Medicare-Medicaid Anti-Fraud Act

Summary

Medicare-Medicaid Anti-Fraud Act - Establishes within the Department of Health, Education, and Welfare, an Office of Central Fraud and Abuse Control. Provides that such Office shall have the overall responsibility for directing and establishing policies with respect to the undertaking of activities which are designed to deal with fraud and abuse in the Maternal and Child Health and Crippled Children's Services, Medicare and Medicaid. Specifies that the Office shall also have responsibility for investigating alleged fraud or abuse in any such program, and assisting State agencies, at their request, in the establishment and operation of State antifraud and abuse activities. Directs that no payment for Medicare service may be made to a person claiming such payment under an assignment, including a power of attorney, but may be made to an agent of the person furnishing such service. Authorizes the Secretary of Health, Education, and Welfare or the Comptroller General to require providers or suppliers of items or services, with respect to which payment is claimed under one of the programs within the jurisdiction of the Office, to furnish specified information including the following: (1) the identity of persons having ownership interest in such entity; and (2) a consolidated certified costs report with respect to its costs and charges, including costs and charges of related organizations. Specifies sanctions which shall be imposed upon entities which fail to comply with requests for information. Increases the penalties for defrauding the Medicare or Medicaid programs. Provides that it shall be a felony (presently misdemeanor) punishable by imprisonment of up to five years for such an offense. States that where a Professional Standards Review Organization is found competent by the Secretary to assume review responsibility with respect to specified types of health care services or specified providers or practitioners of such services and is performing such reviews, such reviews shall constitute the conclusive determination on those issues for purposes of payment under this Act.

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1 official file

• Introduced in Senate

  summary · EN · 10 September 1976

  Open at official source

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