The Fraud and Abuse Provisions in H.R. 3600, the "Health Security Act": Joint Hearing Before the Legislation and National Security Subcommittee and the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, House of Representatives, One Hundred Second Congress, Second Session, on H.R. 3600, to Ensure Individual and Family Security Through Health Care Coverage for All Americans in a Manner that Contains the Rate of Growth in Health Care Costs and Promotes Responsible Health Insurance Practices, to Promote Choice in Health Care, and to Ensure and Protect the Health Care of All Americans, March 17, 1994U.S. Government Printing Office, 1995 - 262 pages |
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ACTION TO DATE activities administrative agent All-Payer Health anti-fraud ARONOVITZ Attorney authority bill Chairman claims CONGRESS THE LIBRARY consumers Control Account CONYERS coordination cost coverage criminal Department of Justice detection dollars durable medical equipment efforts employee leasing entities ERISA established facilities Federal filing fraud and abuse fraud control units fraudulent funds Health and Human health care fraud health care providers health care reform health care system health insurance health plans Health Security Act HMOs Human Services Inspector insurance departments insurance fraud investment involved issue jurisdiction kickbacks legislation LIBRARY OF CONGRESS licensed MCCANDLESS Medicaid Fraud Control Medicaid programs Medicare and Medicaid MFCUS MICA million Model 95 Model Regulation NAIC national health Office oversight participation patient abuse payers payment physician self-referral physicians private sector problem proposals reportable MEWA requirements role Section self-referral specific provision statement statute Subcommittee Thank
Popular passages
Page 201 - Except with the written consent of the Corporation, no person shall serve as a director, officer, or employee of an insured bank who has been convicted, or who is hereafter convicted, of any criminal offense involving dishonesty or a breach of trust.
Page 202 - Nothing contained in any title of this Act shall be construed as indicating an intent on the part of Congress to occupy the field in which any such title operates to the exclusion of State laws on the same subject matter, nor shall any provision of this Act be construed as invalidating any provision of State law unless such provision is inconsistent with any of the purposes of this Act, or any provision thereof.
Page 187 - Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming i Plan requirement after July 1, 1963.
Page 161 - An employee welfare benefit plan or any other arrangement that is established or maintained for the purpose of offering or providing health benefits to the employees of two or more employers. (ix) The health care program for active military personnel under title 10 of the United States Code. (x) The veterans health care program under 38 USC chapter 17.
Page 223 - August 21, 1996, under Federal or State law, in connection with the delivery of a health care item or service...
Page 218 - 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...
Page 138 - The enabling federal legislation emphasizes the necessity of having an integrated multi-disciplinary team in one office in order to successfully prosecute these complex financial crimes. The Units are required to be separate and distinct from the state Medicaid programs and are usually located in the state Attorney General's office, although some Units are located in other state agencies with law enforcement responsibilities such as the state police or the state Bureau of Investigation. The...
Page 224 - In general, physicians should not refer patients to a health care facility which is outside their office practice and at which they do not directly provide care or services when they have an investment interest in that facility.
Page 135 - US HOUSE OF REPRESENTATIVES COMMITTEE ON GOVERNMENT OPERATIONS SUBCOMMITTEE ON HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS PUBLIC HEARING ROOM CHAMBER CITY HALL NEW YORK, NEW YORK AUGUST 2, 1993 Mr.
Page 229 - ... to physician investors who directly provide care or services for their patients in facilities outside their office practice. h. The physician's ownership interest should be disclosed, when requested, to third-party payers.