I

106TH CONGRESS

2D SESSION H. R. 5200

To amend title XVIII of the Social Security Act to ensure that the Secretary

of Health and Human Services provides appropriate guidance to physicians and other health care providers that are attempting to properly

submit claims under the medicare program and to ensure that the Secretary targets truly fraudulent activity for enforcement of medicare billing

regulations, rather than inadvertent billing errors.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 18, 2000

Mr. TOOMEY (for himself and Ms. BERKLEY) introduced the following bill;

which was referred to the Committee on Commerce, and in addition to

the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions

as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to ensure

that the Secretary of Health and Human Services provides appropriate guidance to physicians and other health

care providers that are attempting to properly submit

claims under the medicare program and to ensure that

the Secretary targets truly fraudulent activity for enforcement of medicare billing regulations, rather than

inadvertent billing errors.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

2 (a) SHORT TITLE.—This Act may be cited as the

3 ‘‘Medicare Billing and Education Act of 2000’’.

4 (b) TABLE OF CONTENTS.—The table of contents of

5 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

Sec. 3. Definitions.

TITLE I—REGULATORY REFORM

Sec. 101. Prospective application of certain regulations.

Sec. 102. Requirements for judicial and regulatory challenges of regulations.

Sec. 103. Prohibition of recovering past overpayments by certain means.

Sec. 104. Prohibition of recovering past overpayments if appeal pending.

TITLE II—APPEALS PROCESS REFORMS

Sec. 201. Reform of post-payment audit process.

Sec. 202. Definitions relating to protections for physicians, suppliers, and providers of services.

Sec. 203. Right to appeal on behalf of deceased beneficiaries.

TITLE III—EDUCATION COMPONENTS

Sec. 301. Designated funding levels for provider education.

Sec. 302. Advisory opinions.

TITLE IV—SUSTAINABLE GROWTH RATE REFORMS

Sec. 401. Inclusion of regulatory costs in the calculation of the sustainable

growth rate.

TITLE V—STUDIES AND REPORTS

Sec. 501. GAO audit and report on compliance with certain statutory administrative procedure requirements.

Sec. 502. GAO study and report on provider participation.

6 SEC. 2. FINDINGS.

7 Congress finds the following:

8 (1) Physicians, providers of services, and sup9 pliers of medical equipment and supplies that par10 ticipate in the medicare program under title XVIII

11 of the Social Security Act must contend with over
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1 100,000 pages of complex medicare regulations,

2 most of which are unknowable to the average health

3 care provider.

4 (2) Many physicians are choosing to discontinue

5 participation in the medicare program to avoid be6 coming the target of an overzealous Government in7 vestigation regarding compliance with the extensive

8 regulations governing the submission and payment

9 of medicare claims.

10 (3) Health Care Financing Administration con11 tractors send post-payment review letters to physi12 cians that require the physician to submit to addi13 tional substantial Government interference with the

14 practice of the physician in order to preserve the

15 physician’s right to due process.

16 (4) When a Health Care Financing Administra17 tion contractor sends a post-payment review letter to

18 a physician, that contractor often has no telephone

19 or face-to-face communication with the physician,

20 provider of services, or supplier.

21 (5) The Health Care Financing Administration

22 targets billing errors as though health care providers

23 have committed fraudulent acts, but has not ade24 quately educated physicians, providers of services,
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1 and suppliers regarding medicare billing require2 ments.

3 (6) The Office of the Inspector General of the

4 Department of Health and Human Services found

5 that 75 percent of surveyed physicians had never re6 ceived any educational materials from a Health Care

7 Financing Administration contractor concerning the

8 equipment and supply ordering process.

9 SEC. 3. DEFINITIONS.

10 In this Act:

11 (1) APPLICABLE AUTHORITY.—The term ‘‘ap12 plicable authority’’ has the meaning given such term

13 in section 1861(uu)(1) of the Social Security Act (as

14 added by section 202).

15 (2) CARRIER.—The term ‘‘carrier’’ means a

16 carrier (as defined in section 1842(f) of the Social

17 Security Act (42 U.S.C. 1395u(f))) with a contract

18 under title XVIII of such Act to administer benefits

19 under part B of such title.

20 (3) EXTRAPOLATION.—The term ‘‘extrapo21 lation’’ has the meaning given such term in section

22 1861(uu)(2) of the Social Security Act (as added by

23 section 202).

