By:  Thompson                                                     H.B. No. 1838



A BILL TO BE ENTITLED

AN ACT

relating to the control of health insurance fraud.                            
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Title 7, Chapter 35, Penal Code, Section 35.02 is 
amended by adding subsection (e) as follows:
	Sec. 35.02.  INSURANCE FRAUD.                                                  
	(a)  A person commits an offense if, with intent to defraud 
or deceive an insurer, the person causes to be prepared or presents 
to an insurer in support of a claim for payment under a health or 
property and casualty insurance policy a statement that the person 
knows contains false or misleading information concerning a matter 
that is material to the claim, and the matter affects a person's 
right to a payment or the amount of payment to which a person is 
entitled.
	(b)  A person commits an offense if, with intent to defraud 
or deceive an insurer, the person solicits, offers, pays, or 
receives a benefit in connection with the furnishing of health care 
goods or services for which a claim for payment is submitted under a 
health or property and casualty insurance policy.
	(c)  For purposes of Subsection (a), information concerning 
a matter that is material to a claim for payment under an insurance 
policy includes information concerning:
		(1)  whether health care goods or services were 
provided;                   
		(2)  whether health care goods or services were 
medically necessary under professionally accepted standards;
		(3)  the nature of the health care goods or services 
provided;              
		(4)  the date on which health care goods or services 
were provided;         
		(5)  the medical record of goods or services provided;                        
		(6)  the condition treated or diagnosis made;                                 
		(7)  the identity and applicable license of the 
provider or the recipient of health care goods or services;
		(8)  whether property was damaged or lost in the manner 
and under the circumstances described in a statement related to a 
claim for insurance payment; or
		(9)  whether any other claim for insurance payment has 
been communicated to any other insurer concerning property damage 
or loss to the same property.
	(d)  An offense under this section is:                                         
		(1)  a Class C misdemeanor if the value of the claim is 
less than $20;      
		(2)  a Class B misdemeanor if the value of the claim is 
$20 or more but less than $500;
		(3)  a Class A misdemeanor if the value of the claim is 
$500 or more but less than $1,500;
		(4)  a state jail felony if the value of the claim is 
$1,500 or more but less than $20,000;
		(5)  a felony of the third degree if the value of the 
claim is $20,000 or more but less than $100,000;
		(6)  a felony of the second degree if the value of the 
claim is $100,000 or more but less than $200,000; or
		(7)  a felony of the first degree if:                                         
			(A)  the value of the claim is $200,000 or more; or                          
			(B)  the value of the claim is less than $200,000 
and the commission of the offense placed a person at risk of death 
or serious bodily injury.
	(e)  In addition to the penalties imposed under Subsection 
(d) of this Section, a person convicted of insurance fraud shall be 
ordered to pay restitution to an insurer, including any court costs 
and attorney fees.
	SECTION 2.  This Act takes effect September 1, 2003.