By Wise H.B. No. 2194
76R6785 PEP-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the criminal prosecution of insurance fraud.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 35.01, Penal Code, is amended to read as
1-5 follows:
1-6 Sec. 35.01. DEFINITIONS. In this chapter:
1-7 (1) ["Health care goods" means a tangible product,
1-8 device, medicine, or other object provided in conjunction with a
1-9 health care service.]
1-10 [(2) "Health care provider" means a person who renders
1-11 health care services or an agent or employee of an organization
1-12 that renders or provides a facility and means to render health care
1-13 services. The term includes a physician, surgeon, person who may
1-14 be selected by an insured or a beneficiary under Article 21.52,
1-15 Insurance Code, and person defined as a provider of health care
1-16 under Section 2.05(d)(1), Medical Practice Act (Article 4495b,
1-17 Vernon's Texas Civil Statutes).]
1-18 [(3) "Health care service" means a service that is
1-19 intended to improve or maintain the physical or mental condition of
1-20 an individual and that is rendered, directed, or supervised by a
1-21 health care provider.]
1-22 [(4)] "Insurer" means any [a] person, firm,
1-23 corporation, limited liability company, association, or aggregation
1-24 of persons that:
2-1 (A) [who] engages in the business of insurance
2-2 in this state, as defined by Section 2(a), Article 1.14-1,
2-3 Insurance Code;
2-4 (B) is subject to the supervision of or is
2-5 regulated by the commissioner of insurance under the Insurance
2-6 Code; or
2-7 (C) is subject to the supervision of or is
2-8 regulated by any equivalent insurance supervisory or regulatory
2-9 official of another state [including:]
2-10 [(A) an insurer that is not authorized to do
2-11 business in this state;]
2-12 [(B) a health maintenance organization;]
2-13 [(C) a group hospital service corporation
2-14 regulated under Chapter 20, Insurance Code; and]
2-15 [(D) any person who self-insures and provides
2-16 health care benefits to the person's employees].
2-17 (2) [(5)] "Statement" means an oral or written
2-18 communication or a record or documented representation of fact
2-19 evidencing a loss, injury, or expense. The term includes any
2-20 notice, account statement, invoice, receipt of payment, bill of
2-21 lading, proof of loss, property damage estimate, health care record
2-22 or test result, or other evidence of loss, injury, or expense, and
2-23 includes computer-generated information.
2-24 SECTION 2. Section 35.02, Penal Code, is amended to read as
2-25 follows:
2-26 Sec. 35.02. INSURANCE FRAUD. (a) A person commits an
2-27 offense if, with intent to defraud or deceive an insurer, the
3-1 person causes to be prepared or presents to an insurer in support
3-2 of a claim for payment under an [a health or property and casualty]
3-3 insurance policy, certificate of insurance, or plan of benefits a
3-4 statement that the person knows contains false or misleading
3-5 information concerning a matter that is material to the claim, or
3-6 conceals or fails to disclose information concerning a matter that
3-7 is material to the claim, and the matter affects a person's right
3-8 to a payment or the amount of payment to which a person is
3-9 entitled.
3-10 (b) A person commits an offense if, with intent to defraud
3-11 or deceive an insurer, the person solicits, offers, pays, confers,
3-12 agrees to confer, or receives a benefit in connection with the
3-13 provision [furnishing] of any [health care] goods or services for
3-14 which a claim for payment is submitted under an [a health or
3-15 property and casualty] insurance policy, certificate of insurance,
3-16 or plan of benefits.
3-17 (c) [For purposes of Subsection (a), information concerning
3-18 a matter that is material to a claim for payment under an insurance
3-19 policy includes information concerning:]
3-20 [(1) whether health care goods or services were
3-21 provided;]
3-22 [(2) whether health care goods or services were
3-23 medically necessary under professionally accepted standards;]
3-24 [(3) the nature of the health care goods or services
3-25 provided;]
3-26 [(4) the date on which health care goods or services
3-27 were provided;]
4-1 [(5) the medical record of goods or services provided;]
4-2 [(6) the condition treated or diagnosis made;]
4-3 [(7) the identity and applicable license of the
4-4 provider or the recipient of health care goods or services;]
4-5 [(8) whether property was damaged or lost in the
4-6 manner and under the circumstances described in a statement related
4-7 to a claim for insurance payment; or]
4-8 [(9) whether any other claim for insurance payment has
4-9 been communicated to any other insurer concerning property damage
4-10 or loss to the same property.]
4-11 [(d)] An offense under this section is:
4-12 (1) a Class C misdemeanor if the asserted value of the
4-13 claim is less than $20;
4-14 (2) a Class B misdemeanor if the asserted value of the
4-15 claim is $20 or more but less than $500;
4-16 (3) a Class A misdemeanor if:
4-17 (A) the asserted value of the claim is $500 or
4-18 more but less than $1,500; or
4-19 (B) the asserted value of the claim cannot be
4-20 reasonably ascertained under this section;
4-21 (4) a state jail felony if the asserted value of the
4-22 claim is $1,500 or more but less than $20,000;
4-23 (5) a felony of the third degree if the asserted value
4-24 of the claim is $20,000 or more but less than $100,000;
4-25 (6) a felony of the second degree if the asserted
4-26 value of the claim is $100,000 or more but less than $200,000; or
4-27 (7) a felony of the first degree if:
5-1 (A) the asserted value of the claim is $200,000
5-2 or more; or
5-3 (B) the asserted value of the claim is less than
5-4 $200,000 and, in connection with the commission of the offense, the
5-5 actor placed a person at risk of death or serious bodily injury.
5-6 (d) For purposes of Subsection (c), the asserted value of a
5-7 claim is the value of the claim asserted by the claimant less any
5-8 portion of that value that is attributable to a valid loss, injury,
5-9 or expense.