24 (4) FISCAL INTERMEDIARY.—The term ‘‘fiscal

25 intermediary’’ means a fiscal intermediary (as de-
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1 fined in section 1816(a) of the Social Security Act

2 (42 U.S.C. 1395h(a))) with an agreement under sec3 tion 1816 of such Act to administer benefits under

4 part A or B of such title.

5 (5) HEALTH CARE PROVIDER.—The term

6 ‘‘health care provider’’ has the meaning given the

7 term ‘‘eligible provider’’ in section 1897(a)(2) of the

8 Social Security Act (as added by section 301).

9 (6) MEDICARE PROGRAM.—The term ‘‘medicare

10 program’’ means the health benefits program under

11 title XVIII of the Social Security Act (42 U.S.C.

12 1395 et seq.).

13 (7) PREPAYMENT REVIEW.—The term ‘‘prepay14 ment review’’ has the meaning given such term in

15 section 1861(uu)(3) of the Social Security Act (as

16 added by section 202).

17 (8) SECRETARY.—The term ‘‘Secretary’’ means

18 the Secretary of Health and Human Services.

19 TITLE I—REGULATORY REFORM

20 SEC. 101. PROSPECTIVE APPLICATION OF CERTAIN REGU21 LATIONS.

22 (a) IN GENERAL.—Section 1871(a) of the Social Se23 curity Act (42 U.S.C. 1395hh(a)) is amended by adding

24 at the end the following new paragraph:
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1 ‘‘(3) Any regulation described under paragraph

2 (2) may not take effect earlier than the date on

3 which such regulation becomes a final regulation.

4 Any regulation described under such paragraph that

5 applies to an agency action, including any agency

6 determination, shall only apply as that regulation is

7 in effect at the time that agency action is taken.’’.

8 (b) EFFECTIVE DATE.—The amendment made by

9 this section shall take effect 60 days after the date of en10 actment of this Act.

11 SEC. 102. REQUIREMENTS FOR JUDICIAL AND REGU12 LATORY CHALLENGES OF REGULATIONS.

13 (a) RIGHT TO CHALLENGE CONSTITUTIONALITY AND

14 STATUTORY AUTHORITY OF HCFA REGULATIONS.—Sec15 tion 1872 of the Social Security Act (42 U.S.C. 1395ii)

16 is amended to read as follows:

17 ‘‘APPLICATION OF CERTAIN PROVISIONS OF TITLE II

18 ‘‘SEC. 1872. The provisions of sections 206 and

19 216(j), and of subsections (a), (d), (e), (h), (i), (j), (k),

20 and (l) of section 205, shall also apply with respect to this

21 title to the same extent as they are applicable with respect

22 to title II, except that—

23 ‘‘(1) in applying such provisions with respect to

24 this title, any reference therein to the Commissioner

25 of Social Security or the Social Security Administra26 tion shall be considered a reference to the Secretary
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1 or the Department of Health and Human Services,

2 respectively; and

3 ‘‘(2) section 205(h) shall not apply with respect

4 to any action brought against the Secretary under

5 section 1331 or 1346 of title 28, United States

6 Code, regardless of whether such action is unrelated

7 to a specific determination of the Secretary, that

8 challenges—

9 ‘‘(A) the constitutionality of the Sec10 retary’s regulations or policies;

11 ‘‘(B) the Secretary’s statutory authority to

12 promulgate such regulations or policies; or

13 ‘‘(C) a finding of good cause under sub14 paragraph (B) of the sentence following section

15 553(b)(3), United States Code.’’.

16 (b) CONSTRUCTION OF HEARING RIGHTS RELATING

17 TO DETERMINATIONS BY THE SECRETARY REGARDING

18 AGREEMENTS WITH PROVIDERS OF SERVICES.—Section

19 1866(h) of the Social Security Act (42 U.S.C. 1395cc(h))

20 is amended by adding at the end the following new para21 graph:

22 ‘‘(3) For purposes of applying paragraph (1), an in23 stitution or agency dissatisfied with a determination by

24 the Secretary described in such paragraph shall be entitled

25 to a hearing thereon regardless of whether—
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1 ‘‘(A) such determination has been made by the

2 Secretary or by a State pursuant to an agreement

3 entered into with the Secretary under section 1864;

4 or

5 ‘‘(B) the Secretary has imposed or may impose

6 a remedy, penalty, or other sanction on the institu7 tion or agency in connection with such determina8 tion.’’.

9 (c) EFFECTIVE DATE.—The amendments made by

10 this section shall take effect 60 days after the date of en11 actment of this Act.

