By Maxey H.B. No. 1670
76R4910 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the investigation and prosecution of fraud in the
1-3 uniform group insurance program for state employees; providing
1-4 administrative penalties.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 ARTICLE 1. POWERS AND DUTIES OF THE EMPLOYEES
1-7 RETIREMENT SYSTEM OF TEXAS
1-8 SECTION 1.01. The Texas Employees Uniform Group Insurance
1-9 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code) is
1-10 amended by amending Section 4B and by adding Sections 4D, 4E, 4F,
1-11 and 4G to read as follows:
1-12 Sec. 4B. ADJUDICATION OF CLAIMS; FRAUDULENT CLAIMS. (a)
1-13 The executive director of the Employees Retirement System of Texas
1-14 has exclusive authority to determine all questions relating to
1-15 enrollment in or payment of claims arising from programs or
1-16 coverages provided under authority of this Act, other than
1-17 questions relating to payment of claims by a health maintenance
1-18 organization.
1-19 (b) [(a-1)] If the executive director determines that a
1-20 participant has obtained coverage under any program provided under
1-21 the authority of this Act through the use of any material
1-22 misrepresentation or fraud or has fraudulently induced the
1-23 extension of coverage by making a material misrepresentation or by
1-24 supplying false information on any application for coverage or
2-1 related documentation or in any communication, the executive
2-2 director may rescind the coverage to the date of the inception of
2-3 the coverage or to the date of the fraudulent act or material
2-4 misrepresentation, deny any claim arising out of the fraudulently
2-5 induced coverage, or both. Remedies available to the executive
2-6 director under this subsection are in addition to and independent
2-7 of any expulsion action that may be instituted under Section 13A of
2-8 this Act.
2-9 (c) If the executive director determines that a health care
2-10 provider has obtained payments under any program provided under the
2-11 authority of this Act through a fraudulent insurance act, the
2-12 executive director shall take action against the provider as
2-13 provided by Section 4D of this Act.
2-14 (d) A decision of the executive director under Subsection
2-15 (b) or (c) of this section [subsection] may be appealed to the
2-16 trustee as provided by Subsection (f) [(c)] of this section.
2-17 (e) [(b)] The authority of the executive director to
2-18 determine questions includes the authority to determine that a
2-19 claim arising under any program administered by the trustee may
2-20 expose the program to double or multiple liability. The executive
2-21 director may cause suit concerning the claim to be filed in a
2-22 district court in Travis County on behalf of the Employees
2-23 Retirement System of Texas to protect the program from double or
2-24 multiple liability.
2-25 (f) [(c)] A decision by the executive director under
2-26 Subsection (a), (b), or (c) [(a-1)] of this section may be appealed
2-27 only to the trustee. An appeal to the trustee is a contested case
3-1 under the administrative procedure law, Chapter 2001, Government
3-2 Code. Standing to pursue an administrative appeal under this
3-3 section is limited to employees, annuitants, and covered dependents
3-4 participating in the Texas employees uniform group insurance
3-5 program and to health care providers providing services under that
3-6 program or, after the death of a participant or an affected
3-7 provider, to that person's [the participant's] estate, personal
3-8 representative, heirs at law, or designated beneficiary.
3-9 (g) [(d)] On appeal of a decision made by the trustee under
3-10 Subsection (f) [(c)] of this section, the standard of review is by
3-11 substantial evidence.
3-12 (h) [(e)] The trustee may delegate its duties to hear
3-13 appeals to the executive director.
3-14 (i) [(f)] The executive director may delegate the duties of
3-15 the executive director under this section to another person who is
3-16 employed by the Employees Retirement System of Texas.
3-17 (j) The trustee shall maintain a toll-free telephone number
3-18 for the receipt of complaints regarding fraudulent insurance acts
3-19 by participants or health care providers. The trustee shall
3-20 provide participants with information regarding the telephone
3-21 number during each annual enrollment period and periodically shall
3-22 notify employees of the telephone number by including information
3-23 with employee pay statements.
