Medicare Waste Tax Reduction Act of 1998

Summary

Medicare Waste Tax Reduction Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) establish new minimum levels increasing the number of annual medical, utilization, and fraud reviews and provider cost report audits under the Medicare Integrity Program (MIP), particularly with regard to providers, individuals, and areas that the Secretary of Health and Human Services determines are subject to abuse and most likely to result in mispayment and overpayment recoveries; and (2) provide for an increase in appropriated amounts to MIP's Health Care Fraud and Abuse Control Account, with certain additional amounts to be used for review and audit costs. (Sec. 3) Authorizes appropriations for carrying out, and expanding nationwide, the Administration on Aging's Health Care Anti-Fraud, Waste and Abuse Community Volunteer Demonstration Projects. (Sec. 4) Amends the Balanced Budget Act of 1997 and SSA title XVIII part B (Supplementary Medical Insurance) to eliminate the general 15 percent limitation on the amount of reductions that may be made in payment rates (except those for physician services) that are grossly excessive or grossly deficient and therefore not inherently reasonable. (Sec. 5) Amends SSA title XVIII to: (1) give the Secretary certain oversight responsibility with regard to home health agencies through validation surveys of agencies previously surveyed by the State; (2) restructure the payment rate for prescription drugs and biologicals, setting the payment amount, generally, at the lowest of either the actual acquisition cost or 95 percent of the average wholesale cost; and (3) make certain changes regarding the provision of information by group health plans in order to ensure that Medicare does not reimburse claims owed by other payers. (Sec. 8) Amends SSA title XI and the Health Insurance Portability and Accountability Act of 1996 with regard to criminal penalties for acts involving Federal health care programs to repeal the expanded exception to anti-kickback penalties for eligible organizations and risk-sharing contracts. (Sec. 9) Amends SSA title XI to apply certain criminal penalties for kickbacks to all health care benefit programs. (Sec. 10) Provides for: (1) the extension of subpoena and injunction authority with respect to the exclusion of certain individuals and entities from participation in Medicare and State health care programs; (2) civil monetary penalties for services ordered or prescribed by a person excluded from the program under which the claim was made, and the person furnishing the ordered or prescribed item or service knows or should know of such exclusion; and (3) civil monetary penalties for false certification of eligibility to receive partial hospitalization and hospice services. (Sec. 13) Amends part A (General Provisions) of SSA title XI to provide that Medicare- and Medicaid-related disciplinary actions are not stayed by bankruptcy proceedings, and Medicare- and Medicaid-related debt is not dischargeable in bankruptcy. Amends SSA title XVIII to provide for the use of Medicare standards and procedures in bankruptcy proceedings. (Sec. 14) Amends part B (Peer Review) of SSA title XI, in order to improve private sector coordination in combatting health care fraud, to shield health plans, plan issuers, and their employees from liability in any civil action for providing information to applicable Federal, State, or local law enforcement officials regarding suspected health care fraud, as long as such information is not false, and the person providing the information had no reason to believe the information was false. (Sec. 15) Amends SSA title XVIII with regard to agreements with service providers to allow the Secretary to: (1) establish a procedure for enrollment of individuals or entities that are not service providers subject to such provisions, but that furnish health care items or services under Medicare; and (2) impose fees for initiation and renewal of provider agreements and for enrollment and periodic reenrollment of other individuals and entities furnishing health care items or services under Medicare. (Sec. 16) Directs the Secretary to: (1) develop and implement a comprehensive plan of activities to improve compliance among health care providers with rules and regulations under the Medicare program; and (2) contract with the Institute of Medicine of the National Academy of Sciences to establish a committee to study and report to the Secretary and appropriate congressional committees on Medicare program administrative requirements applicable to Medicare health care providers, including any recommendations for minimizing such requirements. Provides for funding for such plan and authorizes appropriations for such study. (Sec. 18) Amends SSA title XI with regard to the exclusion of certain individuals and entities from participation in Federal health care programs (which includes certain State health care programs), to apply such exclusion to employment under such programs as well. Restricts certain notice requirements to Federal health care programs (currently, State health care programs). Includes the Federal Employees Health Benefit Program among Federal health care programs. (Sec. 19) Amends SSA title XVIII to modify the special payment rules for items of durable medical equipment to add as alternative payment bases the least expensive amount that the supplier of the item is paid by a Medicare+Choice organization or by any Federal health care program for such item. Requires the Secretary to adjust the payment rate for an item based on either such alternative basis to reflect any excess of administrative costs (of billing and receiving reimbursement) over the administrative costs associated with providing such item to a Medicare+Choice organization or by any Federal health care program. (Sec. 20) Directs the Secretary to require Medicare carriers to use commercial claims auditing systems, as a supplement to any other information technology currently used in processing claims, to process Medicare part B claims for the purpose of identifying billing errors and abuses. (Sec. 21) Amends SSA title XVIII with regard to partial hospitalization services to: (1) exclude services provided in a skilled nursing facility or in an individual's personal residence; (2) authorize the Secretary to establish additional conditions for community mental health centers; and (3) authorize the Secretary to establish by regulation a prospective payment system for such services provided by such a center or by a hospital to its outpatients.

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3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 21 July 1998

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 21 July 1998

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• Introduced in Senate

  summary · EN · 21 July 1998

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