Texas 2025 - 89th Regular

Texas House Bill HB4012 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~89R25047~~ SCF-F
	1	+	89R10265 SCF-F
2	2		By: Paul H.B. No. 4012
3		-	Substitute the following for H.B. No. 4012:
4		-	By: Dean C.S.H.B. No. 4012
5	3
6	4
7	5
8	6
9	7		A BILL TO BE ENTITLED
10	8		AN ACT
11	9		relating to health care and insurance fraud; creating a criminal
12	10		offense; authorizing a civil penalty.
13	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14		-	SECTION 1. Section 544.0103(e), Government Code, ~~is amended~~
15		-	to read as follows:
	12	+	SECTION 1. Section 544.0103(e), Government Code, as
	13	+	effective April 1, 2025, is amended to read as follows:
16	14		(e) The office of inspector general may:
17	15		(1) assess administrative penalties otherwise
18	16		authorized by law on behalf of the commission or a health and human
19	17		services agency;
20	18		(2) request that the attorney general obtain an
21	19		injunction to prevent a person from disposing of an asset the office
22	20		of inspector general identifies as potentially subject to recovery
23	21		by the office of inspector general due to the person's fraud or
24	22		abuse;
25	23		(3) provide for coordination between the office of
26	24		inspector general and special investigative units formed by managed
27	25		care organizations under Subchapter H or entities with which
28	26		managed care organizations contract under that subchapter;
29	27		(3-a) provide for coordination between the office of
30	28		inspector general and the Texas Department of Insurance, as
31	29		provided by Section 701.110, Insurance Code, to coordinate health
32	30		care fraud detection and prevention in the state;
33	31		(4) audit the use and effectiveness of state or
34	32		federal funds, including contract and grant funds, administered by
35	33		a person or state agency receiving the funds from a health and human
36	34		services agency;
37	35		(5) conduct investigations relating to the funds
38	36		described by Subdivision (4); and
39	37		(6) recommend policies to:
40	38		(A) promote the economical and efficient
41	39		administration of the funds described by Subdivision (4); and
42	40		(B) prevent and detect fraud and abuse in the
43	41		administration of those funds.
44		-	SECTION 2. Subtitle B, Title 2, Insurance Code, is amended
45		-	by adding Chapter 87 to read as follows:
46		-	CHAPTER 87. CIVIL REMEDIES
47		-	Sec. 87.001. CIVIL REMEDIES. (a) Except as provided by
	42	+	SECTION 2. The heading to Subchapter B, Chapter 701,
	43	+	Insurance Code, is amended to read as follows:
	44	+	SUBCHAPTER B. REPORTING FRAUDULENT INSURANCE ACTS; CIVIL REMEDIES
	45	+	SECTION 3. Subchapter B, Chapter 701, Insurance Code, is
	46	+	amended by adding Section 701.053 to read as follows:
	47	+	Sec. 701.053. CIVIL REMEDIES. (a) Except as provided by
48	48		Subsection (c), a person who violates Section 35A.02(a-1), Penal
49	49		Code, is liable to the state for:
50	50		(1) the amount of a payment made by or the value of a
51	51		benefit provided by a health benefit plan issuer, directly or
52	52		indirectly, as a result of the violation, including any payment
53	53		made to a third party;
54	54		(2) interest on the amount of the payment or the value
55	55		of the benefit described by Subdivision (1) at the prejudgment
56	56		interest rate in effect on the day the payment or benefit was
57	57		received or paid, for the period from the date the benefit was
58	58		received or paid to the date that the state recovers the amount of
59	59		the payment or value of the benefit;
60	60		(3) a civil penalty of:
61	61		(A) not less than $5,500 and not more than
62	62		$15,000 for each violation committed by the person that results in
63	63		injury to an elderly person, as defined by Section 48.002(a)(1),
64	64		Human Resources Code, a person with a disability, as defined by
65	65		Section 48.002(a)(8)(A), Human Resources Code, or a person younger
66	66		than 18 years of age; or
67	67		(B) not less than $5,500 and not more than
68	68		$11,000 for each violation committed by the person that does not
69	69		result in injury to a person described by Paragraph (A); and
70	70		(4) two times the amount of the payment or the value of
71	71		the benefit described by Subdivision (1).
