[Congressional Record Volume 141, Number 166 (Wednesday, October 25, 1995)]
[Senate]
[Pages S15687-S15699]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AMENDMENTS SUBMITTED

                                 ______


             THE BALANCED BUDGET RECONCILIATION ACT OF 1995

                                 ______


                        FORD AMENDMENT NO. 2948

  (Ordered to lie on the table.)
  Mr. FORD submitted an amendment intended to be proposed by him to the 
bill (S. 1357) to provide for reconciliation pursuant to section 105 of 
the concurrent resolution on the budget for fiscal year 1996; as 
follows:

       At the end of title VI, add the following:

     SEC. 6  . CONSTRUCTION OF NATCHER BRIDGE NEAR OWENSBORO, 
                   KENTUCKY.

       (a) Authorization.--The Secretary of Transportation may pay 
     the Federal share of the cost of a project to complete 
     construction of the William H. Natcher Bridge near Owensboro, 
     Kentucky.
       (b) Federal Share.--The Federal share of the cost of the 
     project shall be 80 percent.
       (c) Delegation to States.--Subject to title 23, United 
     States Code, the Secretary of Transportation shall delegate 
     responsibility for construction of the project to the State 
     of Kentucky, on request of the State.
       (d) Advance Construction.--If the State of Kentucky has 
     been delegated responsibility for construction of the project 
     and the State--
       (1) has obligated all funds made available to the State 
     under this section for construction of the project; and
       (2) proceeds to construct the project without the aid of 
     Federal funds, in accordance with all procedures and all 
     requirements applicable to the project, except to the extent 
     that the procedures and requirements limit the State to the 
     construction of projects with the aid of Federal funds 
     previously made available to the State;

     the Secretary of Transportation, on the approval of the 
     application of the State, shall pay to the State the Federal 
     share of the cost of the project at such time as additional 
     funds are made available for the project under this section.
       (e) Applicability of Title 23.--Funds made available under 
     this section shall be available for obligation in the manner 
     provided for funds apportioned under chapter 1 of title 23, 
     United States Code, except that the Federal share of the cost 
     of an project under this section shall be determined in 
     accordance with this section and the funds shall remain 
     available until expended. Funds authorized by this section 
     shall not be subject to any obligation limitation.
       (f) Authorization of Appropriations.--There are authorized 
     to be appropriated from the Highway Trust Fund established by 
     section 9503 of the Internal Revenue Code of 1986 (other than 
     the Mass Transit Account) to carry out the project 
     $44,000,000, to remain available until expended.
       In section 23(b)(2) of the Internal Revenue Code of 1986, 
     as added by section 12001(a), strike ``$110,000'' in 
     subparagraph (A) and insert ``$100,000'' and strike 
     ``$55,000'' in subparagraph (C) and insert ``$50,000''.

  Mr. FORD. Mr. President, over the next few days, we will be debating 
the logic of a $245 billion tax break that adds to the deficit and cuts 
dangerously deep into critical programs for middle-income Americans--
from Medicare to education. My Republican colleagues will justify 
adding to the deficit and making those cuts by striking the familiar 
refrain that these tax breaks will boost the economy.
  But Mr. President, those tax breaks are not only jeopardizing 
important investments in our future economy like education and job 
training, they're jeopardizing critical infrastructure improvements 
that mean much more to local economies than a tax break for America's 
wealthiest few.
  One of those infrastructure projects is a bridge linking my home 
State of Kentucky with Indiana. Without a doubt, the Natcher Bridge 
would mean much more to the local economies of Kentucky and Indiana 
than this tax break. From the increased interstate commerce to making 
the region more attractive to future businesses, industry, and tourism, 
the Natcher Bridge is a long-term investment for every Kentuckian and 
Hossier. But, unfortunately, it was sold down the river for a tax break 
for a wealthy few.

[[Page S15688]]

  I have filed and had planned to offer an amendment to the Budget 
Reconciliation bill authorizing funding for the Natcher Bridge 
connecting Kentucky to Indiana. It would be offset by reducing the 
Republicans' $500 per child tax credit from the proposed income cap of 
$110,000 to $100,000.
  However, it's my understanding that the same Republicans who killed 
this bridge project, will also raise a point of order against my 
amendment. That means I would have to get a super majority for approval 
of my amendment. Without that huge road block, I think I could have 
persuaded my colleagues on the merits of finishing this project.
  That's right. Not starting this project--but finishing this project.
  It's a little bit like the young officer who pointed to the place on 
the map he planned to have the troops cross the river. ``Excellent,'' 
remarked this superior, ``but your finger is not a bridge.'' Well 
neither are two piers sticking out of the Ohio River.
  Nearly $56 million in State and Federal funds have been spent on this 
bridge so far. Along with that financial commitment you'll find the 
initial stages of a new 7.4 mile, four-lane section of U.S. 60 that 
should--and I stress should--connect with a 4.7 mile highway leading to 
the bridge.
  We began this bridge project back in 1988, because the current bridge 
was deemed incapable of dealing with future capacity, fated to become 
functionally obsolete. Because of the serious capacity concerns, we had 
to find the quickest and most efficient way to allocate funds--a 
demonstration project. Kentucky was very lucky to have Congressman 
William Natcher working diligently to get yearly funding for the 
bridge.
  In hindsight, it probably would have been better to get total funding 
for the bridge in just 1 year. But at the time, that would have been 
over $80 million in Federal funds and Mr. Natcher just wasn't that way. 
He didn't want to take any money away from other States, and leave them 
in a pinch. He just took what was essential to the bridge's progress 
each year.
  With his passing, the job of securing funds became much harder, but 
certainly not less worthy. Despite the fact that it was not included in 
the House Transportation Appropriations bill last year, I was able to 
secure the next installment. That's because my colleagues recognized at 
the time that the Natcher Bridge was a critical link in our national 
infrastructure.
  That hasn't changed. And, ending this project now--with nearly $56 
million already invested--would be a considerable waste of Federal and 
State funding, not to mention all but shutting the door to the 
economically important I-64 corridor for these communities.
  While I will not be offering this amendment today, I will be offering 
it in the future. Because the communities on either side of the river, 
and those businesses counting on that corridor for moving their goods 
safely and efficiently, know that building this bridge should come 
before providing a tax break to those making $110,000.
                                 ______


                        BROWN AMENDMENT NO. 2949

  Mr. BROWN proposed an amendment to the motion to commit proposed by 
Mr. Rockefeller to the bill S. 1357, supra; as follows:

       Strike all after ``Finance'' and insert the following: 
     ``With instructions to report the bill back to the Senate 
     forthwith to include the findings of the Trustees of the 
     Federal Insurance Trust Fund that, in order to save Medicare 
     and to keep the Hospital Insurance Trust Fund solvent for 
     future generations, Congress must address both the long-term 
     and short-term shortfalls in the Medicare program.''
                                 ______


                       ABRAHAM AMENDMENT NO. 2950

  Mr. ABRAHAM proposed an amendment to the bill S. 1357, supra; as 
follows:

       At the end of chapter 6 of title VII, insert the following:

     SEC.   . BENEFICIARY INCENTIVE PROGRAMS.

       (a) Program To Collect Information on Fraud and Abuse.--
       (1) Establishment of program.--Not later than 3 months 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services (hereinafter in this section 
     referred to as the ``Secretary'') shall establish a program 
     under which the Secretary shall encourage individuals to 
     report to the Secretary information on individuals and 
     entities who are engaging or who have engaged in acts or 
     omissions which constitute grounds for the imposition of a 
     sanction under section 1128, section 1128A, or section 1128B 
     of the Social Security Act, or who have otherwise engaged in 
     fraud and abuse against the medicare program for which there 
     is a sanction provided under law. The program shall 
     discourage provision of, and not consider, information which 
     is frivolous or otherwise not relevant or material to the 
     imposition of such a sanction.
       (2) Payment of portion of amounts collected.--If an 
     individual reports information to the Secretary under the 
     program established under paragraph (1) which serves as the 
     basis for the collection by the Secretary or the Attorney 
     General of any amount of at least $100 (other than any amount 
     paid as a penalty under section 1128B of the Social Security 
     Act), the Secretary may pay a portion of the amount collected 
     to the individual (under procedures similar to those 
     applicable under section 7623 of the Internal Revenue Code of 
     1986 to payments to individuals providing information on 
     violations of such Code).
       (b) Program To Collect Information on Program Efficiency.--
       (1) Establishment of program.--Not later than 3 months 
     after the date of the enactment of this Act, the Secretary 
     shall establish a program under which the Secretary shall 
     encourage individuals to submit to the Secretary suggestions 
     on methods to improve the efficiency of the medicare program.
       (2) Payment of portion of program savings.--If an 
     individual submits a suggestion to the Secretary under the 
     program established under paragraph (1) which is adopted by 
     the Secretary and which results in savings to the program, 
     the Secretary may make a payment to the individual of such 
     amount as the Secretary considers appropriate.
                                 ______


                    LEAHY AMENDMENTS NOS. 2951-2954

  (Ordered to lie on the table.)
  Mr. LEAHY submitted four amendments intended to be proposed by him to 
the bill S. 1357, supra; as follows--

                           Amendment No. 2951

       Amend section 1109(1)(D) to read as follows--
       ``(D) by amending subsection (h) to read as follows--
       (h) Flood Control.--
       (1) In general.--The Secretary may enter into contracts in 
     accordance with paragraph (2) with producers with crop 
     acreage base on farms with land that is frequently flooded.
       (2) Terms of contract.--The contract described in paragraph 
     (1) shall include the following terms--
       (A) With respect to the acres which are the subject to the 
     contract, the producer shall agree to--
       ((i) the removal of crop acreage base;
       (ii) not build crop acreage base in future years;
       (iii) not apply for crop insurance issued by the Secretary 
     or reinsured by the Secretary;
       (iv) comply with applicable wetlands and highly erodible 
     land conservation compliance requirements described in Title 
     XII of the Food Security Act of 1985;
       (v) not apply for any conservation program payments from 
     the Secretary;
       (vi) not apply for any disaster program benefits issued by 
     the Secretary; and
       (vii) refund the payments with interest issued under the 
     contract to the Secretary, if the producer violates the terms 
     of this contract or if the producer transfers the property to 
     another party who violates the terms specified in this 
     contract.
       (B) The Secretary shall agree to pay producers an amount 
     not more than 95 percent of the projected benefits and 
     subsidies payable to crops planted on the acres from the 
     Commodity Credit Corporation and the Federal Crop Insurance 
     Corporation for the fiscal years covered by the agreement 
     during the period 1997 through 2002.
       (3) Commodity Credit Corporation.--The Secretary shall 
     carry out the program authorized by this subsection through 
     the Commodity Credit Corporation.''
                                                                    ____


                           Amendment No. 2952

       (a) In section 1201(c)(2) by striking (A) and inserting the 
     following:
       ``(A) In general.--Section 1237 of the Food Security Act of 
     1985 (16 U.S.C. 3837) is amended--
       ``(i) in subsection (b)--
       ``(I) in paragraph (1) by striking `and';
       ``(II) in paragraph (2) by--
       ``(aa) by striking `not less' and inserting `not more';
       ``(bb) by striking `2000' and inserting `2002'; and
       ``(cc) by striking the period and inserting\6\; and'; and
       ``(III) adding the following to the end:
       `(3) to the maximum extent possible during the 1996 through 
     2002 calendar years, one-third of the acres in permanent 
     easements, one-third of the acres in 30 year easements, and 
     one-third of the acres in restoration cost-share 
     agreements.'''
       (b) In section 1201(c)(2) strike subparagraph (B) and 
     insert the following:
       ``(B) Cost share agreements.--Section 1237A of the Food 
     Security Act of 1985 (16 U.S.C. 3837A) is amended by--
       ``(i) amending the section heading to read as follows:

     ```SEC. 1237A EASEMENTS AND AGREEMENTS';

       (ii) in subsection (f) striking, except in the case of' 
     through `and the Secretary'; and
       (ii) adding the following the end:

[[Page S15689]]

       ```(h) Cost Share Agreements.--The Secretary may enroll 
     land into wetland reserve through agreements which require 
     the landowner to restore wetlands on the land, provided the 
     agreement does not provide the Secretary with an easement.
       ``(C) Cost share and technical assistance.--Section 
     1237C(b) of the Food Security Act of 1985 (16 U.S.C. 
     3837c(b)) is amended to read as follows:
       `(b) Cost Share and Technical Assistance.--
       `(1) For easements entered into from the 1991 through 1995 
     calendar years in making cost share payments under subsection 
     (a)(1), the Secretary shall pay the owner an amount that is 
     not less than 50 percent but not more than 75 percent of 
     eligible costs with respect to an easement which is not 
     permanent, and not less than 75 percent but not more than 100 
     percent of eligible costs with respect to a permanent 
     easement.
       `(2) For easements and agreements entered into from the 
     1996 through 2002 calendar years, in making cost share 
     payments the Secretary shall--
       (A) pay the owner an amount that is not less than 75 
     percent but not more than 100 percent of the eligible costs 
     with respect to preeminent easements and cost share 
     agreements;
       (B) pay the owner an amount that is not less than 50 
     percent, but not more than 75 percent of the eligible costs 
     with respect to 30 year easements; and
       (C) provide owners technical assistance to assist land 
     owners in complying with the terms of easements and 
     agreements.''
       ``(C) Agreements--
       `(g) Easements and Agreements.--The Secretary shall enroll 
     lands in the wetland reserve through easements and agreements 
     in accordance with this subsection.
       `(1) Easements.--The Secretary may enroll land into wetland 
     reserve through the purchase of easements as provided for in 
     section 1237A.
       `(2) Agreements.--The Secretary may enroll land into the 
     wetland reserve through agreements which require the 
     landowner to restore wetlands on the land, provided the 
     agreement does not provide the Secretary with an easement. 
     Through such agreements the Secretary shall provide 
     landowners cost share and technical assistance in accordance 
     with section 1237C(b).'''
       (c) In section 1201(c)(2) strike subparagraph (B) and 
     insert the following:
       ``(B) Compensation.--Section 1237A(f) of the Food Security 
     Act of 1985 (16 U.S.C. 3837a(f)) is amended by striking', 
     except in the case of through and the Secretary'.''

