S.B. No. 1038 seeks to enhance the administrative remedies for fraud and abuse violations within the Texas Medicaid program by amending existing provisions in the Government Code and Human Resources Code. The bill introduces new language that replaces "administrative penalty" with "remedy," emphasizing a focus on recovery rather than punishment. It establishes a framework for whistleblower awards, capping them at five percent of the recovered remedy, and clarifies the commission's authority to impose administrative remedies for various violations. The bill also expands the definition of Medicaid-related violations, detailing specific fraudulent actions and clarifying that proof of specific intent is not necessary in administrative or civil proceedings.

Furthermore, the bill updates terminology and processes related to violations and penalties under health care programs, ensuring that individuals charged with violations have clear rights and procedures, including the ability to consent to remedies and seek judicial review. It specifies timelines for remedy payments and conditions for enforcement stays, while also repealing certain provisions to streamline the enforcement process. The legislation aims to strengthen the integrity of the Medicaid program by providing clearer guidelines and more robust penalties for fraudulent activities, with an effective date of September 1, 2025, applicable only to violations occurring on or after that date.

Statutes affected:
Introduced: Human Resources Code 32.039, Human Resources Code 32.0391, Human Resources Code 36.002, Human Resources Code 36.006 (Human Resources Code 32, Human Resources Code 36)