‘‘§ 1103. Civil action
‘‘Any person injured in business or property by a vio-
lation of this chapter may in a civil action recover treble
damages. The court may award the prevailing party a rea-
sonable attorney’s fee as a part of the costs.
‘‘§ 1104. Definitions
‘‘As used in this chapter—
‘‘(1) the term ‘health care payment’ means a
payment for health care services or health care prod-
ucts, or the right to have a payment made by a third
party payer for specified health care services or
products; and
‘‘(2) the term ‘third party payer’ means any
person, public or private, who undertakes to indem-
nify another against loss arising from a contingent
or unknown event.’’.
(b) CLERICAL AMENDMENT.—The table of chapters
at the beginning of part I of title 18, United States Code,
is amended by inserting after the item relating to chapter
50A the following new item:
‘‘50B. Health care fraud .................................................................. 1101.’’.
SEC. 3. INJUNCTIONS FOR HEALTH CARE FRAUD.
Section 1345(a) of title 18, United States Code, is
amended—
(1) in paragraph (1)(A), by striking ‘‘or 1001’’
and inserting ‘‘1001, 1101, or 1102’’; and
(2) in paragraph (a)(2), by inserting ‘‘a viola-
tion of section 1101 or 1102 of this title or’’ after
‘‘as a result of’’.
SEC. 4. CRIMINAL FORFEITURE OF FRAUD PROCEEDS.
Section 982(a)(2)(B) of title 18, United States Code,
is amended—
(1) by inserting ‘‘1101, 1102,’’ after ‘‘844,’’;
and
(2) by striking ‘‘or 1030’’ and inserting ‘‘1030,
or 1347’’.
SEC. 5. REWARDS FOR INFORMATION LEADING TO PROS-
ECUTION AND CONVICTION.
Section 3059 of title 18, United States Code, is
amended by adding at the end the following:
‘‘(d)(1) The Attorney General may pay a reward of—
‘‘(A) an amount determined under paragraph
(2) of this subsection, in the case of an offense in
which the United States is a victim and restitution
or a civil recovery is obtained by the United States;
or
‘‘(B) not more than $100,000, in any other
case;
to any person who furnishes information or services that
lead to a conviction under section 1101 or 1102 of this
title.
‘‘(2) The amount referred to in paragraph (1)(A) of
this subsection is an amount equal to—
‘‘(A) not more than 30 percent of the first
$1,000,000 of the recovery;
‘‘(B) not more than 20 percent of the next
$4,000,000; and
‘‘(C) not more than 5 percent of the remaining
portion of the recovery.
‘‘(3) An officer or employee of the United States or
of a State or local government who furnishes information
or renders services in the performance of official duty is
ineligible for a payment under this subsection with respect
to such information or services.’’.
SEC. 6. HEALTH CARE FRAUD TASK FORCES.
(a) IN GENERAL.—The Attorney General, in con-
sultation with the Secretary of Health and Human Serv-
ices, shall establish regional health care fraud task forces
(hereinafter in this section referred to as ‘‘task forces’’).
(b) PURPOSE.—The purpose of the task forces is to
ensure that adequate resources are made available to iden-
tify, investigate, and prosecute health care fraud and to
recover the proceeds of such fraud and other criminal ac-
tivity against health insurers.
(c) DUTIES.—Each such task force shall coordinate
the investigative and prosecutorial efforts within their re-
gion, as determined by the Attorney General.
(d) PARTICIPANTS.—The Federal agencies that shall
participate in the task forces are—
(1) the Department of Justice (including the
Federal Bureau of Investigation);
(2) the Department of Health and Human
Services (including the Food and Drug Administra-
tion and the Office of the Inspector General);
(3) the Internal Revenue Service;
(4) the United States Postal Inspection Service;
and
(5) the Department of Veterans Affairs.
(e) LOCATIONS.—The task forces shall be established
in such cities as the Attorney General deems appropriate.
(f) OBJECTIVES.—The objective of each task force
shall be—
(1) to target, investigate, and prosecute individ-
uals who organize, direct, finance, or are otherwise
engaged in health care fraud;
(2) to promote a coordinated health care fraud
enforcement effort in each task force region, and to
encourage maximum cooperation among all Federal
agencies;
(3) to work fully and effectively with State and
local law enforcement agencies; and
(4) to make full use of financial investigative
techniques, on behalf of both public and private enti-
ties, to maximize recovery of proceeds of unlawful
activities from persons who have committed health
care fraud crimes or have engaged in other criminal
activity in or against the health insurance industry.
