Texas § GV.540.0058 - INFORMATION FOR FRAUD CONTROL

§ GV.540.0058. INFORMATION FOR FRAUD CONTROL

INFORMATION FOR FRAUD CONTROL. (a) Each Medicaid managed care organization shall submit at no cost to the commission and, on request, the office of the attorney general: (1) a description of any financial or other business relationship between the organization and any subcontractor providing health care services under the contract between the organization and the commission; (2) a copy of each type of contract between the organization and a subcontractor relating to the delivery of or payment for health care services; (3) a description of the fraud control program any subcontractor that delivers health care services uses; and (4) a description and breakdown of all funds paid to or by the organization, including a health maintenance organization, primary care case management provider, pharmacy benefit manager, and exclusive provider organization, necessary for the commission to determine the actual cost of administering the Medicaid managed care plan. (b) The information under this section must be: (1) submitted in the form the commission or the office of the attorney general, as applicable, requires; and (2) updated as the commission or the office of the attorney general, as applicable, requires. (c) The commission's office of inspector general or the office of the attorney general, as applicable, shall review the information a Medicaid managed care organization submits under this section as appropriate in investigating fraud in the Medicaid managed care program. (d) Information a Medicaid managed care organization submits to the commission or the office of the attorney general under Subsection (a)(1) is confidential and not subject to disclosure under Chapter 552 . Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.