Section 544.0353 - [Effective 4/1/2025] 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. (Gov. Code, Sec. 531.113(b).)Tex. Gov't. Code § 544.0353
Added by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 769,Sec. 1.01, eff. 4/1/2025.