Text of section effective on April 01, 2025
Sec. 544.0051.  COORDINATION WITH OFFICE OF ATTORNEY GENERAL; ANNUAL REPORT.  (a)  The commission, acting through the office of inspector general, and the office of the attorney general shall enter into a memorandum of understanding to develop and implement joint written procedures for processing:
(1)  cases of suspected fraud, waste, or abuse, as those terms are defined by state or federal law; or
(2)  other violations of state or federal law under Medicaid or another program the commission or a health and human services agency administers, including:
(A)  the financial assistance program under Chapter 31, Human Resources Code;
(B)  the supplemental nutrition assistance program under Chapter 33, Human Resources Code; and
(C)  the child health plan program.
(b)  The memorandum of understanding must:
(1)  require the office of inspector general and the office of the attorney general to:
(A)  set priorities and guidelines for referring cases to appropriate state agencies for investigation, prosecution, or other disposition to:
(i)  enhance deterrence of fraud, waste, abuse, or other violations of state or federal law under the programs described by Subsection (a)(2), including a violation of Chapter 102, Occupations Code; and
(ii)  maximize the imposition of penalties, the recovery of money, and the successful prosecution of cases; and
(B)  submit information the comptroller requests about each resolved case for the comptroller's use in improving fraud detection;
(2)  require the office of inspector general to:
(A)  refer each case of suspected provider fraud, waste, or abuse to the office of the attorney general not later than the 20th business day after the date the office of inspector general determines that the existence of fraud, waste, or abuse is reasonably indicated;
(B)  keep detailed records for cases the office of inspector general or the office of the attorney general processes, including information on the total number of cases processed and, for each case:
(i)  the agency and division to which the case is referred for investigation;
(ii)  the date the case is referred; and
(iii)  the nature of the suspected fraud, waste, or abuse; and
(C)  notify each appropriate division of the office of the attorney general of each case the office of inspector general refers;
(3)  require the office of the attorney general to:
(A)  take appropriate action in response to each case referred to the attorney general, which may include:
(i)  directly initiating prosecution, with the appropriate local district or county attorney's consent;
(ii)  directly initiating civil litigation;
(iii)  referring the case to an appropriate United States attorney, a district attorney, or a county attorney; or
(iv)  referring the case to a collections agency for initiation of civil litigation or other appropriate action;
(B)  ensure that information relating to each case the office of the attorney general investigates is available to each division of the office with responsibility for investigating suspected fraud, waste, or abuse; and
(C)  notify the office of inspector general of each case the attorney general declines to prosecute or prosecutes unsuccessfully;
(4)  require representatives of the office of inspector general and of the office of the attorney general to meet not less than quarterly to share case information and determine the appropriate agency and division to investigate each case;
(5)  ensure that barriers to direct fraud referrals to the office of the attorney general's Medicaid fraud control unit or unreasonable impediments to communication between Medicaid agency employees and the Medicaid fraud control unit are not imposed; and
(6)  include procedures to facilitate the referral of cases directly to the office of the attorney general.
(c)  An exchange of information under this section between the office of the attorney general and the commission, the office of inspector general, or a health and human services agency does not affect whether the information is subject to disclosure under Chapter 552.
(d)  The commission and the office of the attorney general may not assess or collect investigation and attorney's fees on any state agency's behalf unless the office of the attorney general or another state agency collects a penalty, restitution, or other reimbursement payment to this state.
(e)  A district attorney, county attorney, city attorney, or private collection agency may collect and retain:
(1)  costs associated with a case referred to the attorney or agency in accordance with procedures adopted under this section; and
(2)  20 percent of the amount of the penalty, restitution, or other reimbursement payment collected.
(f)  The commission and the office of the attorney general shall jointly prepare and submit to the governor, lieutenant governor, and speaker of the house of representatives an annual report concerning the activities of those agencies in detecting and preventing fraud, waste, and abuse under Medicaid or another program the commission or a health and human services agency administers.  The commission and the office of the attorney general may consolidate the report with any other report relating to the same subject matter the commission or the office of the attorney general is required to submit under other law.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.