reglab/housing_qa huggingface dataset:
TX Govt Code § 531.109 (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 531.109. Selection and Review of Claims

Sec. 531.109.  SELECTION AND REVIEW OF CLAIMS.  (a)  The commission shall annually select and review a random, statistically valid sample of all claims for reimbursement under Medicaid, including under the vendor drug program, for potential cases of fraud, waste, or abuse.(b)  In conducting the annual review of claims under Subsection (a), the commission may directly contact a recipient by telephone or in person, or both, to verify that the services for which a claim for reimbursement was submitted by a provider were actually provided to the recipient.(c)  Based on the results of the annual review of claims, the commission shall determine the types of claims at which commission resources for fraud and abuse detection should be primarily directed.(d)  Absent an allegation of fraud, waste, or abuse, the commission may conduct an annual review of claims under this section only after the commission has completed the prior year's annual review of claims.|Added by Acts 1999, 76th Leg., ch. 1289, Sec. 4, eff. Sept. 1, 1999.Amended by: Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.04(c), eff. September 28, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.145, eff. April 2, 2015.|
TX Govt Code § 531.110 (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 531.110. Electronic Data Matching Program

Sec. 531.110.  ELECTRONIC DATA MATCHING PROGRAM.  (a)  In this section,  "public assistance program" includes:(1)  Medicaid;(2)  the financial assistance program under Chapter 31, Human Resources Code; and(3)  a nutritional assistance program under Chapter 33, Human Resources Code, including the supplemental nutrition assistance program under that chapter. (a-1)  The commission shall conduct electronic data matches for a recipient of benefits under a public assistance program at least quarterly to verify the identity, income, employment status, and other factors that affect the eligibility of the recipient.(b)  To verify eligibility of a recipient of public assistance program benefits, the electronic data matching must match information provided by the recipient with information contained in databases maintained by appropriate federal and state agencies.(c)  The health and human services agencies shall cooperate with the commission by providing data or any other assistance necessary to conduct the electronic data matches required by this section.(c-1)  The commission shall enter into a memorandum of understanding with each state agency from which data is required to conduct electronic data matches under this section and Section 531.1081.(d)  The commission may contract with a public or private entity to conduct the electronic data matches required by this section.(e)  The executive commissioner shall establish procedures by which the commission, or a health and human services agency designated by the commission, verifies the electronic data matches conducted by the commission under this section.  Not later than the 20th day after the date the electronic data match is verified, the commission shall remove from eligibility a recipient who is determined to be ineligible for a public assistance program.(f)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1083, Sec. 25(59), eff. June 17, 2011.|Added by Acts 1999, 76th Leg., ch. 1289, Sec. 4, eff. Sept. 1, 1999.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1050 (S.B. 71), Sec. 21(8), eff. September 1, 2011.Acts 2011, 82nd Leg., R.S., Ch. 1083 (S.B. 1179), Sec. 25(59), eff. June 17, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.146, eff. April 2, 2015.Acts 2021, 87th Leg., R.S., Ch. 879 (S.B. 1341), Sec. 2, eff. September 1, 2021.|
TX Govt Code § 531.111 (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 531.111. Fraud Detection Technology

Sec. 531.111.  FRAUD DETECTION TECHNOLOGY.  The commission may contract with a contractor who specializes in developing technology capable of identifying patterns of fraud exhibited by Medicaid recipients to:(1)  develop and implement the fraud detection technology; and(2)  determine if a pattern of fraud by Medicaid recipients is present in the recipients' eligibility files maintained by the commission.|Added by Acts 1999, 76th Leg., ch. 1289, Sec. 4, eff. Sept. 1, 1999.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.147, eff. April 2, 2015.|
TX Govt Code § 531.1112 (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 531.1112. Study Concerning Increased Use of Technology to Strengthen Fraud Detection and Deterrence; Implementation

