H.B. No. 4012 seeks to strengthen the detection and prevention of health care and insurance fraud in Texas by establishing 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 coordination between the office of inspector general and the Texas Department of Insurance for fraud detection. It also introduces Chapter 87 to the Insurance Code, which provides civil remedies for individuals violating specific fraud-related provisions of the Penal Code, with penalties varying based on the severity of the violation and its impact on vulnerable populations. Additionally, the bill creates a fraud prevention partnership involving the Health and Human Services Commission and stakeholders in the health care sector.

Moreover, the bill 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. The bill also introduces amendments to existing laws regarding litigation rights, allowing courts to limit participation in cases to prevent harassment and to stay discovery during state investigations. It outlines consequences for individuals who initiate actions based on planned violations, emphasizes protections against retaliation for participants, and modifies the Penal Code to define offenses related to health benefit plans, categorizing penalties based on the monetary value of fraudulent claims. The changes will take effect on September 1, 2025, and apply only to offenses committed thereafter.

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