By: Deuell, et al.  S.B. No. 750
         (In the Senate - Filed February 19, 2007; March 7, 2007,
  read first time and referred to Committee on Government
  Organization; April 16, 2007, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 5, Nays 0;
  April 16, 2007, sent to printer.)
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 750 By:  Whitmire
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to the creation of the Office of State Inspector General.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle B, Title 4, Government Code, is amended
  by adding Chapter 422 to read as follows:
  CHAPTER 422. OFFICE OF STATE INSPECTOR GENERAL
  SUBCHAPTER A.  GENERAL PROVISIONS
         Sec. 422.001.  DEFINITIONS. In this chapter:
               (1)  "Covered entity" means a person, entity, or
  representative that has an employment, agency, contractual,
  financial, or fiduciary relationship with a state agency that
  administers or implements state or federally funded programs.  The
  term includes a provider.
               (2)  "Fraud" means an intentional deception or
  misrepresentation made by a person with the knowledge that the
  deception could result in some unauthorized benefit to that person
  or some other person.  The term includes any act that constitutes
  fraud under applicable federal or state law.
               (3)  "Furnished," in reference to items or services:
                     (A)  means items or services provided directly by,
  provided under the direct supervision of, or ordered by:
                           (i)  a practitioner or other individual,
  either as an employee or in the individual's own capacity;
                           (ii)  a covered entity; or
                           (iii)  another supplier of services; and
                     (B)  does not include services ordered by one
  party but billed for and provided by or under the supervision of
  another.
               (4)  "Hold on payment" means the temporary denial of
  payment or reimbursement for items or services furnished by a
  covered entity.  The term includes the temporary denial of
  reimbursement under a state or federal program for items or
  services furnished by a specified provider.
               (5)  "Office" means the office of state inspector
  general established under this chapter.
               (6)  "Practitioner" means a physician or other
  individual licensed under state law to practice the individual's
  profession.
               (7)  "Program exclusion" means the suspension of a
  covered entity's authorization under a state or federal program to
  request payment for, or reimbursement of, items or services
  furnished by that entity.
               (8)  "Provider" means a person, firm, partnership,
  corporation, agency, association, institution, or other entity
  that was or is approved by the Health and Human Services Commission
  to provide:
                     (A)  medical assistance under contract or
  provider agreement with the commission; or
                     (B)  third-party billing vendor services under a
  contract or provider agreement with the commission.
               (9)  "State inspector general" means the state
  inspector general appointed under Section 422.052.
         Sec. 422.002.  APPLICATION OF SUNSET ACT.  The office of
  state inspector general is subject to Chapter 325 (Texas Sunset
  Act).  Unless continued in existence as provided by that chapter,
  the office is abolished and this chapter expires September 1, 2019.
         Sec. 422.003.  REFERENCE IN OTHER STATUTES.  Notwithstanding
  any other provision of law, a reference in law or rule to the Health
  and Human Services Commission's office of investigations and
  enforcement or the Health and Human Services Commission's office of
  inspector general means the office of state inspector general
  established under this chapter.
  [Sections 422.004-422.050 reserved for expansion]
  SUBCHAPTER B.  ADMINISTRATION AND COMPLAINTS
         Sec. 422.051.  OFFICE OF STATE INSPECTOR GENERAL.  (a)  The
  office of state inspector general is an agency of this state.
         (b)  The office is under the direction and supervision of the
  state inspector general.
         (c)  The office shall have its principal office and
  headquarters in Austin.
         Sec. 422.052.  STATE INSPECTOR GENERAL:  APPOINTMENT BY
  GOVERNOR; QUALIFICATIONS.  (a)  The state inspector general is
  appointed by the governor with the advice and consent of the senate.
         (b)  The appointment shall be made without regard to race,
  color, disability, sex, religion, age, or national origin.
         (c)  In making the appointment, the governor shall consider
  the person's knowledge of laws, experience in the enforcement of
  law, honesty, integrity, education, training, and executive
  ability.
         Sec. 422.053.  ELIGIBILITY.  (a)  A person is not eligible
  for appointment as state inspector general if the person or the
  person's spouse is an employee, officer, or paid consultant of a
  trade association in a field under the office's jurisdiction.
         (b)  A person who is required to register as a lobbyist under
  Chapter 305 because of the person's activities for compensation in
  or on behalf of a profession related to a field under the office's
  jurisdiction may not serve as state inspector general.
         (c)  A person is not eligible for appointment as state
  inspector general if the person has a financial interest in a
  corporation, organization, or association receiving state or
  federal money under contract with this state or a political
  subdivision of this state.
         Sec. 422.054.  TERM.  The state inspector general serves a
  two-year term expiring February 1 of each odd-numbered year.
         Sec. 422.055.  MERIT SYSTEM.  (a)  The office may establish
  a merit system for its employees.
         (b)  The merit system may be maintained in conjunction with
  other state agencies that are required by federal law to operate
  under a merit system.
         Sec. 422.056.  PUBLIC INTEREST INFORMATION AND COMPLAINTS.  
  (a)  The office shall develop and implement policies that provide
  the public a reasonable opportunity to appear before the office and
  to speak on any issue under the office's jurisdiction.
         (b)  The office shall prepare information of public interest
  describing the functions of the office and the office's procedures
  by which complaints are filed with and resolved by the office.  The
  office shall make the information available to the public and
  appropriate state agencies.
         (c)  The office shall keep an information file about each
  complaint filed with the office relating to a state agency, license
  holder, or entity receiving state or federal money and falling
  under the jurisdiction of the office.
         Sec. 422.057.  ANNUAL REPORT. (a)  The state inspector
  general annually shall prepare a complete and detailed written
  report describing the activities of the office during the fiscal
  year. The report must separately describe each major
  investigation, audit, review, fraud prevention effort, and agency
  assistance effort completed during the fiscal year.
         (b)  The annual report must meet the reporting requirements
  applicable to financial reporting provided in the General
  Appropriations Act.
         (c)  The state inspector general shall deliver a copy of each
  annual report to:
               (1)  the governor;
               (2)  the lieutenant governor;
               (3)  the speaker of the house of representatives;
               (4)  the presiding officer of each house and senate
  committee having jurisdiction over an agency to which this chapter
  applies;
               (5)  the presiding officer of each agency to which this
  chapter applies; and
               (6)  the comptroller.
         (d)  Each agency to which this chapter applies shall post the
  annual report on its agency website.
         (e)  The state inspector general shall issue the annual
  report not later than the 60th day after the last day of each fiscal
  year.
  [Sections 422.058-422.100 reserved for expansion]
  SUBCHAPTER C.  GENERAL POWERS AND DUTIES
         Sec. 422.101.  GENERAL RESPONSIBILITIES AND POWERS.  
  (a)  The office is responsible for the audit, detection,
  investigation, prevention, and review of fraud, waste, and abuse,
  as defined in applicable state and federal law, in this state's
  implementation or administration of all state or federally funded
  programs, including health and human services programs provided
  under Chapter 531, and in the enforcement of state law relating to
  those programs.
         (b)  The office shall set clear objectives, priorities, and
  performance standards for the office that emphasize:
               (1)  coordinating investigative efforts to
  aggressively recover money;
               (2)  allocating resources to cases that have the
  strongest supportive evidence and the greatest potential for
  recovery of money; and
               (3)  maximizing opportunities for referral of cases to
  the attorney general in accordance with this chapter.
         (c)  The office has all the powers necessary or appropriate
  to carry out its responsibilities and functions under this chapter
  and other law.
         (d)  The state inspector general shall establish policies
  and procedures to guide the operation of the office and to ensure
  that the work and practices of the office are in accordance with
  commonly used and adopted professional standards related to the
  fields of investigation and auditing in public administration
  environments.
         (e)  An investigation, audit, or review conducted by the
  office must conform to professional standards and best practices
  for offices of inspectors general.
         Sec. 422.102.  RULEMAKING AUTHORITY.  The state inspector
  general may adopt rules necessary to implement this chapter and to
  carry out the duties of the office under this chapter and other law.
         Sec. 422.103.  INFORMATION AND TECHNOLOGY.  The office may
  obtain any information or technology necessary to enable the office
  to meet its responsibilities under this chapter or other law.
         Sec. 422.104.  OFFICE STAFF; TRAINING.  The office shall
  employ and train office staff to enable the staff to pursue fraud,
  waste, and abuse cases as necessary.
