[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1668 Introduced in House (IH)]
1st Session
H. R. 1668
To establish a program to control fraud and abuse in the medicare
program, to increase the amount of civil monetary penalties which may
be assessed against individuals and entities committing fraud against
the medicare program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 18, 1995
Ms. Danner 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 establish a program to control fraud and abuse in the medicare
program, to increase the amount of civil monetary penalties which may
be assessed against individuals and entities committing fraud against
the medicare program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Fraud and Abuse Control Act
of 1995''.
SEC. 2. ESTABLISHMENT OF MEDICARE FRAUD AND ABUSE CONTROL PROGRAM.
(a) In General.--Not later than 6 months after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
establish a program to improve the prevention, detection, and control
of fraud and abuse under the medicare program.
(b) Award of Portion of Amounts Collected to Individuals Providing
Information.--Under the program established pursuant to subsection (a),
the Secretary shall pay a portion of any civil monetary penalty
assessed under the medicare program to any individual or entity who
provided information which served as the basis for the assessment of
the penalty, under the same terms and conditions applicable to awards
to qui tam plaintiffs under chapter 37 of title 31, United States Code.
SEC. 3. PROVIDING INFORMATION ON REPORTING FRAUD AND ABUSE WITH
MEDICARE CLAIMS AND BENEFIT FORMS.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) is amended by adding at the end the following new
section:
``solicitation of information on fraud and abuse
``Sec. 1893. With each explanation of benefits provided to an
individual to whom items or services are furnished under this title and
with each notice of payment provided to an individual or entity
furnishing an item or service for which payment is made under this
title, the Secretary shall include a statement soliciting any
information the individual or entity may possess on any fraud and abuse
committed against the program under this title, together with a toll-
free telephone number through which the individual or entity may report
such information.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to items and services furnished and payments made under title
XVIII of the Social Security Act on or after January 1, 1996.
SEC. 4. INCREASE IN AMOUNT OF PENALTIES.
(a) In General.--
(1) General civil monetary penalties.--Section 1128A of the
Social Security Act (42 U.S.C. 1320a-7a) is amended--
(A) in subsection (a)--
(i) by striking ``$2,000'' and inserting
``$4,000'', and
(ii) by striking ``$15,000'' and inserting
``$30,000''; and
(B) in subsection (b), by striking ``$2,000'' each
place it appears and inserting ``$4,000''.
(2) Criminal penalties.--Section 1128B of such Act (42
U.S.C. 1320a-7b) is amended--
(A) in subsection (a)--
(i) by striking ``$25,000'' and inserting
``$50,000'', and
(ii) by striking ``$10,000'' and inserting
``$20,000'';
(B) in subsections (b), (c), and (d), by striking
``$25,000'' each place it appears and inserting
``$50,000''; and
(C) in subsection (e), by striking ``$2,000'' and
inserting ``$4,000''.
(3) Standards for nursing facilities.--
(A) Providing advance notice of survey to nursing
facility.--Section 1819(g)(2)(A)(i) of such Act (42
U.S.C. 1395i@3(g)(2)(A)(i)) is amended by striking
``$2,000'' and inserting ``$4,000''.
(B) Noncompliance with nursing facility
standards.--Section 1819(h)(2)(B)(ii) of such Act (42
U.S.C. 1395i@3(h)(2)(B)(ii)) is amended by striking
``$10,000'' and inserting ``$20,000''.
(4) Failure to provide information on referring physician
on unassigned claims.--Section 1833(q)(2)(B)(i) of such Act (42
U.S.C. 1395l(q)(2)(B)(i)) is amended by striking ``$2,000'' and
inserting ``$4,000''.
(5) Distribution by suppliers of medical equipment of
medical necessity forms.--Section 1834(j)(2)(A)(iii) of such
Act (42 U.S.C. 1395m(j)(2)(A)(iii)), as added by section
131(a)(1) of the Social Security Act Amendments of 1994, is
amended by striking ``$1,000'' and inserting ``$2,000''.
(6) Failure to include diagnosis code on unassigned
claims.--Section 1842(p)(3)(A) of such Act (42 U.S.C.
1395u(p)(3)(A)) is amended by striking ``$2,000'' and inserting
``$4,000''.
(7) Intermediate sanctions for providers or suppliers of
clinical diagnostic laboratory tests.--Section
1846(b)(2)(A)(ii) of such Act (42 U.S.C. 1395w@2(b)(2)(A)(ii))
is amended by striking ``$10,000'' and inserting ``$20,000''.
(8) Medicare secondary payer.--
(A) Offering financial incentives for beneficiaries
not to enroll in primary plans.--The second sentence of
section 1862(b)(3)(C) of such Act (42 U.S.C.
