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AMENDMENTS SUBMITTED


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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)

Text of this article available as: TXT PDF [Pages S15852-S15971] [[Page S15852]] AMENDMENTS SUBMITTED ______ THE BALANCED BUDGET RECONCILIATION ACT OF 1995 ______ KENNEDY (AND OTHERS) AMENDMENT NO. 2959 Mr. KENNEDY (for himself, Mr. Simon, Mr. Pell, Mr. Dodd, Mr. Harkin, Ms. Mikulski, Mr. Wellstone, Mrs. Feinstein, Mrs. Murray, Mr. Kohl, Mr. Baucus, Mr. Bingaman, and Mr. Ford) proposed an amendment to the bill (S. 1357) to provide for reconciliation pursuant to section 105 of the concurrent resolution on the budget for fiscal year 1996; as follows: On page 1409, beginning with line 8, strike all through page 1410, line 25. On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1425, line 16. Strike chapter 3 of subtitle B of title XII. ______ HUTCHISON (AND OTHERS) AMENDMENT NO. 2960 (Ordered to lie on the table.) Mrs. Hutchison (for herself, Mr. McCain, Mr. Lieberman, Mr. Stevens, and Mr. Levin) submitted an amendment intended to be proposed by them to the bill S. 1357, supra; as follows: At the appropriate place, insert the following: (a) The Senate makes the following findings: (1) Human rights violations and atrocities continue unabated in the Former Yugoslavia. (2) The Assistant Secretary of State for Human Rights recently reported that starting in mid-September and intensifying between October 6 and October 12, 1995 many thousands of Bosnian Muslims and Croats in Northwest Bosnia were systematically forced from their homes by paramilitary units, local police and in some instances, Bosnian Serb Army officials and soldiers. (3) Despite the October 12, 1995 cease-fire which went into effect by agreement of the warring parties in the former Yugoslavia, Bosnian Serbs continue to conduct a brutal campaign to expel non-Serb civilians who remain in Northwest Bosnia, and are subjecting non-Serbs to untold horror-- murder, rape, robbery and other violence. (4) Horrible examples of ``ethnic cleansing'' persist in Northwest Bosnia. Some six thousand refugees recently reached Zenica and reported that nearly two thousand family members from this group are still unaccounted for. (5) The UN spokesman in Zagreb reported that many refugees have been given only a few minutes to leave their homes and that ``girls as young as 17 are reported to have been taken into wooded areas and raped.'' Elderly, sick and very young refugees have been driven to remote areas and forced to walk long distances on unsafe roads and cross rivers without bridges. (6) The War Crime Tribunal for the former Yugoslavia has collected volumes of evidence of atrocities, including the establishment of death camps, mass executions and systematic campaigns of rape and terror. This War Crimes Tribunal has already issued 43 indictments on the basis of this evidence. (7) The Assistant Secretary of State for Human Rights has described the eye witness accounts as ``prima facie evidence of war crimes which, if confirmed, could very well lead to further indictments by the War Crimes Tribunal.'' (8) The U.N. High Commissioner for Refugees estimates that more than 22,000 Muslims and Croats have been forced from their homes since mid-September in Bosnian Serb controlled areas. (9) In opening the Dodd Center Symposium on the topic of ``50 Years After Nuremburg'' on October 16, 1995, President Clinton cited the ``excellent progress'' of the War Crimes Tribunal for the former Yugoslavia and said, ``Those accused of war crimes, crimes against humanity and genocide must be brought to justice. They must be tried and, if found guilty, they must be held accountable.'' (10) President Clinton also observed on October 16, 1995, ``some people are concerned that pursuing peace in Bosnia and prosecuting war criminals are incompatible goals. But I believe they are wrong. There must be peace for justice to prevail, but there must be justice when peace prevails. (b) Sense of the Senate.--It is the sense of the Senate that-- (1) the Senate condemns the systematic human rights abuses against the people of Bosnia and Herzogovenia. (2) with peace talks scheduled to begin in the United States on October 31, 1995, and with the President clearly indicating his willingness to send American forces into the heart of this conflict, these new reports of Serbian atrocities are of grave concern to all Americans. (3) the Bosnian Serb leadership should immediately halt these atrocities, fully account for the missing, and allow those who have been separated to return to their families. (4) the International Red Cross, United Nations agencies and human rights organizations should be granted full and complete access to all locations throughout Bosnia and Herzogovenia. (5) the Bosnian Serb leadership should fully cooperate to facilitate the complete investigation of the above allegations so that those responsible may be held accountable under international treaties, conventions, obligations and law. (6) the United States should continue to support the work of the War Crime Tribunal for the Former Yugoslavia. (7) the United States should ensure that any negotiated peace agreements in former Yugoslavia, particularly with respect to Bosnia, require all states of the former Yugoslavia to corporate fully with the War Crimes Tribunal and apprehend and turn over for trial any indicated persons found in their territories. (8) ethnic cleansing by any faction, group, leader, or government is unjustified, immoral and illegal and all perpetrators of war crimes, crimes against humanity, genocide and other human rights violations in former Yugoslavia must be held accountable. ______ BAUCUS AMENDMENT NO. 2961 (Ordered to lie on the table.) Mr. BAUCUS submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: Strike section 1105(4)(B)(iii). ______ KASSEBAUM (AND OTHERS) AMENDMENT NO. 2962 Mrs. KASSEBAUM (for herself, Ms. Snowe, Mr. Jeffords, Mr. Coats, Mr. Gregg, Mr. Frist, Mr. DeWine, Mr. Ashcroft, Mr. Abraham, Mr. Gorton, Mr. Pressler, Mr. Roth, Mr. Domenici, Mr. Stevens, Mr. Specter, Mr. Cohen, Mr. Chafee, and Mr. Baucus) proposed an amendment to the bill S. 1357, supra; as follows: On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1426, line 9. ______ BREAUX (AND KERRY) AMENDMENT NO. 2963 Mr. BREAUX (for himself and Mr. Kerry) proposed an amendment to the bill S. 1357, supra; as follows: On page 1469, beginning on line 2, strike all through page 1471, line 20, and insert the following: SEC. 12001. CHILD TAX CREDIT. (a) In General.--Subpart C of part IV of subchapter A of chapter 1 is amended by redesignating section 35 as section 36 and by inserting after section 34 the following new section: ``SEC. 35. CHILD TAX CREDIT. ``(a) Allowance of Credit.-- ``(1) General rule.--There shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to $500 multiplied by the number of qualifying children of the taxpayer. ``(2) Limitation based on amount of tax.--The credit allowed by paragraph (1) for a taxable year shall not exceed the sum of-- ``(A) the tax imposed by this subtitle for the taxable year (reduced by the credits allowable against such tax other than the credit allowable under section 32), and ``(B) the taxes imposed by sections 3101 and 3201(a) and 50 percent of the taxes imposed by sections 1401 and 3211(a) for such taxable year. ``(b) Adjusted Gross Income Limitation.--The aggregate amount of the credit which would (but for this subsection) be allowed by subsection (a) shall be reduced (but not below zero) by 20 percent for each $3,000 by which the taxpayer's adjusted gross income exceeds $60,000. ``(c) Qualifying Child.--For purposes of this section-- ``(1) In general.--The term `qualifying child' means any individual if-- ``(A) the taxpayer is allowed a deduction under section 151 with respect to such individual for such taxable year, ``(B) such individual has not attained the age of 16 as of the close of the calendar year in which the taxable year of the taxpayer begins, and ``(C) such individual bears a relationship to the taxpayer described in section 32(c)(3)(B) (determined without regard to clause (ii) thereof). ``(2) Exception for certain noncitizens.--The term `qualifying child' shall not include any individual who would not be a dependent if the first sentence of section 152(b)(3) were applied without regard to all that follows `resident of the United States'. ``(d) Certain Other Rules Apply.--Rules similar to the rules of subsections (d) and (e) of section 32 shall apply for purposes of this section.'' (c) Conforming Amendment.--The table of sections for such subpart C is amended by striking the item relating to section 35 and inserting the following new items: ``Sec. 35. Child tax credit. ``Sec. 36. Overpayments of tax.'' (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995. ______ [[Page S15853]] McCAIN (AND OTHERS) AMENDMENT NO. 2964 Mr. McCAIN (for himself, Mr. Dole, Mr. Coats, and Mr. Nickles) proposed an amendment to the bill S. 1357, supra; as follows: At the appropriate place in the Act, add the following: Sec. . Sense of the Senate.--The Senate finds that-- (a) The Senate has held hearings on the social security earnings limit in 1994 and 1995 and the House has held two hearings on the social security earnings limit in 1995; (b) The Senate has overwhelmingly passed Sense of the Senate language calling for substantial reform of the social security earnings limit; (c) The House of Representatives has overwhelmingly passed legislation to raise the exempt amount under the social security earnings limit three times, in 1989, 1992, and 1995; (d) Such legislation is a key provision of the Contract with America; (e) The President in his 1992 campaign document ``Putting People First'' pledged to lift the social security earnings limit; (f) The social security earnings limit is a depression-era relic that unfairly punishes working seniors; therefore, (g) It is the intent of the Congress that legislation will be passed before the end of 1995 to raise the social security earnings limit for working seniors aged 65 through 69 in a manner which will ensure the financial integrity of the social security trust funds and will be consistent with the goal of achieving a balanced budget in 7 years. ______ HELMS AMENDMENT NO. 2965 Mr. HELMS proposed an amendment to the bill S. 1357, supra; as follows: On page 461, line 13, after the period, insert the following: ``(3) Point-of-service coverage.--If a Medicare Choice sponsor offers a Medicare Choice plan that limits benefits to items and services furnished only by providers in a network of providers which have entered into a contract with the sponsors, the sponsor must also offer at the time of enrollment, a Medicare Choice plan that permits payment to be made under the plan for covered items and services when obtained out-of-network by the individual.'' ______ CAMPBELL (AND BROWN) AMENDMENTS NOS. 2966-2967 (Ordered to lie on the table.) Mr. CAMPBELL (for himself and Mr. Brown) submitted two amendments intended to be proposed by them to the bill S. 1357, supra; as follows: Amendment No. 2966 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C.1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ____________.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ____ Amendment No. 2968 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C. 1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. [[Page S15854]] ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ______.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ______ McCAIN AMENDMENT NO. 2968 (Ordered to lie on the table.) Mr. McCain submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: On page 696, between lines 8 and 9, insert the following: SEC. 7116A. MEDICARE WHISTLEBLOWER INCENTIVE. (a) Purpose.--The purpose of this section is to-- (1) reduce and eliminate fraud and abuse under the medicare program; (2) reduce negligent and fraudulent medicare billings by providers; (3) provide medicare beneficiaries with incentives to report inappropriate billing practices; and (4) provide savings to the medicare trust funds by increasing the recovery of medicare overpayments. (b) Request for Itemized Bill for Medicare Items and Services.-- (1) In general.--Section 1128A (42 U.S.C. 1320a-7a), as amended by section 7131(a)(4), is further amended by adding at the end the following new subsection: ``(n) Written Request for Itemized Bill.-- ``(1) In general.--A beneficiary may submit a written request for an itemized bill for medical or other items or services provided to such beneficiary by any person (including an organization, agency, or other entity) that receives payment under title XVIII for providing such items or services to such beneficiary. ``(2) 30-day period to receive bill.-- ``(A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been received, a person described in such paragraph shall furnish an itemized bill describing each medical or other item or service provided to the beneficiary requesting the itemized bill. ``(B) Penalty.--Whoever knowingly fails to furnish an itemized bill in accordance with subparagraph (A) shall be subject to a civil fine of not more than $100 for each such failure. ``(3) Review of itemized bill.-- ``(A) In general.--Not later than 90 days after the receipt of an itemized bill furnished under paragraph (1), a beneficiary may submit a written request for a review of the itemized bill to the appropriate fiscal intermediary or carrier with a contract under section 1816 or 1842. ``(B) Specific allegations.--A request for a review of the itemized bill shall identify-- ``(i) specific medical or other items or services that the beneficiary believes were not provided as claimed, or ``(ii) any other billing irregularity (including duplicate billing). ``(4) Findings of fiscal intermediary or carrier.--Each fiscal intermediary or carrier with a contract under section 1816 or 1842 shall, with respect to each written request submitted to the fiscal intermediary or carrier under paragraph (3), determine whether the itemized bill identifies specific medical or other items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under title XVIII. ``(5) Recovery of amounts.--The Secretary shall require fiscal intermediaries and carriers to take all appropriate measures to recover amounts unnecessarily paid under title XVIII with respect to a bill described in paragraph (4). ``(6) Incentive payments.-- ``(A) In general.--If the fiscal intermediary or carrier recovers amounts in accordance with paragraph (5), the Secretary shall make an incentive payment (in an amount determined under subparagraph (B)) to the beneficiary who submitted the request for the itemized bill under paragraph (1) that resulted in such recovery. No incentive payment shall be made under this subparagraph unless such recovery is made after a final determination on whether such recovered amounts are required to be repaid by the provider. ``(B) Incentive payment determined.-- ``(i) In general.--The amount of the incentive payment determined under this subparagraph is equal to the lesser of-- ``(I) 1 percent of the amount that the bill overcharged for medical or other items or services; or ``(II) $10,000. ``(ii) Limitation of amount.--The amount determined under this subparagraph may not exceed the total amounts recovered with respect to the bill in accordance with paragraph (5). ``(7) Prevention of abuse by beneficiaries.--The Secretary shall-- ``(A) address abuses of the incentive system established under this subsection; and ``(B) establish appropriate procedures to prevent such abuses. ``(8) Requirement that beneficiary discover inaccurate bill to receive incentive payment.--No incentive payment shall be made under paragraph (6) to a beneficiary if the Secretary or the appropriate fiscal intermediary or carrier identified the bill that was the subject of the beneficiary's request for review under this subsection as being overpaid prior to such request.''. (2) Effective date.--The amendments made by this section shall apply with respect to medical or other items or services provided on or after January 1, 1996. Mr. McCAIN. Mr. President, earlier this session, I introduced S. 1325, the Medicare Whistleblower Act of 1995, to reduce provider fraud and abuse in the Medicare Program. The amendment I am submitting today improves upon that bill, and provides a strong incentive for beneficiaries to identify overpayments made by Medicare. An Abraham amendment which passed today, and which I supported, takes a similar approach to achieve this same objective. However, my amendment is preferable because it specifically delineates the whistleblower reward process and does not give the Secretary of HHS discretion not to make incentive payments. I hope that the conferees will adopt this amendment. At Medicare town meetings throughout Arizona, I have heard over and over from senior citizens that the Medicare Program is rampant with inaccurate billings. They have told me, based on their personal experiences, that their Medicare bills frequently include services that they have not received, double billings for the same service, or charges that are disproportionate to the value of services received. Often, they have no idea what Medicare is being billed for on their behalf, and they are not able to obtain explanations from providers. The perceptions of Medicare beneficiaries are confirmed by more systematic analyses. The General Accounting Office has estimated that fraud and abuse in our Nation's health care system costs taxpayers as much as $100 billion each year. Medicare fraud alone costs about $17 billion per year, which is 10 percent of the program's costs. A report by the Republican staff of the Senate Committee on Aging has documented a broad array of fraudulent activities, including false claims for services that were supposed to have been rendered after the beneficiaries had died. The Medicare Program has many problems. A fundamental problem, and the source of many other problems, is that too few people are adequately concerned about its costs because the Government is paying most of the bills. One constituent informed me of a situation in which his provider double-billed for the same service and told him not to worry about it because Medicare is paying. This is an outrage and must be stopped. When Medicare overpays, we all overpay, and costs to beneficiaries and other taxpayers spiral. This amendment addresses this fundamental problem of the Medicare Program. It gives beneficiaries an added incentive to carefully scrutinize their bills and to actively pursue corrections when they believe that there has been inappropriate billing of Medicare. In particular, beneficiaries would be financially rewarded if they uncover negligence or fraud to the benefit of us all. Although such provider fraud is not the entire problem, and there is other legislation that I support which also addresses beneficiary fraud, studies [[Page S15855]] clearly indicate that provider fraud is most prevalent and the greatest concern. The major problem with our current approach to detecting Medicare fraud is that it relies primarily upon bureaucrats who have no firsthand knowledge of what services were provided to a beneficiary and who have extremely limited time and resources to investigate. This approach can be expected to discover only the most apparent fraudulent activities. To discover most fraud, we must obtain the full cooperation of those who know what occurred at providers' offices and who have the time to pursue fraud--the beneficiaries. All they need is the ability and incentive to scrutinize their bills and actively correct inaccuracies. Under this amendment, beneficiaries would have a right to receive in writing from their providers, within 30 days of when their request is received, an itemized bill for Medicare services provided to them. The beneficiary would then have 90 days to raise specific allegations of inappropriate billings to Medicare. The Medicare intermediaries and carriers would then have to review the bills and determine whether an overpayment has been made which must be reimbursed to the Medicare program. The beneficiary would receive a reward of 1 percent of the overpayment reimbursed up to $10,000. Because these rewards would be paid directly out of the overpayments, they would not increase costs to the Federal Government. There are several important safeguards built into this legislation. The Secretary would be required to establish appropriate procedures to ensure that the incentive system is not abused by overzealous beneficiaries. An incentive payment would be awarded only to the extent that HCFA is able to recover the overpayment from the provider, and there would be no incentive payment if HCFA can demonstrate that it-- for its Medicare intermediary or carrier--has identified the overpayment prior to receiving the beneficiary's complaint. Some will argue that many seniors and other beneficiaries do not need personal rewards for fighting fraud, and in any event, this is a matter of national duty. While I agree with this contention, I also recognize that these individuals would not be able to identify and report fraud without having access to the itemized bills that this legislation provides. Moreover, I see nothing wrong with giving beneficiaries an added financial incentive. After all, we pay Federal employees for ideas that save the taxpayers money, and we pay private citizens for identifying fraud by defense contractors. Mr. President, there is no inconsistency between this amendment and the Abraham amendment which passed today. Their objectives are entirely compatible. However, the Abraham amendment effectively delegates responsibility for planning the whistleblower program to the Secretary of HHS. I strongly believe that we should fulfill our legislative responsibility by specifying the parameters of this important antifraud program. Otherwise, we should not be surprised if we end up with something that we had not contemplated and which does not satisfy our objective. Mr. President, I will not request a vote on this amendment, because we have already had a vote on the Abraham amendment. However, for the reasons that I outlined, I hope that the conferees will agree that this is a preferable whistleblower provision and that they will adopt it in the conference report. In so doing, I believe that the conferees should retain the provisions of the Abraham amendment that reward individuals for ideas that improve Medicare. ______ BROWN (AND OTHERS) AMENDMENT NO. 2969 Mr. BROWN (for himself, Mr. Abraham, Mr. Santorum, Mr. McCain, and Mr. Craig) proposed an amendment to the bill S. 1357, supra; as follows: At the end of chapter 8 of subtitle I of title XII, insert the following: SEC. . $1,000,000 COMPENSATION DEDUCTION LIMIT EXTENDED TO ALL EMPLOYEES OF ALL CORPORATIONS. (a) In General.--Section 162(m) is amended-- (1) by striking ``publicly held corporation'' in paragraph (1) and inserting ``taxpayer (other than personal service corporations)'', (2) by striking ``covered employee'' each place it appears in paragraphs (1) and (4) and inserting ``employee'', and (3) by striking paragraphs (2) and (3) and redesignating paragraph (4) as paragraph (3). (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995, except that there shall not be taken into account with respect to any employee to whom section 162(m) of the Internal Revenue Code of 1986 applies solely by reason of such amendments remuneration payable under a written binding contract which was in effect on October 25, 1995, and which was not modified thereafter in any material respect before such remuneration is paid. (c) Use of Revenues.--Notwithstanding any other provision of law, the Commissioner of Social Security shall increase the earnings limit otherwise determined for each year under section 203 of the Social Security Act (42 U.S.C. 403) by an amount which takes into account the increase in revenues for such year as estimated by the Secretary of the Treasury resulting from the amendment to section 162(m)(3) of the Internal Revenue Code of 1986 made by the Balanced Budget Reconciliation Act of 1995. ______ HARKIN (AND OTHERS) AMENDMENT NO. 2970 Mr. HARKIN (for himself, Mr. Graham, and Mr. Biden) proposed an amendment to the bill S. 1357, supra; as follows: Strike Chapter 6 of Title VII except for the text of amendment number 2950 as passed by the Senate and insert in lieu thereof, the following: CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION SEC. 7100. SHORT TITLE. This chapter may be cited as the ``Health Care Fraud and Abuse Prevention Act of 1995''. Subchapter A--Fraud and Abuse Control Program SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM. (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128B the following new section: ``FRAUD AND ABUSE CONTROL PROGRAM ``Sec. 1128C. (a) Establishment of Program.-- ``(1) In general.--Not later than January 1, 1996, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall establish a program-- ``(A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States, ``(B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States, ``(C) to facilitate the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to health care fraud and abuse, and ``(D) to provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts pursuant to section 1128D. ``(2) Coordination with health plans.--In carrying out the program established under paragraph (1), the Secretary and the Attorney General shall consult with, and arrange for the sharing of data with representatives of health plans. ``(3) Guidelines.-- ``(A) In general.--The Secretary and the Attorney General shall issue guidelines to carry out the program under paragraph (1). The provisions of sections 553, 556, and 557 of title 5, United States Code, shall not apply in the issuance of such guidelines. ``(B) Information guidelines.-- ``(i) In general.--Such guidelines shall include guidelines relating to the furnishing of information by health plans, providers, and others to enable the Secretary and the Attorney General to carry out the program (including coordination with health plans under paragraph (2)). ``(ii) Confidentiality.--Such guidelines shall include procedures to assure that such information is provided and utilized in a manner that appropriately protects the confidentiality of the information and the privacy of individuals receiving health care services and items. ``(iii) Qualified immunity for providing information.--The provisions of section 1157(a) (relating to limitation on liability) shall apply to a person providing information to the Secretary or the Attorney General in conjunction with their performance of duties under this section. ``(4) Ensuring access to documentation.--The Inspector General of the Department of Health and Human Services is authorized to exercise such authority described in paragraphs (3) through (9) of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.) as necessary with respect to the activities under the fraud and abuse control program established under this subsection. [[Page S15856]] ``(5) Authority of inspector general.--Nothing in this Act shall be construed to diminish the authority of any Inspector General, including such authority as provided in the Inspector General Act of 1978 (5 U.S.C. App.). ``(b) Additional Use of Funds by Inspector General.-- ``(1) Reimbursements for investigations.--The Inspector General of the Department of Health and Human Services is authorized to receive and retain for current use reimbursement for the costs of conducting investigations and audits and for monitoring compliance plans when such costs are ordered by a court, voluntarily agreed to by the payer, or otherwise. ``(2) Crediting.--Funds received by the Inspector General under paragraph (1) as reimbursement for costs of conducting investigations shall be deposited to the credit of the appropriation from which initially paid, or to appropriations for similar purposes currently available at the time of deposit, and shall remain available for obligation for 1 year from the date of the deposit of such funds. ``(c) Health Plan Defined.--For purposes of this section, the term `health plan' means a plan or program that provides health benefits, whether directly, through insurance, or otherwise, and includes-- ``(1) a policy of health insurance; ``(2) a contract of a service benefit organization; and ``(3) a membership agreement with a health maintenance organization or other prepaid health plan.''. (b) Establishment of Health Care Fraud and Abuse Control Account in Federal Hospital Insurance Trust Fund.--Section 1817 (42 U.S.C. 1395i) is amended by adding at the end the following new subsection: ``(k) Health Care Fraud and Abuse Control Account.-- ``(1) Establishment.--There is hereby established in the Trust Fund an expenditure account to be known as the `Health Care Fraud and Abuse Control Account' (in this subsection referred to as the `Account'). ``(2) Appropriated amounts to trust fund.-- ``(A) In general.--There are hereby appropriated to the Trust Fund-- ``(i) such gifts and bequests as may be made as provided in subparagraph (B); ``(ii) such amounts as may be deposited in the Trust Fund as provided in sections 7141(b) and 7142(c) of the Balanced Budget Reconciliation Act of 1995, and title XI; and ``(iii) such amounts as are transferred to the Trust Fund under subparagraph (C). ``(B) Authorization to accept gifts.--The Trust Fund is authorized to accept on behalf of the United States money gifts and bequests made unconditionally to the Trust Fund, for the benefit of the Account or any activity financed through the Account. ``(C) Transfer of amounts.--The Managing Trustee shall transfer to the Trust Fund, under rules similar to the rules in section 9601 of the Internal Revenue Code of 1986, an amount equal to the sum of the following: ``(i) Criminal fines recovered in cases involving a Federal health care offense (as defined in section 982(a)(6)(B) of title 18, United States Code). ``(ii) Civil monetary penalties and assessments imposed in health care cases, including amounts recovered under titles XI, XVIII, and XXI, and chapter 38 of title 31, United States Code (except as otherwise provided by law). ``(iii) Amounts resulting from the forfeiture of property by reason of a Federal health care offense. ``(iv) Penalties and damages obtained and otherwise creditable to miscellaneous receipts of the general fund of the Treasury obtained under sections 3729 through 3733 of title 31, United States Code (known as the False Claims Act), in cases involving claims related to the provision of health care items and services (other than funds awarded to a relator, for restitution or otherwise authorized by law). ``(3) Appropriated amounts to account.-- ``(A) In general.--There are hereby appropriated to the Account from the Trust Fund such sums as the Secretary and the Attorney General certify are necessary to carry out the purposes described in subparagraph (B), to be available without further appropriation, in an amount-- ``(i) with respect to activities of the Office of the Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigations in carrying out such purposes, not less than-- ``(I) for fiscal year 1996, $110,000,000, ``(II) for fiscal year 1997, $140,000,000, ``(III) for fiscal year 1998, $160,000,000, ``(IV) for fiscal year 1999, $185,000,000, ``(V) for fiscal year 2000, $215,000,000, ``(VI) for fiscal year 2001, $240,000,000, and ``(VII) for fiscal year 2002, $270,000,000; and ``(ii) with respect to all activities (including the activities described in clause (i)) in carrying out such purposes, not more than-- ``(I) for fiscal year 1996, $200,000,000, and ``(II) for each of the fiscal years 1997 through 2002, the limit for the preceding fiscal year, increased by 15 percent; and ``(iii) for each fiscal year after fiscal year 2002, within the limits for fiscal year 2002 as determined under clauses (i) and (ii). ``(B) Use of funds.--The purposes described in this subparagraph are as follows: ``(i) General use.--To cover the costs (including equipment, salaries and benefits, and travel and training) of the administration and operation of the health care fraud and abuse control program established under section 1128C(a), including the costs of-- ``(I) prosecuting health care matters (through criminal, civil, and administrative proceedings); ``(II) investigations; ``(III) financial and performance audits of health care programs and operations; ``(IV) inspections and other evaluations; and ``(V) provider and consumer education regarding compliance with the provisions of title XI. ``(ii) Use by state medicaid fraud control units for investigation reimbursements.