|
AS MANDATED BY THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF
1996
Approved by:
Janet Reno, Attorney General
and
Donna Shalala, Secretary, Department of Health and Human Services
Effective January 1, 1997
Introduction: The Health Insurance Portability and Accountability
Act of
1996 establishes and funds a program to combat fraud and abuse committed
against
all health plans, both public and private. This legislation requires the
Attorney General and the Secretary of Health and Human Services
("Secretary") to
establish a Health Care Fraud and Abuse Control Program within the specific
parameters set forth by the statute. Under the joint direction of the
Attorney
General and the Secretary (acting through the agency's Inspector General
("HHS-OIG")), the Health Care Fraud and Abuse Control Program is to achieve
the
following goals:
- Coordinate Federal, State, and local law enforcement programs to
control
fraud and abuse with respect to health plans;
- Conduct investigations, audits, evaluations, and inspections relating to
the
delivery of and payment for health care in the United States;
- Facilitate the enforcement of the civil, criminal and administrative
statutes
applicable to health care;
- Provide industry guidance, including advisory opinions, safe harbors,
and
special fraud alerts relating to fraudulent health care practices; and
- Establish a national data bank to receive and report final adverse
actions
against health care providers.
To fund the program, the Act directs that an amount equalling
recoveries from health care fraud investigations[FN1] be deposited in or
transferred to the Federal Hospital Insurance Trust Fund ("Trust Fund").
Monies
are then appropriated from the Trust Fund to a newly-created expenditure
account,
called the Health Care Fraud and Abuse Control Account ("Control Account"),
in
an amount the Attorney General and Secretary jointly certify are necessary
to
finance anti-fraud activities. Certain of these sums are available only for
"activities of the Office of the Inspector General (OIG) of the Department
of
Health and Human Services, with respect to Medicare and Medicaid programs."
To
the extent that funds are not spent directly by the Departments of Health
and
Human Services and Justice on the establishment and operation of the
Program,
Control Account funds may be made available to others engaged in health care
fraud control for purposes in furtherance of the Program.
- This amount includes criminal fines and penalties, forfeitures,
civil
judgments and settlements, and administrative monetary penalties. It does
not
include the restitution due to the victim, funds awarded to a relator, or as
otherwise authorized by law.
In addition to establishing the Program, (as set forth in this
overview),
the Act directs the Attorney General and the Secretary to issue joint
guidelines
to carry out the Fraud and Abuse Control Program, including guidelines on
the
collection of information from health plans, and the preservation of the
confidentiality of that information.
[cited in USAM 9-44.150; USAM 9-44.160] |