1-1 By: Zaffirini S.B. No. 1589
1-2 (In the Senate - Filed March 12, 1999; March 15, 1999, read
1-3 first time and referred to Committee on Human Services;
1-4 April 6, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 4, Nays 0; April 6, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1589 By: Zaffirini
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to fraudulent claims for medical or health care benefits
1-11 submitted under certain state programs.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Section 403.026, Government Code, as added by
1-14 Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997,
1-15 is redesignated as Section 403.028 and amended to read as follows:
1-16 Sec. 403.028 [403.026]. HEALTH CARE FRAUD STUDY. (a) The
1-17 comptroller, in consultation with the office of the state auditor,
1-18 shall conduct a study each biennium to determine the number and
1-19 type of fraudulent claims for medical or health care benefits
1-20 submitted:
1-21 (1) under the state Medicaid program, including the
1-22 Medicaid managed care program implemented under Chapter 533;
1-23 (2) under group health insurance programs administered
1-24 through the Employees Retirement System of Texas for active and
1-25 retired state employees; or
1-26 (3) by or on behalf of a state employee and
1-27 administered by the attorney general under Chapter 501, Labor Code.
1-28 (b) For purposes of the study conducted under this section,
1-29 the comptroller or, at the request of the comptroller, a state
1-30 agency that administers a program identified by Subsection (a) may
1-31 make telephone contact with a person identified as receiving
1-32 services for which benefits are provided under the program to
1-33 confirm the delivery of services to the person.
1-34 (c) A state agency that administers a program identified by
1-35 Subsection (a) shall cooperate with the comptroller and provide any
1-36 information required by the comptroller in connection with the
1-37 study. The information must be provided in a format agreed to by
1-38 the comptroller and the state agency to permit examination of both
1-39 patient and health care provider histories to identify unusual or
1-40 suspicious claims or patterns of claims. A state agency may enter
1-41 into a memorandum of understanding with the comptroller regarding
1-42 the use and confidentiality of the information provided. This
1-43 subsection does not require a state agency to provide confidential
1-44 information if release of the information is prohibited by law.
1-45 (d) Each state agency that administers a program identified
1-46 by Subsection (a), in consultation with the comptroller and the
1-47 office of the state auditor, shall establish performance measures
1-48 to be used to evaluate the agency's fraud control procedures.
1-49 (e) [(c)] The comptroller shall report the results of the
1-50 study to each state agency that administers a program included in
1-51 the study so that the agency may modify its fraud control
1-52 procedures as necessary. The report must indicate whether the
1-53 level of fraud in each program included in the study has increased,
1-54 decreased, or remained constant since the last report of the
1-55 comptroller under this section.
1-56 SECTION 2. The importance of this legislation and the
1-57 crowded condition of the calendars in both houses create an
1-58 emergency and an imperative public necessity that the
1-59 constitutional rule requiring bills to be read on three several
1-60 days in each house be suspended, and this rule is hereby suspended,
1-61 and that this Act take effect and be in force from and after its
1-62 passage, and it is so enacted.
1-63 * * * * *