Medicaid Waste, Fraud, and Abuse Control Act of 1997

Summary

Medicaid Waste, Fraud, and Abuse Control Act of 1997 - Amends title XIX (Medicaid) of the Social Security Act (SSA) to ban Medicaid spending for roads, bridges, stadiums, or any other item or service not covered under a State Medicaid plan. (Sec. 3) Conditions State Medicaid plan issuance or renewal of provider numbers for suppliers of durable medical equipment upon the provider's continuing disclosure of specified ownership or control interest information as well as a surety bond of at least $50,000. Requires a $50,000 surety bond from home health agencies. (Sec. 5) Revises conflict-of-interest safeguards. (Sec. 6) Provides authority for the State to refuse to enter into Medicaid agreements with individuals or entities convicted of a felony. Prohibits certain affiliations by managed care entities with persons or entities (or affiliates) debarred by Federal agencies. (Sec. 8) Revises requirements for State mechanized claims processing and information retrieval systems (Medicaid Management Information Systems (MMIS)), including electronic transmission of claims data in a format consistent with the Medicaid Statistical Information System (MSIS). (Sec. 9) Provides for a public process for developing State plan amendments and waiver submissions. (Sec. 10) Directs the Administrator of the Health Care Financing Administration to: (1) develop mechanisms to better monitor and prevent inappropriate Medicaid payments for individuals dually eligible for Medicaid and Medicare benefits; (2) study the use of case management or care coordination in order to improve the appropriateness, quality, and cost-effectiveness of care for dually-eligible individuals; and (3) work with the States to ensure better care coordination for dual eligibles and recommend to the Congress any statutory changes that would not compromise beneficiary protections, and that would improve or facilitate such care. (Sec. 11) Amends SSA title XIX to require State Medicaid plans to provide programs to: (1) ensure program integrity, protect and advocate on behalf of individuals, and to report to the State data concerning beneficiary concerns and complaints and instances of beneficiary abuse or program waste or fraud by managed care plans operating in the State; (2) to assist beneficiaries, especially families of special needs children and persons with disabilities, with explanations of managed care plans; and (3) collect and report to the State data on the number of fraud, waste, or abuse complaints or instances, as well as systematic problems with managed care contractors. (Sec. 12) Authorizes State Medicaid fraud control units to investigate and prosecute, upon the approval of the relevant Federal agency, any aspect of the provision of health care services and activities of service providers under any Federal health care program, if the suspected fraud or violation of law is primarily related to the State Medicaid plan or the Medicare program. Authorizes such units to have procedures for reviewing and prosecuting complaints of patient abuse in Medicaid board and care facilities. (Sec. 13) Amends SSA title XI to provide that: (1) Medicaid-related actions are not stayed by bankruptcy proceedings; (2) Medicaid-related debt is not dischargeable in bankruptcy; and (3) repayment of certain Medicaid-related debt to the United States or to a State is considered final and not a preferential transfer.

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Documents

3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 20 June 1997

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 20 June 1997

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• Introduced in Senate

  summary · EN · 20 June 1997

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