White House crime bill includes new fraud tools
White House crime bill includes new fraud tools
Provisions target kickback schemes
The Clinton administration is asking Congress to approve a legislative package that will give the Department of Justice (DOJ) new tools to speed the investigation and prosecution of health care fraud and abuse cases.
Contained in the Administration’s omnibus crime bill, the health care proposals give the Department of Justice new authority to:
• Prosecute and punish kickback schemes involving federal health care programs.
The new legislation would give the Attorney General authority to stop criminal kickback schemes under Medicare, Medicaid, and state health care programs while they are still under investigation. It also creates new civil fines of $25,000 to $50,000 for individuals or entities involved in such activities. Offenders also would be responsible for damages of triple the total compensation offered.
Federal prosecutors currently are unable to obtain injunctions halting suspected kickback schemes before the suspects are found guilty in court. This in turn often causes officials to abandon cases they feel they only have a marginal chance of winning.
• Facilitate the prosecution of health care fraud.
The proposal, unveiled by Vice President Al Gore, would eliminate the prohibition against exchange of information between criminal investigators and civil prosecutors in health care fraud cases. It also would permit government attorneys to issue subpoenas in connection with any criminal or civil health care fraud case. The Justice Depart ment argues the current prosecution of health care fraud is often inefficient because criminal investigators and civil prosecutors are prohibited from exchanging information about cases that may be related. In addition, the Department of Justice cannot independently issue subpoenas when investigating civil fraud cases, making it difficult to prosecute them in a timely and efficient manner.
• Prevent providers from taking advantage of Medicare by declaring bankruptcy.
Providers who have defrauded and abused Medicare often file for bankruptcy to avoid paying fines or returning overpayments, leaving Medicare stuck with the bills, argues the Administration. This provision would prevent individuals or corporations that declare bankruptcy from discharging those debts associated with their health care fraud conviction.
• Give new fraud fighting authority to the Federal Employee Health Benefits Program (FEHBP).
All federal health programs except FEHBP are provided a number of tools through the Health Insurance Portability and Accountability Act to facilitate investigation of health care fraud. The new legislative package would expand the HIPAA provisions to include FEHBP, providing: stronger sanctions for providers who have been convicted of health care fraud, including mandatory exclusion from FEHBP; expanded anti-kickback provisions to prevent FEHBP health care providers from receiving improper gratuities for referrals or related services; a lower standard of proof for fraudulent claims; and an increase in the penalty per false claim from $2,000 to $10,000.
• Ensure that penalties for health care fraud are adequate.
The Administration wants the United States Sentencing Commission to study current sentencing guidelines for health care fraud, and, if necessary, to amend them to reflect the serious harms associated with health care fraud. A final report would be due by Dec. 31, 2000. Specifically, the White House wants to amend health care fraud sentencing guidelines that permit courts to offer offenders leniency if the provider or corporation admits responsibility for the fraud.
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