Texas False Claims Act – Qui Tam Whistleblower

The state of Texas passed the Texas False Claims Act in 1995. It also passed the Texas Medical Fraud Prevention Act (TMFPA). These laws provide recourse for the Texas government after fraud or loss in the Texas Medicaid Program. Fraud in the program costs the taxpayers of Texas millions per year.  The Texas Medicaid Program provides prescription drug coverage and health care to low-income Texans.

The Texas False Claims Act provides protections and rewards for whistleblowers to report Texas Medicaid fraud. Filing a claim on behalf of the Texas government is known as a qui tam lawsuit.

Texas False Claims Act

The Texas False Claims Act and the Texas Medicaid False Claims Act allows individuals to bring a case on behalf of the state government to recover from Medicaid fraud. The whistleblower proceeds with a claim on behalf of the state. As encouragement for reporting wrongdoing, the whistleblower is eligible to receive part of the judgement or settlement. Another name for the whistleblower is the “relator”. A relator need not have all the evidence needed to prove a claim. An investigation can uncover new evidence or witnesses once a claim is made.

Texas Medicaid fraud whistleblower cases are filed under seal.

Texas False Claim Act Penalties

The combined Texas laws allow for penalties of $5,500 to $15,000 per violation that results in injuries to the elderly, disabled, or minors. Additionally, those who violate the law are subject to penalties of two times the damage. For example, if a physician overcharged Texas Medicaid by $300,000 through three separate actions, the total penalties could be up to $645,000.

Physicians, hospitals, and drug companies are all entities that have had qui tam lawsuits against them for overcharging or mischarging the State of Texas. An example in 2014, the State of Texas reached a nearly $20 million settlement with Taro Pharmaceuticals for inflating prices in reports to Medicaid.

I Have a Texas False Claims Act Claim

If you believe you have knowledge of a wrongdoing affecting the Medicaid system of Texas, contact the experienced whistleblower qui tam lawyers of Schneider Wallace. An experienced attorney can review your claim to determine and assist with proceeding with a Texas qui tam lawsuit.

Texas provides protections against retaliation for whistleblowers under their statute. Contact the lawyers of Schneider Wallace at 1-800-689-0024 or info@schneiderwallace.com.

Texas False Claim Act Rewards

Texas whistleblower rewards can be up to 30 percent of the recovery. This reward is to recognize the efforts of the whistleblower to assist the government in a recovery, and to encourage those with knowledge of wrongdoing to step forward and report Medicaid fraud.

Schneider Wallace works on a contingency fee, so whistleblowers do not need to spend their own money to hire a qui tam lawyer. Schneider Wallace only recovers fees and costs if they secure a whistleblower reward for a client. Schneider Wallace maintains a Houston Texas office and can represent Texas whistleblowers.

Texas False Claim Act Rules

Texas law establishes these liabilities:

Sec. 36.002. UNLAWFUL ACTS.
Sec. 36.002.  UNLAWFUL ACTS.  A person commits an unlawful act if the person:

    (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;

    (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;

    (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;

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

                      (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:

                                                       (i)  a hospital;

                                                       (ii)  a nursing facility or skilled nursing facility;

                                                       (iii)  a hospice;

                                                       (iv)  an ICF-IID;

                                                       (v)  an assisted living facility; or

                                                       (vi)  a home health agency; or

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

    (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;

    (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:

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

                                     (B)  is not licensed in the manner claimed;

    (7)  knowingly makes or causes to be made a claim under the Medicaid program for:

                      (A)  a service or product that has not been approved or acquiesced in by a treating physician or health care practitioner;

                      (B)  a service or product that is substantially inadequate or inappropriate when compared to generally recognized standards within the particular discipline or within the health care industry; or

                      (C)  a product that has been adulterated, debased, mislabeled, or that is otherwise inappropriate;

    (8)  makes a claim under the Medicaid program and knowingly fails to indicate the type of license and the identification number of the licensed health care provider who actually provided the service;

    (9)  conspires to commit a violation of Subdivision (1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (12), or (13);

    (10)  is a managed care organization that contracts with the commission or other state agency to provide or arrange to provide health care benefits or services to individuals eligible under the Medicaid program and knowingly:

                      (A)  fails to provide to an individual a health care benefit or service that the organization is required to provide under the contract;

                      (B)  fails to provide to the commission or appropriate state agency information required to be provided by law, commission or agency rule, or contractual provision; or

                      (C)  engages in a fraudulent activity in connection with the enrollment of an individual eligible under the Medicaid program in the organization’s managed care plan or in connection with marketing the organization’s services to an individual eligible under the Medicaid program;

    (11)  knowingly obstructs an investigation by the attorney general of an alleged unlawful act under this section;

    (12)  knowingly makes, uses, or causes the making or use of a false record or statement material to an obligation to pay or transmit money or property to this state under the Medicaid program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to this state under the Medicaid program; or

    (13)  knowingly engages in conduct that constitutes a violation under Section 32.039(b).

Texas’s establishes these rights and awards to qui tam lawsuits:

Sec. 36.110. AWARD TO PLAINTIFF.
Sec. 36.110.  AWARD TO PRIVATE PLAINTIFF.

(a)  If the state proceeds with an action under this subchapter, the person bringing the action is entitled, except as provided by Subsection (b), to receive at least 15 percent but not more than 25 percent of the proceeds of the action, depending on the extent to which the person substantially contributed to the prosecution of the action.

(a-1)  If the state does not proceed with an action under this subchapter, the person bringing the action is entitled, except as provided by Subsection (b), to receive at least 25 percent but not more than 30 percent of the proceeds of the action.  The entitlement of a person under this subsection is not affected by any subsequent intervention in the action by the state in accordance with Section 36.104(b-1).

(b)  If the court finds that the action is based primarily on disclosures of specific information, other than information provided by the person bringing the action, relating to allegations or transactions in a Texas or federal criminal or civil hearing, in a Texas or federal legislative or administrative report, hearing, audit, or investigation, or from the news media, the court may award the amount the court considers appropriate but not more than 10 percent of the proceeds of the action.  The court shall consider the significance of the information and the role of the person bringing the action in advancing the case to litigation.

(c)  A payment to a person under this section shall be made from the proceeds of the action.  A person receiving a payment under this section is also entitled to receive from the defendant an amount for reasonable expenses, reasonable attorney’s fees, and costs that the court finds to have been necessarily incurred.  The court’s determination of expenses, fees, and costs to be awarded under this subsection shall be made only after the defendant has been found liable in the action or the claim is settled.

(d)  In this section, “proceeds of the action” includes proceeds of a settlement of the action.

Texas False Claims Act Statute of Limitations

The Texas False Claims Act and Texas Medical Fraud Prevention Act allows for claims up to six years from the time of the act. Any claim made for actions more than six years in the past would be beyond the statute of limitations.

A company or person may commit multiple violations. If a company is incorrectly billing the government for over a decade, the violations that have occurred within the last six years can still be subject to a claim.

Texas False Claim Lawyer

Schneider Wallace represents Texas whistleblowers. Schedule a consult with our false claim lawyers for a free and confidential consultation. Contact us at 1-800-689-0024 or info@schneiderwallace.com.

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