Texas 2025 - 89th Regular

Texas House Bill HB2886 Compare Versions

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Old	New		Differences
1		-	~~89R18109 JG-D~~
	1	+	2025S0051-1 01/30/25
2	2		By: Noble H.B. No. 2886
3		-	~~Substitute the following for H.B. No. 2886:~~
4		-	~~By: Hull C.S.H.B. No. 2886~~
	3	+
	4	+
5	5
6	6
7	7		A BILL TO BE ENTITLED
8	8		AN ACT
9	9		relating to administrative remedies for certain fraud and abuse
10	10		violations under Medicaid; providing administrative penalties.
11	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12		SECTION 1. Sections 544.0205(a) and (b), Government Code,
13	13		as effective April 1, 2025, are amended to read as follows:
14	14		(a) The commission may grant an award to an individual who
15	15		reports activity that constitutes fraud or abuse of Medicaid funds
16	16		or who reports Medicaid overcharges if the commission determines
17	17		that the disclosure results in the recovery of a remedy [an
18	18		administrative penalty] imposed under Section 32.039, Human
19	19		Resources Code. The commission may not grant an award to an
20	20		individual in connection with a report if the commission or
21	21		attorney general had independent knowledge of the activity the
22	22		individual reported.
23	23		(b) The commission shall determine the amount of an
24	24		award. The award may not exceed five percent of the amount of the
25	25		remedy [administrative penalty] imposed under Section 32.039,
26	26		Human Resources Code, that resulted from the individual's
27	27		disclosure. In determining the award amount, the commission:
28	28		(1) shall consider how important the disclosure is in
29	29		ensuring the fiscal integrity of Medicaid; and
30	30		(2) may consider whether the individual participated
31	31		in the fraud, abuse, or overcharge.
32	32		SECTION 2. The heading to Section 32.039, Human Resources
33	33		Code, is amended to read as follows:
34	34		Sec. 32.039. ADMINISTRATIVE REMEDIES [DAMAGES AND
35	35		PENALTIES].
36	36		SECTION 3. Section 32.039(a), Human Resources Code, is
37	37		amended by amending Subdivision (1) and adding Subdivision (3-a) to
38	38		read as follows:
39	39		(1) "Claim" means an application, request, or demand
40	40		for a benefit or payment [of health care services] under Title XIX
41	41		of the [federal] Social Security Act (42 U.S.C. Section 1396 et
42	42		seq.) [that is submitted by a person who is under a contract or
43	43		provider agreement with the commission].
44	44		(3-a) "Material" means having a natural tendency to
45	45		influence or to be capable of influencing.
46	46		SECTION 4. Section 32.039, Human Resources Code, is amended
47		-	by adding Subsections (a-1), (a-2), (c-1)~~, and (c-2)~~ and amending
48		-	Subsections (b), (c), (d), (f), (g), (h), (i), (~~k), (~~l), (m), (n),
49		-	~~(o),~~ (p), (q), (r), (s), and (x) to read as follows:
	47	+	by adding Subsections (a-1), (a-2), and (c-1) and amending
	48	+	Subsections (b), (c), (d), (f), (g), (h), (i), (l), (m), (n), (o),
	49	+	(p), (q), (r), (s), and (x) to read as follows:
50	50		(a-1) For purposes of this section, a person acts knowingly
51	51		with respect to information if the person:
52	52		(1) has knowledge of the information;
53	53		(2) acts with conscious indifference to the truth or
54	54		falsity of the information; or
55	55		(3) acts in reckless disregard of the truth or falsity
56	56		of the information.
57		-	(a-2) Proof of the person's specific intent to commit a
58		-	violation under this section is not required in a civil or
59		-	administrative proceeding to show that the person acted "knowingly"
60		-	with respect to information under this section.
	57	+	(a-2) Proof of a person's specific intent to violate this
	58	+	section is not required in an administrative or civil proceeding to
	59	+	show that the person acted knowingly with respect to information.