3-24 (k) The executive director shall implement annual training
3-25 classes for appropriate members of the staff of the trustee and
3-26 contractors or administering firms who process medical claims under
3-27 this Act to assist those persons in identifying potential
4-1 misrepresentation or fraud in the operation of the uniform group
4-2 insurance program established by this Act. The executive director
4-3 may contract with the Health and Human Services Commission or with
4-4 a private entity for the operation of the training classes.
4-5 (l) Each carrier and health care provider who participates
4-6 in the uniform group insurance program shall, as a condition of
4-7 that participation, cooperate fully in any investigation of a
4-8 fraudulent insurance act that is conducted by the executive
4-9 director or the Texas Department of Insurance, including providing
4-10 to the trustee timely access to patient medical records determined
4-11 by the trustee to be necessary to conduct an investigation.
4-12 Notwithstanding any other law regarding the confidentiality of
4-13 patient records, the trustee is entitled to access to patient
4-14 medical records for the limited purpose provided by this subsection
4-15 and is a "governmental agency" for purposes of Section 5.08,
4-16 Medical Practice Act (Article 4495b, Vernon's Texas Civil
4-17 Statutes). A medical record submitted to the trustee under this
4-18 subsection is confidential and is not subject to disclosure under
4-19 Chapter 552, Government Code.
4-20 Sec. 4D. FRAUDULENT INSURANCE ACTS BY PROVIDERS. (a) The
4-21 executive director shall investigate each complaint alleging a
4-22 fraudulent insurance act made by an annuitant, an employee, a
4-23 health care provider, or a carrier regarding a health care provider
4-24 participating in a health benefit plan operated under the uniform
4-25 group insurance program.
4-26 (b) If, after initial investigation, the executive director
4-27 determines that the complaint is unfounded, the executive director
5-1 shall terminate the investigation. If the executive director
5-2 determines that further action is warranted, the executive director
5-3 shall refer the complaint to the trustee for appropriate sanctions
5-4 or administrative action and shall provide information regarding
5-5 the complaint and the action taken to the Texas Department of
5-6 Insurance and the affected carrier.
5-7 (c) Sanctions against a health care provider may include:
5-8 (1) exclusion from participation as a provider in the
5-9 program;
5-10 (2) withholding during the pendency of an
5-11 investigation, payments to be made to the provider;
5-12 (3) recoupment of unauthorized payments from future
5-13 payments made to the provider; and
5-14 (4) restrictions on provider reimbursement.
5-15 (d) Administrative actions against a health care provider
5-16 may include:
5-17 (1) peer review of claims;
5-18 (2) required participation by the provider in
5-19 educational programs conducted by the trustee or the Texas
5-20 Department of Insurance regarding insurance fraud;
5-21 (3) required prior authorization for claims;
5-22 (4) review of payments made to the provider, both
5-23 before and after health care services are provided; and
5-24 (5) referral to the appropriate licensing agency for
5-25 further disciplinary action.
5-26 (e) The executive director shall use fraud detection
5-27 software to identify suspicious provider billing patterns in the
6-1 claims history files of the system. The executive director shall
6-2 report the results of the use of the software to the trustee and
6-3 the commissioner of insurance at least monthly.
6-4 Sec. 4E. CLAIMS AUDIT. (a) The executive director shall
6-5 conduct a quarterly audit of health care claims as provided by this
6-6 section.
6-7 (b) The executive director shall randomly select claims
6-8 submitted under the uniform group insurance program, in a
6-9 percentage set by the trustee of total claims made during the
6-10 preceding quarter, to audit the claims to determine the validity of
6-11 the claims. In performing the audit, the executive director shall
6-12 interview employees, annuitants, and dependents in person or by
6-13 telephone to ensure that the services were received. The audit
6-14 must also include a review of contextual patient information and
6-15 the patient's medical records.
6-16 (c) If the executive director determines on the basis of the
6-17 audit that a claim is fraudulent, the executive director shall
6-18 refer the claim to the trustee and the Texas Department of
6-19 Insurance for further investigation.
6-20 (d) The executive director may contract with a private
6-21 entity for the operation of the audit.
6-22 Sec. 4F. COOPERATION WITH INSURANCE DEPARTMENT; MEMORANDUM
6-23 OF UNDERSTANDING. (a) The trustee and the commissioner of
6-24 insurance by rule shall adopt guidelines and priorities for
6-25 referring cases of alleged fraudulent insurance acts by health care
6-26 providers participating in the program.
