[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2999 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 2999

     To amend title XVIII of the Social Security Act to reform the 
 regulatory processes used by the Health Care Financing Administration 
      to administer the medicare program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 27, 2000

 Mr. Abraham (for himself, Mr. Cochran, and Mr. Grams) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
     To amend title XVIII of the Social Security Act to reform the 
 regulatory processes used by the Health Care Financing Administration 
      to administer 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Care 
Provider Bill of Rights''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
               TITLE I--REFORM OF HCFA REGULATORY PROCESS

Sec. 101. Prospective application of certain regulations.
Sec. 102. Notice and hearing requirements for certain interim final 
                            regulations.
Sec. 103. GAO Audit and report on compliance with certain statutory 
                            administrative procedure requirements.
Sec. 104. Requirements for judicial and regulatory challenges of 
                            regulations.
Sec. 105. Reform of national coverage determination process.
                  TITLE II--REFORM OF APPEALS PROCESS

Sec. 201. Appeal of overpayment determinations.
Sec. 202. Time lines for appeals.
Sec. 203. Right to appeal on behalf of deceased beneficiaries.
Sec. 204. Suspension of certain activities while appeals are pending.
Sec. 205. National precedence of departmental appeals board 
                            determinations.
Sec. 206. Requirements for affirmative appeal of HCFA actions.
Sec. 207. GAO audit of random sample audits.
               TITLE III--REFORM OF OVERPAYMENT PROCEDURE

Sec. 301. Prohibition of retroactive overpayment determinations.
Sec. 302. Prohibition of sampling audits to reduce future 
                            reimbursements.
Sec. 303. Prohibition of recovering past overpayments by certain means.
Sec. 304. Prohibition of recovering past overpayments if appeal 
                            pending.
           TITLE IV--REFORM OF VOLUNTARY DISCLOSURE PROCEDURE

Sec. 401. Promulgation of joint voluntary disclosure procedures.
               TITLE V--CRIMINAL LAW ENFORCEMENT REFORMS

Sec. 501. No law enforcement authority for employees of the Office of 
                            Inspector General of the Department of 
                            Health and Human Services.
Sec. 502. Search warrants on health care facilities.
                TITLE VI--PROVIDER COMPLIANCE EDUCATION

Sec. 601. Education.
Sec. 602. Advisory opinions.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Carrier.--The term ``carrier'' means a carrier (as 
        defined in section 1842(f) of the Social Security Act (42 
        U.S.C. 1395u(f))) with a contract under title XVIII of such Act 
        to administer benefits under part B of such title.
            (2) Fiscal intermediary.--The term ``fiscal intermediary'' 
        means a fiscal intermediary (as defined in section 1816(a) of 
        the Social Security Act (42 U.S.C. 1395h(a))) with an agreement 
        under section 1816 of such Act to administer benefits under 
        part A or part B of such title.
            (3) HCFA.--The term ``HCFA'' means the Health Care 
        Financing Administration.
            (4) Health care provider.--The term ``health care 
        provider'' means any individual or entity participating in the 
        medicare program, including a Medicare+Choice organization 
        under part C of such program.
            (5) Medicare program.--The term ``medicare program'' means 
        the health benefits program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

               TITLE I--REFORM OF HCFA REGULATORY PROCESS

SEC. 101. PROSPECTIVE APPLICATION OF CERTAIN REGULATIONS.

    Section 1871(a) of the Social Security Act (42 U.S.C. 1395hh(a)) is 
amended by adding at the end the following new paragraph:
            ``(3) Any regulation described under paragraph (2) may not 
        take effect earlier than the date on which such regulation 
        becomes a final regulation. Any regulation described under such 
        paragraph that applies to an agency action, including any 
        agency determination, shall only apply as that regulation is in 
        effect at the time that agency action is taken.''.

SEC. 102. NOTICE AND HEARING REQUIREMENTS FOR CERTAIN INTERIM FINAL 
              REGULATIONS.

    Section 1871(a) of the Social Security Act (42 U.S.C. 1395hh(a)), 
as amended by section 101, is amended by adding at the end the 
following new paragraph:
            ``(4) In prescribing any interim final regulation described 
        under paragraph (2)--
                    ``(A) the Secretary shall provide notice and a 
                hearing in accordance with section 553(b) of title 5, 
                United States Code; and
                    ``(B) subparagraph (B) of the sentence following 
                section 553(b)(3) of such title shall not apply.''.

