text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Health Care Fraud Prosecution Act of 
  1993''.
  
  SEC. 2. INCREASED PENALTIES FOR HEALTH CARE FRAUD.
  
      (a) Offense.--Part I of title 18, United States Code, is amended by 
  inserting after chapter 50A the following:
  
                      ``CHAPTER 50B--HEALTH CARE FRAUD
  
  ``Sec.
  ``1101. Health care fraud.
  ``1102. Illegal remunerations.
  ``1103. Civil Action.
  ``1104. Definitions.
  ``Sec. 1101. Health care fraud
      ``(a) In General.--Whoever, in or affecting interstate commerce, 
  knowingly--
              ``(1) executes, or attempts to execute, a scheme or 
          artifice to defraud to obtain a health care payment; or
              ``(2) presents to any person any statement as part of, or 
          in support of, a claim for a health care payment, knowing that 
          such statement contains any false or misleading information 
          concerning any fact or thing material to such claim;
  shall be fined under this title or imprisoned not more than 10 years, 
  or both.
      ``(b) Aggravated Offenses.--In an offense under subsection (a) of 
  this section--
                      ``(1) if the offender knowingly or recklessly 
                  causes serious bodily injury to an individual or 
                  knowingly or recklessly endangers the life of a person, 
                  the offender shall be fined under this title or 
                  imprisoned not more than 15 years, or both; and
                      ``(2) if the offender knowingly or recklessly 
                  causes the death of an individual, the offender shall 
                  be fined under this title or imprisoned not more than 
                  25 years, or both.
  ``Sec. 1102. Illegal remunerations
      ``Whoever, in or affecting interstate commerce, knowingly solicits, 
  receives, offers, or provides anything of value--
              ``(1) for the referral of an individual to a person for the 
          furnishing of any item or service for which a health care 
          payment may be paid by a third party payer;
              ``(2) for recommending, or arranging for, the furnishing of 
          any item or service for which a health care payment may be paid 
          by a third party payer; or
              ``(3) which in effect reduces the cost of an item or 
          service for which a health care payment may be paid by a third 
          party payer, and then seeks that health care payment from the 
          third party payer;
  without informing the third party payer fully about having done so and 
  reflecting the amount of the thing of value in the claim for the health 
  care payment, shall be fined under this title or imprisoned not more 
  than 5 years, or both.
  ``Sec. 1103. Civil action
      ``Any person injured in business or property by a violation of this 
  chapter may in a civil action recover treble damages. The court may 
  award the prevailing party a reasonable attorney's fee as a part of the 
  costs.
  ``Sec. 1104. Definitions
      ``As used in this chapter--
              ``(1) the term `health care payment' means a payment for 
          health care services or health care products, or the right to 
          have a payment made by a third party payer for specified health 
          care services or products; and
              ``(2) the term `third party payer' means any person, public 
          or private, who undertakes to indemnify another against loss 
          arising from a contingent or unknown event.''.
      (b) Clerical Amendment.--The table of chapters at the beginning of 
  part I of title 18, United States Code, is amended by inserting after 
  the item relating to chapter 50A the following new item:
  
  ``50B. Health care fraud....................................   1101.''.
  
  SEC. 3. INJUNCTIONS FOR HEALTH CARE FRAUD.
  
      Section 1345(a) of title 18, United States Code, is amended--
              (1) in paragraph (1)(A), by striking ``or 1001'' and 
          inserting ``1001, 1101, or 1102''; and
              (2) in paragraph (a)(2), by inserting ``a violation of 
          section 1101 or 1102 of this title or'' after ``as a result 
          of''.
  
  SEC. 4. CRIMINAL FORFEITURE OF FRAUD PROCEEDS.
  
      Section 982(a)(2)(B) of title 18, United States Code, is amended--
              (1) by inserting ``1101, 1102,'' after ``844,''; and
              (2) by striking ``or 1030'' and inserting ``1030, or 
          1347''.
  
  SEC. 5. REWARDS FOR INFORMATION LEADING TO PROSECUTION AND CONVICTION.
  
