[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.
                                 <all>