SEC. 103. GAO AUDIT AND REPORT ON COMPLIANCE WITH CERTAIN STATUTORY 
              ADMINISTRATIVE PROCEDURE REQUIREMENTS.

    (a) Audit.--The Comptroller General of the United States shall 
conduct an audit of the compliance of the Health Care Financing 
Administration and all regulations promulgated by the Department of 
Health and Human Resources under statutes administered by the Health 
Care Financing Administration with--
            (1) the provisions of such statutes;
            (2) subchapter II of chapter 5 of title 5, United States 
        Code (including section 553 of such title); and
            (3) chapter 6 of title 5, United States Code.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Comptroller General shall submit to Congress a report 
on the audit conducted under subsection (a), together with such 
recommendations for legislative and administrative action as the 
Comptroller General determines appropriate.

SEC. 104. REQUIREMENTS FOR JUDICIAL AND REGULATORY CHALLENGES OF 
              REGULATIONS.

    (a) Right To Challenge Constitutionality and Statutory Authority of 
HCFA Regulations.--Section 1872 of the Social Security Act (42 U.S.C. 
1395ii) is amended to read as follows:

            ``application of certain provisions of title ii

    ``Sec. 1872. The provisions of sections 206 and 216(j), and of 
subsections (a), (d), (e), (h), (i), (j), (k), and (l) of section 205, 
shall also apply with respect to this title to the same extent as they 
are applicable with respect to title II, except that--
            ``(1) in applying such provisions with respect to this 
        title, any reference therein to the Commissioner of Social 
        Security or the Social Security Administration shall be 
        considered a reference to the Secretary or the Department of 
        Health and Human Services, respectively; and
            ``(2) section 205(h) shall not apply with respect to any 
        action brought against the Secretary under sections 1331 or 
        1346 of title 28, United States Code, regardless of whether 
        such action is unrelated to a specific determination of the 
        Secretary, that challenges--
                    ``(A) the constitutionality of the Secretary's 
                regulations or policies;
                    ``(B) the Secretary's statutory authority to 
                promulgate such regulations or policies; or
                    ``(C) a finding of good cause under subparagraph 
                (B) of the sentence following section 553(b)(3), United 
                States Code.''.
    (b) Construction of Hearing Rights Relating to Determinations by 
the Secretary Regarding Agreements With Providers of Services.--Section 
1866(h) of the Social Security Act (42 U.S.C. 1395cc(h)) is amended by 
adding at the end the following new paragraph:
    ``(3) For purposes of applying paragraph (1), an institution or 
agency dissatisfied with a determination by the Secretary described in 
such paragraph shall be entitled to a hearing thereon regardless of 
whether--
            ``(A) such determination has been made by the Secretary or 
        by a State pursuant to an agreement entered into with the 
        Secretary under section 1864; and
            ``(B) the Secretary has imposed or may impose a remedy, 
        penalty, or other sanction on the institution or agency in 
        connection with such determination.''.

SEC. 105. REFORM OF NATIONAL COVERAGE DETERMINATION PROCESS.

    (a) In General.--Section 1871(a) of the Social Security Act (42 
U.S.C. 1395hh(a)), as amended by section 102, is amended by adding at 
the end the following new paragraph:
            ``(5) In the case of any national coverage determination, 
        the Secretary shall provide for--
                    ``(A) notice of the proposed national coverage 
                determination in the Federal Register; and
                    ``(B) a period of not less than 30 days for public 
                comment thereon, during which--
                            ``(i) any provider of services to present 
                        comments in oral or written form to the 
                        Medicare Coverage Advisory Committee or any 
                        other official of the Health Care Financing 
                        Administration responsible for making the 
                        national coverage determination; and
                            ``(ii) any other person may present 
                        comments in written form to such Committee or 
                        official.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to national coverage determinations made on or after the date of 
enactment of this Act.

                  TITLE II--REFORM OF APPEALS PROCESS

SEC. 201. APPEAL OF OVERPAYMENT DETERMINATIONS.

    Notwithstanding sections 1870 and 1879 of the Social Security Act 
(42 U.S.C. 1395gg and 1395pp) or any other provision of law, the 
Secretary may not require a health care provider to waive any right 
under the medicare program to appeal an overpayment determination of 
the Secretary if such provider agrees to accept a stated dollar amount 
potential projected overpayment.

SEC. 202. TIME LINES FOR APPEALS.

