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[show]Texas False Claims: Supplemental Medicaid Provision (Information and Rewards)
(The Secret Weapon Used to Fight Waste, Abuse and Fraud Against The State of Texas)
The Texas Medicaid Fraud Prevention Act (TMFPA) is the state's version of the False Claims Act. It lets an insider file a qui tam lawsuit over fraud against Texas Medicaid and collect 15 to 30 percent of what the state recovers. It covers Texas Medicaid only, the seal runs 180 days instead of 60, and it carries extra penalties when the fraud harms the elderly, the disabled, or children. Call (888) 713-6653 for a free, confidential review.
The Federal False Claims Act applies to any company or individual who receives payments from the US Government. These payments can be for services, products or devices.
Since the law has been such a success at combating fraud nationally, States have also adopted their own versions to protect public funds.
Texas put false claim laws into place in 1995 modeled after that Federal False Claim Act. In Texas these laws apply directly to the State’s Medicaid programs only.
The State’s Medicaid programs are designed to help lower income families and individuals afford healthcare, medical devices and prescriptions drugs.
The Texas Medicaid Fraud Prevention Act (TMFPA) allows Texans to take action against those individuals or companies making false claims for payment under Texas’s Medicaid program.
Understanding TMFPA before coming forward with a qui tam action on behalf of the State of Texas it is important.
Knowledge of the Federal FCA, Texas’s differences, the benefits/protections provided to people who expose fraud, and how the TMFPA Act works will strengthen your claims.
"More than $78 billion has been recovered under the False Claims Act since the 1986 amendments, including over $2.9 billion in fiscal year 2024 alone."
Have Knowledge of Fraud?
Keep reading to learn how people are rewarded for whistleblowing to help fight fraud.
Understanding the Federal False Claims Act (Quick Review)
Texas’s False Claim Act is limited compared to the Federal version. The following is a brief review of the Federal FCA that summarizes what you need to know before looking at the differences. (Go here to read the Lawsuit Legal guide to the Federal False Claims Act)
- The Federal False Claims Act provides comprehensive protection and rewards for relators.
- Federal FCA has a qui-tam section allowing whistleblowers to bring lawsuits against persons or entities knowingly defrauding the Government.
- Penalties for defendants are trebled (3 times) the amount of damages to the Government. Federal civil penalties run from $14,308 to $28,619 per claim, an amount the Department of Justice adjusts for inflation each year.
- Plaintiffs who file a lawsuit properly and first can expect 15%-30% of the recovered funds
The success of the Federal False Claims Act prompted the State of Texas to enact its own version in 1995. There is a major difference between the Federal and Texas versions of this important whistleblower law…
TMFPA vs. Federal FCA (1 Major Difference)
If you are wondering what is different about the False Claims Act in Texas, it can be summarized with one major difference. Texas whistleblowers can only file a qui tam lawsuit for fraud committed against Texas’s State Medicaid programs.
The Federal Act allows for broader prosecution of fraudulent actions committed against any Government program. For example, Medicare fraud, Tax Fraud and Government Contracts.
While this is the most obvious difference, Texas has also added some unique provisions that further differentiate it from the Federal statute.
Specific Differences (FCA vs TMFPA)
Larger Penalties for Injury
The TMFPA imposes a civil penalty for each unlawful act, and Texas ties its base per-claim penalty to the federal civil penalty range that the Department of Justice adjusts for inflation each year. On top of that, Texas adds an enhanced penalty of $5,000 to $15,000 per violation for fraud that injures the elderly, the disabled, or minors.
Time for Sealed qui tam records
FCA qui tam complaints remain sealed for 60 days. Texas seals the records for 180 days. In either case however prosecutors can extend the seal if they have good cause to do so.
Available Remedies
Damages are not a part of TMFPA claims. Texas is not obligated to prove payments or benefits received through fraudulent actions are an overpayment or are damages. Defendants are liable to the State for double (2x) the entire amount received.
Unlike the FCA, the TMFPA is geared specifically toward fighting Medicaid fraud in Texas.
While this is different both Acts do share similarities. Learn how to become a whistleblower here. An insider is encouraged to review what they know with their attorney who will be able to determine if their case has merit under the State or Federal False Claims Act and how to proceed.
The Texas FCA Similarities to the Federal Law
An important part of all false claim laws are it’s qui tam provisions. Both Texas and the Federal government have similar protections and rewards for individuals who report Medicaid violations.
Are Texas Medicaid Whistleblowers Protected?