61	60		(b) A person commits a violation if the person:
62	61		(1) knowingly submits [presents] or causes to be
63		-	submitted [presented to the commission] a claim that contains:
64		-	(A) a false statement;
65		-	(B) a misrepresentation; or
66		-	(C) an omission of a material fact
	62	+	submitted [presented to the commission] a claim that contains a
	63	+	false statement, misrepresentation, or omission of a material fact
67	64		[representation the person knows or should know to be false];
68	65		(2) [(1-a)] engages in conduct that violates Section
69	66		102.001, Occupations Code;
70	67		(3) [(1-b)] solicits or receives, directly or
71	68		indirectly, overtly or covertly any remuneration, including any
72	69		kickback, bribe, or rebate, in cash or in kind for referring an
73	70		individual to a person for the furnishing of, or for arranging the
74	71		furnishing of, any item or service for which payment may be made, in
75	72		whole or in part, under the medical assistance program, provided
76	73		that this subdivision does not prohibit the referral of a patient to
77	74		another practitioner within a multispecialty group or university
78	75		medical services research and development plan (practice plan) for
79	76		medically necessary services;
80	77		(4) [(1-c)] solicits or receives, directly or
81	78		indirectly, overtly or covertly any remuneration, including any
82	79		kickback, bribe, or rebate, in cash or in kind for purchasing,
83	80		leasing, or ordering, or arranging for or recommending the
84	81		purchasing, leasing, or ordering of, any good, facility, service,
85	82		or item for which payment may be made, in whole or in part, under the
86	83		medical assistance program;
87	84		(5) [(1-d)] offers or pays, directly or indirectly,
88	85		overtly or covertly any remuneration, including any kickback,
89	86		bribe, or rebate, in cash or in kind to induce a person to refer an
90	87		individual to another person for the furnishing of, or for
91	88		arranging the furnishing of, any item or service for which payment
92	89		may be made, in whole or in part, under the medical assistance
93	90		program, provided that this subdivision does not prohibit the
94	91		referral of a patient to another practitioner within a
95	92		multispecialty group or university medical services research and
96	93		development plan (practice plan) for medically necessary services;
97	94		(6) [(1-e)] offers or pays, directly or indirectly,
98	95		overtly or covertly any remuneration, including any kickback,
99	96		bribe, or rebate, in cash or in kind to induce a person to purchase,
100	97		lease, or order, or arrange for or recommend the purchase, lease, or
101	98		order of, any good, facility, service, or item for which payment may
102	99		be made, in whole or in part, under the medical assistance program;
103	100		(7) [(1-f)] provides, offers, or receives an
104	101		inducement in a manner or for a purpose not otherwise prohibited by
105	102		this section or Section 102.001, Occupations Code, to or from a
106	103		person, including a recipient, provider, employee or agent of a
107	104		provider, third-party vendor, or public servant, for the purpose of
108	105		influencing or being influenced in a decision regarding:
109	106		(A) selection of a provider or receipt of a good
110	107		or service under the medical assistance program;
111	108		(B) the use of goods or services provided under
112	109		the medical assistance program; or
113	110		(C) the inclusion or exclusion of goods or
114	111		services available under the medical assistance program;
115	112		(8) knowingly makes or causes to be made a false
116	113		statement or misrepresentation of a material fact to permit a
117	114		person to receive a benefit or payment under the medical assistance
118		-	program that is not authorized or that is greater than the ~~benefit~~
119		-	or payment ~~that is authorized~~;
	115	+	program that is not authorized or that is greater than the
	116	+	authorized benefit or payment;
120	117		(9) knowingly conceals or fails to disclose
121	118		information that permits a person to receive a benefit or payment
122	119		under the medical assistance program that is not authorized or that
123		-	is greater than the benefit or payment ~~that is authorized~~;
	120	+	is greater than the authorized benefit or payment;
124	121		(10) knowingly applies for and receives a benefit or
125	122		payment on behalf of another person under the medical assistance
126	123		program and converts any part of the benefit or payment to a use
127	124		other than for the benefit of the person on whose behalf it was
128	125		received;
129	126		(11) knowingly makes, causes to be made, induces, or
130	127		seeks to induce the making of a false statement or
131		-	misrepresentation of a material fact concerning the ~~conditions~~ or
132		-	operation of a facility in order ~~that~~ the facility ~~may qualify for~~
133		-	certification or recertification ~~under the medical assistance~~