72	72		(b) In determining the amount of the civil penalty described
73	73		by Subsection (a)(3), the trier of fact shall consider:
74	74		(1) whether the person has previously violated Section
75	75		35A.02(a-1), Penal Code;
76	76		(2) the seriousness of the violation committed by the
77	77		person, including the nature, circumstances, extent, and gravity of
78	78		the violation;
79	79		(3) whether the health and safety of the public or an
80	80		individual was threatened by the violation;
81	81		(4) whether the person acted in bad faith when the
82	82		person engaged in the conduct that formed the basis of the
83	83		violation; and
84	84		(5) the amount necessary to deter future violations.
85	85		(c) The trier of fact may assess a total of not more than two
86	86		times the amount of a payment or the value of a benefit described by
87	87		Subsection (a)(1) if the trier of fact finds that:
88	88		(1) the person reported to the insurance fraud unit of
89	89		the department all information known to the person about the
90	90		violation not later than the 30th day after the date on which the
91	91		person first obtained the information; and
92	92		(2) at the time the person furnished all the
93	93		information to the insurance fraud unit of the department, the
94	94		insurance fraud unit of the department had not yet begun an
95	95		investigation under this chapter.
96		-	SECTION 3. Subchapter C, Chapter 701, Insurance Code, is
	96	+	SECTION 4. Section 701.102, Insurance Code, is amended to
	97	+	read as follows:
	98	+	Sec. 701.102. INVESTIGATION OF CERTAIN ACTS OF FRAUD. (a)
	99	+	If the commissioner has reason to believe a person has engaged in,
	100	+	is engaging in, has committed, or is about to commit a fraudulent
	101	+	insurance act, the commissioner may conduct any investigation
	102	+	necessary inside or outside this state to:
	103	+	(1) determine whether the act occurred; or
	104	+	(2) aid in enforcing laws relating to fraudulent
	105	+	insurance acts, including by providing technical or litigation
	106	+	assistance to other governmental agencies.
	107	+	(b) In exercising the commissioner's authority under
	108	+	Subsection (a), the commissioner shall prioritize investigating
	109	+	alleged violations of Section 35A.02(a-1), Penal Code.
	110	+	(c) Except as provided by Section 701.214, the department
	111	+	may retain up to 50 percent of any money recovered as a result of an
	112	+	investigation conducted under Subsection (b). The department shall
	113	+	remit the remaining amount of money to the person or persons harmed
	114	+	by the offense.
	115	+	SECTION 5. Subchapter C, Chapter 701, Insurance Code, is
97	116		amended by adding Section 701.110 to read as follows:
98	117		Sec. 701.110. FRAUD PREVENTION PARTNERSHIP. (a) The
99	118		department shall, in coordination with the Health and Human
100	119		Services Commission office of inspector general, establish the
101	120		fraud prevention partnership to detect and prevent health care
102	121		fraud in this state across the private and public markets.
103	122		(b) The partnership shall include:
104	123		(1) a representative of one or more Medicaid managed
105	124		care organizations;
106	125		(2) a representative of one or more health benefit
107	126		plan issuers, as defined by Section 1222.0001; and
108	127		(3) any other appropriate person as determined by the
109	128		commissioner and inspector general.
110		-	SECTION 4. The heading to Chapter 703, Insurance Code, is
111		-	amended to read as follows:
112		-	CHAPTER 703. [COVERED ENTITY'S] ANTIFRAUD ACTION BY COVERED ENTITY
113		-	OR OTHER PRIVATE PERSON
114		-	SECTION 5. Chapter 703, Insurance Code, is amended by
115		-	adding Subchapter D to read as follows:
116		-	SUBCHAPTER D. ACTION BY PRIVATE PERSON
117		-	Sec. 703.151. ACTION BY PRIVATE PERSON AUTHORIZED. (a) A
118		-	private person may bring a civil action for a violation of Section
	129	+	SECTION 6. Chapter 701, Insurance Code, is amended by
	130	+	adding Subchapter E to read as follows:
	131	+	SUBCHAPTER E. ACTION BY PRIVATE PERSON
	132	+	Sec. 701.201. ACTION BY PRIVATE PERSON AUTHORIZED. (a) A
	133	+	person may bring a civil action for a violation of Section
119	134		35A.02(a-1), Penal Code, on behalf of the person and the state. The
120	135		action must be brought in the name of the person and of the state.
121	136		(b) In an action brought under this subchapter, a person who
122	137		violates Section 35A.02(a-1), Penal Code, is liable as provided by
123		-	Section 87.~~001~~.
124		-	Sec. ~~703~~.~~152~~. INITIATION OF ACTION. (a) A person bringing
	138	+	Section 701.053.