12 SEC. 103. PROHIBITION OF RECOVERING PAST OVERPAY13 MENTS BY CERTAIN MEANS.

14 (a) IN GENERAL.—Except as provided in subsection

15 (b) and notwithstanding sections 1815(a), 1842(b), and

16 1861(v)(1)(A)(ii) of the Social Security Act (42 U.S.C.

17 1395g(a), 1395u(a), and 1395x(v)(1)(A)(ii)), or any other

18 provision of law, for purposes of applying sections

19 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 of

20 such Act (42 U.S.C. 1395u(b)(3)(B)(ii),

21 1395cc(a)(1)(B)(ii), 1395gg, and 1395ddd), the Secretary

22 may not offset any future payment to a health care pro23 vider to recoup a previously made overpayment, but in24 stead shall establish a repayment plan to recoup such an

25 overpayment.
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1 (b) EXCEPTION.—This section shall not apply to

2 cases in which the Secretary finds clear and convincing

3 evidence of fraud or similar fault on the part of such pro4 vider.

5 SEC. 104. PROHIBITION OF RECOVERING PAST OVERPAY6 MENTS IF APPEAL PENDING.

7 Notwithstanding any provision of law, for purposes

8 of applying sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii),

9 1870, and 1893 of the Social Security Act (42 U.S.C.

10 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, and

11 1395ddd), the Secretary may not take any action (or au12 thorize any other person, including any fiscal inter13 mediary, carrier, and contractor under section 1893 of

14 such Act (42 U.S.C. 1395ddd)) to recoup an overpayment

15 during the period in which a health care provider is ap16 pealing a determination that such an overpayment has

17 been made or the amount of the overpayment.

18 TITLE II—APPEALS PROCESS

19 REFORMS

20 SEC. 201. REFORM OF POST-PAYMENT AUDIT PROCESS.

21 (a) COMMUNICATIONS TO PHYSICIANS.—Section

22 1842 of the Social Security Act (42 U.S.C. 1395u) is

23 amended by adding at the end the following new sub24 section:
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1 ‘‘(u) In carrying out its contract under subsection

2 (b)(3), with respect to physicians’ services, the carrier

3 shall provide for the recoupment of overpayments in the

4 following manner:

5 ‘‘(1)(A) During the 1-year period beginning on

6 the date on which a physician receives an overpay7 ment, the physician may return the overpayment to

8 the carrier making such overpayment if—

9 ‘‘(i) the carrier or a contractor under sec10 tion 1893 has not requested any relevant record

11 or file; and

12 ‘‘(ii) the case has not been referred to the

13 Department of Justice or the Office of Inspec14 tor General.

15 ‘‘(B) If a physician returns an overpayment

16 under subparagraph (A), neither the carrier, con17 tractor under section 1893, nor any law enforcement

18 agency may begin an investigation or target such

19 physician based on any claim associated with the

20 amount the physician has repaid.

21 ‘‘(2) If a carrier or a contractor under section

22 1893 identifies (before or during post-payment re23 view activities) that a physician has submitted a

24 claim with a coding, documentation, or billing incon25 sistency, before sending any written communication
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1 to such physician, the carrier or a contractor under

2 section 1893 shall contact the physician by telephone

3 or in person at the physician’s place of business dur4 ing regular business hours and shall—

5 ‘‘(A) identify the billing anomaly;

6 ‘‘(B) inform the physician of how to ad7 dress the anomaly; and

8 ‘‘(C) describe the type of coding or docu9 mentation that is required for the claim.

10 ‘‘(3) The carrier or a contractor under section

11 1893 may not recoup or offset payment amounts

12 based on extrapolation (as defined in section

13 1861(uu)(2)) if the physician has not been the sub14 ject of a post-payment audit.

15 ‘‘(4) As part of any written consent settlement

16 communication, the carrier or a contractor under

17 section 1893 shall clearly state that the physician

18 may submit additional information (including evi19 dence other than medical records) to dispute the

20 overpayment amount without waiving any adminis21 trative remedy or right to appeal the amount of the

22 overpayment.

23 ‘‘(5) As part of the administrative appeals proc24 ess for any amount in controversy, a physician may

25 directly appeal any adverse determination of the car-
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1 rier or a contractor under section 1893 to an admin2 istrative law judge.

