HR 362 IH
Health Care Fraud and Abuse Control
Unit and such office with respect to the
detection, investigation, and prosecution of
suspected health care fraud or abuse in
violation of any Federal law.
(B) The entity conducts a statewide pro-
gram for the investigation and prosecution of
violations of all applicable State laws regarding
any and all aspects of health care fraud and
abuse in violation of any Federal law.
(C) The entity has procedures for—
(i) reviewing complaints of the abuse
or neglect of patients of health care facili-
ties in the State; and
(ii) where appropriate, investigating
and prosecuting such complaints under the
criminal laws of the State or for referring
the complaints to other State or Federal
agencies for action.
(D) The entity provides for the collection,
or referral for collection to the appropriate
agency, of overpayments that—
(i) are made under any federally fund-
ed or mandated health care program re-
quired by this Act; and
HR 362 IH
(ii) it discovers in carrying out its ac-
tivities.
(E) The entity employs attorneys, auditors,
investigators, and other necessary personnel, is
organized in such a manner, and provides suffi-
cient resources, as is necessary to promote the
effective and efficient conduct of its activities.
(3) SUBMISSION
OF
ANNUAL
PLAN.—Each
Health Care Fraud and Abuse Control Unit may
submit each year to the Inspector General a plan for
preventing, detecting, and controlling, consistent
with the program established under subsection
(a)(3)(A), health care fraud and abuse in violation
of any Federal law.
(4) APPROVAL OF ANNUAL PLAN.—The Inspec-
tor General shall approve a plan submitted under
paragraph (3) by the Health Care Fraud and Abuse
Control Unit of a State, unless the Inspector Gen-
eral establishes that the plan—
(A) is inconsistent with the program estab-
lished under subsection (a)(3)(A); or
(B) will not enable the agencies of the
State designated under paragraph (1)(A) to
prevent, detect, and control health care fraud
and abuse in violation of any Federal law.
HR 362 IH
(5) REPORTS.—Each Health Care Fraud and
Abuse Control Unit shall submit to the Inspector
General an annual report containing such informa-
tion as the Inspector General determines to be nec-
essary.
(6) SEMIANNUAL REPORTS OF INSPECTOR GEN-
ERAL OF HEALTH AND HUMAN SERVICES.—The In-
spector General shall include in each semiannual re-
port of the Inspector General to the Congress under
section 5(a) of the Inspector General Act of 1978 (5
U.S.C. App.) an assessment of the Inspector General
of how well States are preventing, detecting, and
controlling health care fraud and abuse.
(c) PAYMENTS TO STATES.—
(1) IN GENERAL.—For each year for which a
State has a plan approved under subsection (b)(4),
and subject to the availability of appropriations, the
Inspector General shall pay to the State for each
quarter an amount equal to 75 percent of the sums
expended during the quarter by agencies designated
by the Governor of the State under subsection
(b)(1)(A) in conducting activities described in that
subsection.
(2) TIME OF PAYMENT.—The Inspector General
shall make a payment under paragraph (1) for a
HR 362 IH
quarter by not later than 30 days after the end of
the quarter.
(3) PAYMENTS ARE ADDITIONAL.—Payments to
a State under this subsection shall be in addition to
any amounts paid under subsection (g).
(d) DATA SHARING.—The Inspector General shall es-
tablish a program for the sharing among Federal agencies,
State and local law enforcement agencies, and health care
providers and insurers, consistent with data sharing provi-
sions of subtitle B, of data related to possible health care
fraud and abuse in violation of any Federal law.
(e) HEALTH CARE FRAUD AND ABUSE CONTROL AC-
COUNT.—
(1) ESTABLISHMENT.—There is established on
the books of the Treasury of the United States a
separate account, which shall be known as the
Health Care Fraud and Abuse Control Account. The
Account shall consist of—
(A) the Health Care Fraud and Abuse Ex-
penses Subaccount; and
(B) the Health Care Fraud and Abuse Re-
serve Subaccount.
