I
104TH CONGRESS
1ST SESSION
H. R. 1850
To improve Federal enforcement against health care fraud and abuse.
IN THE HOUSE OF REPRESENTATIVES
JUNE 14, 1995
Mr. TOWNS introduced the following bill; which was referred to the Committee
on Government Reform and Oversight
A BILL
To improve Federal enforcement against health care fraud
and abuse.
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 ‘‘Health Fraud and
Abuse Act of 1995’’.
SEC. 2. HEALTH CARE FRAUD AND ABUSE.
(a) FEDERAL ENFORCEMENT BY INSPECTORS GEN-
ERAL.—
(1) AUDITS, INVESTIGATIONS, INSPECTIONS,
AND EVALUATIONS.—The Inspector General of each
of the Department of Health and Human Services,
the Department of Defense, the Department of
Labor, the Office of Personnel Management, and the
Department of Veterans Affairs shall conduct au-
dits, civil and criminal investigations, inspections,
and evaluations relating to the prevention, detection,
and control of health care fraud and abuse in viola-
tion of any Federal law.
(2) POWERS.—For purposes of carrying out du-
ties and responsibilities under paragraph (1), each
Inspector General referred to in paragraph (1) may
exercise powers that are available to the Inspector
General for purposes of audits, investigations, and
other activities under the Inspector General Act of
1978 (5 U.S.C. App.).
(3) COORDINATION AND REVIEW OF ACTIVITIES
OF
OTHER
FEDERAL, STATE, AND
LOCAL
AGEN-
CIES.—
(A) PROGRAM.—The Inspector General
shall—
(i) jointly establish, on the effective
date specified in subsection (j)(1), a pro-
gram to prevent, detect, and control health
care fraud and abuse in violation of any
Federal law, which considers the activities
of Federal, State, and local law enforce-
ment agencies, Federal and State agencies
responsible for the licensing and certifi-
cation of health care providers, and State
agencies 
designated 
under 
subsection
(b)(1)(A); and
(ii) publish a description of the pro-
gram in the Federal Register, by not later
than June 30, 1996.
(B) ANNUAL INVESTIGATIVE PLAN.—Each
Inspector General referred to in paragraph (1)
shall develop an annual investigative plan for
the prevention, detection, and control of health
care fraud and abuse in accordance with the
program established under subparagraph (A).
(4) CONSULTATIONS.—Each of the Inspectors
General referred to in paragraph (1) 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 coordinating the prevention, detection, and
control of health care fraud and abuse in violation
of any Federal law.
(b) STATE ENFORCEMENT.—
(1) DESIGNATION OF STATE AGENCIES AND ES-
TABLISHMENT OF HEALTH CARE FRAUD AND ABUSE
CONTROL UNIT.—The Governor of each State—
(A) shall, consistent with State law, des-
ignate agencies of the State which conduct, su-
pervise, and coordinate audits, civil and crimi-
nal investigations, inspections, and evaluations
relating to the prevention, detection, and con-
trol of health care fraud and abuse in violation
of any Federal law in the State; and
(B) may establish and maintain in accord-
ance with paragraph (2) a State agency to act
as a Health Care Fraud and Abuse Control
Unit for purposes of this section.
(2) HEALTH CARE FRAUD AND ABUSE CONTROL
UNIT REQUIREMENTS.—A Health Care Fraud and
Abuse Control Unit established by a State under
paragraph (1)(B) shall be a single identifiable entity
of State government which is separate and distinct
from any State agency with principal responsibility
for the administration of health care programs, and
which meets the following requirements:
(A) The entity—
(i) is a unit of the office of the State
Attorney General or of another department
of State government that possesses state-
wide authority to prosecute individuals for
criminal violations;
(ii) 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, ap-
proved by the Secretary, that assure it will
refer suspected criminal violations relating
to health care fraud or abuse in violation
of any Federal law to the appropriate au-
thority or authorities of the State for pros-
ecution and assure it will assist such au-
thority or authorities in such prosecutions;
or
(iii) has a formal working relationship
with the office of the State Attorney Gen-
eral or the appropriate authority or au-
thorities for prosecution and has formal
procedures (including procedures under
which it will refer suspected criminal viola-
tions to such office), that provide effective
coordination of activities between the
Health Care Fraud and Abuse Control
Unit and such office with respect to the