text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Fraud and Abuse Control Act 
  of 1995''.
  
  SEC. 2. ESTABLISHMENT OF MEDICARE FRAUD AND ABUSE CONTROL PROGRAM.
  
      (a) In General.--Not later than 6 months after the date of the 
  enactment of this Act, the Secretary of Health and Human Services shall 
  establish a program to improve the prevention, detection, and control 
  of fraud and abuse under the medicare program.
      (b) Award of Portion of Amounts Collected to Individuals Providing 
  Information.--Under the program established pursuant to subsection (a), 
  the Secretary shall pay a portion of any civil monetary penalty 
  assessed under the medicare program to any individual or entity who 
  provided information which served as the basis for the assessment of 
  the penalty, under the same terms and conditions applicable to awards 
  to qui tam plaintiffs under chapter 37 of title 31, United States Code.
  
  SEC. 3. PROVIDING INFORMATION ON REPORTING FRAUD AND ABUSE WITH 
                MEDICARE CLAIMS AND BENEFIT FORMS.
  
      (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
  1395 et seq.) is amended by adding at the end the following new 
  section:
  
              ``solicitation of information on fraud and abuse
  
      ``Sec. 1893. With each explanation of benefits provided to an 
  individual to whom items or services are furnished under this title and 
  with each notice of payment provided to an individual or entity 
  furnishing an item or service for which payment is made under this 
  title, the Secretary shall include a statement soliciting any 
  information the individual or entity may possess on any fraud and abuse 
  committed against the program under this title, together with a toll-
  free telephone number through which the individual or entity may report 
  such information.''.
      (b) Effective Date.--The amendment made by subsection (a) shall 
  apply to items and services furnished and payments made under title 
  XVIII of the Social Security Act on or after January 1, 1996.
  
  SEC. 4. INCREASE IN AMOUNT OF PENALTIES.
  
