Texas 2025 - 89th Regular

Texas Senate Bill SB2579 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R10265 SCF-F
2	2	By: Hancock S.B. No. 2579
3	3
4	4
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to health care and insurance fraud; creating a criminal
10	10	offense; authorizing a civil penalty.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 544.0103(e), Government Code, as
13	13	effective April 1, 2025, is amended to read as follows:
14	14	(e) The office of inspector general may:
15	15	(1) assess administrative penalties otherwise
16	16	authorized by law on behalf of the commission or a health and human
17	17	services agency;
18	18	(2) request that the attorney general obtain an
19	19	injunction to prevent a person from disposing of an asset the office
20	20	of inspector general identifies as potentially subject to recovery
21	21	by the office of inspector general due to the person's fraud or
22	22	abuse;
23	23	(3) provide for coordination between the office of
24	24	inspector general and special investigative units formed by managed
25	25	care organizations under Subchapter H or entities with which
26	26	managed care organizations contract under that subchapter;
27	27	(3-a) provide for coordination between the office of
28	28	inspector general and the Texas Department of Insurance, as
29	29	provided by Section 701.110, Insurance Code, to coordinate health
30	30	care fraud detection and prevention in the state;
31	31	(4) audit the use and effectiveness of state or
32	32	federal funds, including contract and grant funds, administered by
33	33	a person or state agency receiving the funds from a health and human
34	34	services agency;
35	35	(5) conduct investigations relating to the funds
36	36	described by Subdivision (4); and
37	37	(6) recommend policies to:
38	38	(A) promote the economical and efficient
39	39	administration of the funds described by Subdivision (4); and
40	40	(B) prevent and detect fraud and abuse in the
41	41	administration of those funds.
42	42	SECTION 2. The heading to Subchapter B, Chapter 701,
43	43	Insurance Code, is amended to read as follows:
44	44	SUBCHAPTER B. REPORTING FRAUDULENT INSURANCE ACTS; CIVIL REMEDIES
45	45	SECTION 3. Subchapter B, Chapter 701, Insurance Code, is
46	46	amended by adding Section 701.053 to read as follows:
47	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	96	SECTION 4. Section 701.102, Insurance Code, is amended to
97	97	read as follows:
98	98	Sec. 701.102. INVESTIGATION OF CERTAIN ACTS OF FRAUD. (a)
99	99	If the commissioner has reason to believe a person has engaged in,
100	100	is engaging in, has committed, or is about to commit a fraudulent
101	101	insurance act, the commissioner may conduct any investigation
102	102	necessary inside or outside this state to:
103	103	(1) determine whether the act occurred; or
104	104	(2) aid in enforcing laws relating to fraudulent
105	105	insurance acts, including by providing technical or litigation
106	106	assistance to other governmental agencies.
107	107	(b) In exercising the commissioner's authority under
108	108	Subsection (a), the commissioner shall prioritize investigating
109	109	alleged violations of Section 35A.02(a-1), Penal Code.
110	110	(c) Except as provided by Section 701.214, the department
111	111	may retain up to 50 percent of any money recovered as a result of an
112	112	investigation conducted under Subsection (b). The department shall
113	113	remit the remaining amount of money to the person or persons harmed
114	114	by the offense.
115	115	SECTION 5. Subchapter C, Chapter 701, Insurance Code, is
116	116	amended by adding Section 701.110 to read as follows:
117	117	Sec. 701.110. FRAUD PREVENTION PARTNERSHIP. (a) The
118	118	department shall, in coordination with the Health and Human
119	119	Services Commission office of inspector general, establish the
120	120	fraud prevention partnership to detect and prevent health care
121	121	fraud in this state across the private and public markets.
122	122	(b) The partnership shall include:
123	123	(1) a representative of one or more Medicaid managed
124	124	care organizations;
125	125	(2) a representative of one or more health benefit
126	126	plan issuers, as defined by Section 1222.0001; and
127	127	(3) any other appropriate person as determined by the
128	128	commissioner and inspector general.