Sec. 531.1112.  STUDY CONCERNING INCREASED USE OF TECHNOLOGY TO STRENGTHEN FRAUD DETECTION AND DETERRENCE; IMPLEMENTATION.  (a)  The commission and the commission's office of inspector general shall jointly study the feasibility of increasing the use of technology to strengthen the detection and deterrence of fraud in Medicaid.  The study must include the determination of the feasibility of using technology to verify a person's citizenship and eligibility for coverage.(b)  The commission shall implement any methods the commission and the commission's office of inspector general determine are effective at strengthening fraud detection and deterrence.|Added by Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 6(a), eff. September 1, 2007.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.148, eff. April 2, 2015.|
TX Govt Code § 531.112 (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 531.112. Expunction of Information Related to Certain Chemical Dependency Diagnoses in Certain Records

Sec. 531.112.  EXPUNCTION OF INFORMATION RELATED TO CERTAIN CHEMICAL DEPENDENCY DIAGNOSES IN CERTAIN RECORDS.  (a)  In this section:(1)  "Chemical dependency" has the meaning assigned by Section 461A.002, Health and Safety Code.(2)  "Child" means a person 13 years of age or younger.(b)  Following the final conviction of a chemical dependency treatment provider for an offense, an element of which involves submitting a fraudulent claim for reimbursement for services under Medicaid, the commission or other health and human services agency that operates a portion of Medicaid shall expunge or provide for the expunction of a diagnosis of chemical dependency in a child that has been made by the treatment provider and entered in any:(1)  appropriate official record of the commission or agency;(2)  applicable medical record that is in the commission's or agency's custody; and(3)  applicable record of a company that the commission contracts with for the processing and payment of claims under Medicaid.|Added by Acts 2001, 77th Leg., ch. 1081, Sec. 1, eff. Sept. 1, 2001.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.149, eff. April 2, 2015.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.150, eff. April 2, 2015.|
TX Govt Code § 531.1132 (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 531.1132. Annual Report on Certain Fraud and Abuse Recoveries

Sec. 531.1132.  ANNUAL REPORT ON CERTAIN FRAUD AND ABUSE RECOVERIES.  Not later than December 1 of each year, the commission shall prepare and submit a report to the legislature relating to the amount of money recovered during the preceding 12-month period as a result of investigations and recovery efforts made under Sections 531.113 and 531.1131 by special investigative units or entities with which a managed care organization contracts under Section 531.113(a)(2). The report must specify the amount of money retained by each managed care organization under Section 531.1131(c).|Added by Acts 2011, 82nd Leg., R.S., Ch. 980 (H.B. 1720), Sec. 7, eff. September 1, 2011.|
TX Govt Code § 531.1135 (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 531.1135. Managed Care Organizations: Process to Recoup Certain Overpayments

Sec. 531.1135.  MANAGED CARE ORGANIZATIONS:  PROCESS TO RECOUP CERTAIN OVERPAYMENTS.  (a)  The executive commissioner shall adopt rules that standardize the process by which a managed care organization collects alleged overpayments that are made to a health care provider and discovered through an audit or investigation conducted by the organization secondary to missing electronic visit verification information.  In adopting rules under this section, the executive commissioner shall require that the managed care organization:(1)  provide written notice of the organization's intent to recoup overpayments not later than the 30th day after the date an audit is complete; and(2)  limit the duration of audits to 24 months.(b)  The executive commissioner shall require that the notice required under this section inform the provider: (1)  of the specific claims and electronic visit verification transactions that are the basis of the overpayment;(2)  of the process the provider should use to communicate with the managed care organization to provide information about the electronic visit verification transactions;(3)  of the provider's option to seek an informal resolution of the alleged overpayment;(4)  of the process to appeal the determination that an overpayment was made; and(5)  if the provider intends to respond to the notice, that the provider must respond not later than the 30th day after the date the provider receives the notice.(c)  Notwithstanding any other law, a managed care organization may not attempt to recover an overpayment described by Subsection (a) until the provider has exhausted all rights to an appeal.|Added by Acts 2019, 86th Leg., R.S., Ch. 667 (S.B. 1991), Sec. 3, eff. September 1, 2019.|
TX Govt Code § 531.114 (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 531.114. Financial Assistance Fraud

