Office of House Bill AnalysisS.B. 1589
By: Zaffirini
Public Health


Texas expended $7.3 billion in 1997 on its Medicaid program, $3.8 billion
of which was spent on acute care services. The 75th Texas Legislature
directed the comptroller of public accounts (comptroller) to study the size
and nature of fraud and overpayments in the Medicaid program and other
state health care programs. The comptroller and the State Auditor's Office
reported possible overpayments of approximately $162 million for Medicaid
acute care services based on 1997 expenditures. The comptroller included
recommendations in the Fraud Measurement Study for improving the state's
ability to ensure that state health care program funds are properly
expended. S.B. 1589 sets forth provisions for conducting a study of
fraudulent medical or health care benefit claims submitted under certain
state programs.  


It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 


SECTION 1.  Redesignates Section 403.026, Government Code, as Section
403.028, and amends that section as follows: 

(a)  Adds language to provide that the study to determine the number and
type of fraudulent claims for medical or health care benefits submitted
under the state Medicaid program which the comptroller of public accounts
(comptroller) is required to conduct, is to be conducted in consultation
with the office of the state auditor.  Specifies that the state Medicaid
program includes the Medicaid managed care program implemented under
Chapter 533 (Implementation of Medicaid Managed Care Program).  

(b)  Authorizes the comptroller or, at the request of the comptroller, a
state agency that administers a program identified by Subsection (a), to
make telephone contact with a person identified as receiving services for
which benefits are provided under the program, to confirm delivery of
services to a person.  

(c)  Creates this subsection from existing text.  Provides that the
information must be provided in a certain specified format agreed to by the
comptroller and the state agency that aids in identifying unusual or
suspicious claims or patterns of claims.  

(d)  Requires each state agency that administers a program identified by
Subsection (a), in consultation with the comptroller and the office of the
state auditor, to establish performance measures to be used to evaluate the
agency's fraud control procedures.  

(e)  Redesignated from existing Subsection (c).  Provides that a report
must indicate whether the level of fraud in each program included in the
study has increased, decreased, or remained constant since the
comptroller's last report.  Makes conforming changes.  

SECTION 2.  Emergency clause.
 Effective date: upon passage.