{"data":{"id":"us-tx/tex.-government-code-544.0353","jurisdiction":"us-tx","citation":"Tex. Government Code § 544.0353","heading":"FRAUD AND ABUSE PREVENTION PLAN.","body":"(a) A managed care organization to which this subchapter applies shall:\n(1) adopt a plan to prevent and reduce fraud and abuse; and\n(2) annually file the plan with the office of inspector general for approval.\n(b) The plan must include:\n(1) a description of the organization's procedures for:\n(A) detecting and investigating possible acts of fraud or abuse;\n(B) mandatory reporting of possible acts of fraud or abuse to the office of inspector general; and\n(C) educating and training personnel to prevent fraud and abuse;\n(2) the name, address, telephone number, and fax number of the individual responsible for carrying out the plan;\n(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;\n(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\n(5) provisions for maintaining the confidentiality of any patient information relevant to a fraud or abuse investigation.\nAdded by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.","path":["GOVERNMENT CODE","TITLE 4. EXECUTIVE BRANCH","SUBTITLE I. HEALTH AND HUMAN SERVICES","CHAPTER 544. FRAUD, WASTE, ABUSE, AND OVERCHARGES RELATING TO HEALTH AND HUMAN SERVICES","SUBCHAPTER H. MANAGED CARE ORGANIZATION PREVENTION AND INVESTIGATION OF FRAUD AND ABUSE"],"source_url":"https://statutes.capitol.texas.gov/Docs/GV/htm/GV.544.htm#544.0353","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:16Z","sha256":"576928a9e98ab3d2647d70c3d4cc4d334a5c9016a0c94516748652f7569e7de9","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-government-code-544.0352","next":"us-tx/tex.-government-code-544.0354"},"notice":"GroundRules: Original legal text. Not legal advice."}