    Section 1869 of the Social Security Act (42 U.S.C. 1395ff) is 
amended--
            (1) in subsection (a), by inserting ``consistent with 
        subsections (c) and (d)'' before the period; and
            (2) by adding at the end the following new subsections:
    ``(c) Deadlines for Reconsiderations and Appeals Under Part A.--
Reconsideration and appeals under subsections (a) and (b) with respect 
to matters under part A shall be conducted consistent with the 
following deadlines:
            ``(1) Deadlines for administrative action.--
                    ``(A) Reconsidered determination.--The Secretary 
                shall conduct and conclude a reconsideration of an 
                initial determination, and mail the notice of 
                reconsidered determination, by not later than the end 
                of the 60-day period beginning on the date a request 
                for reconsideration has been timely filed.
                    ``(B) Hearing by administrative law judge.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), an administrative law judge shall 
                        conduct and conclude a hearing and render a 
                        decision on such hearing by not later than the 
                        end of the 90-day period beginning on the date 
                        a request for hearing has been timely filed.
                            ``(ii) Waiver of deadline by party seeking 
                        hearing.--The 90-day period under clause (i) 
                        shall not apply in the case of a motion or 
                        stipulation by the party requesting the hearing 
                        to waive such period.
                    ``(C) Departmental appeals board review.--The 
                Departmental Appeals Board of the Department of Health 
                and Human Services shall conduct and conclude a review 
                of the decision on a hearing described in subparagraph 
                (B) and make a decision or remand the case to the 
                administrative law judge for reconsideration by not 
                later than the end of the 90-day period beginning on 
                the date a request for review has been timely filed.
            ``(2) Consequences of failure to meet deadlines.--
                    ``(A) In general.--
                            ``(i) Failure to notify.--In the case of a 
                        failure by the Secretary to mail the notice of 
                        reconsidered determination by the end of the 
                        period described in paragraph (1)(A), the party 
                        requesting the reconsideration may request a 
                        hearing before an administrative law judge, 
                        notwithstanding any requirements for a 
                        reconsidered determination for purposes of the 
                        party's right to such hearing.
                            ``(ii) Failure of alj to decide.--In the 
                        case of a failure by an administrative law 
                        judge to render a decision by the end of the 
                        period described in paragraph (1)(B), the party 
                        requesting the hearing may request a review by 
                        the Departmental Appeals Board of the 
                        Department of Health and Human Services, 
                        notwithstanding any requirements for a hearing 
                        for purposes of the party's right to such a 
                        review.
                    ``(B) DAB hearing procedure.--In the case of a 
                request described in subparagraph (A)(ii), the 
                Departmental Appeals Board shall review the case de 
                novo.
    ``(d) Deadlines for Reviews and Appeals Under Part B.--Reviews and 
appeals under subsections (a) and (b) with respect to matters under 
part B shall be conducted consistent with the following deadlines:
            ``(1) Deadlines.--
                    ``(A) Review of initial determination.--A carrier 
                shall conduct and conclude a review of an initial 
                determination, and mail the notice of review 
                determination, by not later than the end of the 60-day 
                period beginning on the date a request for review has 
                been timely filed.
                    ``(B) Carrier hearing.--
                            ``(i) Deadline for decision.--A carrier 
                        shall conduct and conclude a hearing, and mail 
                        the notice of the decision, by not later than 
                        the end of the 60-day period beginning on the 
                        date a request for a carrier hearing has been 
                        timely filed.
                            ``(ii) Option to proceed to hearing by 
                        administrative law judge.--No carrier hearing 
                        shall be held, and no requirement for a carrier 
                        hearing shall apply, with respect to rights to 
                        a hearing before an administrative law judge, 
                        if the party to the carrier review elects a 
                        hearing before an administrative law judge in 
                        lieu of a carrier hearing.
                    ``(C) Hearing by administrative law judge.--
                            ``(i) In general.--Except as provided in 
                        clause (ii), an administrative law judge shall 
                        conduct and conclude a hearing and render a 
                        decision on such hearing by not later than the 
                        end of the 90-day period beginning on the date 
                        a request for hearing has been timely filed.
                            ``(ii) Waiver of deadline by party seeking 
                        hearing.--The 90-day period under clause (i) 
                        shall not apply in the case of a motion or 
stipulation by the party requesting the hearing to waive such period.
                    ``(D) Departmental appeals board review.--The 
                Departmental Appeals Board of the Department of Health 
                and Human Services shall conduct and conclude a review 
                of the decision on a hearing described in subparagraph 
                (C) and make a decision or remand the case to the 
                administrative law judge for reconsideration by not 
                later than the end of the 90-day period beginning on 
                the date a request for review has been timely filed.
            ``(2) Consequences of failure to meet deadlines.--
                    ``(A) In general.--
                            ``(i) Failure to notify.--In the case of a 
                        failure by a carrier to mail notice within the 
                        time period described in paragraph (A) or (B) 
                        of paragraph (1), the party requesting the 
                        review or carrier hearing (as the case may be) 
                        may request a hearing before an administrative 
                        law judge, notwithstanding any requirements for 
                        a carrier review or a carrier hearing for 
                        purposes of the party's right to a hearing 
                        before such judge.
                            ``(ii) Failure of alj to decide.--In the 
                        case of a failure by an administrative law 
                        judge to render a decision by the end of the 
                        period described in paragraph (1)(C), the party 
                        requesting the hearing may request a review by 
                        the Departmental Appeals Board, notwithstanding 
                        any requirements for a hearing for purposes of 
                        the party's right to such a review.
                    ``(B) DAB hearing procedure.--In the case of a 
                request described in subparagraph (A)(ii), the 
                Departmental Appeals Board shall review the case de 
                novo.''.

