By Alvarado                                      H.B. No. 672

      75R3409 KKA-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to measurement of fraud in certain state-funded health

 1-3     care programs.

 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-5           SECTION 1.  Subchapter B, Chapter 403, Government Code, is

 1-6     amended by adding Section 403.026 to read as follows:

 1-7           Sec. 403.026.  HEALTH CARE FRAUD STUDY.  (a)  The comptroller

 1-8     shall conduct a study each biennium to determine the number and

 1-9     type of fraudulent claims for medical or health care benefits

1-10     submitted:

1-11                 (1)  under the state Medicaid program;

1-12                 (2)  under group health insurance programs administered

1-13     through the Employees Retirement System of Texas for active and

1-14     retired state employees; or

1-15                 (3)  by or on behalf of a state employee and

1-16     administered by the attorney general under Chapter 501, Labor Code.

1-17           (b)  A state agency that administers a program identified by

1-18     Subsection (a) shall cooperate with the comptroller and provide any

1-19     information required by the comptroller in connection with the

1-20     study.  A state agency may enter into a memorandum of understanding

1-21     with the comptroller regarding the use and confidentiality of the

1-22     information provided.  This subsection does not require a state

1-23     agency to provide confidential information if release of the

1-24     information is prohibited by law.

 2-1           (c)  The comptroller shall report the results of the study to

 2-2     each state agency that administers a program  included in the study

 2-3     so that the agency may modify its fraud control procedures as

 2-4     necessary.

 2-5           SECTION 2.  Subchapter B, Chapter 531, Government Code, is

 2-6     amended by adding Section 531.0215 to read as follows:

 2-7           Sec. 531.0215.  COMPILATION OF STATISTICS RELATING TO FRAUD.

 2-8     The commission and each health and human services agency that

 2-9     administers a part of the state Medicaid program shall maintain

2-10     statistics on the number, type, and disposition of fraudulent

2-11     claims for benefits submitted under the part of the program the

2-12     agency administers.

2-13           SECTION 3.  Subchapter C, Chapter 501, Labor Code, is amended

2-14     by adding Section 501.0431 to read as follows:

2-15           Sec. 501.0431.  COMPILATION OF STATISTICS RELATING TO FRAUD.

2-16     The director shall maintain statistics on the number, type, and

2-17     disposition of fraudulent claims for medical benefits under this

2-18     chapter.

2-19           SECTION 4.  Section 17(a), Texas Employees Uniform Group

2-20     Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance

2-21     Code), is amended to read as follows:

2-22           (a)  The trustee shall:

2-23                 (1)  make a continuing study of the operation and

2-24     administration of this Act, including surveys and reports of group

2-25     coverages and benefits available to employees and on the experience

2-26     thereof; and

2-27                 (2)  maintain statistics on the number, type, and

 3-1     disposition of fraudulent claims for benefits under this Act.

 3-2           SECTION 5.  The comptroller of public accounts shall complete

 3-3     the initial study required by Section 403.026, Government Code, as

 3-4     added by this Act, not later than December 1, 1998.

 3-5           SECTION 6.  The importance of this legislation and the

 3-6     crowded condition of the calendars in both houses create an

 3-7     emergency and an imperative public necessity that the

 3-8     constitutional rule requiring bills to be read on three several

 3-9     days in each house be suspended, and this rule is hereby suspended,

3-10     and that this Act take effect and be in force from and after its

3-11     passage, and it is so enacted.