--To reimburse the various State medicaid fraud control units upon request to the Secretary for the costs of the activities authorized under section 2134(b). ``(4) Annual report.--The Secretary and the Attorney General shall submit jointly an annual report to Congress on the amount of revenue which is generated and disbursed, and the justification for such disbursements, by the Account in each fiscal year.''. SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL HEALTH PROGRAMS. (a) Crimes.-- (1) Social security act.--Section 1128B (42 U.S.C. 1320a- 7b) is amended as follows: (A) In the heading, by striking ``medicare or state health care programs'' and inserting ``federal health care programs''. (B) In subsection (a)(1), by striking ``a program under title XVIII or a State health care program (as defined in section 1128(h))'' and inserting ``a Federal health care program''. (C) In subsection (a)(5), by striking ``a program under title XVIII or a State health care program'' and inserting ``a Federal health care program''. (D) In the second sentence of subsection (a)-- (i) by striking ``a State plan approved under title XIX'' and inserting ``a Federal health care program''; and (ii) by striking ``the State may at its option (notwithstanding any other provision of that title or of such plan)'' and inserting ``the administrator of such program may at its option (notwithstanding any other provision of such program)''. (E) In subsection (b)-- (i) by striking ``and willfully'' each place it appears; (ii) by striking ``$25,000'' each place it appears and inserting ``$50,000''; (iii) by striking ``title XVIII or a State health care program'' each place it appears and inserting ``Federal health care program''; (iv) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind--'' and inserting ``kind with intent to be influenced--''; (v) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (vi) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; (vii) in paragraph (2) in the matter proceeding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''; (viii) by adding at the end of paragraphs (1) and (2) the following sentence: ``A violation exists under this paragraph if one or more purposes of the remuneration is unlawful under this paragraph.''; (ix) by redesignating paragraph (3) as paragraph (4); (x) in paragraph (4) (as redesignated), by striking ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), (2), and (3)''; and (xi) by inserting after paragraph (2) the following new paragraph: ``(3)(A) The Attorney General may bring an action in the district courts to impose upon any person who carries out any activity in violation of this subsection a civil penalty of not less than $25,000 and not more than $50,000 for each such violation, plus three times the total remuneration offered, paid, solicited, or received. ``(B) A violation exists under this paragraph if one or more purposes of the remuneration is unlawful, and the damages shall be the full amount of such remuneration. ``(C) Section 3731 of title 31, United States Code, and the Federal Rules of Civil Procedure shall apply to actions brought under this paragraph. ``(D) The provisions of this paragraph do not affect the availability of other criminal and civil remedies for such violations.''. (F) In subsection (c), by inserting ``(as defined in section 1128(h))'' after ``a State health care program''. (G) By adding at the end the following new subsections: ``(f) For purposes of this section, the term `Federal health care program' means-- ``(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the United States Government; or ``(2) any State health care program, as defined in section 1128(h). ``(g)(1) The Secretary and Administrator of the departments and agencies with a Federal health care program may conduct an investigation or audit relating to violations of this section and claims within the jurisdiction of other Federal departments or agencies if the following conditions are satisfied: [[Page S15857]] ``(A) The investigation or audit involves primarily claims submitted to the Federal health care programs of the department or agency conducting the investigation or audit. ``(B) The Secretary or Administrator of the department or agency conducting the investigation or audit gives notice and an opportunity to participate in the investigation or audit to the Inspector General of the department or agency with primary jurisdiction over the Federal health care programs to which the claims were submitted. ``(2) If the conditions specified in paragraph (1) are fulfilled, the Inspector General of the department or agency conducting the investigation or audit may exercise all powers granted under the Inspector General Act of 1978 with respect to the claims submitted to the other departments or agencies to the same manner and extent as provided in that Act with respect to claims submitted to such departments or agencies.''. (2) Identification of community service opportunities.-- Section 1128B (42 U.S.C. 1320a-7b) is further amended by adding at the end the following new subsection: ``(h) The Secretary may-- ``(1) in consultation with State and local health care officials, identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of an offense under this section, and ``(2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.''. (b) Effective Date.--The amendments made by this section shall take effect on January 1, 1996. SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE. (a) Solicitation and Publication of Modifications to Existing Safe Harbors and New Safe Harbors.-- (1) In general.-- (A) Solicitation of proposals for safe harbors.--Not later than January 1, 1996, and not less than annually thereafter, the Secretary shall publish a notice in the Federal Register soliciting proposals, which will be accepted during a 60-day period, for-- (i) modifications to existing safe harbors issued pursuant to section 14(a) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (42 U.S.C. 1320a-7b note); (ii) additional safe harbors specifying payment practices that shall not be treated as a criminal offense under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) and shall not serve as the basis for an exclusion under section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7)); (iii) interpretive rulings to be issued pursuant to subsection (b); and (iv) special fraud alerts to be issued pursuant to subsection (c). (B) Publication of proposed modifications and proposed additional safe harbors.--After considering the proposals described in clauses (i) and (ii) of subparagraph (A), the Secretary, in consultation with the Attorney General, shall publish in the Federal Register proposed modifications to existing safe harbors and proposed additional safe harbors, if appropriate, with a 60-day comment period. After considering any public comments received during this period, the Secretary shall issue final rules modifying the existing safe harbors and establishing new safe harbors, as appropriate. (C) Report.--The Inspector General of the Department of Health and Human Services (in this section referred to as the ``Inspector General'') shall, in an annual report to Congress or as part of the year-end semiannual report required by section 5 of the Inspector General Act of 1978 (5 U.S.C. App.), describe the proposals received under clauses (i) and (ii) of subparagraph (A) and explain which proposals were included in the publication described in subparagraph (B), which proposals were not included in that publication, and the reasons for the rejection of the proposals that were not included. (2) Criteria for modifying and establishing safe harbors.-- In modifying and establishing safe harbors under paragraph (1)(B), the Secretary may consider the extent to which providing a safe harbor for the specified payment practice may result in any of the following: (A) An increase or decrease in access to health care services. (B) An increase or decrease in the quality of health care services. (C) An increase or decrease in patient freedom of choice among health care providers. (D) An increase or decrease in competition among health care providers. (E) An increase or decrease in the ability of health care facilities to provide services in medically underserved areas or to medically underserved populations. (F) An increase or decrease in the cost to Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)). (G) An increase or decrease in the potential overutilization of health care services. (H) The existence or nonexistence of any potential financial benefit to a health care professional or provider which may vary based on their decisions of-- (i) whether to order a health care item or service; or (ii) whether to arrange for a referral of health care items or services to a particular practitioner or provider. (I) Any other factors the Secretary deems appropriate in the interest of preventing fraud and abuse in Federal health care programs (as so defined). (b) Interpretive Rulings.-- (1) In general.-- (A) Request for interpretive ruling.--Any person may present, at any time, a request to the Inspector General for a statement of the Inspector General's current interpretation of the meaning of a specific aspect of the application of sections 1128A and 1128B of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as an ``interpretive ruling''). (B) Issuance and effect of interpretive ruling.-- (i) In general.--If appropriate, the Inspector General shall in consultation with the Attorney General, issue an interpretive ruling not later than 120 days after receiving a request described in subparagraph (A). Interpretive rulings shall not have the force of law and shall be treated as an interpretive rule within the meaning of section 553(b) of title 5, United States Code. All interpretive rulings issued pursuant to this clause shall be published in the Federal Register or otherwise made available for public inspection. (ii) Reasons for denial.--If the Inspector General does not issue an interpretive ruling in response to a request described in subparagraph (A), the Inspector General shall notify the requesting party of such decision not later than 120 days after receiving such a request and shall identify the reasons for such decision. (2) Criteria for interpretive rulings.-- (A) In general.--In determining whether to issue an interpretive ruling under paragraph (1)(B), the Inspector General may consider-- (i) whether and to what extent the request identifies an ambiguity within the language of the statute, the existing safe harbors, or previous interpretive rulings; and (ii) whether the subject of the requested interpretive ruling can be adequately addressed by interpretation of the language of the statute, the existing safe harbor rules, or previous interpretive rulings, or whether the request would require a substantive ruling (as defined in section 552 of title 5, United States Code) not authorized under this subsection. (B) No rulings on factual issues.--The Inspector General shall not give an interpretive ruling on any factual issue, including the intent of the parties or the fair market value of particular leased space or equipment. (c) Special Fraud Alerts.-- (1) In general.-- (A) Request for special fraud alerts.--Any person may present, at any time, a request to the Inspector General for a notice which informs the public of practices which the Inspector General considers to be suspect or of particular concern under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) (in this subsection referred to as a ``special fraud alert''). (B) Issuance and publication of special fraud alerts.--Upon receipt of a request described in subparagraph (A), the Inspector General shall investigate the subject matter of the request to determine whether a special fraud alert should be issued. If appropriate, the Inspector General shall issue a special fraud alert in response to the request. All special fraud alerts issued pursuant to this subparagraph shall be published in the Federal Register. (2) Criteria for special fraud alerts.--In determining whether to issue a special fraud alert upon a request described in paragraph (1),

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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)

Text of this article available as: TXT PDF [Pages S15852-S15971] [[Page S15852]] AMENDMENTS SUBMITTED ______ THE BALANCED BUDGET RECONCILIATION ACT OF 1995 ______ KENNEDY (AND OTHERS) AMENDMENT NO. 2959 Mr. KENNEDY (for himself, Mr. Simon, Mr. Pell, Mr. Dodd, Mr. Harkin, Ms. Mikulski, Mr. Wellstone, Mrs. Feinstein, Mrs. Murray, Mr. Kohl, Mr. Baucus, Mr. Bingaman, and Mr. Ford) proposed an amendment to the bill (S. 1357) to provide for reconciliation pursuant to section 105 of the concurrent resolution on the budget for fiscal year 1996; as follows: On page 1409, beginning with line 8, strike all through page 1410, line 25. On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1425, line 16. Strike chapter 3 of subtitle B of title XII. ______ HUTCHISON (AND OTHERS) AMENDMENT NO. 2960 (Ordered to lie on the table.) Mrs. Hutchison (for herself, Mr. McCain, Mr. Lieberman, Mr. Stevens, and Mr. Levin) submitted an amendment intended to be proposed by them to the bill S. 1357, supra; as follows: At the appropriate place, insert the following: (a) The Senate makes the following findings: (1) Human rights violations and atrocities continue unabated in the Former Yugoslavia. (2) The Assistant Secretary of State for Human Rights recently reported that starting in mid-September and intensifying between October 6 and October 12, 1995 many thousands of Bosnian Muslims and Croats in Northwest Bosnia were systematically forced from their homes by paramilitary units, local police and in some instances, Bosnian Serb Army officials and soldiers. (3) Despite the October 12, 1995 cease-fire which went into effect by agreement of the warring parties in the former Yugoslavia, Bosnian Serbs continue to conduct a brutal campaign to expel non-Serb civilians who remain in Northwest Bosnia, and are subjecting non-Serbs to untold horror-- murder, rape, robbery and other violence. (4) Horrible examples of ``ethnic cleansing'' persist in Northwest Bosnia. Some six thousand refugees recently reached Zenica and reported that nearly two thousand family members from this group are still unaccounted for. (5) The UN spokesman in Zagreb reported that many refugees have been given only a few minutes to leave their homes and that ``girls as young as 17 are reported to have been taken into wooded areas and raped.'' Elderly, sick and very young refugees have been driven to remote areas and forced to walk long distances on unsafe roads and cross rivers without bridges. (6) The War Crime Tribunal for the former Yugoslavia has collected volumes of evidence of atrocities, including the establishment of death camps, mass executions and systematic campaigns of rape and terror. This War Crimes Tribunal has already issued 43 indictments on the basis of this evidence. (7) The Assistant Secretary of State for Human Rights has described the eye witness accounts as ``prima facie evidence of war crimes which, if confirmed, could very well lead to further indictments by the War Crimes Tribunal.'' (8) The U.N. High Commissioner for Refugees estimates that more than 22,000 Muslims and Croats have been forced from their homes since mid-September in Bosnian Serb controlled areas. (9) In opening the Dodd Center Symposium on the topic of ``50 Years After Nuremburg'' on October 16, 1995, President Clinton cited the ``excellent progress'' of the War Crimes Tribunal for the former Yugoslavia and said, ``Those accused of war crimes, crimes against humanity and genocide must be brought to justice. They must be tried and, if found guilty, they must be held accountable.'' (10) President Clinton also observed on October 16, 1995, ``some people are concerned that pursuing peace in Bosnia and prosecuting war criminals are incompatible goals. But I believe they are wrong. There must be peace for justice to prevail, but there must be justice when peace prevails. (b) Sense of the Senate.--It is the sense of the Senate that-- (1) the Senate condemns the systematic human rights abuses against the people of Bosnia and Herzogovenia. (2) with peace talks scheduled to begin in the United States on October 31, 1995, and with the President clearly indicating his willingness to send American forces into the heart of this conflict, these new reports of Serbian atrocities are of grave concern to all Americans. (3) the Bosnian Serb leadership should immediately halt these atrocities, fully account for the missing, and allow those who have been separated to return to their families. (4) the International Red Cross, United Nations agencies and human rights organizations should be granted full and complete access to all locations throughout Bosnia and Herzogovenia. (5) the Bosnian Serb leadership should fully cooperate to facilitate the complete investigation of the above allegations so that those responsible may be held accountable under international treaties, conventions, obligations and law. (6) the United States should continue to support the work of the War Crime Tribunal for the Former Yugoslavia. (7) the United States should ensure that any negotiated peace agreements in former Yugoslavia, particularly with respect to Bosnia, require all states of the former Yugoslavia to corporate fully with the War Crimes Tribunal and apprehend and turn over for trial any indicated persons found in their territories. (8) ethnic cleansing by any faction, group, leader, or government is unjustified, immoral and illegal and all perpetrators of war crimes, crimes against humanity, genocide and other human rights violations in former Yugoslavia must be held accountable. ______ BAUCUS AMENDMENT NO. 2961 (Ordered to lie on the table.) Mr. BAUCUS submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: Strike section 1105(4)(B)(iii). ______ KASSEBAUM (AND OTHERS) AMENDMENT NO. 2962 Mrs. KASSEBAUM (for herself, Ms. Snowe, Mr. Jeffords, Mr. Coats, Mr. Gregg, Mr. Frist, Mr. DeWine, Mr. Ashcroft, Mr. Abraham, Mr. Gorton, Mr. Pressler, Mr. Roth, Mr. Domenici, Mr. Stevens, Mr. Specter, Mr. Cohen, Mr. Chafee, and Mr. Baucus) proposed an amendment to the bill S. 1357, supra; as follows: On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1426, line 9. ______ BREAUX (AND KERRY) AMENDMENT NO. 2963 Mr. BREAUX (for himself and Mr. Kerry) proposed an amendment to the bill S. 1357, supra; as follows: On page 1469, beginning on line 2, strike all through page 1471, line 20, and insert the following: SEC. 12001. CHILD TAX CREDIT. (a) In General.--Subpart C of part IV of subchapter A of chapter 1 is amended by redesignating section 35 as section 36 and by inserting after section 34 the following new section: ``SEC. 35. CHILD TAX CREDIT. ``(a) Allowance of Credit.-- ``(1) General rule.--There shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to $500 multiplied by the number of qualifying children of the taxpayer. ``(2) Limitation based on amount of tax.--The credit allowed by paragraph (1) for a taxable year shall not exceed the sum of-- ``(A) the tax imposed by this subtitle for the taxable year (reduced by the credits allowable against such tax other than the credit allowable under section 32), and ``(B) the taxes imposed by sections 3101 and 3201(a) and 50 percent of the taxes imposed by sections 1401 and 3211(a) for such taxable year. ``(b) Adjusted Gross Income Limitation.--The aggregate amount of the credit which would (but for this subsection) be allowed by subsection (a) shall be reduced (but not below zero) by 20 percent for each $3,000 by which the taxpayer's adjusted gross income exceeds $60,000. ``(c) Qualifying Child.--For purposes of this section-- ``(1) In general.--The term `qualifying child' means any individual if-- ``(A) the taxpayer is allowed a deduction under section 151 with respect to such individual for such taxable year, ``(B) such individual has not attained the age of 16 as of the close of the calendar year in which the taxable year of the taxpayer begins, and ``(C) such individual bears a relationship to the taxpayer described in section 32(c)(3)(B) (determined without regard to clause (ii) thereof). ``(2) Exception for certain noncitizens.--The term `qualifying child' shall not include any individual who would not be a dependent if the first sentence of section 152(b)(3) were applied without regard to all that follows `resident of the United States'. ``(d) Certain Other Rules Apply.--Rules similar to the rules of subsections (d) and (e) of section 32 shall apply for purposes of this section.'' (c) Conforming Amendment.--The table of sections for such subpart C is amended by striking the item relating to section 35 and inserting the following new items: ``Sec. 35. Child tax credit. ``Sec. 36. Overpayments of tax.'' (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995. ______ [[Page S15853]] McCAIN (AND OTHERS) AMENDMENT NO. 2964 Mr. McCAIN (for himself, Mr. Dole, Mr. Coats, and Mr. Nickles) proposed an amendment to the bill S. 1357, supra; as follows: At the appropriate place in the Act, add the following: Sec. . Sense of the Senate.--The Senate finds that-- (a) The Senate has held hearings on the social security earnings limit in 1994 and 1995 and the House has held two hearings on the social security earnings limit in 1995; (b) The Senate has overwhelmingly passed Sense of the Senate language calling for substantial reform of the social security earnings limit; (c) The House of Representatives has overwhelmingly passed legislation to raise the exempt amount under the social security earnings limit three times, in 1989, 1992, and 1995; (d) Such legislation is a key provision of the Contract with America; (e) The President in his 1992 campaign document ``Putting People First'' pledged to lift the social security earnings limit; (f) The social security earnings limit is a depression-era relic that unfairly punishes working seniors; therefore, (g) It is the intent of the Congress that legislation will be passed before the end of 1995 to raise the social security earnings limit for working seniors aged 65 through 69 in a manner which will ensure the financial integrity of the social security trust funds and will be consistent with the goal of achieving a balanced budget in 7 years. ______ HELMS AMENDMENT NO. 2965 Mr. HELMS proposed an amendment to the bill S. 1357, supra; as follows: On page 461, line 13, after the period, insert the following: ``(3) Point-of-service coverage.--If a Medicare Choice sponsor offers a Medicare Choice plan that limits benefits to items and services furnished only by providers in a network of providers which have entered into a contract with the sponsors, the sponsor must also offer at the time of enrollment, a Medicare Choice plan that permits payment to be made under the plan for covered items and services when obtained out-of-network by the individual.'' ______ CAMPBELL (AND BROWN) AMENDMENTS NOS. 2966-2967 (Ordered to lie on the table.) Mr. CAMPBELL (for himself and Mr. Brown) submitted two amendments intended to be proposed by them to the bill S. 1357, supra; as follows: Amendment No. 2966 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C.1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ____________.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ____ Amendment No. 2968 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C. 1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. [[Page S15854]] ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ______.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ______ McCAIN AMENDMENT NO. 2968 (Ordered to lie on the table.) Mr. McCain submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: On page 696, between lines 8 and 9, insert the following: SEC. 7116A. MEDICARE WHISTLEBLOWER INCENTIVE. (a) Purpose.--The purpose of this section is to-- (1) reduce and eliminate fraud and abuse under the medicare program; (2) reduce negligent and fraudulent medicare billings by providers; (3) provide medicare beneficiaries with incentives to report inappropriate billing practices; and (4) provide savings to the medicare trust funds by increasing the recovery of medicare overpayments. (b) Request for Itemized Bill for Medicare Items and Services.-- (1) In general.--Section 1128A (42 U.S.C. 1320a-7a), as amended by section 7131(a)(4), is further amended by adding at the end the following new subsection: ``(n) Written Request for Itemized Bill.-- ``(1) In general.--A beneficiary may submit a written request for an itemized bill for medical or other items or services provided to such beneficiary by any person (including an organization, agency, or other entity) that receives payment under title XVIII for providing such items or services to such beneficiary. ``(2) 30-day period to receive bill.-- ``(A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been received, a person described in such paragraph shall furnish an itemized bill describing each medical or other item or service provided to the beneficiary requesting the itemized bill. ``(B) Penalty.--Whoever knowingly fails to furnish an itemized bill in accordance with subparagraph (A) shall be subject to a civil fine of not more than $100 for each such failure. ``(3) Review of itemized bill.-- ``(A) In general.--Not later than 90 days after the receipt of an itemized bill furnished under paragraph (1), a beneficiary may submit a written request for a review of the itemized bill to the appropriate fiscal intermediary or carrier with a contract under section 1816 or 1842. ``(B) Specific allegations.--A request for a review of the itemized bill shall identify-- ``(i) specific medical or other items or services that the beneficiary believes were not provided as claimed, or ``(ii) any other billing irregularity (including duplicate billing). ``(4) Findings of fiscal intermediary or carrier.--Each fiscal intermediary or carrier with a contract under section 1816 or 1842 shall, with respect to each written request submitted to the fiscal intermediary or carrier under paragraph (3), determine whether the itemized bill identifies specific medical or other items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under title XVIII. ``(5) Recovery of amounts.--The Secretary shall require fiscal intermediaries and carriers to take all appropriate measures to recover amounts unnecessarily paid under title XVIII with respect to a bill described in paragraph (4). ``(6) Incentive payments.-- ``(A) In general.--If the fiscal intermediary or carrier recovers amounts in accordance with paragraph (5), the Secretary shall make an incentive payment (in an amount determined under subparagraph (B)) to the beneficiary who submitted the request for the itemized bill under paragraph (1) that resulted in such recovery. No incentive payment shall be made under this subparagraph unless such recovery is made after a final determination on whether such recovered amounts are required to be repaid by the provider. ``(B) Incentive payment determined.-- ``(i) In general.--The amount of the incentive payment determined under this subparagraph is equal to the lesser of-- ``(I) 1 percent of the amount that the bill overcharged for medical or other items or services; or ``(II) $10,000. ``(ii) Limitation of amount.--The amount determined under this subparagraph may not exceed the total amounts recovered with respect to the bill in accordance with paragraph (5). ``(7) Prevention of abuse by beneficiaries.--The Secretary shall-- ``(A) address abuses of the incentive system established under this subsection; and ``(B) establish appropriate procedures to prevent such abuses. ``(8) Requirement that beneficiary discover inaccurate bill to receive incentive payment.--No incentive payment shall be made under paragraph (6) to a beneficiary if the Secretary or the appropriate fiscal intermediary or carrier identified the bill that was the subject of the beneficiary's request for review under this subsection as being overpaid prior to such request.''. (2) Effective date.--The amendments made by this section shall apply with respect to medical or other items or services provided on or after January 1, 1996. Mr. McCAIN. Mr. President, earlier this session, I introduced S. 1325, the Medicare Whistleblower Act of 1995, to reduce provider fraud and abuse in the Medicare Program. The amendment I am submitting today improves upon that bill, and provides a strong incentive for beneficiaries to identify overpayments made by Medicare. An Abraham amendment which passed today, and which I supported, takes a similar approach to achieve this same objective. However, my amendment is preferable because it specifically delineates the whistleblower reward process and does not give the Secretary of HHS discretion not to make incentive payments. I hope that the conferees will adopt this amendment. At Medicare town meetings throughout Arizona, I have heard over and over from senior citizens that the Medicare Program is rampant with inaccurate billings. They have told me, based on their personal experiences, that their Medicare bills frequently include services that they have not received, double billings for the same service, or charges that are disproportionate to the value of services received. Often, they have no idea what Medicare is being billed for on their behalf, and they are not able to obtain explanations from providers. The perceptions of Medicare beneficiaries are confirmed by more systematic analyses. The General Accounting Office has estimated that fraud and abuse in our Nation's health care system costs taxpayers as much as $100 billion each year. Medicare fraud alone costs about $17 billion per year, which is 10 percent of the program's costs. A report by the Republican staff of the Senate Committee on Aging has documented a broad array of fraudulent activities, including false claims for services that were supposed to have been rendered after the beneficiaries had died. The Medicare Program has many problems. A fundamental problem, and the source of many other problems, is that too few people are adequately concerned about its costs because the Government is paying most of the bills. One constituent informed me of a situation in which his provider double-billed for the same service and told him not to worry about it because Medicare is paying. This is an outrage and must be stopped. When Medicare overpays, we all overpay, and costs to beneficiaries and other taxpayers spiral. This amendment addresses this fundamental problem of the Medicare Program. It gives beneficiaries an added incentive to carefully scrutinize their bills and to actively pursue corrections when they believe that there has been inappropriate billing of Medicare. In particular, beneficiaries would be financially rewarded if they uncover negligence or fraud to the benefit of us all. Although such provider fraud is not the entire problem, and there is other legislation that I support which also addresses beneficiary fraud, studies [[Page S15855]] clearly indicate that provider fraud is most prevalent and the greatest concern. The major problem with our current approach to detecting Medicare fraud is that it relies primarily upon bureaucrats who have no firsthand knowledge of what services were provided to a beneficiary and who have extremely limited time and resources to investigate. This approach can be expected to discover only the most apparent fraudulent activities. To discover most fraud, we must obtain the full cooperation of those who know what occurred at providers' offices and who have the time to pursue fraud--the beneficiaries. All they need is the ability and incentive to scrutinize their bills and actively correct inaccuracies. Under this amendment, beneficiaries would have a right to receive in writing from their providers, within 30 days of when their request is received, an itemized bill for Medicare services provided to them. The beneficiary would then have 90 days to raise specific allegations of inappropriate billings to Medicare. The Medicare intermediaries and carriers would then have to review the bills and determine whether an overpayment has been made which must be reimbursed to the Medicare program. The beneficiary would receive a reward of 1 percent of the overpayment reimbursed up to $10,000. Because these rewards would be paid directly out of the overpayments, they would not increase costs to the Federal Government. There are several important safeguards built into this legislation. The Secretary would be required to establish appropriate procedures to ensure that the incentive system is not abused by overzealous beneficiaries. An incentive payment would be awarded only to the extent that HCFA is able to recover the overpayment from the provider, and there would be no incentive payment if HCFA can demonstrate that it-- for its Medicare intermediary or carrier--has identified the overpayment prior to receiving the beneficiary's complaint. Some will argue that many seniors and other beneficiaries do not need personal rewards for fighting fraud, and in any event, this is a matter of national duty. While I agree with this contention, I also recognize that these individuals would not be able to identify and report fraud without having access to the itemized bills that this legislation provides. Moreover, I see nothing wrong with giving beneficiaries an added financial incentive. After all, we pay Federal employees for ideas that save the taxpayers money, and we pay private citizens for identifying fraud by defense contractors. Mr. President, there is no inconsistency between this amendment and the Abraham amendment which passed today. Their objectives are entirely compatible. However, the Abraham amendment effectively delegates responsibility for planning the whistleblower program to the Secretary of HHS. I strongly believe that we should fulfill our legislative responsibility by specifying the parameters of this important antifraud program. Otherwise, we should not be surprised if we end up with something that we had not contemplated and which does not satisfy our objective. Mr. President, I will not request a vote on this amendment, because we have already had a vote on the Abraham amendment. However, for the reasons that I outlined, I hope that the conferees will agree that this is a preferable whistleblower provision and that they will adopt it in the conference report. In so doing, I believe that the conferees should retain the provisions of the Abraham amendment that reward individuals for ideas that improve Medicare. ______ BROWN (AND OTHERS) AMENDMENT NO. 2969 Mr. BROWN (for himself, Mr. Abraham, Mr. Santorum, Mr. McCain, and Mr. Craig) proposed an amendment to the bill S. 1357, supra; as follows: At the end of chapter 8 of subtitle I of title XII, insert the following: SEC. . $1,000,000 COMPENSATION DEDUCTION LIMIT EXTENDED TO ALL EMPLOYEES OF ALL CORPORATIONS. (a) In General.