                           Amendment No. 2953

       Amend section 1201(b) by adding the following after ``To 
     receive cost sharing or inventive payments, or technical 
     assistance, participating operators shall comply with all 
     terms and conditions of the contract and a plan, as 
     established by the Secretary''.
       `(3) Contract effective date.--A contract between an 
     operator and the Secretary under this chapter shall become 
     effective on October 1st following the date the contract is 
     fully entered into.'''
                                                                    ____


                           Amendment No. 2954

       Amend section 1106 by striking ``for calendar year 1996, 
     subject to subsection (d).'' through ``beginning January 1, 
     1996, and ending December 31, 2002''.
                                 ______


                   GRASSLEY AMENDMENTS NOS. 2955-2956

  (Ordered to lie on the table.)
  Mr. GRASSLEY submitted two amendments intended to be proposed by him 
to the bill S. 1357, supra; as follows:

                           Amendment No. 2955

       Subsection (e) of Section 2123 is amended by adding ``, 
     other than a program operated or financed by the Indian 
     Health Service,'' after ``other federally operated or 
     financed health care program''.
       As amended, the subsection would read:
       (e) Medicaid as Secondary Payer.--Except as otherwise 
     provided by law, no payment shall be made to a State under 
     this part for expenditures for medical assistance provided 
     for an individual under its medicaid plan to the extent that 
     payment has been made or can reasonably be expected to be 
     made promptly (as determined in accordance with regulations) 
     under any other federally operated or financed health care 
     program, other than a program operated or financed by the 
     Indian Health Service, as identified by the Secretary. For 
     purposes of this subsection, rules similar to the rules for 
     overpayments under section 2122(b) shall apply.
                                                                    ____


                           Amendment No. 2956

       On Pages 764 and 765, section 2106, Medicaid Task Force--
     under subsection (c) Advisory Group for the Task Force, add 
     new number (14) to read: ``(14) American Osteopathic 
     Association''.
       Redesignate old No. 14 to be No. 15
       Redesignate old No. 15 to be No. 16
       Redesignate old No. 16 to be No. 17
       Redesignate old No. 17 to be No. 18.
                                 ______


                       HARKIN AMENDMENT NO. 2957

  Mr. HARKIN proposed an amendment to the bill S. 1357, supra; as 
follows:

       Strike all after the word ``Sec.'' on page 1 line 3 and 
     insert the following:
       Sec.  . The following provisions shall constitute all of 
     the provisions regarding Medicare Fraud and Abuse in Title 
     VII of this bill:

           CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION

     SEC. 7100. SHORT TITLE.

       This chapter may be cited as the ``Health Care Fraud and 
     Abuse Prevention Act of 1995''.

             Subchapter A--Fraud and Abuse Control Program

     SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM.

       (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et 
     seq.) is amended by inserting after section 1128B the 
     following new section:


                   ``FRAUD AND ABUSE CONTROL PROGRAM

       ``Sec. 1128C. (a) Establishment of Program.--
       ``(1) In general.--Not later than January 1, 1996, the 
     Secretary, acting through the Office of the Inspector General 
     of the Department of Health and Human Services, and the 
     Attorney General shall establish a program--
       ``(A) to coordinate Federal, State, and local law 
     enforcement programs to control fraud and abuse with respect 
     to the delivery of and payment for health care in the United 
     States,
       ``(B) to conduct investigations, audits, evaluations, and 
     inspections relating to the delivery of and payment for 
     health care in the United States,
       ``(C) to facilitate the enforcement of the provisions of 
     sections 1128, 1128A, and 1128B and other statutes applicable 
     to health care fraud and abuse, and
       ``(D) to provide for the modification and establishment of 
     safe harbors and to issue interpretative rulings and special 
     fraud alerts pursuant to section 1128D.
       ``(2) Coordination with health plans.--In carrying out the 
     program established under paragraph (1), the Secretary and 
     the Attorney General shall consult with, and arrange for the 
     sharing of data with representatives of health plans.
       ``(3) Guidelines.--
       ``(A) In general.--The Secretary and the Attorney General 
     shall issue guidelines to carry out the program under 
     paragraph (1). The provisions of sections 553, 556, and 557 
     of title 5, United States Code, shall not apply in the 
     issuance of such guidelines.
       ``(B) Information guidelines.--
       ``(i) In general.--Such guidelines shall include guidelines 
     relating to the furnishing of information by health plans, 
     providers, and others to enable the Secretary and the 
     Attorney General to carry out the program (including 
     coordination with health plans under paragraph (2)).
       ``(ii) Confidentiality.--Such guidelines shall include 
     procedures to assure that such information is provided and 
     utilized in a manner that appropriately protects the 
     confidentiality of the information and the privacy of 
     individuals receiving health care services and items.
       ``(iii) Qualified immunity for providing information.--The 
     provisions of section 1157(a) (relating to limitation on 
     liability) shall apply to a person providing information to 
     the Secretary or the Attorney General in conjunction with 
     their performance of duties under this section.
       ``(4) Ensuring access to documentation.--The Inspector 
     General of the Department of Health and Human Services is 
     authorized to exercise such authority described in paragraphs 
     (3) through (9) of section 6 of the Inspector General Act of 
     1978 (5 U.S.C. App.) as necessary with respect to the 
     activities under the fraud and abuse control program 
     established under this subsection.
       ``(5) Authority of inspector general.--Nothing in this Act 
     shall be construed to diminish the authority of any Inspector 
     General, including such authority as provided in the 
     Inspector General Act of 1978 (5 U.S.C. App.).
       ``(b) Additional Use of Funds by Inspector General.--
       ``(1) Reimbursements for investigations.--The Inspector 
     General of the Department of Health and Human Services is 
     authorized to receive and retain for current use 
     reimbursement for the costs of conducting investigations and 
     audits and for monitoring compliance plans when such costs 
     are ordered by a court, voluntarily agreed to by the payer, 
     or otherwise.
       ``(2) Crediting.--Funds received by the Inspector General 
     under paragraph (1) as reimbursement for costs of conducting 
     investigations shall be deposited to the credit of the 
     appropriation from which initially paid, or to appropriations 
     for similar purposes currently available at the time of 
     deposit, and shall remain available for obligation for 1 year 
     from the date of the deposit of such funds.
       ``(c) Health Plan Defined.--For purposes of this section, 
     the term `health plan' means a plan or program that provides 
     health benefits, whether directly, through insurance, or 
     otherwise, and includes--
       ``(1) a policy of health insurance;
       ``(2) a contract of a service benefit organization; and
       ``(3) a membership agreement with a health maintenance 
     organization or other prepaid health plan.''.
       (b) Establishment of Health Care Fraud and Abuse Control 
     Account in Federal Hospital Insurance Trust Fund.--Section 
     1817 (42 U.S.C. 1395i) is amended by adding at the end the 
     following new subsection:

[[Page S15690]]

       ``(k) Health Care Fraud and Abuse Control Account.--
       ``(1) Establishment.--There is hereby established in the 
     Trust Fund an expenditure account to be known as the `Health 
     Care Fraud and Abuse Control Account' (in this subsection 
     referred to as the `Account').
       ``(2) Appropriated amounts to trust fund.--
       ``(A) In general.--There are hereby appropriated to the 
     Trust Fund--
       ``(i) such gifts and bequests as may be made as provided in 
     subparagraph (B);
       ``(ii) such amounts as may be deposited in the Trust Fund 
     as provided in sections 7141(b) and 7142(c) of the Balanced 
     Budget Reconciliation Act of 1995, and title XI; and
       ``(iii) such amounts as are transferred to the Trust Fund 
     under subparagraph (C).
       ``(B) Authorization to accept gifts.--The Trust Fund is 
     authorized to accept on behalf of the United States money 
     gifts and bequests made unconditionally to the Trust Fund, 
     for the benefit of the Account or any activity financed 
     through the Account.
       ``(C) Transfer of amounts.--The Managing Trustee shall 
     transfer to the Trust Fund, under rules similar to the rules 
     in section 9601 of the Internal Revenue Code of 1986, an 
     amount equal to the sum of the following:
       ``(i) Criminal fines recovered in cases involving a Federal 
     health care offense (as defined in section 982(a)(6)(B) of 
     title 18, United States Code).
       ``(ii) Civil monetary penalties and assessments imposed in 
     health care cases, including amounts recovered under titles 
     XI, XVIII, and XXI, and chapter 38 of title 31, United States 
     Code (except as otherwise provided by law).
       ``(iii) Amounts resulting from the forfeiture of property 
     by reason of a Federal health care offense.
       ``(iv) Penalties and damages obtained and otherwise 
     creditable to miscellaneous receipts of the general fund of 
     the Treasury obtained under sections 3729 through 3733 of 
     title 31, United States Code (known as the False Claims Act), 
     in cases involving claims related to the provision of health 
     care items and services (other than funds awarded to a 
     relator, for restitution or otherwise authorized by law).
       ``(3) Appropriated amounts to account.--
       ``(A) In general.--There are hereby appropriated to the 
     Account from the Trust Fund such sums as the Secretary and 
     the Attorney General certify are necessary to carry out the 
     purposes described in subparagraph (B), to be available 
     without further appropriation, in an amount--
       ``(i) with respect to activities of the Office of the 
     Inspector General of the Department of Health and Human 
     Services and the Federal Bureau of Investigations in carrying 
     out such purposes, not less than--

       ``(I) for fiscal year 1996, $110,000,000,
       ``(II) for fiscal year 1997, $140,000,000,
       ``(III) for fiscal year 1998, $160,000,000,
       ``(IV) for fiscal year 1999, $185,000,000,
       ``(V) for fiscal year 2000, $215,000,000,
       ``(VI) for fiscal year 2001, $240,000,000, and
       ``(VII) for fiscal year 2002, $270,000,000; and

       ``(ii) with respect to all activities (including the 
     activities described in clause (i)) in carrying out such 
     purposes, not more than--

       ``(I) for fiscal year 1996, $200,000,000, and
       ``(II) for each of the fiscal years 1997 through 2002, the 
     limit for the preceding fiscal year, increased by 15 percent; 
     and

       ``(iii) for each fiscal year after fiscal year 2002, within 
     the limits for fiscal year 2002 as determined under clauses 
     (i) and (ii).
       ``(B) Use of funds.--The purposes described in this 
     subparagraph are as follows:
       ``(i) General use.--To cover the costs (including 
     equipment, salaries and benefits, and travel and training) of 
     the administration and operation of the health care fraud and 
     abuse control program established under section 1128C(a), 
     including the costs of--

       ``(I) prosecuting health care matters (through criminal, 
     civil, and administrative proceedings);
       ``(II) investigations;
       ``(III) financial and performance audits of health care 
     programs and operations;
       ``(IV) inspections and other evaluations; and
       ``(V) provider and consumer education regarding compliance 
     with the provisions of title XI.

       ``(ii) Use by state medicaid fraud control units for 
     investigation reimbursements.--To reimburse the various State 
     medicaid fraud control units upon request to the Secretary 
     for the costs of the activities authorized under section 
     2134(b).
       ``(4) Annual report.--The Secretary and the Attorney 
     General shall submit jointly an annual report to Congress on 
     the amount of revenue which is generated and disbursed, and 
     the justification for such disbursements, by the Account in 
     each fiscal year.''.

     SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE 
                   SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL 
                   HEALTH PROGRAMS.

