H.R. 27 would amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program.
Detailed Summary
Medicare Fraud Prevention and Enforcement Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to conduct an additional site inspection for each applicable items or services provider that applies for a provider number.
Sets forth rules for the Secretary to conduct a background check on any individual or entity that applies for a Medicare provider number.
Directs the Secretary to establish procedures for the registration of all applicant billing agencies and individuals. Requires the Secretary to assign a unique identification number to each registered agency and individual, which must appear on every claim for Medicare reimbursement.
Amends SSA title XI to allow the Secretary to exclude from participation in any federal health care program any billing agency or individual that knowingly submitted or caused to be submitted a claim for Medicare reimbursement that it knows or should know is false or fraudulent.
Requires that the information in the health integrity protection database (HIPDB) to be available to certain health care providers, suppliers, or practitioners as well as utilization and quality control peer review organizations and accreditation entities.
Amends SSA title XVIII to require Medicare administrative contracts to require contractor reimbursements to the Secretary for amounts paid to excluded providers.
Revises criteria for community mental health centers.
Amends SSA titles XI and XVIII to deny a discharge in bankruptcy to civil monetary penalties for fraudulent activities by a health care provider or supplier, overpayments to service providers under Medicare part A and of benefits under Medicare part B (Supplementary Medical Insurance), and past-due obligations arising from breach of a scholarship or loan contract.
Amends SSA title XI to prescribe a criminal penalty for illegal distribution of a Medicare or Medicaid beneficiary identification or provider number with intent to defraud.
Amends the federal criminal code to: (1) prescribe criminal penalties for knowing, unauthorized use of information in the HIPDB; and (2) provide for the treatment of certain acts involving federal health care programs federal health care offenses.
Authorizes any criminal investigator of the Office of Inspector General of HHS to: (1) obtain and execute any warrant or other process issued under federal authority; and (2) make warrantless arrests in specified circumstances.
Requires all claims forms developed or used by the Secretary for Medicare reimbursement to accommodate the use of universal product numbers (UPNs, or bar codes) for a UPN-covered item, and all claims for such an item to contain the UPN.
Status of the Legislation
Latest Major Action: 2/9/2009: Referred to House subcommittee. Status: Referred to the Subcommittee on Crime, Terrorism, and Homeland Security.
Points in Favor
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Points Against
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Visitor Comments
K. Walker
January 12, 2009, 5:16am (report abuse)For anyone concerned about governmental fraud, waste, and abuse, the proper course of action would be to scrap the social security program, including the Medicare and Medicaid programs.
The government's job is not to provide a retirement stipend or any type of health care services, especially when it has to extort money from its citizens in the form of taxes.
The government's only legitimate function is to serve as a protector of individual rights.
H. H.
January 20, 2009, 11:15am (report abuse)Calling, visiting the local office, and filling out forms online concerning disability fraud has gotten nowhere. The last resort by an individual video recording an individual that claims to have a spinal injury was to post it on YouTube and referencing it within the complaints. The individual within the videos can do many things that a non disabled person would have trouble doing yet there never seems to be any investigations into this. The individual even has a handicap placard for his vehicle yet running, jumping, carrying heavy objects such as sofas, wallboard, and many other feats do not hinder this person.
Again to see the examples of what is taking place can be viewed at
http://www.youtube.com/profile?user=Pauline0000000&view=videos
Why should the taxpayers be footing the bill for this? It is a travesty to all those that are truly disabled.