	139	+	Sec. 701.202. INITIATION OF ACTION. (a) A person bringing
125	140		an action under this subchapter shall serve a copy of the petition
126	141		and a written disclosure of substantially all material evidence and
127	142		information the person possesses on the attorney general in
128	143		compliance with the Texas Rules of Civil Procedure.
129	144		(b) A person shall file a petition for an action under this
130		-	subchapter in camera and, except as provided by Section ~~703~~.~~153~~(b)
	145	+	subchapter in camera and, except as provided by Section 701.203(b)
131	146		or (c), the petition must remain under seal until the earlier of:
132	147		(1) the 180th day after the date the petition is served
133	148		on the attorney general; or
134	149		(2) the date on which the state elects to intervene.
135	150		(c) A person bringing an action under this subchapter may
136	151		not serve process on a defendant until the court orders service of
137	152		process.
138		-	Sec. ~~703~~.~~153~~. STATE INTERVENTION. (a) The state may elect
	153	+	Sec. 701.203. STATE INTERVENTION. (a) The state may elect
139	154		to intervene and proceed with an action under this subchapter not
140	155		later than the 180th day after the date the attorney general
141	156		receives the petition and the material evidence and information
142		-	under Section ~~703~~.~~152~~(a).
	157	+	under Section 701.202(a).
143	158		(b) At the time the state intervenes in an action under this
144	159		subchapter, the attorney general may file a motion with the court
145	160		requesting that the petition remain under seal for an extended
146	161		period.
147	162		(c) In an action under this subchapter, the state may, for
148	163		good cause shown, move the court to extend the 180-day periods
149		-	prescribed by Subsection (a) or Section ~~703~~.~~152~~(b). A motion under
	164	+	prescribed by Subsection (a) or Section 701.202(b). A motion under
150	165		this subsection may be supported by affidavits or other submissions
151	166		in camera.
152		-	Sec. ~~703~~.~~154~~. CONSENT REQUIRED FOR DISMISSAL. An action
	167	+	Sec. 701.204. CONSENT REQUIRED FOR DISMISSAL. An action
153	168		under this subchapter may be dismissed only if the court and the
154	169		attorney general consent in writing to the dismissal and state
155	170		their reasons for consenting.
156		-	Sec. ~~703~~.~~155~~. ANSWER BY DEFENDANT. A defendant is not
	171	+	Sec. 701.205. ANSWER BY DEFENDANT. A defendant is not
157	172		required to file in accordance with the Texas Rules of Civil
158	173		Procedure an answer to a petition filed under this subchapter until
159	174		the petition is unsealed and served on the defendant.
160		-	Sec. ~~703~~.~~156~~. STATE DECISION; CONTINUATION OF ACTION. (a)
	175	+	Sec. 701.206. STATE DECISION; CONTINUATION OF ACTION. (a)
161	176		Not later than the last day of the period prescribed by Section
162		-	~~703~~.~~153~~(a) or an extension of that period as provided by Section
163		-	~~703~~.~~153~~(c), the state shall:
	177	+	701.203(a) or an extension of that period as provided by Section
	178	+	701.203(c), the state shall:
164	179		(1) proceed with the action; or
165	180		(2) notify the court that the state declines to take
166	181		over the action.
167	182		(b) If the state declines to take over an action under this
168	183		subchapter, the person bringing the action may proceed without the
169	184		state's participation. A person proceeding under this subsection
170	185		may recover for a violation for a period of up to six years before
171	186		the date the action was filed, or for a period beginning when the
172	187		violation occurred until up to three years from the date the state
173	188		knows or reasonably should have known facts material to the
174	189		violation, whichever of these two periods is longer, regardless of
175	190		whether the violation occurred more than six years before the date
176	191		the action was filed. Notwithstanding this subsection, a person
177	192		proceeding under this subsection may not recover for a violation
178	193		that occurred more than 10 years before the date the action was
179	194		filed.
180	195		(c) On request by the state, the state is entitled to be
181	196		served with copies of all pleadings filed in an action under this
182	197		subchapter and be provided at the state's expense with copies of all
183	198		deposition transcripts. If the person bringing the action proceeds
184	199		without the state's participation, the court, without limiting the
185	200		status and right of that person, may permit the state to intervene
186	201		at a later date on a showing of good cause.
187		-	Sec. ~~703~~.~~157~~. REPRESENTATION OF STATE BY PRIVATE ATTORNEY.
	202	+	Sec. 701.207. REPRESENTATION OF STATE BY PRIVATE ATTORNEY.
188	203		The attorney general may contract with a private attorney to
189	204		represent the state in an action under this subchapter with which
190	205		the state elects to proceed.