6-27 (b) The executive director shall maintain a detailed record
7-1 of those cases, including:
7-2 (1) the total number of cases referred to the Texas
7-3 Department of Insurance each fiscal year; and
7-4 (2) for each specific case:
7-5 (A) the type of fraudulent insurance act
7-6 alleged; and
7-7 (B) the date of the referral to the Texas
7-8 Department of Insurance.
7-9 (c) The trustee and the Texas Department of Insurance shall
7-10 enter into a memorandum of understanding regarding the processing
7-11 of referrals of suspected fraudulent insurance acts in the uniform
7-12 group insurance program and the payment of the costs of prosecution
7-13 of fraud cases.
7-14 Sec. 4G. ADMINISTRATIVE PENALTY. (a) The trustee may
7-15 impose an administrative penalty on a participant or health care
7-16 provider who commits a fraudulent insurance act in obtaining a
7-17 benefit or a payment under this Act.
7-18 (b) The amount of the penalty may not exceed $10,000, and
7-19 each day a violation continues or occurs is a separate violation
7-20 for the purpose of imposing a penalty. The amount shall be based
7-21 on:
7-22 (1) the seriousness of the violation, including the
7-23 nature, circumstances, extent, and gravity of the violation;
7-24 (2) the history of previous violations;
7-25 (3) the amount necessary to deter a future violation;
7-26 (4) efforts to correct the violation; and
7-27 (5) any other matter that justice may require.
8-1 (c) The enforcement of the penalty may be stayed during the
8-2 time the order is under judicial review if the person pays the
8-3 penalty to the clerk of the court or files a supersedeas bond with
8-4 the court in the amount of the penalty. A person who cannot afford
8-5 to pay the penalty or file the bond may stay the enforcement by
8-6 filing an affidavit in the manner required by the Texas Rules of
8-7 Civil Procedure for a party who cannot afford to file security for
8-8 costs, subject to the right of the board to contest the affidavit
8-9 as provided by those rules.
8-10 (d) The attorney general may sue to collect the penalty.
8-11 (e) Fifty percent of an administrative penalty collected
8-12 under this section shall be deposited in the employees life,
8-13 accident, and health insurance and benefits fund established under
8-14 Section 16 of this Act and may be spent by the trustee in
8-15 investigating and prosecuting fraudulent insurance acts committed
8-16 against the state employees uniform group benefits program. The
8-17 remainder of the administrative penalty shall be remitted to the
8-18 comptroller for deposit in the general revenue fund.
8-19 (f) A proceeding to impose the penalty is considered to be a
8-20 contested case under Chapter 2001, Government Code.
8-21 SECTION 1.02. Section 815.510, Government Code, is amended
8-22 to read as follows:
8-23 Sec. 815.510. ANNUAL REPORT. (a) The Employees Retirement
8-24 System of Texas shall submit a report not later than the 25th day
8-25 of the month following the end of each fiscal year to the governor,
8-26 the lieutenant governor, the speaker of the house of
8-27 representatives, the executive director of the State Pension Review
9-1 Board, the appropriate oversight committees of the house and
9-2 senate, and the Legislative Budget Board. The report shall
9-3 include:
9-4 (1) the following information regarding the
9-5 investments made by the retirement system:
9-6 (A) [(1)] the current end-of-fiscal-year market
9-7 value of the trust fund;
9-8 (B) [(2)] the asset allocations of the trust
9-9 fund expressed in percentages of stocks, fixed income, cash, or
9-10 other financial investments; and
9-11 (C) [(3)] the investment performance of the
9-12 trust fund utilizing accepted industry measurement standards; and
9-13 (2) a description of the activities conducted during
9-14 the preceding fiscal year by the retirement system and the Texas
9-15 Department of Insurance under Sections 4B, 4D, 4E, and 4F, Texas
9-16 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
9-17 Vernon's Texas Insurance Code), to combat fraudulent insurance acts
9-18 by health care providers in the operation of the state employees
9-19 health benefits program.
9-20 (b) The report required by this section is the only periodic
9-21 report of investments required to be made by the retirement system
9-22 other than a report required by [Section 815.108 or] the General
9-23 Appropriations Act.