3 ‘‘(6)(A) Each consent settlement communica4 tion from the carrier or a contractor under section

5 1893 shall clearly state that prepayment review (as

6 defined in section 1861(uu)(3)) may be imposed

7 where the physician submits an actual or projected

8 repayment to the carrier or a contractor under sec9 tion 1893. Any prepayment review shall cease if the

10 physician demonstrates to the carrier that the physi11 cian has properly submitted clean claims (as defined

12 in section 1816(c)(2)(B)(i)).

13 ‘‘(B) Prepayment review may not be applied as

14 a result of an action under section 201(a), 301(b),

15 or 302.’’.

16 (b) EFFECTIVE DATE.—The amendments made by

17 this section shall take effect 60 days after the date of en18 actment of this Act.

19 SEC. 202. DEFINITIONS RELATING TO PROTECTIONS FOR

20 PHYSICIANS, SUPPLIERS, AND PROVIDERS OF

21 SERVICES.

22 (a) IN GENERAL.—Section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395 et seq.) is amended by adding

24 at the end the following new subsection:
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1 ‘‘Definitions Relating to Protections for Physicians,

2 Suppliers, and Providers of Services

3 ‘‘(uu) For purposes of provisions of this title relating

4 to protections for physicians, suppliers of medical equip5 ment and supplies, and providers of services:

6 ‘‘(1) APPLICABLE AUTHORITY.—The term ‘ap7 plicable authority’ means the carrier, contractor

8 under section 1893, or fiscal intermediary that is re9 sponsible for making any determination regarding a

10 payment for any item or service under the medicare

11 program under this title.

12 ‘‘(2) EXTRAPOLATION.—The term ‘extrapo13 lation’ means the application of an overpayment dol14 lar amount to a larger grouping of physician claims

15 than those in the audited sample to calculate a pro16 jected overpayment figure.

17 ‘‘(3) PREPAYMENT REVIEW.—The term ‘pre18 payment review’ means the carriers’ and fiscal inter19 mediaries’ practice of withholding claim reimburse20 ments from eligible providers even if the claims have

21 been properly submitted and reflect medical services

22 provided.’’.
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1 SEC. 203. RIGHT TO APPEAL ON BEHALF OF DECEASED

2 BENEFICIARIES.

3 Notwithstanding section 1870 of the Social Security

4 Act (42 U.S.C. 1395gg) or any other provision of law, the

5 Secretary shall permit any health care provider to appeal

6 any determination of the Secretary under the medicare

7 program on behalf of a deceased beneficiary where no sub8 stitute party is available.

9 TITLE III—EDUCATION

10 COMPONENTS

11 SEC. 301. DESIGNATED FUNDING LEVELS FOR PROVIDER

12 EDUCATION.

13 (a) EDUCATION PROGRAMS FOR PHYSICIANS, PRO14 VIDERS OF SERVICES, AND SUPPLIERS.—Title XVIII of

15 the Social Security Act (42 U.S.C. 1395 et seq.) is amend16 ed by adding at the end the following new section:

17 ‘‘EDUCATION PROGRAMS FOR PHYSICIANS, PROVIDERS OF

18 SERVICES, AND SUPPLIERS

19 ‘‘SEC. 1897. (a) DEFINITIONS.—In this section:

20 ‘‘(1) EDUCATION PROGRAMS.—The term ‘edu21 cation programs’ means programs undertaken in

22 conjunction with State and local medical societies

23 and specialty societies that focus on current billing,

24 coding, and documentation laws, regulations, and

25 carrier manual instructions and that place special

26 emphasis on billing, coding, and documentation er-
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1 rors that the Secretary has found occur with the

2 highest frequency and remedies for these improper

3 billing, coding, and documentation practices.

4 ‘‘(2) ELIGIBLE PROVIDERS.—The term ‘eligible

5 provider’ means a physician (as defined in section

6 1861(r)), a provider of services (as defined in sec7 tion 1861(u)), or a supplier of medical equipment

8 and supplies (as defined in section 1834(j)(5)).

9 ‘‘(b) CONDUCT OF EDUCATION PROGRAMS.—

10 ‘‘(1) IN GENERAL.—Carriers and fiscal inter11 mediaries shall conduct education programs for any

12 eligible provider that submits a claim under para13 graph (2)(A).

14 ‘‘(2) ELIGIBLE PROVIDER EDUCATION.—

15 ‘‘(A) SUBMISSION OF CLAIMS AND

16 RECORDS.—Any eligible provider may volun17 tarily submit any present or prior claim or med18 ical record to the applicable authority (as de19 fined in section 1861(uu)(1)) to determine

20 whether the billing, coding, and documentation

21 associated with the claim is appropriate.