134		-	program, including ~~certification or recertification as~~:
	128	+	misrepresentation of a material fact concerning the condition or
	129	+	operation of a facility in order for the facility to meet
	130	+	certification or recertification standards required to participate
	131	+	under the medical assistance program, including:
135	132		(A) a hospital;
136		-	(B) a nursing facility or skilled nursing
137		-	facility;
	133	+	(B) a nursing facility;
138	134		(C) a hospice provider;
139	135		(D) an intermediate care facility for
140	136		individuals with an intellectual disability;
141	137		(E) an assisted living facility; or
142	138		(F) a home and community support services agency;
143	139		(12) knowingly makes, causes to be made, induces, or
144	140		seeks to induce the making of a false statement or
145	141		misrepresentation of a material fact concerning information
146		-	required to be provided under a federal or state law, rule,
147		-	regulation, or provider agreement pertaining to the medical
148		-	assistance program;
	142	+	required to be provided under a federal or state law, rule, or
	143	+	provider agreement pertaining to the medical assistance program;
149	144		(13) knowingly presents or causes to be presented a
150	145		claim for payment for a product provided or a service rendered by a
151	146		person who:
152	147		(A) is not licensed to provide the product or
153	148		render the service, if a license is required; or
154	149		(B) is not licensed in the manner claimed;
155	150		(14) knowingly makes or causes to be made a claim for:
156	151		(A) a service or product that has not been
157	152		approved or accepted by a treating physician or health care
158	153		practitioner;
159	154		(B) a service or product that is substantially
160	155		inadequate or inappropriate as compared to generally recognized
161	156		standards within the particular discipline or within the health
162	157		care industry; or
163	158		(C) a product that has been adulterated, debased,
164	159		or mislabeled, or that is otherwise inappropriate;
165	160		(15) makes a claim and knowingly fails to indicate the
166	161		type of license of the provider who actually provided the service;
167	162		(16) makes a claim and knowingly fails to indicate the
168	163		identification number of the licensed provider who actually
169	164		provided the service;
170	165		(17) knowingly obstructs the office of inspector
171	166		general from carrying out the office's duties under Section
172	167		544.0103, Government Code;
173	168		(18) knowingly makes, uses, or causes the making or
174	169		use of a false record or statement material to an obligation to pay
175	170		or transmit money or property to this state under the medical
176	171		assistance program, or knowingly conceals or knowingly and
177	172		improperly avoids or decreases an obligation to pay or transmit
178	173		money or property to this state under the medical assistance
179	174		program;
180	175		(19) [(2)] is a managed care organization that
181	176		contracts with the commission to provide or arrange to provide
182	177		health care benefits or services to individuals eligible for
183	178		medical assistance and:
184	179		(A) fails to provide to an individual a health
185	180		care benefit or service that the organization is required to
186	181		provide under the contract with the commission;
187	182		(B) fails to provide to the commission or other
188	183		appropriate agency information required to be provided by law,
189	184		commission or agency rule, or contractual provision;
190	185		(C) engages in a fraudulent activity in
191	186		connection with the enrollment in the organization's managed care
192	187		plan of an individual eligible for medical assistance or in
193	188		connection with marketing the organization's services to an
194	189		individual eligible for medical assistance; or
195	190		(D) engages in actions that indicate a pattern
196	191		of:
197	192		(i) wrongful denial of payment for a health
198	193		care benefit or service that the organization is required to
199	194		provide under the contract with the commission; or
200	195		(ii) wrongful delay of at least 45 days or a
201	196		longer period specified in the contract with the commission, not to
202	197		exceed 60 days, in making payment for a health care benefit or
203	198		service that the organization is required to provide under the
204		-	contract with the commission; [or]
205		-	(20) [(3)] fails to maintain documentation to support
206		-	a claim for payment in accordance with the requirements specified
207		-	by commission rule or medical assistance program policy; or
	199	+	contract with the commission;
	200	+	(20) [or
	201	+	[(3)] fails to maintain documentation to support a
	202	+	claim for payment in accordance with the requirements specified by
	203	+	commission rule or medical assistance program policy; or
208	204		(21) engages in any other conduct that a commission
209	205		rule has defined as a violation of the medical assistance program.
