I

104TH CONGRESS

1ST SESSION H. R. 1668

To establish a program to control fraud and abuse in the medicare program,

to increase the amount of civil monetary penalties which may be assessed

against individuals and entities committing fraud against the medicare

program, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MAY 18, 1995

Ms. DANNER introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Commerce,

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 establish a program to control fraud and abuse in the

medicare program, to increase the amount of civil monetary penalties which may be assessed against individuals

and entities committing fraud against the medicare program, and for other purposes.

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 ‘‘Medicare Fraud and

5 Abuse Control Act of 1995’’.
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1 SEC. 2. ESTABLISHMENT OF MEDICARE FRAUD AND ABUSE

2 CONTROL PROGRAM.

3 (a) IN GENERAL.—Not later than 6 months after the

4 date of the enactment of this Act, the Secretary of Health

5 and Human Services shall establish a program to improve

6 the prevention, detection, and control of fraud and abuse

7 under the medicare program.

8 (b) AWARD OF PORTION OF AMOUNTS COLLECTED

9 TO INDIVIDUALS PROVIDING INFORMATION.—Under the

10 program established pursuant to subsection (a), the Sec11 retary shall pay a portion of any civil monetary penalty

12 assessed under the medicare program to any individual or

13 entity who provided information which served as the basis

14 for the assessment of the penalty, under the same terms

15 and conditions applicable to awards to qui tam plaintiffs

16 under chapter 37 of title 31, United States Code.

17 SEC. 3. PROVIDING INFORMATION ON REPORTING FRAUD

18 AND ABUSE WITH MEDICARE CLAIMS AND

19 BENEFIT FORMS.

20 (a) IN GENERAL.—Title XVIII of the Social Security

21 Act (42 U.S.C. 1395 et seq.) is amended by adding at

22 the end the following new section:

23 ‘‘SOLICITATION OF INFORMATION ON FRAUD AND ABUSE

24 ‘‘SEC. 1893. With each explanation of benefits pro25 vided to an individual to whom items or services are fur26 nished under this title and with each notice of payment
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1 provided to an individual or entity furnishing an item or

2 service for which payment is made under this title, the

3 Secretary shall include a statement soliciting any informa4 tion the individual or entity may possess on any fraud and

5 abuse committed against the program under this title, to6 gether with a toll-free telephone number through which

7 the individual or entity may report such information.’’.

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

9 subsection (a) shall apply to items and services furnished

10 and payments made under title XVIII of the Social Secu11 rity Act on or after January 1, 1996.

12 SEC. 4. INCREASE IN AMOUNT OF PENALTIES.

13 (a) IN GENERAL.—

14 (1) GENERAL CIVIL MONETARY PENALTIES.—

15 Section 1128A of the Social Security Act (42 U.S.C.

16 1320a–7a) is amended—

17 (A) in subsection (a)—

18 (i) by striking ‘‘$2,000’’ and inserting

19 ‘‘$4,000’’, and

20 (ii) by striking ‘‘$15,000’’ and insert21 ing ‘‘$30,000’’; and

22 (B) in subsection (b), by striking ‘‘$2,000’’

23 each place it appears and inserting ‘‘$4,000’’.

24 (2) CRIMINAL PENALTIES.—Section 1128B of

25 such Act (42 U.S.C. 1320a–7b) is amended—
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1 (A) in subsection (a)—

2 (i) by striking ‘‘$25,000’’ and insert3 ing ‘‘$50,000’’, and

4 (ii) by striking ‘‘$10,000’’ and insert5 ing ‘‘$20,000’’;

6 (B) in subsections (b), (c), and (d), by

7 striking ‘‘$25,000’’ each place it appears and

8 inserting ‘‘$50,000’’; and

9 (C) in subsection (e), by striking ‘‘$2,000’’

10 and inserting ‘‘$4,000’’.

11 (3) STANDARDS FOR NURSING FACILITIES.—

12 (A) PROVIDING ADVANCE NOTICE OF SUR13 VEY TO NURSING FACILITY.—Section

14 1819(g)(2)(A)(i) of such Act (42 U.S.C.

15 1395i@3(g)(2)(A)(i)) is amended by striking

16 ‘‘$2,000’’ and inserting ‘‘$4,000’’.

