Tex. Gov't Code § 544.0353 · Subchapter H. MANAGED CARE ORGANIZATION PREVENTION AND INVESTIGATION OF FRAUD AND ABUSE
FRAUD AND ABUSE PREVENTION PLAN.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) A managed care organization to which this subchapter applies shall:
(1) adopt a plan to prevent and reduce fraud and abuse; and
(2) annually file the plan with the office of inspector general for approval.
(b) The plan must include:
(1) a description of the organization's procedures for:
(A) detecting and investigating possible acts of fraud or abuse;
(B) mandatory reporting of possible acts of fraud or abuse to the office of inspector general; and
(C) educating and training personnel to prevent fraud and abuse;
(2) the name, address, telephone number, and fax number of the individual responsible for carrying out the plan;
(3) a description or chart outlining the organizational arrangement of the organization's personnel responsible for investigating and reporting possible acts of fraud or abuse;
(4) a detailed description of the results of fraud and abuse investigations the organization's special investigative unit or the entity with which the organization contracts under Section 544.0352(a)(2) conducts; and
(5) provisions for maintaining the confidentiality of any patient information relevant to a fraud or abuse investigation.
Notes and commentary — not statutory text
History
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/GV/htm/GV.544.htm
- Text hash
- sha256 b10eb3322386f50ae9e800ad6b17d6e20ccf491dcb3de1445698488099d94e05
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
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