129	129	SECTION 6. Chapter 701, Insurance Code, is amended by
130	130	adding Subchapter E to read as follows:
131	131	SUBCHAPTER E. ACTION BY PRIVATE PERSON
132	132	Sec. 701.201. ACTION BY PRIVATE PERSON AUTHORIZED. (a) A
133	133	person may bring a civil action for a violation of Section
134	134	35A.02(a-1), Penal Code, on behalf of the person and the state. The
135	135	action must be brought in the name of the person and of the state.
136	136	(b) In an action brought under this subchapter, a person who
137	137	violates Section 35A.02(a-1), Penal Code, is liable as provided by
138	138	Section 701.053.
139	139	Sec. 701.202. INITIATION OF ACTION. (a) A person bringing
140	140	an action under this subchapter shall serve a copy of the petition
141	141	and a written disclosure of substantially all material evidence and
142	142	information the person possesses on the attorney general in
143	143	compliance with the Texas Rules of Civil Procedure.
144	144	(b) A person shall file a petition for an action under this
145	145	subchapter in camera and, except as provided by Section 701.203(b)
146	146	or (c), the petition must remain under seal until the earlier of:
147	147	(1) the 180th day after the date the petition is served
148	148	on the attorney general; or
149	149	(2) the date on which the state elects to intervene.
150	150	(c) A person bringing an action under this subchapter may
151	151	not serve process on a defendant until the court orders service of
152	152	process.
153	153	Sec. 701.203. STATE INTERVENTION. (a) The state may elect
154	154	to intervene and proceed with an action under this subchapter not
155	155	later than the 180th day after the date the attorney general
156	156	receives the petition and the material evidence and information
157	157	under Section 701.202(a).
158	158	(b) At the time the state intervenes in an action under this
159	159	subchapter, the attorney general may file a motion with the court
160	160	requesting that the petition remain under seal for an extended
161	161	period.
162	162	(c) In an action under this subchapter, the state may, for
163	163	good cause shown, move the court to extend the 180-day periods
164	164	prescribed by Subsection (a) or Section 701.202(b). A motion under
165	165	this subsection may be supported by affidavits or other submissions
166	166	in camera.
167	167	Sec. 701.204. CONSENT REQUIRED FOR DISMISSAL. An action
168	168	under this subchapter may be dismissed only if the court and the
169	169	attorney general consent in writing to the dismissal and state
170	170	their reasons for consenting.
171	171	Sec. 701.205. ANSWER BY DEFENDANT. A defendant is not
172	172	required to file in accordance with the Texas Rules of Civil
173	173	Procedure an answer to a petition filed under this subchapter until
174	174	the petition is unsealed and served on the defendant.
175	175	Sec. 701.206. STATE DECISION; CONTINUATION OF ACTION. (a)
176	176	Not later than the last day of the period prescribed by Section
177	177	701.203(a) or an extension of that period as provided by Section
178	178	701.203(c), the state shall:
179	179	(1) proceed with the action; or
180	180	(2) notify the court that the state declines to take
181	181	over the action.
182	182	(b) If the state declines to take over an action under this
183	183	subchapter, the person bringing the action may proceed without the
184	184	state's participation. A person proceeding under this subsection
185	185	may recover for a violation for a period of up to six years before
186	186	the date the action was filed, or for a period beginning when the
187	187	violation occurred until up to three years from the date the state
188	188	knows or reasonably should have known facts material to the
189	189	violation, whichever of these two periods is longer, regardless of
190	190	whether the violation occurred more than six years before the date
191	191	the action was filed. Notwithstanding this subsection, a person
192	192	proceeding under this subsection may not recover for a violation
193	193	that occurred more than 10 years before the date the action was
194	194	filed.
195	195	(c) On request by the state, the state is entitled to be
196	196	served with copies of all pleadings filed in an action under this
197	197	subchapter and be provided at the state's expense with copies of all
198	198	deposition transcripts. If the person bringing the action proceeds
199	199	without the state's participation, the court, without limiting the
200	200	status and right of that person, may permit the state to intervene
201	201	at a later date on a showing of good cause.