      Section 3059 of title 18, United States Code, is amended by adding 
  at the end the following:
      ``(c)(1) The Attorney General may pay a reward of--
              ``(A) an amount determined under paragraph (2) of this 
          subsection, in the case of an offense in which the United 
          States is a victim and restitution or a civil recovery is 
          obtained by the United States; or
              ``(B) not more than $100,000, in any other case;
  to any person who furnishes information or services that lead to a 
  conviction under section 1101 or 1102 of this title.
      ``(2) The amount referred to in paragraph (1)(A) of this subsection 
  is an amount equal to--
              ``(A) not more than 30 percent of the first $1,000,000 of 
          the recovery;
              ``(B) not more than 20 percent of the next $4,000,000; and
              ``(C) not more than 5 percent of the remaining portion of 
          the recovery.
      ``(3) An officer or employee of the United States or of a State or 
  local government who furnishes information or renders services in the 
  performance of official duty is ineligible for a payment under this 
  subsection with respect to such information or services.''.
  
  SEC. 6. HEALTH CARE FRAUD TASK FORCES.
  
      (a) In General.--The Attorney General, in consultation with the 
  Secretary of Health and Human Services, shall establish regional health 
  care fraud task forces (hereinafter in this section referred to as 
  ``task forces'').
      (b) Purpose.--The purpose of the task forces is to ensure that 
  adequate resources are made available to identify, investigate, and 
  prosecute health care fraud and to recover the proceeds of such fraud 
  and other criminal activity against health insurers.
      (c) Duties.--Each such task force shall coordinate the 
  investigative and prosecutorial efforts within their region, as 
  determined by the Attorney General.
      (d) Participants.--The Federal agencies that shall participate in 
  the task forces are--
              (1) the Department of Justice (including the Federal Bureau 
          of Investigation);
              (2) the Department of Health and Human Services (including 
          the Food and Drug Administration and the Office of the 
          Inspector General);
              (3) the Internal Revenue Service;
              (4) the United States Postal Inspection Service; and
              (5) the Veteran's Administration.
      (e) Locations.--The task forces shall be established in such cities 
  as the Attorney General deems appropriate.
      (f) Objectives.--The objective of each task force shall be--
              (1) to target, investigate and prosecute individuals who 
          organize, direct, finance, or are otherwise engaged in health 
          care fraud;
              (2) to promote a coordinated health care fraud enforcement 
          effort in each task force region, and to encourage maximum 
          cooperation among all Federal agencies;
              (3) to work fully and effectively with State and local law 
          enforcement agencies; and
              (4) to make full use of financial investigative techniques, 
          on behalf of both public and private entities, to maximize 
          recovery of proceeds of unlawful activities from persons who 
          have committed health care fraud crimes or have engaged in 
          other criminal activity in or against the health insurance 
          industry.
      (g) Standards for Task Force Cases.--Each task force should focus 
  upon significant investigations of major health care fraud cases, or 
  organizations engaging in health care fraud, that warrant the 
  involvement of more than one investigative agency or that require 
  significant resources during the investigative stage.
      (h) Administration.--The administrative functions of the national 
  task force program will be performed by an executive office to be 
  established within the Department of Justice in Washington, D.C. It 
  shall be supervised by a Director, and the staff shall consist of 
  professional and support staff deemed necessary for the performance of 
  management and administrative functions.
      (i) Oversight.--An Executive Review Board shall oversee the task 
  force program. It shall be composed of ranking officials from each of 
  the participating Federal agencies and the Advisory Committee of the 
  United States Attorneys. Its role shall be to articulate policy, review 
  allocation of resources and coordinate the development and maintenance 
  of the task force program. The Board shall also be responsible for 
  resolving policy disputes that cannot be resolved within or among the 
  regional task forces or the participating agencies. The Board shall 
  meet no less frequently than quarterly.
      (j) Guidelines.--The Attorney General shall, in consultation with 
  the Executive Review Board, establish guidelines for the operation and 
  management of the task force program.
  
  SEC. 7. NATIONAL HEALTH CARE FRAUD AND ABUSE DATA BASE.
  
