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103D CONGRESS

1ST SESSION H. R. 671

To establish a national commission on health care fraud and abuse.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 27, 1993

Mr. DURBIN (for himself, Ms. SNOWE, Mr. HUGHES, Mr. HALL of Ohio, Mrs.

UNSOELD, Mr. BACCHUS of Florida, and Mr. DEFAZIO) introduced the

following bill; which was referred to the Committee on Energy and Commerce

A BILL

To establish a national commission on health care fraud

and abuse.

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 ‘‘Ted Weiss Memorial

5 Health Care Fraud and Abuse Commission Act of 1993’’.

6 SEC. 2. ESTABLISHMENT OF NATIONAL HEALTH CARE

7 FRAUD AND ABUSE COMMISSION.

8 (a) IN GENERAL.—There is established a commission

9 to be known as the ‘‘Ted Weiss Memorial Health Care
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1 Fraud and Abuse Commission’’ (in this Act referred to

2 as the ‘‘Commission’’).

3 (b) COMPOSITION.—The Commission shall be com4 posed of 18 members as follows:

5 (1) OFFICIALS.—

6 (A) The Secretary of Health and Human

7 Services (or the Secretary’s designee).

8 (B) The Inspector General of the Depart9 ment of Health and Human Services (or the In10 spector General’s designee).

11 (C) The Attorney General (or the Attorney

12 General’s designee).

13 (D) The Director of the Federal Bureau of

14 Investigation (or the Director’s designee).

15 (E) The Administrator of the Health Care

16 Financing Administration (or the Administra17 tor’s designee).

18 (2) PUBLIC MEMBERS.—Thirteen members, ap19 pointed by the President, of which—

20 (A) one shall be an Attorney General of a

21 State;

22 (B) one shall be a representative of State

23 medicaid fraud control programs;

24 (C) one shall be a State official directly re25 sponsible for regulation of health insurance;
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1 (D) one shall be a representative of physi2 cians;

3 (E) one shall be a representative of hos4 pital administrators;

5 (F) one shall be a representative of health

6 insurance companies;

7 (G) one shall be a representative of em8 ployers who self-fund employee health benefit

9 plans;

10 (H) one shall be a representative of em11 ployers who purchase a health benefit plan from

12 a health insurance company;

13 (I) one shall be a representative of medi14 care carriers;

15 (J) one shall be a representative of medi16 care peer review organizations;

17 (K) one shall be a representative of health

18 care consumers;

19 (L) one shall be a representative of medi20 care beneficiaries; and

21 (M) one shall be a representative of labor

22 unions.

23 In making appointments under this paragraph of an

24 individual who is a representative of persons or or25 ganizations, the President shall consider the rec-
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1 ommendations of national organizations that rep2 resent such persons or organizations. The President

3 shall report to Congress, within 90 days after the

4 date of the enactment of this Act, the names of the

5 members appointed under this paragraph.

6 (c) TERMS.—Each member shall be appointed for the

7 life of the Commission. A vacancy in the Commission shall

8 be filled in the manner in which the original appointment

9 was made.

10 SEC. 3. FUNCTIONS OF COMMISSION.

11 (a) IN GENERAL.—The Commission shall—

12 (1) investigate the nature, magnitude, and cost

13 of health care fraud and abuse in the United States,

14 and

15 (2) identify and develop the most effective

16 methods of preventing, detecting, and prosecuting or

17 litigating such fraud and abuse, with particular em18 phasis on coordinating public and private prevention,

19 detection, and enforcement efforts.

20 (b) PARTICULARS.—Among other items, the Commis21 sion shall examine at least the following:

22 (1) Mechanisms to provide greater standardiza23 tion of claims administration in order to accommo24 date fraud prevention and detection.
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1 (2) Mechanisms to allow more freedom of

2 health benefit plans to exchange information for co3 ordinating case development and prosecution or liti4 gation efforts, without undermining patient and pro5 vider privacy protections or violating anti-trust laws.

6 (3) The extension to private health insurers of

7 administrative remedies currently available to public

8 insurers.

9 (4) Mechanisms for private insurers to organize

10 and finance investigation and litigation efforts when

11 more than one insurer may have received fraudulent

12 claims from a provider.

13 (5) Creating a model State statute for estab14 lishing State insurance fraud units and State laws to

15 strengthen insurers’ ability to pursue and recover

16 from fraudulent providers.

17 (6) The need for regulation of new types of

18 health care providers.

19 (7) Criteria for physician referrals to facilities

20 in which they (or family members) have a financial

21 interest.

22 (8) The availability of resources to law enforce23 ment authorities to combat health care fraud and

24 abuse.
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1 (c) REPORT.—After approval by a majority vote, a

2 quorum being present, the Commission shall transmit to

3 Congress a report on its activities. The report shall be

4 transmitted not later than 18 months after the date that

5 a majority of the public members of the Commission have

6 been appointed. The report shall contain a detailed state7 ment of the Commission’s findings, together with such rec8 ommendations as the Commission considers appropriate.

