[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1769 Introduced in House (IH)]







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 Medicare 
 overpayment collection, and to require automated prepayment screening 
              of Medicare claims, 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 ``Reduction In Medicare Overpayment 
Costs Act of 1997''.

SEC. 2. ADMINISTRATIVE FEES FOR MEDICARE OVERPAYMENT 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 inserting ``(1)'' after ``(d)'' and by adding at the end the 
following 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 
Administrative 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 prospective basis only if such 
provider's cost report with respect 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 
Administrative 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 REQUIREMENT.

    (a) Determination by Administrator.--By September 1 of each year 
(beginning with 1997), the Administrator 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 services under 
        title XVIII of the Social Security Act which frequently result 
        in overpayments to such providers under such title; and
            (2) the percentage of claims involving the diagnoses 
        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 
Security 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 Carriers.--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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