         Sec. 422.105.  STATE AGENCY INSPECTORS GENERAL.  (a)  The
  state inspector general, in consultation with the office of the
  governor and as necessary to implement this chapter, may designate
  persons to serve as agency inspectors general for state agencies
  that implement or administer state or federally funded programs.  A
  state agency inspector general may be colocated with a state
  agency.
         (b)  An agency inspector general shall report to and perform
  duties as directed by the state inspector general.
         (c)  A state agency shall provide facilities and support
  services including suitable office space, furniture, computer
  equipment, communications equipment, and administrative support,
  to each state agency inspector general colocated at the agency and
  the state agency inspector general's staff.
         (d)  The office and each state agency that has a designated
  state agency inspector general shall execute a service level
  agreement to establish performance standards regarding the
  facilities and support services provided by the agency.  The
  agreement must be reviewed at least annually to ensure that
  facilities and support services are provided in accordance with the
  agreement.
         Sec. 422.106.  PEACE OFFICERS. (a)  The office may employ
  and commission peace officers, in a number not to exceed 10 percent
  of the total number of employees of the office, to assist the state
  inspector general in carrying out the duties of the office under
  this chapter or other law.
         (b)  A commissioned peace officer or other designated law
  enforcement officer employed by the office is not entitled to
  supplemental benefits from the law enforcement and custodial
  officer supplemental retirement fund under Title 8.
         Sec. 422.107.  AWARD FOR REPORTING FRAUD, WASTE, ABUSE, OR
  OVERCHARGES.  (a)  If the office determines that the report results
  in the recovery of an administrative or civil penalty imposed by
  law, the office may grant an award to an individual who reports:
               (1)  activity that constitutes fraud, waste, or abuse
  of money related to any state or federally funded program
  implemented or administered by a state agency; or
               (2)  overcharges in a program described by Subdivision
  (1).
         (b)  The office may not grant an award to an individual in
  connection with a report if the office or attorney general had
  independent knowledge of the activity reported by the individual.
         (c)  The office shall determine the amount of an award
  granted under this section.  The amount may not exceed five percent
  of the amount of the administrative or civil penalty imposed by law
  that resulted from the individual's report.
         (d)  In determining the amount of an award granted under this
  section, the office:
               (1)  shall consider the importance of the report in
  ensuring the fiscal integrity of the program; and
               (2)  may consider whether the individual participated
  in the reported fraud, waste, abuse, or overcharge.
         (e)  A person who brings an action under Subchapter C,
  Chapter 36, Human Resources Code, is not eligible for an award under
  this section.
         Sec. 422.108.  STATE AUDITOR AUDITS, INVESTIGATIONS, AND
  ACCESS TO INFORMATION NOT IMPAIRED. This chapter or other law
  related to the operation of the state inspector general or a state
  agency inspector general does not prohibit the state auditor from
  conducting an audit, investigation, or other review or from having
  full and complete access to all records and other information,
  including witnesses and electronic data, that the state auditor
  considers necessary for the audit, investigation, or other review.
         Sec. 422.109.  AUTHORITY OF STATE AUDITOR TO CONDUCT TIMELY
  AUDITS NOT IMPAIRED. This chapter or other law related to the
  operation of the state inspector general or a state agency
  inspector general does not take precedence over the authority of
  the state auditor to conduct an audit under Chapter 321 or other
  law.
  [Sections 422.110-422.150 reserved for expansion]
  SUBCHAPTER D.  INVESTIGATIONS AND ENFORCEMENT ACTIONS
         Sec. 422.151.  AGENCY COOPERATION.  Each state agency shall
  provide assistance as necessary for the office to perform the
  office's duties relating to the investigation of fraud, waste, and
  abuse in the implementation or administration of state or federally
  funded programs.  The office is entitled to access any information
  maintained by a state agency or by any covered entity, including
  internal records, relevant to the functions of the office.
         Sec. 422.152.  CRITERIA FOR INVESTIGATIONS.  The office by
  rule shall set specific criteria, including claims criteria, that
  when met require the office to begin an investigation.
         Sec. 422.153.  INTEGRITY REVIEWS.  (a)  If the office
  receives a complaint of fraud, waste, or abuse from any source, the
  office shall conduct an integrity review to determine whether there
  is sufficient basis to warrant a full investigation.
         (b)  The office shall begin the integrity review not later
  than the 30th day after the date the office receives a complaint or
  has reason to believe that fraud, waste, or abuse has occurred.  An
  integrity review must be completed not later than the 90th day after
  the date the review began.
         (c)  If the findings of an integrity review give the office
  reason to believe that fraud, waste, or abuse involving possible
  criminal conduct has occurred in the administration or
  implementation of a state or federally funded program, the office
  shall take the following action:
               (1)  if a covered entity is suspected of fraud, waste,
  or abuse involving criminal conduct, the office shall refer the
  case to the appropriate state or local official having jurisdiction
  to prosecute the criminal conduct; or
               (2)  if there is reason to believe that a recipient has
  defrauded a federally funded program, the office may conduct a full
  investigation of the suspected fraud.
         (d)  A criminal referral by the office does not preclude the
  office from continuing its investigation of the covered entity and
  imposing appropriate administrative or civil penalties.
         Sec. 422.154.  WITHHELD, CONCEALED, OR DESTROYED RECORDS;
  HOLD ON PAYMENT OF CLAIMS.  (a)  If the office learns or has reason
  to suspect that a covered entity's records are being withheld,
  concealed, destroyed, fabricated, or in any way falsified, the
  office shall immediately refer the case to the appropriate state or
  local official having jurisdiction to prosecute criminal conduct.
         (b)  A criminal referral by the office does not preclude the
  office from continuing its investigation of the covered entity and
  imposing appropriate administrative or civil penalties.
         (c)  In addition to any hold on payment of claims authorized
  under other state or federal law, the office shall impose, without
  prior notice, a hold on payment of money owed or claimed to be owed,
  including a claim for reimbursement, submitted to a state agency by
  a covered entity:
               (1)  to compel production of records; or
               (2)  on request by the appropriate state or local
  official having jurisdiction to prosecute a case under this
  section.
         (d)  The office shall notify the covered entity of the hold
  not later than the fifth working day after the date the hold is
  imposed.
         Sec. 422.155.  ADMINISTRATIVE HEARING ON PAYMENT CLAIM HOLD.  
  (a)  On timely written request by a covered entity subject to a hold
  on payment of claims under Section 422.154, other than a hold
  requested under that section by an appropriate state or local
  official having jurisdiction to prosecute, the office shall file a
  request with the State Office of Administrative Hearings for an
  expedited administrative hearing regarding the hold.
         (b)  The state inspector general shall adopt rules that allow
  a covered entity subject to a hold under Section 422.154, other than
  a hold requested under that section by the appropriate state or
  local official having jurisdiction to prosecute, to seek an
  informal resolution of the issues identified by the office in the
  notice provided by the office.
         (c)  A covered entity subject to a hold shall seek an
  expedited hearing under Subsection (a) or an informal resolution
  under Subsection (b) not later than the 10th day after the date the
  entity receives notice of the hold from the office.
         (d)  A covered entity's decision to seek an informal
  resolution under Subsection (b) does not extend the time by which
  the entity must request an expedited administrative hearing under
  Subsection (a).  An expedited hearing initiated under Subsection
  (a) shall be stayed at the office's request until the informal
  resolution process is completed.
         Sec. 422.156.  GUIDELINES FOR IMPOSING PAYMENT CLAIM HOLDS
  OR PROGRAM EXCLUSIONS.  The office shall establish guidelines under
  which holds on payment of claims or program exclusions:
               (1)  may discretionally be imposed on a covered entity;
  or
               (2)  shall automatically be imposed on a covered
  entity.