--Section 162(m) is amended-- (1) by striking ``publicly held corporation'' in paragraph (1) and inserting ``taxpayer (other than personal service corporations)'', (2) by striking ``covered employee'' each place it appears in paragraphs (1) and (4) and inserting ``employee'', and (3) by striking paragraphs (2) and (3) and redesignating paragraph (4) as paragraph (3). (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995, except that there shall not be taken into account with respect to any employee to whom section 162(m) of the Internal Revenue Code of 1986 applies solely by reason of such amendments remuneration payable under a written binding contract which was in effect on October 25, 1995, and which was not modified thereafter in any material respect before such remuneration is paid. (c) Use of Revenues.--Notwithstanding any other provision of law, the Commissioner of Social Security shall increase the earnings limit otherwise determined for each year under section 203 of the Social Security Act (42 U.S.C. 403) by an amount which takes into account the increase in revenues for such year as estimated by the Secretary of the Treasury resulting from the amendment to section 162(m)(3) of the Internal Revenue Code of 1986 made by the Balanced Budget Reconciliation Act of 1995. ______ HARKIN (AND OTHERS) AMENDMENT NO. 2970 Mr. HARKIN (for himself, Mr. Graham, and Mr. Biden) proposed an amendment to the bill S. 1357, supra; as follows: Strike Chapter 6 of Title VII except for the text of amendment number 2950 as passed by the Senate and insert in lieu thereof, the following: CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION SEC. 7100. SHORT TITLE. This chapter may be cited as the ``Health Care Fraud and Abuse Prevention Act of 1995''. Subchapter A--Fraud and Abuse Control Program SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM. (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128B the following new section: ``FRAUD AND ABUSE CONTROL PROGRAM ``Sec. 1128C. (a) Establishment of Program.-- ``(1) In general.--Not later than January 1, 1996, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall establish a program-- ``(A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States, ``(B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States, ``(C) to facilitate the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to health care fraud and abuse, and ``(D) to provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts pursuant to section 1128D. ``(2) Coordination with health plans.--In carrying out the program established under paragraph (1), the Secretary and the Attorney General shall consult with, and arrange for the sharing of data with representatives of health plans. ``(3) Guidelines.-- ``(A) In general.--The Secretary and the Attorney General shall issue guidelines to carry out the program under paragraph (1). The provisions of sections 553, 556, and 557 of title 5, United States Code, shall not apply in the issuance of such guidelines. ``(B) Information guidelines.-- ``(i) In general.--Such guidelines shall include guidelines relating to the furnishing of information by health plans, providers, and others to enable the Secretary and the Attorney General to carry out the program (including coordination with health plans under paragraph (2)). ``(ii) Confidentiality.--Such guidelines shall include procedures to assure that such information is provided and utilized in a manner that appropriately protects the confidentiality of the information and the privacy of individuals receiving health care services and items. ``(iii) Qualified immunity for providing information.--The provisions of section 1157(a) (relating to limitation on liability) shall apply to a person providing information to the Secretary or the Attorney General in conjunction with their performance of duties under this section. ``(4) Ensuring access to documentation.--The Inspector General of the Department of Health and Human Services is authorized to exercise such authority described in paragraphs (3) through (9) of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.) as necessary with respect to the activities under the fraud and abuse control program established under this subsection. [[Page S15856]] ``(5) Authority of inspector general.--Nothing in this Act shall be construed to diminish the authority of any Inspector General, including such authority as provided in the Inspector General Act of 1978 (5 U.S.C. App.). ``(b) Additional Use of Funds by Inspector General.-- ``(1) Reimbursements for investigations.--The Inspector General of the Department of Health and Human Services is authorized to receive and retain for current use reimbursement for the costs of conducting investigations and audits and for monitoring compliance plans when such costs are ordered by a court, voluntarily agreed to by the payer, or otherwise. ``(2) Crediting.--Funds received by the Inspector General under paragraph (1) as reimbursement for costs of conducting investigations shall be deposited to the credit of the appropriation from which initially paid, or to appropriations for similar purposes currently available at the time of deposit, and shall remain available for obligation for 1 year from the date of the deposit of such funds. ``(c) Health Plan Defined.--For purposes of this section, the term `health plan' means a plan or program that provides health benefits, whether directly, through insurance, or otherwise, and includes-- ``(1) a policy of health insurance; ``(2) a contract of a service benefit organization; and ``(3) a membership agreement with a health maintenance organization or other prepaid health plan.''. (b) Establishment of Health Care Fraud and Abuse Control Account in Federal Hospital Insurance Trust Fund.--Section 1817 (42 U.S.C. 1395i) is amended by adding at the end the following new subsection: ``(k) Health Care Fraud and Abuse Control Account.-- ``(1) Establishment.--There is hereby established in the Trust Fund an expenditure account to be known as the `Health Care Fraud and Abuse Control Account' (in this subsection referred to as the `Account'). ``(2) Appropriated amounts to trust fund.-- ``(A) In general.--There are hereby appropriated to the Trust Fund-- ``(i) such gifts and bequests as may be made as provided in subparagraph (B); ``(ii) such amounts as may be deposited in the Trust Fund as provided in sections 7141(b) and 7142(c) of the Balanced Budget Reconciliation Act of 1995, and title XI; and ``(iii) such amounts as are transferred to the Trust Fund under subparagraph (C). ``(B) Authorization to accept gifts.--The Trust Fund is authorized to accept on behalf of the United States money gifts and bequests made unconditionally to the Trust Fund, for the benefit of the Account or any activity financed through the Account. ``(C) Transfer of amounts.--The Managing Trustee shall transfer to the Trust Fund, under rules similar to the rules in section 9601 of the Internal Revenue Code of 1986, an amount equal to the sum of the following: ``(i) Criminal fines recovered in cases involving a Federal health care offense (as defined in section 982(a)(6)(B) of title 18, United States Code). ``(ii) Civil monetary penalties and assessments imposed in health care cases, including amounts recovered under titles XI, XVIII, and XXI, and chapter 38 of title 31, United States Code (except as otherwise provided by law). ``(iii) Amounts resulting from the forfeiture of property by reason of a Federal health care offense. ``(iv) Penalties and damages obtained and otherwise creditable to miscellaneous receipts of the general fund of the Treasury obtained under sections 3729 through 3733 of title 31, United States Code (known as the False Claims Act), in cases involving claims related to the provision of health care items and services (other than funds awarded to a relator, for restitution or otherwise authorized by law). ``(3) Appropriated amounts to account.-- ``(A) In general.--There are hereby appropriated to the Account from the Trust Fund such sums as the Secretary and the Attorney General certify are necessary to carry out the purposes described in subparagraph (B), to be available without further appropriation, in an amount-- ``(i) with respect to activities of the Office of the Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigations in carrying out such purposes, not less than-- ``(I) for fiscal year 1996, $110,000,000, ``(II) for fiscal year 1997, $140,000,000, ``(III) for fiscal year 1998, $160,000,000, ``(IV) for fiscal year 1999, $185,000,000, ``(V) for fiscal year 2000, $215,000,000, ``(VI) for fiscal year 2001, $240,000,000, and ``(VII) for fiscal year 2002, $270,000,000; and ``(ii) with respect to all activities (including the activities described in clause (i)) in carrying out such purposes, not more than-- ``(I) for fiscal year 1996, $200,000,000, and ``(II) for each of the fiscal years 1997 through 2002, the limit for the preceding fiscal year, increased by 15 percent; and ``(iii) for each fiscal year after fiscal year 2002, within the limits for fiscal year 2002 as determined under clauses (i) and (ii). ``(B) Use of funds.--The purposes described in this subparagraph are as follows: ``(i) General use.--To cover the costs (including equipment, salaries and benefits, and travel and training) of the administration and operation of the health care fraud and abuse control program established under section 1128C(a), including the costs of-- ``(I) prosecuting health care matters (through criminal, civil, and administrative proceedings); ``(II) investigations; ``(III) financial and performance audits of health care programs and operations; ``(IV) inspections and other evaluations; and ``(V) provider and consumer education regarding compliance with the provisions of title XI. ``(ii) Use by state medicaid fraud control units for investigation reimbursements.--To reimburse the various State medicaid fraud control units upon request to the Secretary for the costs of the activities authorized under section 2134(b). ``(4) Annual report.--The Secretary and the Attorney General shall submit jointly an annual report to Congress on the amount of revenue which is generated and disbursed, and the justification for such disbursements, by the Account in each fiscal year.''. SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL HEALTH PROGRAMS. (a) Crimes.-- (1) Social security act.--Section 1128B (42 U.S.C. 1320a- 7b) is amended as follows: (A) In the heading, by striking ``medicare or state health care programs'' and inserting ``federal health care programs''. (B) In subsection (a)(1), by striking ``a program under title XVIII or a State health care program (as defined in section 1128(h))'' and inserting ``a Federal health care program''. (C) In subsection (a)(5), by striking ``a program under title XVIII or a State health care program'' and inserting ``a Federal health care program''. (D) In the second sentence of subsection (a)-- (i) by striking ``a State plan approved under title XIX'' and inserting ``a Federal health care program''; and (ii) by striking ``the State may at its option (notwithstanding any other provision of that title or of such plan)'' and inserting ``the administrator of such program may at its option (notwithstanding any other provision of such program)''. (E) In subsection (b)-- (i) by striking ``and willfully'' each place it appears; (ii) by striking ``$25,000'' each place it appears and inserting ``$50,000''; (iii) by striking ``title XVIII or a State health care program'' each place it appears and inserting ``Federal health care program''; (iv) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind--'' and inserting ``kind with intent to be influenced--''; (v) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (vi) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; (vii) in paragraph (2) in the matter proceeding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''; (viii) by adding at the end of paragraphs (1) and (2) the following sentence: ``A violation exists under this paragraph if one or more purposes of the remuneration is unlawful under this paragraph.''; (ix) by redesignating paragraph (3) as paragraph (4); (x) in paragraph (4) (as redesignated), by striking ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), (2), and (3)''; and (xi) by inserting after paragraph (2) the following new paragraph: ``(3)(A) The Attorney General may bring an action in the district courts to impose upon any person who carries out any activity in violation of this subsection a civil penalty of not less than $25,000 and not more than $50,000 for each such violation, plus three times the total remuneration offered, paid, solicited, or received. ``(B) A violation exists under this paragraph if one or more purposes of the remuneration is unlawful, and the damages shall be the full amount of such remuneration. ``(C) Section 3731 of title 31, United States Code, and the Federal Rules of Civil Procedure shall apply to actions brought under this paragraph. ``(D) The provisions of this paragraph do not affect the availability of other criminal and civil remedies for such violations.''. (F) In subsection (c), by inserting ``(as defined in section 1128(h))'' after ``a State health care program''. (G) By adding at the end the following new subsections: ``(f) For purposes of this section, the term `Federal health care program' means-- ``(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the United States Government; or ``(2) any State health care program, as defined in section 1128(h). ``(g)(1) The Secretary and Administrator of the departments and agencies with a Federal health care program may conduct an investigation or audit relating to violations of this section and claims within the jurisdiction of other Federal departments or agencies if the following conditions are satisfied: [[Page S15857]] ``(A) The investigation or audit involves primarily claims submitted to the Federal health care programs of the department or agency conducting the investigation or audit. ``(B) The Secretary or Administrator of the department or agency conducting the investigation or audit gives notice and an opportunity to participate in the investigation or audit to the Inspector General of the department or agency with primary jurisdiction over the Federal health care programs to which the claims were submitted. ``(2) If the conditions specified in paragraph (1) are fulfilled, the Inspector General of the department or agency conducting the investigation or audit may exercise all powers granted under the Inspector General Act of 1978 with respect to the claims submitted to the other departments or agencies to the same manner and extent as provided in that Act with respect to claims submitted to such departments or agencies.''. (2) Identification of community service opportunities.-- Section 1128B (42 U.S.C. 1320a-7b) is further amended by adding at the end the following new subsection: ``(h) The Secretary may-- ``(1) in consultation with State and local health care officials, identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of an offense under this section, and ``(2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.''. (b) Effective Date.--The amendments made by this section shall take effect on January 1, 1996. SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE. (a) Solicitation and Publication of Modifications to Existing Safe Harbors and New Safe Harbors.-- (1) In general.-- (A) Solicitation of proposals for safe harbors.--Not later than January 1, 1996, and not less than annually thereafter, the Secretary shall publish a notice in the Federal Register soliciting proposals, which will be accepted during a 60-day period, for-- (i) modifications to existing safe harbors issued pursuant to section 14(a) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (42 U.S.C. 1320a-7b note); (ii) additional safe harbors specifying payment practices that shall not be treated as a criminal offense under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) and shall not serve as the basis for an exclusion under section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7)); (iii) interpretive rulings to be issued pursuant to subsection (b); and (iv) special fraud alerts to be issued pursuant to subsection (c). (B) Publication of proposed modifications and proposed additional safe harbors.--After considering the proposals described in clauses (i) and (ii) of subparagraph (A), the Secretary, in consultation with the Attorney General, shall publish in the Federal Register proposed modifications to existing safe harbors and proposed additional safe harbors, if appropriate, with a 60-day comment period. After considering any public comments received during this period, the Secretary shall issue final rules modifying the existing safe harbors and establishing new safe harbors, as appropriate. (C) Report.--The Inspector General of the Department of Health and Human Services (in this section referred to as the ``Inspector General'') shall, in an annual report to Congress or as part of the year-end semiannual report required by section 5 of the Inspector General Act of 1978 (5 U.S.C. App.), describe the proposals received under clauses (i) and (ii) of subparagraph (A) and explain which proposals were included in the publication described in subparagraph (B), which proposals were not included in that publication, and the reasons for the rejection of the proposals that were not included. (2) Criteria for modifying and establishing safe harbors.-- In modifying and establishing safe harbors under paragraph (1)(B), the Secretary may consider the extent to which providing a safe harbor for the specified payment practice may result in any of the following: (A) An increase or decrease in access to health care services. (B) An increase or decrease in the quality of health care services. (C) An increase or decrease in patient freedom of choice among health care providers. (D) An increase or decrease in competition among health care providers. (E) An increase or decrease in the ability of health care facilities to provide services in medically underserved areas or to medically underserved populations. (F) An increase or decrease in the cost to Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)). (G) An increase or decrease in the potential overutilization of health care services. (H) The existence or nonexistence of any potential financial benefit to a health care professional or provider which may vary based on their decisions of-- (i) whether to order a health care item or service; or (ii) whether to arrange for a referral of health care items or services to a particular practitioner or provider. (I) Any other factors the Secretary deems appropriate in the interest of preventing fraud and abuse in Federal health care programs (as so defined). (b) Interpretive Rulings.-- (1) In general.-- (A) Request for interpretive ruling.--Any person may present, at any time, a request to the Inspector General for a statement of the Inspector General's current interpretation of the meaning of a specific aspect of the application of sections 1128A and 1128B of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as an ``interpretive ruling''). (B) Issuance and effect of interpretive ruling.-- (i) In general.--If appropriate, the Inspector General shall in consultation with the Attorney General, issue an interpretive ruling not later than 120 days after receiving a request described in subparagraph (A). Interpretive rulings shall not have the force of law and shall be treated as an interpretive rule within the meaning of section 553(b) of title 5, United States Code. All interpretive rulings issued pursuant to this clause shall be published in the Federal Register or otherwise made available for public inspection. (ii) Reasons for denial.--If the Inspector General does not issue an interpretive ruling in response to a request described in subparagraph (A), the Inspector General shall notify the requesting party of such decision not later than 120 days after receiving such a request and shall identify the reasons for such decision. (2) Criteria for interpretive rulings.-- (A) In general.--In determining whether to issue an interpretive ruling under paragraph (1)(B), the Inspector General may consider-- (i) whether and to what extent the request identifies an ambiguity within the language of the statute, the existing safe harbors, or previous interpretive rulings; and (ii) whether the subject of the requested interpretive ruling can be adequately addressed by interpretation of the language of the statute, the existing safe harbor rules, or previous interpretive rulings, or whether the request would require a substantive ruling (as defined in section 552 of title 5, United States Code) not authorized under this subsection. (B) No rulings on factual issues.--The Inspector General shall not give an interpretive ruling on any factual issue, including the intent of the parties or the fair market value of particular leased space or equipment. (c) Special Fraud Alerts.-- (1) In general.-- (A) Request for special fraud alerts.--Any person may present, at any time, a request to the Inspector General for a notice which informs the public of practices which the Inspector General considers to be suspect or of particular concern under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) (in this subsection referred to as a ``special fraud alert''). (B) Issuance and publication of special fraud alerts.--Upon receipt of a request described in subparagraph (A), the Inspector General shall investigate the subject matter of the request to determine whether a special fraud alert should be issued. If appropriate, the Inspector General shall issue a special fraud alert in response to the request. All special fraud alerts issued pursuant to this subparagraph shall be published in the Federal Register. (2) Criteria for special fraud alerts.--In determining whether to issue a special fraud alert upon a request described in para

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AMENDMENTS SUBMITTED


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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)

Text of this article available as: TXT PDF [Pages S15852-S15971] [[Page S15852]] AMENDMENTS SUBMITTED ______ THE BALANCED BUDGET RECONCILIATION ACT OF 1995 ______ KENNEDY (AND OTHERS) AMENDMENT NO. 2959 Mr. KENNEDY (for himself, Mr. Simon, Mr. Pell, Mr. Dodd, Mr. Harkin, Ms. Mikulski, Mr. Wellstone, Mrs. Feinstein, Mrs. Murray, Mr. Kohl, Mr. Baucus, Mr. Bingaman, and Mr. Ford) proposed an amendment to the bill (S. 1357) to provide for reconciliation pursuant to section 105 of the concurrent resolution on the budget for fiscal year 1996; as follows: On page 1409, beginning with line 8, strike all through page 1410, line 25. On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1425, line 16. Strike chapter 3 of subtitle B of title XII. ______ HUTCHISON (AND OTHERS) AMENDMENT NO. 2960 (Ordered to lie on the table.) Mrs. Hutchison (for herself, Mr. McCain, Mr. Lieberman, Mr. Stevens, and Mr. Levin) submitted an amendment intended to be proposed by them to the bill S. 1357, supra; as follows: At the appropriate place, insert the following: (a) The Senate makes the following findings: (1) Human rights violations and atrocities continue unabated in the Former Yugoslavia. (2) The Assistant Secretary of State for Human Rights recently reported that starting in mid-September and intensifying between October 6 and October 12, 1995 many thousands of Bosnian Muslims and Croats in Northwest Bosnia were systematically forced from their homes by paramilitary units, local police and in some instances, Bosnian Serb Army officials and soldiers. (3) Despite the October 12, 1995 cease-fire which went into effect by agreement of the warring parties in the former Yugoslavia, Bosnian Serbs continue to conduct a brutal campaign to expel non-Serb civilians who remain in Northwest Bosnia, and are subjecting non-Serbs to untold horror-- murder, rape, robbery and other violence. (4) Horrible examples of ``ethnic cleansing'' persist in Northwest Bosnia. Some six thousand refugees recently reached Zenica and reported that nearly two thousand family members from this group are still unaccounted for. (5) The UN spokesman in Zagreb reported that many refugees have been given only a few minutes to leave their homes and that ``girls as young as 17 are reported to have been taken into wooded areas and raped.'' Elderly, sick and very young refugees have been driven to remote areas and forced to walk long distances on unsafe roads and cross rivers without bridges. (6) The War Crime Tribunal for the former Yugoslavia has collected volumes of evidence of atrocities, including the establishment of death camps, mass executions and systematic campaigns of rape and terror. This War Crimes Tribunal has already issued 43 indictments on the basis of this evidence. (7) The Assistant Secretary of State for Human Rights has described the eye witness accounts as ``prima facie evidence of war crimes which, if confirmed, could very well lead to further indictments by the War Crimes Tribunal.'' (8) The U.N. High Commissioner for Refugees estimates that more than 22,000 Muslims and Croats have been forced from their homes since mid-September in Bosnian Serb controlled areas. (9) In opening the Dodd Center Symposium on the topic of ``50 Years After Nuremburg'' on October 16, 1995, President Clinton cited the ``excellent progress'' of the War Crimes Tribunal for the former Yugoslavia and said, ``Those accused of war crimes, crimes against humanity and genocide must be brought to justice. They must be tried and, if found guilty, they must be held accountable.'' (10) President Clinton also observed on October 16, 1995, ``some people are concerned that pursuing peace in Bosnia and prosecuting war criminals are incompatible goals. But I believe they are wrong. There must be peace for justice to prevail, but there must be justice when peace prevails. (b) Sense of the Senate.--It is the sense of the Senate that-- (1) the Senate condemns the systematic human rights abuses against the people of Bosnia and Herzogovenia. (2) with peace talks scheduled to begin in the United States on October 31, 1995, and with the President clearly indicating his willingness to send American forces into the heart of this conflict, these new reports of Serbian atrocities are of grave concern to all Americans. (3) the Bosnian Serb leadership should immediately halt these atrocities, fully account for the missing, and allow those who have been separated to return to their families. (4) the International Red Cross, United Nations agencies and human rights organizations should be granted full and complete access to all locations throughout Bosnia and Herzogovenia. (5) the Bosnian Serb leadership should fully cooperate to facilitate the complete investigation of the above allegations so that those responsible may be held accountable under international treaties, conventions, obligations and law. (6) the United States should continue to support the work of the War Crime Tribunal for the Former Yugoslavia. (7) the United States should ensure that any negotiated peace agreements in former Yugoslavia, particularly with respect to Bosnia, require all states of the former Yugoslavia to corporate fully with the War Crimes Tribunal and apprehend and turn over for trial any indicated persons found in their territories. (8) ethnic cleansing by any faction, group, leader, or government is unjustified, immoral and illegal and all perpetrators of war crimes, crimes against humanity, genocide and other human rights violations in former Yugoslavia must be held accountable. ______ BAUCUS AMENDMENT NO. 2961 (Ordered to lie on the table.) Mr. BAUCUS submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: Strike section 1105(4)(B)(iii). ______ KASSEBAUM (AND OTHERS) AMENDMENT NO. 2962 Mrs. KASSEBAUM (for herself, Ms. Snowe, Mr. Jeffords, Mr. Coats, Mr. Gregg, Mr. Frist, Mr. DeWine, Mr. Ashcroft, Mr. Abraham, Mr. Gorton, Mr. Pressler, Mr. Roth, Mr. Domenici, Mr. Stevens, Mr. Specter, Mr. Cohen, Mr. Chafee, and Mr. Baucus) proposed an amendment to the bill S. 1357, supra; as follows: On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1426, line 9. ______ BREAUX (AND KERRY) AMENDMENT NO. 2963 Mr. BREAUX (for himself and Mr. Kerry) proposed an amendment to the bill S. 1357, supra; as follows: On page 1469, beginning on line 2, strike all through page 1471, line 20, and insert the following: SEC. 12001. CHILD TAX CREDIT. (a) In General.--Subpart C of part IV of subchapter A of chapter 1 is amended by redesignating section 35 as section 36 and by inserting after section 34 the following new section: ``SEC. 35. CHILD TAX CREDIT. ``(a) Allowance of Credit.-- ``(1) General rule.--There shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to $500 multiplied by the number of qualifying children of the taxpayer. ``(2) Limitation based on amount of tax.--The credit allowed by paragraph (1) for a taxable year shall not exceed the sum of-- ``(A) the tax imposed by this subtitle for the taxable year (reduced by the credits allowable against such tax other than the credit allowable under section 32), and ``(B) the taxes imposed by sections 3101 and 3201(a) and 50 percent of the taxes imposed by sections 1401 and 3211(a) for such taxable year. ``(b) Adjusted Gross Income Limitation.--The aggregate amount of the credit which would (but for this subsection) be allowed by subsection (a) shall be reduced (but not below zero) by 20 percent for each $3,000 by which the taxpayer's adjusted gross income exceeds $60,000. ``(c) Qualifying Child.--For purposes of this section-- ``(1) In general.--The term `qualifying child' means any individual if-- ``(A) the taxpayer is allowed a deduction under section 151 with respect to such individual for such taxable year, ``(B) such individual has not attained the age of 16 as of the close of the calendar year in which the taxable year of the taxpayer begins, and ``(C) such individual bears a relationship to the taxpayer described in section 32(c)(3)(B) (determined without regard to clause (ii) thereof). ``(2) Exception for certain noncitizens.