Trial De Novo Gone: SB 1803 Changed Before Going Before House

Texas CapitolThe bill that was to enshrine due process rights for Medicaid providers now heads for a House vote and bears less resemblance to the bill that entered the House.

SB 1803, now CSSB 1803, while having many good points remaining, has been firmly changed to eliminate key due process points for Medicaid providers dealing with “credible allegations of fraud” overpayments by the HHSC’s Office of the Inspector General.

In fact, while clarifying the procedure for placing and removing payment holds and dealing with overpayments, the bill now expressly denies any appeal on SOAH overpayment hearings to a district court. It does not even any longer mention trial de novo. A provider has a choice on overpayment, if that overpayment is deemed to be over $1 million – he takes it to SOAH or a district court. There is no appeal from either. For an overpayment amount, under $1 million, the provider can choose SOAH or the appeals division of HHSC. It doesn’t mention a further appeal on these options. Informal resolution remains an option as well.

An interesting addition to the bill is to expressly provide employees of HHSC/OIG with whistleblower protection under Texas Government Code 554.

The above points are not meant to represent a legal analysis. The legislation as currently proposed can be read from the link above. There is also an analysis on the Capitol website.

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