reglab/housing_qa huggingface dataset:
TX Govt Code § 531.1021 (2021)
2021 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 531.1021. Subpoenas

Sec. 531.1021.  SUBPOENAS.  (a)  The office of inspector general may issue a subpoena in connection with an investigation conducted by the office.  A subpoena may be issued under this section to compel the attendance of a relevant witness or the production, for inspection or copying, of relevant evidence that is in this state.(b)  A subpoena may be served personally or by certified mail.(c)  If a person fails to comply with a subpoena, the office, acting through the attorney general, may file suit to enforce the subpoena in a district court in this state.(d)  On finding that good cause exists for issuing the subpoena, the court shall order the person to comply with the subpoena.  The court may punish a person who fails to obey the court order.(e)  The office shall pay a reasonable fee for photocopies subpoenaed under this section in an amount not to exceed the amount the office may charge for copies of its records.(f)  The reimbursement of the expenses of a witness whose attendance is compelled under this section is governed by Section 2001.103.(g)  All information and materials subpoenaed or compiled by the office in connection with an audit, inspection, or investigation or by the office of the attorney general in connection with a Medicaid fraud investigation are confidential and not subject to disclosure under Chapter 552, and not subject to disclosure, discovery, subpoena, or other means of legal compulsion for their release to anyone other than the office or the attorney general or their employees or agents involved in the audit, inspection, or investigation conducted by the office or the attorney general, except that this information may be disclosed to the state auditor's office, law enforcement agencies, and other entities as permitted by other law.(h)  A person who receives information under Subsection (g) may disclose the information only in accordance with Subsection (g) and in a manner that is consistent with the authorized purpose for which the person first received the information.|Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.20, eff. Sept. 1, 2003.Amended by: Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 18(b), eff. September 1, 2005.Acts 2011, 82nd Leg., R.S., Ch. 620 (S.B. 688), Sec. 4, eff. September 1, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.134, eff. April 2, 2015.Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 3, eff. September 1, 2015.Acts 2017, 85th Leg., R.S., Ch. 277 (H.B. 2379), Sec. 2, eff. May 29, 2017.|
TX Govt Code § 531.1022 (2021)
2021 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 531.1022. Peace Officers

Sec. 531.1022.  PEACE OFFICERS.  (a)  The commission's office of inspector general shall employ and commission not more than five peace officers at any given time for the purpose of assisting the office in carrying out the duties of the office relating to the investigation of fraud, waste, and abuse in Medicaid.(b)  Peace officers employed under this section are administratively attached to the Department of Public Safety.  The commission shall provide administrative support to the department necessary to support the assignment of peace officers employed under this section.(c)  A peace officer employed and commissioned by the office under this section is a peace officer for purposes of Article 2.12, Code of Criminal Procedure.(d)  A peace officer employed and commissioned under this section shall obtain prior approval from the office of attorney general before carrying out any duties requiring peace officer status.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1311 (S.B. 8), Sec. 6, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.135, eff. April 2, 2015.|
TX Govt Code § 531.1023 (2021)
2021 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 531.1023. Compliance With Federal Coding Guidelines

Sec. 531.1023.  COMPLIANCE WITH FEDERAL CODING GUIDELINES.  (a)  The commission's office of inspector general, including office staff and any third party with which the office contracts to perform coding services, and the commission's medical and utilization review appeals unit shall comply with federal coding guidelines, including guidelines for diagnosis-related group (DRG) validation and related audits.(b)  In this section, "federal coding guidelines" means the code sets and guidelines adopted by the United States Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.).|Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 11, eff. September 1, 2015.Amended by: Acts 2019, 86th Leg., R.S., Ch. 680 (S.B. 2138), Sec. 2, eff. June 10, 2019.|
TX Govt Code § 531.1024 (2021)
2021 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 531.1024. Hospital Utilization Reviews and Audits: Provider Education Process

Sec. 531.1024.  HOSPITAL UTILIZATION REVIEWS AND AUDITS:  PROVIDER EDUCATION PROCESS.  The executive commissioner, in consultation with the office, shall by rule develop a process for the commission's office of inspector general, including office staff and any third party with which the office contracts to perform coding services, to communicate with and educate providers about the diagnosis-related group (DRG) validation criteria that the office uses in conducting hospital utilization reviews and audits.|Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 11, eff. September 1, 2015.|
TX Govt Code § 531.1025 (2021)
2021 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 531.1025. Performance Audits and Coordination of Audit Activities

