I
107TH CONGRESS
1ST SESSION
H. R. 18
To amend title XVIII of the Social Security Act to establish additional
provisions to combat waste, fraud, and abuse within the Medicare Pro-
gram, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 3, 2001
Mrs. BIGGERT introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committees on Energy
and Commerce, and the Judiciary, for a period to be subsequently deter-
mined 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 establish
additional provisions to combat waste, fraud, and abuse
within the Medicare Program, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Fraud Prevention and Enforcement Act of
2001’’.
(b) TABLE OF CONTENTS.—The table of contents for
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Site inspections and background checks.
Sec. 3. Registration of billing agencies.
Sec. 4. Expanded access to the health integrity protection database (HIPDB).
Sec. 5. Liability of medicare carriers and fiscal intermediaries for claims sub-
mitted by excluded providers.
Sec. 6. Community mental health centers.
Sec. 7. Limiting the use of discharge in bankruptcy proceedings for provider li-
ability for health care fraud.
Sec. 8. Illegal distribution of a medicare or medicaid beneficiary identification
or provider number.
Sec. 9. Treatment of certain Social Security Act crimes as Federal health care
offenses.
Sec. 10. Authority of Office of Inspector General of the Department of Health
and Human Services.
Sec. 11. Universal product numbers on claims forms for reimbursement under
the medicare program.
SEC. 2. SITE INSPECTIONS AND BACKGROUND CHECKS.
(a) SITE INSPECTIONS FOR DME SUPPLIERS, COM-
MUNITY MENTAL HEALTH CENTERS, AND OTHER PRO-
VIDER GROUPS.—Title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) is amended by adding at the end
the following:
‘‘SITE INSPECTIONS FOR DME SUPPLIERS, COMMUNITY
MENTAL HEALTH CENTERS, AND OTHER PROVIDER
GROUPS
‘‘SEC. 1897. (a) SITE INSPECTIONS.—
‘‘(1) IN GENERAL.—The Secretary shall con-
duct a site inspection for each applicable provider
(as defined in paragraph (2)) that applies for a pro-
vider number in order to provide items or services
under this title. Such site inspection shall be in addi-
tion to any other site inspection that the Secretary
would otherwise conduct with regard to an applica-
ble provider.
‘‘(2) APPLICABLE PROVIDER DEFINED.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), in this section the term ‘ap-
plicable provider’ means—
‘‘(i) a supplier of durable medical
equipment (including items described in
section 1834(a)(13));
‘‘(ii) 
a 
supplier 
of 
prosthetics,
orthotics, or supplies (including items de-
scribed in paragraphs (8) and (9) of sec-
tion 1861(s));
‘‘(iii) a community mental health cen-
ter; or
‘‘(iv) any other provider group, as de-
termined by the Secretary.
‘‘(B) EXCEPTION.—In this section, the
term ‘applicable provider’ does not include—
‘‘(i) a physician that provides durable
medical equipment (as described in sub-
paragraph (A)(i)) or prosthetics, orthotics,
or supplies (as described in subparagraph
(A)(ii)) to an individual as incident to an
office visit by such individual; or
‘‘(ii) a hospital that provides durable
medical equipment (as described in sub-
paragraph (A)(i)) or prosthetics, orthotics,
or supplies (as described in subparagraph
(A)(ii)) to an individual as incident to an
emergency room visit by such individual.
‘‘(b) STANDARDS
AND REQUIREMENTS.—In con-
ducting the site inspection pursuant to subsection (a), the
Secretary shall ensure that the site being inspected is in
full compliance with all the conditions and standards of
participation and requirements for obtaining medicare bill-
ing privileges under this title.
‘‘(c) TIME.—The Secretary shall conduct the site in-
spection for an applicable provider prior to the issuance
of a provider number to such provider.
‘‘(d) TIMELY REVIEW.—The Secretary shall provide
for procedures to ensure that the site inspection required
under this section does not unreasonably delay the
issuance of a provider number to an applicable provider.’’.
(b) BACKGROUND CHECKS.—Title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) (as amended
by subsection (a)) is amended by adding at the end the
following:
‘‘BACKGROUND CHECKS
‘‘SEC. 1898. (a) BACKGROUND CHECK REQUIRED.—
Except as provided in subsection (b), the Secretary shall
conduct a background check on any individual or entity
that applies to the Secretary for a provider number for
the purpose of furnishing any item or service under this
title. In performing the background check, the Secretary
shall—
‘‘(1) conduct the background check before
issuing a provider number to an individual or entity;
‘‘(2) include a search of criminal records in the
background check; and
‘‘(3) provide for procedures that ensure the
background check does not unreasonably delay the
issuance of a provider number to an eligible indi-
vidual or entity.
‘‘(b) USE OF STATE LICENSING PROCEDURE.—The
Secretary may use the results of a State licensing proce-
dure as a background check under subsection (a) if the
State licensing procedure meets the requirements of sub-
section (a).
‘‘(c) ATTORNEY GENERAL REQUIRED TO PROVIDE
INFORMATION.—
‘‘(1) IN GENERAL.—Upon request of the Sec-
retary, the Attorney General shall provide the crimi-
nal background check information referred to in sub-
section (a)(2) to the Secretary.
‘‘(2) RESTRICTION ON USE OF DISCLOSED IN-
FORMATION.—The Secretary may only use the infor-
mation disclosed under subsection (a) for the pur-
pose of carrying out the Secretary’s responsibilities
under this title.
‘‘(d) REFUSAL TO ISSUE PROVIDER NUMBER.—
‘‘(1) AUTHORITY.—In addition to any other
remedy available to the Secretary, the Secretary may
refuse to issue a provider number to an individual
or entity if the Secretary determines, after a back-
ground check conducted under this section, that
such individual or entity has a history of acts that
indicate issuance of a provider number to such indi-
vidual or entity would be detrimental to the best in-
terests of the program or program beneficiaries.
Such acts may include, but are not limited to—
‘‘(A) any bankruptcy;
‘‘(B) any act resulting in a civil judgment
against such individual or entity; or
‘‘(C) any felony conviction under Federal
or State law.
‘‘(2) REPORTING OF REFUSAL TO ISSUE PRO-
VIDER NUMBER TO THE HEALTH INTEGRITY PRO-
TECTION
DATABASE
(HIPDB).—A determination to
refuse to issue a provider number to an individual
SEC. 10. AUTHORITY OF OFFICE OF INSPECTOR GENERAL
OF 
THE 
DEPARTMENT 
OF 
HEALTH 
AND
HUMAN SERVICES.
(a) AUTHORITY.—Notwithstanding any other provi-
sion of law, upon designation by the Inspector General of
the Department of Health and Human Services, any
criminal investigator of the Office of Inspector General of
such department may, in accordance with guidelines
issued by the Secretary of Health and Human Services
and approved by the Attorney General, while engaged in
activities within the lawful jurisdiction of such Inspector
General—
(1) obtain and execute any warrant or other
process issued under the authority of the United
States;
(2) make an arrest without a warrant for—
(A) any offense against the United States
committed in the presence of such investigator;
or
(B) any felony offense against the United
States, if such investigator has reasonable cause
to believe that the person to be arrested has
committed or is committing that felony offense;
and