SUBCHAPTER J.  USE OF TECHNOLOGY TO DETECT, INVESTIGATE, AND PREVENT FRAUD, ABUSE, AND OVERCHARGES


Text of section effective on April 01, 2025

Sec. 544.0451.  LEARNING, NEURAL NETWORK, OR OTHER TECHNOLOGY RELATING TO MEDICAID.  (a)  The commission shall:
(1)  use learning, neural network, or other technology to identify and deter Medicaid fraud throughout this state; and
(2)  require each health and human services agency that performs any part of Medicaid to participate in implementing and using the technology.
(b)  The commission shall contract with a private or public entity to develop and implement the technology.  The commission may require the contracted entity to install and operate the technology at locations the commission specifies, including commission offices.
(c)  The commission shall maintain all information necessary to apply the technology to claims data covering a period of at least two years.  The data used for data processing shall be maintained as an independent subset for security purposes.
(d)  The commission shall refer cases the technology identifies to the office of inspector general or the office of the attorney general, as appropriate.
(e)  Each month, the technology must match vital statistics unit death records with Medicaid claims filed by a provider.  If the commission determines that a provider filed a claim for services provided to an individual after the individual's date of death, as determined by the vital statistics unit death records, the commission shall refer the case to the office of inspector general for investigation.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.