Bill Text: TX HB1034 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to unlawful acts against and criminal offenses involving the Medicaid program.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-04-06 - Left pending in committee [HB1034 Detail]
Download: Texas-2011-HB1034-Introduced.html
82R4916 EES-F | ||
By: Shelton | H.B. No. 1034 |
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relating to unlawful acts against and criminal offenses involving | ||
the Medicaid program. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 36.002, Human Resources Code, is amended | ||
to read as follows: | ||
Sec. 36.002. UNLAWFUL ACTS. A person commits an unlawful | ||
act if the person: | ||
(1) knowingly makes or causes to be made a false | ||
statement or misrepresentation of a material fact to permit a | ||
person to receive a benefit or payment under the Medicaid program | ||
that is not authorized or that is greater than the benefit or | ||
payment that is authorized; | ||
(2) knowingly conceals or fails to disclose | ||
information that permits a person to receive a benefit or payment | ||
under the Medicaid program that is not authorized or that is greater | ||
than the benefit or payment that is authorized; | ||
(3) knowingly applies for and receives a benefit or | ||
payment on behalf of another person under the Medicaid program and | ||
converts any part of the benefit or payment to a use other than for | ||
the benefit of the person on whose behalf it was received; | ||
(4) knowingly makes, causes to be made, induces, or | ||
seeks to induce the making of a false statement or | ||
misrepresentation of material fact concerning: | ||
(A) the conditions or operation of a facility in | ||
order that the facility may qualify for certification or | ||
recertification required by the Medicaid program, including | ||
certification or recertification as: | ||
(i) a hospital; | ||
(ii) a nursing facility or skilled nursing | ||
facility; | ||
(iii) a hospice; | ||
(iv) an intermediate care facility for the | ||
mentally retarded; | ||
(v) an assisted living facility; or | ||
(vi) a home health agency; or | ||
(B) information required to be provided by a | ||
federal or state law, rule, regulation, or provider agreement | ||
pertaining to the Medicaid program; | ||
(5) except as authorized under the Medicaid program, | ||
knowingly pays, charges, solicits, accepts, or receives, in | ||
addition to an amount paid under the Medicaid program, a gift, | ||
money, a donation, or other consideration as a condition to the | ||
provision of a service or product or the continued provision of a | ||
service or product if the cost of the service or product is paid | ||
for, in whole or in part, under the Medicaid program; | ||
(6) knowingly presents or causes to be presented a | ||
claim for payment under the Medicaid program for a product provided | ||
or a service rendered by a person who: | ||
(A) is not licensed to provide the product or | ||
render the service, if a license is required; or | ||
(B) is not licensed in the manner claimed; | ||
(7) knowingly makes or causes to be made a claim under | ||
the Medicaid program for: | ||
(A) a service or product that has not been | ||
approved or acquiesced in by a treating physician or health care | ||
practitioner; | ||
(B) a service or product that is substantially | ||
inadequate or inappropriate when compared to generally recognized | ||
standards within the particular discipline or within the health | ||
care industry; or | ||
(C) a product that has been adulterated, debased, | ||
mislabeled, or that is otherwise inappropriate; | ||
(8) makes a claim under the Medicaid program and | ||
knowingly fails to indicate the type of license and the | ||
identification number of the licensed health care provider who | ||
actually provided the service; | ||
(9) knowingly enters into an agreement, combination, | ||
or conspiracy to defraud the state by obtaining or aiding another | ||
person in obtaining an unauthorized payment or benefit from the | ||
Medicaid program or a fiscal agent; | ||
(10) is a managed care organization that contracts | ||
with the Health and Human Services Commission or other state agency | ||
to provide or arrange to provide health care benefits or services to | ||
individuals eligible under the Medicaid program and knowingly: | ||
(A) fails to provide to an individual a health | ||
care benefit or service that the organization is required to | ||
provide under the contract; | ||
(B) fails to provide to the commission or | ||
appropriate state agency information required to be provided by | ||
law, commission or agency rule, or contractual provision; or | ||
(C) engages in a fraudulent activity in | ||
connection with the enrollment of an individual eligible under the | ||
Medicaid program in the organization's managed care plan or in | ||
connection with marketing the organization's services to an | ||
individual eligible under the Medicaid program; | ||
(11) knowingly obstructs an investigation by the | ||
attorney general of an alleged unlawful act under this section; | ||
(12) knowingly makes, uses, or causes the making or | ||
use of a false record or statement to conceal, avoid, or decrease an | ||
obligation to pay or transmit money or property to this state under | ||
the Medicaid program; or | ||
(13) knowingly engages in conduct that constitutes a | ||
violation under Section 32.039(b). | ||