22 ‘‘(B) PROHIBITION OF EXTRAPOLATION.—

23 No claim submitted under subparagraph (A) is

24 subject to any type of extrapolation (as defined

25 in section 1861(uu)(2)).
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1 ‘‘(c) SAFE HARBOR.—No submission of a claim or

2 record under this section shall result in the carrier, a con3 tractor under section 1893, or any law enforcement agency

4 beginning an investigation or targeting an investigation

5 based on any claim or record submitted under such sub6 paragraph.

7 ‘‘(3) TREATMENT OF IMPROPER CLAIMS.—If

8 the carrier or fiscal intermediary finds a claim to be

9 improper, the eligible provider shall have the fol10 lowing options:

11 ‘‘(A) CORRECTION OF PROBLEMS.—To

12 correct the documentation, coding, or billing

13 problem to appropriately substantiate the claim

14 and either—

15 ‘‘(i) remit the actual overpayment; or

16 ‘‘(ii) receive the appropriate additional

17 payment from the carrier or fiscal inter18 mediary.

19 ‘‘(B) REPAYMENT.—To repay the actual

20 overpayment amount if the service was not cov21 ered under the medicare program under this

22 title or if adequate documentation does not

23 exist.

24 ‘‘(4) PROHIBITION OF ELIGIBLE PROVIDER

25 TRACKING.—The applicable authorities may not use
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1 the record of attendance of any eligible provider at

2 an education program conducted under this section

3 or the inquiry regarding claims under paragraph

4 (2)(A) to select, identify, or track such eligible pro5 vider for the purpose of conducting any type of audit

6 or prepayment review.’’.

7 (b) FUNDING OF EDUCATION PROGRAMS.—

8 (1) MEDICARE INTEGRITY PROGRAM.—Section

9 1893(b)(4) of the Social Security Act (42 U.S.C.

10 1395ddd(b)(4)) is amended by adding at the end the

11 following new sentence: ‘‘No less than 10 percent of

12 the program funds shall be devoted to the education

13 programs for eligible providers under section 1897.’’.

14 (2) CARRIERS.—Section 1842(b)(3)(H) of the

15 Social Security Act (42 U.S.C. 1395u(b)(3)(H)) is

16 amended by adding at the end the following new

17 clause:

18 ‘‘(iii) No less than 2 percent of carrier

19 funds shall be devoted to the education

20 programs for eligible providers under sec21 tion 1897.’’.

22 (3) FISCAL INTERMEDIARIES.—Section

23 1816(b)(1) of the Social Security Act (42 U.S.C.

24 1395h(b)(1)) is amended—
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1 (A) in subparagraph (A), by striking

2 ‘‘and’’ at the end;

3 (B) in subparagraph (B), by striking

4 ‘‘; and’’ and inserting a comma; and

5 (C) by adding at the end the following new

6 subparagraph:

7 ‘‘(C) that such agency or organization is

8 using no less than 1 percent of its funding for

9 education programs for eligible providers under

10 section 1897.’’.

11 (c) EFFECTIVE DATE.—The amendments made by

12 this section shall take effect 60 days after the date of en13 actment of this Act.

14 SEC. 302. ADVISORY OPINIONS.

15 (a) STRAIGHT ANSWERS.—Fiscal intermediaries and

16 carriers shall do their utmost to provide health care pro17 viders with one, straight and correct answer regarding bill18 ing and cost reporting questions under the medicare pro19 gram, and will, when requested, give their true first and

20 last names to providers.

21 (b) WRITTEN REQUESTS.—

22 (1) IN GENERAL.—The Secretary shall establish

23 a process under which a health care provider may

24 request, in writing from a fiscal intermediary or car25 rier, assistance in addressing questionable coverage,
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1 billing, documentation, coding and cost reporting

2 procedures under the medicare program and then

3 the fiscal intermediary or carrier shall respond in

4 writing within 30 business days with the correct bill5 ing or procedural answer.

6 (2) USE OF WRITTEN STATEMENT.—

7 (A) IN GENERAL.—Subject to subpara8 graph (B), a written statement under para9 graph (1) may be used as proof against a fu10 ture audit or overpayment under the medicare

11 program.

12 (B) EXTRAPOLATION PROHIBITION.—Sub13 ject to subparagraph (C), no claim submitted

14 under this section shall be subject to extrapo15 lation.

16 (C) LIMITATION ON APPLICATION.—Sub17 paragraphs (A) and (B) shall not apply to cases

18 of fraudulent billing.