Yes.
Texas has a Whistleblower Protection Act. Employees, contractors and agents who are terminated, suspended, threatened, transferred, demoted, harassed or discriminated against are entitled to:
- Two times (2x) back pay
- Full reinstatement to previous position
- Compensation of special damages including attorney’s fees and case costs resulting from discrimination
- Interest for backpay
Attorney Tip: These protections exist but the time to report is short. Also, employer retaliation must be proven. There must be a link between the employer’s retaliation and the reporting of Medicaid violations. You can read more on how to prove whistleblower retaliation here.
Relators are protected under both the Federal and Texas false claims acts. The rewards are similar as well.
Do you have knowledge of fraud to report?
Review what you know with an attorney who will help determine if your case has legal merit and if so, how to proceed safely! You may be eligible for a significant financial bounty by coming forward.
Do Texas Medicaid Whistleblowers Receive Rewards for Reporting Fraud?
Yes. The amount is based on the total recovered by the State and how the case was pursued.
If the Texas Attorney General’s office intervenes on your behalf, relators are entitled up to 15%-25% of the recovered sum.
Sometimes the State declines and does not join the case on your behalf. Just like the Federal FCA, you and your legal representation are allowed to pursue the case on your own.
A successful self-fought case will allow for two additional benefits:
- Increased rewards. 25%-30% of the recovered sum is awarded.
- Reimbursement of legal expenses. You will receive repayment for reasonable attorney’s fees and other costs approved by the court.
Attorney Tip: While you receive a lesser percentage of rewards when the Texas Attorney General’s office intervenes, it is a good thing. This means your case is strong and you now have the assistance of the Texas Government. Settlements are higher in these cases.
Texas also has an award for just reporting and not pursuing legal action under the TMFPA.
An individual whose reporting leads directly to the recovery of funds gained through Medicaid fraud can receive up to 5% of the administrative penalty. The State commission will determine the value of the reporting and if it leads directly to the recovery of funds.
Individuals not wanting to get caught up in legal actions can report Medicaid violations anonymously.
The TMFPA had these two provisions (protections & rewards) as part of the original Act. One that was recently changed was the time available to file a qui tam action in the State of Texas.
Litigation involving fraud against government programs can be very complex. In Texas, Medicaid whistleblowers who expose waste and abuse are a key component of rooting out corruption and protecting taxpayer resources.
Is There a Statute of limitations for Qui Tam Claims in Texas?
Yes, there is now, and it is exactly the same as the Federal False Claims Act.
Prior to 2013 there was no time limit to file a claim for Texas Medicaid fraud. In September 2013 the Act was amended to follow FCA rules.
The statute of limitations on false claims can be confusing. This is because the time to file is based on when actions happened or when they became known and not on a specific time frame.
Qui tam actions must be filed:
- within 6 year of the unlawful act (alleged false claim) or...
- within 3 years of when facts about the case should have been known or...
- Within a maximum time limit of 10 years of the purported false claim - whichever transpired last
Attorney Tip: Don’t wait and don’t try to it figure out. Waiting to file only devalues your claims. Assuming you figured it out can also result in case dismissal and a loss of evidence. Consult with a qualified qui tam attorney to protect your rights and increase your rewards for free.
Texas applying time limits to Medicaid qui tam claims is a good thing. This pushes individuals to report faster and helps avoid increased financial damages to the State.
Can anyone file a Medicaid Claim in Texas?
Yes, anyone can file but the assistance of an attorney is recommended.
In Texas, public employees can also file and are protected under the Texas Whistleblower Act. [1]
The protection public employees are provided is similar to those of the general public.
- Injunctive relief
- Full reinstatement to previous position
- Compensation for lost wages
- Recovery of benefits and rights
- Damages
- Attorney’s fees and court costs
Those caught-up in Medicaid fraud and participated can also report. Individuals who participate willingly in defrauding the State can still receive rewards.
The State will determine an employee’s level of involvement verse the information provided. In most cases they will receive a reduced award since they were culpable.
In any case properly filing is important. Information presented to the government under oath will become evidence that the Attorney General can pursue.
They can also compel you to file and present additional evidence. Having an attorney to properly file and represent you is essential.
Reporting Fraud & Misconduct
While the Texas statute addresses Medicaid fraud specifically - if government money is involved and an individual has insider knowledge of misconduct report it to an attorney. Texas companies which are actively defrauding State or Federal government programs are violating the law.
Whether a State program or Federal, help bring the fraudsters to account.
