Texas 2025 - 89th Regular

Texas House Bill HB4273 Compare Versions

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Version 2 (New)

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1	1	89R14147 AND-F
2	2	By: Oliverson H.B. No. 4273
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to unlawful acts involving certain health care programs.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 36.002, Human Resources Code, is amended
12	12	to read as follows:
13	13	Sec. 36.002. UNLAWFUL ACTS. A person commits an unlawful
14	14	act if the person:
15	15	(1) knowingly makes or causes to be made a false
16	16	statement or misrepresentation of a material fact to permit a
17	17	person to receive a benefit or payment under a health care program
18	18	that is not authorized or that is greater than the benefit or
19	19	payment that is authorized;
20	20	(2) knowingly conceals or fails to disclose
21	21	information that permits a person to receive a benefit or payment
22	22	under a health care program that is not authorized or that is
23	23	greater than the benefit or payment that is authorized;
24	24	(3) knowingly applies for and receives a benefit or
25	25	payment on behalf of another person under a health care program and
26	26	converts any part of the benefit or payment to a use other than for
27	27	the benefit of the person on whose behalf it was received;
28	28	(4) knowingly makes, causes to be made, induces, or
29	29	seeks to induce the making of a false statement or
30	30	misrepresentation of material fact concerning:
31	31	(A) the conditions or operation of a facility in
32	32	order that the facility may qualify for certification or
33	33	recertification required by a health care program, including
34	34	certification or recertification as:
35	35	(i) a hospital;
36	36	(ii) a nursing facility or skilled nursing
37	37	facility;
38	38	(iii) a hospice;
39	39	(iv) an ICF-IID;
40	40	(v) an assisted living facility; or
41	41	(vi) a home health agency; or
42	42	(B) information required to be provided by a
43	43	federal or state law, rule, regulation, or provider agreement
44	44	pertaining to a health care program;
45	45	(5) except as authorized under a health care program,
46	46	knowingly pays, charges, solicits, accepts, or receives, in
47	47	addition to an amount paid under the program, a gift, money, a
48	48	donation, or other consideration as a condition to the provision of
49	49	a service or product or the continued provision of a service or
50	50	product if the cost of the service or product is paid for, in whole
51	51	or in part, under the program;
52	52	(6) knowingly presents or causes to be presented a
53	53	claim for payment under a health care program for a product provided
54	54	or a service rendered by a person who:
55	55	(A) is not licensed to provide the product or
56	56	render the service, if a license is required; or
57	57	(B) is not licensed in the manner claimed;
58	58	(7) knowingly makes or causes to be made a claim under
59	59	a health care program for:
60	60	(A) a service or product that has not been
61	61	approved or acquiesced in by a treating physician or health care
62	62	practitioner;
63	63	(B) a service or product that is substantially
64	64	inadequate or inappropriate when compared to generally recognized
65	65	standards within the particular discipline or within the health
66	66	care industry; or
67	67	(C) a product that has been adulterated, debased,
68	68	mislabeled, or that is otherwise inappropriate;
69	69	(8) makes a claim under a health care program and
70	70	knowingly fails to indicate:
71	71	(A) the type of license held by the licensed
72	72	health care provider who actually provided the service; or
73	73	(B) [and] the identification number of the
74	74	licensed health care provider who actually provided the service;
75	75	(9) conspires to commit a violation of Subdivision
76	76	(1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (12), or (13);
77	77	(10) is a managed care organization that contracts
78	78	with the commission or other state agency to provide or arrange to
79	79	provide health care benefits or services to individuals eligible
80	80	under a health care program and knowingly:
81	81	(A) fails to provide to an individual a health
82	82	care benefit or service that the organization is required to
83	83	provide under the contract;
84	84	(B) fails to provide to the commission or
85	85	appropriate state agency information required to be provided by
86	86	law, commission or agency rule, or contractual provision; or
87	87	(C) engages in a fraudulent activity in
88	88	connection with the enrollment of an individual eligible under the
89	89	program in the organization's managed care plan or in connection
90	90	with marketing the organization's services to an individual
91	91	eligible under the program;
92	92	(11) knowingly obstructs an investigation by the
93	93	attorney general of an alleged unlawful act under this section;
94	94	(12) knowingly makes, uses, or causes the making or
95	95	use of a false record or statement material to an obligation to pay
96	96	or transmit money or property to this state under a health care
97	97	program, or knowingly conceals or knowingly and improperly avoids
98	98	or decreases an obligation to pay or transmit money or property to
99	99	this state under a health care program; or
100	100	(13) knowingly engages in conduct that constitutes a
101	101	violation under Section 32.039(b).
102	102	SECTION 2. Section 36.002, Human Resources Code, as amended
103	103	by this Act, applies only to an unlawful act committed on or after
104	104	the effective date of this Act.
105	105	SECTION 3. If before implementing any provision of this Act
106	106	a state agency determines that a waiver or authorization from a
107	107	federal agency is necessary for the implementation of that
108	108	provision, the agency affected by the provision shall request the
109	109	waiver or authorization and may delay implementing that provision
110	110	until the waiver or authorization is granted.
111	111	SECTION 4. This Act takes effect September 1, 2025.