Grassley bill would expand powers of HHS, OIG
New legislation would strip bankruptcy protections, toughen enrollment, and unleash bounty hunters
Congress wound up its pre-Fourth of July session by introducing a flurry of health care anti-fraud bills that could swamp hospitals, physicians, nursing homes, and other providers with a barrage of new regulations and requirements and unleash an army of private sector auditors to detect billing errors and recoup overpayments. (See related story, below.)
Sen. Charles Grassley (R-IA), who chairs the Senate Special Committee on Aging, introduced the most comprehensive legislation — the Medicare Fraud Prevention and Enforcement Act of 1999 — on June 24. That legislation, co-sponsored by Sen. Susan Collins (R-ME) and Richard Durbin (D-IL), would strip bankruptcy protections for health care providers, increase registration requirements for Medicare contractors, beef up the investigative powers of the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), and crackdown on community mental health centers (CHMC) that provide partial hospitalization services.
Grassley is no newcomer to the health care fraud scene. He was instrumental in pushing for changes that revived the False Claims Act, which had been dormant for years and has been a leading proponent of further regulating the nursing home industry. Now Grassley is seeking to expand his portfolio.
Here is a snapshot of the provisions included in Grassley’s bill:
Restrictions on bankruptcy protection. The bill would strip bankruptcy protection from health care providers for overpayments resulting from fraud. Also, any civil monetary penalty or collection of past-due obligations arising from fraudulent activities would no longer be dischargeable through the bankruptcy process. Expanded authority of Inspector General for HHS. The legislation would give OIG investigators authority to obtain and execute warrants, and arrest without warrant, if the investigator believes a felony has been committed. The Health Insurance Portability and Accountability Act (HIPAA) established several enforcement tools for deterring health care related crime including streamlined investigative powers and subpoena procedures. But according to this legislation, they were "inadvertently omitted" in cases of kickbacks, false certifications, and overbilling Medicare beneficiaries. Expanded background checks. The legislation would require the Secretary of HHS to conduct background checks on any individual or entity that applies for a new Medicare provider number. It also instructs the Attorney General to provide criminal background information to HHS concerning Medicare applicants and gives HHS the power to deny the applicant a Medicare number if the applicant would be "detrimental to the best interests of the Medicare program or its beneficiaries." Site inspections. The legislation would require HCFA to conduct site visits for new durable medical equipment (DME) suppliers and CMHCs as a condition of their participation in Medicare. CMHCs are paid by Medicare to provide partial hospitalization services to patients who would otherwise be admitted for inpatient psychiatric treatment. The program has grown from about $30 million in 1993 to more than $350 million in 1997. Of the 1,500 CMHCs nationwide, more than 250 are located in Florida, and recent on-site visits to some facilities uncovered non-licensed staff and non-therapeutic services. "In essence, Medicare was paying for adult daycare, which is not allowed," the bill asserts. Registration of billing agencies. The bill would increase scrutiny over billing agencies by requiring them to register with HCFA. It would also give HHS the authority to exclude a billing agency from participating in the Medicare program if it knowingly submits a false or fraudulent claim. The legislation will also hold Medicare contractors liable for any amounts paid by HCFA to an excluded provider.The legislation would also codify various acts in the criminal code, including the illegal sale or distribution of a Medicare provider number or beneficiary identification number, and require all medical claims forms to accommodate a Universal Product Number (UPN) in order to receive Medicare reimbursement for DME, orthotics, and prosthetics.
Grassley spokeswoman Jill Cosney says it is still uncertain what legislation this bill will be attached to, but she adds that the measure has already generated widespread bipartisan support and no real opposition.
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