202	202	Sec. 701.207. REPRESENTATION OF STATE BY PRIVATE ATTORNEY.
203	203	The attorney general may contract with a private attorney to
204	204	represent the state in an action under this subchapter with which
205	205	the state elects to proceed.
206	206	Sec. 701.208. INTERVENTION BY OTHER PARTIES PROHIBITED. A
207	207	person other than the state may not intervene or bring a related
208	208	action based on the facts underlying a pending action under this
209	209	subchapter.
210	210	Sec. 701.209. RIGHTS OF PARTIES IF STATE CONTINUES ACTION.
211	211	(a) If the state proceeds with an action under this subchapter, the
212	212	state has the primary responsibility for prosecuting the action and
213	213	is not bound by an act of the person bringing the action. The person
214	214	bringing the action has the right to continue as a party to the
215	215	action, subject to the limitations set forth by this section.
216	216	(b) The state may dismiss an action under this subchapter
217	217	notwithstanding the objections of the person bringing the action
218	218	if:
219	219	(1) the attorney general notifies the person that the
220	220	state has filed a motion to dismiss; and
221	221	(2) the court provides the person with an opportunity
222	222	for a hearing on the motion.
223	223	(c) The state may settle an action under this subchapter
224	224	with the defendant notwithstanding the objections of the person
225	225	bringing the action if the court determines, after a hearing, that
226	226	the proposed settlement is fair, adequate, and reasonable under all
227	227	the circumstances. On a showing of good cause, the hearing may be
228	228	held in camera.
229	229	(d) On a showing by the state that unrestricted
230	230	participation during the course of the litigation by the person
231	231	bringing an action under this subchapter would interfere with or
232	232	unduly delay the state's prosecution of the action, or would be
233	233	repetitious, irrelevant, or for purposes of harassment, the court
234	234	may impose limitations on the person's participation, including:
235	235	(1) limiting the number of witnesses the person may
236	236	call;
237	237	(2) limiting the length of the testimony of witnesses
238	238	called by the person;
239	239	(3) limiting the person's cross-examination of
240	240	witnesses; or
241	241	(4) otherwise limiting the participation by the person
242	242	in the litigation.
243	243	(e) On a showing by a defendant in an action under this
244	244	subchapter that unrestricted participation during the course of the
245	245	litigation by the person bringing the action would be for purposes
246	246	of harassment or would cause the defendant undue burden or
247	247	unnecessary expense, the court may limit the participation by the
248	248	person in the litigation.
249	249	Sec. 701.210. STAY OF CERTAIN DISCOVERY. (a) On a showing
250	250	by the state that certain actions of discovery by the person
251	251	bringing an action under this subchapter would interfere with the
252	252	state's investigation or prosecution of a criminal or civil matter
253	253	arising out of the same facts, the court may stay the discovery for
254	254	a period not to exceed 60 days.
255	255	(b) The court shall hear a motion to stay discovery under
256	256	this section in camera.
257	257	(c) The court may extend the period prescribed by Subsection
258	258	(a) on a further showing in camera that the state has pursued the
259	259	criminal or civil investigation or proceedings with reasonable
260	260	diligence and that any proposed discovery in the civil action will
261	261	interfere with the ongoing criminal or civil investigation or
262	262	proceedings.
263	263	Sec. 701.211. PURSUIT OF ALTERNATE REMEDY BY STATE. (a)
264	264	Notwithstanding Section 701.201, the state may elect to pursue the
265	265	state's claim through any alternate remedy available to the state,
266	266	including any administrative proceeding to determine an
267	267	administrative penalty. If an alternate remedy is pursued in
268	268	another proceeding, the person bringing an action under this
269	269	subchapter has the same rights in the other proceeding as the person
270	270	would have had if the action had continued under this subchapter.