      (a) In General.--The Attorney General, in consultation with the 
  Secretary of Health and Human Services, shall establish a data base for 
  the reporting of final adverse actions against health care providers, 
  suppliers, or practitioners, in order to provide a central repository 
  of such information to assist in the prevention, detection, and 
  prosecution of health care fraud and abuse.
      (b) Reporting of Information.--
              (1) In general.--Each government agency and health care 
          plan shall report any final adverse action taken against a 
          health care provider, supplier, or practitioner.
              (2) Information to be reported.--The information to be 
          reported under paragraph (1) includes the following:
                      (A) The name of any health care provider, supplier, 
                  or practitioner who is the subject of a final adverse 
                  action.
                      (B) The name (if known) of any health care entity 
                  with which a health care provider, supplier, or 
                  practitioner is affiliated or associated.
                      (C) The nature of the final adverse action.
                      (D) A description of the acts or omissions and 
                  injuries upon which the final adverse action was based, 
                  and such other information as required by the Attorney 
                  General.
              (3) Confidentiality.--The Attorney General shall establish 
          procedures to assure that the privacy of individuals receiving 
          health care services is appropriately protected.
              (4) Form and manner of reporting.--The information required 
          to be reported under this subsection shall be reported on a 
          monthly basis and in such form and manner as determined by the 
          Attorney General. Such information shall first be required to 
          be reported on a date specified by the Attorney General.
              (5) To whom reported.--The information required to be 
          reported under this subsection shall be reported to the 
          Attorney General or such person or persons designated by the 
          Attorney General.
      (c) Correction of Erroneous Information.--
              (1) Disclosure and correction.--The Attorney General shall 
          provide for a procedure through which a person, to whom 
          information within the data base established under this section 
          pertains, may review that information and obtain the correction 
          of errors pertaining to that person.
              (2) Other corrections.--Each Government agency and health 
          care plan shall report corrections of information already 
          reported about any final adverse action taken against a health 
          care provider, supplier, or practitioner, in such form and 
          manner as required by the Attorney General.
      (d) Access to Reported Information.--
              (1) Availability.--The information in this data base shall 
          be available to the public, Federal and State government 
          agencies, and health care plans pursuant to procedures 
          established by the Attorney General.
              (2) Fees.--The Attorney General may establish reasonable 
          fees for the disclosure of information in this data base.
      (e) Protection From Liability for Reporting.--No person or entity 
  shall be held liable in any civil action with respect to any report 
  made as required by this section, without knowledge of the falsity of 
  the information contained in the report.
      (f) Definitions and Special Rules.--For purposes of this section:
              (1) The term ``final adverse action'' includes the 
          following:
                      (A) Civil judgments in Federal or State court 
                  related to the delivery of a health care item or 
                  service.
                      (B) Federal or State criminal convictions related 
                  to the delivery of a health care item or service.
                      (C) Actions by State or Federal agencies 
                  responsible for the licensing and certification of 
                  health care providers, suppliers, and licensed health 
                  care practitioners, including--
                              (i) formal or official actions, such as 
                          revocation or suspension of a license (and the 
                          length of any such suspension), reprimand, 
                          censure or probation,
                              (ii) any other loss of license of the 
                          provider, supplier, or practitioner, whether by 
                          operation of law, voluntary surrender or 
                          otherwise, or
                              (iii) any other negative action or finding 
                          by such State or Federal agency that is 
                          publicly available information.
                      (D) Exclusion from participation in Federal or 
                  State health care programs.
                      (E) Any other actions as required by the Attorney 
                  General.
              (2) The terms ``licensed health care practitioner'', 
          ``licensed practitioner'', and ``practitioner'' mean, with 
          respect to a State, an individual who is licensed or otherwise 
          authorized by the State to provide health care services (or any 
          individual who, without authority holds himself or herself out 
          to be so licensed or authorized).
              (3) The term ``health care provider'' means a provider of 
          services as defined in section 1861(u) of the Social Security 
          Act, and any entity, including a health maintenance 
          organization, group medical practice, or any other entity 
          listed by the Secretary in regulation, that provides health 
          care services.
              (4) The term ``supplier'' means a supplier of health care 
          items and services described in sections 1819 (a) and (b), and 
          section 1861 of the Social Security Act.
              (5) The term ``Government agency'' includes--
                      (A) The Department of Justice.
                      (B) The Department of Health and Human Services.
                      (C) Any other Federal agency that either 
                  administers or provides payment for the delivery of 
                  health care services, including, but not limited to the 
                  Department of Defense and the Veterans' Administration.
                      (D) State law enforcement agencies.
                      (E) State Medicaid fraud and abuse units.
                      (F) State or Federal agencies responsible for the 
                  licensing and certification of health care providers 
                  and licensed health care practitioners.
              (6) The term ``health care plan'' has the meaning given to 
          such term by section 1128(i) of the Social Security Act.
              (7) For purposes of paragraph (2), the existence of a 
          conviction shall be determined under paragraph (4) of section 
          1128(j) of the Social Security Act.
  
  SEC. 8. NATIONAL HEALTH CARE FRAUD AND ABUSE HOTLINE.
  
      The Attorney General shall--
              (1) establish a national, toll-free health care fraud and 
          abuse hotline to enable all persons, including health care 
          consumers, providers, and insurers, to report (anonymously, if 
          so desired) suspected instances of health care fraud or abuse;
              (2) provide for the appropriate referral of all information 
          that is obtained through the hot line; and
              (3) assure that the public is provided adequate publicity 
          about the existence and capabilities of the hotline.
  