       (a) Crimes.--
       (1) Social security act.--Section 1128B (42 U.S.C. 1320a-
     7b) is amended as follows:
       (A) In the heading, by striking ``medicare or state health 
     care programs'' and inserting ``federal health care 
     programs''.
       (B) In subsection (a)(1), by striking ``a program under 
     title XVIII or a State health care program (as defined in 
     section 1128(h))'' and inserting ``a Federal health care 
     program''.
       (C) In subsection (a)(5), by striking ``a program under 
     title XVIII or a State health care program'' and inserting 
     ``a Federal health care program''.
       (D) In the second sentence of subsection (a)--
       (i) by striking ``a State plan approved under title XIX'' 
     and inserting ``a Federal health care program''; and
       (ii) by striking ``the State may at its option 
     (notwithstanding any other provision of that title or of such 
     plan)'' and inserting ``the administrator of such program may 
     at its option (notwithstanding any other provision of such 
     program)''.
       (E) In subsection (b)--
       (i) by striking ``and willfully'' each place it appears;
       (ii) by striking ``$25,000'' each place it appears and 
     inserting ``$50,000'';
       (iii) by striking ``title XVIII or a State health care 
     program'' each place it appears and inserting ``Federal 
     health care program'';
       (iv) in paragraph (1) in the matter preceding subparagraph 
     (A), by striking ``kind--'' and inserting ``kind with intent 
     to be influenced--'';
       (v) in paragraph (1)(A), by striking ``in return for 
     referring'' and inserting ``to refer'';
       (vi) in paragraph (1)(B), by striking ``in return for 
     purchasing, leasing, ordering, or arranging for or 
     recommending'' and inserting ``to purchase, lease, order, or 
     arrange for or recommend'';
       (vii) in paragraph (2) in the matter proceeding 
     subparagraph (A), by striking ``to induce such person'' and 
     inserting ``with intent to influence such person'';
       (viii) by adding at the end of paragraphs (1) and (2) the 
     following sentence: ``A violation exists under this paragraph 
     if one or more purposes of the remuneration is unlawful under 
     this paragraph.'';
       (ix) by redesignating paragraph (3) as paragraph (4);
       (x) in paragraph (4) (as redesignated), by striking 
     ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), 
     (2), and (3)''; and
       (xi) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3)(A) The Attorney General may bring an action in the 
     district courts to impose upon any person who carries out any 
     activity in violation of this subsection a civil penalty of 
     not less than $25,000 and not more than $50,000 for each such 
     violation, plus three times the total remuneration offered, 
     paid, solicited, or received.
       ``(B) A violation exists under this paragraph if one or 
     more purposes of the remuneration is unlawful, and the 
     damages shall be the full amount of such remuneration.
       ``(C) Section 3731 of title 31, United States Code, and the 
     Federal Rules of Civil Procedure shall apply to actions 
     brought under this paragraph.
       ``(D) The provisions of this paragraph do not affect the 
     availability of other criminal and civil remedies for such 
     violations.''.
       (F) In subsection (c), by inserting ``(as defined in 
     section 1128(h))'' after ``a State health care program''.
       (G) By adding at the end the following new subsections:
       ``(f) For purposes of this section, the term `Federal 
     health care program' means--
       ``(1) any plan or program that provides health benefits, 
     whether directly, through insurance, or otherwise, which is 
     funded, in whole or in part, by the United States Government; 
     or
       ``(2) any State health care program, as defined in section 
     1128(h).
       ``(g)(1) The Secretary and Administrator of the departments 
     and agencies with a Federal health care program may conduct 
     an investigation or audit relating to violations of this 
     section and claims within the jurisdiction of other Federal 
     departments or agencies if the following conditions are 
     satisfied:
       ``(A) The investigation or audit involves primarily claims 
     submitted to the Federal health care programs of the 
     department or agency conducting the investigation or audit.
       ``(B) The Secretary or Administrator of the department or 
     agency conducting the investigation or audit gives notice and 
     an opportunity to participate in the investigation or audit 
     to the Inspector General of the department or agency with 
     primary jurisdiction over the Federal health care programs to 
     which the claims were submitted.
       ``(2) If the conditions specified in paragraph (1) are 
     fulfilled, the Inspector General of the department or agency 
     conducting the investigation or audit may exercise all powers 
     granted under the Inspector General Act of 1978 with respect 
     to the claims submitted to the other departments or agencies 
     to the same manner and extent as provided in that Act with 
     respect to claims submitted to such departments or 
     agencies.''.
       (2) Identification of community service opportunities.--
     Section 1128B (42 U.S.C. 1320a-7b) is further amended by 
     adding at the end the following new subsection:
       ``(h) The Secretary may--
       ``(1) in consultation with State and local health care 
     officials, identify opportunities for the satisfaction of 
     community service obligations that a court may impose upon 
     the conviction of an offense under this section, and
       ``(2) make information concerning such opportunities 
     available to Federal and State law enforcement officers and 
     State and local health care officials.''.
       (b) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 1996.

[[Page S15691]]


     SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE.

       (a) Solicitation and Publication of Modifications to 
     Existing Safe Harbors and New Safe Harbors.--
       (1) In general.--
       (A) Solicitation of proposals for safe harbors.--Not later 
     than January 1, 1996, and not less than annually thereafter, 
     the Secretary shall publish a notice in the Federal Register 
     soliciting proposals, which will be accepted during a 60-day 
     period, for--
       (i) modifications to existing safe harbors issued pursuant 
     to section 14(a) of the Medicare and Medicaid Patient and 
     Program Protection Act of 1987 (42 U.S.C. 1320a-7b note);
       (ii) additional safe harbors specifying payment practices 
     that shall not be treated as a criminal offense under section 
     1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) 
     and shall not serve as the basis for an exclusion under 
     section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7));
       (iii) interpretive rulings to be issued pursuant to 
     subsection (b); and
       (iv) special fraud alerts to be issued pursuant to 
     subsection (c).
       (B) Publication of proposed modifications and proposed 
     additional safe harbors.--After considering the proposals 
     described in clauses (i) and (ii) of subparagraph (A), the 
     Secretary, in consultation with the Attorney General, shall 
     publish in the Federal Register proposed modifications to 
     existing safe harbors and proposed additional safe harbors, 
     if appropriate, with a 60-day comment period. After 
     considering any public comments received during this period, 
     the Secretary shall issue final rules modifying the existing 
     safe harbors and establishing new safe harbors, as 
     appropriate.
       (C) Report.--The Inspector General of the Department of 
     Health and Human Services (in this section referred to as the 
     ``Inspector General'') shall, in an annual report to Congress 
     or as part of the year-end semiannual report required by 
     section 5 of the Inspector General Act of 1978 (5 U.S.C. 
     App.), describe the proposals received under clauses (i) and 
     (ii) of subparagraph (A) and explain which proposals were 
     included in the publication described in subparagraph (B), 
     which proposals were not included in that publication, and 
     the reasons for the rejection of the proposals that were not 
     included.
       (2) Criteria for modifying and establishing safe harbors.--
     In modifying and establishing safe harbors under paragraph 
     (1)(B), the Secretary may consider the extent to which 
     providing a safe harbor for the specified payment practice 
     may result in any of the following:
       (A) An increase or decrease in access to health care 
     services.
       (B) An increase or decrease in the quality of health care 
     services.
       (C) An increase or decrease in patient freedom of choice 
     among health care providers.
       (D) An increase or decrease in competition among health 
     care providers.
       (E) An increase or decrease in the ability of health care 
     facilities to provide services in medically underserved areas 
     or to medically underserved populations.
       (F) An increase or decrease in the cost to Federal health 
     care programs (as defined in section 1128B(f) of the Social 
     Security Act (42 U.S.C. 1320a-7b(f)).
       (G) An increase or decrease in the potential 
     overutilization of health care services.
       (H) The existence or nonexistence of any potential 
     financial benefit to a health care professional or provider 
     which may vary based on their decisions of--
       (i) whether to order a health care item or service; or
       (ii) whether to arrange for a referral of health care items 
     or services to a particular practitioner or provider.
       (I) Any other factors the Secretary deems appropriate in 
     the interest of preventing fraud and abuse in Federal health 
     care programs (as so defined).
       (b) Interpretive Rulings.--
       (1) In general.--
       (A) Request for interpretive ruling.--Any person may 
     present, at any time, a request to the Inspector General for 
     a statement of the Inspector General's current interpretation 
     of the meaning of a specific aspect of the application of 
     sections 1128A and 1128B of the Social Security Act (42 
     U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as 
     an ``interpretive ruling'').
       (B) Issuance and effect of interpretive ruling.--
       (i) In general.--If appropriate, the Inspector General 
     shall in consultation with the Attorney General, issue an 
     interpretive ruling not later than 120 days after receiving a 
     request described in subparagraph (A). Interpretive rulings 
     shall not have the force of law and shall be treated as an 
     interpretive rule within the meaning of section 553(b) of 
     title 5, United States Code. All interpretive rulings issued 
     pursuant to this clause shall be published in the Federal 
     Register or otherwise made available for public inspection.
       (ii) Reasons for denial.--If the Inspector General does not 
     issue an interpretive ruling in response to a request 
     described in subparagraph (A), the Inspector General shall 
     notify the requesting party of such decision not later than 
     120 days after receiving such a request and shall identify 
     the reasons for such decision.
       (2) Criteria for interpretive rulings.--
       (A) In general.--In determining whether to issue an 
     interpretive ruling under paragraph (1)(B), the Inspector 
     General may consider--
       (i) whether and to what extent the request identifies an 
     ambiguity within the language of the statute, the existing 
     safe harbors, or previous interpretive rulings; and
       (ii) whether the subject of the requested interpretive 
     ruling can be adequately addressed by interpretation of the 
     language of the statute, the existing safe harbor rules, or 
     previous interpretive rulings, or whether the request would 
     require a substantive ruling (as defined in section 552 of 
     title 5, United States Code) not authorized under this 
     subsection.
       (B) No rulings on factual issues.--The Inspector General 
     shall not give an interpretive ruling on any factual issue, 
     including the intent of the parties or the fair market value 
     of particular leased space or equipment.
       (c) Special Fraud Alerts.--
       (1) In general.--
       (A) Request for special fraud alerts.--Any person may 
     present, at any time, a request to the Inspector General for 
     a notice which informs the public of practices which the 
     Inspector General considers to be suspect or of particular 
     concern under section 1128B(b) of the Social Security Act (42 
     U.S.C. 1320a-7b(b)) (in this subsection referred to as a 
     ``special fraud alert'').
       (B) Issuance and publication of special fraud alerts.--Upon 
     receipt of a request described in subparagraph (A), the 
     Inspector General shall investigate the subject matter of the 
     request to determine whether a special fraud alert should be 
     issued. If appropriate, the Inspector General shall issue a 
     special fraud alert in response to the request. All special 
     fraud alerts issued pursuant to this subparagraph shall be 
     published in the Federal Register.
       (2) Criteria for special fraud alerts.--In determining 
     whether to issue a special fraud alert upon a request 
     described in paragraph (1), the Inspector General may 
     consider--
       (A) whether and to what extent the practices that would be 
     identified in the special fraud alert may result in any of 
     the consequences described in subsection (a)(2); and
       (B) the volume and frequency of the conduct that would be 
     identified in the special fraud alert.

     SEC. 7104. MEDICARE/MEDICAID BENEFICIARY PROTECTION PROGRAM.

       (a) Establishment of Program.--Not later than January 1, 
     1996, the Secretary (through the Administrator of the Health 
     Care Financing Administration and the Inspector General of 
     the Department of Health and Human Services) shall establish 
     the Medicare/Medicaid Beneficiary Protection Program. Under 
     such program the Secretary shall--
       (1) educate medicare and medicaid beneficiaries regarding--
       (A) medicare and medicaid program coverage;
       (B) fraudulent and abusive practices;
       (C) medically unnecessary health care items and services; 
     and
       (D) substandard health care items and services;
       (2) identify and publicize fraudulent and abusive practices 
     with respect to the delivery of health care items and 
     services; and
       (3) establish a procedure for the reporting of fraudulent 
     and abusive health care providers, practitioners, claims, 
     items, and services to appropriate law enforcement and payer 
     agencies.
       (b) Recognition and Publication of Contributions.--The 
     program established by the Secretary under this section shall 
     recognize and publicize significant contributions made by 
     individual health care patients toward the combating of 
     health care fraud and abuse.
       (c) Dissemination of Information.--The Secretary shall 
     provide for the broad dissemination of information regarding 
     the Medicare/Medicaid Beneficiary Protection Program.

     SEC. 7105. MEDICARE BENEFIT QUALITY ASSURANCE.

       (a) In General.--Part D of title XVIII (42 U.S.C. 1395 et 
     seq.), as redesignated in section 7003, is amended by 
     inserting after section 1888 the following new section:


                  ``medicare benefit integrity system

       ``Sec. 1889. (a) Appropriation.--There are appropriated 
     from the Federal Hospital Insurance Trust Fund and the 
     Federal Supplementary Medical Insurance Trust Fund for each 
     fiscal year such amounts as are necessary to carry out the 
     benefit quality assurance program activities described in 
     subsection (b), subject to subsections (c) and (d).
       ``(b) Activities Described.--The benefit quality assurance 
     program activities described in this subsection are as 
     follows:
       ``(1) Review of activities of providers of services or 
     other persons in connection with this title, including 
     medical and utilization review and fraud review.
       ``(2) Audit of cost reports.
       ``(3) Determinations as to whether payment should not be, 
     or should not have been, made under this title by reason of 
     section 1862(b), and recovery of payments that should not 
     have been made.
       ``(4) Education of providers of services, beneficiaries, 
     and other persons with respect to payment integrity and 
     benefit quality assurance issues.
       ``(c) Amounts Specified.--The amount appropriated under 
     subsection (a) for a fiscal year is as follows:
       ``(1) For fiscal year 1996, such amount shall be 
     $525,000,000.

[[Page S15692]]

       ``(2) For fiscal year 1997, such amount shall be 
     $550,000,000.
       ``(3) For fiscal year 1998, such amount shall be 
     $575,000,000.
       ``(4) For fiscal year 1999, such amount shall be 
     $600,000,000.
       ``(5) For fiscal year 2000, such amount shall be 
     $619,000,000.
       ``(6) For fiscal year 2001 and each succeeding fiscal year, 
     the greater of--
       ``(A) $619,000,000 increased by a percentage equal to the 
     percentage increase in expenditures under this title (other 
     than expenditures pursuant to this section) for the preceding 
     fiscal year over fiscal year 1999; or
       ``(B) an amount equal to the aggregate amount expended for 
     activities described in subsection (b) in fiscal year 2000, 
     increased, as determined by the Secretary, to reflect--
       ``(i) inflation; and
       ``(ii) any costs attributable to oversight responsibilities 
     added with respect to periods after fiscal year 2000.
       ``(d) Allocation of Payments Among Trust Funds.--The 
     appropriations made under subsection (a) shall be allocated 
     to reasonably reflect the proportion of expenditures 
     associated with part A and part B.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to obligations incurred after fiscal year 1995.

     SEC. 7106. MEDICARE BENEFIT INTEGRITY SYSTEM.

