Medicare-Medicaid Anti-Fraud and Abuse Amendments

Summary

Medicare-Medicaid Anti-Fraud and Abuse Amendments - Amends Titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to require that Medicare and Medicaid payments be made directly to the physician or other person providing the service involved. Allows payment in accordance with an assignment from the person or institution providing care or service if such assignment is made to a governmental agency or entity or is established by the order of a court of competent jurisdiction or to an agent of such person or institution if the agency does so pursuant to an agency agreement under which the compensation to be paid to the agency for his services or in connection with the billing or collection of payments due such person or institution under the plan is unrelated to the amount of such payments or the billings thereof, and is not dependent upon the actual collection of any such payment. States that the Secretary of Health, Education, and Welfare shall by regulation (or by contract provision) provide that any entity (other than a public agency) which is a provider or supplier that furnishes or arranges for the furnishing of items or services with respect to which payment is claimed under Title XVIII, Title V (Maternal and Child Welfare), or under Title XIX of the Social Security Act to a party to an agreement with the Secretary under such titles shall promptly comply with any request, specifically addressed to that entity by the Secretary or the Comptroller General of the United States, for information concerning ownership, control, or costs of such entities. Increases the maximum penalty for defrauding the Medicare and Medicaid programs. Authorizes the Comptroller General of the United States to sign and issue subpoenas for the purpose of any audit, investigation, examination, analysis, review, evaluation, or other function authorized by law with respect to any program authorized under this Act. Requires the Secretary to suspend any physician or practitioner from participation in the Medicare or Medicaid programs whenever such individual is convicted of a criminal offense related to their involvement in such programs. Conditions participation in or certification or recertification under the programs established by titles XVIII, XIX, and XX (Grants to States for Services) upon disclosure of the name of any person who: (1) has a direct or indirect ownership or control interest of five percent or more in such provider, institution, organization, or agency; and (2) has been convicted of a criminal offense related to the involvement of such person in any of such programs. Prohibits expenditure under the Medicaid plan to the extent that any agency, organization, or other person (other than a member of the individual's family) would have been obligated by a State law or contract to provide such care or services but for a provision of the State law or contract which limits or excludes such obligation because the individual is eligible for or receives care or services under the plan.

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Documents

2 official files

• Indefinitely postponed in Senate

  summary · EN · 30 September 1977

  Open at official source

• Introduced in Senate

  summary · EN · 11 January 1977

  Open at official source

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