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HEHS-96-111R 1 (1996-03-18)

handle is hein.gao/gaobaclcs0001 and id is 1 raw text is: United States General Accounting Office Washington, D.C. 20548 Health, Education and Human Services Division B-270093 March 18, 1996 The Honorable Fortney H. (Pete) Stark Ranking Minority Member Subcommittee on Health Committee on Ways and Means House of Representatives Dear Mr. Stark: On March 15, 1996, you asked us to review the fraud and abuse provisions of House Rule (H.R.) 3063, the Health Coverage Availability and Affordability Act of 1996. Specifically, you asked whether the comments that we had provided to you on October 7, 1995, about the fraud and abuse provisions of H.R. 2425, the Medicare Preservation Act of 1995, were applicable to H.R. 3063. You also asked that we review the provisions of H.R. 3063 regarding (1) an exception for managed care organizations to the Social Security Act's anti-kickback criminal provision and (2) a requirement that the Department of Health and Human Services (HHS) provide binding advisory opinions on whether certain health care arrangements are subject to sanction under the Social Security Act. To respond to your request, we reviewed-t-he relevant sections of H.R. 3063; we did not review the remainder of that bill. APPLICABILITY TO H.R. 3063 OF GAO COMMENTS ON H.R, 2425 In our earlier review of the fraud and abuse provisions of H.R. 2425 related to health programs under the Social Security Act' (enclosed is a copy of our response), we co nented on sections that would (1) make obtaining convictions harder under the Medicare anti-kickback law, (2) curtail enforcement of civil monetary penalties under Medicare, (3) make administration of antifraud and antiabuse programs more difficult with the resources available by adding duties for HHS, and (4) reduce savings from Medicare's physician self-referral prohibition. 'Fraud and Abuse Provisions in H.R.2425 (GAO/HEHS-96-37R, Oct. 7, 1995). GAO/HEHS-96-111R Fraud and Abuse Provisions in H.R. 3063

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