Texas Statutes
Subchapter C. Medicaid and Other Health and Human Services Fraud, Abuse, or Overcharges
Section 531.101. Award for Reporting Medicaid Fraud, Abuse, or Overcharges

Sec. 531.101. AWARD FOR REPORTING MEDICAID FRAUD, ABUSE, OR OVERCHARGES. (a) The commission may grant an award to an individual who reports activity that constitutes fraud or abuse of funds in Medicaid or reports overcharges in Medicaid if the commission determines that the disclosure results in the recovery of an administrative penalty imposed under Section 32.039, Human Resources Code. The commission may not grant an award to an individual in connection with a report if the commission or attorney general had independent knowledge of the activity reported by the individual.
(b) The commission shall determine the amount of an award. The award may not exceed five percent of the amount of the administrative penalty imposed under Section 32.039, Human Resources Code, that resulted from the individual's disclosure. In determining the amount of the award, the commission shall consider how important the disclosure is in ensuring the fiscal integrity of Medicaid. The commission may also consider whether the individual participated in the fraud, abuse, or overcharge.
(c) A person who brings an action under Subchapter C, Chapter 36, Human Resources Code, is not eligible for an award under this section.
Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.16, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1153, Sec. 1.06(a), eff. Sept. 1, 1997. Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.18(a), eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.129, eff. April 2, 2015.

Structure Texas Statutes

Texas Statutes

Government Code

Title 4 - Executive Branch

Subtitle I - Health and Human Services

Chapter 531 - Health and Human Services Commission

Subchapter C. Medicaid and Other Health and Human Services Fraud, Abuse, or Overcharges

Section 531.101. Award for Reporting Medicaid Fraud, Abuse, or Overcharges

Section 531.1011. Definitions

Section 531.102. Office of Inspector General

Section 531.1021. Subpoenas

Section 531.1022. Peace Officers

Section 531.1023. Compliance With Federal Coding Guidelines

Section 531.1024. Hospital Utilization Reviews and Audits: Provider Education Process

Section 531.1025. Performance Audits and Coordination of Audit Activities

Section 531.103. Interagency Coordination

Section 531.1031. Duty to Exchange Information

Section 531.1032. Office of Inspector General: Criminal History Record Information Check

Section 531.1033. Monitoring of Certain Federal Databases

Section 531.1034. Time to Determine Provider Eligibility; Performance Metrics

Section 531.104. Assisting Investigations by Attorney General

Section 531.105. Fraud Detection Training

Section 531.106. Learning, Neural Network, or Other Technology

Section 531.1061. Fraud Investigation Tracking System

Section 531.1062. Recovery Monitoring System

Section 531.108. Fraud Prevention

Section 531.1081. Integrity of Certain Public Assistance Programs

Section 531.109. Selection and Review of Claims

Section 531.110. Electronic Data Matching Program

Section 531.111. Fraud Detection Technology

Section 531.1112. Study Concerning Increased Use of Technology to Strengthen Fraud Detection and Deterrence; Implementation

Section 531.112. Expunction of Information Related to Certain Chemical Dependency Diagnoses in Certain Records

Section 531.113. Managed Care Organizations: Special Investigative Units or Contracts

Section 531.1131. Fraud and Abuse Recovery by Certain Persons; Retention of Recovered Amounts

Section 531.1132. Annual Report on Certain Fraud and Abuse Recoveries

Section 531.1135. Managed Care Organizations: Process to Recoup Certain Overpayments

Section 531.114. Financial Assistance Fraud

Section 531.115. Federal Felony Match

Section 531.116. Compliance With Law Prohibiting Solicitation

Section 531.117. Recovery Audit Contractors

Section 531.118. Preliminary Investigations of Allegations of Fraud or Abuse and Fraud Referrals

Section 531.119. Website Posting

Section 531.120. Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt

Section 531.1201. Appeal of Determination to Recoup Overpayment or Debt

Section 531.1202. Record and Confidentiality of Informal Resolution Meetings

Section 531.1203. Rights of and Provision of Information to Pharmacies Subject to Certain Audits