BILL ANALYSIS
Senate Research Center S.B. 1170
81R8682 ALB-F By: Nichols
AUTHOR'S / SPONSOR'S STATEMENT OF INTENT
Under current law, hospital districts are authorized to adopt procedures to prevent and detect fraud in their indigent care programs. The statute also allows hospital districts to disqualify persons from these programs in cases where fraud appears to exist. The purpose of the current statute is to address frauds involving the misrepresentation of applicant information. Some frauds for which hospital districts disqualify persons involve the person's presentation of fraudulent applicant information involving residency, income, or resources.
Due to Texas' high rate of uninsured and other factors, hospital districts and public hospitals are experiencing increasing demand for district-funded indigent care services. These entities have a duty to assure that their public funds are spent on services that are not fraudulently obtained and to seek recovery for services gained in such a manner.
As proposed, S.B. 1170 amends Section 61.066 (Prevention and Detection of Fraud), Health and Safety Code, to authorize hospital districts to recover the value to the hospital district of fraudulently-obtained health care services provided to a person who is disqualified under that section.
RULEMAKING AUTHORITY
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 61.066, Health and Safety Code, by adding Subsection (c), to authorize a hospital district to recover an amount equal to the value of any fraudulently obtained health care services provided to a person disqualified under this section.
SECTION 2. Amends Subchapter C, Chapter 61, Health and Safety Code, by adding Section 61.067, as follows:
Sec. 61.067. SUBROGATION. (a) Provides that the filing of an application for or receipt of health care services provided or paid for by a hospital district or public hospital constitutes an assignment of the applicant's or recipient's right of recovery from personal insurance, other sources, or another person for personal injury caused by the other person's negligence or wrong.
(b) Requires a person who applies for or receives health care services to inform the hospital district or public hospital, at the time of application or at any time during eligibility for services, of any unsettled tort claim that may affect medical needs; any private accident or health insurance coverage that is or may become available; and any injury that is caused by the act or failure to act of some other person.
(c) Requires an applicant or eligible resident to inform the hospital district or public hospital of information required by Subsection (b) within 10 days of the date the person learns of the person's insurance coverage, tort claim, or potential cause of action.
(d) Provides that a claim for damages for personal injury does not constitute grounds for denying or discontinuing services under this chapter.
(e) Provides that a separate and distinct cause of action is created in favor of the hospital district or public hospital, and authorizes the hospital district or public hospital, with the approval of the board of directors or managers, to take direct civil action in any court of competent jurisdiction. Provides that a suit brought under this section does not need to be ancillary to or dependent on any other action.
(f) Provides that the hospital district's or public hospital's right of recovery under this section is limited to the amount of the cost of services paid by the hospital district or public hospital. Limits other subrogation rights granted under this section to the cost of the services provided by the hospital district or public hospital.
(g) Provides that an applicant or eligible resident who knowingly and intentionally fails to disclose the information required by Subsection (b) is subject to denial of services under Section 61.066 following an administrative hearing.
(h) Requires procedures established by a hospital district or public hospital for administrative hearings under this section to provide for appropriate due process, including procedures for appeals.
SECTION 3. Makes application of this Act prospective.
SECTION 4. Effective date: September 1, 2009.