I
105TH CONGRESS
1ST SESSION
H. R. 1769
To provide for the imposition of administrative fees for Medicare overpayment
collection, and to require automated prepayment screening of Medicare
claims, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 3, 1997
Mr. STARK introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To provide for the imposition of administrative fees for Medi-
care overpayment collection, and to require automated
prepayment screening of Medicare claims, 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.
This Act may be cited as the ‘‘Reduction In Medicare
Overpayment Costs Act of 1997’’.
SEC. 2. ADMINISTRATIVE FEES FOR MEDICARE OVERPAY-
MENT COLLECTION.
(a) ADMINISTRATIVE FEES
FOR PROVIDERS
OF
SERVICES UNDER PART A.—Section 1815(d) of the Social
Security Act (42 U.S.C. 1395g(d)) is amended by insert-
ing ‘‘(1)’’ after ‘‘(d)’’ and by adding at the end the follow-
ing new paragraph:
‘‘(2)(A) Except as provided in subparagraph (B), if
the payment of the excess described in paragraph (1) is
not made (or effected by offset) within 30 days of the date
of the determination, an administrative fee of 1 percent
of the outstanding balance of the excess (after application
of paragraph (1)), or such lower amount as an Adminis-
trative Law Judge may determine upon an appeal of the
initial determination of the excess, shall be imposed on the
provider, for deposit into the Trust Fund under this part.
‘‘(B) The administrative fee shall be imposed under
subparagraph (A) on a provider of services paid on a pro-
spective basis only if such provider’s cost report with re-
spect to the payment determined to be in excess of the
payment due under this part indicates that the provider’s
projected costs exceeded its actual costs by 30 percent or
more.’’.
(b) ADMINISTRATIVE FEES
FOR PROVIDERS
OF
SERVICES OR OTHER PERSONS UNDER PART B.—Section
1833(j) of the Social Security Act (42 U.S.C. 1395l(j))
is amended by inserting ‘‘(1)’’ after ‘‘(j)’’ and by adding
at the end the following new paragraph:
‘‘(2) If the excess described in paragraph (1) is not
made (or effected by offset) within 30 days of the date
of the determination, an administrative fee of 1 percent
of the outstanding balance of the excess (after application
of paragraph (1)), or such lower amount as an Adminis-
trative Law Judge may determine upon an appeal of the
initial determination of the excess, shall be imposed on the
provider, or other person receiving the excess, for deposit
into the Trust Fund under this part.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to final determinations made on
or after the date of enactment of this Act.
SEC. 3. AUTOMATED PREPAYMENT SCREENING REQUIRE-
MENT.
(a) DETERMINATION BY ADMINISTRATOR.—By Sep-
tember 1 of each year (beginning with 1997), the Adminis-
trator of the Health Care Financing Administration, after
consultation with the Comptroller General of the United
States, shall determine—
(1) the medical diagnoses by providers of serv-
ices under title XVIII of the Social Security Act
which frequently result in overpayments to such pro-
viders under such title; and
(2) the percentage of claims involving the diag-
noses described in paragraph (1), that fiscal
intermediaries and carriers under such title shall
screen before payment is made in order to avoid
such overpayments.
(b) REQUIREMENT
FOR FISCAL INTERMEDIARIES
AND CARRIERS.—The Secretary of Health and Human
Services shall not enter into a contract with a fiscal
intermediary or carrier under title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) unless the Secretary
finds that such intermediary or carrier will screen the
claims for payment, in accordance with subsection (a),
under such title.
(c) NOTICE TO FISCAL INTERMEDIARIES AND CAR-
RIERS.—The Secretary shall cause to have published in
the Federal Register, in the last 15 days of October of
each year, the results of the determination made under
subsection (a).
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