Sec. 531.114.  FINANCIAL ASSISTANCE FRAUD.  (a)  For purposes of establishing or maintaining the eligibility of a person and the person's family for financial assistance under Chapter 31, Human Resources Code, or for purposes of increasing or preventing a reduction in the amount of that assistance, a person may not intentionally:(1)  make a statement that the person knows is false or misleading;(2)  misrepresent, conceal, or withhold a fact;  or(3)  knowingly misrepresent a statement as being true.(b)  If after an investigation the commission determines that a person violated Subsection (a), the commission shall:(1)  notify the person of the alleged violation not later than the 30th day after the date the commission completes the investigation and provide the person with an opportunity for a hearing on the matter;  or(2)  refer the matter to the appropriate prosecuting attorney for prosecution.(c)  If a person waives the right to a hearing or if a hearing officer at an administrative hearing held under this section determines that a person violated Subsection (a), the person is ineligible to receive financial assistance as provided by Subsection (d).  A person who a hearing officer determines violated Subsection (a) may appeal that determination by filing a petition in the district court in the county in which the violation occurred not later than the 30th day after the date the hearing officer made the determination.(d)  A person determined under Subsection (c) to have violated Subsection (a) is not eligible for financial assistance:(1)  before the first anniversary of the date of that determination, if the person has no previous violations;  and(2)  permanently, if the person was previously determined to have committed a violation.(e)  If a person is convicted of a state or federal offense for conduct described by Subsection (a), or if the person is granted deferred adjudication or placed on community supervision for that conduct, the person is permanently disqualified from receiving financial assistance.(f)  This section does not affect the eligibility for financial assistance of any other member of the household of a person ineligible as a result of Subsection (d) or (e).(g)  The executive commissioner shall adopt rules as necessary to implement this section.|Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.26(a), eff. Sept. 1, 2003.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.153, eff. April 2, 2015.|
TX Govt Code § 531.115 (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 531.115. Federal Felony Match

Sec. 531.115.  FEDERAL FELONY MATCH.  The commission shall develop and implement a system to cross-reference data collected for the programs listed under Section 531.008(c) with the list of fugitive felons maintained by the federal government.|Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.27, eff. Sept. 1, 2003.|
TX Govt Code § 531.116 (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 531.116. Compliance With Law Prohibiting Solicitation

Sec. 531.116.  COMPLIANCE WITH LAW PROHIBITING SOLICITATION.  A provider who furnishes services under Medicaid or the child health plan program is subject to Chapter 102, Occupations Code, and the provider's compliance with that chapter is a condition of the provider's eligibility to participate as a provider under those programs.|Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.28, eff. Sept. 1, 2003.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.154, eff. April 2, 2015.|
TX Govt Code § 531.117 (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 531.117. Recovery Audit Contractors

Sec. 531.117.  RECOVERY AUDIT CONTRACTORS.  To the extent required under Section 1902(a)(42), Social Security Act (42 U.S.C. Section 1396a(a)(42)), the commission shall establish a program under which the commission contracts with one or more recovery audit contractors for purposes of identifying underpayments and overpayments under Medicaid and recovering the overpayments.|Added by Acts 2011, 82nd Leg., R.S., Ch. 980 (H.B. 1720), Sec. 7, eff. September 1, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.155, eff. April 2, 2015.|
TX Govt Code § 531.119 (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 531.119. Website Posting

Sec. 531.119.  WEBSITE POSTING.  The commission's office of inspector general shall post on its publicly available website a description in plain English of, and a video explaining, the processes and procedures the office uses to determine whether to impose a payment hold on a provider under this subchapter.|Added by Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 3, eff. September 1, 2013.|
TX Govt Code § 531.120 (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 531.120. Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt

