By:  Zaffirini                                        S.B. No. 1589
                                A BILL TO BE ENTITLED
                                       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.