210	206		(c) A person who commits a violation under Subsection (b) is
211	207		liable to the commission for the following administrative remedy:
212	208		(1) the amount paid or benefit received, if any,
213	209		directly or indirectly as a result of the violation, including any
214	210		payment made to a third party, and interest on that amount
215	211		determined at the rate provided by law for legal judgments and
216	212		accruing from the date on which the payment was made; and
217	213		(2) payment of an administrative penalty of an amount
218	214		not to exceed twice the amount paid, if any, as a result of the
219	215		violation, plus an amount:
220	216		(A) not less than $5,000 or more than $15,000 or
221	217		the maximum dollar amount imposed as provided by 31 U.S.C. Section
222	218		3729(a)(1), if that amount exceeds $15,000, for each violation that
223	219		results in injury to an elderly person, as defined by Section
224	220		48.002(a)(1), a person with a disability, as defined by Section
225	221		48.002(a)(8)(A), or a person younger than 18 years of age; or
226	222		(B) not more than $10,000 or the maximum dollar
227	223		amount imposed as provided by 31 U.S.C. Section 3729(a)(1), if that
228	224		amount exceeds $10,000, for each violation that does not result in
229	225		injury to a person described by Paragraph (A).
230	226		(c-1) For purposes of Subsection (c)(2), each day a person
231	227		violates Subsection (b)(17), (18), or (19) constitutes a separate
232	228		violation.
233		-	(c-2) Notwithstanding Subsection (c), a person who commits
234		-	a violation described by Subsection (b)(20) is liable to the
235		-	commission for, as determined by the commission, either:
236		-	(1) the amount paid in response to the claim for
237		-	payment; or
238		-	(2) the payment of an administrative penalty in an
239		-	amount not to exceed $500 for each violation.
240	229		(d) Unless the provider knowingly submitted false or
241	230		misleading information to the commission for use in preparing a
242	231		voucher [that the provider knew or should have known was false] or
243	232		knowingly failed to correct false or misleading information [that
244	233		the provider knew or should have known was false] when provided an
245	234		opportunity to do so, this section does not apply to a claim based
246	235		on the voucher if the commission calculated and printed the amount
247	236		of the claim on the voucher and then submitted the voucher to the
248	237		provider for the provider's signature. In addition, the provider's
249	238		signature on the voucher does not constitute fraud. The executive
250	239		commissioner shall adopt rules that establish a grace period during
251	240		which errors contained in a voucher prepared by the commission may
252	241		be corrected without penalty to the provider.
253	242		(f) If after an examination of the facts the commission
254	243		concludes that the person committed a violation, the commission may
255	244		issue a preliminary report stating the facts on which it based its
256	245		conclusion, recommending that an administrative remedy [penalty]
257	246		under this section be imposed and recommending the amount of the
258	247		proposed remedy [penalty].
259	248		(g) The commission shall give written notice of the report
260	249		to the person charged with committing the violation. The notice
261	250		must include:
262		-	(1) a brief summary of the facts;
263		-	(2) [,] a statement of the amount of the recommended
264		-	remedy;
265		-	(3) [penalty, and] a statement of the person's right to
266		-	an informal review of:
	251	+	(1) a brief summary of the [facts, a statement of the
	252	+	amount of the] recommended remedy; [penalty,] and
	253	+	(2) a statement of the person's right to an informal
	254	+	review of:
267	255		(A) the alleged violation;
268	256		(B) [,] the amount of the recommended remedy;
269	257		[penalty,] or
270	258		(C) both the alleged violation and the amount of
271		-	the recommended remedy; and
272		-	(4) a description of the administrative and judicial
273		-	due process remedies available to the person [penalty].
274		-	(h) Not later than the 30th [10th] day after the date on
275		-	which the person charged with committing the violation receives the
276		-	notice, the person may either give the commission written consent
277		-	to the report, including the recommended remedy [penalty], or make
278		-	a written request for an informal review by the commission.
	259	+	the recommended remedy [penalty].
	260	+	(h) Not later than the 10th day after the date on which the
	261	+	person charged with committing the violation receives the notice,
	262	+	the person may either give the commission written consent to the
	263	+	report, including the recommended remedy [penalty], or make a
	264	+	written request for an informal review by the commission.