--The term `qualifying child' shall not include any individual who would not be a dependent if the first sentence of section 152(b)(3) were applied without regard to all that follows `resident of the United States'. ``(d) Certain Other Rules Apply.--Rules similar to the rules of subsections (d) and (e) of section 32 shall apply for purposes of this section.'' (c) Conforming Amendment.--The table of sections for such subpart C is amended by striking the item relating to section 35 and inserting the following new items: ``Sec. 35. Child tax credit. ``Sec. 36. Overpayments of tax.'' (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995. ______ [[Page S15853]] McCAIN (AND OTHERS) AMENDMENT NO. 2964 Mr. McCAIN (for himself, Mr. Dole, Mr. Coats, and Mr. Nickles) proposed an amendment to the bill S. 1357, supra; as follows: At the appropriate place in the Act, add the following: Sec. . Sense of the Senate.--The Senate finds that-- (a) The Senate has held hearings on the social security earnings limit in 1994 and 1995 and the House has held two hearings on the social security earnings limit in 1995; (b) The Senate has overwhelmingly passed Sense of the Senate language calling for substantial reform of the social security earnings limit; (c) The House of Representatives has overwhelmingly passed legislation to raise the exempt amount under the social security earnings limit three times, in 1989, 1992, and 1995; (d) Such legislation is a key provision of the Contract with America; (e) The President in his 1992 campaign document ``Putting People First'' pledged to lift the social security earnings limit; (f) The social security earnings limit is a depression-era relic that unfairly punishes working seniors; therefore, (g) It is the intent of the Congress that legislation will be passed before the end of 1995 to raise the social security earnings limit for working seniors aged 65 through 69 in a manner which will ensure the financial integrity of the social security trust funds and will be consistent with the goal of achieving a balanced budget in 7 years. ______ HELMS AMENDMENT NO. 2965 Mr. HELMS proposed an amendment to the bill S. 1357, supra; as follows: On page 461, line 13, after the period, insert the following: ``(3) Point-of-service coverage.--If a Medicare Choice sponsor offers a Medicare Choice plan that limits benefits to items and services furnished only by providers in a network of providers which have entered into a contract with the sponsors, the sponsor must also offer at the time of enrollment, a Medicare Choice plan that permits payment to be made under the plan for covered items and services when obtained out-of-network by the individual.'' ______ CAMPBELL (AND BROWN) AMENDMENTS NOS. 2966-2967 (Ordered to lie on the table.) Mr. CAMPBELL (for himself and Mr. Brown) submitted two amendments intended to be proposed by them to the bill S. 1357, supra; as follows: Amendment No. 2966 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C.1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ____________.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ____ Amendment No. 2968 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C. 1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. [[Page S15854]] ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ______.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ______ McCAIN AMENDMENT NO. 2968 (Ordered to lie on the table.) Mr. McCain submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: On page 696, between lines 8 and 9, insert the following: SEC. 7116A. MEDICARE WHISTLEBLOWER INCENTIVE. (a) Purpose.--The purpose of this section is to-- (1) reduce and eliminate fraud and abuse under the medicare program; (2) reduce negligent and fraudulent medicare billings by providers; (3) provide medicare beneficiaries with incentives to report inappropriate billing practices; and (4) provide savings to the medicare trust funds by increasing the recovery of medicare overpayments. (b) Request for Itemized Bill for Medicare Items and Services.-- (1) In general.--Section 1128A (42 U.S.C. 1320a-7a), as amended by section 7131(a)(4), is further amended by adding at the end the following new subsection: ``(n) Written Request for Itemized Bill.-- ``(1) In general.--A beneficiary may submit a written request for an itemized bill for medical or other items or services provided to such beneficiary by any person (including an organization, agency, or other entity) that receives payment under title XVIII for providing such items or services to such beneficiary. ``(2) 30-day period to receive bill.-- ``(A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been received, a person described in such paragraph shall furnish an itemized bill describing each medical or other item or service provided to the beneficiary requesting the itemized bill. ``(B) Penalty.--Whoever knowingly fails to furnish an itemized bill in accordance with subparagraph (A) shall be subject to a civil fine of not more than $100 for each such failure. ``(3) Review of itemized bill.-- ``(A) In general.--Not later than 90 days after the receipt of an itemized bill furnished under paragraph (1), a beneficiary may submit a written request for a review of the itemized bill to the appropriate fiscal intermediary or carrier with a contract under section 1816 or 1842. ``(B) Specific allegations.--A request for a review of the itemized bill shall identify-- ``(i) specific medical or other items or services that the beneficiary believes were not provided as claimed, or ``(ii) any other billing irregularity (including duplicate billing). ``(4) Findings of fiscal intermediary or carrier.--Each fiscal intermediary or carrier with a contract under section 1816 or 1842 shall, with respect to each written request submitted to the fiscal intermediary or carrier under paragraph (3), determine whether the itemized bill identifies specific medical or other items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under title XVIII. ``(5) Recovery of amounts.--The Secretary shall require fiscal intermediaries and carriers to take all appropriate measures to recover amounts unnecessarily paid under title XVIII with respect to a bill described in paragraph (4). ``(6) Incentive payments.-- ``(A) In general.--If the fiscal intermediary or carrier recovers amounts in accordance with paragraph (5), the Secretary shall make an incentive payment (in an amount determined under subparagraph (B)) to the beneficiary who submitted the request for the itemized bill under paragraph (1) that resulted in such recovery. No incentive payment shall be made under this subparagraph unless such recovery is made after a final determination on whether such recovered amounts are required to be repaid by the provider. ``(B) Incentive payment determined.-- ``(i) In general.--The amount of the incentive payment determined under this subparagraph is equal to the lesser of-- ``(I) 1 percent of the amount that the bill overcharged for medical or other items or services; or ``(II) $10,000. ``(ii) Limitation of amount.--The amount determined under this subparagraph may not exceed the total amounts recovered with respect to the bill in accordance with paragraph (5). ``(7) Prevention of abuse by beneficiaries.--The Secretary shall-- ``(A) address abuses of the incentive system established under this subsection; and ``(B) establish appropriate procedures to prevent such abuses. ``(8) Requirement that beneficiary discover inaccurate bill to receive incentive payment.--No incentive payment shall be made under paragraph (6) to a beneficiary if the Secretary or the appropriate fiscal intermediary or carrier identified the bill that was the subject of the beneficiary's request for review under this subsection as being overpaid prior to such request.''. (2) Effective date.--The amendments made by this section shall apply with respect to medical or other items or services provided on or after January 1, 1996. Mr. McCAIN. Mr. President, earlier this session, I introduced S. 1325, the Medicare Whistleblower Act of 1995, to reduce provider fraud and abuse in the Medicare Program. The amendment I am submitting today improves upon that bill, and provides a strong incentive for beneficiaries to identify overpayments made by Medicare. An Abraham amendment which passed today, and which I supported, takes a similar approach to achieve this same objective. However, my amendment is preferable because it specifically delineates the whistleblower reward process and does not give the Secretary of HHS discretion not to make incentive payments. I hope that the conferees will adopt this amendment. At Medicare town meetings throughout Arizona, I have heard over and over from senior citizens that the Medicare Program is rampant with inaccurate billings. They have told me, based on their personal experiences, that their Medicare bills frequently include services that they have not received, double billings for the same service, or charges that are disproportionate to the value of services received. Often, they have no idea what Medicare is being billed for on their behalf, and they are not able to obtain explanations from providers. The perceptions of Medicare beneficiaries are confirmed by more systematic analyses. The General Accounting Office has estimated that fraud and abuse in our Nation's health care system costs taxpayers as much as $100 billion each year. Medicare fraud alone costs about $17 billion per year, which is 10 percent of the program's costs. A report by the Republican staff of the Senate Committee on Aging has documented a broad array of fraudulent activities, including false claims for services that were supposed to have been rendered after the beneficiaries had died. The Medicare Program has many problems. A fundamental problem, and the source of many other problems, is that too few people are adequately concerned about its costs because the Government is paying most of the bills. One constituent informed me of a situation in which his provider double-billed for the same service and told him not to worry about it because Medicare is paying. This is an outrage and must be stopped. When Medicare overpays, we all overpay, and costs to beneficiaries and other taxpayers spiral. This amendment addresses this fundamental problem of the Medicare Program. It gives beneficiaries an added incentive to carefully scrutinize their bills and to actively pursue corrections when they believe that there has been inappropriate billing of Medicare. In particular, beneficiaries would be financially rewarded if they uncover negligence or fraud to the benefit of us all. Although such provider fraud is not the entire problem, and there is other legislation that I support which also addresses beneficiary fraud, studies [[Page S15855]] clearly indicate that provider fraud is most prevalent and the greatest concern. The major problem with our current approach to detecting Medicare fraud is that it relies primarily upon bureaucrats who have no firsthand knowledge of what services were provided to a beneficiary and who have extremely limited time and resources to investigate. This approach can be expected to discover only the most apparent fraudulent activities. To discover most fraud, we must obtain the full cooperation of those who know what occurred at providers' offices and who have the time to pursue fraud--the beneficiaries. All they need is the ability and incentive to scrutinize their bills and actively correct inaccuracies. Under this amendment, beneficiaries would have a right to receive in writing from their providers, within 30 days of when their request is received, an itemized bill for Medicare services provided to them. The beneficiary would then have 90 days to raise specific allegations of inappropriate billings to Medicare. The Medicare intermediaries and carriers would then have to review the bills and determine whether an overpayment has been made which must be reimbursed to the Medicare program. The beneficiary would receive a reward of 1 percent of the overpayment reimbursed up to $10,000. Because these rewards would be paid directly out of the overpayments, they would not increase costs to the Federal Government. There are several important safeguards built into this legislation. The Secretary would be required to establish appropriate procedures to ensure that the incentive system is not abused by overzealous beneficiaries. An incentive payment would be awarded only to the extent that HCFA is able to recover the overpayment from the provider, and there would be no incentive payment if HCFA can demonstrate that it-- for its Medicare intermediary or carrier--has identified the overpayment prior to receiving the beneficiary's complaint. Some will argue that many seniors and other beneficiaries do not need personal rewards for fighting fraud, and in any event, this is a matter of national duty. While I agree with this contention, I also recognize that these individuals would not be able to identify and report fraud without having access to the itemized bills that this legislation provides. Moreover, I see nothing wrong with giving beneficiaries an added financial incentive. After all, we pay Federal employees for ideas that save the taxpayers money, and we pay private citizens for identifying fraud by defense contractors. Mr. President, there is no inconsistency between this amendment and the Abraham amendment which passed today. Their objectives are entirely compatible. However, the Abraham amendment effectively delegates responsibility for planning the whistleblower program to the Secretary of HHS. I strongly believe that we should fulfill our legislative responsibility by specifying the parameters of this important antifraud program. Otherwise, we should not be surprised if we end up with something that we had not contemplated and which does not satisfy our objective. Mr. President, I will not request a vote on this amendment, because we have already had a vote on the Abraham amendment. However, for the reasons that I outlined, I hope that the conferees will agree that this is a preferable whistleblower provision and that they will adopt it in the conference report. In so doing, I believe that the conferees should retain the provisions of the Abraham amendment that reward individuals for ideas that improve Medicare. ______ BROWN (AND OTHERS) AMENDMENT NO. 2969 Mr. BROWN (for himself, Mr. Abraham, Mr. Santorum, Mr. McCain, and Mr. Craig) proposed an amendment to the bill S. 1357, supra; as follows: At the end of chapter 8 of subtitle I of title XII, insert the following: SEC. . $1,000,000 COMPENSATION DEDUCTION LIMIT EXTENDED TO ALL EMPLOYEES OF ALL CORPORATIONS. (a) In General.--Section 162(m) is amended-- (1) by striking ``publicly held corporation'' in paragraph (1) and inserting ``taxpayer (other than personal service corporations)'', (2) by striking ``covered employee'' each place it appears in paragraphs (1) and (4) and inserting ``employee'', and (3) by striking paragraphs (2) and (3) and redesignating paragraph (4) as paragraph (3). (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995, except that there shall not be taken into account with respect to any employee to whom section 162(m) of the Internal Revenue Code of 1986 applies solely by reason of such amendments remuneration payable under a written binding contract which was in effect on October 25, 1995, and which was not modified thereafter in any material respect before such remuneration is paid. (c) Use of Revenues.--Notwithstanding any other provision of law, the Commissioner of Social Security shall increase the earnings limit otherwise determined for each year under section 203 of the Social Security Act (42 U.S.C. 403) by an amount which takes into account the increase in revenues for such year as estimated by the Secretary of the Treasury resulting from the amendment to section 162(m)(3) of the Internal Revenue Code of 1986 made by the Balanced Budget Reconciliation Act of 1995. ______ HARKIN (AND OTHERS) AMENDMENT NO. 2970 Mr. HARKIN (for himself, Mr. Graham, and Mr. Biden) proposed an amendment to the bill S. 1357, supra; as follows: Strike Chapter 6 of Title VII except for the text of amendment number 2950 as passed by the Senate and insert in lieu thereof, the following: CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION SEC. 7100. SHORT TITLE. This chapter may be cited as the ``Health Care Fraud and Abuse Prevention Act of 1995''. Subchapter A--Fraud and Abuse Control Program SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM. (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128B the following new section: ``FRAUD AND ABUSE CONTROL PROGRAM ``Sec. 1128C. (a) Establishment of Program.-- ``(1) In general.--Not later than January 1, 1996, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall establish a program-- ``(A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States, ``(B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States, ``(C) to facilitate the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to health care fraud and abuse, and ``(D) to provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts pursuant to section 1128D. ``(2) Coordination with health plans.--In carrying out the program established under paragraph (1), the Secretary and the Attorney General shall consult with, and arrange for the sharing of data with representatives of health plans. ``(3) Guidelines.-- ``(A) In general.--The Secretary and the Attorney General shall issue guidelines to carry out the program under paragraph (1). The provisions of sections 553, 556, and 557 of title 5, United States Code, shall not apply in the issuance of such guidelines. ``(B) Information guidelines.-- ``(i) In general.--Such guidelines shall include guidelines relating to the furnishing of information by health plans, providers, and others to enable the Secretary and the Attorney General to carry out the program (including coordination with health plans under paragraph (2)). ``(ii) Confidentiality.--Such guidelines shall include procedures to assure that such information is provided and utilized in a manner that appropriately protects the confidentiality of the information and the privacy of individuals receiving health care services and items. ``(iii) Qualified immunity for providing information.--The provisions of section 1157(a) (relating to limitation on liability) shall apply to a person providing information to the Secretary or the Attorney General in conjunction with their performance of duties under this section. ``(4) Ensuring access to documentation.--The Inspector General of the Department of Health and Human Services is authorized to exercise such authority described in paragraphs (3) through (9) of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.) as necessary with respect to the activities under the fraud and abuse control program established under this subsection. [[Page S15856]] ``(5) Authority of inspector general.--Nothing in this Act shall be construed to diminish the authority of any Inspector General, including such authority as provided in the Inspector General Act of 1978 (5 U.S.C. App.). ``(b) Additional Use of Funds by Inspector General.-- ``(1) Reimbursements for investigations.--The Inspector General of the Department of Health and Human Services is authorized to receive and retain for current use reimbursement for the costs of conducting investigations and audits and for monitoring compliance plans when such costs are ordered by a court, voluntarily agreed to by the payer, or otherwise. ``(2) Crediting.--Funds received by the Inspector General under paragraph (1) as reimbursement for costs of conducting investigations shall be deposited to the credit of the appropriation from which initially paid, or to appropriations for similar purposes currently available at the time of deposit, and shall remain available for obligation for 1 year from the date of the deposit of such funds. ``(c) Health Plan Defined.--For purposes of this section, the term `health plan' means a plan or program that provides health benefits, whether directly, through insurance, or otherwise, and includes-- ``(1) a policy of health insurance; ``(2) a contract of a service benefit organization; and ``(3) a membership agreement with a health maintenance organization or other prepaid health plan.''. (b) Establishment of Health Care Fraud and Abuse Control Account in Federal Hospital Insurance Trust Fund.--Section 1817 (42 U.S.C. 1395i) is amended by adding at the end the following new subsection: ``(k) Health Care Fraud and Abuse Control Account.-- ``(1) Establishment.--There is hereby established in the Trust Fund an expenditure account to be known as the `Health Care Fraud and Abuse Control Account' (in this subsection referred to as the `Account'). ``(2) Appropriated amounts to trust fund.-- ``(A) In general.--There are hereby appropriated to the Trust Fund-- ``(i) such gifts and bequests as may be made as provided in subparagraph (B); ``(ii) such amounts as may be deposited in the Trust Fund as provided in sections 7141(b) and 7142(c) of the Balanced Budget Reconciliation Act of 1995, and title XI; and ``(iii) such amounts as are transferred to the Trust Fund under subparagraph (C). ``(B) Authorization to accept gifts.--The Trust Fund is authorized to accept on behalf of the United States money gifts and bequests made unconditionally to the Trust Fund, for the benefit of the Account or any activity financed through the Account. ``(C) Transfer of amounts.--The Managing Trustee shall transfer to the Trust Fund, under rules similar to the rules in section 9601 of the Internal Revenue Code of 1986, an amount equal to the sum of the following: ``(i) Criminal fines recovered in cases involving a Federal health care offense (as defined in section 982(a)(6)(B) of title 18, United States Code). ``(ii) Civil monetary penalties and assessments imposed in health care cases, including amounts recovered under titles XI, XVIII, and XXI, and chapter 38 of title 31, United States Code (except as otherwise provided by law). ``(iii) Amounts resulting from the forfeiture of property by reason of a Federal health care offense. ``(iv) Penalties and damages obtained and otherwise creditable to miscellaneous receipts of the general fund of the Treasury obtained under sections 3729 through 3733 of title 31, United States Code (known as the False Claims Act), in cases involving claims related to the provision of health care items and services (other than funds awarded to a relator, for restitution or otherwise authorized by law). ``(3) Appropriated amounts to account.-- ``(A) In general.--There are hereby appropriated to the Account from the Trust Fund such sums as the Secretary and the Attorney General certify are necessary to carry out the purposes described in subparagraph (B), to be available without further appropriation, in an amount-- ``(i) with respect to activities of the Office of the Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigations in carrying out such purposes, not less than-- ``(I) for fiscal year 1996, $110,000,000, ``(II) for fiscal year 1997, $140,000,000, ``(III) for fiscal year 1998, $160,000,000, ``(IV) for fiscal year 1999, $185,000,000, ``(V) for fiscal year 2000, $215,000,000, ``(VI) for fiscal year 2001, $240,000,000, and ``(VII) for fiscal year 2002, $270,000,000; and ``(ii) with respect to all activities (including the activities described in clause (i)) in carrying out such purposes, not more than-- ``(I) for fiscal year 1996, $200,000,000, and ``(II) for each of the fiscal years 1997 through 2002, the limit for the preceding fiscal year, increased by 15 percent; and ``(iii) for each fiscal year after fiscal year 2002, within the limits for fiscal year 2002 as determined under clauses (i) and (ii). ``(B) Use of funds.--The purposes described in this subparagraph are as follows: ``(i) General use.--To cover the costs (including equipment, salaries and benefits, and travel and training) of the administration and operation of the health care fraud and abuse control program established under section 1128C(a), including the costs of-- ``(I) prosecuting health care matters (through criminal, civil, and administrative proceedings); ``(II) investigations; ``(III) financial and performance audits of health care programs and operations; ``(IV) inspections and other evaluations; and ``(V) provider and consumer education regarding compliance with the provisions of title XI. ``(ii) Use by state medicaid fraud control units for investigation reimbursements.--To reimburse the various State medicaid fraud control units upon request to the Secretary for the costs of the activities authorized under section 2134(b). ``(4) Annual report.--The Secretary and the Attorney General shall submit jointly an annual report to Congress on the amount of revenue which is generated and disbursed, and the justification for such disbursements, by the Account in each fiscal year.''. SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL HEALTH PROGRAMS. (a) Crimes.-- (1) Social security act.--Section 1128B (42 U.S.C. 1320a- 7b) is amended as follows: (A) In the heading, by striking ``medicare or state health care programs'' and inserting ``federal health care programs''. (B) In subsection (a)(1), by striking ``a program under title XVIII or a State health care program (as defined in section 1128(h))'' and inserting ``a Federal health care program''. (C) In subsection (a)(5), by striking ``a program under title XVIII or a State health care program'' and inserting ``a Federal health care program''. (D) In the second sentence of subsection (a)-- (i) by striking ``a State plan approved under title XIX'' and inserting ``a Federal health care program''; and (ii) by striking ``the State may at its option (notwithstanding any other provision of that title or of such plan)'' and inserting ``the administrator of such program may at its option (notwithstanding any other provision of such program)''. (E) In subsection (b)-- (i) by striking ``and willfully'' each place it appears; (ii) by striking ``$25,000'' each place it appears and inserting ``$50,000''; (iii) by striking ``title XVIII or a State health care program'' each place it appears and inserting ``Federal health care program''; (iv) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind--'' and inserting ``kind with intent to be influenced--''; (v) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (vi) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; (vii) in paragraph (2) in the matter proceeding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''; (viii) by adding at the end of paragraphs (1) and (2) the following sentence: ``A violation exists under this paragraph if one or more purposes of the remuneration is unlawful under this paragraph.''; (ix) by redesignating paragraph (3) as paragraph (4); (x) in paragraph (4) (as redesignated), by striking ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), (2), and (3)''; and (xi) by inserting after paragraph (2) the following new paragraph: ``(3)(A) The Attorney General may bring an action in the district courts to impose upon any person who carries out any activity in violation of this subsection a civil penalty of not less than $25,000 and not more than $50,000 for each such violation, plus three times the total remuneration offered, paid, solicited, or received. ``(B) A violation exists under this paragraph if one or more purposes of the remuneration is unlawful, and the damages shall be the full amount of such remuneration. ``(C) Section 3731 of title 31, United States Code, and the Federal Rules of Civil Procedure shall apply to actions brought under this paragraph. ``(D) The provisions of this paragraph do not affect the availability of other criminal and civil remedies for such violations.''. (F) In subsection (c), by inserting ``(as defined in section 1128(h))'' after ``a State health care program''. (G) By adding at the end the following new subsections: ``(f) For purposes of this section, the term `Federal health care program' means-- ``(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the United States Government; or ``(2) any State health care program, as defined in section 1128(h). ``(g)(1) The Secretary and Administrator of the departments and agencies with a Federal health care program may conduct an investigation or audit relating to violations of this section and claims within the jurisdiction of other Federal departments or agencies if the following conditions are satisfied: [[Page S15857]] ``(A) The investigation or audit involves primarily claims submitted to the Federal health care programs of the department or agency conducting the investigation or audit. ``(B) The Secretary or Administrator of the department or agency conducting the investigation or audit gives notice and an opportunity to participate in the investigation or audit to the Inspector General of the department or agency with primary jurisdiction over the Federal health care programs to which the claims were submitted. ``(2) If the conditions specified in paragraph (1) are fulfilled, the Inspector General of the department or agency conducting the investigation or audit may exercise all powers granted under the Inspector General Act of 1978 with respect to the claims submitted to the other departments or agencies to the same manner and extent as provided in that Act with respect to claims submitted to such departments or agencies.''. (2) Identification of community service opportunities.-- Section 1128B (42 U.S.C. 1320a-7b) is further amended by adding at the end the following new subsection: ``(h) The Secretary may-- ``(1) in consultation with State and local health care officials, identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of an offense under this section, and ``(2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.''. (b) Effective Date.--The amendments made by this section shall take effect on January 1, 1996. SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE. (a) Solicitation and Publication of Modifications to Existing Safe Harbors and New Safe Harbors.-- (1) In general.-- (A) Solicitation of proposals for safe harbors.--Not later than January 1, 1996, and not less than annually thereafter, the Secretary shall publish a notice in the Federal Register soliciting proposals, which will be accepted during a 60-day period, for-- (i) modifications to existing safe harbors issued pursuant to section 14(a) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (42 U.S.C. 1320a-7b note); (ii) additional safe harbors specifying payment practices that shall not be treated as a criminal offense under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) and shall not serve as the basis for an exclusion under section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7)); (iii) interpretive rulings to be issued pursuant to subsection (b); and (iv) special fraud alerts to be issued pursuant to subsection (c). (B) Publication of proposed modifications and proposed additional safe harbors.--After considering the proposals described in clauses (i) and (ii) of subparagraph (A), the Secretary, in consultation with the Attorney General, shall publish in the Federal Register proposed modifications to existing safe harbors and proposed additional safe harbors, if appropriate, with a 60-day comment period. After considering any public comments received during this period, the Secretary shall issue final rules modifying the existing safe harbors and establishing new safe harbors, as appropriate. (C) Report.--The Inspector General of the Department of Health and Human Services (in this section referred to as the ``Inspector General'') shall, in an annual report to Congress or as part of the year-end semiannual report required by section 5 of the Inspector General Act of 1978 (5 U.S.C. App.), describe the proposals received under clauses (i) and (ii) of subparagraph (A) and explain which proposals were included in the publication described in subparagraph (B), which proposals were not included in that publication, and the reasons for the rejection of the proposals that were not included. (2) Criteria for modifying and establishing safe harbors.-- In modifying and establishing safe harbors under paragraph (1)(B), the Secretary may consider the extent to which providing a safe harbor for the specified payment practice may result in any of the following: (A) An increase or decrease in access to health care services. (B) An increase or decrease in the quality of health care services. (C) An increase or decrease in patient freedom of choice among health care providers. (D) An increase or decrease in competition among health care providers. (E) An increase or decrease in the ability of health care facilities to provide services in medically underserved areas or to medically underserved populations. (F) An increase or decrease in the cost to Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)). (G) An increase or decrease in the potential overutilization of health care services. (H) The existence or nonexistence of any potential financial benefit to a health care professional or provider which may vary based on their decisions of-- (i) whether to order a health care item or service; or (ii) whether to arrange for a referral of health care items or services to a particular practitioner or provider. (I) Any other factors the Secretary deems appropriate in the interest of preventing fraud and abuse in Federal health care programs (as so defined). (b) Interpretive Rulings.-- (1) In general.-- (A) Request for interpretive ruling.--Any person may present, at any time, a request to the Inspector General for a statement of the Inspector General's current interpretation of the meaning of a specific aspect of the application of sections 1128A and 1128B of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as an ``interpretive ruling''). (B) Issuance and effect of interpretive ruling.-- (i) In general.--If appropriate, the Inspector General shall in consultation with the Attorney General, issue an interpretive ruling not later than 120 days after receiving a request described in subparagraph (A). Interpretive rulings shall not have the force of law and shall be treated as an interpretive rule within the meaning of section 553(b) of title 5, United States Code. All interpretive rulings issued pursuant to this clause shall be published in the Federal Register or otherwise made available for public inspection. (ii) Reasons for denial.--If the Inspector General does not issue an interpretive ruling in response to a request described in subparagraph (A), the Inspector General shall notify the requesting party of such decision not later than 120 days after receiving such a request and shall identify the reasons for such decision. (2) Criteria for interpretive rulings.-- (A) In general.--In determining whether to issue an interpretive ruling under paragraph (1)(B), the Inspector General may consider-- (i) whether and to what extent the request identifies an ambiguity within the language of the statute, the existing safe harbors, or previous interpretive rulings; and (ii) whether the subject of the requested interpretive ruling can be adequately addressed by interpretation of the language of the statute, the existing safe harbor rules, or previous interpretive rulings, or whether the request would require a substantive ruling (as defined in section 552 of title 5, United States Code) not authorized under this subsection. (B) No rulings on factual issues.--The Inspector General shall not give an interpretive ruling on any factual issue, including the intent of the parties or the fair market value of particular leased space or equipment. (c) Special Fraud Alerts.-- (1) In general.-- (A) Request for special fraud alerts.--Any person may present, at any time, a request to the Inspector General for a notice which informs the public of practices which the Inspector General considers to be suspect or of particular concern under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) (in this subsection referred to as a ``special fraud alert''). (B) Issuance and publication of special fraud alerts.--Upon receipt of a request described in subparagraph (A), the Inspector General shall investigate the subject matter of the request to determine whether a special fraud alert should be issued. If appropriate, the Inspector General shall issue a special fraud alert in response to the request. All special fraud alerts issued pursuant to this subparagraph shall be published in the Federal Register. (2) Criteria for special fraud alerts.--In determining whether to issue a special fraud alert upon a request described in paragraph (1),