       (a) In General.--Part D of title XVIII (42 U.S.C. 1395 et 
     seq.), as redesignated in section 7003 and amended by section 
     7045, is amended by inserting after section 1888 the 
     following new section:


                 ``medicare benefit integrity contracts

       ``Sec. 1890. (a) Authority To Contract.--
       ``(1) In general.--In order to improve the effectiveness of 
     benefit quality assurance activities relating to programs 
     under this title, and to enhance the Secretary's capability 
     to carry out program safeguard functions and related 
     education activities to avoid the improper expenditure of 
     assets of the Federal Hospital Insurance Trust Fund and the 
     Federal Supplementary Medical Insurance Trust Fund, the 
     Secretary shall enter into contracts with organizations or 
     other entities having demonstrated capability to carry out 
     one or more of the activities described in section 1889(b). 
     The provisions of sections 1816 and 1842 shall be 
     inapplicable to contracts under this section.
       ``(2) Number of contracts.--The Secretary shall determine 
     the number of separate contracts which are necessary to 
     achieve, with the maximum degree of efficiency and cost 
     effectiveness, the objectives of this section. The Secretary 
     may enter into contracts under this section at such time or 
     times as are appropriate so long as not later than the fiscal 
     year beginning October 1, 1998, and for each fiscal year 
     thereafter, there are in effect contracts that, considered 
     collectively, provide for benefit quality assurance 
     activities with respect to all payments under this title.
       ``(b) Contract Requirements.--A benefit quality assurance 
     contract entered into under subsection (a) must provide for 
     one or more benefit quality assurance program activities 
     described in section 1889(b). Each such contract shall 
     include an agreement by the contractor to cooperate with the 
     Inspector General of the Department of Health and Human 
     Services, and the Attorney General, and other law enforcement 
     agencies, as appropriate, in the investigation and deterrence 
     of fraud and abuse in relation to this title and in other 
     cases arising out of the activities described in such 
     section, and shall contain such other provisions as the 
     Secretary finds necessary or appropriate to achieve the 
     purposes of this part. The provisions of section 1153(e)(1) 
     shall apply to contracts and contracting authority under this 
     section, except that competitive procedures must be used when 
     entering into new contracts under this section, or at any 
     other time when it is in the best interests of the United 
     States. A contract under this section may be renewed from 
     term to term without regard to any provision of law requiring 
     competition if the contractor has met or exceeded the 
     performance requirements established in the current contract.
       ``(c) Limitations.--
       ``(1) In general.--In carrying out this section, the 
     Secretary may not enter into a contract with an organization 
     or other entity if the Secretary determines that such 
     organization's or entity's financial holdings, interests, or 
     relationships would interfere with its ability to perform the 
     functions to be required by the contract in an effective and 
     impartial manner.
       ``(2) Limitation of liability.--The Secretary shall by 
     regulation provide for the limitation of a contractor's 
     liability for actions taken to carry out a contract under 
     this section, and such regulations shall, to the extent the 
     Secretary finds appropriate, employ the same or comparable 
     standards and other substantive and procedural provisions as 
     are contained in section 1157.''.

      PART II--REVISIONS TO CURRENT SANCTIONS FOR FRAUD AND ABUSE

     SEC. 7110. MANDATORY EXCLUSION FROM PARTICIPATION IN MEDICARE 
                   AND STATE HEALTH CARE PROGRAMS.

       (a) Individual Convicted of Felony Relating to Health Care 
     Fraud.--
       (1) In general.--Section 1128(a) (42 U.S.C. 1320a-7(a)) is 
     amended by adding at the end the following new paragraph:
       ``(3) Felony conviction relating to health care fraud.--Any 
     individual or entity that has been convicted after the date 
     of the enactment of the Medicare Improvement and Solvency 
     Protection Act of 1995, under Federal or State law, in 
     connection with the delivery of a health care item or service 
     or with respect to any act or omission in a health care 
     program (other than those specifically described in paragraph 
     (1)) operated by or financed in whole or in part by any 
     Federal, State, or local government agency, of a criminal 
     offense consisting of a felony relating to fraud, theft, 
     embezzlement, breach of fiduciary responsibility, or other 
     financial misconduct.''.
       (2) Conforming amendment.--Paragraph (1) of section 1128(b) 
     (42 U.S.C. 1320a-7(b)) is amended to read as follows:
       ``(1) Conviction relating to fraud.--Any individual or 
     entity that has been convicted after the date of the 
     enactment of the Medicare Improvement and Solvency Protection 
     Act of 1995, under Federal or State law--
       ``(A) of a criminal offense consisting of a misdemeanor 
     relating to fraud, theft, embezzlement, breach of fiduciary 
     responsibility, or other financial misconduct--
       ``(i) in connection with the delivery of a health care item 
     or service, or
       ``(ii) with respect to any act or omission in a health care 
     program (other than those specifically described in 
     subsection (a)(1)) operated by or financed in whole or in 
     part by any Federal, State, or local government agency; or
       ``(B) of a criminal offense relating to fraud, theft, 
     embezzlement, breach of fiduciary responsibility, or other 
     financial misconduct with respect to any act or omission in a 
     program (other than a health care program) operated by or 
     financed in whole or in part by any Federal, State, or local 
     government agency.''.
       (b) Individual Convicted of Felony Relating to Controlled 
     Substance.--
       (1) In general.--Section 1128(a) (42 U.S.C. 1320a-7(a)), as 
     amended by subsection (a), is amended by adding at the end 
     the following new paragraph:
       ``(4) Felony conviction relating to controlled substance.--
     Any individual or entity that has been convicted after the 
     date of the enactment of the Medicare Improvement and 
     Solvency Protection Act of 1995, under Federal or State law, 
     of a criminal offense consisting of a felony relating to the 
     unlawful manufacture, distribution, prescription, or 
     dispensing of a controlled substance.''.
       (2) Conforming amendment.--Section 1128(b)(3) (42 U.S.C. 
     1320a-7(b)(3)) is amended--
       (A) in the heading, by striking ``Conviction'' and 
     inserting ``Misdemeanor conviction''; and
       (B) by striking ``criminal offense'' and inserting 
     ``criminal offense consisting of a misdemeanor''.

     SEC. 7111. ESTABLISHMENT OF MINIMUM PERIOD OF EXCLUSION FOR 
                   CERTAIN INDIVIDUALS AND ENTITIES SUBJECT TO 
                   PERMISSIVE EXCLUSION FROM MEDICARE AND STATE 
                   HEALTH CARE PROGRAMS.

       Section 1128(c)(3) (42 U.S.C. 1320a-7(c)(3)) is amended by 
     adding at the end the following new subparagraphs:
       ``(D) In the case of an exclusion of an individual or 
     entity under paragraph (1), (2), or (3) of subsection (b), 
     the period of the exclusion shall be 3 years, unless the 
     Secretary determines in accordance with published regulations 
     that a shorter period is appropriate because of mitigating 
     circumstances or that a longer period is appropriate because 
     of aggravating circumstances.
       ``(E) In the case of an exclusion of an individual or 
     entity under subsection (b)(4) or (b)(5), the period of the 
     exclusion shall not be less than the period during which the 
     individual's or entity's license to provide health care is 
     revoked, suspended, or surrendered, or the individual or the 
     entity is excluded or suspended from a Federal or State 
     health care program.
       ``(F) In the case of an exclusion of an individual or 
     entity under subsection (b)(6)(B), the period of the 
     exclusion shall be not less than 1 year.''.

     SEC. 7112. PERMISSIVE EXCLUSION OF INDIVIDUALS WITH OWNERSHIP 
                   OR CONTROL INTEREST IN SANCTIONED ENTITIES.

       Section 1128(b) (42 U.S.C. 1320a-7(b)) is amended by adding 
     at the end the following new paragraph:
       ``(15) Individuals controlling a sanctioned entity.--Any 
     individual who has a direct or indirect ownership or control 
     interest of 5 percent or more, or an ownership or control 
     interest (as defined in section 1124(a)(3)) in, or who is an 
     officer or managing employee (as defined in section 1126(b)) 
     of, an entity--
       ``(A) that has been convicted of any offense described in 
     subsection (a) or in paragraph (1), (2), or (3) of this 
     subsection; or
       ``(B) that has been excluded from participation under a 
     program under title XVIII or under a State health care 
     program.''.

     SEC. 7113. SANCTIONS AGAINST PRACTITIONERS AND PERSONS FOR 
                   FAILURE TO COMPLY WITH STATUTORY OBLIGATIONS.

       (a) Minimum Period of Exclusion for Practitioners and 
     Persons Failing To Meet Statutory Obligations.--
       (1) In general.--The second sentence of section 1156(b)(1) 
     (42 U.S.C. 1320c-5(b)(1)) is amended by striking ``may 
     prescribe)'' and inserting ``may prescribe, except that such 
     period may not be less than 1 year)''.
       (2) Conforming amendment.--Section 1156(b)(2) (42 U.S.C. 
     1320c-5(b)(2)) is amended 

[[Page S15693]]

     by striking ``shall remain'' and inserting ``shall (subject 
     to the minimum period specified in the second sentence of 
     paragraph (1)) remain''.
       (b) Repeal of ``Unwilling or Unable'' Condition for 
     Imposition of Sanction.--Section 1156(b)(1) (42 U.S.C. 1320c-
     5(b)(1)) is amended--
       (1) in the second sentence, by striking ``and determines'' 
     and all that follows through ``such obligations,''; and
       (2) by striking the third sentence.

     SEC. 7114. SANCTIONS AGAINST PROVIDERS FOR EXCESSIVE FEES OR 
                   PRICES.

       Section 1128(b)(6)(A) (42 U.S.C. 1320a-7(b)(6)(A)) is 
     amended--
       (1) by inserting ``(as specified by the Secretary in 
     regulations)'' after ``substantially in excess of such 
     individual's or entity's usual charges''; and
       (2) striking ``(or, in applicable cases, substantially in 
     excess of such individual's or entity's costs)'' and 
     inserting ``, costs or fees''.

     SEC. 7115. APPLICABILITY OF THE BANKRUPTCY CODE TO PROGRAM 
                   SANCTIONS.

       (a) Exclusion of Individuals and Entities From 
     Participation in Federal Health Care Programs.--Section 1128 
     (42 U.S.C. 1320a-7) is amended by adding at the end the 
     following new subsection:
       ``(j) Applicability of Bankruptcy Provisions.--An exclusion 
     imposed under this section is not subject to the automatic 
     stay imposed under section 362 of title 11, United States 
     Code.''.
       (b) Civil Monetary Penalties.--Section 1128A(a) (42 U.S.C. 
     1320a-7a(a)) is amended by adding at the end the following 
     sentence: ``An exclusion imposed under this subsection is not 
     subject to the automatic stay imposed under section 362 of 
     title 11, United States Code, and any penalties and 
     assessments imposed under this section shall be 
     nondischargeable under the provisions of such title.''.
       (c) Offset of Payments to Individuals.--Section 1892(a)(4) 
     (42 U.S.C. 1395ccc(a)(4)) is amended by adding at the end the 
     following sentence: ``An exclusion imposed under paragraph 
     (2)(C)(ii) or paragraph (3)(B) is not subject to the 
     automatic stay imposed under section 362 of title 11, United 
     States Code.''

     SEC. 7116. AGREEMENTS WITH PEER REVIEW ORGANIZATIONS FOR 
                   MEDICARE COORDINATED CARE ORGANIZATIONS.

       (a) Development of model agreement.--Not later than July 1, 
     1996, the Secretary shall develop a model of the agreement 
     that an eligible organization with a risk-sharing contract 
     under part C of title XVIII of the Social Security Act must 
     enter into with an entity providing peer review services with 
     respect to services provided by the organization under 
     section 1856(d)(7)(A) of such Act, as added by section 
     7003(a).
       (b) Report by GAO.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study of the costs incurred by eligible 
     organizations with risk-sharing contracts under part C of 
     title XVIII of the Social Security Act of complying with the 
     requirement of entering into a written agreement with an 
     entity providing peer review services with respect to 
     services provided by the organization, together with an 
     analysis of how information generated by such entities is 
     used by the Secretary to assess the quality of services 
     provided by such eligible organizations.
       (2) Report to congress.--Not later than July 1, 1998, the 
     Comptroller General shall submit a report to the Committee on 
     Ways and Means and the Committee on Commerce of the House of 
     Representatives and the Committee on Finance and the Special 
     Committee on Aging of the Senate on the study conducted under 
     paragraph (1).

     SEC. 7117. EFFECTIVE DATE.

       The amendments made by this chapter shall take effect 
     January 1, 1996.

         PART III--ADMINISTRATIVE AND MISCELLANEOUS PROVISIONS

     SEC. 7120. ESTABLISHMENT OF THE HEALTH CARE FRAUD AND ABUSE 
                   DATA COLLECTION PROGRAM.

