By Alvarado H.B. No. 1637
75R4151 KKA-D
A BILL TO BE ENTITLED
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.
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 a person younger
1-22 than 18 years of age; or
1-23 (B) not more than $2,000 for each item or
1-24 service for which payment was claimed if the false statement or
2-1 representation does not result in injury to a person younger than
2-2 18 years of age.
2-3 (s) A person found liable under Subsection (b) for a false
2-4 statement or representation that resulted in injury to a person
2-5 younger than 18 years of age may not provide or arrange to provide
2-6 health care services under the medical assistance program for a
2-7 period of 10 years. The department by rule may provide for a
2-8 period of ineligibility longer than 10 years. The period of
2-9 ineligibility begins on the date on which the determination that
2-10 the person is liable becomes final.
2-11 SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
2-12 is amended by adding Section 32.043 to read as follows:
2-13 Sec. 32.043. PROHIBITION OF CERTAIN HEALTH CARE SERVICE
2-14 PROVIDERS. A person is permanently prohibited from providing or
2-15 arranging to provide health care services under the medical
2-16 assistance program if:
2-17 (1) the person is convicted of an offense arising from
2-18 a fraudulent act under the program; and
2-19 (2) the person's fraudulent act results in injury to a
2-20 person younger than 18 years of age.
2-21 SECTION 3. Section 36.004(a), Human Resources Code, is
2-22 amended to read as follows:
2-23 (a) Except as provided by Subsection (c), a person who
2-24 commits an unlawful act is liable to the state for:
2-25 (1) restitution of the value of any payment or
2-26 monetary or in-kind benefit provided under the Medicaid program,
2-27 directly or indirectly, as a result of the unlawful act;
3-1 (2) interest on the value of the payment or benefit
3-2 described by Subdivision (1) at the prejudgment interest rate in
3-3 effect on the day the payment or benefit was received or paid, for
3-4 the period from the date the benefit was received or paid to the
3-5 date that restitution is paid to the state;
3-6 (3) a civil penalty of:
3-7 (A) not less than $5,000 or more than $15,000
3-8 for each unlawful act committed by the person that results in
3-9 injury to a person younger than 18 years of age; or
3-10 (B) not less than $1,000 or more than $10,000
3-11 for each unlawful act committed by the person that does not result
3-12 in injury to a person younger than 18 years of age; and
3-13 (4) two times the value of the payment or benefit
3-14 described by Subdivision (1).
3-15 SECTION 4. Section 36.009, Human Resources Code, is amended
3-16 to read as follows:
3-17 Sec. 36.009. SUSPENSION OR REVOCATION OF AGREEMENT;
3-18 PROFESSIONAL DISCIPLINE. (a) The commissioner of human services,
3-19 the commissioner of public health, the commissioner of mental
3-20 health and mental retardation, the executive director of the
3-21 Department of Protective and Regulatory Services, or the executive
3-22 director of another state health care regulatory agency:
3-23 (1) shall suspend or revoke:
3-24 (A) a provider agreement between the department
3-25 or agency and a person found liable under Section 36.004 for an
3-26 unlawful act that resulted in injury to a person younger than 18
3-27 years of age; and
4-1 (B) a permit, license, or certification granted
4-2 by the department or agency to a person found liable under Section
4-3 36.004 for an unlawful act that resulted in injury to a person
4-4 younger than 18 years of age; and
4-5 (2) may suspend or revoke:
4-6 (A) [(1)] a provider agreement between the
4-7 department or agency and a person found liable under Section 36.004
4-8 for an unlawful act that does not result in injury to a person
4-9 younger than 18 years of age; or
4-10 (B) [(2)] a permit, license, or certification
4-11 granted by the department or agency to a person found liable under
4-12 Section 36.004 for an unlawful act that does not result in injury
4-13 to a person younger than 18 years of age.
4-14 (b) A person found liable under Section 36.004 for an
4-15 unlawful act that resulted in injury to a person younger than 18
4-16 years of age may not provide or arrange to provide health care
4-17 services under the state Medicaid program for a period of 10 years.
4-18 The board of a state agency that operates part of the state
4-19 Medicaid program may by rule provide for a period of ineligibility
4-20 longer than 10 years. The period of ineligibility begins on the
4-21 date on which the determination that the person is liable becomes
4-22 final.
4-23 (c) A person licensed by a state regulatory agency who
4-24 commits an unlawful act is subject to professional discipline under
4-25 the applicable licensing law or rules adopted under that law.
4-26 SECTION 5. If before implementing any provision of this Act,
4-27 the Health and Human Services Commission or other state agency
5-1 determines that a waiver or authorization from a federal agency is
5-2 necessary for implementation, the commission or other state agency
5-3 shall request the waiver or authorization and may delay
5-4 implementing that provision until the waiver or authorization is
5-5 granted.
5-6 SECTION 6. (a) The change in law made by this Act applies
5-7 only to a violation committed on or after the effective date of
5-8 this Act. For purposes of this section, a violation is committed
5-9 on or after the effective date of this Act only if each element of
5-10 the violation occurs on or after that date.
5-11 (b) A violation committed before the effective date of this
5-12 Act is covered by the law in effect when the violation was
5-13 committed, and the former law is continued in effect for this
5-14 purpose.
5-15 SECTION 7. This Act takes effect September 1, 1997.
5-16 SECTION 8. The importance of this legislation and the
5-17 crowded condition of the calendars in both houses create an
5-18 emergency and an imperative public necessity that the
5-19 constitutional rule requiring bills to be read on three several
5-20 days in each house be suspended, and this rule is hereby suspended.