State Codes and Statutes
Statutes > Texas > Occupations-code > Title-3-health-professions > Chapter-105-unprofessional-conduct-by-health-care-provider
OCCUPATIONS CODE
TITLE 3. HEALTH PROFESSIONS
SUBTITLE A. PROVISIONS APPLYING TO HEALTH PROFESSIONS GENERALLY
CHAPTER 105. UNPROFESSIONAL CONDUCT BY HEALTH CARE PROVIDER
Sec. 105.001. DEFINITION. In this chapter, "health care
provider" means a person who furnishes services under a license,
certificate, registration, or other authority issued by this
state or another state to diagnose, prevent, alleviate, or cure a
human illness or injury.
Added by Acts 2001, 77th Leg., ch. 1033, Sec. 4, eff. Sept. 1,
2001.
Sec. 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, Sec. 4, eff. Sept. 1,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
836, Sec. 1, eff. September 1, 2005.
State Codes and Statutes
Statutes > Texas > Occupations-code > Title-3-health-professions > Chapter-105-unprofessional-conduct-by-health-care-provider
OCCUPATIONS CODE
TITLE 3. HEALTH PROFESSIONS
SUBTITLE A. PROVISIONS APPLYING TO HEALTH PROFESSIONS GENERALLY
CHAPTER 105. UNPROFESSIONAL CONDUCT BY HEALTH CARE PROVIDER
Sec. 105.001. DEFINITION. In this chapter, "health care
provider" means a person who furnishes services under a license,
certificate, registration, or other authority issued by this
state or another state to diagnose, prevent, alleviate, or cure a
human illness or injury.
Added by Acts 2001, 77th Leg., ch. 1033, Sec. 4, eff. Sept. 1,
2001.
Sec. 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, Sec. 4, eff. Sept. 1,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
836, Sec. 1, eff. September 1, 2005.
State Codes and Statutes
Statutes >
Texas >
Occupations-code >
Title-3-health-professions >
Chapter-105-unprofessional-conduct-by-health-care-provider OCCUPATIONS CODE
TITLE 3. HEALTH PROFESSIONS
SUBTITLE A. PROVISIONS APPLYING TO HEALTH PROFESSIONS GENERALLY
CHAPTER 105. UNPROFESSIONAL CONDUCT BY HEALTH CARE PROVIDER
Sec. 105.001. DEFINITION. In this chapter, "health care
provider" means a person who furnishes services under a license,
certificate, registration, or other authority issued by this
state or another state to diagnose, prevent, alleviate, or cure a
human illness or injury.
Added by Acts 2001, 77th Leg., ch. 1033, Sec. 4, eff. Sept. 1,
2001.
Sec. 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, Sec. 4, eff. Sept. 1,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
836, Sec. 1, eff. September 1, 2005.
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