Texas Medicaid Fraud and Prevention Act (“TMFPA”)

In 1995, the Texas Legislature passed the Texas Medicaid Fraud Prevention Act (“TMFPA”). Whereas the FCA involves many categories of fraud, the TMFPA only involves the Texas Medicaid Program. Whistleblowers who have knowledge of unlawful acts in violation of the TMFPA are entitled to bring an action pursuant to the TMFPA.

Under the TMFPA, Petitions initially remain sealed for 180 days (this time period is extended in most every case), as opposed to 60 days under the FCA, in order for the State of Texas to decide if it wants to intervene in the case. If it does so, the Whistleblower/Relator is entitled to 15-25% of the recovery by the government, plus attorneys’ fees, expenses and costs.

Similar to the FCA, however, in the event the Government declines to intervene in the case (which is most often the case), the TMFPA contains a provision that allows private individuals who have knowledge about fraud involving the Texas Medicaid Program to bring an action on behalf of the State of Texas for violations of the TMFPA. In the event of a recovery, the Whistleblower is entitled to 25-30% of the recovery, plus attorneys’ fees, expenses and costs.

Comparison of the TMFPA and FCA

For each Unlawful Act in violation of the TMFPA, the state is entitled to receive (a) the amount of the Medicaid benefit improperly obtained, (b) civil penalties in the amount of two times the amount of the claims per Chapter 36.052(a)(4); and (c) civil penalties of $5,500-$11,000 per Unlawful Act as set forth in Chapter 36.052(a)(3) until July 31, 2016, and for the time period August 1, 2016 until present the civil penalties are $10,781.40 to $21,562.80 per Unlawful Act. Unlike the FCA, the majority of Unlawful Acts set forth in the TMFPA do not require that a false claim be submitted to Medicaid, as only 2 of the 13 Unlawful Acts set forth below require the presentment of any claim. Instead, the TMFPA prohibits Unlawful Acts involving the Medicaid program. Unlike the FCA, damages are not required to be shown to recover for an Unlawful Act in violation of the TMFPA.

Do You Have Knowledge of Medicaid Fraud by Your Employer or Others?

Do you suspect your employer is participating in a scheme to profit financially from Texas Medicaid? Do you have original first-hand knowledge that a person or company is committing Medicaid Fraud? The TMFPA provides whistleblowers with powerful protections and potentially large cash rewards for reporting information. You may be eligible for a significant cash award as Whistleblowers who report fraud are entitled to 15-30% of the government’s recovery, plus attorneys’ fees and expenses. Contact Attorney Rusty Tucker at 214-617-2181 or contact us today for a free case evaluation.

TMFPA Unlawful Acts

There are 13 enumerated Unlawful Acts set forth in Chapter 36 the TMFPA, the first being a person making a false statement in order to receive a benefit from the Texas Medicaid program to which they are not entitled.  All 13 of these Unlawful Acts are set forth in the statute in full as follows: https://statutes.capitol.texas.gov/Docs/HR/htm/HR.36.htm

Blow the Whistle on TMFPA Fraud

Individuals with knowledge of TMFPA fraud committed by employers, healthcare facilities, dentists, government contractors, pharmaceutical companies, and others may be able to blow the whistle on the fraud using the TMFPA. Whistleblowers play a critical role in bringing this fraud to light and holding wrongdoers accountable when they try to cheat the system.

To talk with me about your TMFPA case, call my Dallas law offices at 214-617-2181 or contact me online. Consultations with a Dallas County Qui Tam attorney are free and confidential. I handle these types of cases on a contingent fee basis, meaning you owe me no legal fees or expenses unless I obtain a recovery for you.