The bill amends various sections of the Government Code and Human Resources Code to strengthen administrative remedies for Medicaid fraud and abuse violations. It introduces provisions that allow the commission to award individuals who report such violations, with the award capped at five percent of the recovery amount. The bill clarifies the definition of "claim" and introduces the term "material" to describe influential information regarding Medicaid benefits. It also establishes a framework for determining administrative penalties, with specific penalties for actions harming vulnerable populations, and replaces the term "administrative penalty" with "remedy" to emphasize recovery and accountability.

Additionally, the bill modifies procedures related to violations and remedies under the Human Resources Code. It specifies the content of written notices for individuals charged with violations, requiring a summary of facts, a recommended remedy, and available due process options. The response timeline for individuals is extended from 10 to 30 days, and the process for informal reviews and hearings is clarified. The bill repeals certain provisions and updates definitions related to violations, ensuring that civil remedies do not preclude other legal remedies and preventing double liability for the same act. These changes will take effect on September 1, 2025, with prior violations governed by existing law. Overall, the bill aims to enhance clarity and streamline the process for addressing Medicaid fraud and abuse.

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)
House Committee Report: Human Resources Code 32.039, Human Resources Code 32.0391, Human Resources Code 36.006 (Human Resources Code 32, Human Resources Code 36)