a person
in violation of Section 2259.002.
Adds Chapter 2259D, Government Code, to establish the action taken by the
prosecuting authority in investigating and bringing an action against a
person in violation of Section 2259.002.
Adds Chapter 2259E, Government Code, to set forth the terms by which a
person may bring a civil action in a district court for a violation of
Section 2259.002, and must serve a copy of the petition in the action.
Establishes the conditions by which the the attorney general or the
prosecuting authority may assume responsibility for prosecution of the
action. Sets forth the award for a private party if the government
prosecutes an action, or does not prosecute an action. Authorizes the
court to reduce an award in certain situations, and requires the court to
dismiss the person from the civil action in other circumstances.
Adds Chapter 2259F, Government Code, to establish the conditions by which
a person is entitled to disclose information and participate in an action;
and by which an employer is prohibited from adopting or enforcing a rule
or policy that prevents an employee from exercising the person's rights,
or from discriminating against an employee.