9-24 ARTICLE 2. POWERS AND DUTIES OF
9-25 TEXAS DEPARTMENT OF INSURANCE
9-26 SECTION 2.01. Chapter 1, Insurance Code, is amended by
9-27 adding Article 1.64 to read as follows:
10-1 Art. 1.64. ADMINISTRATIVE ACTIONS AGAINST INSURANCE FRAUD IN
10-2 GROUP INSURANCE PROGRAM FOR STATE EMPLOYEES. (a) The department,
10-3 through the insurance fraud division and in cooperation with the
10-4 Employees Retirement System of Texas, shall bring an administrative
10-5 action under this article against a health care provider who
10-6 commits a fraudulent insurance act regarding the group insurance
10-7 program for state employees administered under the Texas Employees
10-8 Uniform Group Insurance Benefits Act (Article 3.50-2, Vernon's
10-9 Texas Insurance Code) that results in payments to the provider that
10-10 are not authorized under that program.
10-11 (b) On determination that a health care provider has
10-12 committed a fraudulent insurance act subject to Subsection (a) of
10-13 this article, the commissioner may impose an administrative penalty
10-14 under Article 1.10E of this code in an amount not to exceed $10,000
10-15 plus twice the amount of the inappropriate payment.
10-16 (c) Notwithstanding Section 6, Article 1.10E of this code,
10-17 50 percent of an administrative penalty collected under this
10-18 article shall be deposited in the Texas Department of Insurance
10-19 operating fund established under Article 1.31A of this code and may
10-20 be spent by the department in investigating and prosecuting
10-21 fraudulent insurance acts committed against state-funded health
10-22 care programs. The remainder of the administrative penalty shall be
10-23 remitted to the comptroller for deposit in the general revenue
10-24 fund.
10-25 ARTICLE 3. QUI TAM ACTION
10-26 SECTION 3.01. Chapter 1, Insurance Code, is amended by
10-27 adding Article 1.65 to read as follows:
11-1 Art. 1.65. ACTION BY PRIVATE PERSON
11-2 Sec. 1. ACTION BY PRIVATE PERSON AUTHORIZED. (a) A person
11-3 may bring a civil action for a fraudulent insurance act committed
11-4 in violation of Section 4B, Texas Employees Uniform Group Insurance
11-5 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code), for
11-6 the person and for the state. The action shall be brought in the
11-7 name of the state.
11-8 (b) In an action brought under this article, a person who
11-9 commits a fraudulent insurance act with respect to a claim under
11-10 the Texas Employees Uniform Group Insurance Benefits Act (Article
11-11 3.50-2, Vernon's Texas Insurance Code) is liable for the amount of
11-12 loss incurred by the uniform group insurance program or a carrier
11-13 who participates in the program as a result of the loss, plus an
11-14 amount equivalent to the amount of the administrative penalty that
11-15 may be assessed under that Act.
11-16 Sec. 2. INITIATION OF ACTION. (a) A person bringing an
11-17 action under this article shall serve a copy of the petition and a
11-18 written disclosure of substantially all material evidence and
11-19 information the person possesses on the attorney general in
11-20 compliance with the Texas Rules of Civil Procedure.
11-21 (b) The petition shall be filed in camera and shall remain
11-22 under seal until at least the 60th day after the date the petition
11-23 is filed. The petition may not be served on the defendant until
11-24 the court orders service on the defendant.
11-25 (c) The state may elect to intervene and proceed with the
11-26 action not later than the 60th day after the date the attorney
11-27 general receives the petition and the material evidence and
12-1 information.
12-2 (d) The state may, for good cause shown, move the court to
12-3 extend the time during which the petition remains under seal under
12-4 Subsection (b) of this section. A motion under this subsection may
12-5 be supported by affidavits or other submissions in camera.
12-6 (e) An action under this article may be dismissed before the
12-7 end of the period prescribed by Subsection (b) of this section, as
12-8 extended as provided by Subsection (d) of this section, if
12-9 applicable, only if the court and the attorney general consent in
12-10 writing to the dismissal and state their reasons for consenting.
