NCJ Number
68105
Date Published
1977
Length
35 pages
Annotation
THESE MEDICARE-MEDICAID ANTIFRAUD AND ABUSE AMENDMENTS STRENGTHEN THE CAPABILITY OF THE GOVERNMENT TO DETECT, PROSECUTE, AND PUNISH FRAUDULENT ACTIVITIES UNDER THE MEDICARE AND MEDICAID PROGRAMS.
Abstract
THE AMENDMENTS COVER PROHIBITION AGAINST ASSIGNMENT BY PHYSICIANS AND OTHERS OF CLAIMS FOR SERVICES AND CLAIMS PAYMENT PROCEDURES FOR THE MEDICAID PROGRAM. ALSO INCLUDED ARE AMENDMENTS ON DISCLOSURE OF OWNERSHIP AND RELATED INFORMATION, PENALTIES FOR DEFRAUDING MEDICARE AND MEDICAID PROGRAMS, AND PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS. GENERAL FEDERAL AND STATE RELATIONS, ANNUAL REPORTS, ISSUANCE OF SUBPEONAS BY THE COMPTROLLER GENERAL, AND SUSPENSION OF PRACTITIONERS CONVICTED OF MEDICARE- OR MEDICAID-RELATED CRIMES ARE FURTHER SUBJECTS ADDRESSED IN THE AMENDMENTS. OTHER AMENDMENTS COVER DISCLOSURE OF INSTITUTIONS, ORGANIZATIONS, AND AGENCIES OF OWNERS AND OTHER INDIVIDUALS WHO HAVE BEEN CONVICTED OF CERTAIN OFFENSES; FEDERAL ACCESS TO RECORDS; RESTRICTIONS OF FEDERAL MEDICAID PAYMENTS; ASSIGNMENT OF RIGHTS OF PAYMENT; INCENTIVE PAYMENTS; REVIEW OF MEDICARE CLAIMS PROCESSING; ABOLITION OF PROGRAM REVIEW TEAMS UNDER MEDICARE; AND FISCAL INTERMEDIARIES. THERE ARE ALSO AMENDMENTS ON PAYMENT FOR DURABLE MEDICAL EQUIPMENT, FUNDING OF STATE MEDICAID FRAUD CONTROL UNITS, REPORTS ON IN-HOME SERVICES, UNIFORM REPORTING SYSTEMS, WAIVER OF IMPOSITION OF REDUCTION OF FEDERAL MEDICAL ASSISTANCE PERCENTAGE DUE TO A STATE'S FAILURE TO HAVE AN EFFECTIVE MEDICAID UTILIZATION CONTROL PROGRAM, PROTECTION OF PATIENT FUNDS, PAYMENT FOR INSTITUTIONAL CARE BEYOND DATE DETERMINED MEDICALLY NECESSARY, AND PAYMENT UNDER MEDICARE FOR CETAIN SERVICES IN VETERANS' ADMINISTRATIONS HOSPITALS. A FINAL AMENDMENT STATES THAT MEDICAL OFFICERS IN AMERICAN SAMOA, THE NORTHERN MARIANA ISLANDS, AND THE TRUST TERRITORY OF THE PACIFIC ISLANDS ARE INCLUDED IN THE PROFESSIONAL STANDARDS REVIEW PROGRAM. THE AMENDMENTS' LEGISLATIVE HISTORY IS INCLUDED. (JLF)