271	271	(b) A finding of fact or conclusion of law made in the other
272	272	proceeding that has become final is conclusive on all parties to an
273	273	action under this subchapter. For purposes of this subsection, a
274	274	finding or conclusion is final if:
275	275	(1) the finding or conclusion has been finally
276	276	determined on appeal to the appropriate court;
277	277	(2) no appeal has been filed with respect to the
278	278	finding or conclusion and all time for filing an appeal has expired;
279	279	or
280	280	(3) the finding or conclusion is not subject to
281	281	judicial review.
282	282	Sec. 701.212. AWARD TO PRIVATE CLAIMANT. (a) If the state
283	283	proceeds with an action under this subchapter, the person bringing
284	284	the action is entitled, except as provided by Subsection (c), to
285	285	receive at least 15 percent but not more than 25 percent of the
286	286	proceeds of the action, depending on the extent to which the person
287	287	substantially contributed to the prosecution of the action.
288	288	(b) If the state does not proceed with an action under this
289	289	subchapter, the person bringing the action is entitled, except as
290	290	provided by Subsection (c), to receive at least 25 percent but not
291	291	more than 30 percent of the proceeds of the action. The entitlement
292	292	of a person under this subsection is not affected by any subsequent
293	293	intervention in the action by the state in accordance with Section
294	294	701.206(c).
295	295	(c) If the court finds that an action under this subchapter
296	296	is based primarily on disclosures of specific information, other
297	297	than information provided by the person bringing the action,
298	298	relating to allegations or transactions in a Texas or federal
299	299	criminal or civil hearing, in a Texas or federal legislative or
300	300	administrative report, hearing, audit, or investigation, or from
301	301	the news media, the court may award the amount the court considers
302	302	appropriate but not more than 10 percent of the proceeds of the
303	303	action. The court shall consider the significance of the
304	304	information and the role of the person bringing the action in
305	305	advancing the case to litigation.
306	306	(d) A payment to a person under this section shall be made
307	307	from the proceeds of the action. A person receiving a payment under
308	308	this section is also entitled to receive from the defendant an
309	309	amount for reasonable expenses, reasonable attorney's fees, and
310	310	costs that the court finds to have been necessarily incurred. The
311	311	court's determination of expenses, fees, and costs to be awarded
312	312	under this subsection shall be made only after the defendant has
313	313	been found liable in the action or the claim is settled.
314	314	(e) In this section, "proceeds of the action" includes
315	315	proceeds of a settlement of the action.
316	316	Sec. 701.213. REDUCTION OF AWARD. (a) If the court finds
317	317	that an action under this subchapter was brought by a person who
318	318	planned and initiated the violation on which the action was
319	319	brought, the court may, to the extent the court considers
320	320	appropriate, reduce the share of the proceeds of the action the
321	321	person would otherwise receive under Section 701.212, taking into
322	322	account the person's role in advancing the case to litigation and
323	323	any relevant circumstances pertaining to the violation.
324	324	(b) If the person bringing an action under this subchapter
325	325	is convicted of criminal conduct arising from the person's role in
326	326	the violation, the court shall dismiss the person from the civil
327	327	action and the person may not receive any share of the proceeds of
328	328	the action. A dismissal under this subsection does not prejudice
329	329	the right of the state to continue the action.
330	330	Sec. 701.214. AWARD TO DEPARTMENT. (a) If the state
331	331	proceeds with an action under this subchapter, the department is
332	332	entitled to receive at least 15 percent but not more than 25 percent
333	333	of the proceeds of the action, depending on the extent to which the
334	334	department substantially contributed to the prosecution of the
335	335	action.
336	336	(b) In this section, "proceeds of the action" includes
337	337	proceeds of a settlement of the action.
338	338	Sec. 701.215. AWARD TO INJURED INSURER. If the person
339	339	bringing an action under this subchapter is not an insurer harmed by
340	340	the violation that is the subject of the action, the insurer is
341	341	entitled to any money remaining after all awards and costs are
342	342	distributed as provided by this subchapter, including, in an action
343	343	where the state proceeds, reasonable expenses, reasonable
344	344	attorney's fees, and costs to the state that the court finds to have
345	345	been necessarily incurred.
346	346	Sec. 701.216. AWARD TO DEFENDANT FOR FRIVOLOUS ACTION.
