Medicare Antifraud Act of 1996

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: Civil Monetary Penalties Title V: Amendments to Criminal Law Title VI: State Health Care Fraud Control Units Title VII: Medicare-Medicaid Billing Abuse Prevention Medicare Antifraud Act of 1996 - Title I: Fraud and Abuse Control Program - Amends title XI of the Social Security Act (SSA) to direct the Secretary of Health and Human Services (HHS) and the Attorney General to establish: (1) an all-payer fraud and abuse control program that provides, among other things, for the reporting and disclosure of certain final adverse actions against health care providers, suppliers, or practitioners pursuant to the data collection system established by this Act; and (2) guidelines, including information guidelines, to carry out such program. (Sec. 101) Amends SSA title XVIII (Medicare) to establish in the Federal Hospital Insurance Trust Fund the Health Care Fraud and Abuse Control Account, which shall consist in part of criminal fines recovered in cases involving a Federal health care offense, in order to fund both the all-payer fraud and abuse control program and the Medicare Benefit Integrity System. Makes appropriations for such Account. (Sec. 102) Establishes under Medicare part C (Miscellaneous Provisions) a new Medicare Benefit Integrity System in order to: (1) improve the effectiveness of Medicare benefit quality assurance activities; and (2) enhance the HHS Secretary's capability to carry out Medicare program safeguard functions and related education activities to avoid the improper expenditure of assets in the Medicare trust funds. (Sec. 103) Applies specified Medicare and State health care anti-fraud and abuse provisions of part A (General Provisions) of SSA title XI to all Federal health programs. (Sec. 104) Directs the HHS Secretary annually to solicit proposals for modifications to existing safe harbors and for additional safe harbors, according to certain criteria, for payment practices. Permits any person, at any time, to request a notice from the HHS Inspector General (IG) which informs the public of practices which the IG considers to be suspect or of particular concern (special fraud alerts), as well as interpretive rulings with regard to the application of certain anti-fraud and abuse provisions under SSA title XI. (Sec. 105) Directs the HHS Secretary to establish the Medicare-Medicaid Beneficiary Protection Program, among other things, for educating Medicare and Medicaid beneficiaries regarding Medicare and Medicaid program coverage and how to protect themselves against certain fraudulent and abusive practices with respect to the delivery of health care items and services. (Sec. 106) Sets forth measures for the HHS Secretary and the Attorney General to ensure the integrity of the Federal Hospital Insurance Trust Fund. Title II: Revisions to Current Sanctions for Fraud and Abuse - Amends SSA titles XI and XVIII (Medicare) to provide for: (1) the mandatory exclusion from participation in Medicare and State health care programs of individuals with a health care felony fraud or a controlled substance conviction; (2) a minimum period of permissive exclusion for certain individuals and entities subject to such an exclusion from Medicare and State health care programs; (3) the permissive exclusion of individuals with ownership or control interest in sanctioned entities; (4) a minimum period of exclusion for practitioners and individuals failing to meet certain statutory obligations; and (5) intermediate sanctions for Medicare health maintenance organizations. (Sec. 206) Exempts certain program exclusions from an automatic stay imposed under the Federal bankruptcy code. (Sec. 208) Requires reimbursement of the Secretary by Medicare carriers, fiscal intermediaries, and States for their payment of claims by excluded providers after due notice of their exclusion. Title III: Administrative and Miscellaneous Provisions - Directs the HHS Secretary to: (1) provide for the establishment of a national health care fraud and abuse data collection program for the reporting of final adverse actions against health care providers, suppliers, or practitioners; and (2) maintain a database of the information collected for it. (Sec. 302) Amends the Health Care Quality Improvement Act of 1986 to: (1) grant the HHS and other specified Federal IGs access to the National Practitioner Data Bank; and (2) permit the HHS Secretary to recover the full costs of providing Data Bank information, and to disallow the imposition of any information fees for requests by the HHS IG. (Sec. 303) Requires the HHS Secretary to establish a corporate whistleblower program whereby corporate and other legal entities may voluntarily disclose instances of unlawful conduct and seek to resolve liability for such conduct through means specified by the Secretary. Prohibits individual civil actions against proposed defendants which have made voluntary disclosures to the United States and have been accepted into such program. (Sec. 304) Bases home health billing, payment, and cost limit calculation on the geographical location where the service is furnished. (Sec. 305) Modifies the special payment rules under Medicare for durable medical equipment with regard to adjustment for inherent reasonableness. (Sec. 306) Revises Medicare secondary payor provisions with regard to time and filing limitations for a claim, liability of third party administrators, and payment amounts to Medicare. (Sec. 309) Revises the meaning of carriers with respect to contracts for Medicare claims processing to include agencies and organizations. Title IV: Civil Monetary Penalties - Revises requirements for civil money penalties under part A of SSA title XI, among other things, to provide for: (1) payment into the Health Care Fraud and Abuse Control Account of a portion of civil money penalty amounts recovered; and (2) an increase in the civil monetary penalty. Subjects to such a penalty an excluded individual retaining an ownership or controlling interest in a Medicare or State health care program. Permits the HHS Secretary to impose a penalty on any individual (including any organization, but not a beneficiary) who knowingly receives any kickback or bribe in return for making a referral or purchasing equipment in a Medicare or State health care program. Title V: Amendments to Criminal Law - Amends the Federal criminal code with respect to: (1) mail fraud to establish penalties for health care fraud; (2) forfeiture of property in certain Federal health care offenses; (3) injunctive relief to prevent such offenses; (4) penalties for false statements, theft, and embezzlement relating to health care matters; (5) penalties for obstruction of criminal investigations of Federal health care offenses, theft, or embezzlement in connection with health care; and (6) laundering of monetary instruments in connection with a Federal health care offense. (Sec. 509) Specifies authorized investigative demand procedures. Title VI: State Health Care Fraud Control Units - Amends SSA title XIX (Medicaid) to provide for extension of concurrent authority to investigate and prosecute: (1) fraud in other Federal programs; and (2) patient abuse in non-Medicaid board and care facilities. Title VII: Medicare-Medicaid Billing Abuse Prevention - Directs the HHS Secretary to: (1) establish certain procedures and a uniform application form for individuals or entities seeking to participate in Medicare or Medicaid; (2) establish standards for claim forms and submission; (3) develop specific standards governing claims submission via electronic media in order to control fraud and abuse; and (4) establish a system for issuance of a unique identifier code for each service provider, including code fees. (Sec. 705) Makes certain Medicare debts nondischargeable under the Federal bankruptcy code.

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3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 11 June 1996

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 11 June 1996

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• Introduced in Senate

  summary · EN · 11 June 1996

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