SEC. 221. ESTABLISHMENT OF THE HEALTH CARE FRAUD AND ABUSE DATA COLLECTION
PROGRAM.
Title[ Title II\Subtitle C Contents
Subtitle C--Data Collection
(a) In General.--Title XI (42 U.S.C. 1301 et seq.), as amended by
sections 201 and 205, is amended by inserting after section 1128D the
following new section:
``health care fraud and abuse data collection program
``Sec. 1128E. (a) General <<NOTE: 42 USC 1320a-7e.>> Purpose.--Not
later than January 1, 1997, 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), and shall maintain a database of the information
collected under this section.
``(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, who is the subject of a final adverse
action, 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 with respect to 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 the database
maintained under this section shall be available to Federal and
State government agencies and health plans 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
such database (other than with respect to requests by Federal
agencies). The amount of such a fee shall be sufficient to
recover the full costs of operating the database. 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,
including the agency designated by the Secretary in subsection (b)(5)
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) Coordination With National Practitioner Data Bank.--The
Secretary shall implement this section in such a manner as to avoid
duplication with the reporting requirements established for the National
Practitioner Data Bank under the Health Care Quality Improvement Act of
1986 (42 U.S.C. 11101 et seq.).
``(g) Definitions and Special Rules.--For purposes of this section:
``(1) Final adverse action.--
``(A) In general.--The term `final adverse action'
includes:
``(i) Civil judgments against a health care
provider, supplier, 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, non-
renewability, 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 (as defined in
sections 1128B(f) and 1128(h), respectively).
``(v) Any other adjudicated actions or
decisions that the Secretary shall establish by
regulation.
``(B) Exception.--The term does not include any
action with respect to a malpractice claim.
``(2) Practitioner.--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) Government agency.--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 control units.
``(F) Federal or State agencies responsible for the
licensing and certification of health care providers and
licensed health care practitioners.
``(4) Health plan.--The term `health plan' has the meaning
given such term by section 1128C(c).
``(5) Determination of conviction.--For purposes of
paragraph (1), the existence of a conviction shall be determined
under paragraph (4) of section 1128(i).''.
(b) Improved Prevention in Issuance of Medicare Provider Numbers.--
Section 1842(r) (42 U.S.C. 1395u(r)) is amended by adding at the end the
following new sentence: ``Under such system, the Secretary may impose
appropriate fees on such physicians to cover the costs of investigation
and recertification activities with respect to the issuance of the
identifiers.''.
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