Sec. 531.120.  NOTICE AND INFORMAL RESOLUTION OF PROPOSED RECOUPMENT OF OVERPAYMENT OR DEBT.  (a)  The commission or the commission's office of inspector general shall provide a provider with written notice of any proposed recoupment of an overpayment or debt and any damages or penalties relating to a proposed recoupment of an overpayment or debt arising out of a fraud or abuse investigation.  The notice must include:(1)  the specific basis for the overpayment or debt;(2)  a description of facts and supporting evidence;(3)  a representative sample of any documents that form the basis for the overpayment or debt;(4)  the extrapolation methodology;(4-a)  information relating to the extrapolation methodology used as part of the investigation and the methods used to determine the overpayment or debt in sufficient detail so that the extrapolation results may be demonstrated to be statistically valid and are fully reproducible;(5)  the calculation of the overpayment or debt amount;(6)  the amount of damages and penalties, if applicable; and(7)  a description of administrative and judicial due process remedies, including the provider's option to seek informal resolution, the provider's right to seek a formal administrative appeal hearing, or that the provider may seek both.(b)  A provider may request an informal resolution meeting under this section, and on receipt of the request, the office shall schedule the informal resolution meeting.  The office shall give notice to the provider of the time and place of the informal resolution meeting.  The informal resolution process shall run concurrently with the administrative hearing process, and the administrative hearing process may not be delayed on account of the informal resolution process.(c)  The commission shall provide the notice required by Subsection (a) to a provider that is a hospital not later than the 90th day before the date the overpayment or debt that is the subject of the notice must be paid.|Added by Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 3, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 8, eff. September 1, 2015.Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 3, eff. September 1, 2017.|
TX Govt Code § 531.1201 (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 531.1201. Appeal of Determination to Recoup Overpayment or Debt

Sec. 531.1201.  APPEAL OF DETERMINATION TO RECOUP OVERPAYMENT OR DEBT.  (a)  A provider must request an appeal under this section not later than the 30th day after the date the provider is notified that the commission or the commission's office of inspector general will seek to recover an overpayment or debt from the provider.  On receipt of a timely written request by a provider who is the subject of a recoupment of overpayment or recoupment of debt arising out of a fraud or abuse investigation, the office of inspector general shall file a docketing request with the State Office of Administrative Hearings or the Health and Human Services Commission appeals division, as requested by the provider, for an administrative hearing regarding the proposed recoupment amount and any associated damages or penalties.  The office shall file the docketing request under this section not later than the 60th day after the date of the provider's request for an administrative hearing or not later than the 60th day after the completion of the informal resolution process, if applicable.(b)  The commission's office of inspector general is responsible for the costs of an administrative hearing held under Subsection (a), but a provider is responsible for the provider's own costs incurred in preparing for the hearing.(c)  Repealed by Acts 2015, 84th Leg., R.S., Ch. 945 , Sec. 13(1), eff. September 1, 2015.(d)  Following an administrative hearing under Subsection (a), a provider who is the subject of a recoupment of overpayment or recoupment of debt arising out of a fraud or abuse investigation may appeal a final administrative order by filing a petition for judicial review in a district court in Travis County.|Added by Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 3, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 9, eff. September 1, 2015.Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 13(1), eff. September 1, 2015.|
TX Govt Code § 531.1202 (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 531.1202. Record and Confidentiality of Informal Resolution Meetings

Sec. 531.1202.  RECORD AND CONFIDENTIALITY OF INFORMAL RESOLUTION MEETINGS.  (a)  On the written request of the provider, the commission shall, at no expense to the provider who requested the meeting, provide for an informal resolution meeting held under Section 531.102(g)(6) or 531.120(b) to be recorded.  The recording of an informal resolution meeting shall be made available to the provider who requested the meeting.  The commission may not record an informal resolution meeting unless the commission receives a written request from a provider under this subsection.(b)  Notwithstanding Section 531.1021(g) and except as provided by this section, an informal resolution meeting held under Section 531.102(g)(6) or 531.120(b) is confidential, and any information or materials obtained by the commission's office of inspector general, including the office's employees or the office's agents, during or in connection with an informal resolution meeting, including a recording made under Subsection (a), are privileged and confidential and not subject to disclosure under Chapter 552 or any other means of legal compulsion for release, including disclosure, discovery, or subpoena.|Added by Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 3, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 10, eff. September 1, 2015.|