Sec. 531.1025.  PERFORMANCE AUDITS AND COORDINATION OF AUDIT ACTIVITIES.  (a)  Notwithstanding any other law, the commission's office of inspector general may conduct a performance audit of any program or project administered or agreement entered into by the commission or a health and human services agency, including an audit related to:(1)  contracting procedures of the commission or a health and human services agency; or(2)  the performance of the commission or a health and human services agency.(b)  In addition to the coordination required by Section 531.102(w), the office shall coordinate the office's other audit activities with those of the commission, including the development of audit plans, the performance of risk assessments, and the reporting of findings, to minimize the duplication of audit activities.  In coordinating audit activities with the commission under this subsection, the office shall:(1)  seek input from the commission and consider previous audits conducted by the commission for purposes of determining whether to conduct a performance audit; and(2)  request the results of an audit conducted by the commission if those results could inform the office's risk assessment when determining whether to conduct, or the scope of, a performance audit.|Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 11, eff. September 1, 2015.|
TX Govt Code § 531.1033 (2021)
2021 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 531.1033. Monitoring of Certain Federal Databases

Sec. 531.1033.  MONITORING OF CERTAIN FEDERAL DATABASES.  The office shall routinely check appropriate federal databases, including databases referenced in 42 C.F.R. Section 455.436, to ensure that a person who is excluded from participating in Medicaid or in the Medicare program by the federal government is not participating as a provider in Medicaid.|Added by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 2.15(b), eff. September 1, 2015.Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 5, eff. September 1, 2015.|
TX Govt Code § 531.1034 (2021)
2021 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 531.1034. Time to Determine Provider Eligibility; Performance Metrics

Sec. 531.1034.  TIME TO DETERMINE PROVIDER ELIGIBILITY; PERFORMANCE METRICS.  (a)  Not later than the 10th day after the date the office receives the complete application of a health care professional seeking to participate in Medicaid, the office shall inform the commission or the health care professional, as appropriate, of the office's determination regarding whether the health care professional should be denied participation in Medicaid based on:(1)  information concerning the licensing status of the health care professional obtained as described by Section 531.1032(a);(2)  information contained in the criminal history record information check that is evaluated in accordance with guidelines adopted under Section 531.1032(c);(3)  a review of federal databases under Section 531.1033;(4)  the pendency of an open investigation by the office; or(5)  any other reason the office determines appropriate.(b)  Completion of an on-site visit of a health care professional during the period prescribed by Subsection (a) is not required.(c)  The office shall develop performance metrics to measure the length of time for conducting a determination described by Subsection (a) with respect to applications that are complete when submitted and all other applications.|Added by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 2.15(b), eff. September 1, 2015.Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 5, eff. September 1, 2015.|
TX Govt Code § 531.104 (2021)
2021 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 531.104. Assisting Investigations by Attorney General

Sec. 531.104.  ASSISTING INVESTIGATIONS BY ATTORNEY GENERAL.  (a)  The commission and the attorney general shall execute a memorandum of understanding under which the commission shall provide investigative support as required to the attorney general in connection with cases under Subchapter B, Chapter 36, Human Resources Code.  Under the memorandum of understanding, the commission shall assist in performing preliminary investigations and ongoing investigations for actions prosecuted by the attorney general under Subchapter C, Chapter 36, Human Resources Code.(b)  The memorandum of understanding must specify the type, scope, and format of the investigative support provided to the attorney general under this section.(c)  The memorandum of understanding must ensure that no barriers to direct fraud referrals to the state's Medicaid fraud control unit by Medicaid agencies or unreasonable impediments to communication between Medicaid agency employees and the state's Medicaid fraud control unit will be imposed.|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.06(a), eff. Sept. 1, 1997.  Amended by Acts 2003 78th Leg., ch. 198, Sec. 2.22, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 257, Sec. 11, eff. Sept. 1, 2003.|
TX Govt Code § 531.105 (2021)
2021 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 531.105. Fraud Detection Training