279	265		(i) If the person charged with committing the violation
280	266		consents to the remedy [penalty] recommended by the commission or
281	267		fails to timely request an informal review, the commission shall
282	268		assess the remedy [penalty]. The commission shall give the person
283	269		written notice of its action. The person shall pay the remedy
284	270		[penalty] not later than the 30th day after the date on which the
285	271		person receives the notice.
286		-	(k) Not later than the 30th [10th] day after the date on
287		-	which the person charged with committing the violation receives the
288		-	notice prescribed by Subsection (j), the person may make to the
289		-	commission a written request for a hearing. The hearing must be
290		-	conducted in accordance with Chapter 2001, Government Code.
291	272		(l) If, after informal review, a person who has been ordered
292	273		to pay a remedy [penalty] fails to request a formal hearing in a
293	274		timely manner, the commission shall assess the remedy [penalty].
294	275		The commission shall give the person written notice of its action.
295	276		The person shall pay the remedy [penalty] not later than the 30th
296	277		day after the date on which the person receives the notice.
297	278		(m) Within 30 days after the date on which the commission's
298	279		order issued after a hearing under Subsection (k) becomes final as
299	280		provided by Section 2001.144, Government Code, the person shall:
300	281		(1) pay the amount of the remedy [penalty];
301	282		(2) pay the amount of the remedy [penalty] and file a
302	283		petition for judicial review contesting the occurrence of the
303	284		violation, the amount of the remedy [penalty], or both the
304	285		occurrence of the violation and the amount of the remedy [penalty];
305	286		or
306	287		(3) without paying the amount of the remedy [penalty],
307	288		file a petition for judicial review contesting the occurrence of
308	289		the violation, the amount of the remedy [penalty], or both the
309	290		occurrence of the violation and the amount of the remedy [penalty].
310	291		(n) A person who acts under Subsection (m)(3) within the
311	292		30-day period may:
312	293		(1) stay enforcement of the remedy [penalty] by:
313	294		(A) paying the amount of the remedy [penalty] to
314	295		the court for placement in an escrow account; or
315	296		(B) giving to the court a supersedeas bond that
316	297		is approved by the court for the amount of the remedy [penalty] and
317	298		that is effective until all judicial review of the commission's
318	299		order is final; or
319	300		(2) request the court to stay enforcement of the
320	301		remedy [penalty] by:
321	302		(A) filing with the court a sworn affidavit of
322	303		the person stating that the person is financially unable to pay the
323	304		amount of the remedy [penalty] and is financially unable to give the
324	305		supersedeas bond; and
325	306		(B) giving a copy of the affidavit to the
326	307		executive commissioner by certified mail.
327	308		(o) If the executive commissioner receives a copy of an
328	309		affidavit under Subsection (n)(2), the executive commissioner may
329	310		file with the court, within five days after the date the copy is
330	311		received, a contest to the affidavit. The court shall hold a hearing
331	312		on the facts alleged in the affidavit as soon as practicable and
332	313		shall stay the enforcement of the remedy [penalty] on finding that
333	314		the alleged facts are true. The person who files an affidavit has
334	315		the burden of proving that the person is financially unable to pay
335	316		the amount of the remedy [penalty] and to give a supersedeas bond.
336	317		(p) If the person charged does not pay the amount of the
337	318		remedy [penalty] and the enforcement of the remedy [penalty] is not
338	319		stayed, the commission may forward the matter to the attorney
339	320		general for enforcement of the remedy [penalty] and interest as
340	321		provided by law for legal judgments. An action to enforce a remedy
341	322		[penalty] order under this section must be initiated in a court of
342	323		competent jurisdiction in Travis County or in the county in which
343	324		the violation was committed.
344	325		(q) Judicial review of a commission order or review under
345	326		this section assessing a remedy [penalty] is under the substantial
346	327		evidence rule. A suit may be initiated by filing a petition with a
347	328		district court in Travis County, as provided by Subchapter G,
348	329		Chapter 2001, Government Code.
