1-1 AN ACT
1-2 relating to increased penalties for fraudulent or other unlawful
1-3 acts committed under the state Medicaid program that result in
1-4 injury to a child or an elderly or disabled person.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section 32.039, Human Resources Code, is amended
1-7 by amending Subsection (b) and adding Subsection (s) to read as
1-8 follows:
1-9 (b) A person who presents or causes to be presented to the
1-10 department a claim that contains a statement or representation the
1-11 person knows to be false is liable to the department for:
1-12 (1) the amount paid because of the false claim and
1-13 interest on that amount determined at the rate provided by law for
1-14 legal judgments and accruing from the date on which the payment was
1-15 made;
1-16 (2) payment of a civil penalty not to exceed twice the
1-17 amount paid because of the false claim; and
1-18 (3) payment of a civil penalty of:
1-19 (A) not less than $5,000 or more than $15,000
1-20 for each item or service for which payment was claimed if the false
1-21 statement or representation results in injury to an elderly person,
1-22 as defined by Section 48.002(1), a disabled person, as defined by
1-23 Section 48.002(8)(A), or a person younger than 18 years of age; or
1-24 (B) not more than $2,000 for each item or
2-1 service for which payment was claimed if the false statement or
2-2 representation does not result in injury to a person described by
2-3 Paragraph (A).
2-4 (s) A person found liable under Subsection (b) for a false
2-5 statement or representation that resulted in injury to an elderly
2-6 person, as defined by Section 48.002(1), a disabled person, as
2-7 defined by Section 48.002(8)(A), or a person younger than 18 years
2-8 of age may not provide or arrange to provide health care services
2-9 under the medical assistance program for a period of 10 years. The
2-10 department by rule may provide for a period of ineligibility longer
2-11 than 10 years. The period of ineligibility begins on the date on
2-12 which the determination that the person is liable becomes final.
2-13 This subsection does not apply to a person who operates a nursing
2-14 facility.
2-15 SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
2-16 is amended by adding Section 32.047 to read as follows:
2-17 Sec. 32.047. PROHIBITION OF CERTAIN HEALTH CARE SERVICE
2-18 PROVIDERS. A person is permanently prohibited from providing or
2-19 arranging to provide health care services under the medical
2-20 assistance program if:
2-21 (1) the person is convicted of an offense arising from
2-22 a fraudulent act under the program; and
2-23 (2) the person's fraudulent act results in injury to
2-24 an elderly person, as defined by Section 48.002(1), a disabled
2-25 person, as defined by Section 48.002(8)(A), or a person younger
2-26 than 18 years of age.
2-27 SECTION 3. Section 36.004(a), Human Resources Code, is
3-1 amended to read as follows:
3-2 (a) Except as provided by Subsection (c), a person who
3-3 commits an unlawful act is liable to the state for:
3-4 (1) restitution of the value of any payment or
3-5 monetary or in-kind benefit provided under the Medicaid program,
3-6 directly or indirectly, as a result of the unlawful act;
3-7 (2) interest on the value of the payment or benefit
3-8 described by Subdivision (1) at the prejudgment interest rate in
3-9 effect on the day the payment or benefit was received or paid, for
3-10 the period from the date the benefit was received or paid to the
3-11 date that restitution is paid to the state;
3-12 (3) a civil penalty of:
3-13 (A) not less than $5,000 or more than $15,000
3-14 for each unlawful act committed by the person that results in
3-15 injury to an elderly person, as defined by Section 48.002(1), a
3-16 disabled person, as defined by Section 48.002(8)(A), or a person
3-17 younger than 18 years of age; or
3-18 (B) not less than $1,000 or more than $10,000
3-19 for each unlawful act committed by the person that does not result
3-20 in injury to a person described by Paragraph (A); and
3-21 (4) two times the value of the payment or benefit
3-22 described by Subdivision (1).
3-23 SECTION 4. Section 36.009, Human Resources Code, is amended
3-24 to read as follows:
3-25 Sec. 36.009. SUSPENSION OR REVOCATION OF AGREEMENT;
3-26 PROFESSIONAL DISCIPLINE. (a) The commissioner of human services,
3-27 the commissioner of public health, the commissioner of mental
4-1 health and mental retardation, the executive director of the
4-2 Department of Protective and Regulatory Services, or the executive
4-3 director of another state health care regulatory agency:
4-4 (1) shall suspend or revoke:
4-5 (A) a provider agreement between the department
4-6 or agency and a person, other than a person who operates a nursing
4-7 facility, found liable under Section 36.004; and
4-8 (B) a permit, license, or certification granted
4-9 by the department or agency to a person, other than a person who
4-10 operates a nursing facility, found liable under Section 36.004; and
4-11 (2) may suspend or revoke:
4-12 (A) [(1)] a provider agreement between the
4-13 department or agency and a person who operates a nursing facility
4-14 found liable under Section 36.004; or
4-15 (B) [(2)] a permit, license, or certification
4-16 granted by the department or agency to a person who operates a
4-17 nursing facility found liable under Section 36.004.
4-18 (b) A person found liable under Section 36.004 for an
4-19 unlawful act may not provide or arrange to provide health care
4-20 services under the state Medicaid program for a period of 10 years.
4-21 The board of a state agency that operates part of the Medicaid
4-22 program may by rule provide for a period of ineligibility longer
4-23 than 10 years. The period of ineligibility begins on the date on
4-24 which the determination that the person is liable becomes final.
4-25 This subsection does not apply to a person who operates a nursing
4-26 facility.
4-27 (c) A person licensed by a state regulatory agency who
5-1 commits an unlawful act is subject to professional discipline under
5-2 the applicable licensing law or rules adopted under that law.
5-3 SECTION 5. If before implementing any provision of this Act,
5-4 the Health and Human Services Commission or other state agency
5-5 determines that a waiver or authorization from a federal agency is
5-6 necessary for implementation, the commission or other state agency
5-7 shall request the waiver or authorization and may delay
5-8 implementing that provision until the waiver or authorization is
5-9 granted.
5-10 SECTION 6. (a) The change in law made by this Act applies
5-11 only to a violation committed on or after the effective date of
5-12 this Act. For purposes of this section, a violation is committed
5-13 on or after the effective date of this Act only if each element of
5-14 the violation occurs on or after that date.
5-15 (b) A violation committed before the effective date of this
5-16 Act is covered by the law in effect when the violation was
5-17 committed, and the former law is continued in effect for this
5-18 purpose.
5-19 SECTION 7. This Act takes effect September 1, 1997, but only
5-20 if S.B. No. 30, Acts of the 75th Legislature, Regular Session,
5-21 1997, does not become law.
5-22 SECTION 8. The importance of this legislation and the
5-23 crowded condition of the calendars in both houses create an
5-24 emergency and an imperative public necessity that the
5-25 constitutional rule requiring bills to be read on three several
5-26 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1637 was passed by the House on May
6, 1997, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 1637 on May 23, 1997, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1637 was passed by the Senate, with
amendments, on May 20, 1997, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor