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Bill

HB 3984

Relating to the review of claims and recovery of overpayments by Medicaid recovery audit contractors.

89th Legislature (2025) Introduced by Tom Oliverson

HB 3984 establishes procedures for Texas Medicaid recovery audit contractors to review claims and recover overpayments, creating dispute resolution and provider protections.

Referred to Health & Human Services
#audits&auditors(s4334) #health&humanservicescommission(v0177) #humanservices--medicalassistance(i0905) #managedcare(s0454) #medicaid(s4885)
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Bill Summary · HB 3984

Legislative bill overview

HB 3984 establishes procedures for how Medicaid recovery audit contractors (RACs) in Texas review claims and recover overpayments from healthcare providers. The bill creates a framework governing the claims review process, dispute resolution mechanisms, and conditions under which overpayments can be reclaimed.

Why is this important

Recovery audit contractors play a significant role in identifying and reclaiming improper Medicaid payments, which affects both program finances and healthcare provider operations. Clear statutory procedures can reduce disputes between providers and RACs, provide providers with due process protections, and establish consistency in how overpayment claims are handled across the state.

Potential points of contention

  • Provider burden and costs: Overpayment recovery demands can create substantial administrative and financial strain on healthcare providers, particularly smaller practices, and the bill's review procedures may be seen as either insufficiently protective or overly burdensome depending on perspective
  • Balance of enforcement authority: Defining RAC power to demand repayment versus provider rights to challenge findings involves tension between program integrity (preventing fraud/waste) and fairness to providers who may dispute audit conclusions
  • Timeline and appeals process: The specific procedures for claim review, notice periods, and appeal opportunities will determine whether providers have meaningful opportunity to respond or face rapid, difficult-to-challenge demands

Compiled from official sources — confirm details with the bill’s official record.

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