I
104TH CONGRESS
2D SESSION
H. R. 3224
To improve Federal efforts to combat fraud and abuse against health care
programs, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 29, 1996
Mr. SCHIFF (for himself and Mr. SHAYS) introduced the following bill; which
was referred to the Committee on the Judiciary, and in addition to the
Committees on Government Reform and Oversight, Ways and Means, and
Commerce, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To improve Federal efforts to combat fraud and abuse
against health care programs, 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
‘‘Health Care Fraud and Abuse Prevention Act of 1996’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—COORDINATION OF FEDERAL ENFORCEMENT
Sec. 101. Federal enforcement by Inspectors General and Attorney General.
Sec. 102. State enforcement.
Sec. 103. Payments to States.
Sec. 104. Health Care Fraud and Abuse Control Account.
Sec. 105. Acceptance of gifts, bequests, and devises.
Sec. 106. Reimbursements of expenses and other payments to participating
agencies.
Sec. 107. Account Payments Advisory Board.
Sec. 108. Establishment of health care fraud and abuse data base.
Sec. 109. Definitions.
Sec. 110. Effective date.
TITLE II—REVISIONS TO CRIMINAL LAW
Sec. 201. Definition of Federal health care offense.
Sec. 202. Health care fraud.
Sec. 203. Theft or embezzlement.
Sec. 204. False Statements.
Sec. 205. Bribery and graft.
Sec. 206. Illegal remuneration with respect to health care benefit programs.
Sec. 207. Obstruction of criminal investigations of health care offenses.
Sec. 208. Civil penalties for violations of Federal health care offenses.
Sec. 209. Injunctive relief relating to health care offenses.
Sec. 210. Authorized investigative demand procedures.
Sec. 211. Grand jury disclosure.
Sec. 212. Miscellaneous amendments to title 18, United States code.
TITLE III—ANTI-FRAUD INITIATIVES UNDER MEDICARE AND
MEDICAID
Sec. 301. Revision to current penalties.
Sec. 302. Solicitation and publication of modifications to existing safe harbors
and new safe harbors; additional exception for certain discount-
ing and managed care arrangements.
Sec. 303. Expediting implementation of payment adjustments for durable medi-
cal equipment based upon inherent reasonableness.
Sec. 304. Requiring annual notice to medicare beneficiaries of need to prevent
fraud and abuse against medicare program.
Sec. 305. Requiring use of single provider number in submission of claims for
payment under medicare and medicaid.
Sec. 306. Liability of carriers and fiscal intermediaries for claims submitted by
excluded providers.
Sec. 307. Requiring fiscal intermediaries and carriers to use automated data
processing equipment comparable to equipment used in private
insurance business.
Sec. 308. Nondischargeability under bankruptcy code of amounts owed for over-
payments.
TITLE I—COORDINATION OF
FEDERAL ENFORCEMENT
SEC. 101. FEDERAL ENFORCEMENT BY INSPECTORS GEN-
ERAL AND ATTORNEY GENERAL.
(a) AUDITS, INVESTIGATIONS, INSPECTIONS, AND
EVALUATIONS.—
(1) IN GENERAL.—Except as provided in para-
graph (2), the Inspector General of each of the De-
partment of Health and Human Services, the De-
partment of Defense, the Department of Labor, the
Office of Personnel Management, and the Depart-
ment of Veterans Affairs, and the Attorney General
shall conduct audits, civil and criminal investiga-
tions, inspections, and evaluations relating to the
prevention, detection, and control of health care
fraud and abuse in violation of any Federal law.
(2) LIMITATION.—An Inspector General, other
than the Inspector General of the Department of
Health and Human Services, may not conduct any
audit, investigation, inspection, or evaluation under
paragraph (1) with respect to health care fraud or
abuse under title V, XI, XVIII, XIX, or XX of the
Social Security Act.
(b) POWERS.—For purposes of carrying out duties
and responsibilities under subsection (a), each Inspector
General referred to in subsection (a) may exercise powers
that are available to the Inspector General for purposes
of audits, investigations, and other activities under the In-
spector General Act of 1978 (5 U.S.C. App.).