12-11 Sec. 3. ANSWER BY DEFENDANT. A defendant is not required to
12-12 file an answer to a petition filed under this article until the
12-13 20th day after the date the petition is unsealed and served on the
12-14 defendant in compliance with the Texas Rules of Civil Procedure.
12-15 Sec. 4. STATE'S DECISION TO CONTINUE ACTION. Not later than
12-16 the last day of the period prescribed by Section 2(b) of this
12-17 article, as extended as provided by Section 2(d) of this article,
12-18 if applicable, the state shall notify the court that the state:
12-19 (1) will intervene and proceed with the action; or
12-20 (2) declines to intervene and proceed with the action.
12-21 Sec. 5. INTERVENTION BY OTHER PARTIES PROHIBITED. A person
12-22 other than the state may not intervene or bring a related action
12-23 based on the facts underlying a pending action brought under this
12-24 article.
12-25 Sec. 6. RIGHTS OF PARTIES IF STATE INTERVENES AND PROCEEDS
12-26 WITH ACTION. (a) If the state proceeds with the action, the state
12-27 has the primary responsibility for prosecuting the action and is
13-1 not bound by an act of the person bringing the action. The person
13-2 bringing the action has the right to continue as a party to the
13-3 action subject to the limitations set forth by this section.
13-4 (b) The state may dismiss the action notwithstanding the
13-5 objections of the person bringing the action if:
13-6 (1) the attorney general notifies the person that the
13-7 state has filed a motion to dismiss; and
13-8 (2) the court provides the person with an opportunity
13-9 for a hearing on the motion.
13-10 (c) The state may settle the action with the defendant
13-11 notwithstanding the objections of the person bringing the action if
13-12 the court determines, after a hearing, that the proposed settlement
13-13 is fair, adequate, and reasonable under all the circumstances. On
13-14 a showing of good cause, the hearing may be held in camera.
13-15 (d) On a showing by the state that unrestricted
13-16 participation during the course of the litigation by the person
13-17 bringing the action would interfere with or unduly delay the
13-18 state's prosecution of the case, or would be repetitious,
13-19 irrelevant, or for purposes of harassment, the court may impose
13-20 limitations on the person's participation, including:
13-21 (1) limiting the number of witnesses the person may
13-22 call;
13-23 (2) limiting the length of the testimony of witnesses
13-24 called by the person;
13-25 (3) limiting the person's cross-examination of
13-26 witnesses; or
13-27 (4) otherwise limiting the participation by the person
14-1 in the litigation.
14-2 (e) On a showing by the defendant that unrestricted
14-3 participation during the course of the litigation by the person
14-4 bringing the action would be for purposes of harassment or would
14-5 cause the defendant undue burden or unnecessary expense, the court
14-6 may limit the participation by the person in the litigation.
14-7 Sec. 7. RIGHTS OF PARTIES IF STATE DOES NOT INTERVENE AND
14-8 PROCEED WITH ACTION. (a) If the state elects not to proceed with
14-9 the action, the person bringing the action may conduct the action.
14-10 (b) If the state requests pleadings and deposition
14-11 transcripts, the parties shall serve the attorney general with
14-12 copies of all pleadings filed in the action and shall send the
14-13 attorney general copies of all deposition transcripts at the
14-14 state's expense.
14-15 (c) The court, without limiting the status and rights of the
14-16 person bringing the action, may permit the state to intervene at a
14-17 later date on a showing of good cause.
14-18 Sec. 8. STAY OF CERTAIN DISCOVERY. (a) Regardless of
14-19 whether the state proceeds with the action, on a showing by the
14-20 state that discovery by the person bringing the action would
14-21 interfere with the state's investigation or prosecution of a
14-22 criminal or civil matter arising out of the same facts, the court
14-23 may stay the discovery for a period not to exceed 60 days.
14-24 (b) The court shall hear a motion to stay discovery under
14-25 this section in camera.
14-26 (c) The court may extend the period prescribed by Subsection
14-27 (a) on a further showing in camera that the state has pursued the
15-1 criminal or civil investigation or proceedings with reasonable
15-2 diligence and that discovery in the civil action will interfere
15-3 with the ongoing criminal or civil investigation or proceedings.
15-4 Sec. 9. PURSUIT OF ALTERNATE REMEDY BY STATE.
