II

106TH CONGRESS

1ST SESSION S. 1417

To amend title XIX of the Social Security Act to extend the authority

of State Medicaid fraud control units to investigate and prosecute fraud

in connection with Federal health care programs and abuse of residents

of board and care facilities.

IN THE SENATE OF THE UNITED STATES

JULY 22, 1999

Mr. GRASSLEY (for himself and Mr. BREAUX) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to extend

the authority of State Medicaid fraud control units to

investigate and prosecute fraud in connection with Federal health care programs and abuse of residents of

board and care facilities.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Health Care Fraud

5 Control Act of 1999’’.
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1 SEC. 2. EXTENSION OF AUTHORITY OF STATE MEDICAID

2 FRAUD CONTROL UNITS.

3 (a) EXTENSION OF CONCURRENT AUTHORITY TO IN4 VESTIGATE AND PROSECUTE FRAUD IN OTHER FEDERAL

5 HEALTH CARE PROGRAMS.—Section 1903(q)(3) of the

6 Social Security Act (42 U.S.C. 1396b(q)(3)) is amended—

7 (1) by inserting ‘‘(A)’’ after ‘‘in connection

8 with’’; and

9 (2) by striking ‘‘title.’’ and inserting ‘‘title; and

10 (B) upon the approval of the Inspector General of

11 the relevant Federal agency in a particular case or

12 investigation, any aspect of the provision of health

13 care services and activities of providers of such serv14 ices under any Federal health care program (as de15 fined in section 1128B(f)(1)), if (i) the suspected

16 fraud or violation of law in such case or investiga17 tion is primarily related to the State plan under this

18 title, and (ii) when such approval is granted, the In19 spector General of the relevant Federal agency re20 tains the continuing authority to join the case or in21 vestigation, or after consultation with the entity, to

22 replace the entity as the primary agency assigned to

23 the case or investigation.’’.

24 (b) RECOUPMENT OF FUNDS.—Section 1903(q)(5) of

25 such Act (42 U.S.C. 1396b(q)(5)) is amended—
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1 (1) by inserting ‘‘or under any Federal health

2 care program (as so defined)’’ after ‘‘plan’’; and

3 (2) by adding at the end the following: ‘‘All

4 funds collected in accordance with this paragraph

5 shall be credited exclusively to, and available for ex6 penditure under, the Federal health care program

7 (including the State plan under this title) that was

8 subject to the activity that was the basis for the col9 lection.’’.

10 (c) EXTENSION OF AUTHORITY TO INVESTIGATE

11 AND PROSECUTE RESIDENT ABUSE IN NON-MEDICAID

12 BOARD AND CARE FACILITIES.—Section 1903(q)(4) of

13 such Act (42 U.S.C. 1396b(q)(4)) is amended to read as

14 follows:

15 ‘‘(4)(A) The entity has—

16 ‘‘(i) procedures for reviewing complaints of

17 abuse or neglect of patients in health care fa18 cilities which receive payments under the State

19 plan under this title;

20 ‘‘(ii) at the option of the entity, procedures

21 for reviewing complaints of abuse or neglect of

22 patients residing in board and care facilities;

23 and

24 ‘‘(iii) procedures for acting upon such com25 plaints under the criminal laws of the State or
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1 for referring such complaints to other State

2 agencies for action.

3 ‘‘(B) For purposes of this paragraph, the term

4 ‘board and care facility’ means a residential setting

5 which receives payment (regardless of whether such

6 payment is made under the State plan under this

7 title) from or on behalf of two or more unrelated

8 adults who reside in such facility, and for whom one

9 or both of the following is provided:

10 ‘‘(i) Nursing care services provided by, or

11 under the supervision of, a registered nurse, li12 censed practical nurse, or licensed nursing as13 sistant.

14 ‘‘(ii) A substantial amount of personal care

15 services that assist residents with the activities

16 of daily living, including personal hygiene,

17 dressing, bathing, eating, toileting, ambulation,

18 transfer, positioning, self-medication, body care,

19 travel to medical services, essential shopping,

20 meal preparation, laundry, and housework.’’.

21 (d) EFFECTIVE DATE.—The amendments made by

22 this section take effect on the date of enactment of this

23 Act.

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