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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)

Text of this article available as: TXT PDF [Pages S15852-S15971] [[Page S15852]] AMENDMENTS SUBMITTED ______ THE BALANCED BUDGET RECONCILIATION ACT OF 1995 ______ KENNEDY (AND OTHERS) AMENDMENT NO. 2959 Mr. KENNEDY (for himself, Mr. Simon, Mr. Pell, Mr. Dodd, Mr. Harkin, Ms. Mikulski, Mr. Wellstone, Mrs. Feinstein, Mrs. Murray, Mr. Kohl, Mr. Baucus, Mr. Bingaman, and Mr. Ford) proposed an amendment to the bill (S. 1357) to provide for reconciliation pursuant to section 105 of the concurrent resolution on the budget for fiscal year 1996; as follows: On page 1409, beginning with line 8, strike all through page 1410, line 25. On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1425, line 16. Strike chapter 3 of subtitle B of title XII. ______ HUTCHISON (AND OTHERS) AMENDMENT NO. 2960 (Ordered to lie on the table.) Mrs. Hutchison (for herself, Mr. McCain, Mr. Lieberman, Mr. Stevens, and Mr. Levin) submitted an amendment intended to be proposed by them to the bill S. 1357, supra; as follows: At the appropriate place, insert the following: (a) The Senate makes the following findings: (1) Human rights violations and atrocities continue unabated in the Former Yugoslavia. (2) The Assistant Secretary of State for Human Rights recently reported that starting in mid-September and intensifying between October 6 and October 12, 1995 many thousands of Bosnian Muslims and Croats in Northwest Bosnia were systematically forced from their homes by paramilitary units, local police and in some instances, Bosnian Serb Army officials and soldiers. (3) Despite the October 12, 1995 cease-fire which went into effect by agreement of the warring parties in the former Yugoslavia, Bosnian Serbs continue to conduct a brutal campaign to expel non-Serb civilians who remain in Northwest Bosnia, and are subjecting non-Serbs to untold horror-- murder, rape, robbery and other violence. (4) Horrible examples of ``ethnic cleansing'' persist in Northwest Bosnia. Some six thousand refugees recently reached Zenica and reported that nearly two thousand family members from this group are still unaccounted for. (5) The UN spokesman in Zagreb reported that many refugees have been given only a few minutes to leave their homes and that ``girls as young as 17 are reported to have been taken into wooded areas and raped.'' Elderly, sick and very young refugees have been driven to remote areas and forced to walk long distances on unsafe roads and cross rivers without bridges. (6) The War Crime Tribunal for the former Yugoslavia has collected volumes of evidence of atrocities, including the establishment of death camps, mass executions and systematic campaigns of rape and terror. This War Crimes Tribunal has already issued 43 indictments on the basis of this evidence. (7) The Assistant Secretary of State for Human Rights has described the eye witness accounts as ``prima facie evidence of war crimes which, if confirmed, could very well lead to further indictments by the War Crimes Tribunal.'' (8) The U.N. High Commissioner for Refugees estimates that more than 22,000 Muslims and Croats have been forced from their homes since mid-September in Bosnian Serb controlled areas. (9) In opening the Dodd Center Symposium on the topic of ``50 Years After Nuremburg'' on October 16, 1995, President Clinton cited the ``excellent progress'' of the War Crimes Tribunal for the former Yugoslavia and said, ``Those accused of war crimes, crimes against humanity and genocide must be brought to justice. They must be tried and, if found guilty, they must be held accountable.'' (10) President Clinton also observed on October 16, 1995, ``some people are concerned that pursuing peace in Bosnia and prosecuting war criminals are incompatible goals. But I believe they are wrong. There must be peace for justice to prevail, but there must be justice when peace prevails. (b) Sense of the Senate.--It is the sense of the Senate that-- (1) the Senate condemns the systematic human rights abuses against the people of Bosnia and Herzogovenia. (2) with peace talks scheduled to begin in the United States on October 31, 1995, and with the President clearly indicating his willingness to send American forces into the heart of this conflict, these new reports of Serbian atrocities are of grave concern to all Americans. (3) the Bosnian Serb leadership should immediately halt these atrocities, fully account for the missing, and allow those who have been separated to return to their families. (4) the International Red Cross, United Nations agencies and human rights organizations should be granted full and complete access to all locations throughout Bosnia and Herzogovenia. (5) the Bosnian Serb leadership should fully cooperate to facilitate the complete investigation of the above allegations so that those responsible may be held accountable under international treaties, conventions, obligations and law. (6) the United States should continue to support the work of the War Crime Tribunal for the Former Yugoslavia. (7) the United States should ensure that any negotiated peace agreements in former Yugoslavia, particularly with respect to Bosnia, require all states of the former Yugoslavia to corporate fully with the War Crimes Tribunal and apprehend and turn over for trial any indicated persons found in their territories. (8) ethnic cleansing by any faction, group, leader, or government is unjustified, immoral and illegal and all perpetrators of war crimes, crimes against humanity, genocide and other human rights violations in former Yugoslavia must be held accountable. ______ BAUCUS AMENDMENT NO. 2961 (Ordered to lie on the table.) Mr. BAUCUS submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: Strike section 1105(4)(B)(iii). ______ KASSEBAUM (AND OTHERS) AMENDMENT NO. 2962 Mrs. KASSEBAUM (for herself, Ms. Snowe, Mr. Jeffords, Mr. Coats, Mr. Gregg, Mr. Frist, Mr. DeWine, Mr. Ashcroft, Mr. Abraham, Mr. Gorton, Mr. Pressler, Mr. Roth, Mr. Domenici, Mr. Stevens, Mr. Specter, Mr. Cohen, Mr. Chafee, and Mr. Baucus) proposed an amendment to the bill S. 1357, supra; as follows: On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1426, line 9. ______ BREAUX (AND KERRY) AMENDMENT NO. 2963 Mr. BREAUX (for himself and Mr. Kerry) proposed an amendment to the bill S. 1357, supra; as follows: On page 1469, beginning on line 2, strike all through page 1471, line 20, and insert the following: SEC. 12001. CHILD TAX CREDIT. (a) In General.--Subpart C of part IV of subchapter A of chapter 1 is amended by redesignating section 35 as section 36 and by inserting after section 34 the following new section: ``SEC. 35. CHILD TAX CREDIT. ``(a) Allowance of Credit.-- ``(1) General rule.--There shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to $500 multiplied by the number of qualifying children of the taxpayer. ``(2) Limitation based on amount of tax.--The credit allowed by paragraph (1) for a taxable year shall not exceed the sum of-- ``(A) the tax imposed by this subtitle for the taxable year (reduced by the credits allowable against such tax other than the credit allowable under section 32), and ``(B) the taxes imposed by sections 3101 and 3201(a) and 50 percent of the taxes imposed by sections 1401 and 3211(a) for such taxable year. ``(b) Adjusted Gross Income Limitation.--The aggregate amount of the credit which would (but for this subsection) be allowed by subsection (a) shall be reduced (but not below zero) by 20 percent for each $3,000 by which the taxpayer's adjusted gross income exceeds $60,000. ``(c) Qualifying Child.--For purposes of this section-- ``(1) In general.--The term `qualifying child' means any individual if-- ``(A) the taxpayer is allowed a deduction under section 151 with respect to such individual for such taxable year, ``(B) such individual has not attained the age of 16 as of the close of the calendar year in which the taxable year of the taxpayer begins, and ``(C) such individual bears a relationship to the taxpayer described in section 32(c)(3)(B) (determined without regard to clause (ii) thereof). ``(2) Exception for certain noncitizens.--The term `qualifying child' shall not include any individual who would not be a dependent if the first sentence of section 152(b)(3) were applied without regard to all that follows `resident of the United States'. ``(d) Certain Other Rules Apply.--Rules similar to the rules of subsections (d) and (e) of section 32 shall apply for purposes of this section.'' (c) Conforming Amendment.--The table of sections for such subpart C is amended by striking the item relating to section 35 and inserting the following new items: ``Sec. 35. Child tax credit. ``Sec. 36. Overpayments of tax.'' (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995. ______ [[Page S15853]] McCAIN (AND OTHERS) AMENDMENT NO. 2964 Mr. McCAIN (for himself, Mr. Dole, Mr. Coats, and Mr. Nickles) proposed an amendment to the bill S. 1357, supra; as follows: At the appropriate place in the Act, add the following: Sec. . Sense of the Senate.--The Senate finds that-- (a) The Senate has held hearings on the social security earnings limit in 1994 and 1995 and the House has held two hearings on the social security earnings limit in 1995; (b) The Senate has overwhelmingly passed Sense of the Senate language calling for substantial reform of the social security earnings limit; (c) The House of Representatives has overwhelmingly passed legislation to raise the exempt amount under the social security earnings limit three times, in 1989, 1992, and 1995; (d) Such legislation is a key provision of the Contract with America; (e) The President in his 1992 campaign document ``Putting People First'' pledged to lift the social security earnings limit; (f) The social security earnings limit is a depression-era relic that unfairly punishes working seniors; therefore, (g) It is the intent of the Congress that legislation will be passed before the end of 1995 to raise the social security earnings limit for working seniors aged 65 through 69 in a manner which will ensure the financial integrity of the social security trust funds and will be consistent with the goal of achieving a balanced budget in 7 years. ______ HELMS AMENDMENT NO. 2965 Mr. HELMS proposed an amendment to the bill S. 1357, supra; as follows: On page 461, line 13, after the period, insert the following: ``(3) Point-of-service coverage.--If a Medicare Choice sponsor offers a Medicare Choice plan that limits benefits to items and services furnished only by providers in a network of providers which have entered into a contract with the sponsors, the sponsor must also offer at the time of enrollment, a Medicare Choice plan that permits payment to be made under the plan for covered items and services when obtained out-of-network by the individual.'' ______ CAMPBELL (AND BROWN) AMENDMENTS NOS. 2966-2967 (Ordered to lie on the table.) Mr. CAMPBELL (for himself and Mr. Brown) submitted two amendments intended to be proposed by them to the bill S. 1357, supra; as follows: Amendment No. 2966 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C.1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ____________.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ____ Amendment No. 2968 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C. 1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. [[Page S15854]] ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ______.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ______ McCAIN AMENDMENT NO. 2968 (Ordered to lie on the table.) Mr. McCain submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: On page 696, between lines 8 and 9, insert the following: SEC. 7116A. MEDICARE WHISTLEBLOWER INCENTIVE. (a) Purpose.--The purpose of this section is to-- (1) reduce and eliminate fraud and abuse under the medicare program; (2) reduce negligent and fraudulent medicare billings by providers; (3) provide medicare beneficiaries with incentives to report inappropriate billing practices; and (4) provide savings to the medicare trust funds by increasing the recovery of medicare overpayments. (b) Request for Itemized Bill for Medicare Items and Services.-- (1) In general.--Section 1128A (42 U.S.C. 1320a-7a), as amended by section 7131(a)(4), is further amended by adding at the end the following new subsection: ``(n) Written Request for Itemized Bill.-- ``(1) In general.--A beneficiary may submit a written request for an itemized bill for medical or other items or services provided to such beneficiary by any person (including an organization, agency, or other entity) that receives payment under title XVIII for providing such items or services to such beneficiary. ``(2) 30-day period to receive bill.-- ``(A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been received, a person described in such paragraph shall furnish an itemized bill describing each medical or other item or service provided to the beneficiary requesting the itemized bill. ``(B) Penalty.--Whoever knowingly fails to furnish an itemized bill in accordance with subparagraph (A) shall be subject to a civil fine of not more than $100 for each such failure. ``(3) Review of itemized bill.-- ``(A) In general.--Not later than 90 days after the receipt of an itemized bill furnished under paragraph (1), a beneficiary may submit a written request for a review of the itemized bill to the appropriate fiscal intermediary or carrier with a contract under section 1816 or 1842. ``(B) Specific allegations.--A request for a review of the itemized bill shall identify-- ``(i) specific medical or other items or services that the beneficiary believes were not provided as claimed, or ``(ii) any other billing irregularity (including duplicate billing). ``(4) Findings of fiscal intermediary or carrier.--Each fiscal intermediary or carrier with a contract under section 1816 or 1842 shall, with respect to each written request submitted to the fiscal intermediary or carrier under paragraph (3), determine whether the itemized bill identifies specific medical or other items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under title XVIII. ``(5) Recovery of amounts.--The Secretary shall require fiscal intermediaries and carriers to take all appropriate measures to recover amounts unnecessarily paid under title XVIII with respect to a bill described in paragraph (4). ``(6) Incentive payments.-- ``(A) In general.--If the fiscal intermediary or carrier recovers amounts in accordance with paragraph (5), the Secretary shall make an incentive payment (in an amount determined under subparagraph (B)) to the beneficiary who submitted the request for the itemized bill under paragraph (1) that resulted in such recovery. No incentive payment shall be made under this subparagraph unless such recovery is made after a final determination on whether such recovered amounts are required to be repaid by the provider. ``(B) Incentive payment determined.-- ``(i) In general.--The amount of the incentive payment determined under this subparagraph is equal to the lesser of-- ``(I) 1 percent of the amount that the bill overcharged for medical or other items or services; or ``(II) $10,000. ``(ii) Limitation of amount.--The amount determined under this subparagraph may not exceed the total amounts recovered with respect to the bill in accordance with paragraph (5). ``(7) Prevention of abuse by beneficiaries.--The Secretary shall-- ``(A) address abuses of the incentive system established under this subsection; and ``(B) establish appropriate procedures to prevent such abuses. ``(8) Requirement that beneficiary discover inaccurate bill to receive incentive payment.--No incentive payment shall be made under paragraph (6) to a beneficiary if the Secretary or the appropriate fiscal intermediary or carrier identified the bill that was the subject of the beneficiary's request for review under this subsection as being overpaid prior to such request.''. (2) Effective date.--The amendments made by this section shall apply with respect to medical or other items or services provided on or after January 1, 1996. Mr. McCAIN. Mr. President, earlier this session, I introduced S. 1325, the Medicare Whistleblower Act of 1995, to reduce provider fraud and abuse in the Medicare Program. The amendment I am submitting today improves upon that bill, and provides a strong incentive for beneficiaries to identify overpayments made by Medicare. An Abraham amendment which passed today, and which I supported, takes a similar approach to achieve this same objective. However, my amendment is preferable because it specifically delineates the whistleblower reward process and does not give the Secretary of HHS discretion not to make incentive payments. I hope that the conferees will adopt this amendment. At Medicare town meetings throughout Arizona, I have heard over and over from senior citizens that the Medicare Program is rampant with inaccurate billings. They have told me, based on their personal experiences, that their Medicare bills frequently include services that they have not received, double billings for the same service, or charges that are disproportionate to the value of services received. Often, they have no idea what Medicare is being billed for on their behalf, and they are not able to obtain explanations from providers. The perceptions of Medicare beneficiaries are confirmed by more systematic analyses. The General Accounting Office has estimated that fraud and abuse in our Nation's health care system costs taxpayers as much as $100 billion each year. Medicare fraud alone costs about $17 billion per year, which is 10 percent of the program's costs. A report by the Republican staff of the Senate Committee on Aging has documented a broad array of fraudulent activities, including false claims for services that were supposed to have been rendered after the beneficiaries had died. The Medicare Program has many problems. A fundamental problem, and the source of many other problems, is that too few people are adequately concerned about its costs because the Government is paying most of the bills. One constituent informed me of a situation in which his provider double-billed for the same service and told him not to worry about it because Medicare is paying. This is an outrage and must be stopped. When Medicare overpays, we all overpay, and costs to beneficiaries and other taxpayers spiral. This amendment addresses this fundamental problem of the Medicare Program. It gives beneficiaries an added incentive to carefully scrutinize their bills and to actively pursue corrections when they believe that there has been inappropriate billing of Medicare. In particular, beneficiaries would be financially rewarded if they uncover negligence or fraud to the benefit of us all. Although such provider fraud is not the entire problem, and there is other legislation that I support which also addresses beneficiary fraud, studies [[Page S15855]] clearly indicate that provider fraud is most prevalent and the greatest concern. The major problem with our current approach to detecting Medicare fraud is that it relies primarily upon bureaucrats who have no firsthand knowledge of what services were provided to a beneficiary and who have extremely limited time and resources to investigate. This approach can be expected to discover only the most apparent fraudulent activities. To discover most fraud, we must obtain the full cooperation of those who know what occurred at providers' offices and who have the time to pursue fraud--the beneficiaries. All they need is the ability and incentive to scrutinize their bills and actively correct inaccuracies. Under this amendment, beneficiaries would have a right to receive in writing from their providers, within 30 days of when their request is received, an itemized bill for Medicare services provided to them. The beneficiary would then have 90 days to raise specific allegations of inappropriate billings to Medicare. The Medicare intermediaries and carriers would then have to review the bills and determine whether an overpayment has been made which must be reimbursed to the Medicare program. The beneficiary would receive a reward of 1 percent of the overpayment reimbursed up to $10,000. Because these rewards would be paid directly out of the overpayments, they would not increase costs to the Federal Government. There are several important safeguards built into this legislation. The Secretary would be required to establish appropriate procedures to ensure that the incentive system is not abused by overzealous beneficiaries. An incentive payment would be awarded only to the extent that HCFA is able to recover the overpayment from the provider, and there would be no incentive payment if HCFA can demonstrate that it-- for its Medicare intermediary or carrier--has identified the overpayment prior to receiving the beneficiary's complaint. Some will argue that many seniors and other beneficiaries do not need personal rewards for fighting fraud, and in any event, this is a matter of national duty. While I agree with this contention, I also recognize that these individuals would not be able to identify and report fraud without having access to the itemized bills that this legislation provides. Moreover, I see nothing wrong with giving beneficiaries an added financial incentive. After all, we pay Federal employees for ideas that save the taxpayers money, and we pay private citizens for identifying fraud by defense contractors. Mr. President, there is no inconsistency between this amendment and the Abraham amendment which passed today. Their objectives are entirely compatible. However, the Abraham amendment effectively delegates responsibility for planning the whistleblower program to the Secretary of HHS. I strongly believe that we should fulfill our legislative responsibility by specifying the parameters of this important antifraud program. Otherwise, we should not be surprised if we end up with something that we had not contemplated and which does not satisfy our objective. Mr. President, I will not request a vote on this amendment, because we have already had a vote on the Abraham amendment. However, for the reasons that I outlined, I hope that the conferees will agree that this is a preferable whistleblower provision and that they will adopt it in the conference report. In so doing, I believe that the conferees should retain the provisions of the Abraham amendment that reward individuals for ideas that improve Medicare. ______ BROWN (AND OTHERS) AMENDMENT NO. 2969 Mr. BROWN (for himself, Mr. Abraham, Mr. Santorum, Mr. McCain, and Mr. Craig) proposed an amendment to the bill S. 1357, supra; as follows: At the end of chapter 8 of subtitle I of title XII, insert the following: SEC. . $1,000,000 COMPENSATION DEDUCTION LIMIT EXTENDED TO ALL EMPLOYEES OF ALL CORPORATIONS. (a) In General.--Section 162(m) is amended-- (1) by striking ``publicly held corporation'' in paragraph (1) and inserting ``taxpayer (other than personal service corporations)'', (2) by striking ``covered employee'' each place it appears in paragraphs (1) and (4) and inserting ``employee'', and (3) by striking paragraphs (2) and (3) and redesignating paragraph (4) as paragraph (3). (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995, except that there shall not be taken into account with respect to any employee to whom section 162(m) of the Internal Revenue Code of 1986 applies solely by reason of such amendments remuneration payable under a written binding contract which was in effect on October 25, 1995, and which was not modified thereafter in any material respect before such remuneration is paid. (c) Use of Revenues.--Notwithstanding any other provision of law, the Commissioner of Social Security shall increase the earnings limit otherwise determined for each year under section 203 of the Social Security Act (42 U.S.C. 403) by an amount which takes into account the increase in revenues for such year as estimated by the Secretary of the Treasury resulting from the amendment to section 162(m)(3) of the Internal Revenue Code of 1986 made by the Balanced Budget Reconciliation Act of 1995. ______ HARKIN (AND OTHERS) AMENDMENT NO. 2970 Mr. HARKIN (for himself, Mr. Graham, and Mr. Biden) proposed an amendment to the bill S. 1357, supra; as follows: Strike Chapter 6 of Title VII except for the text of amendment number 2950 as passed by the Senate and insert in lieu thereof, the following: CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION SEC. 7100. SHORT TITLE. This chapter may be cited as the ``Health Care Fraud and Abuse Prevention Act of 1995''. Subchapter A--Fraud and Abuse Control Program SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM. (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128B the following new section: ``FRAUD AND ABUSE CONTROL PROGRAM ``Sec. 1128C. (a) Establishment of Program.-- ``(1) In general.--Not later than January 1, 1996, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall establish a program-- ``(A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States, ``(B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States, ``(C) to facilitate the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to health care fraud and abuse, and ``(D) to provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts pursuant to section 1128D. ``(2) Coordination with health plans.--In carrying out the program established under paragraph (1), the Secretary and the Attorney General shall consult with, and arrange for the sharing of data with representatives of health plans. ``(3) Guidelines.-- ``(A) In general.--The Secretary and the Attorney General shall issue guidelines to carry out the program under paragraph (1). The provisions of sections 553, 556, and 557 of title 5, United States Code, shall not apply in the issuance of such guidelines. ``(B) Information guidelines.-- ``(i) In general.--Such guidelines shall include guidelines relating to the furnishing of information by health plans, providers, and others to enable the Secretary and the Attorney General to carry out the program (including coordination with health plans under paragraph (2)). ``(ii) Confidentiality.--Such guidelines shall include procedures to assure that such information is provided and utilized in a manner that appropriately protects the confidentiality of the information and the privacy of individuals receiving health care services and items. ``(iii) Qualified immunity for providing information.--The provisions of section 1157(a) (relating to limitation on liability) shall apply to a person providing information to the Secretary or the Attorney General in conjunction with their performance of duties under this section. ``(4) Ensuring access to documentation.--The Inspector General of the Department of Health and Human Services is authorized to exercise such authority described in paragraphs (3) through (9) of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.) as necessary with respect to the activities under the fraud and abuse control program established under this subsection. [[Page S15856]] ``(5) Authority of inspector general.--Nothing in this Act shall be construed to diminish the authority of any Inspector General, including such authority as provided in the Inspector General Act of 1978 (5 U.S.C. App.). ``(b) Additional Use of Funds by Inspector General.-- ``(1) Reimbursements for investigations.--The Inspector General of the Department of Health and Human Services is authorized to receive and retain for current use reimbursement for the costs of conducting investigations and audits and for monitoring compliance plans when such costs are ordered by a court, voluntarily agreed to by the payer, or otherwise. ``(2) Crediting.--Funds received by the Inspector General under paragraph (1) as reimbursement for costs of conducting investigations shall be deposited to the credit of the appropriation from which initially paid, or to appropriations for similar purposes currently available at the time of deposit, and shall remain available for obligation for 1 year from the date of the deposit of such funds. ``(c) Health Plan Defined.--For purposes of this section, the term `health plan' means a plan or program that provides health benefits, whether directly, through insurance, or otherwise, and includes-- ``(1) a policy of health insurance; ``(2) a contract of a service benefit organization; and ``(3) a membership agreement with a health maintenance organization or other prepaid health plan.''. (b) Establishment of Health Care Fraud and Abuse Control Account in Federal Hospital Insurance Trust Fund.