SECTION 2. Section 35A.02(a), Penal Code, is amended to | ||
read as follows: | ||
(a) A person commits an offense if the person: | ||
(1) knowingly makes or causes to be made a false | ||
statement or misrepresentation of a material fact to permit a | ||
person to receive a benefit or payment under the Medicaid program | ||
that is not authorized or that is greater than the benefit or | ||
payment that is authorized; | ||
(2) knowingly conceals or fails to disclose | ||
information that permits a person to receive a benefit or payment | ||
under the Medicaid program that is not authorized or that is greater | ||
than the benefit or payment that is authorized; | ||
(3) knowingly applies for and receives a benefit or | ||
payment on behalf of another person under the Medicaid program and | ||
converts any part of the benefit or payment to a use other than for | ||
the benefit of the person on whose behalf it was received; | ||
(4) knowingly makes, causes to be made, induces, or | ||
seeks to induce the making of a false statement or | ||
misrepresentation of material fact concerning: | ||
(A) the conditions or operation of a facility in | ||
order that the facility may qualify for certification or | ||
recertification required by the Medicaid program, including | ||
certification or recertification as: | ||
(i) a hospital; | ||
(ii) a nursing facility or skilled nursing | ||
facility; | ||
(iii) a hospice; | ||
(iv) an intermediate care facility for the | ||
mentally retarded; | ||
(v) an assisted living facility; or | ||
(vi) a home health agency; or | ||
(B) information required to be provided by a | ||
federal or state law, rule, regulation, or provider agreement | ||
pertaining to the Medicaid program; | ||
(5) except as authorized under the Medicaid program, | ||
knowingly pays, charges, solicits, accepts, or receives, in | ||
addition to an amount paid under the Medicaid program, a gift, | ||
money, a donation, or other consideration as a condition to the | ||
provision of a service or product or the continued provision of a | ||
service or product if the cost of the service or product is paid | ||
for, in whole or in part, under the Medicaid program; | ||
(6) knowingly presents or causes to be presented a | ||
claim for payment under the Medicaid program for a product provided | ||
or a service rendered by a person who: | ||
(A) is not licensed to provide the product or | ||
render the service, if a license is required; or | ||
(B) is not licensed in the manner claimed; | ||
(7) knowingly makes or causes to be made a claim under | ||
the Medicaid program for: | ||
(A) a service or product that has not been | ||
approved or acquiesced in by a treating physician or health care | ||
practitioner; | ||
(B) a service or product that is substantially | ||
inadequate or inappropriate when compared to generally recognized | ||
standards within the particular discipline or within the health | ||
care industry; or | ||
(C) a product that has been adulterated, debased, | ||
mislabeled, or that is otherwise inappropriate; | ||
(8) makes a claim under the Medicaid program and | ||
knowingly fails to indicate the type of license and the | ||
identification number of the licensed health care provider who | ||
actually provided the service; | ||
(9) knowingly enters into an agreement, combination, | ||
or conspiracy to defraud the state by obtaining or aiding another | ||
person in obtaining an unauthorized payment or benefit from the | ||
Medicaid program or a fiscal agent; | ||
(10) is a managed care organization that contracts | ||
with the Health and Human Services Commission or other state agency | ||
to provide or arrange to provide health care benefits or services to | ||
individuals eligible under the Medicaid program and knowingly: | ||
(A) fails to provide to an individual a health | ||
care benefit or service that the organization is required to | ||
provide under the contract; | ||
(B) fails to provide to the commission or | ||
appropriate state agency information required to be provided by | ||
law, commission or agency rule, or contractual provision; or | ||
(C) engages in a fraudulent activity in | ||
connection with the enrollment of an individual eligible under the | ||
Medicaid program in the organization's managed care plan or in | ||
connection with marketing the organization's services to an | ||
individual eligible under the Medicaid program; | ||
(11) knowingly obstructs an investigation by the | ||
attorney general of an alleged unlawful act under this section or | ||
under Section 32.039, 32.0391, or 36.002, Human Resources Code; or | ||
(12) knowingly makes, uses, or causes the making or | ||
use of a false record or statement to conceal, avoid, or decrease an | ||
obligation to pay or transmit money or property to this state under | ||
the Medicaid program. | ||
SECTION 3. (a) The change in law made by this Act applies | ||
only to conduct that occurs on or after the effective date of this | ||
Act. Conduct that occurs before the effective date of this Act is | ||
governed by the law in effect at the time the conduct occurred, and | ||
that law is continued in effect for that purpose. | ||
(b) For purposes of this section, conduct constituting an | ||
offense under the penal law of this state occurred before the | ||
effective date of this Act if any element of the offense occurred | ||
before that date. | ||
SECTION 4. This Act takes effect September 1, 2011. |