15-5 Notwithstanding Section 1 of this article, the state may elect to
15-6 pursue the state's claim through any alternate remedy available to
15-7 the state, including any administrative proceeding to determine an
15-8 administrative penalty.
15-9 Sec. 10. AWARD TO PRIVATE PLAINTIFF. (a) If the state
15-10 proceeds with an action under this article, the person bringing the
15-11 action is entitled, except as provided by Subsection (b) of this
15-12 section, to receive at least 10 percent but not more than 25
15-13 percent of the proceeds of the action, depending on the extent to
15-14 which the person substantially contributed to the prosecution of
15-15 the action.
15-16 (b) If the court finds that the action is based primarily on
15-17 disclosures of specific information, other than information
15-18 provided by the person bringing the action, relating to allegations
15-19 or transactions in a criminal or civil proceeding, in a legislative
15-20 or administrative report, hearing, audit, or investigation, or from
15-21 the news media, the court may award to the person bringing the
15-22 action the amount the court considers appropriate but not more than
15-23 seven percent of the proceeds of the action. The court shall
15-24 consider the significance of the information and the role of the
15-25 person bringing the action in advancing the case to litigation.
15-26 (c) If the state does not proceed with an action under this
15-27 article, the person bringing the action or settling the claim is
16-1 entitled to receive an amount that the court decides is reasonable
16-2 for collecting the civil penalty and damages. The amount may not
16-3 be less than 25 percent or more than 30 percent of the proceeds of
16-4 the action.
16-5 (d) A payment to a person under this section shall be made
16-6 from the proceeds of the action. A person receiving a payment
16-7 under this section is also entitled to receive an amount for
16-8 reasonable expenses that the court finds to have been necessarily
16-9 incurred, plus reasonable attorney's fees and costs. Expenses,
16-10 fees, and costs shall be awarded against the defendant.
16-11 (e) In this section, "proceeds of the action" includes
16-12 proceeds of a settlement of the action.
16-13 Sec. 11. REDUCTION OF AWARD. (a) Regardless of whether the
16-14 state proceeds with the action, if the court finds that the action
16-15 was brought by a person who planned and initiated the violation on
16-16 which the action was brought, the court may, to the extent the
16-17 court considers appropriate, reduce the share of the proceeds of
16-18 the action the person would otherwise receive under Section 10 of
16-19 this article, taking into account the person's role in advancing
16-20 the case to litigation and any relevant circumstances pertaining to
16-21 the violation.
16-22 (b) If the person bringing the action is convicted of
16-23 criminal conduct arising from the person's fraudulent insurance
16-24 act, the court shall dismiss the person from the civil action and
16-25 the person may not receive any share of the proceeds of the action.
16-26 A dismissal under this subsection does not prejudice the right of
16-27 the state to continue the action.
17-1 Sec. 12. AWARD TO DEFENDANT FOR FRIVOLOUS ACTION. (a)
17-2 Chapter 10, Civil Practice and Remedies Code, applies in an action
17-3 under this article in which the state does not proceed with the
17-4 action and the person originally bringing the action conducts the
17-5 action.
17-6 (b) Chapter 105, Civil Practice and Remedies Code, applies
17-7 in an action under this article in which the state conducts the
17-8 action.
17-9 Sec. 13. CERTAIN ACTIONS BARRED. (a) A person may not
17-10 bring an action under this article that is based on allegations or
17-11 transactions that are the subject of a pending civil suit or an
17-12 administrative penalty proceeding in which the state is a party.
17-13 (b) A person may not bring an action under this article that
17-14 is based on the public disclosure of allegations or transactions in
17-15 a criminal or civil hearing, in a legislative or administrative
17-16 report, hearing, audit, or investigation, or from the news media,
17-17 unless the person bringing the action is an original source of the
17-18 information. In this subsection, "original source" means an
17-19 individual who has direct and independent knowledge of the
17-20 information on which the allegations are based and has voluntarily
17-21 provided the information to the state before filing an action under
17-22 this article that is based on the information.
17-23 Sec. 14. STATE NOT LIABLE FOR CERTAIN EXPENSES. The state
17-24 is not liable for expenses that a person incurs in bringing an
17-25 action under this section.
