H. R. 3103—55
‘‘(A) The first sentence of paragraph (1) applies in lieu
of the first sentence of subsection (g)(1)(A).
‘‘(B) This subsection may not be construed as deeming
any free clinic to be an employee of the Public Health Service
for purposes of this section.
‘‘(C) With respect to a free clinic, a health care practitioner
is not a free clinic health professional unless the free clinic
sponsors the health care practitioner. For purposes of this
subsection, the free clinic shall be considered to be sponsoring
the health care practitioner if—
‘‘(i) with respect to the health care practitioner, the
free clinic submits to the Secretary an application meeting
the requirements of subsection (g)(1)(D); and
‘‘(ii) the Secretary, pursuant to subsection (g)(1)(E),
determines that the health care practitioner is deemed
to be an employee of the Public Health Service.
‘‘(D) In the case of a health care practitioner who is deter-
mined by the Secretary pursuant to subsection (g)(1)(E) to
be a free clinic health professional, this subsection applies
to the health care practitioner (with respect to the free clinic
sponsoring the health care practitioner pursuant to subpara-
graph (C)) for any cause of action arising from an act or
omission of the health care practitioner occurring on or after
the date on which the Secretary makes such determination.
‘‘(E) Subsection (g)(1)(F) applies to a health care practi-
tioner for purposes of this subsection only to the extent that,
in providing health services to an individual, each of the condi-
tions specified in paragraph (2) is met.
‘‘(6)(A) For purposes of making payments for judgments against
the United States (together with related fees and expenses of wit-
nesses) pursuant to this section arising from the acts or omissions
of free clinic health professionals, there is authorized to be appro-
priated $10,000,000 for each fiscal year.
‘‘(B) The Secretary shall establish a fund for purposes of this
subsection. Each fiscal year amounts appropriated under subpara-
graph (A) shall be deposited in such fund.
‘‘(C) Not later than May 1 of each fiscal year, the Attorney
General, in consultation with the Secretary, shall submit to the
Congress a report providing an estimate of the amount of claims
(together with related fees and expenses of witnesses) that, by
reason of the acts or omissions of free clinic health professionals,
will be paid pursuant to this section during the calendar year
that begins in the following fiscal year. Subsection (k)(1)(B) applies
to the estimate under the preceding sentence regarding free clinic
health professionals to the same extent and in the same manner
as such subsection applies to the estimate under such subsection
regarding officers, governing board members, employees, and con-
tractors of entities described in subsection (g)(4).
‘‘(D) Not later than December 31 of each fiscal year, the Sec-
retary shall transfer from the fund under subparagraph (B) to
the appropriate accounts in the Treasury an amount equal to the
estimate made under subparagraph (C) for the calendar year begin-
ning in such fiscal year, subject to the extent of amounts in the
fund.
‘‘(7)(A) This subsection takes effect on the date of the enactment
of the first appropriations Act that makes an appropriation under
paragraph (6)(A), except as provided in subparagraph (B)(i).
H. R. 3103—56
‘‘(B)(i) Effective on the date of the enactment of the Health
Insurance Portability and Accountability Act of 1996—
‘‘(I) the Secretary may issue regulations for carrying out
this subsection, and the Secretary may accept and consider
applications submitted pursuant to paragraph (5)(C); and
‘‘(II) reports under paragraph (6)(C) may be submitted to
the Congress.
‘‘(ii) For the first fiscal year for which an appropriation is
made under subparagraph (A) of paragraph (6), if an estimate
under subparagraph (C) of such paragraph has not been made
for the calendar year beginning in such fiscal year, the transfer
under subparagraph (D) of such paragraph shall be made notwith-
standing the lack of the estimate, and the transfer shall be made
in an amount equal to the amount of such appropriation.’’.
SEC. 195. FINDINGS; SEVERABILITY.
(a) FINDINGS RELATING TO EXERCISE OF COMMERCE CLAUSE
AUTHORITY.—Congress finds the following in relation to the provi-
sions of this title:
(1) Provisions in group health plans and health insurance
coverage that impose certain preexisting condition exclusions
impact the ability of employees to seek employment in inter-
state commerce, thereby impeding such commerce.
(2) Health insurance coverage is commercial in nature and
is in and affects interstate commerce.
(3) It is a necessary and proper exercise of Congressional
authority to impose requirements under this title on group
health plans and health insurance coverage (including coverage
offered to individuals previously covered under group health
plans) in order to promote commerce among the States.
(4) Congress, however, intends to defer to States, to the
maximum extent practicable, in carrying out such requirements
with respect to insurers and health maintenance organizations
that are subject to State regulation, consistent with the provi-
sions of the Employee Retirement Income Security Act of 1974.
(b) SEVERABILITY.—If any provision of this title or the applica-
tion of such provision to any person or circumstance is held to
be unconstitutional, the remainder of this title and the application
of the provisions of such to any person or circumstance shall not
be affected thereby.
TITLE II—PREVENTING HEALTH CARE
FRAUD AND ABUSE; ADMINISTRATIVE
SIMPLIFICATION
SEC. 200. REFERENCES IN TITLE.
Except as otherwise specifically provided, whenever in this
title an amendment is expressed in terms of an amendment to
or repeal of a section or other provision, the reference shall be
considered to be made to that section or other provision of the
Social Security Act.
H. R. 3103—57
Subtitle A—Fraud and Abuse Control
Program
SEC. 201. FRAUD AND ABUSE CONTROL PROGRAM.