         Sec. 422.157.  ASSESSMENT OF ADMINISTRATIVE PENALTIES;
  INJUNCTIONS; AUDITS AND INVESTIGATIONS.  In addition to performing
  functions and duties otherwise provided by law, the office may:
               (1)  assess administrative penalties authorized by law
  on behalf of the state agency implementing or administering the
  state or federally funded program and retain from amounts collected
  money sufficient to cover investigative and collection costs;
               (2)  request the attorney general to obtain an
  injunction to prevent a person from disposing of an asset
  identified by the office as potentially subject to recovery by the
  office due to the person's fraud, waste, or abuse;
               (3)  provide for coordination between the office and
  special investigative units formed by managed care organizations
  under Section 531.113 or entities with which managed care
  organizations contract under that section;
               (4)  audit the use and effectiveness of state or
  federal money, including contract and grant money, administered by
  a person or state agency receiving the money from a state agency;
               (5)  conduct reviews, investigations, and inspections
  relating to the money described by Subdivision (4);
               (6)  recommend policies promoting economical and
  efficient administration of the money described by Subdivision (4)
  and the prevention and detection of fraud, waste, and abuse in the
  administration of that money; and
               (7)  conduct internal affairs investigations in
  instances of fraud, waste, and abuse and in instances of misconduct
  by employees, contractors, subcontractors, and vendors.
         Sec. 422.158.  FINAL REPORTS; CONFIDENTIALITY.  (a)  The
  office shall prepare a final report on each audit or investigation
  conducted under this chapter.  The final report must include:
               (1)  a summary of the activities performed by the
  office in conducting the audit or investigation;
               (2)  a statement regarding whether the audit or
  investigation resulted in a finding of any wrongdoing; and
               (3)  a description of any finding of wrongdoing.
         (b)  A final report on an audit or investigation is subject
  to required disclosure under Chapter 552.  All information and
  material compiled during the audit or investigation remains
  confidential and is not subject to disclosure, except as provided
  by Section 422.162.
         (c)  Unless otherwise prohibited by this chapter or other
  law, the state inspector general shall deliver a copy of each final
  report that concerns the implementation or administration of a
  state or federally funded program to:
               (1)  the presiding officer of the subject agency;
               (2)  the governor;
               (3)  the lieutenant governor; and
               (4)  the speaker of the house of representatives.
         Sec. 422.159.  AGENCY RESPONSE. (a)  Not later than the
  60th day after the date a state inspector general or state agency
  inspector general report that identifies deficiencies or
  recommends specified corrective measures in the operations of a
  state agency is issued, the agency shall file with the office a
  response that includes:
               (1)  an implementation plan and timeline for
  implementing corrective measures; or
               (2)  the agency's rationale for declining to implement
  corrective measures for the identified deficiencies or to implement
  the state inspector general's or state agency inspector general's
  recommended corrective measures.
         (b)  The office by rule shall specify the format and
  requirements of a state agency response.
         (c)  A state agency to which this chapter applies shall adopt
  rules to respond to reports and recommendations from the state
  inspector general or a state agency inspector general.
         Sec. 422.160.  FRAUD PREVENTION INFORMATION. (a)  The
  office shall compile and disseminate accurate information and
  statistics relating to:
               (1)  fraud prevention; and
               (2)  post-fraud referrals received and accepted or
  rejected from the office's case management system or the case
  management system of a state agency.
         (b)  The office shall:
               (1)  aggressively publicize successful fraud
  prosecutions and fraud-prevention programs through all available
  means, including the use of statewide press releases; and
               (2)  maintain and promote a toll-free hotline for
  reporting suspected fraud in state or federally funded programs
  implemented or administered by an agency.
         Sec. 422.161.  ADMINISTRATIVE SUBPOENA.  (a)  The office may
  issue an administrative subpoena in connection with an
  investigation conducted by the office to compel the attendance of a
  relevant witness or the production, for inspection or copying, of
  relevant evidence that is in this state.
         (b)  A subpoena may be served personally or by certified
  mail.
         (c)  If a person fails to comply with a subpoena, the office,
  acting through the attorney general, may file suit to enforce the
  subpoena in a district court in this state.
         (d)  On finding that good cause exists for issuing the
  subpoena, the court shall order the person to comply with the
  subpoena.  The court may punish a person who fails to obey the court
  order.
         (e)  The reimbursement of the expenses of a witness whose
  attendance is compelled under this section is governed by Section
  2001.103.
         Sec. 422.162.  CONFIDENTIALITY.  (a)  Information and
  material subpoenaed or compiled by the office in connection with an
  audit or investigation is confidential and not subject to
  disclosure under Chapter 552.  The information and material is not
  subject to disclosure, discovery, subpoena, or other means of legal
  compulsion for release to anyone other than the office or its
  employees or agents involved in the audit or investigation
  conducted by the office, except that the information may be
  disclosed to the attorney general, the state auditor's office, and
  law enforcement agencies.
         (b)  A person who receives information under Subsection (a)
  may disclose the information only in accordance with Subsection (a)
  and in a manner that is consistent with the authorized purpose for
  which the person received the information.
         Sec. 422.163.  INTERAGENCY COORDINATION.  (a)  The office
  and the attorney general shall enter into a memorandum of
  understanding to develop and implement joint written procedures for
  processing cases of suspected fraud, waste, or abuse, as those
  terms are defined by state or federal law, or other violations of
  state or federal law under any state or federally funded program
  implemented or administered by a state agency.
         (b)  The memorandum of understanding must require:
               (1)  the office and the attorney general to set
  priorities and guidelines for referring cases to appropriate state
  agencies for investigation, prosecution, or other disposition to
  enhance deterrence of fraud, waste, abuse, or other violations of
  state or federal law, including a violation of Chapter 102,
  Occupations Code, in the programs and maximize the imposition of
  penalties, the recovery of money, and the successful prosecution of
  cases;
               (2)  the office to refer each case of suspected covered
  entity fraud, waste, or abuse to the attorney general not later than
  the 20th business day after the date the office determines that the
  existence of fraud, waste, or abuse is reasonably indicated;
               (3)  the attorney general to take appropriate action in
  response to each case referred to the attorney general, including
  the direct initiation of prosecution with the consent of the
  appropriate local district or county attorney, direct initiation of
  civil litigation, referral to an appropriate United States
  attorney, district attorney, or county attorney, and referral to a
  collections agency for initiation of civil litigation or other
  appropriate action;
               (4)  the office to keep detailed records for cases
  processed by the office or the attorney general, including
  information on the total number of cases processed and, for each
  case:
                     (A)  the agency and division to which the case is
  referred for investigation;
                     (B)  the date on which the case is referred; and
                     (C)  the nature of the suspected fraud, waste, or
  abuse;
               (5)  the office to notify each appropriate division of
  the attorney general's office of each case referred by the office;
               (6)  the attorney general to ensure that information
  relating to each case investigated by the attorney general is
  available to each division of the attorney general's office with
  responsibility for investigating suspected fraud, waste, or abuse;
               (7)  the attorney general to notify the office of each
  case the attorney general declines to prosecute or prosecutes
  unsuccessfully;
               (8)  representatives of the office and of the attorney
  general to meet not less than quarterly to share case information
  and determine the appropriate agency and division to investigate
  each case; and
               (9)  the office and the attorney general to submit
  information requested by the comptroller about each resolved case
  for the comptroller's use in improving fraud detection.
         (c)  With respect to Medicaid fraud, in addition to the
  requirements under Subsection (b), the memorandum of understanding
  must:
               (1)  ensure that barriers to direct fraud referrals to
  the office of the attorney general's Medicaid fraud control unit or
  unreasonable impediments to communication between Medicaid agency
  employees and the Medicaid fraud control unit are not imposed; and
               (2)  include procedures to facilitate the referral of
  cases directly to the attorney general.
         Sec. 422.164.  EXCHANGE OF INFORMATION.  An exchange of
  information under this subchapter between the attorney general and
  the office or any other state agency does not affect whether the
  information is subject to disclosure under Chapter 552.
         Sec. 422.165.  SEMIANNUAL REPORT.  (a)  The office and the
  attorney general shall jointly prepare and submit a semiannual
  report to the governor, lieutenant governor, speaker of the house
  of representatives, state auditor, and comptroller on:
               (1)  the activities of the attorney general and the
  office in detecting and preventing fraud, waste, and abuse under
  any state or federally funded program implemented or administered
  by a state agency that is reviewed by the office under this chapter;
  and
               (2)  the activities of the office during the fiscal
  year, including separate descriptions of each major investigation,
  audit, review, fraud prevention effort, and agency assistance
  effort completed during the fiscal year.
         (b)  The report may be consolidated with any other report
  relating to the same subject matter the office or the attorney
  general is required to submit under other law.
         Sec. 422.166.  ASSESSMENT AND COLLECTION OF CERTAIN FEES AND
  COSTS.  (a)  The office and the attorney general may not assess or
  collect investigation or attorney's fees on behalf of any state
  agency unless the attorney general or other state agency collects a
  penalty, restitution, or other reimbursement payment to this state.