19 (3) SAFE HARBOR.—If a physician requests an

20 advisory opinion under this subsection, neither the

21 fiscal intermediary, the carrier, a contractor under

22 section 1893 of the Social Security Act (42 U.S.C.

23 1395ddd), nor any law enforcement agency may

24 begin an investigation or target such physician based

25 on any claim cited in the request.
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1 TITLE IV—SUSTAINABLE

2 GROWTH RATE REFORMS

3 SEC. 401. INCLUSION OF REGULATORY COSTS IN THE CAL4 CULATION OF THE SUSTAINABLE GROWTH

5 RATE.

6 (a) IN GENERAL.—Section 1848(f)(2) of the Social

7 Security Act (42 U.S.C. 1395w–4(f)(2)) is amended—

8 (1) by redesignating subparagraphs (A) through

9 (D) as clauses (i) through (iv), respectively;

10 (2) by striking ‘‘SPECIFICATION OF GROWTH

11 RATE.—The sustainable growth rate’’ and inserting

12 ‘‘SPECIFICATION OF GROWTH RATE.—

13 ‘‘(A) IN GENERAL.—The sustainable

14 growth rate’’; and

15 (3) by adding at the end the following new sub16 paragraphs:

17 ‘‘(B) INCLUSION OF SGR REGULATORY

18 COSTS.—The Secretary shall include in the esti19 mate established under clause (iv)—

20 ‘‘(i) the costs for each physicians’

21 service resulting from any regulation im22 plemented by the Secretary during the year

23 for which the sustainable growth rate is es24 timated, including those regulations that

25 may be implemented during such year; and
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1 ‘‘(ii) the costs described in subpara2 graph (C).

3 ‘‘(C) INCLUSION OF OTHER REGULATORY

4 COSTS.—The costs described in this subpara5 graph are any per procedure costs incurred by

6 each physicians’ practice in complying with

7 each regulation promulgated by the Secretary,

8 regardless of whether such regulation affects

9 the fee schedule established under subsection

10 (b)(1).

11 ‘‘(D) INCLUSION OF COSTS IN REGU12 LATORY IMPACT ANALYSES.—With respect to

13 any regulation promulgated on or after January

14 1, 2001, that may impose a regulatory cost de15 scribed in subparagraph (B)(i) or (C) on a phy16 sician, the Secretary shall include in the regu17 latory impact analysis accompanying such regu18 lation an estimate of any such cost.’’.

19 (b) EFFECTIVE DATE.—The amendments made by

20 subsection (a) shall apply with respect to any estimate

21 made by the Secretary of Health and Human Services on

22 or after the date of enactment of this Act.
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1 TITLE V—STUDIES AND

2 REPORTS

3 SEC. 501. GAO AUDIT AND REPORT ON COMPLIANCE WITH

4 CERTAIN STATUTORY ADMINISTRATIVE PRO5 CEDURE REQUIREMENTS.

6 (a) AUDIT.—The Comptroller General of the United

7 States shall conduct an audit of the compliance of the

8 Health Care Financing Administration and all regulations

9 promulgated by the Department of Health and Human

10 Resources under statutes administered by the Health Care

11 Financing Administration with—

12 (1) the provisions of such statutes;

13 (2) subchapter II of chapter 5 of title 5, United

14 States Code (including section 553 of such title);

15 and

16 (3) chapter 6 of title 5, United States Code.

17 (b) REPORT.—Not later than 18 months after the

18 date of enactment of this Act, the Comptroller General

19 shall submit to Congress a report on the audit conducted

20 under subsection (a), together with such recommendations

21 for legislative and administrative action as the Comp22 troller General determines appropriate.
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1 SEC. 502. GAO STUDY AND REPORT ON PROVIDER PARTICI2 PATION.

3 (a) STUDY.—The Comptroller General of the United

4 States shall conduct a study on provider participation in

5 the medicare program to determine whether policies or en6 forcement efforts against health care providers have re7 duced access to care for medicare beneficiaries. Such study

8 shall include a determination of the total cost to physician

9 practices of compliance with medicare laws and regula10 tions, the number of physician audits, the actual overpay11 ments assessed in consent settlements, and the attendant

12 projected overpayments communicated to physicians as

13 part of the consent settlement process.

14 (b) REPORT.—Not later than 18 months after the

15 date of enactment of this Act, the Comptroller General

16 shall submit to Congress a report on the study conducted

17 under subsection (a), together with such recommendations

18 for legislative and administrative action as the Comp19 troller General determines appropriate.

Æ