(a) ESTABLISHMENT OF PROGRAM.—Title XI (42 U.S.C. 1301
et seq.) is amended by inserting after section 1128B the following
new section:
‘‘FRAUD AND ABUSE CONTROL PROGRAM
‘‘SEC. 1128C. (a) ESTABLISHMENT OF PROGRAM.—
‘‘(1) IN GENERAL.—Not later than January 1, 1997, the
Secretary, acting through the Office of the Inspector General
of the Department of Health and Human Services, and the
Attorney General shall establish a program—
‘‘(A) to coordinate Federal, State, and local law enforce-
ment programs to control fraud and abuse with respect
to health plans,
‘‘(B) to conduct investigations, audits, evaluations, and
inspections relating to the delivery of and payment for
health care in the United States,
‘‘(C) to facilitate the enforcement of the provisions of
sections 1128, 1128A, and 1128B and other statutes
applicable to health care fraud and abuse,
‘‘(D) to provide for the modification and establishment
of safe harbors and to issue advisory opinions and special
fraud alerts pursuant to section 1128D, and
‘‘(E) to provide for the reporting and disclosure of cer-
tain final adverse actions against health care providers,
suppliers, or practitioners pursuant to the data collection
system established under section 1128E.
‘‘(2) COORDINATION WITH HEALTH PLANS.—In carrying out
the program established under paragraph (1), the Secretary
and the Attorney General shall consult with, and arrange for
the sharing of data with representatives of health plans.
‘‘(3) GUIDELINES.—
‘‘(A) IN
GENERAL.—The Secretary and the Attorney
General shall issue guidelines to carry out the program
under paragraph (1). The provisions of sections 553, 556,
and 557 of title 5, United States Code, shall not apply
in the issuance of such guidelines.
‘‘(B) INFORMATION GUIDELINES.—
‘‘(i) IN
GENERAL.—Such guidelines shall include
guidelines relating to the furnishing of information
by health plans, providers, and others to enable the
Secretary and the Attorney General to carry out the
program (including coordination with health plans
under paragraph (2)).
‘‘(ii) 
CONFIDENTIALITY.—Such 
guidelines 
shall
include procedures to assure that such information
is provided and utilized in a manner that appropriately
protects the confidentiality of the information and the
privacy of individuals receiving health care services
and items.
‘‘(iii) 
QUALIFIED
IMMUNITY
FOR
PROVIDING
INFORMATION.—The provisions of section 1157(a) (relat-
H. R. 3103—58
ing to limitation on liability) shall apply to a person
providing information to the Secretary or the Attorney
General in conjunction with their performance of duties
under this section.
‘‘(4) ENSURING ACCESS TO DOCUMENTATION.—The Inspector
General of the Department of Health and Human Services
is authorized to exercise such authority described in paragraphs
(3) through (9) of section 6 of the Inspector General Act of
1978 (5 U.S.C. App.) as necessary with respect to the activities
under the fraud and abuse control program established under
this subsection.
‘‘(5) AUTHORITY OF INSPECTOR GENERAL.—Nothing in this
Act shall be construed to diminish the authority of any Inspec-
tor General, including such authority as provided in the Inspec-
tor General Act of 1978 (5 U.S.C. App.).
‘‘(b) ADDITIONAL USE OF FUNDS BY INSPECTOR GENERAL.—
‘‘(1) REIMBURSEMENTS FOR INVESTIGATIONS.—The Inspector
General of the Department of Health and Human Services
is authorized to receive and retain for current use reimburse-
ment for the costs of conducting investigations and audits and
for monitoring compliance plans when such costs are ordered
by a court, voluntarily agreed to by the payor, or otherwise.
‘‘(2) CREDITING.—Funds received by the Inspector General
under paragraph (1) as reimbursement for costs of conducting
investigations shall be deposited to the credit of the appropria-
tion from which initially paid, or to appropriations for similar
purposes currently available at the time of deposit, and shall
remain available for obligation for 1 year from the date of
the deposit of such funds.
‘‘(c) HEALTH PLAN DEFINED.—For purposes of this section, the
term ‘health plan’ means a plan or program that provides health
benefits, whether directly, through insurance, or otherwise, and
includes—
‘‘(1) a policy of health insurance;
‘‘(2) a contract of a service benefit organization; and
‘‘(3) a membership agreement with a health maintenance
organization or other prepaid health plan.’’.
(b) ESTABLISHMENT OF HEALTH CARE FRAUD AND ABUSE CON-
TROL ACCOUNT IN FEDERAL HOSPITAL INSURANCE TRUST FUND.—
Section 1817 (42 U.S.C. 1395i) is amended by adding at the end
the following new subsection:
‘‘(k) HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT.—
‘‘(1) ESTABLISHMENT.—There is hereby established in the
Trust Fund an expenditure account to be known as the ‘Health
Care Fraud and Abuse Control Account’ (in this subsection
referred to as the ‘Account’).
‘‘(2) APPROPRIATED AMOUNTS TO TRUST FUND.—
‘‘(A) IN GENERAL.—There are hereby appropriated to
the Trust Fund—
‘‘(i) such gifts and bequests as may be made as
provided in subparagraph (B);
‘‘(ii) such amounts as may be deposited in the
Trust Fund as provided in sections 242(b) and 249(c)
of the Health Insurance Portability and Accountability
Act of 1996, and title XI; and
‘‘(iii) such amounts as are transferred to the Trust
Fund under subparagraph (C).