349	330		(r) If a remedy [penalty] is reduced or not assessed, the
350	331		commission shall remit to the person the appropriate amount plus
351	332		accrued interest if the remedy [penalty] has been paid or shall
352	333		execute a release of the bond if a supersedeas bond has been posted.
353	334		The accrued interest on amounts remitted by the commission under
354	335		this subsection shall be paid at a rate equal to the rate provided
355	336		by law for legal judgments and shall be paid for the period
356	337		beginning on the date the remedy [penalty] is paid to the commission
357	338		under this section and ending on the date the remedy [penalty] is
358	339		remitted.
359	340		(s) A remedy [damage, cost, or penalty] collected under this
360	341		section is not an allowable expense in a claim or cost report that
361	342		is or could be used to determine a rate or payment under the medical
362	343		assistance program.
363	344		(x) Subsections (b)(3) [(b)(1-b)] through (7) [(1-f)] do
364	345		not prohibit a person from engaging in:
365	346		(1) generally accepted business practices, as
366	347		determined by commission rule, including:
367	348		(A) conducting a marketing campaign;
368	349		(B) providing token items of minimal value that
369	350		advertise the person's trade name; and
370	351		(C) providing complimentary refreshments at an
371	352		informational meeting promoting the person's goods or services;
372	353		(2) the provision of a value-added service if the
373	354		person is a managed care organization; or
374	355		(3) other conduct specifically authorized by law,
375	356		including conduct authorized by federal safe harbor regulations (42
376	357		C.F.R. Section 1001.952).
377	358		SECTION 5. Section 32.0391(a), Human Resources Code, is
378	359		amended to read as follows:
379	360		(a) A person commits an offense if the person intentionally
380	361		or knowingly commits a violation under Section 32.039(b)(3), (4),
381	362		(5), (6), or (7) [32.039(b)(1-b), (1-c), (1-d), (1-e), or (1-f)].
382		-	SECTION 6. Section 36.006, Human Resources Code, is amended
	363	+	SECTION 6. Section 36.002, Human Resources Code, is amended
	364	+	to read as follows:
	365	+	Sec. 36.002. UNLAWFUL ACTS. A person commits an unlawful
	366	+	act if the person:
	367	+	(1) knowingly makes or causes to be made a false
	368	+	statement or misrepresentation of a material fact to permit a
	369	+	person to receive a benefit or payment under a health care program
	370	+	that is not authorized or that is greater than the benefit or
	371	+	payment that is authorized;
	372	+	(2) knowingly conceals or fails to disclose
	373	+	information that permits a person to receive a benefit or payment
	374	+	under a health care program that is not authorized or that is
	375	+	greater than the benefit or payment that is authorized;
	376	+	(3) knowingly applies for and receives a benefit or
	377	+	payment on behalf of another person under a health care program and
	378	+	converts any part of the benefit or payment to a use other than for
	379	+	the benefit of the person on whose behalf it was received;
	380	+	(4) knowingly makes, causes to be made, induces, or
	381	+	seeks to induce the making of a false statement or
	382	+	misrepresentation of material fact concerning:
	383	+	(A) the conditions or operation of a facility in
	384	+	order that the facility may qualify for certification or
	385	+	recertification required by a health care program, including
	386	+	certification or recertification as:
	387	+	(i) a hospital;
	388	+	(ii) a nursing facility or skilled nursing
	389	+	facility;
	390	+	(iii) a hospice;
	391	+	(iv) an ICF-IID;
	392	+	(v) an assisted living facility; or
	393	+	(vi) a home health agency; or
	394	+	(B) information required to be provided by a
	395	+	federal or state law, rule, regulation, or provider agreement
	396	+	pertaining to a health care program;
	397	+	(5) except as authorized under a health care program,
	398	+	knowingly pays, charges, solicits, accepts, or receives, in
	399	+	addition to an amount paid under the program, a gift, money, a
	400	+	donation, or other consideration as a condition to the provision of
	401	+	a service or product or the continued provision of a service or
	402	+	product if the cost of the service or product is paid for, in whole
	403	+	or in part, under the program;
	404	+	(6) knowingly presents or causes to be presented a
	405	+	claim for payment under a health care program for a product provided
	406	+	or a service rendered by a person who:
	407	+	(A) is not licensed to provide the product or