(2) EXPENSES SUBACCOUNT.—
(A) 
CONTENTS.—The 
Expenses 
Sub-
account consists of—
HR 362 IH
(i) amounts deposited under subpara-
graph (B); and
(ii) amounts transferred from the Re-
serve Subaccount and deposited under
paragraph (3)(B).
(B) DEPOSITS.—Except as provided in
paragraph (3)(A), there shall be deposited in
the Expenses Subaccount all amounts received
by the United States as—
(i) fines for health care fraud and
abuse in violation of any Federal law;
(ii) civil penalties or damages (other
than restitution) in actions under section
3729 or 3730 of title 31, United States
Code (commonly referred to as the ‘‘False
Claims Act’’), that are based on health
care fraud and abuse in violation of any
Federal law;
(iii) administrative penalties under the
Social Security Act;
(iv) proceeds of seizures and forfeit-
ures of property for acts or omissions that
constitute health care fraud or abuse in
violation of any Federal law; and
HR 362 IH
(v) money and proceeds of property
that are accepted under subsection (f).
(C) USE.—Amounts in the Expenses Sub-
account shall be available to the Inspector Gen-
eral, under such terms and conditions as the
Inspector General determines to be appropriate,
for—
(i) paying expenses incurred by their
respective agencies in carrying out activi-
ties under subsection (a); and
(ii) making reimbursements to other
Inspectors General and Federal, State, and
local agencies in accordance with sub-
section (g).
(3) RESERVE SUBACCOUNT.—
(A) DEPOSITS.—An amount otherwise re-
quired under paragraph (2)(A) to be deposited
in the Expenses Subaccount in a fiscal year
shall be deposited in the Reserve Subaccount,
if—
(i) the amount in the Expenses Sub-
account is greater than $500,000,000; and
(ii) the deposit of that amount in the
Expenses Subaccount would result in the
HR 362 IH
amount in the Expenses Subaccount ex-
ceeding 110 percent of the total amount
deposited in the Expenses Subaccount in
the preceding fiscal year.
(B) 
TRANSFERS
TO
EXPENSES
SUB-
ACCOUNT.—
(i) ESTIMATION OF SHORTFALL.—Not
later than the first day of the last quarter
of each fiscal year, the Inspector General
shall estimate whether sufficient amounts
will be available during such quarter in the
Expenses Subaccount for the uses de-
scribed in paragraph (2)(C).
(ii) TRANSFER
TO
COVER
SHORT-
FALL.—If the Inspector General estimates
under clause (i) that there will not be
available sufficient amounts in the Ex-
penses Subaccount during the last quarter
of a fiscal year, there shall be transferred
from the Reserve Subaccount and depos-
ited in the Expenses Subaccount such
amount as the Inspector General estimates
is required to ensure that sufficient
amounts are available in the Expenses
Subaccount during such quarter.
HR 362 IH
(C) LIMITATION
ON
AMOUNT
CARRIED
OVER
TO
SUCCEEDING
FISCAL
YEAR.—There
shall be transferred to the general fund of the
Treasury any amount remaining in the Reserve
Subaccount at the end of a fiscal year (after
any transfer made under subparagraph (B)) in
excess of 10 percent of the total amount au-
thorized to be deposited in the Expenses Sub-
account (consistent with subparagraph (A))
during the fiscal year.
(f) ACCEPTANCE OF GIFTS, BEQUESTS, AND DE-
VISES.—Any Inspector General referred to in subsection
(a)(1) may accept, use, and dispose of gifts, bequests, or
devises of services or property (real or personal), for the
purpose of aiding or facilitating activities under this sec-
tion regarding health care fraud and abuse. Gifts, be-
quests, or devises of money and proceeds from sales of
other property received as gifts, bequests, or devises shall
be deposited in the Account and shall be available for use
in accordance with subsection (e)(2)(C).
