Text of section effective on April 01, 2025
Sec. 544.0353.  FRAUD AND ABUSE PREVENTION PLAN.  (a)  A managed care organization to which this subchapter applies shall:
(1)  adopt a plan to prevent and reduce fraud and abuse; and
(2)  annually file the plan with the office of inspector general for approval.
(b)  The plan must include:
(1)  a description of the organization's procedures for:
(A)  detecting and investigating possible acts of fraud or abuse;
(B)  mandatory reporting of possible acts of fraud or abuse to the office of inspector general; and
(C)  educating and training personnel to prevent fraud and abuse;
(2)  the name, address, telephone number, and fax number of the individual responsible for carrying out the plan;
(3)  a description or chart outlining the organizational arrangement of the organization's personnel responsible for investigating and reporting possible acts of fraud or abuse;
(4)  a detailed description of the results of fraud and abuse investigations the organization's special investigative unit or the entity with which the organization contracts under Section 544.0352(a)(2) conducts; and
(5)  provisions for maintaining the confidentiality of any patient information relevant to a fraud or abuse investigation.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.