(c) COORDINATION AND REVIEW OF ACTIVITIES OF
OTHER FEDERAL, STATE, AND LOCAL AGENCIES.—
(1) PROGRAM.—The Inspector General and the
Attorney General shall—
(A) jointly establish, on the effective date
specified in section 110(a), a program to pre-
vent, detect, and control health care fraud and
abuse in violation of any Federal law, which
takes into account the activities of Federal,
State, and local law enforcement agencies, Fed-
eral and State agencies responsible for the li-
censing and certification of health care provid-
ers, and State agencies designated under sec-
tion 102(a)(1); and
(B) publish a description of the program in
the Federal Register, by not later than 180
days after the date of the enactment of this
Act.
(2) ANNUAL INVESTIGATIVE PLAN.—Each In-
spector General referred to in subsection (a)(1) and
the Attorney General shall each develop an annual
investigative plan for the prevention, detection, and
control of health care fraud and abuse in accordance
with the program established under paragraph (1).
(d) CONSULTATIONS.—Each of the Inspectors Gen-
eral referred to in subsection (a)(1) and the Attorney Gen-
eral shall regularly consult with each other, with Federal,
State, and local law enforcement agencies, with Federal
and State agencies responsible for the licensing and cer-
tification of health care providers, and with Health Care
Fraud and Abuse Control Units, in order to assist in co-
ordinating the prevention, detection, and control of health
care fraud and abuse in violation of any federal law.
SEC. 102. STATE ENFORCEMENT.
(a) DESIGNATION OF STATE AGENCIES AND ESTAB-
LISHMENT OF HEALTH CARE FRAUD AND ABUSE CON-
TROL UNIT.—The Governor of each State—
(1) shall, consistent with State law, designate
agencies of the State which conduct, supervise, and
coordinate audits, civil and criminal investigations,
inspections, and evaluations relating to the preven-
tion, detection, and control of health care fraud and
abuse in violation of any Federal law in the State;
and
(2) may establish and maintain in accordance
with subsection (b) a State agency to act as a
Health Care Fraud and Abuse Control Unit for pur-
poses of this title.
(b) HEALTH CARE FRAUD AND ABUSE CONTROL
UNIT REQUIREMENTS.—A Health Care Fraud and Abuse
Control Unit established by a State under subsection
(a)(2) shall be a single identifiable entity of State govern-
ment which is separate and distinct from any State agency
with principal responsibility for the administration of
health care programs, and which meets the following re-
quirements:
(1) The entity—
(A) is a unit of the office of the State At-
torney General or of another department of
State government that possesses statewide au-
thority to prosecute individuals for criminal vio-
lations;
(B) is in a State the constitution of which
does not provide for the criminal prosecution of
individuals by a statewide authority, and has
formal procedures, approved by the Secretary,
that assure it will refer suspected criminal vio-
lations relating to health care fraud or abuse in
violation of any Federal law to the appropriate
authority or authorities of the State for pros-
given such term in section 24(a) of title 18, United
States Code.
(4) HEALTH CARE FRAUD AND ABUSE CONTROL
UNIT.—The term ‘‘Health Care Fraud and Abuse
Control Unit’’ means such a unit established by a
State in accordance with section 102(b).
(5) INSPECTOR GENERAL.—Except as otherwise
provided, the term ‘‘Inspector General’’ means the
Inspector General of the Department of Health and
Human Services.
(6) RESERVE
SUBACCOUNT.—The term ‘‘Re-
serve Subaccount’’ means the Health Care Fraud
and Abuse Reserve Subaccount of the Account.
SEC. 110. EFFECTIVE DATE.
(a) IN GENERAL.—Except as provided in subsection
(b), this title shall take effect after the expiration of the
180-day period which begins on the date of the enactment
of this Act.
(b) DEVELOPMENT AND PUBLICATION OF DESCRIP-
TION OF PROGRAM.—Section 101(c)(1) shall take effect
on the date of the enactment of this Act.