Health Care Waste, Fraud, and Abuse: Hearing Before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives, One Hundred Fifth Congress, First Session, October 9, 1997, Volume 4 |
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AARP Accountability Act Administration alternative medicine ambulance America Speaks anti-fraud areas audits Balanced Budget Act BECERRA believe billed Medicare CANJA Chairman THOMAS Committee Congress consumers costs criminal defraud doctor drugs durable medical equipment efforts false claims federal fight fiscal fraud and abuse fraudulent funding HCFA HCFA's Health and Human health care fraud health care system Health Insurance Portability hearing HIPAA HMOs home health agencies home healthcare hospital hotline Human Services implement increased insurance companies investigations issue kickbacks legislation lymphedema MANGANO Medi Medicare and Medicaid Medicare beneficiaries Medicare fraud Medicare program Medicare's ment million nursing home Office of Inspector overpayments patients penalties percent Pete Stark physician Portability and Accountability problems program integrity prospective payment system providers reduce health reforms reimbursement require responsibility scam Semiannual Report skilled nursing facility statement submitted suppliers surety bond Thank tion waste
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Page 120 - Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice — (1) to defraud any health care benefit program, or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody of, any health care benefit program...
Page 3 - Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee. 3. A witness appearing at a public hearing, or submitting a statement for the record of a public hearing, or submitting written comments in response to a published request for comments by the Committee,...
Page 6 - Committee by a witness, any written statement or exhibit submitted for the printed record or any written comments in response to a request for written comments must conform to the guidelines listed below. Any statement or exhibit not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee. 1. All statements and any accompanying exhibits for printing must be typed in single space on legal-size paper and may not exceed...
Page 120 - ... claimed, including any person who engages in a pattern or practice of presenting or causing to be presented a claim for an item or service that is based on a code that the person knows or should know will result in a greater payment to the person than the code the person knows or should know is applicable to the item or service actually provided...
Page 126 - ... an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under...
Page 3 - TTD/TTY in advance of the event (four business days notice is requested). Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may oe directed to the Committee as noted above.
Page 123 - Department of Health and Human Services (HHS) Office of Inspector General (OIG), which oversees MFCUs at the federal level.
Page 87 - Here, physicians, hospitals, and other providers serving these HMOs' enrollees do not submit a per-service claim for reimbursement. Instead, they are paid by the HMO, which in turn is paid a monthly amount by Medicare for each beneficiary enrolled. This amount is fixed in advance. In this sense, the HMO has a "risk" contract because regardless of what it spends for each enrollee's care, the HMO assumes the financial risk of providing health care within a fixed budget. HMOs profit if their cost of...
Page 88 - HMOs' quality assurance plans, examining only the description rather than the implementation of HMOS' quality assurance processes.12 Moreover, HCFA was reluctant to take action against noncompliant HMOS, even when there was a history of abusive sales practices, delays in processing beneficiaries' appeals of HMO decisions to deny coverage, or poor-quality care.