191		-	Sec. ~~703~~.~~158~~. INTERVENTION BY OTHER PARTIES PROHIBITED. A
	206	+	Sec. 701.208. INTERVENTION BY OTHER PARTIES PROHIBITED. A
192	207		person other than the state may not intervene or bring a related
193	208		action based on the facts underlying a pending action under this
194	209		subchapter.
195		-	Sec. ~~703~~.~~159~~. RIGHTS OF PARTIES IF STATE CONTINUES ACTION.
	210	+	Sec. 701.209. RIGHTS OF PARTIES IF STATE CONTINUES ACTION.
196	211		(a) If the state proceeds with an action under this subchapter, the
197	212		state has the primary responsibility for prosecuting the action and
198	213		is not bound by an act of the person bringing the action. The person
199	214		bringing the action has the right to continue as a party to the
200	215		action, subject to the limitations set forth by this section.
201	216		(b) The state may dismiss an action under this subchapter
202	217		notwithstanding the objections of the person bringing the action
203	218		if:
204	219		(1) the attorney general notifies the person that the
205	220		state has filed a motion to dismiss; and
206	221		(2) the court provides the person with an opportunity
207	222		for a hearing on the motion.
208	223		(c) The state may settle an action under this subchapter
209	224		with the defendant notwithstanding the objections of the person
210	225		bringing the action if the court determines, after a hearing, that
211	226		the proposed settlement is fair, adequate, and reasonable under all
212	227		the circumstances. On a showing of good cause, the hearing may be
213	228		held in camera.
214	229		(d) On a showing by the state that unrestricted
215	230		participation during the course of the litigation by the person
216	231		bringing an action under this subchapter would interfere with or
217	232		unduly delay the state's prosecution of the action, or would be
218	233		repetitious, irrelevant, or for purposes of harassment, the court
219	234		may impose limitations on the person's participation, including:
220	235		(1) limiting the number of witnesses the person may
221	236		call;
222	237		(2) limiting the length of the testimony of witnesses
223	238		called by the person;
224	239		(3) limiting the person's cross-examination of
225	240		witnesses; or
226	241		(4) otherwise limiting the participation by the person
227	242		in the litigation.
228	243		(e) On a showing by a defendant in an action under this
229	244		subchapter that unrestricted participation during the course of the
230	245		litigation by the person bringing the action would be for purposes
231	246		of harassment or would cause the defendant undue burden or
232	247		unnecessary expense, the court may limit the participation by the
233	248		person in the litigation.
234		-	Sec. ~~703~~.~~160~~. STAY OF CERTAIN DISCOVERY. (a) On a showing
	249	+	Sec. 701.210. STAY OF CERTAIN DISCOVERY. (a) On a showing
235	250		by the state that certain actions of discovery by the person
236	251		bringing an action under this subchapter would interfere with the
237	252		state's investigation or prosecution of a criminal or civil matter
238	253		arising out of the same facts, the court may stay the discovery for
239	254		a period not to exceed 60 days.
240	255		(b) The court shall hear a motion to stay discovery under
241	256		this section in camera.
242	257		(c) The court may extend the period prescribed by Subsection
243	258		(a) on a further showing in camera that the state has pursued the
244	259		criminal or civil investigation or proceedings with reasonable
245	260		diligence and that any proposed discovery in the civil action will
246	261		interfere with the ongoing criminal or civil investigation or
247	262		proceedings.
248		-	Sec. ~~703~~.~~161~~. PURSUIT OF ALTERNATE REMEDY BY STATE. (a)
249		-	Notwithstanding Section ~~703~~.~~151~~, the state may elect to pursue the
	263	+	Sec. 701.211. PURSUIT OF ALTERNATE REMEDY BY STATE. (a)
	264	+	Notwithstanding Section 701.201, the state may elect to pursue the
250	265		state's claim through any alternate remedy available to the state,
251	266		including any administrative proceeding to determine an
252	267		administrative penalty. If an alternate remedy is pursued in
253	268		another proceeding, the person bringing an action under this
254	269		subchapter has the same rights in the other proceeding as the person
255	270		would have had if the action had continued under this subchapter.
256	271		(b) A finding of fact or conclusion of law made in the other
257	272		proceeding that has become final is conclusive on all parties to an
258	273		action under this subchapter. For purposes of this subsection, a
259	274		finding or conclusion is final if:
260	275		(1) the finding or conclusion has been finally
261	276		determined on appeal to the appropriate court;
262	277		(2) no appeal has been filed with respect to the
263	278		finding or conclusion and all time for filing an appeal has expired;
264	279		or
265	280		(3) the finding or conclusion is not subject to
266	281		judicial review.