17 (B) NONCOMPLIANCE WITH NURSING FA18 CILITY STANDARDS.—Section 1819(h)(2)(B)(ii)

19 of such Act (42 U.S.C. 1395i@3(h)(2)(B)(ii))

20 is amended by striking ‘‘$10,000’’ and inserting

21 ‘‘$20,000’’.

22 (4) FAILURE TO PROVIDE INFORMATION ON RE23 FERRING PHYSICIAN ON UNASSIGNED CLAIMS.—Sec24 tion 1833(q)(2)(B)(i) of such Act (42 U.S.C.
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1 1395l(q)(2)(B)(i)) is amended by striking ‘‘$2,000’’

2 and inserting ‘‘$4,000’’.

3 (5) DISTRIBUTION BY SUPPLIERS OF MEDICAL

4 EQUIPMENT OF MEDICAL NECESSITY FORMS.—Sec5 tion 1834(j)(2)(A)(iii) of such Act (42 U.S.C.

6 1395m(j)(2)(A)(iii)), as added by section 131(a)(1)

7 of the Social Security Act Amendments of 1994, is

8 amended by striking ‘‘$1,000’’ and inserting

9 ‘‘$2,000’’.

10 (6) FAILURE TO INCLUDE DIAGNOSIS CODE ON

11 UNASSIGNED CLAIMS.—Section 1842(p)(3)(A) of

12 such Act (42 U.S.C. 1395u(p)(3)(A)) is amended by

13 striking ‘‘$2,000’’ and inserting ‘‘$4,000’’.

14 (7) INTERMEDIATE SANCTIONS FOR PROVIDERS

15 OR SUPPLIERS OF CLINICAL DIAGNOSTIC LABORA16 TORY TESTS.—Section 1846(b)(2)(A)(ii) of such Act

17 (42 U.S.C. 1395w@2(b)(2)(A)(ii)) is amended by

18 striking ‘‘$10,000’’ and inserting ‘‘$20,000’’.

19 (8) MEDICARE SECONDARY PAYER.—

20 (A) OFFERING FINANCIAL INCENTIVES

21 FOR BENEFICIARIES NOT TO ENROLL IN PRI22 MARY PLANS.—The second sentence of section

23 1862(b)(3)(C) of such Act (42 U.S.C.

24 1395y(b)(3)(C)) is amended by striking

25 ‘‘$5,000’’ and inserting ‘‘$10,000’’.
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1 (B) FAILURE OF EMPLOYER TO PROVIDE

2 MATCHING INFORMATION ON SECONDARY

3 PAYER SITUATIONS.—The second sentence of

4 section 1862(b)(5)(C)(ii) of such Act (42

5 U.S.C. 1395y(b)(5)(C)(ii)) is amended by strik6 ing ‘‘$1,000’’ and inserting ‘‘$2,000’’.

7 (C) FAILURE OF PROVIDER TO PROVIDE

8 INFORMATION ON AVAILABILITY OF OTHER

9 PAYERS.—Section 1862(b)(6)(B) of such Act

10 (42 U.S.C. 1395y(b)(6)(B)), as added by sec11 tion 151(a)(2)(A) of the Social Security Act

12 Amendments of 1994, is amended by striking

13 ‘‘$2,000’’ and inserting ‘‘$4,000’’.

14 (9) IMPROPER BILLING BY HOSPITALS.—Sec15 tion 1866(g) of such Act (42 U.S.C. 1395cc(g)) is

16 amended by striking ‘‘$2,000’’ and inserting

17 ‘‘$4,000’’.

18 (10) VIOLATION OF ANTI-DUMPING RESTRIC19 TIONS.—Section 1867(d)(1) of such Act (42 U.S.C.

20 1395dd(d)(1)) is amended—

21 (A) by striking ‘‘$50,000’’ each place it

22 appears and inserting ‘‘$100,000’’; and

23 (B) in subparagraph (A), by striking

24 ‘‘$25,000’’ and inserting ‘‘$50,000’’.
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1 (11) SANCTIONS AGAINST HEALTH MAINTE2 NANCE ORGANIZATIONS.—Section 1876(i)(6)(B)(i)

3 of such Act (42 U.S.C. 1395mm(i)(6)(B)(i)) is

4 amended—

5 (A) by striking ‘‘$25,000’’ and inserting

6 ‘‘$50,000’’;

7 (B) by striking ‘‘$100,000’’ and inserting

8 ‘‘$200,000’’; and

9 (C) by striking ‘‘$15,000’’ and inserting

10 ‘‘$30,000’’.