SEC. 203. RIGHT TO APPEAL ON BEHALF OF DECEASED BENEFICIARIES.

    Notwithstanding section 1870 of the Social Security Act (42 U.S.C. 
1395gg) or any other provision of law, the Secretary shall permit any 
health care provider to appeal any determination of the Secretary under 
the medicare program on behalf of a deceased beneficiary where no 
substitute party is available.

SEC. 204. SUSPENSION OF CERTAIN ACTIVITIES WHILE APPEALS ARE PENDING.

    (a) In General.--Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended by adding at the end the following new subsection:
    ``(j) For purposes of subsections (b) and (c), the Secretary--
            ``(1) may not impose any sanction, terminate an agreement, 
        or refuse to renew such an agreement with a provider of 
        services under this title during the period in which any appeal 
        of such provider regarding a deficiency that is the basis of 
        such sanction, termination, or nonrenewal is pending;
            ``(2) may not publicly disseminate any information 
        regarding any deficiency of a provider of services that is the 
        subject of an appeal before such appeal is finally adjudicated; 
        and
            ``(3) shall permit any provider of services to appeal a 
        surveyor deficiency of such provider that does not result in a 
        recommendation of termination.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to agreements entered into or renewed on or after the date of the 
enactment of this Act.

SEC. 205. NATIONAL PRECEDENCE OF DEPARTMENTAL APPEALS BOARD 
              DETERMINATIONS.

    Notwithstanding any other provision of law, any determination of 
the Departmental Appeals Board of the Department of Health and Human 
Services under the medicare program shall have national precedential 
value with respect to any determination of an administrative law judge 
under such program.

SEC. 206. REQUIREMENTS FOR AFFIRMATIVE APPEAL OF HCFA ACTIONS.