Your legal representation will be able to review the details and help suss out if indeed the law is being violated and how to protect oneself.
Texas TMFPA vs. Federal FCA at a Glance
| Texas (TMFPA) | Federal FCA | |
|---|---|---|
| Scope | Texas Medicaid fraud only | Fraud against any federal program |
| Seal period | 180 days | 60 days |
| Damages | Double the amount received | Treble (3x) damages |
| Enhanced penalty | Extra $5,000 to $15,000 per violation when victims are elderly, disabled, or minors | Per-claim civil penalty of $14,308 to $28,619 |
| Relator share | 15-25% if the state intervenes, 25-30% if it declines | 15-25% if the government intervenes, 25-30% if it declines |
| Deadline | 6 years, or 3 years after the facts are known, max 10 years (matches federal since 2013) | 6 years, or 3 years after the facts are known, max 10 years |
Other states have their own versions too. More than 30 states and the District of Columbia have enacted False Claims Acts, including Florida.
TMFPA Lawsuit Process in Texas
Where do you file cases under the TMFPA?
- State False Claim Actions are filed in the Court of Travis County
What is the process of claims in Texas?
- Once a qui-tam action is filed in district court an official copy of the complaint will be sent to the Texas Attorney General.
- The Attorney General’s Office will decide whether to intervene on behalf of the State (or not). This should occur within 180 days after they receive the material evidence and information. They can request additional time if needed.
Texas aggressively pursues fraudulent Medicaid actions. Since 2000 the Texas Medicaid Fraud Prevention Act (Texas False Claims) has helped recover more than $2 billion in State funds.
Recently recovering over $235 million from the Xerox Corporation, Conduent Inc and other parties for fraudulent actions against Texas’s Medicaid program. [7]
A relator in this case could have received up to 25% of this recovery if the evidence they provided leads to financial recovery.
Texas False Claims Act FAQ
- Q: What is the Texas False Claims Act?
-
A: It is the Texas Medicaid Fraud Prevention Act (TMFPA), the state's version of the False Claims Act. It lets a private citizen file a qui tam lawsuit on behalf of Texas against anyone who defrauds the state Medicaid program, and rewards that whistleblower with a share of the recovery.
- Q: How is the TMFPA different from the federal False Claims Act?
-
A: The biggest difference is scope: the TMFPA covers Texas Medicaid fraud only, while the federal FCA covers fraud against any federal program. Texas also seals qui tam complaints for 180 days instead of 60, holds defendants liable for double the amount received, and adds enhanced penalties when the fraud harms the elderly, disabled, or minors.
- Q: What reward can a Texas whistleblower get?
-
A: If the Texas Attorney General intervenes, 15 to 25 percent of what the state recovers. If the state declines and you pursue it yourself, 25 to 30 percent plus reimbursement of reasonable attorney's fees and costs. Texas also offers a smaller award (up to 5 percent of the penalty) for simply reporting.
- Q: How long do I have to file in Texas?
-
A: Since a 2013 amendment, the TMFPA follows the federal deadlines: within 6 years of the violation, or within 3 years of when the facts should have been known, but never more than 10 years after the violation. Filing first and filing early both matter, so do not wait.
- Q: Are Texas whistleblowers protected from retaliation?
-
A: Yes. Employees, contractors, and agents who are fired, demoted, suspended, harassed, or otherwise retaliated against are entitled to reinstatement, double back pay with interest, and special damages including attorney's fees. Public employees are separately protected under the Texas Whistleblower Act.
State Encouragement to Do What's Right
The power of qui-tam actions brought through the TMFPA has benefited the State of Texas and relators greatly.
Whistleblowers are provided a civil path to redress false claims, are rewarded for disclosing fraud, and in so doing help the State fight Medicaid abuses and related waste to the taxpayers.
An honest and straightforward Texas False Claims Act attorney will be the first to tell you that qui tam litigation has risks and potential rewards.
While insiders who blow the whistle are protected and incentivized under the Texas Law it's highly recommended potential relators seek counsel before taking action for help with what can quickly become a complex legal situation.
Lawsuit Legal handles Texas Medicaid fraud cases the way they have to be handled: filed first, filed under seal, and built to prove. We know the Travis County process, the 180-day seal, and how the Attorney General decides whether to intervene. We work on contingency. You Win or It's Free. Call (888) 713-6653 for a free, confidential review. We help the nurses, billers, coders, and administrators inside Texas healthcare who saw the fraud and decided to stop it.
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