      (a) In General.--
              (1) General civil monetary penalties.--Section 1128A of the 
          Social Security Act (42 U.S.C. 1320a-7a) is amended--
                      (A) in subsection (a)--
                              (i) by striking ``$2,000'' and inserting 
                          ``$4,000'', and
                              (ii) by striking ``$15,000'' and inserting 
                          ``$30,000''; and
                      (B) in subsection (b), by striking ``$2,000'' each 
                  place it appears and inserting ``$4,000''.
              (2) Criminal penalties.--Section 1128B of such Act (42 
          U.S.C. 1320a-7b) is amended--
                      (A) in subsection (a)--
                              (i) by striking ``$25,000'' and inserting 
                          ``$50,000'', and
                              (ii) by striking ``$10,000'' and inserting 
                          ``$20,000'';
                      (B) in subsections (b), (c), and (d), by striking 
                  ``$25,000'' each place it appears and inserting 
                  ``$50,000''; and
                      (C) in subsection (e), by striking ``$2,000'' and 
                  inserting ``$4,000''.
              (3) Standards for nursing facilities.--
                      (A) Providing advance notice of survey to nursing 
                  facility.--Section 1819(g)(2)(A)(i) of such Act (42 
                  U.S.C. 1395i@3(g)(2)(A)(i)) is amended by striking 
                  ``$2,000'' and inserting ``$4,000''.
                      (B) Noncompliance with nursing facility 
                  standards.--Section 1819(h)(2)(B)(ii) of such Act (42 
                  U.S.C. 1395i@3(h)(2)(B)(ii)) is amended by striking 
                  ``$10,000'' and inserting ``$20,000''.
              (4) Failure to provide information on referring physician 
          on unassigned claims.--Section 1833(q)(2)(B)(i) of such Act (42 
          U.S.C. 1395l(q)(2)(B)(i)) is amended by striking ``$2,000'' and 
          inserting ``$4,000''.
              (5) Distribution by suppliers of medical equipment of 
          medical necessity forms.--Section 1834(j)(2)(A)(iii) of such 
          Act (42 U.S.C. 1395m(j)(2)(A)(iii)), as added by section 
          131(a)(1) of the Social Security Act Amendments of 1994, is 
          amended by striking ``$1,000'' and inserting ``$2,000''.
              (6) Failure to include diagnosis code on unassigned 
          claims.--Section 1842(p)(3)(A) of such Act (42 U.S.C. 
          1395u(p)(3)(A)) is amended by striking ``$2,000'' and inserting 
          ``$4,000''.
              (7) Intermediate sanctions for providers or suppliers of 
          clinical diagnostic laboratory tests.--Section 
          1846(b)(2)(A)(ii) of such Act (42 U.S.C. 1395w@2(b)(2)(A)(ii)) 
          is amended by striking ``$10,000'' and inserting ``$20,000''.
              (8) Medicare secondary payer.--
                      (A) Offering financial incentives for beneficiaries 
                  not to enroll in primary plans.--The second sentence of 
                  section 1862(b)(3)(C) of such Act (42 U.S.C. 
                  1395y(b)(3)(C)) is amended by striking ``$5,000'' and 
                  inserting ``$10,000''.
                      (B) Failure of employer to provide matching 
                  information on secondary payer situations.--The second 
                  sentence of section 1862(b)(5)(C)(ii) of such Act (42 
                  U.S.C. 1395y(b)(5)(C)(ii)) is amended by striking 
                  ``$1,000'' and inserting ``$2,000''.
                      (C) Failure of provider to provide information on 
                  availability of other payers.--Section 1862(b)(6)(B) of 
                  such Act (42 U.S.C. 1395y(b)(6)(B)), as added by 
                  section 151(a)(2)(A) of the Social Security Act 
                  Amendments of 1994, is amended by striking ``$2,000'' 
                  and inserting ``$4,000''.
              (9) Improper billing by hospitals.--Section 1866(g) of such 
          Act (42 U.S.C. 1395cc(g)) is amended by striking ``$2,000'' and 
          inserting ``$4,000''.
              (10) Violation of anti-dumping restrictions.--Section 
          1867(d)(1) of such Act (42 U.S.C. 1395dd(d)(1)) is amended--
                      (A) by striking ``$50,000'' each place it appears 
                  and inserting ``$100,000''; and
                      (B) in subparagraph (A), by striking ``$25,000'' 
                  and inserting ``$50,000''.
              (11) Sanctions against health maintenance organizations.--
          Section 1876(i)(6)(B)(i) of such Act (42 U.S.C. 
          1395mm(i)(6)(B)(i)) is amended--
                      (A) by striking ``$25,000'' and inserting 
                  ``$50,000'';
                      (B) by striking ``$100,000'' and inserting 
                  ``$200,000''; and
                      (C) by striking ``$15,000'' and inserting 
                  ``$30,000''.
              (12) Referrals by physicians with ownership or investment 
          interests.--
                      (A) Improper claims.--Section 1877(g)(3) of such 
                  Act (42 U.S.C. 1395nn(g)(3)) is amended by striking 
                  ``$15,000'' and inserting ``$30,000''.
                      (B) Circumvention schemes.--Section 1877(g)(4) of 
                  such Act (42 U.S.C. 1395nn(g)(4)) is amended by 
                  striking ``$100,000'' and inserting ``$200,000''.
                      (C) Failure to report information.--Section 
                  1877(g)(5) of such Act (42 U.S.C. 1395nn(g)(5)) is 
                  amended by striking ``$10,000'' and inserting 
                  ``$20,000''.
              (13) Medicare supplemental policies.--
                      (A) Issuance of policies where no standards in 
                  effect.--The second sentence of section 1882(a)(2) of 
                  such Act (42 U.S.C. 1395ss(a)(2)) is amended by 
                  striking ``$25,000'' and inserting ``$50,000''.
                      (B) Misrepresentations of policies.--Section 
                  1882(d) of such Act (42 U.S.C. 1395ss(d)) is amended--
                              (i) in paragraphs (1), (2), and (4)(A), by 
                          striking ``$5,000'' and inserting ``$10,000''; 
                          and
                              (ii) in paragraphs (3)(A) and (3)(B)(iv), 
                          by striking ``$25,000 (or $15,000'' and 
                          inserting ``$50,000 (or $30,000''.
                      (C) Violation of benefits standards.--Section 
                  1882(p) of such Act (42 U.S.C. 1395ss(p)) is amended by 
                  striking ``$25,000 (or $15,000'' each place it appears 
                  in paragraphs (8) and (9)(C) and inserting ``$50,000 
                  (or $30,000''.
                      (D) Violation of guaranteed renewability 
                  standards.--Section 1882(q)(5)(C) of such Act (42 
                  U.S.C. 1395ss(q)(5)(C)) is amended by striking 
                  ``$25,000'' and inserting ``$50,000''.
                      (E) Violation of loss ratio standards.--Section 
                  1882(r)(6)(A) of such Act (42 U.S.C. 1395ss(r)(6)(A)) 
                  is amended by striking ``$25,000'' and inserting 
                  ``$50,000''.
                      (F) Violation of pre-existing condition 
                  standards.--Section 1882(s)(3) of such Act (42 U.S.C. 
                  1395ss(s)(3)) is amended by striking ``$5,000'' and 
                  inserting ``$10,000''.
                      (G) Medicare select policies.--Section 1882(t)(2) 
                  of such Act (42 U.S.C. 1395ss(t)(2)) is amended by 
                  striking ``$25,000'' and inserting ``$50,000''.
              (14) Violation of home health participation standards.--
          Section 1891 of such Act (42 U.S.C. 1395bbb) is amended--
                      (A) in subsection (a)(3)(D)(iii)(III), by striking 
                  ``$5,000'' and inserting ``$10,000'';
                      (B) in subsection (c)(1), by striking ``$2,000'' 
                  and inserting ``$4,000'' ; and
                      (C) in subsection (f)(2)(A)(i), by striking 
                  ``$10,000'' and inserting ``$20,000''.
      (b) Effective Date.--The amendments made by subsection (a) shall 
  apply to civil monetary penalties imposed with respect to acts or 
  omissions occurring on or after January 1, 1996.
target: Medicare Fraud and Abuse Control Act of 1995 - Directs the Secretary of Health and Human Services to establish a federal program to prevent, detect, and control fraud and abuse under Medicare. Requires the Secretary to pay a portion of any civil monetary penalty for a Medicare violation to any person or entity whose information led to the imposition of that penalty. 
  Amends title XVIII (Medicare) of the Social Security Act:  (1) to require that a statement soliciting information of any fraud or abuse be included with every explanation of benefits received and notice of payment made under Medicare; and (2) to double the amount of criminal and civil monetary penalties that are assessed for various Medicare violations.
feat_title: Medicare Fraud and Abuse Control Act of 1995