267		-	Sec. ~~703~~.~~162~~. AWARD TO PRIVATE CLAIMANT. (a) If the state
	282	+	Sec. 701.212. AWARD TO PRIVATE CLAIMANT. (a) If the state
268	283		proceeds with an action under this subchapter, the person bringing
269	284		the action is entitled, except as provided by Subsection (c), to
270	285		receive at least 15 percent but not more than 25 percent of the
271	286		proceeds of the action, depending on the extent to which the person
272	287		substantially contributed to the prosecution of the action.
273	288		(b) If the state does not proceed with an action under this
274	289		subchapter, the person bringing the action is entitled, except as
275	290		provided by Subsection (c), to receive at least 25 percent but not
276	291		more than 30 percent of the proceeds of the action. The entitlement
277	292		of a person under this subsection is not affected by any subsequent
278	293		intervention in the action by the state in accordance with Section
279		-	~~703~~.~~156~~(c).
	294	+	701.206(c).
280	295		(c) If the court finds that an action under this subchapter
281	296		is based primarily on disclosures of specific information, other
282	297		than information provided by the person bringing the action,
283	298		relating to allegations or transactions in a Texas or federal
284	299		criminal or civil hearing, in a Texas or federal legislative or
285	300		administrative report, hearing, audit, or investigation, or from
286	301		the news media, the court may award the amount the court considers
287	302		appropriate but not more than 10 percent of the proceeds of the
288	303		action. The court shall consider the significance of the
289	304		information and the role of the person bringing the action in
290	305		advancing the case to litigation.
291	306		(d) A payment to a person under this section shall be made
292	307		from the proceeds of the action. A person receiving a payment under
293	308		this section is also entitled to receive from the defendant an
294	309		amount for reasonable expenses, reasonable attorney's fees, and
295	310		costs that the court finds to have been necessarily incurred. The
296	311		court's determination of expenses, fees, and costs to be awarded
297	312		under this subsection shall be made only after the defendant has
298	313		been found liable in the action or the claim is settled.
299	314		(e) In this section, "proceeds of the action" includes
300	315		proceeds of a settlement of the action.
301		-	Sec. ~~703~~.~~163~~. REDUCTION OF AWARD. (a) If the court finds
	316	+	Sec. 701.213. REDUCTION OF AWARD. (a) If the court finds
302	317		that an action under this subchapter was brought by a person who
303	318		planned and initiated the violation on which the action was
304	319		brought, the court may, to the extent the court considers
305	320		appropriate, reduce the share of the proceeds of the action the
306		-	person would otherwise receive under Section ~~703~~.~~162~~, taking into
	321	+	person would otherwise receive under Section 701.212, taking into
307	322		account the person's role in advancing the case to litigation and
308	323		any relevant circumstances pertaining to the violation.
309	324		(b) If the person bringing an action under this subchapter
310	325		is convicted of criminal conduct arising from the person's role in
311	326		the violation, the court shall dismiss the person from the civil
312	327		action and the person may not receive any share of the proceeds of
313	328		the action. A dismissal under this subsection does not prejudice
314	329		the right of the state to continue the action.
315		-	Sec. ~~703~~.~~164~~. AWARD TO DEPARTMENT. (a) If the state
	330	+	Sec. 701.214. AWARD TO DEPARTMENT. (a) If the state
316	331		proceeds with an action under this subchapter, the department is
317	332		entitled to receive at least 15 percent but not more than 25 percent
318	333		of the proceeds of the action, depending on the extent to which the
319	334		department substantially contributed to the prosecution of the
320	335		action.
321	336		(b) In this section, "proceeds of the action" includes
322	337		proceeds of a settlement of the action.
323		-	Sec. 703.165. AWARD TO INJURED HEALTH BENEFIT PLAN ISSUER.
324		-	(a) In this section, "health benefit plan issuer" has the meaning
325		-	assigned by Section 35A.01, Penal Code.
326		-	(b) If the person bringing an action under this subchapter
327		-	is not a health benefit plan issuer harmed by the violation that is
328		-	the subject of the action, the health benefit plan issuer is
	338	+	Sec. 701.215. AWARD TO INJURED INSURER. If the person
	339	+	bringing an action under this subchapter is not an insurer harmed by
	340	+	the violation that is the subject of the action, the insurer is
329	341		entitled to any money remaining after all awards and costs are
330	342		distributed as provided by this subchapter, including, in an action
331	343		where the state proceeds, reasonable expenses, reasonable
332	344		attorney's fees, and costs to the state that the court finds to have
333	345		been necessarily incurred.
