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A BILL TO BE ENTITLED
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AN ACT
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relating to the detection and reporting of fraud in Medicaid or |
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other health and human services programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 531.102(j) and (k), Government Code, |
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are amended to read as follows: |
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(j) The office shall prepare a final report on each audit, |
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inspection, or investigation conducted under this section. The |
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final report must include: |
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(1) a summary of the activities performed by the |
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office in conducting the audit, inspection, or investigation; |
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(2) a statement regarding whether the audit, |
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inspection, or investigation resulted in a finding of any |
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wrongdoing; and |
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(3) a description of any findings of wrongdoing. |
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(k) A final report on an audit, inspection, or investigation |
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is subject to required disclosure under Chapter 552. All |
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information and materials compiled during the audit, inspection, or |
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investigation remain confidential and not subject to required |
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disclosure in accordance with Section 531.1021(g). A confidential |
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draft report on an audit, inspection, or investigation that |
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concerns the death of a child may be shared with the Department of |
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Family and Protective Services. A draft report that is shared with |
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the Department of Family and Protective Services remains |
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confidential and is not subject to disclosure under Chapter 552. |
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SECTION 2. Section 531.1021(g), Government Code, is amended |
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to read as follows: |
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(g) All information and materials subpoenaed or compiled by |
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the office in connection with an audit, inspection, or |
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investigation or by the office of the attorney general in |
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connection with a Medicaid fraud investigation are confidential and |
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not subject to disclosure under Chapter 552, and not subject to |
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disclosure, discovery, subpoena, or other means of legal compulsion |
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for their release to anyone other than the office or the attorney |
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general or their employees or agents involved in the audit, |
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inspection, or investigation conducted by the office or the |
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attorney general, except that this information may be disclosed to |
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the state auditor's office, law enforcement agencies, and other |
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entities as permitted by other law. |
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SECTION 3. The heading to Section 531.106, Government Code, |
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is amended to read as follows: |
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Sec. 531.106. LEARNING, [OR] NEURAL NETWORK, OR OTHER |
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TECHNOLOGY. |
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SECTION 4. Sections 531.106(a), (c), and (g), Government |
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Code, are amended to read as follows: |
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(a) The commission shall use learning, [or] neural network, |
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or other technology to identify and deter fraud in Medicaid |
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throughout this state. |
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(c) The data used for data [neural network] processing shall |
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be maintained as an independent subset for security purposes. |
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(g) Each month, the [learning or neural network] technology |
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implemented under this section must match vital statistics unit |
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death records with Medicaid claims filed by a provider. If the |
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commission determines that a provider has filed a claim for |
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services provided to a person after the person's date of death, as |
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determined by the vital statistics unit death records, the |
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commission shall refer the case for investigation to the |
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commission's office of inspector general. |
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SECTION 5. Section 531.1061(b), Government Code, is amended |
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to read as follows: |
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(b) For each case of suspected fraud, abuse, or insufficient |
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quality of care identified by the [learning or neural network] |
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technology required under Section 531.106, the automated fraud |
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investigation tracking system must: |
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(1) receive electronically transferred records |
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relating to the identified case from the [learning or neural
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network] technology; |
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(2) record the details and monitor the status of an |
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investigation of the identified case, including maintaining a |
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record of the beginning and completion dates for each phase of the |
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case investigation; |
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(3) generate documents and reports related to the |
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status of the case investigation; and |
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(4) generate standard letters to a provider regarding |
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the status or outcome of an investigation. |
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SECTION 6. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 7. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2017. |