By Zaffirini S.B. No. 1589
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.