347	347	Chapter 105, Civil Practice and Remedies Code, applies to an action
348	348	under this subchapter with which the state proceeds.
349	349	Sec. 701.217. CERTAIN ACTIONS BARRED. (a) A person may not
350	350	bring an action under this subchapter that is based on allegations
351	351	or transactions that are the subject of a civil action or an
352	352	administrative penalty proceeding in which the state is already a
353	353	party.
354	354	(b) The court shall dismiss an action or claim under this
355	355	subchapter, unless opposed by the attorney general, if
356	356	substantially the same allegations or transactions as alleged in
357	357	the action or claim were publicly disclosed in a Texas or federal
358	358	criminal or civil hearing in which the state or an agent of the
359	359	state is a party, in a legislative or administrative report of this
360	360	state, or other hearing, audit, or investigation in this state, or
361	361	from the news media, unless the person bringing the action is an
362	362	original source of the information. In this subsection, "original
363	363	source" means an individual who:
364	364	(1) before a public disclosure described by this
365	365	subsection, has voluntarily disclosed to the state the information
366	366	on which allegations or transactions in a claim are based; or
367	367	(2) has knowledge that is independent of and
368	368	materially adds to the publicly disclosed allegations or
369	369	transactions and who has voluntarily provided the information to
370	370	the state before filing an action under this subchapter.
371	371	Sec. 701.218. STATE NOT LIABLE FOR CERTAIN EXPENSES. The
372	372	state is not liable for expenses that a person incurs in bringing an
373	373	action under this subchapter.
374	374	Sec. 701.219. RETALIATION AGAINST PERSON PROHIBITED. (a)
375	375	A person, including an employee, contractor, or agent, who is
376	376	discharged, demoted, suspended, threatened, harassed, or in any
377	377	other manner discriminated against in the terms or conditions of
378	378	employment because of a lawful act taken by the person or associated
379	379	others in furtherance of an action under this subchapter, including
380	380	investigation for, initiation of, testimony for, or assistance in
381	381	an action filed or to be filed under this subchapter, or other
382	382	efforts taken by the person to stop one or more violations is
383	383	entitled to:
384	384	(1) reinstatement with the same seniority status the
385	385	person would have had but for the discrimination; and
386	386	(2) not less than two times the amount of back pay,
387	387	interest on the back pay, and compensation for any special damages
388	388	sustained as a result of the discrimination, including litigation
389	389	costs and reasonable attorney's fees.
390	390	(b) A person may bring an action under this section in the
391	391	appropriate district court not later than the third anniversary of
392	392	the date on which the cause of action accrues. For purposes of this
393	393	subsection, the cause of action accrues on the date the retaliation
394	394	occurs.
395	395	Sec. 701.220. SOVEREIGN IMMUNITY NOT WAIVED. Except as
396	396	provided by Section 701.216, this subchapter does not waive
397	397	sovereign immunity.
398	398	Sec. 701.221. ATTORNEY GENERAL COMPENSATION. The attorney
399	399	general may retain a reasonable portion of the amount recovered
400	400	under this subchapter, not to exceed amounts specified in the
401	401	General Appropriations Act, for the administration of this
402	402	subchapter.
403	403	SECTION 7. Section 35A.01, Penal Code, is amended by adding
404	404	Subdivisions (2-a), (2-b), and (2-c) and amending Subdivision (9)
405	405	to read as follows:
406	406	(2-a) "Health benefit claim" means a written or
407	407	electronically submitted request or demand that:
408	408	(A) is submitted by a person who provides or
409	409	purports to provide a service or product to an individual covered
410	410	under a health benefit plan or by that person's agent and identifies
411	411	a service or product provided or purported to have been provided to
412	412	the covered individual as reimbursable under the health benefit
413	413	plan, without regard to whether the money that is requested or
414	414	demanded is paid and without regard to whether the individual was
415	415	eligible for benefits under the health benefit plan; or
416	416	(B) states the income earned or expense incurred
417	417	by a person in providing a service or product to an individual
418	418	covered by a health benefit plan and is used to determine a rate of
419	419	payment under the plan.
