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AN ACT
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relating to certain actions that constitute unlawful acts against |
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the Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 36.002, Human Resources Code, is amended |
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to read as follows: |
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Sec. 36.002. UNLAWFUL ACTS. A person commits an unlawful |
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act if the person: |
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(1) knowingly makes or causes to be made a false |
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statement or misrepresentation of a material fact to permit a |
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person to receive a benefit or payment under the Medicaid program |
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that is not authorized or that is greater than the benefit or |
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payment that is authorized; |
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(2) knowingly conceals or fails to disclose |
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information that permits a person to receive a benefit or payment |
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under the Medicaid program that is not authorized or that is greater |
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than the benefit or payment that is authorized; |
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(3) knowingly applies for and receives a benefit or |
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payment on behalf of another person under the Medicaid program and |
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converts any part of the benefit or payment to a use other than for |
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the benefit of the person on whose behalf it was received; |
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(4) knowingly makes, causes to be made, induces, or |
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seeks to induce the making of a false statement or |
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misrepresentation of material fact concerning: |
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(A) the conditions or operation of a facility in |
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order that the facility may qualify for certification or |
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recertification required by the Medicaid program, including |
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certification or recertification as: |
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(i) a hospital; |
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(ii) a nursing facility or skilled nursing |
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facility; |
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(iii) a hospice; |
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(iv) an intermediate care facility for the |
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mentally retarded; |
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(v) an assisted living facility; or |
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(vi) a home health agency; or |
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(B) information required to be provided by a |
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federal or state law, rule, regulation, or provider agreement |
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pertaining to the Medicaid program; |
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(5) except as authorized under the Medicaid program, |
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knowingly pays, charges, solicits, accepts, or receives, in |
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addition to an amount paid under the Medicaid program, a gift, |
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money, a donation, or other consideration as a condition to the |
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provision of a service or product or the continued provision of a |
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service or product if the cost of the service or product is paid |
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for, in whole or in part, under the Medicaid program; |
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(6) knowingly presents or causes to be presented a |
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claim for payment under the Medicaid program for a product provided |
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or a service rendered by a person who: |
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(A) is not licensed to provide the product or |
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render the service, if a license is required; or |
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(B) is not licensed in the manner claimed; |
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(7) knowingly makes a claim under the Medicaid program |
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for: |
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(A) a service or product that has not been |
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approved or acquiesced in by a treating physician or health care |
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practitioner; |
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(B) a service or product that is substantially |
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inadequate or inappropriate when compared to generally recognized |
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standards within the particular discipline or within the health |
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care industry; or |
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(C) a product that has been adulterated, debased, |
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mislabeled, or that is otherwise inappropriate; |
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(8) makes a claim under the Medicaid program and |
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knowingly fails to indicate the type of license and the |
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identification number of the licensed health care provider who |
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actually provided the service; |
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(9) knowingly enters into an agreement, combination, |
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or conspiracy to defraud the state by obtaining or aiding another |
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person in obtaining an unauthorized payment or benefit from the |
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Medicaid program or a fiscal agent; |
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(10) is a managed care organization that contracts |
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with the Health and Human Services Commission or other state agency |
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to provide or arrange to provide health care benefits or services to |
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individuals eligible under the Medicaid program and knowingly: |
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(A) fails to provide to an individual a health |
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care benefit or service that the organization is required to |
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provide under the contract; |
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(B) fails to provide to the commission or |
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appropriate state agency information required to be provided by |
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law, commission or agency rule, or contractual provision; or |
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(C) engages in a fraudulent activity in |
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connection with the enrollment of an individual eligible under the |
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Medicaid program in the organization's managed care plan or in |
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connection with marketing the organization's services to an |
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individual eligible under the Medicaid program; |
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(11) knowingly obstructs an investigation by the |
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attorney general of an alleged unlawful act under this section; |
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[or] |
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(12) knowingly makes, uses, or causes the making or |
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use of a false record or statement to conceal, avoid, or decrease an |
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obligation to pay or transmit money or property to this state under |
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the Medicaid program; or |
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(13) knowingly engages in conduct that constitutes a |
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violation under Section 32.039(b). |
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SECTION 2. (a) Section 36.002, Human Resources Code, as |
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amended by this Act, applies only to conduct that occurs on or after |
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the effective date of this Act. Conduct that occurs before the |
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effective date of this Act is governed by the law in effect at the |
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time the conduct occurred, and that law is continued in effect for |
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that purpose. |
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(b) For purposes of this section, conduct constituting an |
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offense under the penal law of this state occurred before the |
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effective date of this Act if any element of the offense occurred |
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before that date. |
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SECTION 3. This Act takes effect September 1, 2007. |
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____________________________________________________________ |
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President of the SenateSpeaker of the House |
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I certify that H.B. No. 889 was passed by the House on March |
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22, 2007, by the following vote: Yeas 144, Nays 0, 2 present, not |
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voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 889 was passed by the Senate on May 1, |
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2007, by the following vote: Yeas 31, Nays 0. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: _____________________ |
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APPROVED: _____________________ |
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Date |
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_____________________ |
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Governor |