(g) STANDARDS FOR TASK FORCE CASES.—Each
task force should focus upon significant investigations of
major health care fraud cases, or organizations engaging
in health care fraud, that warrant the involvement of more
than one investigative agency or that require significant
resources during the investigative stage.
(h) ADMINISTRATION.—The administrative functions
of the national task force program will be performed by
an executive office to be established within the Depart-
ment of Justice in Washington, D.C. It shall be supervised
by a Director, and the staff shall consist of professional
and support staff deemed necessary for the performance
of management and administrative functions.
(i) OVERSIGHT.—An Executive Review Board shall
oversee the task force program. It shall be composed of
ranking officials from each of the participating Federal
agencies and the Advisory Committee of the United States
Attorneys. Its role shall be to articulate policy, review allo-
cation of resources and coordinate the development and
maintenance of the task force program. The Board shall
also be responsible for resolving policy disputes that can-
not be resolved within or among the regional task forces
or the participating agencies. The Board shall meet no less
frequently than quarterly.
(j) GUIDELINES.—The Attorney General shall, in
consultation with the Executive Review Board, establish
guidelines for the operation and management of the task
force program.
SEC. 7. NATIONAL HEALTH CARE FRAUD AND ABUSE DATA
BASE.
(a) IN GENERAL.—The Attorney General, in con-
sultation with the Secretary of Health and Human Serv-
ices, shall establish a data base for the reporting of final
adverse actions against health care providers, suppliers,
or practitioners, in order to provide a central repository
of such information to assist in the prevention, detection,
and prosecution of health care fraud and abuse.
(b) REPORTING OF INFORMATION.—
(1) IN
GENERAL.—Each government agency
and health care plan shall report any final adverse
action taken against a health care provider, supplier,
or practitioner.
(2) INFORMATION TO BE REPORTED.—The in-
formation to be reported under paragraph (1) in-
cludes the following:
(A) The name of any health care provider,
supplier, or practitioner who is the subject of a
final adverse action.
(B) The name (if known) of any health
care entity with which a health care provider,
supplier, or practitioner is affiliated or associ-
ated.
(C) The nature of the final adverse action.
(D) A description of the acts or omissions
and injuries upon which the final adverse action
was based, and such other information as re-
quired by the Attorney General.
(3) CONFIDENTIALITY.—The Attorney General
shall establish procedures to assure that the privacy
of individuals receiving health care services is appro-
priately protected.
(4) FORM AND MANNER OF REPORTING.—The
information required to be reported under this sub-
section shall be reported on a monthly basis and in
such form and manner as determined by the Attor-
ney General. Such information shall first be required
to be reported on a date specified by the Attorney
General.
(5) TO WHOM REPORTED.—The information re-
quired to be reported under this subsection shall be
reported to the Attorney General or such person or
persons designated by the Attorney General.
(c) CORRECTION OF ERRONEOUS INFORMATION.—
(1) DISCLOSURE AND CORRECTION.—The At-
torney General shall provide for a procedure through
which a person, to whom information within the
data base established under this section pertains,
may review that information and obtain the correc-
tion of errors pertaining to that person.
(2) OTHER CORRECTIONS.—Each Government
agency and health care plan shall report corrections
of information already reported about any final ad-
verse action taken against a health care provider,
supplier, or practitioner, in such form and manner
as required by the Attorney General.
(d) ACCESS TO REPORTED INFORMATION.—
(1) AVAILABILITY.—The information in this
data base shall be available to the public, Federal
and State government agencies, and health care
plans pursuant to procedures established by the
Attorney General.
(2) FEES.—The Attorney General may estab-
lish reasonable fees for the disclosure of information
in this data base.
(e) PROTECTION FROM LIABILITY
FOR REPORT-
ING.—No person or entity shall be held liable in any civil
action with respect to any report made as required by this
section, without knowledge of the falsity of the informa-
tion contained in the report.
(f) DEFINITIONS AND SPECIAL RULES.—For pur-
poses of this section:
(1) The term ‘‘final adverse action’’ includes
the following:
(A) Civil judgments in Federal or State
court related to the delivery of a health care
item or service.
(B) Federal or State criminal convictions
related to the delivery of a health care item or
service.