334		-	Sec. ~~703~~.~~166~~. AWARD TO DEFENDANT FOR FRIVOLOUS ACTION.
	346	+	Sec. 701.216. AWARD TO DEFENDANT FOR FRIVOLOUS ACTION.
335	347		Chapter 105, Civil Practice and Remedies Code, applies to an action
336	348		under this subchapter with which the state proceeds.
337		-	Sec. ~~703~~.~~167~~. CERTAIN ACTIONS BARRED. (a) A person may not
	349	+	Sec. 701.217. CERTAIN ACTIONS BARRED. (a) A person may not
338	350		bring an action under this subchapter that is based on allegations
339	351		or transactions that are the subject of a civil action or an
340	352		administrative penalty proceeding in which the state is already a
341	353		party.
342	354		(b) The court shall dismiss an action or claim under this
343	355		subchapter, unless opposed by the attorney general, if
344	356		substantially the same allegations or transactions as alleged in
345	357		the action or claim were publicly disclosed in a Texas or federal
346	358		criminal or civil hearing in which the state or an agent of the
347	359		state is a party, in a legislative or administrative report of this
348	360		state, or other hearing, audit, or investigation in this state, or
349	361		from the news media, unless the person bringing the action is an
350	362		original source of the information. In this subsection, "original
351	363		source" means an individual who:
352	364		(1) before a public disclosure described by this
353	365		subsection, has voluntarily disclosed to the state the information
354	366		on which allegations or transactions in a claim are based; or
355	367		(2) has knowledge that is independent of and
356	368		materially adds to the publicly disclosed allegations or
357	369		transactions and who has voluntarily provided the information to
358	370		the state before filing an action under this subchapter.
359		-	Sec. ~~703~~.~~168~~. STATE NOT LIABLE FOR CERTAIN EXPENSES. The
	371	+	Sec. 701.218. STATE NOT LIABLE FOR CERTAIN EXPENSES. The
360	372		state is not liable for expenses that a person incurs in bringing an
361	373		action under this subchapter.
362		-	Sec. ~~703~~.~~169~~. RETALIATION AGAINST PERSON PROHIBITED. (a)
	374	+	Sec. 701.219. RETALIATION AGAINST PERSON PROHIBITED. (a)
363	375		A person, including an employee, contractor, or agent, who is
364	376		discharged, demoted, suspended, threatened, harassed, or in any
365	377		other manner discriminated against in the terms or conditions of
366	378		employment because of a lawful act taken by the person or associated
367	379		others in furtherance of an action under this subchapter, including
368	380		investigation for, initiation of, testimony for, or assistance in
369	381		an action filed or to be filed under this subchapter, or other
370	382		efforts taken by the person to stop one or more violations is
371	383		entitled to:
372	384		(1) reinstatement with the same seniority status the
373	385		person would have had but for the discrimination; and
374	386		(2) not less than two times the amount of back pay,
375	387		interest on the back pay, and compensation for any special damages
376	388		sustained as a result of the discrimination, including litigation
377	389		costs and reasonable attorney's fees.
378	390		(b) A person may bring an action under this section in the
379	391		appropriate district court not later than the third anniversary of
380	392		the date on which the cause of action accrues. For purposes of this
381	393		subsection, the cause of action accrues on the date the retaliation
382	394		occurs.
383		-	Sec. ~~703~~.~~170~~. SOVEREIGN IMMUNITY NOT WAIVED. Except as
384		-	provided by Section ~~703~~.~~166~~, this subchapter does not waive
	395	+	Sec. 701.220. SOVEREIGN IMMUNITY NOT WAIVED. Except as
	396	+	provided by Section 701.216, this subchapter does not waive
385	397		sovereign immunity.
386		-	Sec. ~~703~~.~~171~~. ATTORNEY GENERAL COMPENSATION. The attorney
	398	+	Sec. 701.221. ATTORNEY GENERAL COMPENSATION. The attorney
387	399		general may retain a reasonable portion of the amount recovered
388	400		under this subchapter, not to exceed amounts specified in the
389	401		General Appropriations Act, for the administration of this
390	402		subchapter.
