|
|
|
A BILL TO BE ENTITLED
|
|
AN ACT
|
|
relating to the detection and reporting of fraud in Medicaid or |
|
other health and human services programs. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
SECTION 1. Sections 531.102(j) and (k), Government Code, |
|
are amended to read as follows: |
|
(j) The office shall prepare a final report on each audit, |
|
inspection, or investigation conducted under this section. The |
|
final report must include: |
|
(1) a summary of the activities performed by the |
|
office in conducting the audit, inspection, or investigation; |
|
(2) a statement regarding whether the audit, |
|
inspection, or investigation resulted in a finding of any |
|
wrongdoing; and |
|
(3) a description of any findings of wrongdoing. |
|
(k) A final report on an audit, inspection, or investigation |
|
is subject to required disclosure under Chapter 552. All |
|
information and materials compiled during the audit, inspection, or |
|
investigation remain confidential and not subject to required |
|
disclosure in accordance with Section 531.1021(g). A confidential |
|
draft report on an audit, inspection, or investigation that |
|
concerns the death of a child may be shared with the Department of |
|
Family and Protective Services. A draft report that is shared with |
|
the Department of Family and Protective Services remains |
|
confidential and is not subject to disclosure under Chapter 552. |
|
SECTION 2. Section 531.1021(g), Government Code, is amended |
|
to read as follows: |
|
(g) All information and materials subpoenaed or compiled by |
|
the office in connection with an audit, inspection, or |
|
investigation or by the office of the attorney general in |
|
connection with a Medicaid fraud investigation are confidential and |
|
not subject to disclosure under Chapter 552, and not subject to |
|
disclosure, discovery, subpoena, or other means of legal compulsion |
|
for their release to anyone other than the office or the attorney |
|
general or their employees or agents involved in the audit, |
|
inspection, or investigation conducted by the office or the |
|
attorney general, except that this information may be disclosed to |
|
the state auditor's office, law enforcement agencies, and other |
|
entities as permitted by other law. |
|
SECTION 3. The heading to Section 531.106, Government Code, |
|
is amended to read as follows: |
|
Sec. 531.106. LEARNING, [OR] NEURAL NETWORK, OR OTHER |
|
TECHNOLOGY. |
|
SECTION 4. Sections 531.106(a), (c), and (g), Government |
|
Code, are amended to read as follows: |
|
(a) The commission shall use learning, [or] neural network, |
|
or other technology to identify and deter fraud in Medicaid |
|
throughout this state. |
|
(c) The data used for data [neural network] processing shall |
|
be maintained as an independent subset for security purposes. |
|
(g) Each month, the [learning or neural network] technology |
|
implemented under this section must match vital statistics unit |
|
death records with Medicaid claims filed by a provider. If the |
|
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 vital statistics unit death records, the |
|
commission shall refer the case for investigation to the |
|
commission's office of inspector general. |
|
SECTION 5. Section 531.1061(b), Government Code, is amended |
|
to read as follows: |
|
(b) For each case of suspected fraud, 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. |
|
SECTION 6. If before implementing any provision of this Act |
|
a state agency determines that a waiver or authorization from a |
|
federal agency is necessary for implementation of that provision, |
|
the agency affected by the provision shall request the waiver or |
|
authorization and may delay implementing that provision until the |
|
waiver or authorization is granted. |
|
SECTION 7. 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, 2017. |