(C) Actions by State or Federal agencies
responsible for the licensing and certification of
health care providers, suppliers, and licensed
health care practitioners, including—
(i) formal or official actions, such as
revocation or suspension of a license (and
the length of any such suspension), rep-
rimand, censure or probation,
(ii) any other loss of license of the
provider, supplier, or practitioner, whether
by operation of law, voluntary surrender or
otherwise, or
(iii) any other negative action or find-
ing by such State or Federal agency that
is publicly available information.
(D) Exclusion from participation in Fed-
eral or State health care programs.
(E) Any other actions as required by the
Attorney General.
(2) The terms ‘‘licensed health care practi-
tioner’’, ‘‘licensed practitioner’’, and ‘‘practitioner’’
mean, with respect to a State, an individual who is
licensed or otherwise authorized by the State to pro-
vide health care services (or any individual who,
without authority holds himself or herself out to be
so licensed or authorized).
(3) The term ‘‘health care provider’’ means a
provider of services as defined in section 1861(u) of
the Social Security Act, and any entity, including a
health maintenance organization, group medical
practice, or any other entity listed by the Secretary
in regulation, that provides health care services.
(4) The term ‘‘supplier’’ means a supplier of
health care items and services described in sections
1819 (a) and (b), and section 1861 of the Social Se-
curity Act.
(5) The term ‘‘Government agency’’ includes—
(A) The Department of Justice.
(B) The Department of Health and
Human Services.
(C) Any other Federal agency that either
administers or provides payment for the deliv-
ery of health care services, including, but not
limited to the Departments of Defense and Vet-
erans Affairs.
(D) State law enforcement agencies.
(E) State Medicaid fraud and abuse units.
(F) State or Federal agencies responsible
for the licensing and certification of health care
providers and licensed health care practitioners.
(6) The term ‘‘health care plan’’ has the mean-
ing given to such term by section 1128(i) of the
Social Security Act.
(7) For purposes of paragraph (2), the exist-
ence of a conviction shall be determined under para-
graph (4) of section 1128(j) of the Social Security
Act.
SEC. 8. NATIONAL HEALTH CARE FRAUD AND ABUSE HOT-
LINE.
The Attorney General shall—
(1) establish a national, toll-free health care
fraud and abuse hotline to enable all persons, includ-
ing health care consumers, providers, and insurers,
to report (anonymously, if so desired) suspected in-
stances of health care fraud or abuse;
(2) provide for the appropriate referral of all in-
formation that is obtained through the hot line; and
(3) assure that the public is provided adequate
publicity about the existence and capabilities of the
hotline.
SEC. 9. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated for fiscal
year 1997 for the purposes of carrying out this Act and
the amendments made by this Act—
(1) $23,000,000 for the Federal Bureau of In-
vestigation to hire, equip, and train no fewer than
225 special agents and support staff to investigate
health-care fraud cases;
(2) $5,000,000 to hire, equip, and train no
fewer than 50 assistant United States Attorneys and
support staff to prosecute health-care fraud cases;
(3) $6,000,000 to hire, equip, and train no
fewer than 50 investigators in the Office of Inspec-
tor General, Department of Health and Human
Services, to be devoted exclusively to health-care
fraud cases;
(4) $2,000,000 to establish, operate, and ad-
minister health-care fraud task forces;
(5) $2,000,000 to establish, operate, publicize,
and administer the national health-care fraud and
abuse data base; and
(6) $2,000,000 to establish, operate, publicize,
and administer the national health-care fraud and
abuse hotline.
SEC. 10. SCHEMES AND DEVICES RELATING TO EXPRESS
AND OTHER COMMERCIAL CARRIER SERV-
ICES.
(a) IN GENERAL.—Chapter 63 of title 18, United
States Code, is amended by adding at the end the follow-
ing:
‘‘§ 1347. Express company fraud
‘‘Whoever engages in any conduct with respect to a
private or commercial interstate carrier which, were that
conduct engaged in with respect to the Postal Service,
would be a violation of section 1341 or 1342 of this title,
shall be punished as is provided under such section for
such violation.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of chapter 63 of title 18, United States
Code, is amended by adding at the end the following new
item:
‘‘1347. Express company fraud.’’.
SEC. 11. LAUNDERING OF MONETARY INSTRUMENTS.
Section 1956(c)(7)(D) of title 18, United States
Code, is amended—
(1) by inserting ‘‘section 1101 or 1002 (relating
to health care fraud),’’ after ‘‘875 (relating to inter-
state communications),’’; and
(2) by inserting ‘‘section 1347 (relating to ex-
press company fraud),’’ after ‘‘1203 (relating to hos-
tage taking),’’.
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HR 2866 IH——2