The bill amends the Government Code and Human Resources Code in Texas to enhance 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 information that can influence Medicaid benefit decisions. It also establishes a framework for identifying violations and associated penalties, emphasizing recovery and accountability by replacing "administrative penalty" with "remedy" in several instances. Specific actions that constitute violations are outlined, along with varying monetary fines based on the severity of the offense and potential harm to vulnerable populations.

Additionally, the bill modifies procedures related to violations and remedies assessed by the commission, including a requirement for written notice to inform individuals charged with a violation about the case facts, recommended remedies, and their rights to an informal review. Individuals are given 30 days to consent to the recommended remedy or request a review. The bill also clarifies the judicial review process and ensures that civil remedies do not preclude other legal remedies for the same act. These changes are set to take effect on September 1, 2025, with existing laws governing any violations that occur before this 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)
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)