Sec. 531.105.  FRAUD DETECTION TRAINING.  (a)  The commission shall develop and implement a program to provide annual training to contractors who process Medicaid claims and to appropriate staff of the health and human services agencies in identifying potential cases of fraud, waste, or abuse under Medicaid.  The training provided to the contractors and staff must include clear criteria that specify:(1)  the circumstances under which a person should refer a potential case to the commission; and(2)  the time by which a referral should be made.(b)  The health and human services agencies, in cooperation with the commission, shall periodically set a goal of the number of potential cases of fraud, waste, or abuse under Medicaid that each agency will attempt to identify and refer to the commission.  The commission shall include information on the agencies' goals and the success of each agency in meeting the agency's goal in the report required by Section 531.103(c).|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.06(a), eff. Sept. 1, 1997.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.139, eff. April 2, 2015.|
TX Govt Code § 531.106 (2021)
2021 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 531.106. Learning, Neural Network, or Other Technology

Sec. 531.106.  LEARNING, NEURAL NETWORK, OR OTHER TECHNOLOGY.  (a)  The commission shall use learning, neural network, or other technology to identify and deter fraud in Medicaid throughout this state.(b)  The commission shall contract with a private or public entity to develop and implement the technology.  The commission may require the entity it contracts with to install and operate the technology at locations specified by the commission, including commission offices.(c)  The data used for data processing shall be maintained as an independent subset for security purposes.(d)  The commission shall require each health and human services agency that performs any aspect of Medicaid to participate in the implementation and use of the technology.(e)  The commission shall maintain all information necessary to apply the technology to claims data covering a period of at least two years.(f)  The commission shall refer cases identified by the technology to the commission's office of inspector general or the office of the attorney general, as appropriate.(g)  Each month, the technology implemented under this section must match vital statistics unit death records with Medicaid claims filed by a provider.  If the commission determines that a provider has filed a claim for services provided to a person after the person's date of death, as determined by the vital statistics unit death records, the commission shall refer the case for investigation to the commission's office of inspector general.|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.06(a), eff. June 20, 1997.  Amended by Acts 1999, 76th Leg., ch. 215, Sec. 2, eff. Sept. 1, 1999.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.140, eff. April 2, 2015.Acts 2017, 85th Leg., R.S., Ch. 277 (H.B. 2379), Sec. 3, eff. May 29, 2017.Acts 2017, 85th Leg., R.S., Ch. 277 (H.B. 2379), Sec. 4, eff. May 29, 2017.|
TX Govt Code § 531.1061 (2021)
2021 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 531.1061. Fraud Investigation Tracking System

Sec. 531.1061.  FRAUD INVESTIGATION TRACKING SYSTEM.  (a)  The commission shall use an automated fraud investigation tracking system through the commission's office of inspector general to monitor the progress of an investigation of suspected fraud, abuse, or insufficient quality of care under Medicaid.(b)  For each case of suspected fraud, abuse, or insufficient quality of care identified by the technology required under Section 531.106, the automated fraud investigation tracking system must:(1)  receive electronically transferred records relating to the identified case from the technology;(2)  record the details and monitor the status of an investigation of the identified case, including maintaining a record of the beginning and completion dates for each phase of the case investigation;(3)  generate documents and reports related to the status of the case investigation; and(4)  generate standard letters to a provider regarding the status or outcome of an investigation.(c)  The commission shall require each health and human services agency that performs any aspect of Medicaid to participate in the implementation and use of the automated fraud investigation tracking system.|Added by Acts 1999, 76th Leg., ch. 206, Sec. 1, eff. Sept. 1, 1999.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.141, eff. April 2, 2015.Acts 2017, 85th Leg., R.S., Ch. 277 (H.B. 2379), Sec. 5, eff. May 29, 2017.|
TX Govt Code § 531.1062 (2021)
2021 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 531.1062. Recovery Monitoring System

