85R11240 MM-D
By: Raymond H.B. No. 2969
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.