AN ACT
1-1 relating to fraudulent claims for medical or health care benefits
1-2 submitted under certain state programs.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 403.026, Government Code, as added by
1-5 Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997,
1-6 is redesignated as Section 403.028 and amended to read as follows:
1-7 Sec. 403.028 [403.026]. HEALTH CARE FRAUD STUDY. (a) The
1-8 comptroller, in consultation with the office of the state auditor,
1-9 shall conduct a study each biennium to determine the number and
1-10 type of fraudulent claims for medical or health care benefits
1-11 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; or
1-17 (3) by or on behalf of a state employee and
1-18 administered by the attorney general under Chapter 501, Labor Code.
1-19 (b) For purposes of the study conducted under this section,
1-20 the comptroller or, at the request of the comptroller, a state
1-21 agency that administers a program identified by Subsection (a) may
1-22 make telephone contact with a person identified as receiving
1-23 services for which benefits are provided under the program to
1-24 confirm the delivery of services to the person.
2-1 (c) A state agency that administers a program identified by
2-2 Subsection (a) shall cooperate with the comptroller and provide any
2-3 information required by the comptroller in connection with the
2-4 study. The information must be provided in a format agreed to by
2-5 the comptroller and the state agency to permit examination of both
2-6 patient and health care provider histories to identify unusual or
2-7 suspicious claims or patterns of claims. A state agency may enter
2-8 into a memorandum of understanding with the comptroller regarding
2-9 the use and confidentiality of the information provided. This
2-10 subsection does not require a state agency to provide confidential
2-11 information if release of the information is prohibited by law.
2-12 (d) Each state agency that administers a program identified
2-13 by Subsection (a), in consultation with the comptroller and the
2-14 office of the state auditor, shall establish performance measures
2-15 to be used to evaluate the agency's fraud control procedures.
2-16 (e) [(c)] The comptroller shall report the results of the
2-17 study to each state agency that administers a program included in
2-18 the study so that the agency may modify its fraud control
2-19 procedures as necessary. The report must indicate whether the
2-20 level of fraud in each program included in the study has increased,
2-21 decreased, or remained constant since the last report of the
2-22 comptroller under this section.
2-23 SECTION 2. The importance of this legislation and the
2-24 crowded condition of the calendars in both houses create an
2-25 emergency and an imperative public necessity that the
2-26 constitutional rule requiring bills to be read on three several
3-1 days in each house be suspended, and this rule is hereby suspended,
3-2 and that this Act take effect and be in force from and after its
3-3 passage, and it is so enacted.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1589 passed the Senate on
April 15, 1999, by the following vote: Yeas 30, Nays 0.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1589 passed the House on
May 25, 1999, by the following vote: Yeas 145, Nays 0, two present
not voting.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor