Texas § GV.544.0353 - FRAUD AND ABUSE PREVENTION PLAN

§ GV.544.0353. FRAUD AND ABUSE PREVENTION PLAN

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.