Texas Occupations Code - Section 105.002. Unprofessional Conduct
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§ 105.002. UNPROFESSIONAL CONDUCT. (a) A health care
provider commits unprofessional conduct if the health care
provider, in connection with the provider's professional
activities:
(1) knowingly presents or causes to be presented a
false or fraudulent claim for the payment of a loss under an
insurance policy;
(2) knowingly prepares, makes, or subscribes to any
writing, with intent to present or use the writing, or to allow it
to be presented or used, in support of a false or fraudulent claim
under an insurance policy; or
(3) knowingly directs or requires a patient to obtain
health care goods or services from a niche hospital in which the
health care provider or an immediate family member of the provider
has a financial interest, unless the provider:
(A) discloses to the patient, in writing, that
the provider or the provider's family member has a financial
interest in the niche hospital; and
(B) informs the patient that the patient has the
option of using an alternative health care facility.
(b) In addition to other provisions of civil or criminal
law, commission of unprofessional conduct under Subsection (a)
constitutes cause for the revocation or suspension of a provider's
license, permit, registration, certificate, or other authority or
other disciplinary action.
(c) Subsection (a)(3) does not apply to a financial interest
in publicly available shares of a registered investment company,
such as a mutual fund, that owns publicly traded equity securities
or debt obligations issued by a niche hospital or an entity that
owns the niche hospital.
(d) In this section:
(1) "Diagnosis-related group" means the
classification system mandated by Medicare regulations for
reimbursement purposes that groups patients according to principal
diagnosis, presence of a surgical procedure, age, presence or
absence of significant complications, and other relevant criteria.
(2) "Niche hospital" means a hospital that:
(A) classifies at least two-thirds of the
hospital's Medicare patients or, if data is available, all
patients:
(i) in not more than two major
diagnosis-related groups; or
(ii) in surgical diagnosis-related groups;
(B) specializes in one or more of the following
areas:
(i) cardiac;
(ii) orthopedics;
(iii) surgery; or
(iv) women's health; and
(C) is not:
(i) a public hospital;
(ii) a hospital for which the majority of
inpatient claims are for major diagnosis-related groups relating to
rehabilitation, psychiatry, alcohol and drug treatment, or
children or newborns; or
(iii) a hospital with fewer than 10 claims
per bed per year.
Added by Acts 2001, 77th Leg., ch. 1033, § 4, eff. Sept. 1, 2001.
Amended by Acts 2005, 79th Leg., ch. 836, § 1, eff. Sept. 1,
2005.
Section: 104.002 104.003 104.004 104.005 104.006 104.007 105.001 105.002 106.001 107.001 107.002 107.003 107.051 107.052 107.053
Last modified: August 10, 2007
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