	408	+	render the service, if a license is required; or
	409	+	(B) is not licensed in the manner claimed;
	410	+	(7) knowingly makes or causes to be made a claim under
	411	+	a health care program for:
	412	+	(A) a service or product that has not been
	413	+	approved or acquiesced in by a treating physician or health care
	414	+	practitioner;
	415	+	(B) a service or product that is substantially
	416	+	inadequate or inappropriate when compared to generally recognized
	417	+	standards within the particular discipline or within the health
	418	+	care industry; or
	419	+	(C) a product that has been adulterated, debased,
	420	+	or mislabeled, or that is otherwise inappropriate;
	421	+	(8) makes a claim under a health care program and
	422	+	knowingly fails to indicate the type of license and the
	423	+	identification number of the licensed health care provider who
	424	+	actually provided the service;
	425	+	(9) conspires to commit a violation of Subdivision
	426	+	(1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (12), or (13);
	427	+	(10) is a managed care organization that contracts
	428	+	with the commission or other state agency to provide or arrange to
	429	+	provide health care benefits or services to individuals eligible
	430	+	under a health care program and knowingly:
	431	+	(A) fails to provide to an individual a health
	432	+	care benefit or service that the organization is required to
	433	+	provide under the contract;
	434	+	(B) fails to provide to the commission or
	435	+	appropriate state agency information required to be provided by
	436	+	law, commission or agency rule, or contractual provision; or
	437	+	(C) engages in a fraudulent activity in
	438	+	connection with the enrollment of an individual eligible under the
	439	+	program in the organization's managed care plan or in connection
	440	+	with marketing the organization's services to an individual
	441	+	eligible under the program;
	442	+	(11) knowingly obstructs an investigation by the
	443	+	attorney general of an alleged unlawful act under this section;
	444	+	(12) knowingly makes, uses, or causes the making or
	445	+	use of a false record or statement material to an obligation to pay
	446	+	or transmit money or property to this state under a health care
	447	+	program, or knowingly conceals or knowingly and improperly avoids
	448	+	or decreases an obligation to pay or transmit money or property to
	449	+	this state under a health care program; or
	450	+	(13) knowingly engages in conduct that constitutes a
	451	+	violation under Section 32.039(b)(1), (2), (3), (4), (5), (6), (7),
	452	+	or (17) [32.039(b)].
	453	+	SECTION 7. Section 36.006, Human Resources Code, is amended
383	454		to read as follows:
384	455		Sec. 36.006. APPLICATION OF OTHER LAW. The application of a
385	456		civil remedy under this chapter does not preclude the application
386	457		of another common law, statutory, or regulatory remedy, except that
387	458		a person may not be liable for a civil remedy under this chapter and
388	459		an administrative remedy [civil damages or a penalty] under Section
389	460		32.039 if the civil remedy and administrative remedy [civil damages
390	461		or penalty] are assessed for the same act.
391		-	SECTION 7. The following provisions of the Human Resources
	462	+	SECTION 8. The following provisions of the Human Resources
392	463		Code are repealed:
393	464		(1) Section 32.039(a)(4); and
394	465		(2) Section 32.039(b-1).
395		-	SECTION 8. Section 32.039, Human Resources Code, as amended
	466	+	SECTION 9. Section 32.039, Human Resources Code, as amended
396	467		by this Act, applies only to a violation that occurs on or after the
397	468		effective date of this Act. A violation that occurs before the
398	469		effective date of this Act is governed by the law in effect on the
399	470		date the violation occurred, and that law is continued in effect for
400	471		that purpose.
401		-	SECTION 9. If before implementing any provision of this ~~Act~~
402		-	a state agency determines that a waiver or authorization from a
	472	+	SECTION 10. If before implementing any provision of this
	473	+	Act a state agency determines that a waiver or authorization from a
403	474		federal agency is necessary for implementation of that provision,
404	475		the agency affected by the provision shall request the waiver or
405	476		authorization and may delay implementing that provision until the
406	477		waiver or authorization is granted.
407		-	SECTION 10. This Act takes effect September 1, 2025.
	478	+	SECTION 11. This Act takes effect September 1, 2025.