Proposed Legislation to Strengthen the Capability of the Government to Detect, Prosecute, and Punish Fraudulent Activities under the Medicare and Medicaid Programs

HRD-77-65: Published: Mar 10, 1977. Publicly Released: Mar 10, 1977.

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Several revisions would improve H.R. 3, 95th Congress, the purpose of which is to strengthen the capability of the Government to detect, prosecute, and punish fraudulent activities under the Medicare and Medicaid programs.

Sections 3 and 8 of the bill, which relate to the disclosure of ownership and financial information and disclosure by providers or owners convicted of certain offenses, should be conformed to apply to the same programs since they appear to be applicable to many of the same providers and organizations. Section 5, which relates to changes in the Professional Standards Review Organizations (PSROs), should be modified to include a statement that the General Accounting Office has access to all PSRO records for the purpose of any audit, investigation, examination, analysis, review, or evaluation authorized by law with respect to titles V, XI, XVIII, or XIX of the Social Security Act. This section should also be modified to require the annual report to Congress on the PSRO program to report the results of PSRO effectiveness assessments that were made by the Department of Health, Education, and Welfare and the actions taken or proposed to be taken to improve the effectiveness of the PSROs so assessed. Section 11 of the proposed legislation should merely prohibit Federal sharing in State Medicaid expenditures which result from State laws or contracts which exclude or limit insurance benefits because an individual is eligible for Medicaid. (SC)

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