       (a) General Purpose.--Not later than January 1, 1996, the 
     Secretary shall establish a national health care fraud and 
     abuse data collection program for the reporting of final 
     adverse actions (not including settlements in which no 
     findings of liability have been made) against health care 
     providers, suppliers, or practitioners as required by 
     subsection (b), with access as set forth in subsection (c).
       (b) Reporting of Information.--
       (1) In general.--Each government agency and health plan 
     shall report any final adverse action (not including 
     settlements in which no findings of liability have been made) 
     taken against a health care provider, supplier, or 
     practitioner.
       (2) Information to be reported.--The information to be 
     reported under paragraph (1) includes:
       (A) The name and TIN (as defined in section 7701(a)(41) of 
     the Internal Revenue Code of 1986) of any health care 
     provider, supplier, or practitioner who is the subject of a 
     final adverse action.
       (B) The name (if known) of any health care entity with 
     which a health care provider, supplier, or practitioner is 
     affiliated or associated.
       (C) The nature of the final adverse action and whether such 
     action is on appeal.
       (D) A description of the acts or omissions and injuries 
     upon which the final adverse action was based, and such other 
     information as the Secretary determines by regulation is 
     required for appropriate interpretation of information 
     reported under this section.
       (3) Confidentiality.--In determining what information is 
     required, the Secretary shall include procedures to assure 
     that the privacy of individuals receiving health care 
     services is appropriately protected.
       (4) Timing and form of reporting.--The information required 
     to be reported under this subsection shall be reported 
     regularly (but not less often than monthly) and in such form 
     and manner as the Secretary prescribes. Such information 
     shall first be required to be reported on a date specified by 
     the Secretary.
       (5) To whom reported.--The information required to be 
     reported under this subsection shall be reported to the 
     Secretary.
       (c) Disclosure and Correction of Information.--
       (1) Disclosure.--With respect to the information about 
     final adverse actions (not including settlements in which no 
     findings of liability have been made) reported to the 
     Secretary under this section respecting a health care 
     provider, supplier, or practitioner, the Secretary shall, by 
     regulation, provide for--
       (A) disclosure of the information, upon request, to the 
     health care provider, supplier, or licensed practitioner, and
       (B) procedures in the case of disputed accuracy of the 
     information.
       (2) Corrections.--Each Government agency and health plan 
     shall report corrections of information already reported 
     about any final adverse action taken against a health care 
     provider, supplier, or practitioner, in such form and manner 
     that the Secretary prescribes by regulation.
       (d) Access to Reported Information.--
       (1) Availability.--The information in this database shall 
     be available to Federal and State government agencies, health 
     plans, and the public pursuant to procedures that the 
     Secretary shall provide by regulation.
       (2) Fees for disclosure.--The Secretary may establish or 
     approve reasonable fees for the disclosure of information in 
     this database (other than with respect to requests by Federal 
     agencies). The amount of such a fee may be sufficient to 
     recover the full costs of carrying out the provisions of this 
     section, including reporting, disclosure, and administration. 
     Such fees shall be available to the Secretary or, in the 
     Secretary's discretion to the agency designated under this 
     section to cover such costs.
       (e) Protection From Liability for Reporting.--No person or 
     entity shall be held liable in any civil action with respect 
     to any report made as required by this section, without 
     knowledge of the falsity of the information contained in the 
     report.
       (f) Definitions and Special Rules.--For purposes of this 
     section:
       (1)(A) The term ``final adverse action'' includes:
       (i) Civil judgments against a health care provider or 
     practitioner in Federal or State court related to the 
     delivery of a health care item or service.
       (ii) Federal or State criminal convictions related to the 
     delivery of a health care item or service.
       (iii) Actions by Federal or State agencies responsible for 
     the licensing and certification of health care providers, 
     suppliers, and licensed health care practitioners, 
     including--
       (I) formal or official actions, such as revocation or 
     suspension of a license (and the length of any such 
     suspension), reprimand, censure or probation,
       (II) any other loss of license, or the right to apply for 
     or renew a license of the provider, supplier, or 
     practitioner, whether by operation of law, voluntary 
     surrender, nonrenewability, or otherwise, or
       (III) any other negative action or finding by such Federal 
     or State agency that is publicly available information.
       (iv) Exclusion from participation in Federal or State 
     health care programs.
       (v) Any other adjudicated actions or decisions that the 
     Secretary shall establish by regulation.
       (B) The term does not include any action with respect to a 
     malpractice claim.
       (2) The terms ``licensed health care practitioner'', 
     ``licensed practitioner'', and ``practitioner'' mean, with 
     respect to a State, an individual who is licensed or 
     otherwise authorized by the State to provide health care 
     services (or any individual who, without authority holds 
     himself or herself out to be so licensed or authorized).
       (3) The term ``health care provider'' means a provider of 
     services as defined in section 1861(u) of the Social Security 
     Act (42 U.S.C. 1395x(u)), and any person or entity, including 
     a health maintenance organization, group medical practice, or 
     any other entity listed by the Secretary in regulation, that 
     provides health care services.
       (4) The term ``supplier'' means a supplier of health care 
     items and services described in section 1819(a) and (b), and 
     section 1861 of the Social Security Act (42 U.S.C. 1395i-3(a) 
     and (b), and 1395x).
       (5) The term ``Government agency'' shall include:
       (A) The Department of Justice.
       (B) The Department of Health and Human Services.
       (C) Any other Federal agency that either administers or 
     provides payment for the delivery of health care services, 
     including, but not limited to the Department of Defense and 
     the Veterans' Administration.
       (D) State law enforcement agencies.
       (E) State medicaid fraud and abuse units.

[[Page S15694]]

       (F) Federal or State agencies responsible for the licensing 
     and certification of health care providers and licensed 
     health care practitioners.
       (6) The term ``health plan'' means a plan or program that 
     provides health benefits, whether directly, through 
     insurance, or otherwise, and includes--
       (A) a policy of health insurance;
       (B) a contract of a service benefit organization;
       (C) a membership agreement with a health maintenance 
     organization or other prepaid health plan; and
       (D) an employee welfare benefit plan or a multiple employer 
     welfare plan (as such terms are defined in section 3 of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1002).
       (7) For purposes of paragraph (1), the existence of a 
     conviction shall be determined under section 1128(i) of the 
     Social Security Act.
       (g) Conforming Amendment.--Section 1921(d) (42 U.S.C. 
     1396r-2(d)) is amended by inserting ``and section 7061 of the 
     Medicare Improvement and Solvency Protection Act of 1995'' 
     after ``section 422 of the Health Care Quality Improvement 
     Act of 1986''.

     SEC. 7121. INSPECTOR GENERAL ACCESS TO ADDITIONAL 
                   PRACTITIONER DATA BANK.

       Section 427 of the Health Care Quality Improvement Act of 
     1986 (42 U.S.C. 11137) is amended--
       (1) in subsection (a), by adding at the end the following 
     sentence: ``Information reported under this part shall also 
     be made available, upon request, to the Inspector General of 
     the Departments of Health and Human Services, Defense, and 
     Labor, the Office of Personnel Management, and the Railroad 
     Retirement Board.''; and
       (2) by amending subsection (b)(4) to read as follows:
       ``(4) Fees.--The Secretary may impose fees for the 
     disclosure of information under this part sufficient to 
     recover the full costs of carrying out the provisions of this 
     part, including reporting, disclosure, and administration, 
     except that a fee may not be imposed for requests made by the 
     Inspector General of the Department of Health and Human 
     Services. Such fees shall remain available to the Secretary 
     (or, in the Secretary's discretion, to the agency designated 
     in section 424(b)) until expended.''.

     SEC. 7112. CORPORATE WHISTLEBLOWER PROGRAM.

       Title XI (42 U.S.C. 1301 et seq.) is amended by inserting 
     after section 1128B the following new section:


                    CORPORATE WHISTLEBLOWER PROGRAM

       ``Sec. 1128C (a) Establishment of Program.--The Secretary, 
     through the Inspector General of the Department of Health and 
     Human Services, shall establish a procedure whereby 
     corporations, partnerships, and other legal entities 
     specified by the Secretary, may voluntarily disclose 
     instances of unlawful conduct and seek to resolve liability 
     for such conduct through means specified by the Secretary.
       ``(b) Limitation.--No person may bring an action under 
     section 3730(b) of title 31, United States Code, if, on the 
     date of filing--
       ``(1) the matter set forth in the complaint has been 
     voluntarily disclosed to the United States by the proposed 
     defendant and the defendant has been accepted into the 
     voluntary disclosure program established pursuant to 
     subsection (a); and
       ``(2) any new information provided in the complaint under 
     such section does not add substantial grounds for additional 
     recovery beyond those encompassed within the scope of the 
     voluntary disclosure.''.

                   PART IV--CIVIL MONETARY PENALTIES

     SEC. 7121. SOCIAL SECURITY ACT CIVIL MONETARY PENALTIES.

       (a) General Civil Monetary Penalties.--Section 1128A (42 
     U.S.C. 1320a-7a) is amended as follows:
       (1) In the third sentence of subsection (a), by striking 
     ``programs under title XVIII'' and inserting ``Federal health 
     care programs (as defined in section 1128B(b)(f))''.
       (2) In subsection (f)--
       (A) by redesignating paragraph (3) as paragraph (4); and
       (B) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) With respect to amounts recovered arising out of a 
     claim under a Federal health care program (as defined in 
     section 1128B(f)), the portion of such amounts as is 
     determined to have been paid by the program shall be repaid 
     to the program, and the portion of such amounts attributable 
     to the amounts recovered under this section by reason of the 
     amendments made by the Medicare Improvement and Solvency 
     Protection Act of 1995 (as estimated by the Secretary) shall 
     be deposited into the Hospital Insurance Trust Fund.''.
       (3) In subsection (i)--
       (A) in paragraph (2), by striking ``title V, XVIII, XIX, or 
     XX of this Act'' and inserting ``a Federal health care 
     program (as defined in section 1128B(f))'';
       (B) in paragraph (4), by striking ``a health insurance or 
     medical services program under title XVIII or XIX of this 
     Act'' and inserting ``a Federal health care program (as so 
     defined)''; and
       (C) in paragraph (5), by striking ``title V, XVIII, XIX, or 
     XX'' and inserting ``a Federal health care program (as so 
     defined)''.
       (4) By adding at the end the following new subsection:
       ``(m)(1) For purposes of this section, with respect to a 
     Federal health care program not contained in this Act, 
     references to the Secretary in this section shall be deemed 
     to be references to the Secretary or Administrator of the 
     department or agency with jurisdiction over such program and 
     references to the Inspector General of the Department of 
     Health and Human Services in this section shall be deemed to 
     be references to the Inspector General of the applicable 
     department or agency.
       ``(2)(A) The Secretary and Administrator of the departments 
     and agencies referred to in paragraph (1) may include in any 
     action pursuant to this section, claims within the 
     jurisdiction of other Federal departments or agencies as long 
     as the following conditions are satisfied:
       ``(i) The case involves primarily claims submitted to the 
     Federal health care programs of the department or agency 
     initiating the action.
       ``(ii) The Secretary or Administrator of the department or 
     agency initiating the action gives notice and an opportunity 
     to participate in the investigation to the Inspector General 
     of the department or agency with primary jurisdiction over 
     the Federal health care programs to which the claims were 
     submitted.
       ``(B) If the conditions specified in subparagraph (A) are 
     fulfilled, the Inspector General of the department or agency 
     initiating the action is authorized to exercise all powers 
     granted under the Inspector General Act of 1978 with respect 
     to the claims submitted to the other departments or agencies 
     to the same manner and extent as provided in that Act with 
     respect to claims submitted to such departments or 
     agencies.''.
       (b) Excluded Individual Retaining Ownership or Control 
     Interest in Participating Entity.--Section 1128A(a) (42 
     U.S.C. 1320a-7a(a)) is amended--
       (1) by striking ``or'' at the end of paragraph (1)(D);
       (2) by striking ``, or'' at the end of paragraph (2) and 
     inserting a semicolon;
       (3) by striking the semicolon at the end of paragraph (3) 
     and inserting ``; or''; and
       (4) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) in the case of a person who is not an organization, 
     agency, or other entity, is excluded from participating in a 
     program under title XVIII or a State health care program in 
     accordance with this subsection or under section 1128 and 
     who, at the time of a violation of this subsection, retains a 
     direct or indirect ownership or control interest of 5 percent 
     or more, or an ownership or control interest (as defined in 
     section 1124(a)(3)) in, or who is an officer or managing 
     employee (as defined in section 1126(b)) of, an entity that 
     is participating in a program under title XVIII or a State 
     health care program;''.
       (c) Employer Billing for Services Furnished, Directed, or 
     Prescribed by an Excluded Employee.--Section 1128A(a)(1) (42 
     U.S.C. 1320a-7a(a)(1)) is amended--
       (1) by striking ``or'' at the end of subparagraph (C);
       (2) by striking ``; or'' at the end of subparagraph (D) and 
     inserting ``, or''; and
       (3) by adding at the end the following new subparagraph:
       ``(E) is for a medical or other item or service furnished, 
     directed, or prescribed by an individual who is an employee 
     or agent of the person during a period in which such employee 
     or agent was excluded from the program under which the claim 
     was made on any of the grounds for exclusion described in 
     subparagraph (D);''.
       (d) Civil Money Penalties for Items or Services Furnished, 
     Directed, or Prescribed by an Excluded Individual.--Section 
     1128A(a)(1)(D) (42 U.S.C. 1320a-7a(a)(1)(D)) is amended by 
     inserting ``, directed, or prescribed'' after ``furnished''.
       (e) Modifications of Amounts of Penalties and 
     Assessments.--Section 1128A(a) (42 U.S.C. 1320a-7a(a)), as 
     amended by subsection (b), is amended in the matter following 
     paragraph (4)--
       (1) by striking ``$2,000'' and inserting ``$10,000'';
       (2) by inserting ``; in cases under paragraph (4), $10,000 
     for each day the prohibited relationship occurs'' after 
     ``false or misleading information was given''; and
       (3) by striking ``twice the amount'' and inserting ``3 
     times the amount''.
       (f) Claim for Item or Service Based on Incorrect Coding or 
     Medically Unnecessary Services.--Section 1128A(a)(1) (42 
     U.S.C. 1320a-7a(a)(1)) is amended--
       (1) in subparagraph (A) by striking ``claimed,'' and 
     inserting ``claimed, including any person who engages in a 
     pattern or practice of presenting or causing to be presented 
     a claim for an item or service that is based on a code that 
     the person knows or has reason to know will result in a 
     greater payment to the person than the code the person knows 
     or has reason to know is applicable to the item or service 
     actually provided,'';
       (2) in subparagraph (C), by striking ``or'' at the end;
       (3) in subparagraph (D), by striking ``; or'' and inserting 
     ``, or''; and
       (4) by inserting after subparagraph (D) the following new 
     subparagraph:
       ``(E) is for a medical or other item or service that a 
     person knows or has reason to know is not medically 
     necessary; or''.
       (g) Permitting Secretary To Impose Civil Monetary 
     Penalty.--Section 1128A(b) (42 U.S.C. 1320a-7a(a)) is amended 
     by adding the following new paragraph:
       ``(3) Any person (including any organization, agency, or 
     other entity, but excluding a 