--Section 1817 (42 U.S.C. 1395i) is amended by adding at the end the following new subsection: ``(k) Health Care Fraud and Abuse Control Account.-- ``(1) Establishment.--There is hereby established in the Trust Fund an expenditure account to be known as the `Health Care Fraud and Abuse Control Account' (in this subsection referred to as the `Account'). ``(2) Appropriated amounts to trust fund.-- ``(A) In general.--There are hereby appropriated to the Trust Fund-- ``(i) such gifts and bequests as may be made as provided in subparagraph (B); ``(ii) such amounts as may be deposited in the Trust Fund as provided in sections 7141(b) and 7142(c) of the Balanced Budget Reconciliation Act of 1995, and title XI; and ``(iii) such amounts as are transferred to the Trust Fund under subparagraph (C). ``(B) Authorization to accept gifts.--The Trust Fund is authorized to accept on behalf of the United States money gifts and bequests made unconditionally to the Trust Fund, for the benefit of the Account or any activity financed through the Account. ``(C) Transfer of amounts.--The Managing Trustee shall transfer to the Trust Fund, under rules similar to the rules in section 9601 of the Internal Revenue Code of 1986, an amount equal to the sum of the following: ``(i) Criminal fines recovered in cases involving a Federal health care offense (as defined in section 982(a)(6)(B) of title 18, United States Code). ``(ii) Civil monetary penalties and assessments imposed in health care cases, including amounts recovered under titles XI, XVIII, and XXI, and chapter 38 of title 31, United States Code (except as otherwise provided by law). ``(iii) Amounts resulting from the forfeiture of property by reason of a Federal health care offense. ``(iv) Penalties and damages obtained and otherwise creditable to miscellaneous receipts of the general fund of the Treasury obtained under sections 3729 through 3733 of title 31, United States Code (known as the False Claims Act), in cases involving claims related to the provision of health care items and services (other than funds awarded to a relator, for restitution or otherwise authorized by law). ``(3) Appropriated amounts to account.-- ``(A) In general.--There are hereby appropriated to the Account from the Trust Fund such sums as the Secretary and the Attorney General certify are necessary to carry out the purposes described in subparagraph (B), to be available without further appropriation, in an amount-- ``(i) with respect to activities of the Office of the Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigations in carrying out such purposes, not less than-- ``(I) for fiscal year 1996, $110,000,000, ``(II) for fiscal year 1997, $140,000,000, ``(III) for fiscal year 1998, $160,000,000, ``(IV) for fiscal year 1999, $185,000,000, ``(V) for fiscal year 2000, $215,000,000, ``(VI) for fiscal year 2001, $240,000,000, and ``(VII) for fiscal year 2002, $270,000,000; and ``(ii) with respect to all activities (including the activities described in clause (i)) in carrying out such purposes, not more than-- ``(I) for fiscal year 1996, $200,000,000, and ``(II) for each of the fiscal years 1997 through 2002, the limit for the preceding fiscal year, increased by 15 percent; and ``(iii) for each fiscal year after fiscal year 2002, within the limits for fiscal year 2002 as determined under clauses (i) and (ii). ``(B) Use of funds.--The purposes described in this subparagraph are as follows: ``(i) General use.--To cover the costs (including equipment, salaries and benefits, and travel and training) of the administration and operation of the health care fraud and abuse control program established under section 1128C(a), including the costs of-- ``(I) prosecuting health care matters (through criminal, civil, and administrative proceedings); ``(II) investigations; ``(III) financial and performance audits of health care programs and operations; ``(IV) inspections and other evaluations; and ``(V) provider and consumer education regarding compliance with the provisions of title XI. ``(ii) Use by state medicaid fraud control units for investigation reimbursements.--To reimburse the various State medicaid fraud control units upon request to the Secretary for the costs of the activities authorized under section 2134(b). ``(4) Annual report.--The Secretary and the Attorney General shall submit jointly an annual report to Congress on the amount of revenue which is generated and disbursed, and the justification for such disbursements, by the Account in each fiscal year.''. SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL HEALTH PROGRAMS. (a) Crimes.-- (1) Social security act.--Section 1128B (42 U.S.C. 1320a- 7b) is amended as follows: (A) In the heading, by striking ``medicare or state health care programs'' and inserting ``federal health care programs''. (B) In subsection (a)(1), by striking ``a program under title XVIII or a State health care program (as defined in section 1128(h))'' and inserting ``a Federal health care program''. (C) In subsection (a)(5), by striking ``a program under title XVIII or a State health care program'' and inserting ``a Federal health care program''. (D) In the second sentence of subsection (a)-- (i) by striking ``a State plan approved under title XIX'' and inserting ``a Federal health care program''; and (ii) by striking ``the State may at its option (notwithstanding any other provision of that title or of such plan)'' and inserting ``the administrator of such program may at its option (notwithstanding any other provision of such program)''. (E) In subsection (b)-- (i) by striking ``and willfully'' each place it appears; (ii) by striking ``$25,000'' each place it appears and inserting ``$50,000''; (iii) by striking ``title XVIII or a State health care program'' each place it appears and inserting ``Federal health care program''; (iv) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind--'' and inserting ``kind with intent to be influenced--''; (v) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (vi) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; (vii) in paragraph (2) in the matter proceeding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''; (viii) by adding at the end of paragraphs (1) and (2) the following sentence: ``A violation exists under this paragraph if one or more purposes of the remuneration is unlawful under this paragraph.''; (ix) by redesignating paragraph (3) as paragraph (4); (x) in paragraph (4) (as redesignated), by striking ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), (2), and (3)''; and (xi) by inserting after paragraph (2) the following new paragraph: ``(3)(A) The Attorney General may bring an action in the district courts to impose upon any person who carries out any activity in violation of this subsection a civil penalty of not less than $25,000 and not more than $50,000 for each such violation, plus three times the total remuneration offered, paid, solicited, or received. ``(B) A violation exists under this paragraph if one or more purposes of the remuneration is unlawful, and the damages shall be the full amount of such remuneration. ``(C) Section 3731 of title 31, United States Code, and the Federal Rules of Civil Procedure shall apply to actions brought under this paragraph. ``(D) The provisions of this paragraph do not affect the availability of other criminal and civil remedies for such violations.''. (F) In subsection (c), by inserting ``(as defined in section 1128(h))'' after ``a State health care program''. (G) By adding at the end the following new subsections: ``(f) For purposes of this section, the term `Federal health care program' means-- ``(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the United States Government; or ``(2) any State health care program, as defined in section 1128(h). ``(g)(1) The Secretary and Administrator of the departments and agencies with a Federal health care program may conduct an investigation or audit relating to violations of this section and claims within the jurisdiction of other Federal departments or agencies if the following conditions are satisfied: [[Page S15857]] ``(A) The investigation or audit involves primarily claims submitted to the Federal health care programs of the department or agency conducting the investigation or audit. ``(B) The Secretary or Administrator of the department or agency conducting the investigation or audit gives notice and an opportunity to participate in the investigation or audit to the Inspector General of the department or agency with primary jurisdiction over the Federal health care programs to which the claims were submitted. ``(2) If the conditions specified in paragraph (1) are fulfilled, the Inspector General of the department or agency conducting the investigation or audit may exercise all powers granted under the Inspector General Act of 1978 with respect to the claims submitted to the other departments or agencies to the same manner and extent as provided in that Act with respect to claims submitted to such departments or agencies.''. (2) Identification of community service opportunities.-- Section 1128B (42 U.S.C. 1320a-7b) is further amended by adding at the end the following new subsection: ``(h) The Secretary may-- ``(1) in consultation with State and local health care officials, identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of an offense under this section, and ``(2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.''. (b) Effective Date.--The amendments made by this section shall take effect on January 1, 1996. SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE. (a) Solicitation and Publication of Modifications to Existing Safe Harbors and New Safe Harbors.-- (1) In general.-- (A) Solicitation of proposals for safe harbors.--Not later than January 1, 1996, and not less than annually thereafter, the Secretary shall publish a notice in the Federal Register soliciting proposals, which will be accepted during a 60-day period, for-- (i) modifications to existing safe harbors issued pursuant to section 14(a) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (42 U.S.C. 1320a-7b note); (ii) additional safe harbors specifying payment practices that shall not be treated as a criminal offense under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) and shall not serve as the basis for an exclusion under section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7)); (iii) interpretive rulings to be issued pursuant to subsection (b); and (iv) special fraud alerts to be issued pursuant to subsection (c). (B) Publication of proposed modifications and proposed additional safe harbors.--After considering the proposals described in clauses (i) and (ii) of subparagraph (A), the Secretary, in consultation with the Attorney General, shall publish in the Federal Register proposed modifications to existing safe harbors and proposed additional safe harbors, if appropriate, with a 60-day comment period. After considering any public comments received during this period, the Secretary shall issue final rules modifying the existing safe harbors and establishing new safe harbors, as appropriate. (C) Report.--The Inspector General of the Department of Health and Human Services (in this section referred to as the ``Inspector General'') shall, in an annual report to Congress or as part of the year-end semiannual report required by section 5 of the Inspector General Act of 1978 (5 U.S.C. App.), describe the proposals received under clauses (i) and (ii) of subparagraph (A) and explain which proposals were included in the publication described in subparagraph (B), which proposals were not included in that publication, and the reasons for the rejection of the proposals that were not included. (2) Criteria for modifying and establishing safe harbors.-- In modifying and establishing safe harbors under paragraph (1)(B), the Secretary may consider the extent to which providing a safe harbor for the specified payment practice may result in any of the following: (A) An increase or decrease in access to health care services. (B) An increase or decrease in the quality of health care services. (C) An increase or decrease in patient freedom of choice among health care providers. (D) An increase or decrease in competition among health care providers. (E) An increase or decrease in the ability of health care facilities to provide services in medically underserved areas or to medically underserved populations. (F) An increase or decrease in the cost to Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)). (G) An increase or decrease in the potential overutilization of health care services. (H) The existence or nonexistence of any potential financial benefit to a health care professional or provider which may vary based on their decisions of-- (i) whether to order a health care item or service; or (ii) whether to arrange for a referral of health care items or services to a particular practitioner or provider. (I) Any other factors the Secretary deems appropriate in the interest of preventing fraud and abuse in Federal health care programs (as so defined). (b) Interpretive Rulings.-- (1) In general.-- (A) Request for interpretive ruling.--Any person may present, at any time, a request to the Inspector General for a statement of the Inspector General's current interpretation of the meaning of a specific aspect of the application of sections 1128A and 1128B of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as an ``interpretive ruling''). (B) Issuance and effect of interpretive ruling.-- (i) In general.--If appropriate, the Inspector General shall in consultation with the Attorney General, issue an interpretive ruling not later than 120 days after receiving a request described in subparagraph (A). Interpretive rulings shall not have the force of law and shall be treated as an interpretive rule within the meaning of section 553(b) of title 5, United States Code. All interpretive rulings issued pursuant to this clause shall be published in the Federal Register or otherwise made available for public inspection. (ii) Reasons for denial.--If the Inspector General does not issue an interpretive ruling in response to a request described in subparagraph (A), the Inspector General shall notify the requesting party of such decision not later than 120 days after receiving such a request and shall identify the reasons for such decision. (2) Criteria for interpretive rulings.-- (A) In general.--In determining whether to issue an interpretive ruling under paragraph (1)(B), the Inspector General may consider-- (i) whether and to what extent the request identifies an ambiguity within the language of the statute, the existing safe harbors, or previous interpretive rulings; and (ii) whether the subject of the requested interpretive ruling can be adequately addressed by interpretation of the language of the statute, the existing safe harbor rules, or previous interpretive rulings, or whether the request would require a substantive ruling (as defined in section 552 of title 5, United States Code) not authorized under this subsection. (B) No rulings on factual issues.--The Inspector General shall not give an interpretive ruling on any factual issue, including the intent of the parties or the fair market value of particular leased space or equipment. (c) Special Fraud Alerts.-- (1) In general.-- (A) Request for special fraud alerts.--Any person may present, at any time, a request to the Inspector General for a notice which informs the public of practices which the Inspector General considers to be suspect or of particular concern under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) (in this subsection referred to as a ``special fraud alert''). (B) Issuance and publication of special fraud alerts.--Upon receipt of a request described in subparagraph (A), the Inspector General shall investigate the subject matter of the request to determine whether a special fraud alert should be issued. If appropriate, the Inspector General shall issue a special fraud alert in response to the request. All special fraud alerts issued pursuant to this subparagraph shall be published in the Federal Register. (2) Criteria for special fraud alerts.--In determining whether to issue a special fraud alert upon a request described in para

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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)

Text of this article available as: TXT PDF [Pages S15852-S15971] [[Page S15852]] AMENDMENTS SUBMITTED ______ THE BALANCED BUDGET RECONCILIATION ACT OF 1995 ______ KENNEDY (AND OTHERS) AMENDMENT NO. 2959 Mr. KENNEDY (for himself, Mr. Simon, Mr. Pell, Mr. Dodd, Mr. Harkin, Ms. Mikulski, Mr. Wellstone, Mrs. Feinstein, Mrs. Murray, Mr. Kohl, Mr. Baucus, Mr. Bingaman, and Mr. Ford) proposed an amendment to the bill (S. 1357) to provide for reconciliation pursuant to section 105 of the concurrent resolution on the budget for fiscal year 1996; as follows: On page 1409, beginning with line 8, strike all through page 1410, line 25. On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1425, line 16. Strike chapter 3 of subtitle B of title XII. ______ HUTCHISON (AND OTHERS) AMENDMENT NO. 2960 (Ordered to lie on the table.) Mrs. Hutchison (for herself, Mr. McCain, Mr. Lieberman, Mr. Stevens, and Mr. Levin) submitted an amendment intended to be proposed by them to the bill S. 1357, supra; as follows: At the appropriate place, insert the following: (a) The Senate makes the following findings: (1) Human rights violations and atrocities continue unabated in the Former Yugoslavia. (2) The Assistant Secretary of State for Human Rights recently reported that starting in mid-September and intensifying between October 6 and October 12, 1995 many thousands of Bosnian Muslims and Croats in Northwest Bosnia were systematically forced from their homes by paramilitary units, local police and in some instances, Bosnian Serb Army officials and soldiers. (3) Despite the October 12, 1995 cease-fire which went into effect by agreement of the warring parties in the former Yugoslavia, Bosnian Serbs continue to conduct a brutal campaign to expel non-Serb civilians who remain in Northwest Bosnia, and are subjecting non-Serbs to untold horror-- murder, rape, robbery and other violence. (4) Horrible examples of ``ethnic cleansing'' persist in Northwest Bosnia. Some six thousand refugees recently reached Zenica and reported that nearly two thousand family members from this group are still unaccounted for. (5) The UN spokesman in Zagreb reported that many refugees have been given only a few minutes to leave their homes and that ``girls as young as 17 are reported to have been taken into wooded areas and raped.'' Elderly, sick and very young refugees have been driven to remote areas and forced to walk long distances on unsafe roads and cross rivers without bridges. (6) The War Crime Tribunal for the former Yugoslavia has collected volumes of evidence of atrocities, including the establishment of death camps, mass executions and systematic campaigns of rape and terror. This War Crimes Tribunal has already issued 43 indictments on the basis of this evidence. (7) The Assistant Secretary of State for Human Rights has described the eye witness accounts as ``prima facie evidence of war crimes which, if confirmed, could very well lead to further indictments by the War Crimes Tribunal.'' (8) The U.N. High Commissioner for Refugees estimates that more than 22,000 Muslims and Croats have been forced from their homes since mid-September in Bosnian Serb controlled areas. (9) In opening the Dodd Center Symposium on the topic of ``50 Years After Nuremburg'' on October 16, 1995, President Clinton cited the ``excellent progress'' of the War Crimes Tribunal for the former Yugoslavia and said, ``Those accused of war crimes, crimes against humanity and genocide must be brought to justice. They must be tried and, if found guilty, they must be held accountable.'' (10) President Clinton also observed on October 16, 1995, ``some people are concerned that pursuing peace in Bosnia and prosecuting war criminals are incompatible goals. But I believe they are wrong. There must be peace for justice to prevail, but there must be justice when peace prevails. (b) Sense of the Senate.--It is the sense of the Senate that-- (1) the Senate condemns the systematic human rights abuses against the people of Bosnia and Herzogovenia. (2) with peace talks scheduled to begin in the United States on October 31, 1995, and with the President clearly indicating his willingness to send American forces into the heart of this conflict, these new reports of Serbian atrocities are of grave concern to all Americans. (3) the Bosnian Serb leadership should immediately halt these atrocities, fully account for the missing, and allow those who have been separated to return to their families. (4) the International Red Cross, United Nations agencies and human rights organizations should be granted full and complete access to all locations throughout Bosnia and Herzogovenia. (5) the Bosnian Serb leadership should fully cooperate to facilitate the complete investigation of the above allegations so that those responsible may be held accountable under international treaties, conventions, obligations and law. (6) the United States should continue to support the work of the War Crime Tribunal for the Former Yugoslavia. (7) the United States should ensure that any negotiated peace agreements in former Yugoslavia, particularly with respect to Bosnia, require all states of the former Yugoslavia to corporate fully with the War Crimes Tribunal and apprehend and turn over for trial any indicated persons found in their territories. (8) ethnic cleansing by any faction, group, leader, or government is unjustified, immoral and illegal and all perpetrators of war crimes, crimes against humanity, genocide and other human rights violations in former Yugoslavia must be held accountable. ______ BAUCUS AMENDMENT NO. 2961 (Ordered to lie on the table.) Mr. BAUCUS submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: Strike section 1105(4)(B)(iii). ______ KASSEBAUM (AND OTHERS) AMENDMENT NO. 2962 Mrs. KASSEBAUM (for herself, Ms. Snowe, Mr. Jeffords, Mr. Coats, Mr. Gregg, Mr. Frist, Mr. DeWine, Mr. Ashcroft, Mr. Abraham, Mr. Gorton, Mr. Pressler, Mr. Roth, Mr. Domenici, Mr. Stevens, Mr. Specter, Mr. Cohen, Mr. Chafee, and Mr. Baucus) proposed an amendment to the bill S. 1357, supra; as follows: On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1426, line 9. ______ BREAUX (AND KERRY) AMENDMENT NO. 2963 Mr. BREAUX (for himself and Mr. Kerry) proposed an amendment to the bill S. 1357, supra; as follows: On page 1469, beginning on line 2, strike all through page 1471, line 20, and insert the following: SEC. 12001. CHILD TAX CREDIT. (a) In General.--Subpart C of part IV of subchapter A of chapter 1 is amended by redesignating section 35 as section 36 and by inserting after section 34 the following new section: ``SEC. 35. CHILD TAX CREDIT. ``(a) Allowance of Credit.-- ``(1) General rule.--There shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to $500 multiplied by the number of qualifying children of the taxpayer. ``(2) Limitation based on amount of tax.--The credit allowed by paragraph (1) for a taxable year shall not exceed the sum of-- ``(A) the tax imposed by this subtitle for the taxable year (reduced by the credits allowable against such tax other than the credit allowable under section 32), and ``(B) the taxes imposed by sections 3101 and 3201(a) and 50 percent of the taxes imposed by sections 1401 and 3211(a) for such taxable year. ``(b) Adjusted Gross Income Limitation.--The aggregate amount of the credit which would (but for this subsection) be allowed by subsection (a) shall be reduced (but not below zero) by 20 percent for each $3,000 by which the taxpayer's adjusted gross income exceeds $60,000. ``(c) Qualifying Child.--For purposes of this section-- ``(1) In general.--The term `qualifying child' means any individual if-- ``(A) the taxpayer is allowed a deduction under section 151 with respect to such individual for such taxable year, ``(B) such individual has not attained the age of 16 as of the close of the calendar year in which the taxable year of the taxpayer begins, and ``(C) such individual bears a relationship to the taxpayer described in section 32(c)(3)(B) (determined without regard to clause (ii) thereof). ``(2) Exception for certain noncitizens.--The term `qualifying child' shall not include any individual who would not be a dependent if the first sentence of section 152(b)(3) were applied without regard to all that follows `resident of the United States'. ``(d) Certain Other Rules Apply.--Rules similar to the rules of subsections (d) and (e) of section 32 shall apply for purposes of this section.'' (c) Conforming Amendment.--The table of sections for such subpart C is amended by striking the item relating to section 35 and inserting the following new items: ``Sec. 35. Child tax credit. ``Sec. 36. Overpayments of tax.'' (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995. ______ [[Page S15853]] McCAIN (AND OTHERS) AMENDMENT NO. 2964 Mr. McCAIN (for himself, Mr. Dole, Mr. Coats, and Mr. Nickles) proposed an amendment to the bill S. 1357, supra; as follows: At the appropriate place in the Act, add the following: Sec. . Sense of the Senate.--The Senate finds that-- (a) The Senate has held hearings on the social security earnings limit in 1994 and 1995 and the House has held two hearings on the social security earnings limit in 1995; (b) The Senate has overwhelmingly passed Sense of the Senate language calling for substantial reform of the social security earnings limit; (c) The House of Representatives has overwhelmingly passed legislation to raise the exempt amount under the social security earnings limit three times, in 1989, 1992, and 1995; (d) Such legislation is a key provision of the Contract with America; (e) The President in his 1992 campaign document ``Putting People First'' pledged to lift the social security earnings limit; (f) The social security earnings limit is a depression-era relic that unfairly punishes working seniors; therefore, (g) It is the intent of the Congress that legislation will be passed before the end of 1995 to raise the social security earnings limit for working seniors aged 65 through 69 in a manner which will ensure the financial integrity of the social security trust funds and will be consistent with the goal of achieving a balanced budget in 7 years. ______ HELMS AMENDMENT NO. 2965 Mr. HELMS proposed an amendment to the bill S. 1357, supra; as follows: On page 461, line 13, after the period, insert the following: ``(3) Point-of-service coverage.--If a Medicare Choice sponsor offers a Medicare Choice plan that limits benefits to items and services furnished only by providers in a network of providers which have entered into a contract with the sponsors, the sponsor must also offer at the time of enrollment, a Medicare Choice plan that permits payment to be made under the plan for covered items and services when obtained out-of-network by the individual.'' ______ CAMPBELL (AND BROWN) AMENDMENTS NOS. 2966-2967 (Ordered to lie on the table.) Mr. CAMPBELL (for himself and Mr. Brown) submitted two amendments intended to be proposed by them to the bill S. 1357, supra; as follows: Amendment No. 2966 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C.1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ____________.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ____ Amendment No. 2968 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C. 1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. [[Page S15854]] ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ______.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ______ McCAIN AMENDMENT NO. 2968 (Ordered to lie on the table.) Mr. McCain submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: On page 696, between lines 8 and 9, insert the following: SEC. 7116A. MEDICARE WHISTLEBLOWER INCENTIVE. (a) Purpose.--The purpose of this section is to-- (1) reduce and eliminate fraud and abuse under the medicare program; (2) reduce negligent and fraudulent medicare billings by providers; (3) provide medicare beneficiaries with incentives to report inappropriate billing practices; and (4) provide savings to the medicare trust funds by increasing the recovery of medicare overpayments. (b) Request for Itemized Bill for Medicare Items and Services.-- (1) In general.--Section 1128A (42 U.S.C. 1320a-7a), as amended by section 7131(a)(4), is further amended by adding at the end the following new subsection: ``(n) Written Request for Itemized Bill.-- ``(1) In general.--A beneficiary may submit a written request for an itemized bill for medical or other items or services provided to such beneficiary by any person (including an organization, agency, or other entity) that receives payment under title XVIII for providing such items or services to such beneficiary. ``(2) 30-day period to receive bill.-- ``(A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been received, a person described in such paragraph shall furnish an itemized bill describing each medical or other item or service provided to the beneficiary requesting the itemized bill. ``(B) Penalty.--Whoever knowingly fails to furnish an itemized bill in accordance with subparagraph (A) shall be subject to a civil fine of not more than $100 for each such failure. ``(3) Review of itemized bill.-- ``(A) In general.--Not later than 90 days after the receipt of an itemized bill furnished under paragraph (1), a beneficiary may submit a written request for a review of the itemized bill to the appropriate fiscal intermediary or carrier with a contract under section 1816 or 1842. ``(B) Specific allegations.--A request for a review of the itemized bill shall identify-- ``(i) specific medical or other items or services that the beneficiary believes were not provided as claimed, or ``(ii) any other billing irregularity (including duplicate billing). ``(4) Findings of fiscal intermediary or carrier.--Each fiscal intermediary or carrier with a contract under section 1816 or 1842 shall, with respect to each written request submitted to the fiscal intermediary or carrier under paragraph (3), determine whether the itemized bill identifies specific medical or other items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under title XVIII. ``(5) Recovery of amounts.--The Secretary shall require fiscal intermediaries and carriers to take all appropriate measures to recover amounts unnecessarily paid under title XVIII with respect to a bill described in paragraph (4). ``(6) Incentive payments.-- ``(A) In general.--If the fiscal intermediary or carrier recovers amounts in accordance with paragraph (5), the Secretary shall make an incentive payment (in an amount determined under subparagraph (B)) to the beneficiary who submitted the request for the itemized bill under paragraph (1) that resulted in such recovery. No incentive payment shall be made under this subparagraph unless such recovery is made after a final determination on whether such recovered amounts are required to be repaid by the provider. ``(B) Incentive payment determined.-- ``(i) In general.--The amount of the incentive payment determined under this subparagraph is equal to the lesser of-- ``(I) 1 percent of the amount that the bill overcharged for medical or other items or services; or ``(II) $10,000. ``(ii) Limitation of amount.--The amount determined under this subparagraph may not exceed the total amounts recovered with respect to the bill in accordance with paragraph (5). ``(7) Prevention of abuse by beneficiaries.--The Secretary shall-- ``(A) address abuses of the incentive system established under this subsection; and ``(B) establish appropriate procedures to prevent such abuses. ``(8) Requirement that beneficiary discover inaccurate bill to receive incentive payment.--No incentive payment shall be made under paragraph (6) to a beneficiary if the Secretary or the appropriate fiscal intermediary or carrier identified the bill that was the subject of the beneficiary's request for review under this subsection as being overpaid prior to such request.''. (2) Effective date.