1395y(b)(3)(C)) is amended by striking ``$5,000'' and
inserting ``$10,000''.
(B) Failure of employer to provide matching
information on secondary payer situations.--The second
sentence of section 1862(b)(5)(C)(ii) of such Act (42
U.S.C. 1395y(b)(5)(C)(ii)) is amended by striking
``$1,000'' and inserting ``$2,000''.
(C) Failure of provider to provide information on
availability of other payers.--Section 1862(b)(6)(B) of
such Act (42 U.S.C. 1395y(b)(6)(B)), as added by
section 151(a)(2)(A) of the Social Security Act
Amendments of 1994, is amended by striking ``$2,000''
and inserting ``$4,000''.
(9) Improper billing by hospitals.--Section 1866(g) of such
Act (42 U.S.C. 1395cc(g)) is amended by striking ``$2,000'' and
inserting ``$4,000''.
(10) Violation of anti-dumping restrictions.--Section
1867(d)(1) of such Act (42 U.S.C. 1395dd(d)(1)) is amended--
(A) by striking ``$50,000'' each place it appears
and inserting ``$100,000''; and
(B) in subparagraph (A), by striking ``$25,000''
and inserting ``$50,000''.
(11) Sanctions against health maintenance organizations.--
Section 1876(i)(6)(B)(i) of such Act (42 U.S.C.
1395mm(i)(6)(B)(i)) is amended--
(A) by striking ``$25,000'' and inserting
``$50,000'';
(B) by striking ``$100,000'' and inserting
``$200,000''; and
(C) by striking ``$15,000'' and inserting
``$30,000''.
(12) Referrals by physicians with ownership or investment
interests.--
(A) Improper claims.--Section 1877(g)(3) of such
Act (42 U.S.C. 1395nn(g)(3)) is amended by striking
``$15,000'' and inserting ``$30,000''.
(B) Circumvention schemes.--Section 1877(g)(4) of
such Act (42 U.S.C. 1395nn(g)(4)) is amended by
striking ``$100,000'' and inserting ``$200,000''.
(C) Failure to report information.--Section
1877(g)(5) of such Act (42 U.S.C. 1395nn(g)(5)) is
amended by striking ``$10,000'' and inserting
``$20,000''.
(13) Medicare supplemental policies.--
(A) Issuance of policies where no standards in
effect.--The second sentence of section 1882(a)(2) of
such Act (42 U.S.C. 1395ss(a)(2)) is amended by
striking ``$25,000'' and inserting ``$50,000''.
(B) Misrepresentations of policies.--Section
1882(d) of such Act (42 U.S.C. 1395ss(d)) is amended--
(i) in paragraphs (1), (2), and (4)(A), by
striking ``$5,000'' and inserting ``$10,000'';
and
(ii) in paragraphs (3)(A) and (3)(B)(iv),
by striking ``$25,000 (or $15,000'' and
inserting ``$50,000 (or $30,000''.
(C) Violation of benefits standards.--Section
1882(p) of such Act (42 U.S.C. 1395ss(p)) is amended by
striking ``$25,000 (or $15,000'' each place it appears
in paragraphs (8) and (9)(C) and inserting ``$50,000
(or $30,000''.
(D) Violation of guaranteed renewability
standards.--Section 1882(q)(5)(C) of such Act (42
U.S.C. 1395ss(q)(5)(C)) is amended by striking
``$25,000'' and inserting ``$50,000''.
(E) Violation of loss ratio standards.--Section
1882(r)(6)(A) of such Act (42 U.S.C. 1395ss(r)(6)(A))
is amended by striking ``$25,000'' and inserting
``$50,000''.
(F) Violation of pre-existing condition
standards.--Section 1882(s)(3) of such Act (42 U.S.C.
1395ss(s)(3)) is amended by striking ``$5,000'' and
inserting ``$10,000''.
(G) Medicare select policies.--Section 1882(t)(2)
of such Act (42 U.S.C. 1395ss(t)(2)) is amended by
striking ``$25,000'' and inserting ``$50,000''.
(14) Violation of home health participation standards.--
Section 1891 of such Act (42 U.S.C. 1395bbb) is amended--
(A) in subsection (a)(3)(D)(iii)(III), by striking
``$5,000'' and inserting ``$10,000'';
(B) in subsection (c)(1), by striking ``$2,000''
and inserting ``$4,000'' ; and
(C) in subsection (f)(2)(A)(i), by striking
``$10,000'' and inserting ``$20,000''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to civil monetary penalties imposed with respect to acts or
omissions occurring on or after January 1, 1996.
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