    (a) In General.--Subchapter III of chapter 37 of title 31, United 
States Code, is amended by adding at the end the following new section:
``Sec. 3734. Rules for certain actions based on health care claims
    ``(a) In General.--In the case of any action that is brought under 
this subchapter based on a claim submitted with respect to a federally 
funded health care program, the preceding provisions of this subchapter 
shall apply only to the extent that such provisions are consistent with 
the provisions of this section.
    ``(b) Actions if Amount of Damages Are Material Amount.--
Notwithstanding the preceding sections of this subchapter, no action 
may be brought under this subchapter based on a claim that is submitted 
under a federally funded health care program unless the amount of 
damages alleged to have been sustained by the United States Government 
with respect to such claim is a material amount.
    ``(c) Actions for Claims Submitted in Reliance on Official 
Guidance.--Notwithstanding the preceding sections of this subchapter, 
no action may be brought under this subchapter based on a claim 
submitted--
            ``(1) in reliance on (and correctly using) erroneous 
        information supplied by a Federal agency (or an agent thereof) 
        about matters of fact at issue; or
            ``(2) in reliance on (and correctly applying) written 
        statements of Federal policy which affects such claim provided 
        by a Federal agency (or an agent thereof).
    ``(d) Standard of Proof.--In any action brought under this 
subchapter with respect to a claim submitted to a federally funded 
health care program, section 3731(c) shall be applied by substituting 
`clear and convincing evidence' for `a preponderance of the evidence'.
    ``(e) Rule of Construction.--Nothing in this section shall be 
construed as limiting the authority of the Government of the United 
States to recoup or otherwise recover damages with respect to a claim 
submitted to a federally funded health care program under provisions of 
law other than this subchapter.
    ``(f) Definitions; Related Rules.--For purposes of this section--
            ``(1) the term `claim' means a claim (as defined in section 
        3729(c)) made with respect to a federally funded health care 
        program;
            ``(2) the term `damages' means the amount of any 
        overpayment made by the United States Government with respect 
        to a claim;
            ``(3) the term `federally funded health care program' means 
        a program that provides health benefits, whether directly, 
        through the purchase of insurance, or otherwise, that is 
        established under--
                    ``(A) title XVIII, XIX, or XXI of the Social 
                Security Act, or
                    ``(B) title 10, of this Code; and
            ``(4)(A) the amount of damages alleged to have been 
        sustained by the United States Government with respect to a 
        claim submitted by (or on behalf of) a person shall be treated 
        as a `material amount' only if such amount exceeds a proportion 
        (specified in regulations promulgated by the Secretary in 
        consultation with the Secretary of Defense) of the total of the 
        amounts for which claims were submitted by (or on behalf of) 
        such person--
                    ``(i) to the same federally funded health care 
                program, and
                    ``(ii) for the same calendar year,
        as the claim upon which an action under this subchapter is 
        based;
            ``(B) the regulations specifying the proportion referred to 
        in paragraph (4) shall be based on the definition of the term 
        `material' used by the American Institute of Certified Public 
        Accountants as of the date of the enactment of this section; 
        and
            ``(C) in determining whether an amount of damages is a 
        `material amount' under subparagraph (A), with respect to a 
        person--
                    ``(i) the amount of damages for more than 1 claim 
                may be aggregated only if the acts or omissions 
                resulting in such damages were part of a pattern of 
                related acts or omissions by such person, and
                    ``(ii) if damages for more than 1 claim are 
                aggregated in accordance with clause (i), the 
                proportion referred to in such subparagraph shall be 
                determined by comparing the amount of such aggregate 
                damages to the total of the amounts for which claims 
                were submitted by (or on behalf of) such person to the 
                same federally funded health care program for each of 
                the calendar years for which any claim upon which such 
                aggregate damages were based was submitted.''.
    (b) Conforming Amendment.--The table of sections for chapter 37 of 
title 31, United States Code, is amended by adding after the item 
relating to section 3733 the following new item:

``3734. Rules for certain actions based on health care claims.''.
    (c) Effective Date.--The amendment made by subsection (a) shall 
apply to actions brought under subchapter III of chapter 37 of title 
31, United States Code, with respect to claims submitted before, on, 
and after the date of the enactment of this Act.

SEC. 207. GAO AUDIT OF RANDOM SAMPLE AUDITS.

    (a) Audit.--The Comptroller General of the United States shall 
conduct an audit to determine--
            (1) the statistical validity of random sample audits 
        conducted under the medicare program before the date of the 
        enactment of this Act;
            (2) the necessity of such audits for purposes of 
        administering sections 1815(a), 1842(a), and 1861(v)(1)(A)(ii) 
        of the Social Security Act (42 U.S.C. 1395g(a), 1395u(a), and 
        1395x(v)(1)(A)(ii)); and
            (3) the effects of the application of such audits to health 
        care providers under sections 1842(b), 1866(a)(1)(B)(ii), 1870, 
        and 1893 of such Act (42 U.S.C. 1395u(a), 1395cc(a)(1)(B)(ii), 
        1395gg, and 1395ddd).
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report on the audit conducted under subsection (a), together with 
such recommendations for legislative and administrative action as the 
Comptroller General determines appropriate.

               TITLE III--REFORM OF OVERPAYMENT PROCEDURE

SEC. 301. PROHIBITION OF RETROACTIVE OVERPAYMENT DETERMINATIONS.

