Health Care Anti-Fraud Act of 1995

Summary

TABLE OF CONTENTS: Title I: Fraud and Abuse Control Program Title II: Revisions to Current Sanctions for Fraud and Abuse Title III: Administrative and Miscellaneous Provisions Title IV: Monetary Penalties Title V: Amendments to Anti-Kickback Law Title VI: Amendments to the Physicians Self-Referral Law Title VII: Medicare Billing Abuse Prevention Health Care Anti-Fraud Act of 1995 - Title I: Fraud and Abuse Control Program - Directs the Attorney General to establish a national health care fraud task force to: (1) pursue civil and criminal actions for health care fraud and abuse; and (2) coordinate Federal law enforcement efforts toward controlling such fraud and abuse. (Sec. 103) Requires the Secretary of Health and Human Services (HHS) and the Attorney General to establish a fraud and abuse control program for coordinating Federal, State, and local efforts towards controlling such fraud and abuse. (Sec. 104) Amends title XI of the Social Security Act (SSA) to authorize the Secretary to identify opportunities to satisfy any community service obligations imposed by a court for a health care fraud and abuse conviction. (Sec. 105) Outlines provisions for the solicitation and publication of modifications to existing safe harbors and new safe harbors. Provides for advisory opinions by the Secretary under SSA title XI. Details provisions for special fraud alerts by the HHS Inspector General with regard to possible fraudulent health care practices. Title II: Revisions to Current Sanctions for Fraud and Abuse - Revises current sanctions under SSA titles XI and XVIII (Medicare) for health care fraud and abuse, with changes providing for: (1) mandatory exclusion from participation in Medicare and State health care programs for an individual convicted of a felony relating to health care fraud or to a controlled substance; (2) establishment of a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from such programs; (3) permissive exclusion of individuals with ownership or control interest in sanctioned entities; (4) changes involving Medicare health maintenance organization intermediate sanctions; and (5) repeal of the "unwilling or unable" condition for imposition of certain sanctions. Title III: Administrative and Miscellaneous Provisions - Directs the Secretary to establish a national health care fraud and abuse data collection program for reporting final adverse health care actions. Outlines the mechanism for Government agency and health plan reporting of final health care adverse actions to the task force above. Title IV: Monetary Penalties - Modifies criminal and civil monetary penalty provisions under SSA title XI, increasing the sanctions for various specified offenses. Title V: Amendments To Anti-Kickback Law - Makes various specified technical amendments to anti-kickback provisions under SSA title XI, among other changes specifying additions to the anti-kickback exceptions. Title VI: Amendments to Physician Self-Referral Law - Amends SSA title XVIII with respect to the prohibition on certain physician referrals to remove compensation arrangements from the proscribed financial arrangements between a physician and any entity to which he or she may refer a Medicare beneficiary (thus limiting proscribed financial arrangements to an ownership or investment interest in the entity). Title VII: Medicare Billing Abuse Prevention - Directs the Secretary to require Medicare carriers to acquire commercial automatic data processing equipment meeting certain minimum requirements to process Medicare part B (Supplementary Medical Insurance) claims in order to identify intentional billing code abuse. Prohibits the Secretary from implementing such a system to detect improper billing for items and services under Medicare resulting from the improper unbundling of items and services. Provides for a review and modification of Medicare payment regulations as appropriate.

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3 official files

• Introduced in House (text)

  Introduced in House · EN · 27 September 1995

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• Introduced in House (PDF)

  Introduced in House · EN · 27 September 1995

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• Introduced in House

  summary · EN · 27 September 1995

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