(g) REIMBURSEMENTS OF EXPENSES AND OTHER
PAYMENTS TO PARTICIPATING AGENCIES.—
(1) REIMBURSEMENT OF EXPENSES OF FED-
ERAL AGENCIES.—The Inspector General, subject to
the availability of amounts in the Account, shall
HR 362 IH
promptly reimburse Federal agencies for expenses
incurred in carrying out subsection (a).
(2) PAYMENTS TO STATE AND LOCAL LAW EN-
FORCEMENT
AGENCIES.—The Inspector General,
subject to the availability of amounts in the Account,
shall promptly pay to any State or local law enforce-
ment agency that participated directly in any activ-
ity which led to deposits in the Account, or property
the proceeds of which are deposited in the Account,
an amount that reflects generally and equitably the
participation of the agency in the activity.
(3) FUNDS USED TO SUPPLEMENT AGENCY AP-
PROPRIATIONS.—It is intended that disbursements
made from the Account to any Federal agency be
used to increase and not supplant the recipient
agency’s appropriated operating budget.
(h) ACCOUNT PAYMENTS ADVISORY BOARD.—
(1) ESTABLISHMENT.—There is established the
Account Payments Advisory Board, which shall
make recommendations to the Inspector General re-
garding the equitable allocation of payments from
the Account.
(2) MEMBERSHIP.—The Board shall consist
of—
HR 362 IH
(A) each of the Inspectors General referred
to in subsection (a)(1), other than the Inspector
General of the Department of Health and
Human Services; and
(B) 10 members appointed by the Inspec-
tor General of the Department of Health and
Human Services to represent Health Care
Fraud and Abuse Control Units, of whom one
shall be appointed—
(i) for each of the 10 regions estab-
lished by the Director of the Office of
Management and Budget under Office of
Management and Budget Circular A–105,
to represent Units in that region; and
(ii) from among individuals rec-
ommended by the heads of those agencies
in that region.
(3) TERMS.—The term of a member of the
Board appointed under paragraph (2)(B) shall be 3
years, except that of such members first appointed
3 members shall serve an initial term of one year
and 3 members shall serve an initial term of 2 years,
as specified by the Inspector General at the time of
appointment.
HR 362 IH
(4) VACANCIES.—A vacancy on the Board shall
be filled in the same manner in which the original
appointment was made, except that an individual ap-
pointed to fill a vacancy occurring before the expira-
tion of the term for which the individual is ap-
pointed shall be appointed only for the remainder of
that term.
(5) CHAIRPERSON AND BYLAWS.—The Board
shall elect one of its members as chairperson and
shall adopt bylaws.
(6) COMPENSATION AND EXPENSES.—Members
of the Board shall serve without compensation, ex-
cept that the Inspector General may pay the ex-
penses reasonably incurred by the Board in carrying
out its functions under this section.
(7) NO TERMINATION.—Section 14(a)(2) of the
Federal Advisory Committee Act (5 U.S.C. App.)
does not apply to the Board.
(i) DEFINITIONS.—In this section:
(1) ACCOUNT.—The term ‘‘Account’’ means the
Health Care Fraud and Abuse Control Account es-
tablished by subsection (e)(1).
(2) EXPENSES SUBACCOUNT.—The term ‘‘Ex-
penses Subaccount’’ means the Health Care Fraud
and Abuse Expenses Subaccount of the Account.
HR 362 IH
(3) 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 subsection (b)(2).
(4) INSPECTOR GENERAL.—Except as otherwise
provided, the term ‘‘Inspector General’’ means the
Inspector General of the Department of Health and
Human Services.
(5) RESERVE
SUBACCOUNT.—The term ‘‘Re-
serve Subaccount’’ means the Health Care Fraud
and Abuse Reserve Subaccount of the Account.
(j) EFFECTIVE DATE.—
(1) IN GENERAL.—Except as provided in para-
graph (2), this section shall take effect on January
1, 1997.
(2) DEVELOPMENT AND PUBLICATION OF DE-
SCRIPTION
OF
PROGRAM.—Subsection (a)(3)(A)
shall take effect on the date of the enactment of this
Act.
Æ