    (a) In General.--Section 1870 of the Social Security Act (42 U.S.C. 
1395gg) is amended by adding at the end the following new subsection:
    ``(h)(1)(A) For purposes of applying the 3-year limitation under 
subsections (b) and (c), sections 1842(b)(3)(B)(ii) and 
1866(a)(1)(B)(ii), the Secretary may only revise a determination that 
more than the correct amount has been paid under this title to a 
provider of services or other person for any item or service furnished 
to an individual in accordance with subparagraph (B).
    ``(B) The Secretary may revise a determination that more than the 
correct amount has been paid under this title to a provider of services 
or other person for any item or service furnished to an individual--
            ``(i) within 12 months from the date of the notice of the 
        determination to the party to such determination; or
            ``(ii) after the 12-month period described in clause (i), 
        but within 3 years after the date of the notice of the initial 
        determination to the individual, upon establishment of good 
        cause for reopening such determination.
    ``(2) Notwithstanding the 3-year limitation under subsections (b) 
and (c), and sections 1842(b)(3)(B)(ii) and 1866(a)(1)(B)(ii), the 
Secretary may revise a determination that more than the correct amount 
has been paid under this title to a provider of services or other 
person for any item or service furnished to an individual at any time 
if such determination--
            ``(A) is unfavorable to a provider of services or other 
        person to which the overpayment was made, but only for the 
        purpose of correcting clerical error or error on the face of 
        the evidence on which such determination was based; or
            ``(B) was procured by fraud or similar fault of the 
        beneficiary or some other individual other than the provider of 
        services or other person to which such overpayment was made.
    ``(3) For purposes of making any revision under paragraph (1) or 
(2), the Secretary shall apply regulations in effect at the time the 
overpayment was made.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to overpayment determinations made on or after the date of the 
enactment of this Act.

SEC. 302. PROHIBITION OF SAMPLING AUDITS TO REDUCE FUTURE 
              REIMBURSEMENTS.

    Notwithstanding sections 1815(a), 1842(b), and 1861(v)(1)(A)(ii) of 
the Social Security Act (42 U.S.C. 1395g(a), 1395u(a), and 
1395x(v)(1)(A)(ii)), or any other provision of law, for purposes of 
sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 of such 
Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, 
1395ddd), the Secretary may not determine the amount of any overpayment 
or underpayment based on a sampling audit (including any determination 
based on the rate of denied claims of such provider), unless the 
Secretary finds clear and convincing evidence of fraud or similar fault 
on the part of such provider.

SEC. 303. PROHIBITION OF RECOVERING PAST OVERPAYMENTS BY CERTAIN MEANS.

    Notwithstanding sections 1815(a), 1842(b), and 1861(v)(1)(A)(ii) of 
the Social Security Act (42 U.S.C. 1395g(a), 1395u(a), and 
1395x(v)(1)(A)(ii)), or any other provision of law, for purposes of 
applying sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 
of such Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, 
and 1395ddd), the Secretary may not adjust any payments to a health 
care provider on account of a previously made overpayment unless the 
Secretary finds clear and convincing evidence of fraud or similar fault 
on the part of such provider.

SEC. 304. PROHIBITION OF RECOVERING PAST OVERPAYMENTS IF APPEAL 
              PENDING.

    Notwithstanding any provision of law, for purposes of applying 
sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 of the 
Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 
1395gg, 1395ddd), the Secretary may not take any action (or authorize 
any other person, including any fiscal intermediary, carrier, and 
entity with a contract under section 1893 of such Act (42 U.S.C. 
1395ddd)) to recoup an overpayment during the period in which a health 
care provider may appeal a determination that such an overpayment has 
been made or the amount of the overpayment.

           TITLE IV--REFORM OF VOLUNTARY DISCLOSURE PROCEDURE

SEC. 401. PROMULGATION OF JOINT VOLUNTARY DISCLOSURE PROCEDURES.

    (a) Voluntary Disclosure.--No criminal prosecution under title XI 
of the Social Security Act (42 U.S.C. 1301 et seq.) and no civil action 
under such title, the medicare program, or section 3729, 3730, or 3731 
of title 31, United States Code, may be instituted against a health 
care provider with respect to a matter that such provider has 
voluntarily disclosed in accordance with the regulations promulgated 
under subsection (b).
    (b) Regulations.--
            (1) Promulgation.--The Secretary and the Attorney General, 
        acting jointly, shall establish, by regulation, voluntary 
        disclosure procedures that apply with respect to any potential 
        violations of Federal criminal, civil, or administrative laws 
        by a health care provider under the Medicare program.
            (2) Health care provider immunity.--The regulations 
        promulgated under paragraph (1) shall provide that, unless the 
        Secretary establishes by independently obtained clear and 
        convincing evidence that such potential violation is the result 
        of criminal fraud or similar fault on the part of a health care 
        provider, such provider shall be immune from any action 
        described in paragraph (3) if such provider reports such 
        potential violation in accordance with the regulations 
        promulgated under paragraph (1) before a record or information 
        request is issued by a fiscal intermediary, carrier, entity 
        with a contract under section 1893 of the Social Security Act, 
        Federal law enforcement agency, or other appropriate official 
        with regards to an investigation for such potential violation; 
        and
            (3) Action described.--An action described in this section 
        is any--
                    (A) criminal prosecution or civil action under 
                title XI of the Social Security Act (42 U.S.C. 1301 et 
                seq.);
                    (B) civil action under the medicare program; or
                    (C) civil action for false claims under sections 
                3729, 3730, or 3731 of title 31, United States Code.