[[Page S15695]]

     beneficiary as defined in subsection (i)(5)) who the 
     Secretary determines has violated section 1128B(b) of this 
     title shall be subject to a civil monetary penalty of not 
     more than $10,000 for each such violation. In addition, such 
     person shall be subject to an assessment of not more than 
     twice the total amount of the remuneration offered, paid, 
     solicited, or received in violation of section 1128B(b). The 
     total amount of remuneration subject to an assessment shall 
     be calculated without regard to whether some portion thereof 
     also may have been intended to serve a purpose other than one 
     proscribed by section 1128B(b).''.
       (h) Sanctions Against Practitioners and Persons for Failure 
     To Comply With Statutory Obligations.--Section 1156(b)(3) (42 
     U.S.C. 1320c-5(b)(3)) is amended by striking ``the actual or 
     estimated cost'' and inserting ``up to $10,000 for each 
     instance''.
       (i) Prohibition Against Offering Inducements to Individuals 
     Enrolled Under Programs or Plans.--
       (1) Offer of remuneration.--Section 1128A(a) (42 U.S.C. 
     1320a-7a(a)) is amended--
       (A) by striking ``or'' at the end of paragraph (1)(D);
       (B) by striking ``, or'' at the end of paragraph (2) and 
     inserting a semicolon;
       (C) by striking the semicolon at the end of paragraph (3) 
     and inserting ``; or''; and
       (D) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) offers to or transfers remuneration to any individual 
     eligible for benefits under title XVIII of this Act, or under 
     a State health care program (as defined in section 1128(h)) 
     that such person knows or should know is likely to influence 
     such individual to order or receive from a particular 
     provider, practitioner, or supplier any item or service for 
     which payment may be made, in whole or in part, under title 
     XVIII, or a State health care program;''.
       (2) Remuneration defined.--Section 1128A(i) (42 U.S.C. 
     1320a-7a(i)) is amended by adding the following new 
     paragraph:
       ``(6) The term `remuneration' includes the waiver of 
     coinsurance and deductible amounts (or any part thereof), and 
     transfers of items or services for free or for other than 
     fair market value. The term `remuneration' does not include--
       ``(A) the waiver of coinsurance and deductible amounts by a 
     person, if--
       ``(i) the waiver is not offered as part of any 
     advertisement or solicitation;
       ``(ii) the person does not routinely waive coinsurance or 
     deductible amounts; and
       ``(iii) the person--

       ``(I) waives the coinsurance and deductible amounts after 
     determining in good faith that the individual is in financial 
     need;
       ``(II) fails to collect coinsurance or deductible amounts 
     after making reasonable collection efforts; or
       ``(III) provides for any permissible waiver as specified in 
     section 1128B(b)(3) or in regulations issued by the 
     Secretary;

       ``(B) differentials in coinsurance and deductible amounts 
     as part of a benefit plan design as long as the differentials 
     have been disclosed in writing to all beneficiaries, third 
     party payors, and providers, to whom claims are presented and 
     as long as the differentials meet the standards as defined in 
     regulations promulgated by the Secretary not later than 180 
     days after the date of the enactment of the Medicare 
     Improvement and Solvency Protection Act of 1995; or
       ``(C) incentives given to individuals to promote the 
     delivery of preventive care as determined by the Secretary in 
     regulations so promulgated.''.
       (j) Effective Date.--The amendments made by this section 
     shall take effect January 1, 1996.

             PART V--CHAPTER 5--AMENDMENTS TO CRIMINAL LAW

     SEC. 7131. HEALTH CARE FRAUD.

       (a)  Fines and imprisonment for health care fraud 
     violations.--Chapter 63 of title 18, United States Code, is 
     amended by adding at the end the following new section:

     ``Sec. 1347. Health care fraud

       ``(a) Whoever knowingly and willfully executes, or attempts 
     to execute, a scheme or artifice--
       ``(1) to defraud any health plan or other person, in 
     connection with the delivery of or payment for health care 
     benefits, items, or services; or
       ``(2) to obtain, by means of false or fraudulent pretenses, 
     representations, or promises, any of the money or property 
     owned by, or under he custody or control of, any health plan, 
     or person in connection with the delivery of or payment for 
     health care benefits, items, or services;
     shall be fined under this title or imprisoned not more than 
     10 years, or both. If the violation results in serious bodily 
     injury (as defined in section 1365(g)(3) of this title), such 
     person may be imprisoned for any term of years.
       ``(b) For purposes of this section, the term `health plan' 
     has the same meaning given such term in section 7061(f)(6) of 
     the Medicare Improvement and Solvency Protection Act of 
     1995.''.
       (b) Clerical amendment.--The table of sections at the 
     beginning of chapter 63 of title 18, United States Code, is 
     amended by adding at the end the following:

``1347. Health care fraud.''.

     SEC. 7132. FORFEITURES FOR FEDERAL HEALTH CARE OFFENSES.

       (a) In General.--Section 982(a) of title 18, United States 
     Code, is amended by adding after paragraph (5) the following 
     new paragraph:
       ``(6)(A) The court, in imposing sentence on a person 
     convicted of a Federal health care offense, shall order the 
     person to forfeit property, real or personal, that 
     constitutes or is derived, directly or indirectly, from gross 
     proceeds traceable to the commission of the offense.
       ``(B) For purposes of this paragraph, the term `Federal 
     health care offense' means a violation of, or a criminal 
     conspiracy to violate--
       ``(i) section 1347 of this title;
       ``(ii) section 1128B of the Social Security Act; and
       ``(iii) sections 287, 371, 664, 666, 669, 1001, 1027, 1341, 
     1343, 1920, or 1954 of this title if the violation or 
     conspiracy relates to health care fraud.''.
       (b) Conforming Amendment.--Section 982(b)(1)(A) of title 
     18, United States Code, is amended by inserting ``or (a)(6)'' 
     after ``(a)(1)''.
       (c) Property Forfeited Deposited in Federal Hospital 
     Insurance Trust Fund.--
       (1) In general.--After the payment of the costs of asset 
     forfeiture has been made, and notwithstanding any other 
     provision of law, the Secretary of the Treasury shall deposit 
     into the Federal Hospital Insurance Trust Fund pursuant to 
     section 1817(k)(2)(C) of the Social Security Act, as added by 
     section 7101(b), an amount equal to the net amount realized 
     from the forfeiture of property by reason of a Federal health 
     care offense pursuant to section 982(a)(6) of title 18, 
     United States Code.
       (2) Costs of asset forfeiture.--For purposes of paragraph 
     (1), the term ``payment of the costs of asset forfeiture'' 
     means--
       (A) the payment, at the discretion of the Attorney General, 
     of any expenses necessary to seize, detain, inventory, 
     safeguard, maintain, advertise, sell, or dispose of property 
     under seizure, detention, or forfeited, or of any other 
     necessary expenses incident to the seizure, detention, 
     forfeiture, or disposal of such property, including payment 
     for--
       (i) contract services,
       (ii) the employment of outside contractors to operate and 
     manage properties or provide other specialized services 
     necessary to dispose of such properties in an effort to 
     maximize the return from such properties; and
       (iii) reimbursement of any Federal, State, or local agency 
     for any expenditures made to perform the functions described 
     in this subparagraph;
       (B) at the discretion of the Attorney General, the payment 
     of awards for information or assistance leading to a civil or 
     criminal forfeiture involving any Federal agency 
     participating in the Health Care Fraud and Abuse Control 
     Account;
       (C) the compromise and payment of valid liens and mortgages 
     against property that has been forfeited, subject to the 
     discretion of the Attorney General to determine the validity 
     of any such lien or mortgage and the amount of payment to be 
     made, and the employment of attorneys and other personnel 
     skilled in State real estate law as necessary;
       (D) payment authorized in connection with remission or 
     mitigation procedures relating to property forfeited; and
       (E) the payment of State and local property taxes on 
     forfeited real property that accrued between the date of the 
     violation giving rise to the forfeiture and the date of the 
     forfeiture order.

     SEC. 7133. INJUNCTIVE RELIEF RELATING TO FEDERAL HEALTH CARE 
                   OFFENSES.

       (a) In General.--Section 1345(a)(1) of title 18, United 
     States Code, is amended--
       (1) by striking ``or'' at the end of subparagraph (A);
       (2) by inserting ``or'' at the end of subparagraph (B); and
       (3) by adding at the end the following new subparagraph:
       ``(C) committing or about to commit a Federal health care 
     offense (as defined in section 982(a)(6)(B) of this 
     title);''.
       (b) Freezing of Assets.--Section 1345(a)(2) of title 18, 
     United States Code, is amended by inserting ``or a Federal 
     health care offense (as defined in section 982(a)(6)(B))'' 
     after ``title)''.

     SEC. 7134. GRAND JURY DISCLOSURE.

       Section 3322 of title 18, United States Code, is amended--
       (1) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively; and
       (2) by inserting after subsection (b) the following new 
     subsection:
       ``(c) A person who is privy to grand jury information 
     concerning a Federal health care offense (as defined in 
     section 982(a)(6)(B))--
       ``(1) received in the course of duty as an attorney for the 
     Government; or
       ``(2) disclosed under rule 6(e)(3)(A)(ii) of the Federal 
     Rules of Criminal Procedure;
     may disclose that information to an attorney for the 
     Government to use in any investigation or civil proceeding 
     relating to health care fraud.''.

     SEC. 7135. FALSE STATEMENTS.

       (a) In General.--Chapter 47, of title 18, United States 
     Code, is amended by adding at the end the following new 
     section:

     ``Sec. 1035. False statements relating to health care matters

       ``(a) Whoever, in any matter involving a health plan, 
     knowingly and willfully falsifies, conceals, or covers up by 
     any trick, scheme, or device a material fact, or makes any 
     false, fictitious, or fraudulent statements or 
     representations, or makes or uses any false writing or 
     document knowing the same to contain any false, fictitious, 
     or 

[[Page S15696]]

     fraudulent statement or entry, shall be fined under this 
     title or imprisoned not more than 5 years, or both.
       ``(b) For purposes of this section, the term `health plan' 
     has the same meaning given such term in section 7061(f)(6) of 
     the Medicare Improvement and Solvency Protection Act of 
     1995.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 47 of title 18, United States Code, in 
     amended by adding at the end the following:

``1035. False statements relating to health care matters.''.

     SEC. 7136. OBSTRUCTION OF CRIMINAL INVESTIGATIONS, AUDITS, OR 
                   INSPECTIONS OF FEDERAL HEALTH CARE OFFENSES.

       (a) In General.--Chapter 73 of title 18, United States 
     Code, is amended by adding at the end the following new 
     section:

     ``Sec. 1518. Obstruction of criminal investigations, audits, 
       or inspections of Federal health care offenses

       ``(a) In General.--Whoever willfully prevents, obstructs, 
     misleads, delays or attempts to prevent, obstruct, mislead, 
     or delay the communication of information or records relating 
     to a Federal health care offense to a Federal agent or 
     employee involved in an investigation, audit, inspection, or 
     other activity related to such an offense, shall be fined 
     under this title or imprisoned not more than 5 years, or 
     both.
       ``(b) Federal Health Care Offense.--As used in this section 
     the term `Federal health care offense' has the same meaning 
     given such term in section 982(a)(6)(B) of this title.
       ``(c) Criminal Investigator.--As used in this section the 
     term `criminal investigator' means any individual duly 
     authorized by a department, agency, or armed force of the 
     United States to conduct or engage in investigations for 
     prosecutions for violations of health care offenses.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 73 of title 18, United States Code, is 
     amended by adding at the end the following:

``1518. Obstruction of criminal investigations, audits, or inspections 
              of Federal health care offenses.''.

     SEC. 7137. THEFT OR EMBEZZLEMENT.

       (a) In General.--Chapter 31 of title 18, United States 
     Code, is amended by adding at the end the following new 
     section:

     ``Sec. 669. Theft or embezzlement in connection with health 
       care

       ``(a) In General.--Whoever willfully embezzles, steals, or 
     otherwise without authority willfully and unlawfully converts 
     to the use of any person other than the rightful owner, or 
     intentionally misapplies any of the moneys, funds, 
     securities, premiums, credits, property, or other assets of a 
     health plan, shall be fined under this title or imprisoned 
     not more than 10 years, or both.
       ``(b) Health Plan.--As used in this section the term 
     `health plan' has the same meaning given such term in section 
     7061(f)(6) of the Medicare Improvement and Solvency 
     Protection Act of 1995.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 31 of title 18, United States Code, is 
     amended by adding at the end the following:

``669. Theft or embezzlement in connection with health care.''.

     SEC. 7138. LAUNDERING OF MONETARY INSTRUMENTS.

       Section 1956(c)(7) of title 18, United States Code, is 
     amended by adding at the end the following new subparagraph:
       ``(F) Any act or activity constituting an offense involving 
     a Federal health care offense as that term is defined in 
     section 982(a)(6)(B) of this title.''.

     SEC. 7139. AUTHORIZED INVESTIGATIVE DEMAND PROCEDURES.

