H.R.3461 - Medicare Fraud Prevention and Enforcement Act of 1999106th Congress (1999-2000)
Summary: H.R.3461 — 106th Congress (1999-2000)
Medicare Fraud Prevention and Enforcement Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to conduct an additional site inspection for each applicable items or services provider that applies for a provider number. Requires the Secretary, in conducting the inspection, to ensure that the site is in full compliance with all the conditions and standards of participation and requirements for obtaining Medicare billing privileges. Requires the Secretary to conduct the site inspection for an applicable provider before the issuance of a provider number.
Introduced in House (11/18/1999)
(Sec. 2) Sets forth rules for the Secretary to conduct a background check on any individual or entity that applies for a Medicare provider number, allowing the Secretary to refuse to issue such number if the Secretary determines, after the background check, that such individual or entity has a history of acts that indicate issuance would be detrimental to the best interests of Medicare or Medicare beneficiaries. Requires reporting of such a refusal to the health integrity protection database (HIPDB) in accordance with the procedures for reporting final adverse actions taken against a health care provider, supplier, or practitioner.
(Sec. 3) Directs the Secretary to establish procedures for the registration of all applicant billing agencies. Requires the Secretary to assign a unique identification number to each registered agency, which must appear on every claim for Medicare reimbursement.
(Sec. 3) Amends SSA title XI to allow the Secretary to exclude from participation in any Federal health care program any billing agency that knowingly submitted or caused to be submitted a claim for Medicare reimbursement that it knows or should know is false or fraudulent.
(Sec. 4) Provides for expanded access to the HIPDB. Prescribes a criminal penalty for misuse of HIPDB information.
(Sec. 5) Amends SSA title XVIII with respect to agreements under Medicare part A (Hospital Insurance) with a public agency or private organization that facilitates payment to service providers. Requires such agreements to require that the agency or organization reimburse the Secretary for any amounts it has paid for a Medicare service furnished by an individual or entity during any period for which the individual or entity is excluded from participation in the Medicare health care program, if the amounts are paid after a 60-day period following the notice of exclusion, unless the payment was made as a result of incorrect information provided by the Secretary, or the individual or entity excluded from participation has concealed or altered its identity.
Applies the same reimbursement requirement to contracts with a carrier with respect to payments to an excluded individual or entity for an item or service under Medicare part B (Supplementary Medical Insurance).
(Sec. 6) Revises the definition of community mental health centers with respect to partial hospitalization services, excluding from coverage for ambulatory treatment services any services in an individual's home or in an inpatient or residential setting.
(Sec. 7) Amends SSA titles XI and XVIII to deny a discharge in bankruptcy to: (1) civil monetary penalties for fraudulent activities by a health care provider or supplier; (2) overpayments to service providers under Medicare part A and of benefits under Medicare part B; and (3) past-due obligations arising from breach of scholarship and loan contract.
(Sec. 8) Amends SSA title XI to prescribe a criminal penalty for illegal distribution of a Medicare or Medicaid beneficiary identification or provider number.
(Sec. 9) Amends the Federal criminal code to provide for the treatment of acts involving Federal health care programs described under SSA title XI as Federal health care offenses.
(Sec. 10) Authorizes any criminal investigator of the Office of Inspector General of HHS, upon proper designation, to: (1) obtain and execute any warrant or other process issued under the authority of the United States; (2) make an arrest without a warrant for any offense against the United States committed in the presence of such investigator, or any Federal felony if such investigator has reasonable cause to believe that the person to be arrested has committed or is committing that felony; and (3) exercise any other authority necessary to carry out such authority.
Authorizes the HHS Office of Inspector General to receive and to expend certain funds that represent the equitable share from the forfeiture of property in investigations in which the Office participated.
(Sec. 11) Requires all claims forms developed or used by the Secretary for reimbursement under Medicare to accommodate the use of universal product numbers (UPNs) for a UPN covered item, and all claims for such an item to contain the UPN. Requires the Secretary to study and report to Congress on implementation of this requirement.
Amends SSA title XVIII to set forth rules governing use of UPNs.