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
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 531.102. Office of Inspector General
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 531.113. 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