420	420	(2-b) "Health benefit plan" means a health insurance
421	421	policy, a health care plan, as defined by Section 843.002,
422	422	Insurance Code, or another agreement, contract, or evidence of
423	423	coverage under which a person undertakes to provide, arrange for,
424	424	pay for, or reimburse any part of the cost of health care services.
425	425	(2-c) "Health benefit plan issuer" means a person who
426	426	is authorized or otherwise permitted by law to issue a health
427	427	insurance policy, to arrange for or provide a health care plan, as
428	428	defined by Section 843.002, Insurance Code, or to otherwise provide
429	429	health benefit plan coverage.
430	430	(9) "Service" includes care or treatment of a health
431	431	care recipient or an individual covered under a health benefit
432	432	plan.
433	433	SECTION 8. Section 35A.02, Penal Code, is amended by adding
434	434	Subsection (a-1) and amending Subsections (b) and (d) to read as
435	435	follows:
436	436	(a-1) A person commits an offense if the person:
437	437	(1) knowingly makes or causes to be made a false
438	438	statement or misrepresentation of a material fact to permit a
439	439	person to receive from a health benefit plan issuer a benefit or
440	440	payment that is not authorized or that is greater than the benefit
441	441	or payment that is authorized;
442	442	(2) knowingly conceals or fails to disclose
443	443	information that permits a person to receive from a health benefit
444	444	plan issuer a benefit or payment that is not authorized or that is
445	445	greater than the benefit or payment that is authorized;
446	446	(3) knowingly makes or causes to be made a health
447	447	benefit claim to a health benefit plan issuer for:
448	448	(A) a service or product that has not been
449	449	approved or acquiesced in by a treating physician or health care
450	450	practitioner;
451	451	(B) a service or product that is substantially
452	452	inadequate or inappropriate when compared to generally recognized
453	453	standards within the particular discipline or within the health
454	454	care industry; or
455	455	(C) a product that has been adulterated, debased,
456	456	or mislabeled or that is otherwise inappropriate; or
457	457	(4) knowingly enters into an agreement, combination,
458	458	or conspiracy to defraud a health benefit plan issuer by obtaining
459	459	or aiding another person in obtaining an unauthorized payment or
460	460	benefit from a health benefit plan issuer.
461	461	(b) An offense under this section is:
462	462	(1) a Class C misdemeanor if the amount of any payment
463	463	or the value of any monetary or in-kind benefit provided or claim
464	464	for payment made under a health care program, or the amount of a
465	465	payment made by or the value of a benefit provided by or claim for
466	466	payment made to a health benefit plan issuer, directly or
467	467	indirectly, as a result of the conduct is less than $100;
468	468	(2) a Class B misdemeanor if the amount of any payment
469	469	or the value of any monetary or in-kind benefit provided or claim
470	470	for payment made under a health care program, or the amount of a
471	471	payment made by or the value of a benefit provided by or claim for
472	472	payment made to a health benefit plan issuer, directly or
473	473	indirectly, as a result of the conduct is $100 or more but less than
474	474	$750;
475	475	(3) a Class A misdemeanor if the amount of any payment
476	476	or the value of any monetary or in-kind benefit provided or claim
477	477	for payment made under a health care program, or the amount of a
478	478	payment made by or the value of a benefit provided by or claim for
479	479	payment made to a health benefit plan issuer, directly or
480	480	indirectly, as a result of the conduct is $750 or more but less than
481	481	$2,500;
482	482	(4) a state jail felony if:
483	483	(A) the amount of any payment or the value of any
484	484	monetary or in-kind benefit provided or claim for payment made
485	485	under a health care program, or the amount of a payment made by or
486	486	the value of a benefit provided by or claim for payment made to a
487	487	health benefit plan issuer, directly or indirectly, as a result of
488	488	the conduct is $2,500 or more but less than $30,000;
489	489	(B) the offense is committed under Subsection
490	490	(a)(11); or
491	491	(C) it is shown on the trial of the offense that
492	492	the amount of the payment or value of the benefit described by this
493	493	subsection cannot be reasonably ascertained;