         (b)  A district attorney, county attorney, municipal
  attorney, or private collection agency may collect and retain:
               (1)  costs associated with a case referred to the
  government attorney or private collection agency in accordance with
  procedures adopted under this section; and
               (2)  20 percent of the amount of the penalty,
  restitution, or other reimbursement payment collected.
         Sec. 422.167.  ASSISTING INVESTIGATIONS BY ATTORNEY
  GENERAL.  (a)  The office and the attorney general shall execute a
  memorandum of understanding under which the office shall provide
  investigative support, as required, to the attorney general in
  connection with cases under Subchapter B, Chapter 36, Human
  Resources Code.  Under the memorandum of understanding, the office
  shall assist in performing preliminary investigations and ongoing
  investigations for actions involving the attorney general under
  Chapter 36, Human Resources Code.
         (b)  The memorandum of understanding must:
               (1)  specify the type, scope, and format of the
  investigative support provided to the attorney general under this
  section; and
               (2)  ensure that barriers to direct fraud referrals to
  the state's Medicaid fraud control unit by Medicaid agencies or
  unreasonable impediments to communication between Medicaid agency
  employees and this state's Medicaid fraud control unit are not
  imposed.
         Sec. 422.168.  COOPERATION AND COORDINATION WITH STATE
  AUDITOR. (a)  The state auditor may, on request of the state
  inspector general or a state agency inspector general, provide
  appropriate information or other assistance to the state inspector
  general or office, as determined by the state auditor.
         (b)  The state inspector general or a state agency inspector
  general may meet with the state auditor's office to coordinate a
  review conducted under this subchapter, share information, or
  schedule work plans.
         (c)  The state auditor is entitled to access all information
  maintained by the state inspector general or a state agency
  inspector general, including vouchers, electronic data, internal
  records, and information obtained from a state agency or covered
  entity subject to Section 422.162.
         (d)  Any information obtained or provided by the state
  auditor under this section is confidential and not subject to
  disclosure under Chapter 552.
         Sec. 422.169.  PERIODIC REPORTING TO STATE AUDITOR AND
  GOVERNOR REQUIRED. The state inspector general shall timely inform
  the state auditor and the governor of the initiation of a review of
  a state agency program by the state inspector general or a state
  agency inspector general and the ongoing status of each review by
  the state inspector general or a state agency inspector general.
         Sec. 422.170.  FLAGRANT VIOLATIONS; IMMEDIATE REPORT. The
  state inspector general or a state agency inspector general shall
  immediately report to the governor's general counsel and the state
  auditor a particularly serious or flagrant problem relating to the
  administration of a program, operation of a state agency program,
  or interference with a review by the state inspector general or a
  state agency inspector general.
         SECTION 2.  Section 531.001, Government Code, is amended by
  adding Subdivision (4-a) to read as follows:
               (4-a)  "Office of state inspector general" means the
  office of state inspector general established under Chapter 422.
         SECTION 3.  Subsection (c), Section 531.008, Government
  Code, is amended to read as follows:
         (c)  The executive commissioner shall establish the
  following divisions and offices within the commission:
               (1)  the eligibility services division to make
  eligibility determinations for services provided through the
  commission or a health and human services agency related to:
                     (A)  the child health plan program;
                     (B)  the financial assistance program under
  Chapter 31, Human Resources Code;
                     (C)  the medical assistance program under Chapter
  32, Human Resources Code;
                     (D)  the nutritional assistance programs under
  Chapter 33, Human Resources Code;
                     (E)  long-term care services, as defined by
  Section 22.0011, Human Resources Code;
                     (F)  community-based support services identified
  or provided in accordance with Section 531.02481; and
                     (G)  other health and human services programs, as
  appropriate;
               (2)  [the office of inspector general to perform fraud
  and abuse investigation and enforcement functions as provided by
  Subchapter C and other law;
               [(3)]  the office of the ombudsman to:
                     (A)  provide dispute resolution services for the
  commission and the health and human services agencies; and
                     (B)  perform consumer protection functions
  related to health and human services;
               (3) [(4)]  a purchasing division as provided by Section
  531.017; and
               (4) [(5)]  an internal audit division to conduct a
  program of internal auditing in accordance with [Government Code,]
  Chapter 2102.
         SECTION 4.  Section 531.105, Government Code, is amended to
  read as follows:
         Sec. 531.105.  FRAUD DETECTION TRAINING. (a)  The office of
  state inspector general [commission] shall develop and implement a
  program to provide annual training to contractors who process
  Medicaid claims and appropriate staff of the commission and other
  health and human services agencies [the Texas Department of Health
  and the Texas Department of Human Services] in identifying
  potential cases of fraud, waste, or abuse under the state Medicaid
  program. The training provided to the contractors and staff must
  include clear criteria that specify:
               (1)  the circumstances under which a person should
  refer a potential case to the office [commission]; and
               (2)  the time by which a referral should be made.
         (b)  The commission and other health and human services
  agencies [The Texas Department of Health and the Texas Department
  of Human Services], in cooperation with the office of state
  inspector general [commission], shall periodically set a goal of
  the number of potential cases of fraud, waste, or abuse under the
  state Medicaid program that each agency will attempt to identify
  and refer to the office [commission]. The office [commission]
  shall include information on the agencies' goals and the success of
  each agency in meeting the agency's goal in the report required by
  Section 422.165 [531.103(c)].
         SECTION 5.  Subsections (a), (b), and (d) through (g),
  Sections 531.106, Government Code, are amended to read as follows:
         (a)  The office of state inspector general [commission]
  shall use learning or neural network technology to identify and
  deter fraud in the Medicaid program throughout this state.
         (b)  The office of state inspector general [commission]
  shall contract with a private or public entity to develop and
  implement the technology. The office [commission] may require the
  entity it contracts with to install and operate the technology at
  locations specified by the office [commission], including the
  office of state inspector general's [commission] offices.
         (d)  The office of state inspector general [commission]
  shall require each health and human services agency that performs
  any aspect of the state Medicaid program to participate in the
  implementation and use of the technology.
         (e)  The office of state inspector general [commission]
  shall maintain all information necessary to apply the technology to
  claims data covering a period of at least two years.
         (f)  The office of state inspector general [commission]
  shall investigate [refer] cases identified by the technology and
  shall refer cases to the [commission's office of investigations and
  enforcement or the office of the] attorney general for prosecution,
  as appropriate.
         (g)  Each month, the learning or neural network technology
  implemented under this section must match bureau of vital
  statistics death records with Medicaid claims filed by a provider.
  If the office of state inspector general [commission] determines
  that a provider has filed a claim for services provided to a person
  after the person's date of death, as determined by the bureau of
  vital statistics death records, the office [commission] shall
  investigate [refer] the case [for investigation to the commission's
  office of investigations and enforcement].
         SECTION 6.  Section 531.1061, Government Code, is amended to
  read as follows:
         Sec. 531.1061.  FRAUD INVESTIGATION TRACKING SYSTEM.
  (a)  The office of state inspector general [commission] shall use
  an automated fraud investigation tracking system [through the
  commission's office of investigations and enforcement] to monitor
  the progress of an investigation of suspected fraud, waste, abuse,
  or insufficient quality of care under the state Medicaid program.
         (b)  For each case of suspected fraud, waste, abuse, or
  insufficient quality of care identified by the learning or neural
  network technology required under Section 531.106, the automated
  fraud investigation tracking system must:
               (1)  receive electronically transferred records
  relating to the identified case from the learning or neural network
  technology;
               (2)  record the details and monitor the status of an
  investigation of the identified case, including maintaining a
  record of the beginning and completion dates for each phase of the
  case investigation;
               (3)  generate documents and reports related to the
  status of the case investigation; and
               (4)  generate standard letters to a provider regarding
  the status or outcome of an investigation.
         (c)  The office of state inspector general [commission]
  shall require each health and human services agency that performs
  any aspect of the state Medicaid program to participate in the
  implementation and use of the automated fraud investigation
  tracking system.
         SECTION 7.  Subsection (a), Section 531.1062, Government
  Code, is amended to read as follows:
         (a)  The office of state inspector general [commission]
  shall use an automated recovery monitoring system to monitor the
  collections process for a settled case of fraud, waste, abuse, or
  insufficient quality of care under the state Medicaid program.