391		-	SECTION 6. Section 35A.01, Penal Code, is amended by adding
	403	+	SECTION 7. Section 35A.01, Penal Code, is amended by adding
392	404		Subdivisions (2-a), (2-b), and (2-c) and amending Subdivision (9)
393	405		to read as follows:
394	406		(2-a) "Health benefit claim" means a written or
395	407		electronically submitted request or demand that:
396	408		(A) is submitted by a person who provides or
397	409		purports to provide a service or product to an individual covered
398	410		under a health benefit plan or by that person's agent and identifies
399	411		a service or product provided or purported to have been provided to
400	412		the covered individual as reimbursable under the health benefit
401	413		plan, without regard to whether the money that is requested or
402	414		demanded is paid and without regard to whether the individual was
403	415		eligible for benefits under the health benefit plan; or
404	416		(B) states the income earned or expense incurred
405	417		by a person in providing a service or product to an individual
406	418		covered by a health benefit plan and is used to determine a rate of
407	419		payment under the plan.
408	420		(2-b) "Health benefit plan" means a health insurance
409	421		policy, a health care plan, as defined by Section 843.002,
410	422		Insurance Code, or another agreement, contract, or evidence of
411	423		coverage under which a person undertakes to provide, arrange for,
412	424		pay for, or reimburse any part of the cost of health care services.
413	425		(2-c) "Health benefit plan issuer" means a person who
414	426		is authorized or otherwise permitted by law to issue a health
415	427		insurance policy, to arrange for or provide a health care plan, as
416	428		defined by Section 843.002, Insurance Code, or to otherwise provide
417	429		health benefit plan coverage.
418	430		(9) "Service" includes care or treatment of a health
419	431		care recipient or an individual covered under a health benefit
420	432		plan.
421		-	SECTION 7. Section 35A.02, Penal Code, is amended by adding
	433	+	SECTION 8. Section 35A.02, Penal Code, is amended by adding
422	434		Subsection (a-1) and amending Subsections (b) and (d) to read as
423	435		follows:
424	436		(a-1) A person commits an offense if the person:
425	437		(1) knowingly makes or causes to be made a false
426	438		statement or misrepresentation of a material fact to permit a
427	439		person to receive from a health benefit plan issuer a benefit or
428	440		payment that is not authorized or that is greater than the benefit
429	441		or payment that is authorized;
430	442		(2) knowingly conceals or fails to disclose
431	443		information that permits a person to receive from a health benefit
432	444		plan issuer a benefit or payment that is not authorized or that is
433	445		greater than the benefit or payment that is authorized;
434	446		(3) knowingly makes or causes to be made a health
435	447		benefit claim to a health benefit plan issuer for:
436	448		(A) a service or product that has not been
437	449		approved or acquiesced in by a treating physician or health care
438	450		practitioner;
439	451		(B) a service or product that is substantially
440	452		inadequate or inappropriate when compared to generally recognized
441	453		standards within the particular discipline or within the health
442	454		care industry; or
443	455		(C) a product that has been adulterated, debased,
444	456		or mislabeled or that is otherwise inappropriate; or
445	457		(4) knowingly enters into an agreement, combination,
446	458		or conspiracy to defraud a health benefit plan issuer by obtaining
447	459		or aiding another person in obtaining an unauthorized payment or
448	460		benefit from a health benefit plan issuer.
449	461		(b) An offense under this section is:
450	462		(1) a Class C misdemeanor if the amount of any payment
451	463		or the value of any monetary or in-kind benefit provided or claim
452	464		for payment made under a health care program, or the amount of a
453	465		payment made by or the value of a benefit provided by or claim for
454	466		payment made to a health benefit plan issuer, directly or
455	467		indirectly, as a result of the conduct is less than $100;
456	468		(2) a Class B misdemeanor if the amount of any payment
457	469		or the value of any monetary or in-kind benefit provided or claim
458	470		for payment made under a health care program, or the amount of a
459	471		payment made by or the value of a benefit provided by or claim for
460	472		payment made to a health benefit plan issuer, directly or
461	473		indirectly, as a result of the conduct is $100 or more but less than
462	474		$750;
463	475		(3) a Class A misdemeanor if the amount of any payment
464	476		or the value of any monetary or in-kind benefit provided or claim
465	477		for payment made under a health care program, or the amount of a
466	478		payment made by or the value of a benefit provided by or claim for
467	479		payment made to a health benefit plan issuer, directly or
468	480		indirectly, as a result of the conduct is $750 or more but less than
469	481		$2,500;
470	482		(4) a state jail felony if:
471	483		(A) the amount of any payment or the value of any
472	484		monetary or in-kind benefit provided or claim for payment made