               TITLE V--CRIMINAL LAW ENFORCEMENT REFORMS

SEC. 501. NO LAW ENFORCEMENT AUTHORITY FOR EMPLOYEES OF THE OFFICE OF 
              INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN 
              SERVICES.

    (a) In General.--Chapter 203 of title 18, United States Code, is 
amended by adding at the end the following new section:
``Sec. 3064. No law enforcement authority for employees of the Office 
              of Inspector General of the Department of Health and 
              Human Services
    ``Notwithstanding any other provision of law, no employee of the 
Office of Inspector General of the Department of Health and Human 
Services may--
            ``(1) be deputized or carry out any law enforcement 
        activity, including the execution of a search warrant or the 
        making of an arrest without a warrant; or
            ``(2) carry a firearm in carrying out any official duty of 
        that employee.''.
    (b) Technical and Conforming Amendment.--The analysis for chapter 
203 of title 18, United States Code, is amended by adding at the end 
the following new item:

``3064. No law enforcement authority for employees of the Office of 
                            Inspector General of the Department of 
                            Health and Human Services.''.

SEC. 502. SEARCH WARRANTS ON HEALTH CARE FACILITIES.

    (a) In General.--Chapter 205 of title 18, United States Code, is 
amended by adding at the end the following new section:
``Sec. 3119. Search warrants on health care facilities
    ``(a) Definition.--In this section--
            ``(1) the term `health care facility' means any facility at 
        which direct patient care is routinely conducted or at which 
        confidential medical records are maintained; and
            ``(2) the term `officer' means any person authorized to 
        serve a search warrant under section 3105.
    ``(b) Application for Warrant.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, an application for a search warrant on a health care 
        facility may not be made without the express approval of the 
        Assistant Attorney General for the Criminal Division of the 
        Department of Justice that includes the information required 
        under paragraph (2), after consultation by the Assistant 
        Attorney General with the chief of the fraud section of such 
        Division in accordance with that paragraph.
            ``(2) Consultation.--The consultation required by paragraph 
        (1) shall include a discussion of, and any subsequent approval 
        by the Assistant Attorney General under that paragraph to apply 
        for the search warrant and shall require the inclusion in the 
        application of, specific information regarding the proposed 
        search, including--
                    ``(A) the intended target or targets;
                    ``(B) the potential violation or violations of law 
                being investigated;
                    ``(C) a brief factual summary;
                    ``(D) a description of the premises to be searched;
                    ``(E) any records, information, and objects to be 
                searched;
                    ``(F) the reasons why less intrusive means are 
                unavailable or unreasonable;
                    ``(G) the procedures to be followed in conducting 
                the search to protect patient safety and ensure 
                uninterrupted delivery of health care services; and
                    ``(H) procedures to be followed in conducting the 
                search to protect the confidentiality of patient 
                records and to provide the health care facility the 
                opportunity to copy documents that are confiscated.
            ``(3) Contents of application.--Notwithstanding any other 
        provision of law, an application for a search warrant on a 
        health care facility shall contain a draft search warrant.
    ``(c) Execution of Warrant.--Notwithstanding any other provision of 
law, an officer executing a search warrant on a health care facility--
            ``(1) shall take the least intrusive approach, consistent 
        with vigorous and effective law enforcement, after giving 
        consideration to obtaining information from other sources or 
        through subpoenas (with the prior approval of the Assistant 
        United States Attorney for the appropriate district);
            ``(2) if the search is conducted in a patient care area, 
        shall abide by instructions of the health care facility 
        specific to patient safety, including using special equipment 
        and protective clothing, and complying with specific 
        procedures;
            ``(3) shall make every effort to avoid entering a critical 
        care or patient care room, or a patient room; and
            ``(4) shall not disrupt any employee providing direct 
        patient care or remove any employee from a patient care area, 
        except to protect the safety of the employee, a patient, or the 
        officer.''.
    (b) Technical and Conforming Amendment.--The analysis for chapter 
205 of title 18, United States Code, is amended by adding at the end 
the following new item:

``3119. Search warrants on health care facilities.''.

