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Texas Laws | Penal Code
PENAL CODE
TITLE 7. OFFENSES AGAINST PROPERTY

(b) When three or more separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense, and the classification of the offense shall be one category higher than the most serious single offense proven from the separate claims, except that if the most serious offense is a felony of the first degree, the offense is a felony of the first degree. This subsection shall not be applied if claims are aggregated under Subsection (a). (3823)

Added by Acts 1995, 74th Leg., ch. 621, Sec. 1, eff. Sept. 1, 1995. (3824)

Sec. 35.04. JURISDICTION OF ATTORNEY GENERAL. (3825)(Text)

(a) The attorney general may offer to an attorney representing the state in the prosecution of an offense under Section 35.02 the investigative, technical, and litigation assistance of the attorney general's office. (3826)

(b) The attorney general may prosecute or assist in the prosecution of an offense under Section 35.02 on the request of the attorney representing the state described by Subsection (a). (3827)

Added by Acts 1995, 74th Leg., ch. 621, Sec. 1, eff. Sept. 1, 1995. (3828)

CHAPTER 35A. MEDICAID FRAUD (3829)(Text)

Sec. 35A.01. DEFINITIONS. (3830)(Text)

In this chapter: (3831)

(1) "Claim" has the meaning assigned by Section 36.001, Human Resources Code. (3832)

(2) "Fiscal agent" has the meaning assigned by Section 36.001, Human Resources Code. (3833)

(3) "Health care practitioner" has the meaning assigned by Section 36.001, Human Resources Code. (3834)

(4) "Managed care organization" has the meaning assigned by Section 36.001, Human Resources Code. (3835)

(5) "Medicaid program" has the meaning assigned by Section 36.001, Human Resources Code. (3836)

(6) "Medicaid recipient" has the meaning assigned by Section 36.001, Human Resources Code. (3837)

(7) "Physician" has the meaning assigned by Section 36.001, Human Resources Code. (3838)

(8) "Provider" has the meaning assigned by Section 36.001, Human Resources Code. (3839)

(9) "Service" has the meaning assigned by Section 36.001, Human Resources Code. (3840)

(10) "High managerial agent" means a director, officer, or employee who is authorized to act on behalf of a provider and has duties of such responsibility that the conduct of the director, officer, or employee reasonably may be assumed to represent the policy or intent of the provider. (3841)

Added by Acts 2005, 79th Leg., Ch. 806 (S.B. 563), Sec. 16, eff. September 1, 2005. (3842)

Amended by: (3843)

Acts 2011, 82nd Leg., R.S., Ch. 620 (S.B. 688), Sec. 8, eff. September 1, 2011. (3844)

Sec. 35A.02. MEDICAID FRAUD. (3845)(Text)

(a) A person commits an offense if the person: (3846)

(1) knowingly makes or causes to be made a false statement or misrepresentation of a material fact to permit a person to receive a benefit or payment under the Medicaid program that is not authorized or that is greater than the benefit or payment that is authorized; (3847)

(2) knowingly conceals or fails to disclose information that permits a person to receive a benefit or payment under the Medicaid program that is not authorized or that is greater than the benefit or payment that is authorized; (3848)

(3) knowingly applies for and receives a benefit or payment on behalf of another person under the Medicaid program and converts any part of the benefit or payment to a use other than for the benefit of the person on whose behalf it was received; (3849)

(4) knowingly makes, causes to be made, induces, or seeks to induce the making of a false statement or misrepresentation of material fact concerning: (3850)

(A) the conditions or operation of a facility in order that the facility may qualify for certification or recertification required by the Medicaid program, including certification or recertification as: (3851)

(i) a hospital; (3852)

(ii) a nursing facility or skilled nursing facility; (3853)

(iii) a hospice; (3854)

(iv) an intermediate care facility for the mentally retarded; (3855)

(v) an assisted living facility; or (3856)

(vi) a home health agency; or (3857)

(B) information required to be provided by a federal or state law, rule, regulation, or provider agreement pertaining to the Medicaid program; (3858)

(5) except as authorized under the Medicaid program, knowingly pays, charges, solicits, accepts, or receives, in addition to an amount paid under the Medicaid program, a gift, money, a donation, or other consideration as a condition to the provision of a service or product or the continued provision of a service or product if the cost of the service or product is paid for, in whole or in part, under the Medicaid program; (3859)

(6) knowingly presents or causes to be presented a claim for payment under the Medicaid program for a product provided or a service rendered by a person who: (3860)

(A) is not licensed to provide the product or render the service, if a license is required; or (3861)

(B) is not licensed in the manner claimed; (3862)

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