         SECTION 8.  Subsections (a), (b), and (f), Section 531.107,
  Government Code, are amended to read as follows:
         (a)  The Medicaid and Public Assistance Fraud Oversight Task
  Force advises and assists the [commission and the commission's]
  office of state inspector general [of investigations and
  enforcement] in improving the efficiency of fraud investigations
  and collections.
         (b)  The task force is composed of a representative of the:
               (1)  attorney general's office, appointed by the
  attorney general;
               (2)  comptroller's office, appointed by the
  comptroller;
               (3)  Department of Public Safety, appointed by the
  public safety director;
               (4)  state auditor's office, appointed by the state
  auditor;
               (5)  office of state inspector general, appointed by
  the state inspector general [commission, appointed by the
  commissioner of health and human services];
               (6)  [Texas] Department of Aging and Disability [Human]
  Services, appointed by the commissioner of aging and disability
  [human] services;
               (7)  Texas Department of Insurance, appointed by the
  commissioner of insurance; and
               (8)  [Texas] Department of State Health Services,
  appointed by the commissioner of state [public] health services.
         (f)  At least once each fiscal quarter, the [commission's]
  office of state inspector general [of investigations and
  enforcement] shall provide to the task force:
               (1)  information detailing:
                     (A)  the number of fraud referrals made to the
  office and the origin of each referral;
                     (B)  the time spent investigating each case;
                     (C)  the number of cases investigated each month,
  by program and region;
                     (D)  the dollar value of each fraud case that
  results in a criminal conviction; and
                     (E)  the number of cases the office rejects and
  the reason for rejection, by region; and
               (2)  any additional information the task force
  requires.
         SECTION 9.  Section 531.108, Government Code, is amended to
  read as follows:
         Sec. 531.108.  FRAUD PREVENTION. (a)  [The commission's
  office of investigations and enforcement shall compile and
  disseminate accurate information and statistics relating to:
               [(1)  fraud prevention; and
               [(2)     post-fraud referrals received and accepted or
  rejected from the commission's case management system or the case
  management system of a health and human services agency.
         [(b)  The commission shall:
               [(1)     aggressively publicize successful fraud
  prosecutions and fraud-prevention programs through all available
  means, including the use of statewide press releases issued in
  coordination with the Texas Department of Human Services; and
               [(2)     ensure that a toll-free hotline for reporting
  suspected fraud in programs administered by the commission or a
  health and human services agency is maintained and promoted, either
  by the commission or by a health and human services agency.
         [(c)]  The office of state inspector general [commission]
  shall develop a cost-effective method of identifying applicants for
  public assistance in counties bordering other states and in
  metropolitan areas selected by the office [commission] who are
  already receiving benefits in other states. If economically
  feasible, the office [commission] may develop a computerized
  matching system.
         (b) [(d)]  The office of state inspector general
  [commission] shall:
               (1)  verify automobile information that is used as
  criteria for eligibility; and
               (2)  establish a computerized matching system with the
  Texas Department of Criminal Justice to prevent an incarcerated
  individual from illegally receiving public assistance benefits
  administered by the commission.
         (c) [(e)]  The office of state inspector general
  [commission] shall submit to the governor and Legislative Budget
  Board a semiannual report on the results of computerized matching
  of office [commission] information with information from
  neighboring states, if any, and information from the Texas
  Department of Criminal Justice. The report may be consolidated
  with any other report relating to the same subject matter the office
  [commission] is required to submit under other law.
         SECTION 10.  Section 531.109, Government Code, is amended to
  read as follows:
         Sec. 531.109.  SELECTION AND REVIEW OF CLAIMS.  (a)  The
  office of state inspector general [commission] shall annually
  select and review a random, statistically valid sample of all
  claims for reimbursement under the state Medicaid program,
  including the vendor drug program, for potential cases of fraud,
  waste, or abuse.
         (b)  In conducting the annual review of claims under
  Subsection (a), the office of state inspector general [commission]
  may directly contact a recipient by telephone or in person, or both,
  to verify that the services for which a claim for reimbursement was
  submitted by a provider were actually provided to the recipient.
         (c)  Based on the results of the annual review of claims, the
  office of state inspector general [commission] shall determine the
  types of claims at which office [commission] resources for fraud,
  waste, and abuse detection should be primarily directed.
         SECTION 11.  Subsections (a) and (c) through (f), Section
  531.110, Government Code, are amended to read as follows:
         (a)  The office of state inspector general [commission]
  shall conduct electronic data matches for a recipient of assistance
  under the state Medicaid program at least quarterly to verify the
  identity, income, employment status, and other factors that affect
  the eligibility of the recipient.
         (c)  The commission and other health and human services
  agencies [Texas Department of Human Services] shall cooperate with
  the office of state inspector general [commission] by providing
  data or any other assistance necessary to conduct the electronic
  data matches required by this section.
         (d)  The office of state inspector general [commission] may
  contract with a public or private entity to conduct the electronic
  data matches required by this section.
         (e)  The office of state inspector general [commission, or a
  health and human services agency designated by the commission,] by
  rule shall establish procedures to verify the electronic data
  matches conducted by the office [commission] under this section.
  Not later than the 20th day after the date the electronic data match
  is verified, the commission and other health and human services
  agencies [Texas Department of Human Services] shall remove from
  eligibility a recipient who is determined to be ineligible for
  assistance under the state Medicaid program.
         (f)  The office of state inspector general [commission]
  shall report biennially to the legislature the results of the
  electronic data matching program. The report must include a
  summary of the number of applicants who were removed from
  eligibility for assistance under the state Medicaid program as a
  result of an electronic data match conducted under this section.
         SECTION 12.  Section 531.111, Government Code, is amended to
  read as follows:
         Sec. 531.111.  FRAUD DETECTION TECHNOLOGY. The office of
  state inspector general [commission] may contract with a contractor
  who specializes in developing technology capable of identifying
  patterns of fraud exhibited by Medicaid recipients to:
               (1)  develop and implement the fraud detection
  technology; and
               (2)  determine if a pattern of fraud by Medicaid
  recipients is present in the recipients' eligibility files
  maintained by the commission and other health and human services
  agencies [Texas Department of Human Services].
         SECTION 13.  Section 531.113, Government Code, is amended to
  read as follows:
         Sec. 531.113.  MANAGED CARE ORGANIZATIONS: SPECIAL
  INVESTIGATIVE UNITS OR CONTRACTS.  (a)  Each managed care
  organization that provides or arranges for the provision of health
  care services to an individual under a government-funded program,
  including the Medicaid program and the child health plan program,
  shall:
               (1)  establish and maintain a special investigative
  unit within the managed care organization to investigate fraudulent
  claims and other types of program waste or abuse by recipients and
  service providers; or
               (2)  contract with another entity for the investigation
  of fraudulent claims and other types of program waste or abuse by
  recipients and service providers.
         (b)  Each managed care organization subject to this section
  shall adopt a plan to prevent and reduce fraud, waste, and abuse and
  annually file that plan with the [commission's] office of inspector
  general for approval. The plan must include:
               (1)  a description of the managed care organization's
  procedures for detecting and investigating possible acts of fraud,
  waste, or abuse;
               (2)  a description of the managed care organization's
  procedures for the mandatory reporting of possible acts of fraud,
  waste, or abuse to the [commission's] office of inspector general;
               (3)  a description of the managed care organization's
  procedures for educating and training personnel to prevent fraud,
  waste, and abuse;
               (4)  the name, address, telephone number, and fax
  number of the individual responsible for carrying out the plan;
               (5)  a description or chart outlining the
  organizational arrangement of the managed care organization's
  personnel responsible for investigating and reporting possible
  acts of fraud, waste, or abuse;
               (6)  a detailed description of the results of
  investigations of fraud, waste, and abuse conducted by the managed
  care organization's special investigative unit or the entity with
  which the managed care organization contracts under Subsection
  (a)(2); and
               (7)  provisions for maintaining the confidentiality of
  any patient information relevant to an investigation of fraud,
  waste, or abuse.
         (c)  If a managed care organization contracts for the
  investigation of fraudulent claims and other types of program waste
  or abuse by recipients and service providers under Subsection
  (a)(2), the managed care organization shall file with the
  [commission's] office of inspector general:
               (1)  a copy of the written contract;
               (2)  the names, addresses, telephone numbers, and fax
  numbers of the principals of the entity with which the managed care
  organization has contracted; and
               (3)  a description of the qualifications of the
  principals of the entity with which the managed care organization
  has contracted.
