H.B. No. 4012 seeks to strengthen the detection and prevention of health care and insurance fraud in Texas by introducing new civil penalties and enabling private individuals to initiate legal actions against violators. The bill amends Section 544.0103 of the Government Code to facilitate collaboration between the office of inspector general and the Texas Department of Insurance for fraud detection. It also establishes Chapter 87 in the Insurance Code, which outlines civil remedies for individuals violating specific fraud-related provisions of the Penal Code, including penalties that consider the severity of the violation and its impact on vulnerable populations. Additionally, the bill creates a fraud prevention partnership between the Texas Department of Insurance and the Health and Human Services Commission to enhance cooperation in combating fraud.

The bill further amends Chapter 703 of the Insurance Code to allow private individuals to bring civil actions on behalf of the state for fraud violations, detailing the procedures for such actions and the state's involvement. It includes provisions for civil penalties, damage assessments, and conditions for state intervention in private actions. The bill also introduces amendments to existing laws regarding litigation participation, discovery stays, and protections against retaliation for individuals involved in these actions. It establishes penalties for fraudulent activities related to health benefit plans, categorizing offenses based on the value of fraudulent claims, and modifies the Code of Criminal Procedure to allow evidence of total pecuniary loss during trial punishments. The changes will take effect on September 1, 2025, and apply only to offenses committed after that date.

Statutes affected:
Introduced: Insurance Code 701.102 (Insurance Code 701)
House Committee Report: Government Code 544.0103 (Government Code 544, Insurance Code 701)