494	494	(5) a felony of the third degree if:
495	495	(A) the amount of any payment or the value of any
496	496	monetary or in-kind benefit provided or claim for payment made
497	497	under a health care program, or the amount of a payment made by or
498	498	the value of a benefit provided by or claim for payment made to a
499	499	health benefit plan issuer, directly or indirectly, as a result of
500	500	the conduct is $30,000 or more but less than $150,000; or
501	501	(B) it is shown on the trial of the offense that
502	502	the defendant submitted more than 25 but fewer than 50 fraudulent
503	503	claims under a health care program or to a health benefit plan
504	504	issuer, as applicable, and the submission of each claim constitutes
505	505	conduct prohibited by Subsection (a) or (a-1), as applicable;
506	506	(6) a felony of the second degree if:
507	507	(A) the amount of any payment or the value of any
508	508	monetary or in-kind benefit provided or claim for payment made
509	509	under a health care program, or the amount of a payment made by or
510	510	the value of a benefit provided by or claim for payment made to a
511	511	health benefit plan issuer, directly or indirectly, as a result of
512	512	the conduct is $150,000 or more but less than $300,000; or
513	513	(B) it is shown on the trial of the offense that
514	514	the defendant submitted 50 or more fraudulent claims under a health
515	515	care program or to a health benefit plan issuer, as applicable, and
516	516	the submission of each claim constitutes conduct prohibited by
517	517	Subsection (a) or (a-1), as applicable; or
518	518	(7) a felony of the first degree if the amount of any
519	519	payment or the value of any monetary or in-kind benefit provided or
520	520	claim for payment made under a health care program, or the amount of
521	521	a payment made by or the value of a benefit provided by or claim for
522	522	payment made to a health benefit plan issuer, directly or
523	523	indirectly, as a result of the conduct is $300,000 or more.
524	524	(d) When multiple payments or monetary or in-kind benefits
525	525	are provided under one or more health care programs or by one or
526	526	more health benefit plan issuers as a result of one scheme or
527	527	continuing course of conduct, the conduct may be considered as one
528	528	offense and the amounts of the payments or monetary or in-kind
529	529	benefits aggregated in determining the grade of the offense.
530	530	SECTION 9. Section 3(a)(3), Article 37.07, Code of Criminal
531	531	Procedure, is amended to read as follows:
532	532	(3) Regardless of the plea and whether the punishment
533	533	is assessed by the judge or the jury, during the punishment phase of
534	534	the trial of an offense under Section 35A.02, Penal Code, subject to
535	535	the applicable rules of evidence, the state and the defendant may
536	536	offer evidence not offered during the guilt or innocence phase of
537	537	the trial concerning the total pecuniary loss to the affected
538	538	health care program or health benefit plan issuer, as applicable,
539	539	caused by the defendant's conduct or, if applicable, the scheme or
540	540	continuing course of conduct of which the defendant's conduct is
541	541	part. Evidence may be offered in summary form concerning the total
542	542	pecuniary loss to the affected health care program or health
543	543	benefit plan issuer, as applicable. Testimony regarding the total
544	544	pecuniary loss to the affected health care program or health
545	545	benefit plan issuer, as applicable, is subject to
546	546	cross-examination. Evidence offered under this subdivision may be
547	547	considered by the judge or jury in ordering or recommending the
548	548	amount of any restitution to be made to the affected health care
549	549	program or health benefit plan issuer, as applicable, or the
550	550	appropriate punishment for the defendant.
551	551	SECTION 10. The change in law made by this Act applies only
552	552	to an offense committed on or after the effective date of this Act.
553	553	An offense committed before the effective date of this Act is
554	554	governed by the law in effect at the time the offense was committed,
555	555	and the former law is continued in effect for that purpose. For
556	556	purposes of this section, an offense was committed before the
557	557	effective date of this Act if any element of the offense occurred
558	558	before that date.
559	559	SECTION 11. This Act takes effect September 1, 2025.