By: Duncan S.B. No. 1626
97S0793/1
A BILL TO BE ENTITLED
AN ACT
1-1 relating to certain offenses involving insurance fraud; providing
1-2 penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 35.01, Penal Code, is amended by amending
1-5 Subdivision (4) and adding Subdivision (6) to read as follows:
1-6 (4) "Insurer" means a person who engages in the
1-7 business of insurance in this state, including:
1-8 (A) an insurer that is not authorized to do
1-9 business in this state;
1-10 (B) a health maintenance organization;
1-11 (C) a group hospital service corporation
1-12 regulated under Chapter 20, Insurance Code; [and]
1-13 (D) any person who self-insures; and
1-14 (E) any entity doing the business of insurance
1-15 as identified by the Insurance Code [and provides health care
1-16 benefits to the person's employees].
1-17 (6) "Claim" means any and all written and oral
1-18 communication made to an insurer that may reasonably be construed
1-19 as a demand for payment, or may reasonably be expected to result in
1-20 a payment, by an insurer to another under the terms of a health or
1-21 property and casualty insurance policy. For purposes of
1-22 determining the value of a claim, the entire amount of the claim
1-23 may be considered in determining the degree of the offense.
2-1 SECTION 2. Section 35.02, Penal Code, is amended by amending
2-2 Subsections (c) and (d), adding Subsection (e), and relettering
2-3 existing Subsection (d) as (f) to read as follows:
2-4 (c) For purposes of Subsection (a), information concerning a
2-5 matter that is material to a claim for payment under an insurance
2-6 policy includes information concerning:
2-7 (1) whether health care goods or services were
2-8 provided;
2-9 (2) whether health care goods or services were
2-10 medically necessary under professionally accepted standards;
2-11 (3) the nature of the health care goods or services
2-12 provided;
2-13 (4) the date on which health care goods or services
2-14 were provided;
2-15 (5) the medical record of goods or services provided;
2-16 (6) the condition treated or diagnosis made;
2-17 (7) the identity and applicable license of the
2-18 provider or the recipient of health care goods or services;
2-19 (8) whether property was damaged or lost or an
2-20 individual was injured in the manner and under the circumstances
2-21 described in a statement related to a claim for insurance payment;
2-22 or
2-23 (9) whether any other claim for insurance payment has
2-24 been communicated to any other insurer concerning property damage
2-25 or loss to the same property or injury to an individual.
3-1 (d) A person commits an offense if, with the intent to
3-2 obtain or deny payment of workers' compensation benefits, including
3-3 medical benefits, under this section for himself or another, the
3-4 person knowingly or intentionally:
3-5 (1) makes a false or misleading statement;
3-6 (2) misrepresents or conceals a material fact; or
3-7 (3) fabricates, alters, conceals, or destroys a
3-8 document other than a governmental record.
3-9 (e) A person commits an offense if, with the intent to
3-10 obtain workers' compensation insurance coverage under the workers'
3-11 compensation insurance laws of this state or to avoid payment of
3-12 premiums due for that coverage for himself or another, the person
3-13 knowingly or intentionally:
3-14 (1) makes a false statement;
3-15 (2) misrepresents or conceals a material fact; or
3-16 (3) makes a false entry in, fabricates, alters,
3-17 conceals, or destroys a document other than a governmental record.
3-18 (f) An offense under this section is:
3-19 (1) a Class C misdemeanor if the value of the claim is
3-20 less than $20;
3-21 (2) a Class B misdemeanor if the value of the claim is
3-22 $20 or more but less than $500;
3-23 (3) a Class A misdemeanor if the value of the claim is
3-24 $500 or more but less than $1,500;
3-25 (4) a state jail felony if the value of the claim is
4-1 $1,500 or more but less than $20,000 or if a claim is made to an
4-2 insurer and no value has been attached to the claim;
4-3 (5) a felony of the third degree if the value of the
4-4 claim is $20,000 or more but less than $100,000;
4-5 (6) a felony of the second degree if the value of the
4-6 claim is $100,000 or more but less than $200,000; or
4-7 (7) a felony of the first degree if:
4-8 (A) the value of the claim is $200,000 or more;
4-9 or
4-10 (B) the value of the claim is less than $200,000
4-11 and the commission of the offense placed a person at risk of death
4-12 or serious bodily injury.
4-13 SECTION 3. Subsection (a), Section 71.02, Penal Code, is
4-14 amended to read as follows:
4-15 (a) A person commits an offense if, with the intent to
4-16 establish, maintain, or participate in a combination or in the
4-17 profits of a combination or as a member of a criminal street gang,
4-18 he commits or conspires to commit one or more of the following:
4-19 (1) murder, capital murder, arson, aggravated robbery,
4-20 robbery, burglary, theft, aggravated kidnapping, kidnapping,
4-21 aggravated assault, aggravated sexual assault, sexual assault,
4-22 forgery, deadly conduct, assault punishable as a Class A
4-23 misdemeanor, burglary of a motor vehicle, or unauthorized use of a
4-24 motor vehicle;
4-25 (2) any gambling offense punishable as a Class A
5-1 misdemeanor;
5-2 (3) promotion of prostitution, aggravated promotion of
5-3 prostitution, or compelling prostitution;
5-4 (4) unlawful manufacture, transportation, repair, or
5-5 sale of firearms or prohibited weapons;
5-6 (5) unlawful manufacture, delivery, dispensation, or
5-7 distribution of a controlled substance or dangerous drug, or
5-8 unlawful possession of a controlled substance or dangerous drug
5-9 through forgery, fraud, misrepresentation, or deception;
5-10 (6) any unlawful wholesale promotion or possession of
5-11 any obscene material or obscene device with the intent to wholesale
5-12 promote the same;
5-13 (7) any unlawful employment, authorization, or
5-14 inducing of a child younger than 17 years of age in an obscene
5-15 sexual performance;
5-16 (8) any felony offense under Chapter 32, Penal Code;
5-17 (9) any offense under Chapter 36, Penal Code; [or]
5-18 (10) any offense under Chapter 34, Penal Code; or
5-19 (11) any offense under Chapter 35, Penal Code.
5-20 SECTION 4. Sections 418.001 and 418.002, Labor Code, are
5-21 repealed.
5-22 SECTION 5. (a) The change in law made by this Act applies
5-23 only to an offense committed on or after the effective date of this
5-24 Act. For purposes of this section, an offense is committed before
5-25 the effective date of this Act if any element of the offense occurs
6-1 before the effective date.
6-2 (b) An offense committed before the effective date of this
6-3 Act is covered by the law in effect when the offense was committed,
6-4 and the former law is continued in effect for that purpose.
6-5 SECTION 6. This Act takes effect September 1, 1997.
6-6 SECTION 7. The importance of this legislation and the
6-7 crowded condition of the calendars in both houses create an
6-8 emergency and an imperative public necessity that the
6-9 constitutional rule requiring bills to be read on three several
6-10 days in each house be suspended, and this rule is hereby suspended.