--The amendments made by this section shall apply with respect to medical or other items or services provided on or after January 1, 1996. Mr. McCAIN. Mr. President, earlier this session, I introduced S. 1325, the Medicare Whistleblower Act of 1995, to reduce provider fraud and abuse in the Medicare Program. The amendment I am submitting today improves upon that bill, and provides a strong incentive for beneficiaries to identify overpayments made by Medicare. An Abraham amendment which passed today, and which I supported, takes a similar approach to achieve this same objective. However, my amendment is preferable because it specifically delineates the whistleblower reward process and does not give the Secretary of HHS discretion not to make incentive payments. I hope that the conferees will adopt this amendment. At Medicare town meetings throughout Arizona, I have heard over and over from senior citizens that the Medicare Program is rampant with inaccurate billings. They have told me, based on their personal experiences, that their Medicare bills frequently include services that they have not received, double billings for the same service, or charges that are disproportionate to the value of services received. Often, they have no idea what Medicare is being billed for on their behalf, and they are not able to obtain explanations from providers. The perceptions of Medicare beneficiaries are confirmed by more systematic analyses. The General Accounting Office has estimated that fraud and abuse in our Nation's health care system costs taxpayers as much as $100 billion each year. Medicare fraud alone costs about $17 billion per year, which is 10 percent of the program's costs. A report by the Republican staff of the Senate Committee on Aging has documented a broad array of fraudulent activities, including false claims for services that were supposed to have been rendered after the beneficiaries had died. The Medicare Program has many problems. A fundamental problem, and the source of many other problems, is that too few people are adequately concerned about its costs because the Government is paying most of the bills. One constituent informed me of a situation in which his provider double-billed for the same service and told him not to worry about it because Medicare is paying. This is an outrage and must be stopped. When Medicare overpays, we all overpay, and costs to beneficiaries and other taxpayers spiral. This amendment addresses this fundamental problem of the Medicare Program. It gives beneficiaries an added incentive to carefully scrutinize their bills and to actively pursue corrections when they believe that there has been inappropriate billing of Medicare. In particular, beneficiaries would be financially rewarded if they uncover negligence or fraud to the benefit of us all. Although such provider fraud is not the entire problem, and there is other legislation that I support which also addresses beneficiary fraud, studies [[Page S15855]] clearly indicate that provider fraud is most prevalent and the greatest concern. The major problem with our current approach to detecting Medicare fraud is that it relies primarily upon bureaucrats who have no firsthand knowledge of what services were provided to a beneficiary and who have extremely limited time and resources to investigate. This approach can be expected to discover only the most apparent fraudulent activities. To discover most fraud, we must obtain the full cooperation of those who know what occurred at providers' offices and who have the time to pursue fraud--the beneficiaries. All they need is the ability and incentive to scrutinize their bills and actively correct inaccuracies. Under this amendment, beneficiaries would have a right to receive in writing from their providers, within 30 days of when their request is received, an itemized bill for Medicare services provided to them. The beneficiary would then have 90 days to raise specific allegations of inappropriate billings to Medicare. The Medicare intermediaries and carriers would then have to review the bills and determine whether an overpayment has been made which must be reimbursed to the Medicare program. The beneficiary would receive a reward of 1 percent of the overpayment reimbursed up to $10,000. Because these rewards would be paid directly out of the overpayments, they would not increase costs to the Federal Government. There are several important safeguards built into this legislation. The Secretary would be required to establish appropriate procedures to ensure that the incentive system is not abused by overzealous beneficiaries. An incentive payment would be awarded only to the extent that HCFA is able to recover the overpayment from the provider, and there would be no incentive payment if HCFA can demonstrate that it-- for its Medicare intermediary or carrier--has identified the overpayment prior to receiving the beneficiary's complaint. Some will argue that many seniors and other beneficiaries do not need personal rewards for fighting fraud, and in any event, this is a matter of national duty. While I agree with this contention, I also recognize that these individuals would not be able to identify and report fraud without having access to the itemized bills that this legislation provides. Moreover, I see nothing wrong with giving beneficiaries an added financial incentive. After all, we pay Federal employees for ideas that save the taxpayers money, and we pay private citizens for identifying fraud by defense contractors. Mr. President, there is no inconsistency between this amendment and the Abraham amendment which passed today. Their objectives are entirely compatible. However, the Abraham amendment effectively delegates responsibility for planning the whistleblower program to the Secretary of HHS. I strongly believe that we should fulfill our legislative responsibility by specifying the parameters of this important antifraud program. Otherwise, we should not be surprised if we end up with something that we had not contemplated and which does not satisfy our objective. Mr. President, I will not request a vote on this amendment, because we have already had a vote on the Abraham amendment. However, for the reasons that I outlined, I hope that the conferees will agree that this is a preferable whistleblower provision and that they will adopt it in the conference report. In so doing, I believe that the conferees should retain the provisions of the Abraham amendment that reward individuals for ideas that improve Medicare. ______ BROWN (AND OTHERS) AMENDMENT NO. 2969 Mr. BROWN (for himself, Mr. Abraham, Mr. Santorum, Mr. McCain, and Mr. Craig) proposed an amendment to the bill S. 1357, supra; as follows: At the end of chapter 8 of subtitle I of title XII, insert the following: SEC. . $1,000,000 COMPENSATION DEDUCTION LIMIT EXTENDED TO ALL EMPLOYEES OF ALL CORPORATIONS. (a) In General.--Section 162(m) is amended-- (1) by striking ``publicly held corporation'' in paragraph (1) and inserting ``taxpayer (other than personal service corporations)'', (2) by striking ``covered employee'' each place it appears in paragraphs (1) and (4) and inserting ``employee'', and (3) by striking paragraphs (2) and (3) and redesignating paragraph (4) as paragraph (3). (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995, except that there shall not be taken into account with respect to any employee to whom section 162(m) of the Internal Revenue Code of 1986 applies solely by reason of such amendments remuneration payable under a written binding contract which was in effect on October 25, 1995, and which was not modified thereafter in any material respect before such remuneration is paid. (c) Use of Revenues.--Notwithstanding any other provision of law, the Commissioner of Social Security shall increase the earnings limit otherwise determined for each year under section 203 of the Social Security Act (42 U.S.C. 403) by an amount which takes into account the increase in revenues for such year as estimated by the Secretary of the Treasury resulting from the amendment to section 162(m)(3) of the Internal Revenue Code of 1986 made by the Balanced Budget Reconciliation Act of 1995. ______ HARKIN (AND OTHERS) AMENDMENT NO. 2970 Mr. HARKIN (for himself, Mr. Graham, and Mr. Biden) proposed an amendment to the bill S. 1357, supra; as follows: Strike Chapter 6 of Title VII except for the text of amendment number 2950 as passed by the Senate and insert in lieu thereof, the following: CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION SEC. 7100. SHORT TITLE. This chapter may be cited as the ``Health Care Fraud and Abuse Prevention Act of 1995''. Subchapter A--Fraud and Abuse Control Program SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM. (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128B the following new section: ``FRAUD AND ABUSE CONTROL PROGRAM ``Sec. 1128C. (a) Establishment of Program.-- ``(1) In general.--Not later than January 1, 1996, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall establish a program-- ``(A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States, ``(B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States, ``(C) to facilitate the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to health care fraud and abuse, and ``(D) to provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts pursuant to section 1128D. ``(2) Coordination with health plans.--In carrying out the program established under paragraph (1), the Secretary and the Attorney General shall consult with, and arrange for the sharing of data with representatives of health plans. ``(3) Guidelines.-- ``(A) In general.--The Secretary and the Attorney General shall issue guidelines to carry out the program under paragraph (1). The provisions of sections 553, 556, and 557 of title 5, United States Code, shall not apply in the issuance of such guidelines. ``(B) Information guidelines.-- ``(i) In general.--Such guidelines shall include guidelines relating to the furnishing of information by health plans, providers, and others to enable the Secretary and the Attorney General to carry out the program (including coordination with health plans under paragraph (2)). ``(ii) Confidentiality.--Such guidelines shall include procedures to assure that such information is provided and utilized in a manner that appropriately protects the confidentiality of the information and the privacy of individuals receiving health care services and items. ``(iii) Qualified immunity for providing information.--The provisions of section 1157(a) (relating to limitation on liability) shall apply to a person providing information to the Secretary or the Attorney General in conjunction with their performance of duties under this section. ``(4) Ensuring access to documentation.--The Inspector General of the Department of Health and Human Services is authorized to exercise such authority described in paragraphs (3) through (9) of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.) as necessary with respect to the activities under the fraud and abuse control program established under this subsection. [[Page S15856]] ``(5) Authority of inspector general.--Nothing in this Act shall be construed to diminish the authority of any Inspector General, including such authority as provided in the Inspector General Act of 1978 (5 U.S.C. App.). ``(b) Additional Use of Funds by Inspector General.-- ``(1) Reimbursements for investigations.--The Inspector General of the Department of Health and Human Services is authorized to receive and retain for current use reimbursement for the costs of conducting investigations and audits and for monitoring compliance plans when such costs are ordered by a court, voluntarily agreed to by the payer, or otherwise. ``(2) Crediting.--Funds received by the Inspector General under paragraph (1) as reimbursement for costs of conducting investigations shall be deposited to the credit of the appropriation from which initially paid, or to appropriations for similar purposes currently available at the time of deposit, and shall remain available for obligation for 1 year from the date of the deposit of such funds. ``(c) Health Plan Defined.--For purposes of this section, the term `health plan' means a plan or program that provides health benefits, whether directly, through insurance, or otherwise, and includes-- ``(1) a policy of health insurance; ``(2) a contract of a service benefit organization; and ``(3) a membership agreement with a health maintenance organization or other prepaid health plan.''. (b) Establishment of Health Care Fraud and Abuse Control Account in Federal Hospital Insurance Trust Fund.--Section 1817 (42 U.S.C. 1395i) is amended by adding at the end the following new subsection: ``(k) Health Care Fraud and Abuse Control Account.-- ``(1) Establishment.--There is hereby established in the Trust Fund an expenditure account to be known as the `Health Care Fraud and Abuse Control Account' (in this subsection referred to as the `Account'). ``(2) Appropriated amounts to trust fund.-- ``(A) In general.--There are hereby appropriated to the Trust Fund-- ``(i) such gifts and bequests as may be made as provided in subparagraph (B); ``(ii) such amounts as may be deposited in the Trust Fund as provided in sections 7141(b) and 7142(c) of the Balanced Budget Reconciliation Act of 1995, and title XI; and ``(iii) such amounts as are transferred to the Trust Fund under subparagraph (C). ``(B) Authorization to accept gifts.--The Trust Fund is authorized to accept on behalf of the United States money gifts and bequests made unconditionally to the Trust Fund, for the benefit of the Account or any activity financed through the Account. ``(C) Transfer of amounts.--The Managing Trustee shall transfer to the Trust Fund, under rules similar to the rules in section 9601 of the Internal Revenue Code of 1986, an amount equal to the sum of the following: ``(i) Criminal fines recovered in cases involving a Federal health care offense (as defined in section 982(a)(6)(B) of title 18, United States Code). ``(ii) Civil monetary penalties and assessments imposed in health care cases, including amounts recovered under titles XI, XVIII, and XXI, and chapter 38 of title 31, United States Code (except as otherwise provided by law). ``(iii) Amounts resulting from the forfeiture of property by reason of a Federal health care offense. ``(iv) Penalties and damages obtained and otherwise creditable to miscellaneous receipts of the general fund of the Treasury obtained under sections 3729 through 3733 of title 31, United States Code (known as the False Claims Act), in cases involving claims related to the provision of health care items and services (other than funds awarded to a relator, for restitution or otherwise authorized by law). ``(3) Appropriated amounts to account.-- ``(A) In general.--There are hereby appropriated to the Account from the Trust Fund such sums as the Secretary and the Attorney General certify are necessary to carry out the purposes described in subparagraph (B), to be available without further appropriation, in an amount-- ``(i) with respect to activities of the Office of the Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigations in carrying out such purposes, not less than-- ``(I) for fiscal year 1996, $110,000,000, ``(II) for fiscal year 1997, $140,000,000, ``(III) for fiscal year 1998, $160,000,000, ``(IV) for fiscal year 1999, $185,000,000, ``(V) for fiscal year 2000, $215,000,000, ``(VI) for fiscal year 2001, $240,000,000, and ``(VII) for fiscal year 2002, $270,000,000; and ``(ii) with respect to all activities (including the activities described in clause (i)) in carrying out such purposes, not more than-- ``(I) for fiscal year 1996, $200,000,000, and ``(II) for each of the fiscal years 1997 through 2002, the limit for the preceding fiscal year, increased by 15 percent; and ``(iii) for each fiscal year after fiscal year 2002, within the limits for fiscal year 2002 as determined under clauses (i) and (ii). ``(B) Use of funds.--The purposes described in this subparagraph are as follows: ``(i) General use.--To cover the costs (including equipment, salaries and benefits, and travel and training) of the administration and operation of the health care fraud and abuse control program established under section 1128C(a), including the costs of-- ``(I) prosecuting health care matters (through criminal, civil, and administrative proceedings); ``(II) investigations; ``(III) financial and performance audits of health care programs and operations; ``(IV) inspections and other evaluations; and ``(V) provider and consumer education regarding compliance with the provisions of title XI. ``(ii) Use by state medicaid fraud control units for investigation reimbursements.--To reimburse the various State medicaid fraud control units upon request to the Secretary for the costs of the activities authorized under section 2134(b). ``(4) Annual report.--The Secretary and the Attorney General shall submit jointly an annual report to Congress on the amount of revenue which is generated and disbursed, and the justification for such disbursements, by the Account in each fiscal year.''. SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL HEALTH PROGRAMS. (a) Crimes.-- (1) Social security act.--Section 1128B (42 U.S.C. 1320a- 7b) is amended as follows: (A) In the heading, by striking ``medicare or state health care programs'' and inserting ``federal health care programs''. (B) In subsection (a)(1), by striking ``a program under title XVIII or a State health care program (as defined in section 1128(h))'' and inserting ``a Federal health care program''. (C) In subsection (a)(5), by striking ``a program under title XVIII or a State health care program'' and inserting ``a Federal health care program''. (D) In the second sentence of subsection (a)-- (i) by striking ``a State plan approved under title XIX'' and inserting ``a Federal health care program''; and (ii) by striking ``the State may at its option (notwithstanding any other provision of that title or of such plan)'' and inserting ``the administrator of such program may at its option (notwithstanding any other provision of such program)''. (E) In subsection (b)-- (i) by striking ``and willfully'' each place it appears; (ii) by striking ``$25,000'' each place it appears and inserting ``$50,000''; (iii) by striking ``title XVIII or a State health care program'' each place it appears and inserting ``Federal health care program''; (iv) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind--'' and inserting ``kind with intent to be influenced--''; (v) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (vi) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; (vii) in paragraph (2) in the matter proceeding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''; (viii) by adding at the end of paragraphs (1) and (2) the following sentence: ``A violation exists under this paragraph if one or more purposes of the remuneration is unlawful under this paragraph.''; (ix) by redesignating paragraph (3) as paragraph (4); (x) in paragraph (4) (as redesignated), by striking ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), (2), and (3)''; and (xi) by inserting after paragraph (2) the following new paragraph: ``(3)(A) The Attorney General may bring an action in the district courts to impose upon any person who carries out any activity in violation of this subsection a civil penalty of not less than $25,000 and not more than $50,000 for each such violation, plus three times the total remuneration offered, paid, solicited, or received. ``(B) A violation exists under this paragraph if one or more purposes of the remuneration is unlawful, and the damages shall be the full amount of such remuneration. ``(C) Section 3731 of title 31, United States Code, and the Federal Rules of Civil Procedure shall apply to actions brought under this paragraph. ``(D) The provisions of this paragraph do not affect the availability of other criminal and civil remedies for such violations.''. (F) In subsection (c), by inserting ``(as defined in section 1128(h))'' after ``a State health care program''. (G) By adding at the end the following new subsections: ``(f) For purposes of this section, the term `Federal health care program' means-- ``(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the United States Government; or ``(2) any State health care program, as defined in section 1128(h). ``(g)(1) The Secretary and Administrator of the departments and agencies with a Federal health care program may conduct an investigation or audit relating to violations of this section and claims within the jurisdiction of other Federal departments or agencies if the following conditions are satisfied: [[Page S15857]] ``(A) The investigation or audit involves primarily claims submitted to the Federal health care programs of the department or agency conducting the investigation or audit. ``(B) The Secretary or Administrator of the department or agency conducting the investigation or audit gives notice and an opportunity to participate in the investigation or audit to the Inspector General of the department or agency with primary jurisdiction over the Federal health care programs to which the claims were submitted. ``(2) If the conditions specified in paragraph (1) are fulfilled, the Inspector General of the department or agency conducting the investigation or audit may exercise all powers granted under the Inspector General Act of 1978 with respect to the claims submitted to the other departments or agencies to the same manner and extent as provided in that Act with respect to claims submitted to such departments or agencies.''. (2) Identification of community service opportunities.-- Section 1128B (42 U.S.C. 1320a-7b) is further amended by adding at the end the following new subsection: ``(h) The Secretary may-- ``(1) in consultation with State and local health care officials, identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of an offense under this section, and ``(2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.''. (b) Effective Date.--The amendments made by this section shall take effect on January 1, 1996. SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE. (a) Solicitation and Publication of Modifications to Existing Safe Harbors and New Safe Harbors.-- (1) In general.-- (A) Solicitation of proposals for safe harbors.--Not later than January 1, 1996, and not less than annually thereafter, the Secretary shall publish a notice in the Federal Register soliciting proposals, which will be accepted during a 60-day period, for-- (i) modifications to existing safe harbors issued pursuant to section 14(a) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (42 U.S.C. 1320a-7b note); (ii) additional safe harbors specifying payment practices that shall not be treated as a criminal offense under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) and shall not serve as the basis for an exclusion under section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7)); (iii) interpretive rulings to be issued pursuant to subsection (b); and (iv) special fraud alerts to be issued pursuant to subsection (c). (B) Publication of proposed modifications and proposed additional safe harbors.--After considering the proposals described in clauses (i) and (ii) of subparagraph (A), the Secretary, in consultation with the Attorney General, shall publish in the Federal Register proposed modifications to existing safe harbors and proposed additional safe harbors, if appropriate, with a 60-day comment period. After considering any public comments received during this period, the Secretary shall issue final rules modifying the existing safe harbors and establishing new safe harbors, as appropriate. (C) Report.--The Inspector General of the Department of Health and Human Services (in this section referred to as the ``Inspector General'') shall, in an annual report to Congress or as part of the year-end semiannual report required by section 5 of the Inspector General Act of 1978 (5 U.S.C. App.), describe the proposals received under clauses (i) and (ii) of subparagraph (A) and explain which proposals were included in the publication described in subparagraph (B), which proposals were not included in that publication, and the reasons for the rejection of the proposals that were not included. (2) Criteria for modifying and establishing safe harbors.-- In modifying and establishing safe harbors under paragraph (1)(B), the Secretary may consider the extent to which providing a safe harbor for the specified payment practice may result in any of the following: (A) An increase or decrease in access to health care services. (B) An increase or decrease in the quality of health care services. (C) An increase or decrease in patient freedom of choice among health care providers. (D) An increase or decrease in competition among health care providers. (E) An increase or decrease in the ability of health care facilities to provide services in medically underserved areas or to medically underserved populations. (F) An increase or decrease in the cost to Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)). (G) An increase or decrease in the potential overutilization of health care services. (H) The existence or nonexistence of any potential financial benefit to a health care professional or provider which may vary based on their decisions of-- (i) whether to order a health care item or service; or (ii) whether to arrange for a referral of health care items or services to a particular practitioner or provider. (I) Any other factors the Secretary deems appropriate in the interest of preventing fraud and abuse in Federal health care programs (as so defined). (b) Interpretive Rulings.-- (1) In general.-- (A) Request for interpretive ruling.--Any person may present, at any time, a request to the Inspector General for a statement of the Inspector General's current interpretation of the meaning of a specific aspect of the application of sections 1128A and 1128B of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as an ``interpretive ruling''). (B) Issuance and effect of interpretive ruling.-- (i) In general.--If appropriate, the Inspector General shall in consultation with the Attorney General, issue an interpretive ruling not later than 120 days after receiving a request described in subparagraph (A). Interpretive rulings shall not have the force of law and shall be treated as an interpretive rule within the meaning of section 553(b) of title 5, United States Code. All interpretive rulings issued pursuant to this clause shall be published in the Federal Register or otherwise made available for public inspection. (ii) Reasons for denial.--If the Inspector General does not issue an interpretive ruling in response to a request described in subparagraph (A), the Inspector General shall notify the requesting party of such decision not later than 120 days after receiving such a request and shall identify the reasons for such decision. (2) Criteria for interpretive rulings.-- (A) In general.--In determining whether to issue an interpretive ruling under paragraph (1)(B), the Inspector General may consider-- (i) whether and to what extent the request identifies an ambiguity within the language of the statute, the existing safe harbors, or previous interpretive rulings; and (ii) whether the subject of the requested interpretive ruling can be adequately addressed by interpretation of the language of the statute, the existing safe harbor rules, or previous interpretive rulings, or whether the request would require a substantive ruling (as defined in section 552 of title 5, United States Code) not authorized under this subsection. (B) No rulings on factual issues.--The Inspector General shall not give an interpretive ruling on any factual issue, including the intent of the parties or the fair market value of particular leased space or equipment. (c) Special Fraud Alerts.-- (1) In general.-- (A) Request for special fraud alerts.--Any person may present, at any time, a request to the Inspector General for a notice which informs the public of practices which the Inspector General considers to be suspect or of particular concern under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) (in this subsection referred to as a ``special fraud alert''). (B) Issuance and publication of special fraud alerts.--Upon receipt of a request described in subparagraph (A), the Inspector General shall investigate the subject matter of the request to determine whether a special fraud alert should be issued. If appropriate, the Inspector General shall issue a special fraud alert in response to the request. All special fraud alerts issued pursuant to this subparagraph shall be published in the Federal Register. (2) Criteria for special fraud alerts.--In determining whether to issue a special fraud alert upon a request described in paragraph (1),

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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)