  SEC. 9. AUTHORIZATION OF APPROPRIATIONS.
  
      There are authorized to be appropriated for fiscal year 1994 for 
  the purposes of carrying out this Act and the amendments made by this 
  Act--
              (1) $23,000,000 for the Federal Bureau of Investigation to 
          hire, equip, and train no fewer than 225 special agents and 
          support staff to investigate health-care fraud cases;
              (2) $5,000,000 to hire, equip, and train no fewer than 50 
          assistant United States Attorneys and support staff to 
          prosecute health-care fraud cases;
              (3) $6,000,000 to hire, equip, and train no fewer than 50 
          investigators in the Office of Inspector General, Department of 
          Health and Human Services, to be devoted exclusively to health-
          care fraud cases;
              (4) $2,000,000 to establish, operate, and administer health 
          care fraud task forces;
              (5) $2,000,000 to establish, operate, publicize, and 
          administer the national health care fraud and abuse data base; 
          and
              (6) $2,000,000 to establish, operate, publicize, and 
          administer the national health care fraud and abuse hotline.
  
  SEC. 10. SCHEMES AND DEVICES RELATING TO EXPRESS AND OTHER COMMERCIAL 
                CARRIER SERVICES.
  
      (a) In General.--Chapter 63 of title 18, United States Code, is 
  amended by adding at the end the following:
  ``Sec. 1347. Express company fraud
      ``Whoever engages in any conduct with respect to a private or 
  commercial interstate carrier which, were that conduct engaged in with 
  respect to the Postal Service, would be a violation of section 1341 or 
  1342 of this title, shall be punished as is provided under such section 
  for such violation.''.
      (b) Clerical Amendment.--The table of sections at the beginning of 
  chapter 63 of title 18, United States Code, is amended by adding at the 
  end the following new item:
  
  ``1347. Express company fraud.''.
  
  SEC. 11. LAUNDERING OF MONETARY INSTRUMENTS.-
  
      Section 1956(c)(7)(D) of title 18, United States Code, is amended--
              (1) by inserting ``section 1101 or 1002 (relating to health 
          care fraud),'' after ``875 (relating to interstate 
          communications),''; and
              (2) by inserting ``section 1347 (relating to express 
          company fraud),'' after ``1203 (relating to hostage taking),''.
  
                                   
  
  HR 3093 IH----2
target: Health Care Fraud Prosecution Act of 1993 - Amends the Federal criminal code to set penalties for:  (1) knowingly executing a scheme or artifice to defraud to obtain a health care payment; or (2) presenting a statement as part of, or in support of, a claim for health care payment, knowing that such statement contains false or misleading information concerning any material fact. 
  Limits such penalties to a fine and ten years' imprisonment, unless the offender knowingly or recklessly caused:  (1) serious bodily injury to, or endangered the life of, an individual (up to 15 years' imprisonment); or (2) caused the death of an individual (up to 25 years' imprisonment). 
  Sets forth provisions regarding illegal remunerations. 
  Permits:  (1) persons injured by violations of such provisions to recover treble damages in a civil action; and (2) the court to award the prevailing party a reasonable attorney fee. 
  Makes provisions regarding injunctions against fraud and criminal forfeiture of fraud proceeds applicable to health care fraud. 
  Authorizes the Attorney General to pay specified rewards for information leading to the prosecution and conviction of persons engaging in health care fraud, with exceptions. 
  Directs the Attorney General to establish:  (1) regional health care fraud task forces and a data base for the reporting of final adverse actions against health care providers, suppliers, or practitioners; and (2) a national, toll-free health care fraud and abuse hotline. 
  Authorizes appropriations:  (1) for the Federal Bureau of Investigation, U.S. Attorneys, and the Office of Inspector General of the Department of Health and Human Services to hire, equip, and train personnel in connection with the investigation and prosecution of health care fraud cases; and (2) to establish, operate, and administer health care task forces and the national health care fraud and abuse data base and hotline, and to publicize the data base and hotline. 
  Amends the Federal criminal code to make:  (1) activity which, if engaged in by the U.S. Postal Service, would be a violation of mail fraud provisions, punishable to the same extent with respect to private or commercial interstate carriers (express company fraud); and (2) health care fraud and express company fraud predicates to violations of prohibitions against the laundering of monetary instruments.
feat_title: Health Care Fraud Prosecution Act of 1993