Justice and Law Enforcement:

Fraud and Abuse Provisions in H.R. 2425

HEHS-96-37R, Oct 7, 1995

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Pursuant to a congressional request, GAO reviewed the fraud and abuse provisions in H.R. 2425, focusing on proposed changes to Medicare anti-kickback and civil monetary penalty laws. GAO noted that the proposed changes to the: (1) Medicare anti-kickback law would make it more difficult to prove liability and easier to disguise the intent behind kickback arrangements, and avoid prosecution; and (2) civil monetary penalty law would hinder the enforcement of monetary penalties, make it more difficult to prove negligence, and overburden prosecutors. In addition, GAO noted that it is concerned that the provisions will: (1) increase the Department of Health and Human Services' fraud and abuse detection responsibilities; and (2) make it easier for physicians to refer their patients to facilities in which they have an ownership interest.