SEC. 201. FRAUD AND ABUSE CONTROL PROGRAM.
Title[ Title II\Subtitle A Contents
Subtitle A--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) <<NOTE: 42 USC 1320a-7c.>> Establishment of
Program.--
``(1) In general.--Not later than January 1, 1997, 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 health plans,
``(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,
``(D) to provide for the modification and
establishment of safe harbors and to issue advisory
opinions and special fraud alerts pursuant to section
1128D, and
``(E) to provide for the reporting and disclosure of
certain final adverse actions against health care
providers, suppliers, or practitioners pursuant to the
data collection system established under section 1128E.
``(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 payor, 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:
``(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 242(b) and
249(c) of the Health Insurance Portability and
Accountability Act of 1996, 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 XIX, 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).
``(D) Application.--Nothing in subparagraph (C)(iii)
shall be construed to limit the availability of
recoveries and forfeitures obtained under title I of the
Employee Retirement Income Security Act of 1974 for the
purpose of providing equitable or remedial relief for
employee welfare benefit plans, and for participants and
beneficiaries under such plans, as authorized under such
title.
``(3) Appropriated amounts to account for fraud and abuse
control program, etc.--
``(A) Departments of health and human services and
justice.--
``(i) 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 (C), to be
available without further appropriation, in an
amount not to exceed--
``(I) for fiscal year 1997,
$104,000,000,
``(II) for each of the fiscal years
1998 through 2003, the limit for the
preceding fiscal year, increased by 15
percent; and
``(III) for each fiscal year after
fiscal year 2003, the limit for fiscal
year 2003.
``(ii) Medicare and medicaid activities.--For
each fiscal year, of the amount appropriated in
clause (i), the following amounts shall be
available only for the purposes of the activities
of the Office of the Inspector General of the
Department of Health and Human Services with
respect to the Medicare and medicaid programs--
``(I) for fiscal year 1997, not less than $60,000,000 and not more than
$70,000,000;
``(II) for fiscal year 1998, not less than $80,000,000 and not more than
$90,000,000;
``(III) for fiscal year 1999, not less than $90,000,000 and not more than
$100,000,000;
``(IV) for fiscal year 2000, not less than $110,000,000 and not more than
$120,000,000;
``(V) for fiscal year 2001, not less than $120,000,000 and not more than
$130,000,000;
``(VI) for fiscal year 2002, not less than $140,000,000 and not more than
$150,000,000; and
``(VII) for each fiscal year after fiscal year 2002, not less than
$150,000,000 and not more than $160,000,000.
``(B) Federal bureau of investigation.--There are
hereby appropriated from the general fund of the United
States Treasury and hereby appropriated to the Account
for transfer to the Federal Bureau of Investigation to
carry out the purposes described in subparagraph (C), to
be available without further appropriation--
``(i) for fiscal year 1997, $47,000,000;
``(ii) for fiscal year 1998, $56,000,000;
``(iii) for fiscal year 1999, $66,000,000;
``(iv) for fiscal year 2000, $76,000,000;
``(v) for fiscal year 2001, $88,000,000;
``(vi) for fiscal year 2002, $101,000,000; and
``(vii) for each fiscal year after fiscal year
2002, $114,000,000.
``(C) Use of funds.--The purposes described in this
subparagraph are 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.
``(4) Appropriated amounts to account for Medicare integrity
program.--
``(A) In general.--There are hereby appropriated to
the Account from the Trust Fund for each fiscal year
such amounts as are necessary to carry out the Medicare
Integrity Program under section 1893, subject to
subparagraph (B) and to be available without further
appropriation.
``(B) Amounts specified.--The amount appropriated
under subparagraph (A) for a fiscal year is as follows:
``(i) For fiscal year 1997, such amount shall
be not less than $430,000,000 and not more than
$440,000,000.
``(ii) For fiscal year 1998, such amount shall
be not less than $490,000,000 and not more than
$500,000,000.
``(iii) For fiscal year 1999, such amount
shall be not less than $550,000,000 and not more
than $560,000,000.
``(iv) For fiscal year 2000, such amount shall
be not less than $620,000,000 and not more than
$630,000,000.
``(v) For fiscal year 2001, such amount shall
be not less than $670,000,000 and not more than
$680,000,000.
``(vi) For fiscal year 2002, such amount shall
be not less than $690,000,000 and not more than
$700,000,000.
``(vii) For each fiscal year after fiscal year
2002, such amount shall be not less than
$710,000,000 and not more than $720,000,000.
``(5) Annual report.--Not later than January 1, the
Secretary and the Attorney General shall submit jointly a report
to Congress which identifies--
``(A) the amounts appropriated to the Trust Fund for
the previous fiscal year under paragraph (2)(A) and the
source of such amounts; and
``(B) the amounts appropriated from the Trust Fund
for such year under paragraph (3) and the justification
for the expenditure of such amounts.
``(6) GAO report.--Not later than January 1 of 2000, 2002,
and 2004, the Comptroller General of the United States shall
submit a report to Congress which--
``(A) identifies--
``(i) the amounts appropriated to the Trust
Fund for the previous two fiscal years under
paragraph (2)(A) and the source of such amounts;
and
``(ii) the amounts appropriated from the Trust
Fund for such fiscal years under paragraph (3) and
the justification for the expenditure of such
amounts;
``(B) identifies any expenditures from the Trust
Fund with respect to activities not involving the
Medicare program under title XVIII;
``(C) identifies any savings to the Trust Fund, and
any other savings, resulting from expenditures from the
Trust Fund; and
``(D) analyzes such other aspects of the operation
of the Trust Fund as the Comptroller General of the
United States considers appropriate.''.
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