17-26 Sec. 15. RETALIATION BY EMPLOYER AGAINST PERSON BRINGING
17-27 SUIT PROHIBITED. (a) A person who is discharged, demoted,
18-1 suspended, threatened, harassed, or in any other manner
18-2 discriminated against in the terms of employment by the person's
18-3 employer because of a lawful act taken by the person in furtherance
18-4 of an action under this article, including investigation for,
18-5 initiation of, testimony for, or assistance in an action filed or
18-6 to be filed under this article, is entitled to:
18-7 (1) reinstatement with the same seniority status the
18-8 person would have had but for the discrimination; and
18-9 (2) an amount equal to not less than:
18-10 (A) two times the amount of back pay;
18-11 (B) interest on the back pay; and
18-12 (C) compensation for any special damages
18-13 sustained as a result of the discrimination, including litigation
18-14 costs and reasonable attorney's fees.
18-15 (b) A person may bring an action in a district court for the
18-16 relief provided in this section.
18-17 ARTICLE 4. TRANSITION
18-18 SECTION 4.01. The Employees Retirement System of Texas shall
18-19 implement the toll-free telephone number required under Section
18-20 4B(j), Texas Employees Uniform Group Insurance Benefits Act
18-21 (Article 3.50-2, Vernon's Texas Insurance Code), as added by this
18-22 Act, not later than January 1, 2000.
18-23 SECTION 4.02. The Employees Retirement System of Texas shall
18-24 implement the training classes required under Section 4B(k), Texas
18-25 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
18-26 Vernon's Texas Insurance Code), as added by this Act, not later
18-27 than January 1, 2000.
19-1 SECTION 4.03. (a) The executive director of the Employees
19-2 Retirement System of Texas shall use fraud detection software as
19-3 required under Section 4D(e), Texas Employees Uniform Group
19-4 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
19-5 Code), as added by this Act, not later than September 1, 2000.
19-6 (b) Not later than March 1, 2000, the Employees Retirement
19-7 System of Texas shall analyze the fraud detection program used by
19-8 the Health and Human Services Commission under Chapter 22, Human
19-9 Resources Code, for the detection of fraud in the Medicaid program.
19-10 If the retirement system determines that participation in that
19-11 program would result in compliance with the requirement adopted
19-12 under Section 4D(e), Texas Employees Uniform Group Insurance
19-13 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code), as
19-14 added by this Act, with greater efficiency and less cost than
19-15 implementation of an independent program, the retirement system
19-16 shall enter into a memorandum of understanding with the Health and
19-17 Human Services Commission regarding that participation not later
19-18 than July 1, 2000, and shall pay a proportionate share of the
19-19 operation of the fraud detection program.
19-20 SECTION 4.04. The Employees Retirement System of Texas and
19-21 the Texas Department of Insurance shall enter into the memorandum
19-22 of understanding required under Section 4F, Texas Employees Uniform
19-23 Group Insurance Benefits Act (Article 3.50-2, Vernon's Texas
19-24 Insurance Code), as added by this Act, not later than January 1,
19-25 2000.
19-26 SECTION 4.05. This Act applies only to an administrative
19-27 penalty assessed for conduct that occurs on or after the effective
20-1 date of this Act. An administrative penalty assessed for conduct
20-2 that occurred before the effective date of this Act is governed by
20-3 the law as it existed immediately before the effective date of this
20-4 Act, and that law is continued in effect for that purpose.
20-5 SECTION 4.06. Article 1.65, Insurance Code, as added by this
20-6 Act, applies only to a cause of action that accrues on or after the
20-7 effective date of this Act. A cause of action that accrues before
20-8 that date is governed by the law as it existed immediately before
20-9 the effective date of this Act, and that law is continued in effect
20-10 for that purpose.
20-11 ARTICLE 5. EFFECTIVE DATE; EMERGENCY
20-12 SECTION 5.01. This Act takes effect September 1, 1999.
20-13 SECTION 5.02 The importance of this legislation and the
20-14 crowded condition of the calendars in both houses create an
20-15 emergency and an imperative public necessity that the
20-16 constitutional rule requiring bills to be read on three several
20-17 days in each house be suspended, and this rule is hereby suspended.