Sec. 531.1062.  RECOVERY MONITORING SYSTEM.  (a)  The commission shall use an automated recovery monitoring system to monitor the collections process for a settled case of fraud, abuse, or insufficient quality of care under Medicaid.(b)  The recovery monitoring system must:(1)  monitor the collection of funds resulting from settled cases, including:(A)  recording monetary payments received from a provider who has agreed to a monetary payment plan;  and(B)  recording deductions taken through the recoupment program from subsequent Medicaid claims filed by the provider;  and(2)  provide immediate notice of a provider who has agreed to a monetary payment plan or to deductions through the recoupment program from subsequent Medicaid claims who fails to comply with the settlement agreement, including providing notice of a provider who does not make a scheduled payment or who pays less than the scheduled amount.|Added by Acts 1999, 76th Leg., ch. 206, Sec. 1, eff. Sept. 1, 1999.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.142, eff. April 2, 2015.|
TX Govt Code § 531.108 (2021)
2021 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 531.108. Fraud Prevention

Sec. 531.108.  FRAUD PREVENTION.  (a)  The commission's office of inspector general shall compile and disseminate accurate information and statistics relating to:(1)  fraud prevention; and(2)  post-fraud referrals received and accepted or rejected from the commission's case management system or the case management system of a health and human services agency.(b)  The commission shall:(1)  aggressively publicize successful fraud prosecutions and fraud-prevention programs through all available means, including the use of statewide press releases; and(2)  ensure that a toll-free hotline for reporting suspected fraud in programs administered by the commission or a health and human services agency is maintained and promoted, either by the commission or by a health and human services agency.(c)  The commission shall develop a cost-effective method of identifying applicants for public assistance in counties bordering other states and in metropolitan areas selected by the commission who are already receiving benefits in other states.  If economically feasible, the commission may develop a computerized matching system.(d)  The commission shall:(1)  verify automobile information that is used as criteria for eligibility;  and(2)  establish a computerized matching system with the Texas Department of Criminal Justice to prevent an incarcerated individual from illegally receiving public assistance benefits administered by the commission.(e)  Not later than October 1 of each year, the commission shall submit to the governor and Legislative Budget Board an annual report on the results of computerized matching of commission information with information from neighboring states, if any, and information from the Texas Department of Criminal Justice.  The report may be consolidated with any other report relating to the same subject matter the commission is required to submit under other law.|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.06(a), eff. Sept. 1, 1997.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1312 (S.B. 59), Sec. 38, eff. September 1, 2013.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.144, eff. April 2, 2015.Acts 2021, 87th Leg., R.S., Ch. 856 (S.B. 800), Sec. 8, eff. September 1, 2021.|
TX Govt Code § 531.1081 (2021)
2021 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 531.1081. Integrity of Certain Public Assistance Programs

Sec. 531.1081.  INTEGRITY OF CERTAIN PUBLIC ASSISTANCE PROGRAMS.  (a)  In this section:(1)  "Financial assistance benefits" means money payments under the federal Temporary Assistance for Needy Families program operated under Chapter 31, Human Resources Code, or under the state temporary assistance and support services program operated under Chapter 34, Human Resources Code.(2)  "Supplemental nutrition assistance benefits" means money payments under the supplemental nutrition assistance program operated under Chapter 33, Human Resources Code.(b)  To the extent not otherwise provided by this subtitle or Title 2, Human Resources Code, the commission shall develop and implement, in accordance with this section, methods for reducing abuse, fraud, and waste in public assistance programs.(c)  On a monthly basis, the commission shall:(1)  conduct electronic data matches with the Texas Lottery Commission to determine if a recipient of supplemental nutrition assistance benefits or a recipient's household member received reportable lottery winnings;(2)  use the database system developed under Section 531.0214 to match vital statistics unit death records with a list of individuals eligible for financial assistance or supplemental nutrition assistance benefits, and ensure that any individual receiving assistance under either program who is discovered deceased has their eligibility for assistance promptly terminated; and(3)  review the out-of-state electronic benefit transfer card transactions made by a recipient of supplemental nutrition assistance benefits to determine whether those transactions indicate a possible change in the recipient's residence.(d)  The commission shall immediately review the eligibility of a recipient of public assistance benefits if the commission discovers information under this section that affects the recipient's eligibility.(e)  A  recipient who fails to disclose lottery winnings that are required to be reported to the commission under a public assistance program presumptively commits a program violation.(f)  The executive commissioner shall adopt rules necessary to implement this section.|Added by Acts 2021, 87th Leg., R.S., Ch. 879 (S.B. 1341), Sec. 1, eff. September 1, 2021.|