5-10 (e) For purposes of Subsection (c), if the value of the
5-11 claim is not asserted by the claimant, the value of the claim is
5-12 considered to be:
5-13 (1) the fair market value of the goods or services
5-14 that are the subject of the claim at the time the claim is made; or
5-15 (2) if the fair market value cannot be ascertained,
5-16 the cost of replacing the goods or services that are the subject of
5-17 the claim within a reasonable time after the claim is made.
5-18 SECTION 3. Section 35.04(b), Penal Code, is amended to read
5-19 as follows:
5-20 (b) The attorney general or an attorney employed by the
5-21 Texas Department of Insurance in the insurance fraud unit may
5-22 prosecute or assist in the prosecution of an offense under Section
5-23 35.02 on the request of the attorney representing the state
5-24 described by Subsection (a).
5-25 SECTION 4. Section 71.02(a), Penal Code, is amended to read
5-26 as follows:
5-27 (a) A person commits an offense if, with the intent to
6-1 establish, maintain, or participate in a combination or in the
6-2 profits of a combination or as a member of a criminal street gang,
6-3 the person [he] commits or conspires to commit one or more of the
6-4 following:
6-5 (1) murder, capital murder, arson, aggravated robbery,
6-6 robbery, burglary, theft, aggravated kidnapping, kidnapping,
6-7 aggravated assault, aggravated sexual assault, sexual assault,
6-8 forgery, deadly conduct, assault punishable as a Class A
6-9 misdemeanor, burglary of a motor vehicle, or unauthorized use of a
6-10 motor vehicle;
6-11 (2) any gambling offense punishable as a Class A
6-12 misdemeanor;
6-13 (3) promotion of prostitution, aggravated promotion of
6-14 prostitution, or compelling prostitution;
6-15 (4) unlawful manufacture, transportation, repair, or
6-16 sale of firearms or prohibited weapons;
6-17 (5) unlawful manufacture, delivery, dispensation, or
6-18 distribution of a controlled substance or dangerous drug, or
6-19 unlawful possession of a controlled substance or dangerous drug
6-20 through forgery, fraud, misrepresentation, or deception;
6-21 (6) any unlawful wholesale promotion or possession of
6-22 any obscene material or obscene device with the intent to wholesale
6-23 promote the same;
6-24 (7) any unlawful employment, authorization, or
6-25 inducing of a child younger than 17 years of age in an obscene
6-26 sexual performance;
6-27 (8) any felony offense under Chapter 32, Penal Code;
7-1 (9) any offense under Chapter 34, 35, or 36, Penal
7-2 Code; or
7-3 (10) [any offense under Chapter 34, Penal Code; or]
7-4 [(11)] any offense under Section 37.11(a), Penal Code.
7-5 SECTION 5. Article 12.01, Code of Criminal Procedure, is
7-6 amended to read as follows:
7-7 Art. 12.01. FELONIES. Except as provided in Article 12.03,
7-8 felony indictments may be presented within these limits, and not
7-9 afterward:
7-10 (1) no limitation: murder and manslaughter;
7-11 (2) ten years from the date of the commission of the
7-12 offense:
7-13 (A) theft of any estate, real, personal or
7-14 mixed, by an executor, administrator, guardian or trustee, with
7-15 intent to defraud any creditor, heir, legatee, ward, distributee,
7-16 beneficiary or settlor of a trust interested in such estate;
7-17 (B) theft by a public servant of government
7-18 property over which he exercises control in his official capacity;
7-19 (C) forgery or the uttering, using or passing of
7-20 forged instruments; or
7-21 (D) indecency with a child under Section
7-22 21.11(a)(2), Penal Code;
7-23 (3) seven years from the date of the commission of the
7-24 offense:
7-25 (A) misapplication of fiduciary property or
7-26 property of a financial institution; or
7-27 (B) securing execution of document by deception;
8-1 (4) five years from the date of the commission of the
8-2 offense:
8-3 (A) theft, burglary, robbery;
8-4 (B) arson;
8-5 (C) insurance fraud; or
8-6 (D) sexual assault, except as provided in
8-7 Subsection (5) of this article;
8-8 (5) ten years from the 18th birthday of the victim of
8-9 the offense:
8-10 (A) indecency with a child under Section
8-11 21.11(a)(1), Penal Code;
8-12 (B) sexual assault under Section 22.011(a)(2),
8-13 Penal Code; or
8-14 (C) aggravated sexual assault under Section
8-15 22.021(a)(1)(B), Penal Code; or
8-16 (6) three years from the date of the commission of the
8-17 offense: all other felonies.
8-18 SECTION 6. (a) The changes in law made by Sections 1-4 of
8-19 this Act apply only to an offense committed on or after the
8-20 effective date of this Act. An offense committed before the
8-21 effective date of this Act is covered by the law in effect when the
8-22 offense was committed, and the former law is continued in effect
8-23 for that purpose. For purposes of this section, an offense was
8-24 committed before the effective date of this Act if any element of
8-25 the offense occurred before that date.
8-26 (b) Article 12.01, Code of Criminal Procedure, as amended by
8-27 Section 5 of this Act, does not apply to an offense if the
9-1 prosecution of that offense became barred by limitation before the
9-2 effective date of this Act. The prosecution of that offense
9-3 remains barred as if this Act had not taken place.
9-4 SECTION 7. This Act takes effect September 1, 1999.
9-5 SECTION 8. The importance of this legislation and the
9-6 crowded condition of the calendars in both houses create an
9-7 emergency and an imperative public necessity that the
9-8 constitutional rule requiring bills to be read on three several
9-9 days in each house be suspended, and this rule is hereby suspended.