         (d)  The [commission's] office of inspector general may
  review the records of a managed care organization to determine
  compliance with this section.
         (e)  The state inspector general [commissioner] shall adopt
  rules as necessary to accomplish the purposes of this section.
         SECTION 14.  Subsections (b) and (g), Section 531.114,
  Government Code, are amended to read as follows:
         (b)  If after an investigation the office of state inspector
  general [commission] determines that a person violated Subsection
  (a), the office [commission] shall:
               (1)  notify the person of the alleged violation not
  later than the 30th day after the date the office [commission]
  completes the investigation and provide the person with an
  opportunity for a hearing on the matter; or
               (2)  refer the matter to the appropriate prosecuting
  attorney for prosecution.
         (g)  The office of state inspector general [commission]
  shall adopt rules as necessary to implement this section.
         SECTION 15.  Section 533.001, Government Code, is amended by
  adding Subdivision (8) to read as follows:
               (8)  "State inspector general" means the state
  inspector general appointed under Chapter 422.
         SECTION 16.  Subsection (a), Section 533.005, Government
  Code, is amended to read as follows:
         (a)  A contract between a managed care organization and the
  commission for the organization to provide health care services to
  recipients must contain:
               (1)  procedures to ensure accountability to the state
  for the provision of health care services, including procedures for
  financial reporting, quality assurance, utilization review, and
  assurance of contract and subcontract compliance;
               (2)  capitation rates that ensure the cost-effective
  provision of quality health care;
               (3)  a requirement that the managed care organization
  provide ready access to a person who assists recipients in
  resolving issues relating to enrollment, plan administration,
  education and training, access to services, and grievance
  procedures;
               (4)  a requirement that the managed care organization
  provide ready access to a person who assists providers in resolving
  issues relating to payment, plan administration, education and
  training, and grievance procedures;
               (5)  a requirement that the managed care organization
  provide information and referral about the availability of
  educational, social, and other community services that could
  benefit a recipient;
               (6)  procedures for recipient outreach and education;
               (7)  a requirement that the managed care organization
  make payment to a physician or provider for health care services
  rendered to a recipient under a managed care plan not later than the
  45th day after the date a claim for payment is received with
  documentation reasonably necessary for the managed care
  organization to process the claim, or within a period, not to exceed
  60 days, specified by a written agreement between the physician or
  provider and the managed care organization;
               (8)  a requirement that the commission, on the date of a
  recipient's enrollment in a managed care plan issued by the managed
  care organization, inform the organization of the recipient's
  Medicaid certification date;
               (9)  a requirement that the managed care organization
  comply with Section 533.006 as a condition of contract retention
  and renewal;
               (10)  a requirement that the managed care organization
  provide the information required by Section 533.012 and otherwise
  comply and cooperate with the [commission's] office of state
  inspector general;
               (11)  a requirement that the managed care
  organization's usages of out-of-network providers or groups of
  out-of-network providers may not exceed limits for those usages
  relating to total inpatient admissions, total outpatient services,
  and emergency room admissions determined by the commission;
               (12)  if the commission finds that a managed care
  organization has violated Subdivision (11), a requirement that the
  managed care organization reimburse an out-of-network provider for
  health care services at a rate that is equal to the allowable rate
  for those services, as determined under Sections 32.028 and
  32.0281, Human Resources Code;
               (13)  a requirement that the organization use advanced
  practice nurses in addition to physicians as primary care providers
  to increase the availability of primary care providers in the
  organization's provider network;
               (14)  a requirement that the managed care organization
  reimburse a federally qualified health center or rural health
  clinic for health care services provided to a recipient outside of
  regular business hours, including on a weekend day or holiday, at a
  rate that is equal to the allowable rate for those services as
  determined under Section 32.028, Human Resources Code, if the
  recipient does not have a referral from the recipient's primary
  care physician; and
               (15)  a requirement that the managed care organization
  develop, implement, and maintain a system for tracking and
  resolving all provider appeals related to claims payment, including
  a process that will require:
                     (A)  a tracking mechanism to document the status
  and final disposition of each provider's claims payment appeal;
                     (B)  the contracting with physicians who are not
  network providers and who are of the same or related specialty as
  the appealing physician to resolve claims disputes related to
  denial on the basis of medical necessity that remain unresolved
  subsequent to a provider appeal; and
                     (C)  the determination of the physician resolving
  the dispute to be binding on the managed care organization and
  provider.
         SECTION 17.  Subsections (a), (b), (c), and (e), Section
  533.012, Government Code, are amended to read as follows:
         (a)  Each managed care organization contracting with the
  commission under this chapter shall submit to the office of state
  inspector general [commission]:
               (1)  a description of any financial or other business
  relationship between the organization and any subcontractor
  providing health care services under the contract;
               (2)  a copy of each type of contract between the
  organization and a subcontractor relating to the delivery of or
  payment for health care services;
               (3)  a description of the fraud control program used by
  any subcontractor that delivers health care services; and
               (4)  a description and breakdown of all funds paid to
  the managed care organization, including a health maintenance
  organization, primary care case management, and an exclusive
  provider organization, necessary for the office [commission] to
  determine the actual cost of administering the managed care plan.
         (b)  The information submitted under this section must be
  submitted in the form required by the office of state inspector
  general [commission] and be updated as required by the office
  [commission].
         (c)  The office [commission's office] of state inspector
  general [investigations and enforcement] shall review the
  information submitted under this section as appropriate in the
  investigation of fraud in the Medicaid managed care program. The
  comptroller may review the information in connection with the
  health care fraud study conducted by the comptroller.
         (e)  Information submitted to the office of state inspector
  general [commission] under Subsection (a)(1) is confidential and
  not subject to disclosure under Chapter 552[, Government Code].
         SECTION 18.  Subsection (b), Section 2054.376, Government
  Code, is amended to read as follows:
         (b)  This subchapter does not apply to:
               (1)  the Department of Public Safety's use for criminal
  justice or homeland security purposes of a federal database or
  network;
               (2)  a Texas equivalent of a database or network
  described by Subdivision (1) that is managed by the Department of
  Public Safety;
               (3)  the uniform statewide accounting system, as that
  term is used in Subchapter C, Chapter 2101;
               (4)  the state treasury cash and treasury management
  system; [or]
               (5)  a database or network managed by the comptroller
  to:
                     (A)  collect and process multiple types of taxes
  imposed by the state; or
                     (B)  manage or administer fiscal, financial,
  revenue, and expenditure activities of the state under Chapter 403
  and Chapter 404; or
               (6)  the office of state inspector general's use, for
  criminal justice and statutorily mandated confidentiality
  purposes, of a federal or state database or network.
         SECTION 19.  Subsection (b), Section 21.014, Human Resources
  Code, is amended to read as follows:
         (b)  The [person employed by the department as] inspector
  general shall make reports to and consult with the chairman of the
  board regarding:
               (1)  the selection of internal audit topics;
               (2)  the establishment of internal audit priorities;
  and
               (3)  the findings of each regular or special internal
  audit initiative.
         SECTION 20.  Section 32.003, Human Resources Code, is
  amended by adding Subdivision (5) to read as follows:
               (5)  "Office of state inspector general" means the
  office of state inspector general established under Chapter 422,
  Government Code.
         SECTION 21.  Section 32.0291, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0291.  PREPAYMENT REVIEWS AND POST PAYMENT HOLDS.
  (a)  Notwithstanding any other law, the office of state inspector
  general [department] may:
               (1)  perform a prepayment review of a claim for
  reimbursement under the medical assistance program to determine
  whether the claim involves fraud, waste, or abuse; and
               (2)  as necessary to perform that review, withhold
  payment of the claim for not more than five working days without
  notice to the person submitting the claim.
         (b)  Notwithstanding any other law, the office of state
  inspector general [department] may impose a postpayment hold on
  payment of future claims submitted by a provider if the office
  [department] has reliable evidence that the provider has committed
  fraud, waste, abuse, or wilful misrepresentation regarding a claim
  for reimbursement under the medical assistance program. The office
  [department] must notify the provider of the postpayment hold not
  later than the fifth working day after the date the hold is imposed.
