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Texas Government Code §403.028:
Authorizing the Texas Health Care Claims Study

§ 403.028. Health Care Fraud Study[1]

Text of subsec. (a) as amended by Acts 1999, 76th Leg., ch. 1290, § 1 and Acts 1999, 76th Leg., ch. 1541, § 50

(a) The comptroller, in consultation with the office of the state auditor, shall conduct a study each biennium to determine the number and type of fraudulent claims for medical or health care benefits submitted:

(1) under the state Medicaid program, including the Medicaid managed care program implemented under Chapter 533; or

(2) by or on behalf of a state employee and administered by the attorney general under Chapter 501, Labor Code.

Text of subsec. (a) as amended by Acts 1999, 76th Leg., ch. 1289, § 2 and Acts 1999, 76th Leg., ch. 1541, § 50

(a) The comptroller, in consultation with the state auditor's office, shall conduct a study each biennium to determine:

(1) the number and type of potential fraudulent claims for medical or health care benefits submitted:

(A) under the state Medicaid program; or

(B) by or on behalf of a state employee and administered by the attorney general under Chapter 501, Labor Code; and

(2) the need for changes to the eligibility system used under the state Medicaid program.

(b) For purposes of the study conducted under this section, the comptroller or, at the request of the comptroller, a state agency that administers a program identified by Subsection (a) may make telephone contact with a person identified as receiving services for which benefits are provided under the program to confirm the delivery of services to the person.

(c) A state agency that administers a program identified by Subsection (a) shall cooperate with the comptroller and provide any information required by the comptroller in connection with the study. The information must be provided in a format agreed to by the comptroller and the state agency to permit examination of both patient and health care provider histories to identify unusual or suspicious claims or patterns of claims. A state agency may enter into a memorandum of understanding with the comptroller regarding the use and confidentiality of the information provided. This subsection does not require a state agency to provide confidential information if release of the information is prohibited by law.

(d) Each state agency that administers a program identified by Subsection (a), in consultation with the comptroller and the office of the state auditor, shall establish performance measures to be used to evaluate the agency's fraud control procedures.

(e) The comptroller shall report the results of the study to each state agency that administers a program included in the study so that the agency may modify its fraud control procedures as necessary. The report must indicate whether the level of fraud in each program included in the study has increased, decreased, or remained constant since the last report of the comptroller under this section.

Added by Acts 1997, 75th Leg., ch. 1153, § 6.01(a), eff. Sept. 1, 1997.

Amended by Acts 1999, 76th Leg., ch. 1289, § 2, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1541, § 50, eff. Sept. 1, 1999. Renumbered from § 403.026 by Acts 1999, 76th Leg., ch. 62, § 19.01(32), eff. Sept. 1, 1999. Renumbered from § 403.026 and amended by Acts 1999, 76th Leg., ch. 1290, § 1, eff. June 18, 1999.


ENDNOTES

(1)V.T.C.A., Government Code §403.028 (Texas Legislative Council text online at http://www.capitol.state.tx.us/statutes/docs/GV/content/htm/gv.004.00.000403.00.htm.