H.B. No. 2886 seeks to enhance the administrative remedies available for addressing fraud and abuse within the Texas Medicaid program. The bill introduces provisions that allow the commission to award individuals who report Medicaid fraud or abuse, contingent upon the recovery of a remedy. It amends existing language by replacing "administrative penalty" with "remedy," thereby shifting the focus from punitive measures to recovery. The bill also establishes criteria for determining the award amount, which is capped at five percent of the remedy recovered, while maintaining the commission's authority to impose administrative penalties for violations.

In addition to redefining terms related to claims, the bill expands the list of Medicaid violations and outlines specific actions that constitute fraud or abuse. It establishes administrative remedies, including financial penalties based on the severity of the offense, and clarifies the rights of individuals charged with violations, including options for consent to remedies and requests for reviews. The bill also specifies timelines for remedy payments and conditions for enforcement stays. It repeals certain provisions and clarifies that civil remedies do not preclude other legal remedies for the same act. The changes aim to streamline enforcement and ensure accountability, with the bill set to take effect on September 1, 2025, for 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 36, Human Resources Code 32)