By Maxey                                              H.B. No. 1668
         76R5070 DLF-D                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to fraudulent claims for medical or health care benefits
 1-3     submitted under certain state programs.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1.  Section 403.026, Government Code, as added by
 1-6     Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997,
 1-7     is redesignated as Section 403.028 and amended to read as follows:
 1-8           Sec. 403.028 [403.026].  HEALTH CARE FRAUD STUDY.  (a)  The
 1-9     comptroller shall conduct a study each biennium to determine the
1-10     number and type of fraudulent claims for medical or health care
1-11     benefits submitted:
1-12                 (1)  under the state Medicaid program, including the
1-13     Medicaid managed care program implemented under Chapter 533;
1-14                 (2)  under group health insurance programs administered
1-15     through the Employees Retirement System of Texas for active and
1-16     retired state employees, including managed care programs providing
1-17     health care benefits as a part of the group coverages offered to
1-18     active and retired state employees; or
1-19                 (3)  by or on behalf of a state employee and
1-20     administered by the attorney general under Chapter 501, Labor Code.
1-21           (b)  For purposes of the study conducted under this section,
1-22     the comptroller or, at the request of the comptroller, a state
1-23     agency that administers a program identified by Subsection (a) may
1-24     make telephone contact with a person identified as receiving
 2-1     services for which benefits are provided under the program to
 2-2     confirm the delivery of services to the person.
 2-3           (c)  A state agency that administers a program identified by
 2-4     Subsection (a) shall cooperate with the comptroller and provide any
 2-5     information required by the comptroller in connection with the
 2-6     study.  The information must be provided in the format required by
 2-7     the comptroller to permit examination of both patient and health
 2-8     care provider histories to identify unusual or suspicious claims or
 2-9     patterns of claims.  A state agency may enter into a memorandum of
2-10     understanding with the comptroller regarding the use and
2-11     confidentiality of the information provided.  This subsection does
2-12     not require a state agency to provide confidential information if
2-13     release of the information is prohibited by law.
2-14           (d)  Each state agency that administers a program identified
2-15     by Subsection (a), in consultation with the comptroller, shall
2-16     establish performance measures to be used to evaluate the agency's
2-17     fraud control procedures.
2-18           (e) [(c)]  The comptroller shall report the results of the
2-19     study to each state agency that administers a program included in
2-20     the study so that the agency may modify its fraud control
2-21     procedures as necessary.  The report must indicate whether the
2-22     level of fraud in each program included in the study has increased,
2-23     decreased, or remained constant since the last report of the
2-24     comptroller under this section.
2-25           SECTION 2.  Section 531.102, Government Code, is amended by
2-26     adding Subsection (e) to read as follows:
2-27           (e)  The commission shall ensure that each health and human
 3-1     services agency that administers a part of the Medicaid program
 3-2     maintains and regularly updates a list of the names and telephone
 3-3     numbers of all Medicaid recipients.  The list may be used to
 3-4     confirm the delivery to each recipient of services for which
 3-5     benefits are received.
 3-6           SECTION 3.  The Texas Employees Uniform Group Insurance
 3-7     Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code) is
 3-8     amended by adding Section 4H to read as follows:
 3-9           Sec. 4H.  TELEPHONE NUMBER FOR PROGRAM PARTICIPANTS.  The
3-10     trustee shall maintain and regularly update a list of the names and
3-11     telephone numbers of all participants in any of the group health
3-12     coverages offered under this Act.  The list may be used to confirm
3-13     the delivery to each participant of services for which coverage is
3-14     provided.
3-15           SECTION 4.  Section 501.0431, Labor Code, is amended to read
3-16     as follows:
3-17           Sec. 501.0431.  DIRECTOR'S DUTIES [COMPILATION OF STATISTICS]
3-18     RELATING TO FRAUD.  (a)  The director shall maintain statistics on
3-19     the number, type, and disposition of fraudulent claims for medical
3-20     benefits under this chapter.
3-21           (b)  The director shall maintain and regularly update a list
3-22     of the names and telephone numbers of all persons entitled to
3-23     medical benefits under this chapter. The list may be used to
3-24     confirm the delivery to each person of services for which medical
3-25     benefits are provided.
3-26           SECTION 5.  The importance of this legislation and the
3-27     crowded condition of the calendars in both houses create an
 4-1     emergency and an imperative public necessity that the
 4-2     constitutional rule requiring bills to be read on three several
 4-3     days in each house be suspended, and this rule is hereby suspended,
 4-4     and that this Act take effect and be in force from and after its
 4-5     passage, and it is so enacted.