Texas House Bill HB2938

Texas 2009 - 81st Regular

• Out of House Committee: 4/14/09

Caption

Relating to the conduct of investigations, prepayment reviews, and payment holds in cases of suspected fraud, waste, or abuse in the provision of health and human services.

Impact

If enacted, HB 2938 will significantly affect Texas state law regarding the management of health service fraud investigations. It empowers the executive commissioner of the Health and Human Services Commission to adopt rules ensuring that prepayment reviews are not random but are instead based on precise criteria. Moreover, the bill stipulates that providers must be notified regarding any payment hold and that they are entitled to a hearing if they believe the hold was unjustly imposed. This requirement for due process aims to balance the need for thorough fraud investigations with the rights of healthcare providers.

Summary

House Bill 2938 seeks to amend regulations surrounding investigations, prepayment reviews, and payment holds within the Texas health and human services sector, specifically targeting cases suspected of fraud, waste, or abuse. The bill introduces detailed guidelines for the process of conducting investigations and establishes stronger criteria for holding payments related to claims for reimbursement under the medical assistance program. By providing a clear framework for the criteria that trigger investigations, this bill aims to optimize the efficiency of fraud detection efforts related to healthcare services.

Contention

There could be points of contention surrounding the bill, particularly from healthcare provider organizations concerned about instances where claims could be wrongfully held without sufficient justification. Additionally, questions may arise regarding the strict enforcement of rules and the definition of what constitutes credible evidence of fraud or abuse. The tension between reinforcing fraud prevention measures and allowing providers fair treatment in such investigations could spark significant debate among stakeholders in the health and human services sector.