         (c)  On timely written request by a provider subject to a
  postpayment hold under Subsection (b), the office of state
  inspector general [department] shall file a request with the State
  Office of Administrative Hearings for an expedited administrative
  hearing regarding the hold. The provider must request an expedited
  hearing under this subsection not later than the 10th day after the
  date the provider receives notice from the office [department]
  under Subsection (b). The office [department] shall discontinue
  the hold unless the office [department] makes a prima facie showing
  at the hearing that the evidence relied on by the office
  [department] in imposing the hold is relevant, credible, and
  material to the issue of fraud, waste, abuse, or wilful
  misrepresentation.
         (d)  The state inspector general [department] shall adopt
  rules that allow a provider subject to a postpayment hold under
  Subsection (b) to seek an informal resolution of the issues
  identified by the office [department] in the notice provided under
  that subsection. A provider must seek an informal resolution under
  this subsection not later than the deadline prescribed by
  Subsection (c). A provider's decision to seek an informal
  resolution under this subsection does not extend the time by which
  the provider must request an expedited administrative hearing under
  Subsection (c). However, a hearing initiated under Subsection (c)
  shall be stayed at the office's [department's] request until the
  informal resolution process is completed.
         SECTION 22.  Section 32.032, Human Resources Code, is
  amended to read as follows:
         Sec. 32.032.  PREVENTION AND DETECTION OF FRAUD AND ABUSE.
  The state inspector general [department] shall adopt reasonable
  rules for minimizing the opportunity for fraud and abuse, for
  establishing and maintaining methods for detecting and identifying
  situations in which a question of fraud or abuse in the program may
  exist, and for referring cases where fraud or abuse appears to exist
  to the appropriate law enforcement agencies for prosecution.
         SECTION 23.  Subsections (a) through (d), Section 32.0321,
  Human Resources Code, are amended to read as follows:
         (a)  The office of state inspector general [department] by
  rule may require each provider of medical assistance in a provider
  type that has demonstrated significant potential for fraud or abuse
  to file with the office [department] a surety bond in a reasonable
  amount. The office [department] by rule shall require a provider of
  medical assistance to file with the office [department] a surety
  bond in a reasonable amount if the office [department] identifies a
  pattern of suspected fraud or abuse involving criminal conduct
  relating to the provider's services under the medical assistance
  program that indicates the need for protection against potential
  future acts of fraud or abuse.
         (b)  The bond under Subsection (a) must be payable to the
  office of state inspector general [department] to compensate the
  office [department] for damages resulting from or penalties or
  fines imposed in connection with an act of fraud or abuse committed
  by the provider under the medical assistance program.
         (c)  Subject to Subsection (d) or (e), the office of state
  inspector general [department] by rule may require each provider of
  medical assistance that establishes a resident's trust fund account
  to post a surety bond to secure the account. The bond must be
  payable to the office [department] to compensate residents of the
  bonded provider for trust funds that are lost, stolen, or otherwise
  unaccounted for if the provider does not repay any deficiency in a
  resident's trust fund account to the person legally entitled to
  receive the funds.
         (d)  The office of state inspector general [department] may
  not require the amount of a surety bond posted for a single facility
  provider under Subsection (c) to exceed the average of the total
  average monthly balance of all the provider's resident trust fund
  accounts for the 12-month period preceding the bond issuance or
  renewal date.
         SECTION 24.  Section 32.0322, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0322.  CRIMINAL HISTORY RECORD INFORMATION.
  (a)  The office of state inspector general and the department may
  obtain from any law enforcement or criminal justice agency the
  criminal history record information that relates to a provider
  under the medical assistance program or a person applying to enroll
  as a provider under the medical assistance program.
         (b)  The office of state inspector general [department] by
  rule shall establish criteria for revoking a provider's enrollment
  or denying a person's application to enroll as a provider under the
  medical assistance program based on the results of a criminal
  history check.
         SECTION 25.  Subsection (d), Section 32.070, Human Resources
  Code, is amended to read as follows:
         (d)  This section does not apply to a computerized audit
  conducted using the Medicaid Fraud Detection Audit System or an
  audit or investigation of fraud and abuse conducted by the Medicaid
  fraud control unit of the office of the attorney general, the office
  of the state auditor, the office of state [the] inspector general,
  or the Office of Inspector General in the United States Department
  of Health and Human Services.
         SECTION 26.  Subsection (e), Section 33.015, Human Resources
  Code, is amended to read as follows:
         (e)  The department shall require a person exempted under
  this section from making a personal appearance at department
  offices to provide verification of the person's entitlement to the
  exemption on initial eligibility certification and on each
  subsequent periodic eligibility recertification. If the person
  does not provide verification and the department considers the
  verification necessary to protect the integrity of the food stamp
  program, the department shall initiate a fraud referral to the
  [department's] office of state inspector general.
         SECTION 27.  Section 20.038, Business & Commerce Code, is
  amended to read as follows:
         Sec. 20.038.  EXEMPTION FROM SECURITY FREEZE. A security
  freeze does not apply to a consumer report provided to:
               (1)  a state or local governmental entity, including a
  law enforcement agency or court or private collection agency, if
  the entity, agency, or court is acting under a court order, warrant,
  subpoena, or administrative subpoena;
               (2)  a child support agency as defined by Section
  101.004, Family Code, acting to investigate or collect child
  support payments or acting under Title IV-D of the Social Security
  Act (42 U.S.C. Section 651 et seq.);
               (3)  the office of state inspector general [Health and
  Human Services Commission] acting to investigate fraud, waste, or
  abuse in state agencies under Chapter 422, Government Code, or
  other law [under Section 531.102, Government Code];
               (4)  the comptroller acting to investigate or collect
  delinquent sales or franchise taxes;
               (5)  a tax assessor-collector acting to investigate or
  collect delinquent ad valorem taxes;
               (6)  a person for the purposes of prescreening as
  provided by the Fair Credit Reporting Act (15 U.S.C. Section 1681 et
  seq.), as amended;
               (7)  a person with whom the consumer has an account or
  contract or to whom the consumer has issued a negotiable
  instrument, or the person's subsidiary, affiliate, agent,
  assignee, prospective assignee, or private collection agency, for
  purposes related to that account, contract, or instrument;
               (8)  a subsidiary, affiliate, agent, assignee, or
  prospective assignee of a person to whom access has been granted
  under Section 20.037(b);
               (9)  a person who administers a credit file monitoring
  subscription service to which the consumer has subscribed;
               (10)  a person for the purpose of providing a consumer
  with a copy of the consumer's report on the consumer's request;
               (11)  a check service or fraud prevention service
  company that issues consumer reports:
                     (A)  to prevent or investigate fraud; or
                     (B)  for purposes of approving or processing
  negotiable instruments, electronic funds transfers, or similar
  methods of payment;
               (12)  a deposit account information service company
  that issues consumer reports related to account closures caused by
  fraud, substantial overdrafts, automated teller machine abuses, or
  similar negative information regarding a consumer to an inquiring
  financial institution for use by the financial institution only in
  reviewing a consumer request for a deposit account with that
  institution; or
               (13)  a consumer reporting agency that:
                     (A)  acts only to resell credit information by
  assembling and merging information contained in a database of
  another consumer reporting agency or multiple consumer reporting
  agencies; and
                     (B)  does not maintain a permanent database of
  credit information from which new consumer reports are produced.