       (a) In General.--Chapter 233 of title 18, United States 
     Code, is amended by adding after section 3485 the following 
     new section:

     ``Sec. 3486. Authorized investigative demand procedures

       ``(a) Authorization.--
       ``(1) In any investigation relating to functions set forth 
     in paragraph (2), the Attorney General or designee may issue 
     in writing and cause to be served a subpoena compelling 
     production of any records (including any books, papers, 
     documents, electronic media, or other objects or tangible 
     things), which may be relevant to an authorized law 
     enforcement inquiry, that a person or legal entity may 
     possess or have care, custody, or control. A custodian of 
     records may be required to give testimony concerning the 
     production and authentication of such records. The production 
     of records may be required from any place in any State or in 
     any territory or other place subject to the jurisdiction of 
     the United States at any designated place; except that such 
     production shall not be required more than 500 miles distant 
     from the place where the subpoena is served. Witnesses 
     summoned under this section shall be paid the same fees and 
     mileage that are paid witnesses in the courts of the United 
     States. A subpoena requiring the production of records shall 
     describe the objects required to be produced and prescribe a 
     return date within a reasonable period of time within which 
     the objects can be assembled and made available.
       ``(2) Investigative demands utilizing an administrative 
     subpoena are authorized for any investigation with respect to 
     any act or activity constituting or involving health care 
     fraud, including a scheme or artifice--
       ``(A) to defraud any health plan or other person, in 
     connection with the delivery of or payment for health care 
     benefits, items, or services; or
       ``(B) to obtain, by means of false or fraudulent pretenses, 
     representations, or promises, any of the money or property 
     owned by, or under the custody or control or, any health 
     plan, or person in connection with the delivery of or payment 
     for health care benefits, items, or services.
       ``(b) Service.--A subpoena issued under this section may be 
     served by any person designated in the subpoena to serve it. 
     Service upon a natural person may be made by personal 
     delivery of the subpoena to such person. Service may be made 
     upon a domestic or foreign association which is subject to 
     suit under a common name, by delivering the subpoena to an 
     officer, to a managing or general agent, or to any other 
     agent authorized by appointment or by law to receive service 
     of process. The affidavit of the person serving the subpoena 
     entered on a true copy thereof by the person serving it shall 
     be proof of service.
       ``(c) Enforcement.--In the case of contumacy by or refusal 
     to obey a subpoena issued to any person, the Attorney General 
     may invoke the aid of any court of the United States within 
     the jurisdiction of which the investigation is carried on or 
     of which the subpoenaed person is an inhabitant, or in which 
     such person carries on business or may be found, to compel 
     compliance with the subpoena. The court may issue an order 
     requiring the subpoenaed person to appear before the Attorney 
     General to produce records, if go ordered, or to give 
     testimony touching the matter under investigation. Any 
     failure to obey the order of the court may be punished by the 
     court as a contempt thereof. All process in any such case may 
     be served in any judicial district in which such person may 
     be found.
       ``(d) Immunity From Civil Liability.--Notwithstanding any 
     Federal, State, or local law, any person, including officers, 
     agents, and employees, receiving a subpoena under this 
     section, who complies in good faith with the subpoena and 
     thus produces the materials sought, shall not be liable in 
     any court of any State or the United States to any customer 
     or other person for such production or for nondisclosure of 
     that production to the customer.
       ``(e) Use in Action Against Individuals.--
       ``(1) Health information about an individual that is 
     disclosed under this section may not be used in, or disclosed 
     to any person for use in, any administrative, civil, or 
     criminal action or investigation directed against the 
     individual who is the subject of the information unless the 
     action or investigation arises out of and is directly related 
     to receipt of health care or payment for health care or 
     action involving a fraudulent claim related to health; or if 
     authorized by an appropriate order of a court of competent 
     jurisdiction, granted after application showing good cause 
     therefore.
       ``(2) In assessing good cause, the court shall weigh the 
     public interest and the need for disclosure against the 
     injury to the patient, to the physician-patient relationship, 
     and to the treatment services.
       ``(3) Upon the granting of such order, the court, in 
     determining the extent to which any disclosure of all or any 
     part of any record is necessary, shall impose appropriate 
     safeguards against unauthorized disclosure.
       ``(f) Health Plan.--As used in this section the term 
     `health plan' has the same meaning given such term in section 
     7061(f)(6) of the Medicare Improvement and Solvency 
     Protection Act of 1995.''.
       (b) Clerical Amendment.--The table of sections for chapter 
     223 of title 18, United States Code, is amended by inserting 
     after the item relating to section 3485 the following new 
     item:

``3486. Authorized investigative demand procedures.''.
       (c) Conforming Amendment.--Section 1510(b)(3)(B) of title 
     18, United States Code, is amended by inserting ``or a 
     Department of Justice subpoena (issued under section 3486),'' 
     after ``subpoena''.

             PART VI--STATE HEALTH CARE FRAUD CONTROL UNITS

     SEC. 7141. STATE HEALTH CARE FRAUD CONTROL UNITS.

       (a) Extension of Concurrent Authority To Investigate and 
     Prosecute Fraud in Other Federal Programs.--Section 
     1903(q)(3) (42 U.S.C. 1396b(q)(3)) is amended--
       (1) by inserting ``(A)'' after ``in connection with''; and
       (2) by striking ``title.'' and inserting ``title; and (B) 
     in cases where the entity's function is also described by 
     subparagraph (A), and upon the approval of the relevant 
     Federal agency, any aspect of the provision of health care 
     services and activities of providers of such services under 
     any Federal health care program (as defined in section 
     1128B(b)(1)).''.
       (b) Extension of Authority To Investigate and Prosecute 
     Patient Abuse in Non-Medicaid Board and Care Facilities.--
     Section 1903(q)(4) (42 U.S.C. 1396b(q)(4)) is amended to read 
     as follows:
       ``(4)(A) The entity has--
       ``(i) procedures for reviewing complaints of abuse or 
     neglect of patients in health care facilities which receive 
     payments under the State plan under this title;
       ``(ii) at the option of the entity, procedures for 
     reviewing complaints of abuse or neglect of patients residing 
     in board and care facilities; and
       ``(iii) procedures for acting upon such complaints under 
     the criminal laws of the State 

[[Page S15697]]

     or for referring such complaints to other State agencies for 
     action.
       ``(B) For purposes of this paragraph, the term `board and 
     care facility' means a residential setting which receives 
     payment from or on behalf of two or more unrelated adults who 
     reside in such facility, and for whom one or both of the 
     following is provided:
       ``(i) Nursing care services provided by, or under the 
     supervision of, a registered nurse, licensed practical nurse, 
     or licensed nursing assistant.
       ``(ii) Personal care services that assist residents with 
     the activities of daily living, including personal hygiene, 
     dressing, bathing, eating, toileting, ambulation, transfer, 
     positioning, self-medication, body care, travel to medical 
     services, essential shopping, meal preparation, laundry, and 
     housework.''.

          PART VII--MEDICARE/MEDICAID BILLING ABUSE PREVENTION

     SEC. 7151. UNIFORM MEDICARE/MEDICAID APPLICATION PROCESS.

       Not later than 1 year after the date of the enactment of 
     this Act, the Secretary shall establish procedures and a 
     uniform application form for use by any individual or entity 
     that seeks to participate in the programs under titles XVIII 
     and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 
     42 U.S.C. 1396 et seq.). The procedures established shall 
     include the following:
       (1) Execution of a standard authorization form by all 
     individuals and entities prior to submission of claims for 
     payment which shall include the social security number of the 
     beneficiary and the TIN (as defined in section 7701(a)(41) of 
     the Internal Revenue Code of 1986) of any health care 
     provider, supplier, or practitioner providing items or 
     services under the claim.
       (2) Assumption of responsibility and liability for all 
     claims submitted.
       (3) A right of access by the Secretary to provider records 
     relating to items and services rendered to beneficiaries of 
     such programs.
       (4) Retention of source documentation.
       (5) Provision of complete and accurate documentation to 
     support all claims for payment.
       (6) A statement of the legal consequences for the 
     submission of false or fraudulent claims for payment.

     SEC. 7152. STANDARDS FOR UNIFORM CLAIMS.

       (a) Establishment of Standards.--Not later than 1 year 
     after the date of the enactment of this Act, the Secretary 
     shall establish standards for the form and submission of 
     claims for payment under the medicare program under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and 
     the medicaid program under title XIX of such Act (42 U.S.C. 
     1396 et seq.).
       (b) Ensuring Provider Responsibility.--In establishing 
     standards under subsection (a), the Secretary, in 
     consultation with appropriate agencies including the 
     Department of Justice, shall include such methods of ensuring 
     provider responsibility and accountability for claims 
     submitted as necessary to control fraud and abuse.
       (c) Use of Electronic Media.--The Secretary shall develop 
     specific standards which govern the submission of claims 
     through electronic media in order to control fraud and abuse 
     in the submission of such claims.

     SEC. 7153. UNIQUE PROVIDER IDENTIFICATION CODE.

       (a) Establishment of System.--Not later than 1 year after 
     the date of the enactment of this Act, the Secretary shall 
     establish a system which provides for the issuance of a 
     unique identifier code for each individual or entity 
     furnishing items or services for which payment may be made 
     under title XVIII or XIX of the Social Security (42 U.S.C. 
     1395 et seq.; 1396 et seq.), and the notation of such unique 
     identifier codes on all claims for payment.
       (b) Application Fee.--The Secretary shall require an 
     individual applying for a unique identifier code under 
     subsection (a) to submit a fee in an amount determined by the 
     Secretary to be sufficient to cover the cost of investigating 
     the information on the application and the individual's 
     suitability for receiving such a code.

     SEC. 7154. USE OF NEW PROCEDURES.

       No payment may be made under either title XVIII or XIX of 
     the Social Security Act (42 U.S.C. 1395 et seq.; 42 U.S.C. 
     1396 et seq.) for any item or service furnished by an 
     individual or entity unless the requirements of sections 7102 
     and 7103 are satisfied.

     SEC. 7155. REQUIRED BILLING, PAYMENT, AND COST LIMIT 
                   CALCULATION TO BE BASED ON SITE WHERE SERVICE 
                   IS FURNISHED.

       (a) Conditions of Participation.--Section 1891 (42 U.S.C. 
     1395bbb) is amended by adding at the end the following new 
     subsection:
       ``(g) A home health agency shall submit claims for payment 
     of home health services under this title only on the basis of 
     the geographic location at which the service is furnished, as 
     determined by the Secretary.''.
       (b) Wage Adjustment.--Section 1861(v)(1)(L)(iii) (42 U.S.C. 
     1395x(v)(1)(L)(iii)) is amended by striking ``agency is 
     located'' and inserting ``service is furnished''.

 Subchapter B--Additional Provisions to Combat Waste, Fraud, and Abuse

                   PART I--WASTE AND ABUSE REDUCTION

     SEC. 7161. PROHIBITING UNNECESSARY AND WASTEFUL MEDICARE 
                   PAYMENTS FOR CERTAIN ITEMS.

       Notwithstanding any other provision of law, including any 
     regulation or payment policy, the following categories of 
     charges shall not be reimbursable under title XVIII of the 
     Social Security Act:
       (1) Tickets to sporting or other entertainment events.
       (2) Gifts or donations.
       (3) Costs related to team sports.
       (4) Personal use of motor vehicles.
       (5) Costs for fines and penalties resulting from violations 
     of Federal, State, or local laws.
       (6) Tuition or other education fees for spouses or 
     dependents of providers of services, their employees, or 
     contractors.

     SEC. 7162. APPLICATION OF COMPETITIVE ACQUISITION PROCESS FOR 
                   PART B ITEMS AND SERVICES.

       (a) General Rule.--Part B of title XVIII is amended by 
     inserting after section 1846 the following new section:


            ``competition acquisition for items and services

       ``Sec. 1847. (a) Establishment of Bidding Areas.--
       ``(1) In general.--The Secretary shall establish 
     competitive acquisition areas for the purpose of awarding a 
     contract or contracts for the furnishing under this part of 
     the items and services described in subsection (c) on or 
     after January 1, 1996. The Secretary may establish different 
     competitive acquisition areas under this subsection for 
     different classes of items and services under this part.
       ``(2) Criteria for establishment.--The competitive 
     acquisition areas established under paragraph (1) shall--
       ``(A) initially be within, or be centered around 
     metropolitan statistical areas;
       ``(B) be chosen based on the availability and accessibility 
     of suppliers and the probable savings to be realized by the 
     use of competitive bidding in the furnishing of items and 
     services in the area; and
       ``(C) be chosen so as to not reduce access to such items 
     and services to individuals residing in rural and other 
     underserved areas.
       ``(b) Awarding of Contracts in Areas.--
       ``(1) In general.--The Secretary shall conduct a 
     competition among individuals and entities supplying items 
     and services under this part for each competitive acquisition 
     area established under subsection (a) for each class of items 
     and services.
       ``(2) Conditions for awarding contract.--The Secretary may 
     not award a contract to any individual or entity under the 
     competition conducted pursuant to paragraph (1) to furnish an 
     item or service under this part unless the Secretary finds 
     that the individual or entity--
       ``(A) meets quality standards specified by the Secretary 
     for the furnishing of such item or service; and
       ``(B) offers to furnish a total quantity of such item or 
     service that is sufficient to meet the expected need within 
     the competitive acquisition area and to assure that access to 
     such items (including appropriate customized items) and 
     services to individuals residing in rural and other 
     underserved areas is not reduced.
       ``(3) Contents of contract.--A contract entered into with 
     an individual or entity under the competition conducted 
     pursuant to paragraph (1) shall specify (for all of the items 
     and services within a class)--
       ``(A) the quantity of items and services the entity shall 
     provide; and
       ``(B) such other terms and conditions as the Secretary may 
     require.
       ``(c) Services Described.--The items and services to which 
     the provisions of this section shall apply are as follows:
       ``(1) Durable medical equipment and medical supplies.
       ``(2) Oxygen and oxygen equipment.
       ``(3) Such other items and services with respect to which 
     the Secretary determines the use of competitive acquisition 
     under this section to be appropriate and cost-effective.''.
       (b) Items and Services To Be Furnished Only Through 
     Competitive Acquisition.--Section 1862(a) (42 U.S.C. 
     1395y(a)) is amended--
       (1) by striking ``or'' at the end of paragraph (14);
       (2) by striking the period at the end of paragraph (15) and 
     inserting ``; or''; and
       (3) by inserting after paragraph (15) the following new 
     paragraph:
       ``(16) where such expenses are for an item or service 
     furnished in a competitive acquisition area (as established 
     by the Secretary under section 1847(a)) by an individual or 
     entity other than the supplier with whom the Secretary has 
     entered into a contract under section 1847(b) for the 
     furnishing of such item or service in that area, unless the 
     Secretary finds that such expenses were incurred in a case of 
     urgent need.''.
       (c) Reduction in Payment Amounts if Competitive Acquisition 
     Fails To Achieve Minimum Reduction in Payments.--
     Notwithstanding any other provision of title XVIII of the 
     Social Security Act, if the establishment of competitive 
     acquisition areas under section 1847 of such Act (as added by 
     subsection (a)) and the limitation of coverage for items and 
     services under part B of such title to items and services 
     furnished by providers with competitive acquisition contracts 
     under such section does not result in a reduction, beginning 
     on January 1, 1997, of at least 20 percent (40 percent in the 
     case of oxygen and oxygen equipment) in the projected payment 
     amount that would have applied to an item or service under 
     part B if the item or service had not been furnished through 
     competitive acquisition under such section, the Secretary 
     shall reduce such payment amount by such percentage as the 
     Secretary determines necessary to result in such a reduction. 
     Notwithstanding this section, in no 

[[Page S15698]]

     case can the Secretary make a payment for items and services 
     described in Section 1847(c) that are greater than that 
     required by other provisions of the Balanced Budget 
     Reconciliation Act of 1995.

