S.B. No. 2579 aims to strengthen the enforcement of health care and insurance fraud laws in Texas by introducing new civil penalties and enabling private individuals to take legal action against violators. The bill amends Section 544.0103(e) of the Government Code to enhance coordination between the office of inspector general and the Texas Department of Insurance for fraud detection. It also creates a new section in the Insurance Code, Section 701.053, which outlines civil remedies for individuals violating fraud-related provisions, including penalties based on the severity of the violation and its impact on vulnerable populations. Additionally, a "Fraud Prevention Partnership" is established to foster collaboration among stakeholders, and a new subchapter allows private individuals to initiate civil actions on behalf of themselves and the state against fraud perpetrators.

The bill further amends the Penal Code to define offenses related to health benefit plans, establishing penalties based on the monetary value of fraudulent claims, ranging from Class C misdemeanors for amounts under $100 to first-degree felonies for amounts exceeding $300,000. It also modifies the Code of Criminal Procedure to permit the presentation of total pecuniary loss evidence during the punishment phase of trials for these offenses. The bill includes provisions for the distribution of proceeds from civil actions, limitations on individual participation in legal actions, and protections against retaliation for those involved in such actions. The changes will apply only to offenses committed on or after the effective date of the Act, set for September 1, 2025.

Statutes affected:
Introduced: Insurance Code 701.102 (Insurance Code 701)