article: 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
summary: 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.