                TITLE VI--PROVIDER COMPLIANCE EDUCATION

SEC. 601. EDUCATION.

    (a) Use of Funds.--
            (1) Carriers.--Each carrier shall devote at least 3 percent 
        of the funds provided to it under the medicare program each 
        year (beginning with 2001) toward education of health care 
        providers to ensure that information about the operation of the 
        medicare program is properly disseminated to provider, 
        supplier, and physician.
            (2) Fiscal intermediaries.--Each fiscal intermediary shall 
        devote at least 3 percent of the funds provided it under the 
        medicare program (beginning with 2001) toward education of 
        health care providers to ensure that information about the 
        operation of the medicare program is properly disseminated.
            (3) Medicare integrity program.--The Secretary shall ensure 
        that 10 percent of the funds expended under the medicare 
        integrity program each year (beginning with 2001) are used for 
        education of health care providers to ensure that information 
        about the operation of the medicare program is properly 
        disseminated.
            (4) Purpose.--The purpose of funding under this subsection 
        is to ensure that health care providers learn of new coverage, 
        billing, documentation, and coding changes to medicare laws and 
        regulations in a timely manner.
            (5) Construction.--Education attendance lists or inquiries 
        may not be used as evidence of possible wrongdoings by health 
        care providers under the medicare program and may not lead to 
        fraud investigations under that program.
    (b) Right to Information.--Health care providers have the right to 
timely and accurate information about coverage, billing, documentation, 
and coding changes and modifications to local carrier guidelines under 
the medicare program. Fiscal intermediaries and carriers will offer 
each health care provider the right to receive this information by 
electronic or certified mail (in addition to check stuffers, monthly 
carrier bulletins, the annual ``Dear Doctor'' letter, individual 
letters, seminars, and other means).
    (c) Additional Educational Outreach.--
            (1) In general.--The Secretary shall initiate additional 
        educational outreach for health care providers for coverage, 
        billing, documentation, and coding issues that have the most 
        frequent billing errors. Such outreach shall include issue-
        specific e-mails, faxes, mailings, and telephone calls.
            (2) In-person visits.--If, within 9 months after the date 
        that the additional outreach is initiated under paragraph (1), 
        a carrier finds that no evidence exists that health care 
        provider billing errors under the medicare program have 
        lessened, then the carrier shall complete an in-person visit to 
        relevant health care providers, within three months.
    (d) Right to Telephone Conversation.--A health care provider may 
request a telephone conversation or in-person visit with a carrier, 
without being suspected of fraud, regarding questions about coverage, 
documentation, coding or billing practices under the medicare program.

SEC. 602. ADVISORY OPINIONS.

    (a) Straight Answers.--Fiscal intermediaries and carriers shall do 
their utmost to provide health care providers with one, straight and 
correct answer regarding billing and cost reporting questions under the 
medicare program, and will, when requested, give their true first and 
last names to providers.
    (b) Written Requests.--
            (1) In general.--The Secretary shall establish a process 
        under which a health care provider may request, in writing from 
        a fiscal intermediary or carrier, assistance in addressing 
        questionable coverage, billing, documentation, coding and cost 
        reporting procedures under the medicare program and then the 
        fiscal intermediary or carrier shall respond in writing within 
        30 business days with the correct billing or procedural answer.
            (2) Use of written statement.--
                    (A) In general.--Subject to subparagraph (B), a 
                written statement under paragraph (1) may be used as 
                proof against a future audit or overpayment under the 
                medicare program.
                    (B) Limit on application.--Subparagraph (A) shall 
                not apply retroactively and shall not apply to cases of 
                fraudulent billing.

SEC. 603. EXTENSION OF EXISTING ADVISORY OPINION PROVISIONS OF LAW.

    Section 11280(b)(6) of the Social Security Act (42 U.S.C. 
1320(b)(6)) shall be amended by striking, ``and before the date which 
is 4 years after August 21, 1996''.
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