473	485		under a health care program, or the amount of a payment made by or
474	486		the value of a benefit provided by or claim for payment made to a
475	487		health benefit plan issuer, directly or indirectly, as a result of
476	488		the conduct is $2,500 or more but less than $30,000;
477	489		(B) the offense is committed under Subsection
478	490		(a)(11); or
479	491		(C) it is shown on the trial of the offense that
480	492		the amount of the payment or value of the benefit described by this
481	493		subsection cannot be reasonably ascertained;
482	494		(5) a felony of the third degree if:
483	495		(A) the amount of any payment or the value of any
484	496		monetary or in-kind benefit provided or claim for payment made
485	497		under a health care program, or the amount of a payment made by or
486	498		the value of a benefit provided by or claim for payment made to a
487	499		health benefit plan issuer, directly or indirectly, as a result of
488	500		the conduct is $30,000 or more but less than $150,000; or
489	501		(B) it is shown on the trial of the offense that
490	502		the defendant submitted more than 25 but fewer than 50 fraudulent
491	503		claims under a health care program or to a health benefit plan
492	504		issuer, as applicable, and the submission of each claim constitutes
493	505		conduct prohibited by Subsection (a) or (a-1), as applicable;
494	506		(6) a felony of the second degree if:
495	507		(A) the amount of any payment or the value of any
496	508		monetary or in-kind benefit provided or claim for payment made
497	509		under a health care program, or the amount of a payment made by or
498	510		the value of a benefit provided by or claim for payment made to a
499	511		health benefit plan issuer, directly or indirectly, as a result of
500	512		the conduct is $150,000 or more but less than $300,000; or
501	513		(B) it is shown on the trial of the offense that
502	514		the defendant submitted 50 or more fraudulent claims under a health
503	515		care program or to a health benefit plan issuer, as applicable, and
504	516		the submission of each claim constitutes conduct prohibited by
505	517		Subsection (a) or (a-1), as applicable; or
506	518		(7) a felony of the first degree if the amount of any
507	519		payment or the value of any monetary or in-kind benefit provided or
508	520		claim for payment made under a health care program, or the amount of
509	521		a payment made by or the value of a benefit provided by or claim for
510	522		payment made to a health benefit plan issuer, directly or
511	523		indirectly, as a result of the conduct is $300,000 or more.
512	524		(d) When multiple payments or monetary or in-kind benefits
513	525		are provided under one or more health care programs or by one or
514	526		more health benefit plan issuers as a result of one scheme or
515	527		continuing course of conduct, the conduct may be considered as one
516	528		offense and the amounts of the payments or monetary or in-kind
517	529		benefits aggregated in determining the grade of the offense.
518		-	SECTION 8. Section 3(a)(3), Article 37.07, Code of Criminal
	530	+	SECTION 9. Section 3(a)(3), Article 37.07, Code of Criminal
519	531		Procedure, is amended to read as follows:
520	532		(3) Regardless of the plea and whether the punishment
521	533		is assessed by the judge or the jury, during the punishment phase of
522	534		the trial of an offense under Section 35A.02, Penal Code, subject to
523	535		the applicable rules of evidence, the state and the defendant may
524	536		offer evidence not offered during the guilt or innocence phase of
525	537		the trial concerning the total pecuniary loss to the affected
526	538		health care program or health benefit plan issuer, as applicable,
527	539		caused by the defendant's conduct or, if applicable, the scheme or
528	540		continuing course of conduct of which the defendant's conduct is
529	541		part. Evidence may be offered in summary form concerning the total
530	542		pecuniary loss to the affected health care program or health
531	543		benefit plan issuer, as applicable. Testimony regarding the total
532	544		pecuniary loss to the affected health care program or health
533	545		benefit plan issuer, as applicable, is subject to
534	546		cross-examination. Evidence offered under this subdivision may be
535	547		considered by the judge or jury in ordering or recommending the
536	548		amount of any restitution to be made to the affected health care
537	549		program or health benefit plan issuer, as applicable, or the
538	550		appropriate punishment for the defendant.
539		-	SECTION 9. The change in law made by this Act applies only
	551	+	SECTION 10. The change in law made by this Act applies only
540	552		to an offense committed on or after the effective date of this Act.
541	553		An offense committed before the effective date of this Act is
542	554		governed by the law in effect at the time the offense was committed,
543	555		and the former law is continued in effect for that purpose. For
544	556		purposes of this section, an offense was committed before the
545	557		effective date of this Act if any element of the offense occurred
546	558		before that date.
547		-	SECTION 10. This Act takes effect September 1, 2025.
	559	+	SECTION 11. This Act takes effect September 1, 2025.