     SEC. 7163. REDUCING EXCESSIVE BILLINGS AND UTILIZATION FOR 
                   CERTAIN ITEMS.

       Section 1834(a)(15) (42 U.S.C. 1395m(a)(15)) is amended by 
     striking ``Secretary may'' both places it appears and 
     inserting ``Secretary shall''.

     SEC. 7164. IMPROVED CARRIER AUTHORITY TO REDUCE EXCESSIVE 
                   MEDICARE PAYMENTS.

       (a) General Rule.--Section 1834(a)(10)(B) (42 U.S.C. 
     1395m(a)(10)(B)) is amended by striking ``paragraphs (8) and 
     (9)'' and all that follows through the end of the sentence 
     and inserting ``section 1842(b)(8) to covered items and 
     suppliers of such items and payments under this subsection as 
     such provisions (relating to determinations of grossly 
     excessive payment amounts) apply to items and services and 
     entities and a reasonable charge under section 1842(b)''.
       (b) Repeal of Obsolete Provisions.--
       (1) Section 1842(b)(8) (42 U.S.C. 1395u(b)(8)) is amended--
       (A) by striking subparagraphs (B) and (C),
       (B) by striking ``(8)(A)'' and inserting ``(8)'', and
       (C) by redesignating clauses (i) and (ii) as subparagraphs 
     (A) and (B), respectively.
       (2) Section 1842(b)(9) (42 U.S.C. 1395u(b)(9)) is repealed.
       (c) Payment for Surgical Dressings.--Section 1834(i) (42 
     U.S.C. 1395m(i)) is amended by adding at the end the 
     following new paragraph:
       ``(3) Grossly excessive payment amounts.--Notwithstanding 
     paragraph (1), the Secretary may apply the provisions of 
     section 1842(b)(8) to payments under this subsection.''.

     SEC. 7165. EFFECTIVE DATE.

       The amendments made by this chapter shall apply to items 
     and services furnished under title XVIII of the Social 
     Security Act on or after January 1, 1996.

               PART II--MEDICARE BILLING ABUSE PREVENTION

     SEC. 7171. IMPLEMENTATION OF GENERAL ACCOUNTING OFFICE 
                   RECOMMENDATIONS REGARDING MEDICARE CLAIMS 
                   PROCESSING.

       (a) In General.--Not later than 90 days after the date of 
     the enactment of this Act, the Secretary shall, by 
     regulation, contract, change order, or otherwise, require 
     medicare carriers to acquire commercial automatic data 
     processing equipment (in this subchapter referred to as 
     ``ADPE'') meeting the requirements of section 7122 to process 
     medicare part B claims for the purpose of identifying billing 
     code abuse.
       (b) Supplementation.--Any ADPE acquired in accordance with 
     subsection (a) shall be used as a supplement to any other 
     ADPE used in claims processing by medicare carriers.
       (c) Standardization.--In order to ensure uniformity, the 
     Secretary may require that medicare carriers that use a 
     common claims processing system acquire common ADPE in 
     implementing subsection (a).
       (d) Implementation Date.--Any ADPE acquired in accordance 
     with subsection (a) shall be in use by medicare carriers not 
     later than 180 days after the date of the enactment of this 
     Act.

     SEC. 7172. MINIMUM SOFTWARE REQUIREMENTS.

       (a) In General.--The requirements described in this section 
     are as follows:
       (1) The ADPE shall be a commercial item.
       (2) The ADPE shall surpass the capability of ADPE used in 
     the processing of medicare part B claims for identification 
     of code manipulation on the day before the date of the 
     enactment of this Act.
       (3) The ADPE shall be capable of being modified to--
       (A) satisfy pertinent statutory requirements of the 
     medicare program; and
       (B) conform to general policies of the Health Care 
     Financing Administration regarding claims processing.
       (b) Minimum Standards.--Nothing in this subchapter shall be 
     construed as preventing the use of ADPE which exceeds the 
     minimum requirements described in subsection (a).

     SEC. 7173. DISCLOSURE.

       (a) In General.--Notwithstanding any other provision of 
     law, and except as provided in subsection (b), any ADPE or 
     data related thereto acquired by medicare carriers in 
     accordance with section 7171(a) shall not be subject to 
     public disclosure.
       (b) Exception.--The Secretary may authorize the public 
     disclosure of any ADPE or data related thereto acquired by 
     medicare carriers in accordance with section 7121(a) if the 
     Secretary determines that--
       (1) release of such information is in the public interest; 
     and
       (2) the information to be released is not protected from 
     disclosure under section 552(b) of title 5, United States 
     Code.

     SEC. 7174. REVIEW AND MODIFICATION OF REGULATIONS.

       Not later than 30 days after the date of the enactment of 
     this Act, the Secretary shall order a review of existing 
     regulations, guidelines, and other guidance governing 
     medicare payment policies and billing code abuse to determine 
     if revision of or addition to those regulations, guidelines, 
     or guidance is necessary to maximize the benefits to the 
     Federal Government of the use of ADPE acquired pursuant to 
     section 7171.

     SEC. 7175. DEFINITIONS.

       For purposes of this chapter--
       (1) The term ``automatic data processing equipment'' (ADPE) 
     has the same meaning as in section 111(a)(2) of the Federal 
     Property and Administrative Services Act of 1949 (40 U.S.C. 
     759(a)(2)).
       (2) The term ``billing code abuse'' means the submission to 
     medicare carriers of claims for services that include 
     procedure codes that do not appropriately describe the total 
     services provided or otherwise violate medicare payment 
     policies.
       (3) The term ``commercial item'' has the same meaning as in 
     section 4(12) of the Office of Federal Procurement Policy Act 
     (41 U.S.C. 403(12)).
       (4) The term ``medicare part B'' means the supplementary 
     medical insurance program authorized under part B of title 
     XVIII of the Social Security Act (42 U.S.C. 1395j-1395w-4).
       (5) The term ``medicare carrier'' means an entity that has 
     a contract with the Health Care Financing Administration to 
     determine and make medicare payments for medicare part B 
     benefits payable on a charge basis and to perform other 
     related functions.
       (6) The term ``payment policies'' means regulations and 
     other rules that govern billing code abuses such as 
     unbundling, global service violations, double billing, and 
     unnecessary use of assistants at surgery.
       (7) The term ``Secretary'' means the Secretary of Health 
     and Human Services.

          PART III--REFORMING PAYMENTS FOR AMBULANCE SERVICES

     SEC. 7181. REFORMING PAYMENTS FOR AMBULANCE SERVICES.

       (a) In General.--Section 1834 (42 U.S.C. 1395m) is amended 
     by adding at the end the following new subsection:
       ``(k) Payment for Ambulance Services.--
       ``(1) In general.--Notwithstanding any other provision of 
     this part, (except Section 1861(v)(1)(V)) with respect to 
     ambulance services described in section 1861(s)(7), payment 
     shall be made based on the lesser of--
       ``(A) the actual charges for the services; or
       ``(B) the amount determined by a fee schedule developed by 
     the Secretary.
       ``(2) Fee schedule.--The fee schedule established under 
     paragraph (1) shall be established on a regional, statewide, 
     or carrier service area basis (as the Secretary may determine 
     to be appropriate) for services performed on or after January 
     1, 1996.
       ``(3) Separate payment levels.--
       ``(A) In general.--In establishing the fee schedule under 
     paragraph (2), the Secretary shall establish separate payment 
     rates for advanced life support and basic life support 
     services. Payment levels shall be restricted to the basic 
     life support level unless the patient's medical condition or 
     other circumstance necessitates (as determined by the 
     Secretary in regulations) the provisions of advanced life 
     support services.
       ``(B) Nonroutine basis.--The Secretary shall also establish 
     appropriate payment levels for the provision of ambulance 
     services that are provided on a routine or scheduled basis. 
     Such payment levels shall not exceed 80 percent of the 
     applicable rate for unscheduled transports.
       ``(4) Annual adjustment.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the fee schedules shall be adjusted annually (to become 
     effective on January 1 of each year) by a percentage increase 
     or decrease equal to the percentage increase or decrease in 
     the consumer price index for all urban consumers (United 
     States city average).
       ``(B) Special rule.--Notwithstanding subparagraph (B), the 
     annual adjustment in the fee schedules determined under such 
     subparagraph for each of the years 1996 through 2002 shall be 
     such consumer price index for the year minus 1 percentage 
     point.
       ``(5) Further adjustments.--The Secretary shall adjust the 
     fee schedule to the extent necessary to ensure that the fee 
     schedule takes into consideration the costs incurred in 
     providing the transportation and associated services as well 
     as technological changes.
       ``(6) Special rule for end stage renal disease 
     beneficiaries.--The Secretary shall direct the carriers to 
     identify end stage renal disease beneficiaries who receive 
     ambulance transports and--
       ``(A) make no payment for scheduled ambulance transports 
     unless authorized in advance by the carrier; or
       ``(B) make no additional payment for scheduled ambulance 
     transports for beneficiaries that have utilized ambulance 
     services twice within 4 continuous days, or 7 times within a 
     continuous 15-day period, unless authorized in advance by the 
     carrier; or
       ``(C) institute other such safeguards as the Secretary may 
     determine are necessary to ensure appropriate utilization of 
     ambulance transports by such beneficiaries.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to services furnished under title XVIII of the 
     Social Security Act on and after January 1, 1997.

                    PART IV--REWARDS FOR INFORMATION

     SEC. 7191. REWARDS FOR INFORMATION LEADING TO HEALTH CARE 
                   FRAUD PROSECUTION AND CONVICTION.

       (a) In General.--In special circumstances, the Secretary of 
     Health and Human Services and the Attorney General of the 
     United States may jointly make a payment of up to $10,000 to 
     a person who furnishes information unknown to the Government 
     relating to a possible prosecution for health care fraud.
       (b) Ineligible Persons.--A person is not eligible for a 
     payment under subsection (a) if--

[[Page S15699]]

       (1) the person is a current or former officer or employee 
     of a Federal or State government agency or instrumentality 
     who furnishes information discovered or gathered in the 
     course of government employment;
       (2) the person knowingly participated in the offense;
       (3) the information furnished by the person consists of 
     allegations or transactions that have been disclosed to the 
     public--
       (A) in a criminal, civil, or administrative proceeding;
       (B) in a congressional, administrative, or General 
     Accounting Office report, hearing, audit, or investigation; 
     or
       (C) by the news media, unless the person is the original 
     source of the information; or
       (4) in the judgment of the Attorney General, it appears 
     that a person whose illegal activities are being prosecuted 
     or investigated could benefit from the award.
       (c) Definitions.--
       (1) Health care fraud.--For purposes of this section, the 
     term ``health care fraud'' means health care fraud within the 
     meaning of section 1347 of title 18, United States Code.
       (2) Original source.--For the purposes of subsection 
     (b)(3)(C), the term ``original source'' means a person who 
     has direct and independent knowledge of the information that 
     is furnished and has voluntarily provided the information to 
     the Government prior to disclosure by the news media.
       (d) No Judicial Review.--Neither the failure of the 
     Secretary of Health and Human Services and the Attorney 
     General to authorize a payment under subsection (a) nor the 
     amount authorized shall be subject to judicial review.

     SEC. ____. BENEFICIARY INCENTIVE PROGRAMS.

       (a) Program to Collect Information on Fraud and Abuse.--
       (1) Establishment of program.--Not later than 3 months 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services (hereinafter in this section 
     referred to as the ``Secretary'') shall establish a program 
     under which the Secretary shall encourage individuals to 
     report to the Secretary information on individuals and 
     entities who are engaging or who have engaged in acts or 
     omissions which constitute grounds for the imposition of a 
     sanction under section 1128, section 1128A, or section 1128B 
     of the Social Security Act, or who have otherwise engaged in 
     fraud and abuse against the medicare program for which there 
     is a sanction provided under law. The program shall 
     discourage provision of, and not consider, information which 
     is frivolous or otherwise not relevant or material to the 
     imposition of such a sanction.
       (2) Payment of portion of amounts collected.--If an 
     individual reports information to the Secretary under the 
     program established under paragraph (1) which serves as the 
     basis for the collection by the Secretary or the Attorney 
     General of any amount of at least $100 (other than any amount 
     paid as a penalty under section 1128B of the Social Security 
     Act), the Secretary may pay a portion of the amount collected 
     to the individual (under procedures similar to those 
     applicable under section 7623 of the Internal Revenue Code of 
     1986 to payments to individuals providing information on 
     violations of such Code).
       (b) Program to Collect Information on Program Efficiency.--
       (1) Establishment of program.--Not later than 3 months 
     after the date of the enactment of this Act, the Secretary 
     shall establish a program under which the Secretary shall 
     encourage individuals to submit to the Secretary suggestions 
     on methods to improve the efficiency of the medicare program.
       (2) Payment of portion of program savings.--If an 
     individual submits a suggestion to the Secretary under the 
     program established under paragraph (1) which is adopted by 
     the Secretary and which results in savings to the program, 
     the Secretary may make a payment to the individual of such 
     amount as the Secretary considers appropriate.
                                 ______


                 NICKLES (AND BROWN) AMENDMENT NO. 2958

  Mr. NICKLES (for himself and Mr. Brown) proposed an amendment to the 
motion to commit proposed by Mr. Bradley to the bill S. 1357, supra; as 
follows:

       Strike all after ``Finance'' and insert: ``with 
     instructions to report the bill back to the Senate forthwith 
     including a provision stating:
       ```The maximum earned income credit for a family with one 
     child will increase from $2,094 in 1995 to $2,156 in 1996 and 
     the maximum earned income credit for a family with two or 
     more children will increase from $3,110 in 1995 to $3,208 in 
     1996.';
       ``and the effective date for section 7461, `earned income 
     credit denied to individuals not authorized to be employed in 
     the U.S.', shall be moved to taxable years beginning after 
     December 31, 1994.''

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