9 SEC. 4. ORGANIZATION AND COMPENSATION.

10 (a) ORGANIZATION.—

11 (1) QUORUM.—A majority of the members of

12 the Commission shall constitute a quorum but a

13 lesser number may hold hearings.

14 (2) CHAIRMAN.—The Commission shall elect

15 one of its members to serve as chairman of the Com16 mission.

17 (3) MEETINGS.—The Commission shall meet at

18 the call of the chairman or a majority of its mem19 bers. Meetings of the Commission are open to the

20 public under section 10(a)(10) of the Federal Advi21 sory Committee Act, except that the Commission

22 may conduct meets in executive session but only if

23 a majority of the members of the Commission (a

24 quorum being present) approve going into executive

25 session.
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1 (b) COMPENSATION OF MEMBERS.—Members of the

2 Commission shall serve without compensation, but shall

3 be reimbursed for travel, subsistence, and other necessary

4 expenses incurred in the performance of their duties as

5 members of the Commission.

6 SEC. 5. STAFF OF COMMISSION.

7 (a) IN GENERAL.—The Commission may appoint and

8 fix the compensation of a staff director and such other

9 additional personnel as may be necessary to enable the

10 Commission to carry out its functions, without regard to

11 the laws, rules, and regulations governing appointment

12 and compensation and other conditions of service in the

13 competitive service.

14 (b) DETAIL OF FEDERAL EMPLOYEES.—Upon re15 quest of the chairman, any Federal employee who is sub16 ject to such laws, rules, and regulations, may be detailed

17 to the Commission to assist it in carrying out its functions

18 under this Act, and such detail shall be without interrup19 tion or loss of civil service status or privilege.

20 (c) EXPERTS AND CONSULTANTS.—The Commission

21 may procure temporary and intermittent services under

22 section 3109(b) of title 5, United States Code, but at rates

23 for individuals not to exceed the daily equivalent of 120

24 percent of the maximum annual rate of basic pay payable

25 for GS–15 of the General Schedule.
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1 SEC. 6. AUTHORITY OF COMMISSION.

2 (a) HEARINGS AND SESSIONS.—The Commission

3 may, for the purpose of carrying out this Act, hold hear4 ings, sit and act at times and places, take testimony, and

5 receive evidence as the Commission considers appropriate.

6 The Commission may administer oaths or affirmations to

7 witnesses appearing before it.

8 (b) OBTAINING OFFICIAL DATA.—

9 (1) IN GENERAL.—The Commission may secure

10 directly from any department or agency of the

11 United States information necessary to enable it to

12 carry out this Act. Upon request of the chairman of

13 the Commission, the head of that department or

14 agency shall furnish that information to the Com15 mission.

16 (2) ACCESS TO INFORMATION.—Information ob17 tained by the Commission is available to the public

18 in the same manner in which information may be

19 made available under sections 552 and 552a of title

20 5, United States Code.

21 (c) GIFTS, BEQUESTS, AND DEVISES.—The Commis22 sion may accept, use, and dispose of gifts, bequests, or

23 devises of services or property for the purpose of aiding

24 or facilitating the work of the Commission.

25 (d) MAILS.—The Commission may use the United

26 States mails in the same manner and under the same con-
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1 ditions as other departments and agencies of the United

2 States.

3 (e) ADMINISTRATIVE SUPPORT SERVICES.—Upon

4 the request of the Commission, the Administrator of Gen5 eral Services shall provide to the Commission, on a reim6 bursable basis, the administrative support services nec7 essary for the Commission to carry out its responsibilities

8 under this Act.

9 (f) SUBPOENA POWER.—

10 (1) IN GENERAL.—The Commission may issue

11 subpoenas requiring the attendance and testimony of

12 witnesses and the production of any evidence relat13 ing to any matter which the Commission is author14 ized to investigate under this Act. The attendance of

15 witnesses and the production of evidence may be re16 quired from any place within the United States at

17 any designated place of hearing within the United

18 States.

19 (2) FAILURE TO OBEY A SUBPOENA.—If a per20 son refuses to obey a subpoena issued under para21 graph (1), the Commission may apply to a United

22 States district court for an order requiring that per23 son to appear before the Commission to give testi24 mony, produce evidence, or both, relating to the

25 matter under investigation. The application may be
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1 made within the judicial district where the hearing

2 is conducted or where that person is found, resides,

3 or transacts business. Any failure to obey the order

4 of the court may be punished by the court as civil

5 contempt.

6 (3) SERVICE OF SUBPOENAS.—The subpoenas

7 of the Commission shall be served in the manner

8 provided for subpoenas issued by a United States

9 district court under the Federal Rules of Civil Pro10 cedure for the United States district courts.

11 (4) SERVICE OF PROCESS.—All process of any

12 court to which application is to be made under para13 graph (2) may be served in the judicial district in

14 which the person required to be served resides or

15 may be found.

16 SEC. 7. TERMINATION.

17 The Commission shall terminate 90 days after the

18 date the report is submitted under section 3(c).

19 SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

20 There are authorized to be appropriated to the Com21 mission such sums as are necessary to carry out its func22 tions, to remain available until expended.

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