         SECTION 28.  Article 2.12, Code of Criminal Procedure, is
  amended to read as follows:
         Art. 2.12.  WHO ARE PEACE OFFICERS.  The following are peace
  officers:
               (1)  sheriffs, their deputies, and those reserve
  deputies who hold a permanent peace officer license issued under
  Chapter 1701, Occupations Code;
               (2)  constables, deputy constables, and those reserve
  deputy constables who hold a permanent peace officer license issued
  under Chapter 1701, Occupations Code;
               (3)  marshals or police officers of an incorporated
  city, town, or village, and those reserve municipal police officers
  who hold a permanent peace officer license issued under Chapter
  1701, Occupations Code;
               (4)  rangers and officers commissioned by the Public
  Safety Commission and the Director of the Department of Public
  Safety;
               (5)  investigators of the district attorneys', criminal
  district attorneys', and county attorneys' offices;
               (6)  law enforcement agents of the Texas Alcoholic
  Beverage Commission;
               (7)  each member of an arson investigating unit
  commissioned by a city, a county, or the state;
               (8)  officers commissioned under Section 37.081,
  Education Code, or Subchapter E, Chapter 51, Education Code;
               (9)  officers commissioned by the General Services
  Commission;
               (10)  law enforcement officers commissioned by the
  Parks and Wildlife Commission;
               (11)  airport police officers commissioned by a city
  with a population of more than 1.18 million that operates an airport
  that serves commercial air carriers;
               (12)  airport security personnel commissioned as peace
  officers by the governing body of any political subdivision of this
  state, other than a city described by Subdivision (11), that
  operates an airport that serves commercial air carriers;
               (13)  municipal park and recreational patrolmen and
  security officers;
               (14)  security officers and investigators commissioned
  as peace officers by the comptroller;
               (15)  officers commissioned by a water control and
  improvement district under Section 49.216, Water Code;
               (16)  officers commissioned by a board of trustees
  under Chapter 54, Transportation Code;
               (17)  investigators commissioned by the Texas Medical 
  [State] Board [of Medical Examiners];
               (18)  officers commissioned by the board of managers of
  the Dallas County Hospital District, the Tarrant County Hospital
  District, or the Bexar County Hospital District under Section
  281.057, Health and Safety Code;
               (19)  county park rangers commissioned under
  Subchapter E, Chapter 351, Local Government Code;
               (20)  investigators employed by the Texas Racing
  Commission;
               (21)  officers commissioned under Chapter 554,
  Occupations Code;
               (22)  officers commissioned by the governing body of a
  metropolitan rapid transit authority under Section 451.108,
  Transportation Code, or by a regional transportation authority
  under Section 452.110, Transportation Code;
               (23)  investigators commissioned by the attorney
  general under Section 402.009, Government Code;
               (24)  security officers and investigators commissioned
  as peace officers under Chapter 466, Government Code;
               (25)  an officer employed by the [Texas] Department of
  State Health Services under Section 431.2471, Health and Safety
  Code;
               (26)  officers appointed by an appellate court under
  Subchapter F, Chapter 53, Government Code;
               (27)  officers commissioned by the state fire marshal
  under Chapter 417, Government Code;
               (28)  an investigator commissioned by the commissioner
  of insurance under Section 701.104 [Article 1.10D], Insurance Code;
               (29)  apprehension specialists commissioned by the
  Texas Youth Commission as officers under Section 61.0931, Human
  Resources Code;
               (30)  officers appointed by the executive director of
  the Texas Department of Criminal Justice under Section 493.019,
  Government Code;
               (31)  investigators commissioned by the Commission on
  Law Enforcement Officer Standards and Education under Section
  1701.160, Occupations Code;
               (32)  commission investigators commissioned by the
  Texas [Commission on] Private Security Board under Section
  1702.061(f), Occupations Code;
               (33)  the fire marshal and any officers, inspectors, or
  investigators commissioned by an emergency services district under
  Chapter 775, Health and Safety Code; [and]
               (34)  officers commissioned by the State Board of
  Dental Examiners under Section 254.013, Occupations Code, subject
  to the limitations imposed by that section; and
               (35)  officers commissioned by the office of state
  inspector general established under Chapter 422, Government Code.
         SECTION 29.  The following sections of the Government Code
  are repealed:
               (1)  Section 531.102;
               (2)  Section 531.1021;
               (3)  Section 531.103; and
               (4)  Section 531.104.
         SECTION 30.  (a)  The repeal by this Act of Section 531.102,
  Government Code, does not affect the validity of a complaint,
  investigation, or other proceeding initiated under that section
  before the effective date of this Act. A complaint, investigation,
  or other proceeding initiated under that section is continued in
  accordance with the changes in law made by this Act.
         (b)  The repeal by this Act of Section 531.1021, Government
  Code, does not affect the validity of a subpoena issued under that
  section before the effective date of this Act. A subpoena issued
  under that section before the effective date of this Act is governed
  by the law that existed when the subpoena was issued, and the former
  law is continued in effect for that purpose.
         SECTION 31.  (a)  The office of state inspector general
  under Chapter 422, Government Code, as added by this Act, is created
  on the effective date of this Act.
         (b)  On January 1, 2008, the office of inspector general of
  the Health and Human Services Commission created under Section
  531.102, Government Code, as that section existed before amendment
  by this Act, is abolished.
         (c)  Not later than January 1, 2008:
               (1)  all powers, duties, obligations, rights,
  contracts, records, personal property, unspent appropriations,
  state and federal funds, including overhead costs, support costs,
  and lease or colocation costs, of the office of inspector general of
  the Health and Human Services Commission shall be transferred, as
  consistent with this Act, to the office of state inspector general;
               (2)  all personnel, vacant full-time equivalent
  positions, and assets assigned, as of the effective date of this
  Act, to the office of inspector general of the Health and Human
  Services Commission or engaged in the performance of the functions
  of that office shall be transferred, as consistent with this Act, to
  the office of state inspector general;
               (3)  each state agency for which a state agency
  inspector general is designated by the state inspector general on
  or before October 1, 2007, shall transfer to the office of state
  inspector general, as consistent with this Act, all personnel,
  vacant full-time equivalent positions, and assets engaged in the
  performance of or the support of agency functions relating to the
  detection, investigation, and prevention of fraud, waste, and abuse
  in the implementation or administration of state or federally
  funded programs;
               (4)  all state and federal funding, including funding
  for overhead costs, support costs, and lease or colocation lease
  costs, for the functions to be transferred to the office of state
  inspector general shall be reallocated to that office; and
               (5)  for purposes of federal single state agency
  funding requirements, any federal funds that may not be
  appropriated directly to the office of state inspector general
  shall be transferred from the single state agency receiving the
  funds to the office of state inspector general if the funds are
  intended for a function performed by that office.
         (d)  All future federal funding to be allocated to the office
  of inspector general of the Health and Human Services Commission,
  including drawing funds and transferring funds, shall be
  renegotiated by the state inspector general for reallocation to the
  office of state inspector general.
         (e)  A state agency for which a state agency inspector
  general is designated by the state inspector general after October
  1, 2007, shall, not later than the 90th day after the date of the
  designation, transfer to the office of state inspector general, as
  consistent with this Act, all personnel, vacant full-time
  equivalent positions, and assets engaged in the performance of or
  the support of agency functions relating to the detection,
  investigation, and prevention of fraud, waste, and abuse in the
  implementation or administration of state or federally funded
  programs.
         SECTION 32.  (a)  The Health and Human Services Commission
  shall take all action necessary to provide for the orderly transfer
  of the assets and responsibilities of the commission's office of
  inspector general to the office of state inspector general. In the
  event a transfer is not completed by the date required under this
  Act, all possible efforts shall be made to promptly conclude the
  transfer.
         (b)  A rule or form adopted by the office of inspector
  general of the Health and Human Services Commission is a rule or
  form of the office of state inspector general and remains in effect
  until changed by the state inspector general.
         (c)  A reference in law or administrative rule to the office
  of inspector general of the Health and Human Services Commission
  means the office of state inspector general.
         SECTION 33.  (a)  This section does not prohibit a person
  serving as inspector general of the Health and Human Services
  Commission under Subsection (a-1), Section 531.102, Government
  Code, immediately before the effective date of this Act, from being
  appointed under Chapter 422, Government Code, as added by this Act,
  if the person has the qualifications required under that chapter.
         (b)  As soon as possible after the earlier of the expiration
  date of the term of the inspector general of the Health and Human
  Services Commission under Section 531.102, Government Code, or the
  date the position of inspector general under that law otherwise
  becomes vacant, the governor shall appoint the state inspector
  general under Chapter 422, Government Code, as added by this Act, to
  an initial term expiring February 1, 2009.
         SECTION 34.  The abolition by this Act of the office of
  inspector general of the Health and Human Services Commission under
  Section 531.102, Government Code, as that section existed before
  repeal by this Act, does not affect the validity of an action taken
  by that office before it is abolished.
         SECTION 35.  If, before implementing any provision of this
  Act, a state agency or the state inspector general appointed under
  Chapter 422, Government Code, as added by this Act, determines that
  a waiver or authorization from a federal agency is necessary for
  implementation of that provision, the agency affected by the
  provision or the state inspector general shall request the waiver
  or authorization and may delay implementing that provision until
  the waiver or authorization is granted.
         SECTION 36.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2007.
 
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