11 (12) REFERRALS BY PHYSICIANS WITH OWNER12 SHIP OR INVESTMENT INTERESTS.—

13 (A) IMPROPER CLAIMS.—Section

14 1877(g)(3) of such Act (42 U.S.C.

15 1395nn(g)(3)) is amended by striking

16 ‘‘$15,000’’ and inserting ‘‘$30,000’’.

17 (B) CIRCUMVENTION SCHEMES.—Section

18 1877(g)(4) of such Act (42 U.S.C.

19 1395nn(g)(4)) is amended by striking

20 ‘‘$100,000’’ and inserting ‘‘$200,000’’.

21 (C) FAILURE TO REPORT INFORMATION.—

22 Section 1877(g)(5) of such Act (42 U.S.C.

23 1395nn(g)(5)) is amended by striking

24 ‘‘$10,000’’ and inserting ‘‘$20,000’’.

25 (13) MEDICARE SUPPLEMENTAL POLICIES.—
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1 (A) ISSUANCE OF POLICIES WHERE NO

2 STANDARDS IN EFFECT.—The second sentence

3 of section 1882(a)(2) of such Act (42 U.S.C.

4 1395ss(a)(2)) is amended by striking

5 ‘‘$25,000’’ and inserting ‘‘$50,000’’.

6 (B) MISREPRESENTATIONS OF POLICIES.—

7 Section 1882(d) of such Act (42 U.S.C.

8 1395ss(d)) is amended—

9 (i) in paragraphs (1), (2), and (4)(A),

10 by striking ‘‘$5,000’’ and inserting

11 ‘‘$10,000’’; and

12 (ii) in paragraphs (3)(A) and

13 (3)(B)(iv), by striking ‘‘$25,000 (or

14 $15,000’’ and inserting ‘‘$50,000 (or

15 $30,000’’.

16 (C) VIOLATION OF BENEFITS STAND17 ARDS.—Section 1882(p) of such Act (42 U.S.C.

18 1395ss(p)) is amended by striking ‘‘$25,000 (or

19 $15,000’’ each place it appears in paragraphs

20 (8) and (9)(C) and inserting ‘‘$50,000 (or

21 $30,000’’.

22 (D) VIOLATION OF GUARANTEED RENEW23 ABILITY STANDARDS.—Section 1882(q)(5)(C)

24 of such Act (42 U.S.C. 1395ss(q)(5)(C)) is
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1 amended by striking ‘‘$25,000’’ and inserting

2 ‘‘$50,000’’.

3 (E) VIOLATION OF LOSS RATIO STAND4 ARDS.—Section 1882(r)(6)(A) of such Act (42

5 U.S.C. 1395ss(r)(6)(A)) is amended by striking

6 ‘‘$25,000’’ and inserting ‘‘$50,000’’.

7 (F) VIOLATION OF PRE-EXISTING CONDI8 TION STANDARDS.—Section 1882(s)(3) of such

9 Act (42 U.S.C. 1395ss(s)(3)) is amended by

10 striking ‘‘$5,000’’ and inserting ‘‘$10,000’’.

11 (G) MEDICARE SELECT POLICIES.—Section

12 1882(t)(2) of such Act (42 U.S.C.

13 1395ss(t)(2)) is amended by striking ‘‘$25,000’’

14 and inserting ‘‘$50,000’’.

15 (14) VIOLATION OF HOME HEALTH PARTICIPA16 TION STANDARDS.—Section 1891 of such Act (42

17 U.S.C. 1395bbb) is amended—

18 (A) in subsection (a)(3)(D)(iii)(III), by

19 striking ‘‘$5,000’’ and inserting ‘‘$10,000’’;

20 (B) in subsection (c)(1), by striking

21 ‘‘$2,000’’ and inserting ‘‘$4,000’’ ; and

22 (C) in subsection (f)(2)(A)(i), by striking

23 ‘‘$10,000’’ and inserting ‘‘$20,000’’.

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

25 subsection (a) shall apply to civil monetary penalties im-
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1 posed with respect to acts or omissions occurring on or

2 after January 1, 1996.

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