Sec. 531.106. LEARNING OR NEURAL NETWORK TECHNOLOGY. (a) The commission shall use learning or neural network technology to identify and deter fraud in Medicaid throughout this state.
(b) The commission shall contract with a private or public entity to develop and implement the technology. The commission may require the entity it contracts with to install and operate the technology at locations specified by the commission, including commission offices.
(c) The data used for neural network processing shall be maintained as an independent subset for security purposes.
(d) The commission shall require each health and human services agency that performs any aspect of Medicaid to participate in the implementation and use of the technology.
(e) The commission shall maintain all information necessary to apply the technology to claims data covering a period of at least two years.
(f) The commission shall refer cases identified by the technology to the commission's office of inspector general or the office of the attorney general, as appropriate.
(g) Each month, the learning or neural network technology implemented under this section must match vital statistics unit death records with Medicaid claims filed by a provider. If the commission determines that a provider has filed a claim for services provided to a person after the person's date of death, as determined by the vital statistics unit death records, the commission shall refer the case for investigation to the commission's office of inspector general.
Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.06(a), eff. June 20, 1997. Amended by Acts 1999, 76th Leg., ch. 215, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.140, eff. April 2, 2015.
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