Texas Medicaid Fraud Decision Leaves 2 Open Questions

This article examines a Texas Supreme Court decision holding that claims based on omissions under the Texas Medicaid Fraud Prevention Act require proof that the withheld information was material to the government’s payment decision. The authors identify two major unresolved questions: whether the materiality requirement will extend to other “unlawful acts” under the TMFPA, and whether the decision signals that Texas courts will increasingly rely on federal FCA precedent when interpreting the state law. That second issue could have significant implications for pending Texas cases involving pharmaceutical manufacturer-funded patient support programs and alleged violations of the Texas Anti-Kickback Statute, including claims that were previously dismissed in federal court before being refiled in Texas state court.