Text of this article available as: TXT PDF [Pages S15852-S15971] [[Page S15852]] AMENDMENTS SUBMITTED ______ THE BALANCED BUDGET RECONCILIATION ACT OF 1995 ______ KENNEDY (AND OTHERS) AMENDMENT NO. 2959 Mr. KENNEDY (for himself, Mr. Simon, Mr. Pell, Mr. Dodd, Mr. Harkin, Ms. Mikulski, Mr. Wellstone, Mrs. Feinstein, Mrs. Murray, Mr. Kohl, Mr. Baucus, Mr. Bingaman, and Mr. Ford) proposed an amendment to the bill (S. 1357) to provide for reconciliation pursuant to section 105 of the concurrent resolution on the budget for fiscal year 1996; as follows: On page 1409, beginning with line 8, strike all through page 1410, line 25. On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1425, line 16. Strike chapter 3 of subtitle B of title XII. ______ HUTCHISON (AND OTHERS) AMENDMENT NO. 2960 (Ordered to lie on the table.) Mrs. Hutchison (for herself, Mr. McCain, Mr. Lieberman, Mr. Stevens, and Mr. Levin) submitted an amendment intended to be proposed by them to the bill S. 1357, supra; as follows: At the appropriate place, insert the following: (a) The Senate makes the following findings: (1) Human rights violations and atrocities continue unabated in the Former Yugoslavia. (2) The Assistant Secretary of State for Human Rights recently reported that starting in mid-September and intensifying between October 6 and October 12, 1995 many thousands of Bosnian Muslims and Croats in Northwest Bosnia were systematically forced from their homes by paramilitary units, local police and in some instances, Bosnian Serb Army officials and soldiers. (3) Despite the October 12, 1995 cease-fire which went into effect by agreement of the warring parties in the former Yugoslavia, Bosnian Serbs continue to conduct a brutal campaign to expel non-Serb civilians who remain in Northwest Bosnia, and are subjecting non-Serbs to untold horror-- murder, rape, robbery and other violence. (4) Horrible examples of ``ethnic cleansing'' persist in Northwest Bosnia. Some six thousand refugees recently reached Zenica and reported that nearly two thousand family members from this group are still unaccounted for. (5) The UN spokesman in Zagreb reported that many refugees have been given only a few minutes to leave their homes and that ``girls as young as 17 are reported to have been taken into wooded areas and raped.'' Elderly, sick and very young refugees have been driven to remote areas and forced to walk long distances on unsafe roads and cross rivers without bridges. (6) The War Crime Tribunal for the former Yugoslavia has collected volumes of evidence of atrocities, including the establishment of death camps, mass executions and systematic campaigns of rape and terror. This War Crimes Tribunal has already issued 43 indictments on the basis of this evidence. (7) The Assistant Secretary of State for Human Rights has described the eye witness accounts as ``prima facie evidence of war crimes which, if confirmed, could very well lead to further indictments by the War Crimes Tribunal.'' (8) The U.N. High Commissioner for Refugees estimates that more than 22,000 Muslims and Croats have been forced from their homes since mid-September in Bosnian Serb controlled areas. (9) In opening the Dodd Center Symposium on the topic of ``50 Years After Nuremburg'' on October 16, 1995, President Clinton cited the ``excellent progress'' of the War Crimes Tribunal for the former Yugoslavia and said, ``Those accused of war crimes, crimes against humanity and genocide must be brought to justice. They must be tried and, if found guilty, they must be held accountable.'' (10) President Clinton also observed on October 16, 1995, ``some people are concerned that pursuing peace in Bosnia and prosecuting war criminals are incompatible goals. But I believe they are wrong. There must be peace for justice to prevail, but there must be justice when peace prevails. (b) Sense of the Senate.--It is the sense of the Senate that-- (1) the Senate condemns the systematic human rights abuses against the people of Bosnia and Herzogovenia. (2) with peace talks scheduled to begin in the United States on October 31, 1995, and with the President clearly indicating his willingness to send American forces into the heart of this conflict, these new reports of Serbian atrocities are of grave concern to all Americans. (3) the Bosnian Serb leadership should immediately halt these atrocities, fully account for the missing, and allow those who have been separated to return to their families. (4) the International Red Cross, United Nations agencies and human rights organizations should be granted full and complete access to all locations throughout Bosnia and Herzogovenia. (5) the Bosnian Serb leadership should fully cooperate to facilitate the complete investigation of the above allegations so that those responsible may be held accountable under international treaties, conventions, obligations and law. (6) the United States should continue to support the work of the War Crime Tribunal for the Former Yugoslavia. (7) the United States should ensure that any negotiated peace agreements in former Yugoslavia, particularly with respect to Bosnia, require all states of the former Yugoslavia to corporate fully with the War Crimes Tribunal and apprehend and turn over for trial any indicated persons found in their territories. (8) ethnic cleansing by any faction, group, leader, or government is unjustified, immoral and illegal and all perpetrators of war crimes, crimes against humanity, genocide and other human rights violations in former Yugoslavia must be held accountable. ______ BAUCUS AMENDMENT NO. 2961 (Ordered to lie on the table.) Mr. BAUCUS submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: Strike section 1105(4)(B)(iii). ______ KASSEBAUM (AND OTHERS) AMENDMENT NO. 2962 Mrs. KASSEBAUM (for herself, Ms. Snowe, Mr. Jeffords, Mr. Coats, Mr. Gregg, Mr. Frist, Mr. DeWine, Mr. Ashcroft, Mr. Abraham, Mr. Gorton, Mr. Pressler, Mr. Roth, Mr. Domenici, Mr. Stevens, Mr. Specter, Mr. Cohen, Mr. Chafee, and Mr. Baucus) proposed an amendment to the bill S. 1357, supra; as follows: On page 1421, beginning with line 15, strike all through page 1423, line 13. On page 1424, beginning with line 2, strike all through page 1426, line 9. ______ BREAUX (AND KERRY) AMENDMENT NO. 2963 Mr. BREAUX (for himself and Mr. Kerry) proposed an amendment to the bill S. 1357, supra; as follows: On page 1469, beginning on line 2, strike all through page 1471, line 20, and insert the following: SEC. 12001. CHILD TAX CREDIT. (a) In General.--Subpart C of part IV of subchapter A of chapter 1 is amended by redesignating section 35 as section 36 and by inserting after section 34 the following new section: ``SEC. 35. CHILD TAX CREDIT. ``(a) Allowance of Credit.-- ``(1) General rule.--There shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to $500 multiplied by the number of qualifying children of the taxpayer. ``(2) Limitation based on amount of tax.--The credit allowed by paragraph (1) for a taxable year shall not exceed the sum of-- ``(A) the tax imposed by this subtitle for the taxable year (reduced by the credits allowable against such tax other than the credit allowable under section 32), and ``(B) the taxes imposed by sections 3101 and 3201(a) and 50 percent of the taxes imposed by sections 1401 and 3211(a) for such taxable year. ``(b) Adjusted Gross Income Limitation.--The aggregate amount of the credit which would (but for this subsection) be allowed by subsection (a) shall be reduced (but not below zero) by 20 percent for each $3,000 by which the taxpayer's adjusted gross income exceeds $60,000. ``(c) Qualifying Child.--For purposes of this section-- ``(1) In general.--The term `qualifying child' means any individual if-- ``(A) the taxpayer is allowed a deduction under section 151 with respect to such individual for such taxable year, ``(B) such individual has not attained the age of 16 as of the close of the calendar year in which the taxable year of the taxpayer begins, and ``(C) such individual bears a relationship to the taxpayer described in section 32(c)(3)(B) (determined without regard to clause (ii) thereof). ``(2) Exception for certain noncitizens.--The term `qualifying child' shall not include any individual who would not be a dependent if the first sentence of section 152(b)(3) were applied without regard to all that follows `resident of the United States'. ``(d) Certain Other Rules Apply.--Rules similar to the rules of subsections (d) and (e) of section 32 shall apply for purposes of this section.'' (c) Conforming Amendment.--The table of sections for such subpart C is amended by striking the item relating to section 35 and inserting the following new items: ``Sec. 35. Child tax credit. ``Sec. 36. Overpayments of tax.'' (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995. ______ [[Page S15853]] McCAIN (AND OTHERS) AMENDMENT NO. 2964 Mr. McCAIN (for himself, Mr. Dole, Mr. Coats, and Mr. Nickles) proposed an amendment to the bill S. 1357, supra; as follows: At the appropriate place in the Act, add the following: Sec. . Sense of the Senate.--The Senate finds that-- (a) The Senate has held hearings on the social security earnings limit in 1994 and 1995 and the House has held two hearings on the social security earnings limit in 1995; (b) The Senate has overwhelmingly passed Sense of the Senate language calling for substantial reform of the social security earnings limit; (c) The House of Representatives has overwhelmingly passed legislation to raise the exempt amount under the social security earnings limit three times, in 1989, 1992, and 1995; (d) Such legislation is a key provision of the Contract with America; (e) The President in his 1992 campaign document ``Putting People First'' pledged to lift the social security earnings limit; (f) The social security earnings limit is a depression-era relic that unfairly punishes working seniors; therefore, (g) It is the intent of the Congress that legislation will be passed before the end of 1995 to raise the social security earnings limit for working seniors aged 65 through 69 in a manner which will ensure the financial integrity of the social security trust funds and will be consistent with the goal of achieving a balanced budget in 7 years. ______ HELMS AMENDMENT NO. 2965 Mr. HELMS proposed an amendment to the bill S. 1357, supra; as follows: On page 461, line 13, after the period, insert the following: ``(3) Point-of-service coverage.--If a Medicare Choice sponsor offers a Medicare Choice plan that limits benefits to items and services furnished only by providers in a network of providers which have entered into a contract with the sponsors, the sponsor must also offer at the time of enrollment, a Medicare Choice plan that permits payment to be made under the plan for covered items and services when obtained out-of-network by the individual.'' ______ CAMPBELL (AND BROWN) AMENDMENTS NOS. 2966-2967 (Ordered to lie on the table.) Mr. CAMPBELL (for himself and Mr. Brown) submitted two amendments intended to be proposed by them to the bill S. 1357, supra; as follows: Amendment No. 2966 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C.1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ____________.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ____ Amendment No. 2968 Beginning on page 178, strike out line 3 and all that follows through the end of the matter between lines 7 and 8 on page 178, and insert in lieu thereof the following: ``Sec. 7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills) ``(a) Study of Future of Petroleum Reserves.--(1) The Secretary of Energy shall conduct a study to determine which of the following options, or combination of options, would maximize the value of the naval petroleum reserves to or for the United States: ``(A) Transfer of all or a part of the naval petroleum reserves to the jurisdiction of the Department of the Interior for leasing in accordance with the Mineral Leasing Act (30 U.S.C. 181 et seq.) and surface management in accordance with the Federal Land Policy and Management Act (43 U.S.C. 1701 et seq.). ``(B) Sale of the interest of the United States in the naval petroleum reserves. ``(2) The Secretary shall retain such independent consultants as the Secretary considers appropriate to conduct the study. ``(3) An examination of the value to be derived by the United States from the transfer or sale of the naval petroleum reserves under paragraph (1) shall include an assessment and estimate, in a manner consistent with customary property valuation practices in the oil and gas industry, of the fair market value of the interest of the United States in the naval petroleum reserves. ``(4) Not later than June 1, 1996, the Secretary shall submit to Congress and make available to the public a report describing the results of the study and containing such recommendations as the Secretary considers appropriate to implement the option, or combination of options, identified in the study that would maximize the value of the naval petroleum reserves to or for the United States. ``(b) Implementation of Recommendations.--(1) Not earlier than 31 days after submitting to Congress the report required under subsection (a)(4), and not later than September 30, 1997, the naval petroleum reserves (other than Naval Petroleum Reserve Numbered 1) shall be leased as described in subparagraph (A) of subsection (a)(1) or sold as described in subparagraph (B) of such subsection. ``(2) The Secretary shall use for carrying out this section such amounts of the unobligated balances of funds available to the Department of Energy as are necessary to carry out this section. ``(c) Administration of a Sale.--(1) Except as provided in paragraph (2), subsections (c), (d), (h), (i), (j), (k), (l), (m), and (n) of section 7421a of this title shall apply to any sale of the naval petroleum reserves under subsection (b) as if the reference to Naval Petroleum Reserve Numbered 1 in those subsections of such section 7421a referred to the naval petroleum reserves. ``(2)(A) The time requirements set forth in subsection (c) of section 7421a of this title do not apply under paragraph (1) to the sale of the naval petroleum reserves under this section. [[Page S15854]] ``(B) In the application of subsection (d) of section 7421a of this title under paragraph (1), the reference in that subsection to subsection (e) of such section does not apply. ``(C) In the application of subsections (j) and (k) of section 7421a of this to the sale of the naval petroleum reserves under paragraph (1), `joint resolution of approval' means only a joint resolution that is introduced after the date on which the notification to which the joint resolution relates is received by Congress, and-- ``(i) that does not have a preamble; ``(ii) the matter after the resolving clause of which reads only as follows: `That Congress approves the proposed sale of naval petroleum reserves reported in the notification submitted to Congress by the Secretary of Energy on ______.' (the blank space being filled in with the appropriate date); and ``(iii) the title of which is as follows: `Joint resolution approving the sale of naval petroleum reserves'. ``(D) In the application of subsection (l) of section 7421a of this title to the sale of the naval petroleum reserves under paragraph (1), the period referred in that subsection shall be deemed to be the two-year period beginning on the date of the enactment of the Balanced Budget Reconciliation Act of 1995. ``(d) Inapplicability to Naval Petroleum Reserve Numbered 1.--This section does not apply to Naval Petroleum Reserve Numbered 1, as defined in section 7421a(a)(2)(A) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7421 the following: ``7421a. Sale of Naval Petroleum Reserve Numbered 1 (Elk Hills). ``7421b. Future of naval petroleum reserves other than Naval Petroleum Reserve Numbered 1 (Elk Hills).''. ______ McCAIN AMENDMENT NO. 2968 (Ordered to lie on the table.) Mr. McCain submitted an amendment intended to be proposed by him to the bill S. 1357, supra; as follows: On page 696, between lines 8 and 9, insert the following: SEC. 7116A. MEDICARE WHISTLEBLOWER INCENTIVE. (a) Purpose.--The purpose of this section is to-- (1) reduce and eliminate fraud and abuse under the medicare program; (2) reduce negligent and fraudulent medicare billings by providers; (3) provide medicare beneficiaries with incentives to report inappropriate billing practices; and (4) provide savings to the medicare trust funds by increasing the recovery of medicare overpayments. (b) Request for Itemized Bill for Medicare Items and Services.-- (1) In general.--Section 1128A (42 U.S.C. 1320a-7a), as amended by section 7131(a)(4), is further amended by adding at the end the following new subsection: ``(n) Written Request for Itemized Bill.-- ``(1) In general.--A beneficiary may submit a written request for an itemized bill for medical or other items or services provided to such beneficiary by any person (including an organization, agency, or other entity) that receives payment under title XVIII for providing such items or services to such beneficiary. ``(2) 30-day period to receive bill.-- ``(A) In general.--Not later than 30 days after the date on which a request under paragraph (1) has been received, a person described in such paragraph shall furnish an itemized bill describing each medical or other item or service provided to the beneficiary requesting the itemized bill. ``(B) Penalty.--Whoever knowingly fails to furnish an itemized bill in accordance with subparagraph (A) shall be subject to a civil fine of not more than $100 for each such failure. ``(3) Review of itemized bill.-- ``(A) In general.--Not later than 90 days after the receipt of an itemized bill furnished under paragraph (1), a beneficiary may submit a written request for a review of the itemized bill to the appropriate fiscal intermediary or carrier with a contract under section 1816 or 1842. ``(B) Specific allegations.--A request for a review of the itemized bill shall identify-- ``(i) specific medical or other items or services that the beneficiary believes were not provided as claimed, or ``(ii) any other billing irregularity (including duplicate billing). ``(4) Findings of fiscal intermediary or carrier.--Each fiscal intermediary or carrier with a contract under section 1816 or 1842 shall, with respect to each written request submitted to the fiscal intermediary or carrier under paragraph (3), determine whether the itemized bill identifies specific medical or other items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under title XVIII. ``(5) Recovery of amounts.--The Secretary shall require fiscal intermediaries and carriers to take all appropriate measures to recover amounts unnecessarily paid under title XVIII with respect to a bill described in paragraph (4). ``(6) Incentive payments.-- ``(A) In general.--If the fiscal intermediary or carrier recovers amounts in accordance with paragraph (5), the Secretary shall make an incentive payment (in an amount determined under subparagraph (B)) to the beneficiary who submitted the request for the itemized bill under paragraph (1) that resulted in such recovery. No incentive payment shall be made under this subparagraph unless such recovery is made after a final determination on whether such recovered amounts are required to be repaid by the provider. ``(B) Incentive payment determined.-- ``(i) In general.--The amount of the incentive payment determined under this subparagraph is equal to the lesser of-- ``(I) 1 percent of the amount that the bill overcharged for medical or other items or services; or ``(II) $10,000. ``(ii) Limitation of amount.--The amount determined under this subparagraph may not exceed the total amounts recovered with respect to the bill in accordance with paragraph (5). ``(7) Prevention of abuse by beneficiaries.--The Secretary shall-- ``(A) address abuses of the incentive system established under this subsection; and ``(B) establish appropriate procedures to prevent such abuses. ``(8) Requirement that beneficiary discover inaccurate bill to receive incentive payment.--No incentive payment shall be made under paragraph (6) to a beneficiary if the Secretary or the appropriate fiscal intermediary or carrier identified the bill that was the subject of the beneficiary's request for review under this subsection as being overpaid prior to such request.''. (2) Effective date.--The amendments made by this section shall apply with respect to medical or other items or services provided on or after January 1, 1996. Mr. McCAIN. Mr. President, earlier this session, I introduced S. 1325, the Medicare Whistleblower Act of 1995, to reduce provider fraud and abuse in the Medicare Program. The amendment I am submitting today improves upon that bill, and provides a strong incentive for beneficiaries to identify overpayments made by Medicare. An Abraham amendment which passed today, and which I supported, takes a similar approach to achieve this same objective. However, my amendment is preferable because it specifically delineates the whistleblower reward process and does not give the Secretary of HHS discretion not to make incentive payments. I hope that the conferees will adopt this amendment. At Medicare town meetings throughout Arizona, I have heard over and over from senior citizens that the Medicare Program is rampant with inaccurate billings. They have told me, based on their personal experiences, that their Medicare bills frequently include services that they have not received, double billings for the same service, or charges that are disproportionate to the value of services received. Often, they have no idea what Medicare is being billed for on their behalf, and they are not able to obtain explanations from providers. The perceptions of Medicare beneficiaries are confirmed by more systematic analyses. The General Accounting Office has estimated that fraud and abuse in our Nation's health care system costs taxpayers as much as $100 billion each year. Medicare fraud alone costs about $17 billion per year, which is 10 percent of the program's costs. A report by the Republican staff of the Senate Committee on Aging has documented a broad array of fraudulent activities, including false claims for services that were supposed to have been rendered after the beneficiaries had died. The Medicare Program has many problems. A fundamental problem, and the source of many other problems, is that too few people are adequately concerned about its costs because the Government is paying most of the bills. One constituent informed me of a situation in which his provider double-billed for the same service and told him not to worry about it because Medicare is paying. This is an outrage and must be stopped. When Medicare overpays, we all overpay, and costs to beneficiaries and other taxpayers spiral. This amendment addresses this fundamental problem of the Medicare Program. It gives beneficiaries an added incentive to carefully scrutinize their bills and to actively pursue corrections when they believe that there has been inappropriate billing of Medicare. In particular, beneficiaries would be financially rewarded if they uncover negligence or fraud to the benefit of us all. Although such provider fraud is not the entire problem, and there is other legislation that I support which also addresses beneficiary fraud, studies [[Page S15855]] clearly indicate that provider fraud is most prevalent and the greatest concern. The major problem with our current approach to detecting Medicare fraud is that it relies primarily upon bureaucrats who have no firsthand knowledge of what services were provided to a beneficiary and who have extremely limited time and resources to investigate. This approach can be expected to discover only the most apparent fraudulent activities. To discover most fraud, we must obtain the full cooperation of those who know what occurred at providers' offices and who have the time to pursue fraud--the beneficiaries. All they need is the ability and incentive to scrutinize their bills and actively correct inaccuracies. Under this amendment, beneficiaries would have a right to receive in writing from their providers, within 30 days of when their request is received, an itemized bill for Medicare services provided to them. The beneficiary would then have 90 days to raise specific allegations of inappropriate billings to Medicare. The Medicare intermediaries and carriers would then have to review the bills and determine whether an overpayment has been made which must be reimbursed to the Medicare program. The beneficiary would receive a reward of 1 percent of the overpayment reimbursed up to $10,000. Because these rewards would be paid directly out of the overpayments, they would not increase costs to the Federal Government. There are several important safeguards built into this legislation. The Secretary would be required to establish appropriate procedures to ensure that the incentive system is not abused by overzealous beneficiaries. An incentive payment would be awarded only to the extent that HCFA is able to recover the overpayment from the provider, and there would be no incentive payment if HCFA can demonstrate that it-- for its Medicare intermediary or carrier--has identified the overpayment prior to receiving the beneficiary's complaint. Some will argue that many seniors and other beneficiaries do not need personal rewards for fighting fraud, and in any event, this is a matter of national duty. While I agree with this contention, I also recognize that these individuals would not be able to identify and report fraud without having access to the itemized bills that this legislation provides. Moreover, I see nothing wrong with giving beneficiaries an added financial incentive. After all, we pay Federal employees for ideas that save the taxpayers money, and we pay private citizens for identifying fraud by defense contractors. Mr. President, there is no inconsistency between this amendment and the Abraham amendment which passed today. Their objectives are entirely compatible. However, the Abraham amendment effectively delegates responsibility for planning the whistleblower program to the Secretary of HHS. I strongly believe that we should fulfill our legislative responsibility by specifying the parameters of this important antifraud program. Otherwise, we should not be surprised if we end up with something that we had not contemplated and which does not satisfy our objective. Mr. President, I will not request a vote on this amendment, because we have already had a vote on the Abraham amendment. However, for the reasons that I outlined, I hope that the conferees will agree that this is a preferable whistleblower provision and that they will adopt it in the conference report. In so doing, I believe that the conferees should retain the provisions of the Abraham amendment that reward individuals for ideas that improve Medicare. ______ BROWN (AND OTHERS) AMENDMENT NO. 2969 Mr. BROWN (for himself, Mr. Abraham, Mr. Santorum, Mr. McCain, and Mr. Craig) proposed an amendment to the bill S. 1357, supra; as follows: At the end of chapter 8 of subtitle I of title XII, insert the following: SEC. . $1,000,000 COMPENSATION DEDUCTION LIMIT EXTENDED TO ALL EMPLOYEES OF ALL CORPORATIONS. (a) In General.--Section 162(m) is amended-- (1) by striking ``publicly held corporation'' in paragraph (1) and inserting ``taxpayer (other than personal service corporations)'', (2) by striking ``covered employee'' each place it appears in paragraphs (1) and (4) and inserting ``employee'', and (3) by striking paragraphs (2) and (3) and redesignating paragraph (4) as paragraph (3). (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 1995, except that there shall not be taken into account with respect to any employee to whom section 162(m) of the Internal Revenue Code of 1986 applies solely by reason of such amendments remuneration payable under a written binding contract which was in effect on October 25, 1995, and which was not modified thereafter in any material respect before such remuneration is paid. (c) Use of Revenues.--Notwithstanding any other provision of law, the Commissioner of Social Security shall increase the earnings limit otherwise determined for each year under section 203 of the Social Security Act (42 U.S.C. 403) by an amount which takes into account the increase in revenues for such year as estimated by the Secretary of the Treasury resulting from the amendment to section 162(m)(3) of the Internal Revenue Code of 1986 made by the Balanced Budget Reconciliation Act of 1995. ______ HARKIN (AND OTHERS) AMENDMENT NO. 2970 Mr. HARKIN (for himself, Mr. Graham, and Mr. Biden) proposed an amendment to the bill S. 1357, supra; as follows: Strike Chapter 6 of Title VII except for the text of amendment number 2950 as passed by the Senate and insert in lieu thereof, the following: CHAPTER 6--HEALTH CARE FRAUD AND ABUSE PREVENTION SEC. 7100. SHORT TITLE. This chapter may be cited as the ``Health Care Fraud and Abuse Prevention Act of 1995''. Subchapter A--Fraud and Abuse Control Program SEC. 7101. FRAUD AND ABUSE CONTROL PROGRAM. (a) Establishment of Program.--Title XI (42 U.S.C. 1301 et seq.) is amended by inserting after section 1128B the following new section: ``FRAUD AND ABUSE CONTROL PROGRAM ``Sec. 1128C. (a) Establishment of Program.-- ``(1) In general.--Not later than January 1, 1996, the Secretary, acting through the Office of the Inspector General of the Department of Health and Human Services, and the Attorney General shall establish a program-- ``(A) to coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States, ``(B) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States, ``(C) to facilitate the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to health care fraud and abuse, and ``(D) to provide for the modification and establishment of safe harbors and to issue interpretative rulings and special fraud alerts pursuant to section 1128D. ``(2) Coordination with health plans.--In carrying out the program established under paragraph (1), the Secretary and the Attorney General shall consult with, and arrange for the sharing of data with representatives of health plans. ``(3) Guidelines.-- ``(A) In general.--The Secretary and the Attorney General shall issue guidelines to carry out the program under paragraph (1). The provisions of sections 553, 556, and 557 of title 5, United States Code, shall not apply in the issuance of such guidelines. ``(B) Information guidelines.-- ``(i) In general.--Such guidelines shall include guidelines relating to the furnishing of information by health plans, providers, and others to enable the Secretary and the Attorney General to carry out the program (including coordination with health plans under paragraph (2)). ``(ii) Confidentiality.--Such guidelines shall include procedures to assure that such information is provided and utilized in a manner that appropriately protects the confidentiality of the information and the privacy of individuals receiving health care services and items. ``(iii) Qualified immunity for providing information.--The provisions of section 1157(a) (relating to limitation on liability) shall apply to a person providing information to the Secretary or the Attorney General in conjunction with their performance of duties under this section. ``(4) Ensuring access to documentation.--The Inspector General of the Department of Health and Human Services is authorized to exercise such authority described in paragraphs (3) through (9) of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.) as necessary with respect to the activities under the fraud and abuse control program established under this subsection. [[Page S15856]] ``(5) Authority of inspector general.--Nothing in this Act shall be construed to diminish the authority of any Inspector General, including such authority as provided in the Inspector General Act of 1978 (5 U.S.C. App.). ``(b) Additional Use of Funds by Inspector General.-- ``(1) Reimbursements for investigations.--The Inspector General of the Department of Health and Human Services is authorized to receive and retain for current use reimbursement for the costs of conducting investigations and audits and for monitoring compliance plans when such costs are ordered by a court, voluntarily agreed to by the payer, or otherwise. ``(2) Crediting.--Funds received by the Inspector General under paragraph (1) as reimbursement for costs of conducting investigations shall be deposited to the credit of the appropriation from which initially paid, or to appropriations for similar purposes currently available at the time of deposit, and shall remain available for obligation for 1 year from the date of the deposit of such funds. ``(c) Health Plan Defined.--For purposes of this section, the term `health plan' means a plan or program that provides health benefits, whether directly, through insurance, or otherwise, and includes-- ``(1) a policy of health insurance; ``(2) a contract of a service benefit organization; and ``(3) a membership agreement with a health maintenance organization or other prepaid health plan.''. (b) Establishment of Health Care Fraud and Abuse Control Account in Federal Hospital Insurance Trust Fund.--Section 1817 (42 U.S.C. 1395i) is amended by adding at the end the following new subsection: ``(k) Health Care Fraud and Abuse Control Account.-- ``(1) Establishment.--There is hereby established in the Trust Fund an expenditure account to be known as the `Health Care Fraud and Abuse Control Account' (in this subsection referred to as the `Account'). ``(2) Appropriated amounts to trust fund.-- ``(A) In general.--There are hereby appropriated to the Trust Fund-- ``(i) such gifts and bequests as may be made as provided in subparagraph (B); ``(ii) such amounts as may be deposited in the Trust Fund as provided in sections 7141(b) and 7142(c) of the Balanced Budget Reconciliation Act of 1995, and title XI; and ``(iii) such amounts as are transferred to the Trust Fund under subparagraph (C). ``(B) Authorization to accept gifts.--The Trust Fund is authorized to accept on behalf of the United States money gifts and bequests made unconditionally to the Trust Fund, for the benefit of the Account or any activity financed through the Account. ``(C) Transfer of amounts.--The Managing Trustee shall transfer to the Trust Fund, under rules similar to the rules in section 9601 of the Internal Revenue Code of 1986, an amount equal to the sum of the following: ``(i) Criminal fines recovered in cases involving a Federal health care offense (as defined in section 982(a)(6)(B) of title 18, United States Code). ``(ii) Civil monetary penalties and assessments imposed in health care cases, including amounts recovered under titles XI, XVIII, and XXI, and chapter 38 of title 31, United States Code (except as otherwise provided by law). ``(iii) Amounts resulting from the forfeiture of property by reason of a Federal health care offense. ``(iv) Penalties and damages obtained and otherwise creditable to miscellaneous receipts of the general fund of the Treasury obtained under sections 3729 through 3733 of title 31, United States Code (known as the False Claims Act), in cases involving claims related to the provision of health care items and services (other than funds awarded to a relator, for restitution or otherwise authorized by law). ``(3) Appropriated amounts to account.-- ``(A) In general.--There are hereby appropriated to the Account from the Trust Fund such sums as the Secretary and the Attorney General certify are necessary to carry out the purposes described in subparagraph (B), to be available without further appropriation, in an amount-- ``(i) with respect to activities of the Office of the Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigations in carrying out such purposes, not less than-- ``(I) for fiscal year 1996, $110,000,000, ``(II) for fiscal year 1997, $140,000,000, ``(III) for fiscal year 1998, $160,000,000, ``(IV) for fiscal year 1999, $185,000,000, ``(V) for fiscal year 2000, $215,000,000, ``(VI) for fiscal year 2001, $240,000,000, and ``(VII) for fiscal year 2002, $270,000,000; and ``(ii) with respect to all activities (including the activities described in clause (i)) in carrying out such purposes, not more than-- ``(I) for fiscal year 1996, $200,000,000, and ``(II) for each of the fiscal years 1997 through 2002, the limit for the preceding fiscal year, increased by 15 percent; and ``(iii) for each fiscal year after fiscal year 2002, within the limits for fiscal year 2002 as determined under clauses (i) and (ii). ``(B) Use of funds.--The purposes described in this subparagraph are as follows: ``(i) General use.--To cover the costs (including equipment, salaries and benefits, and travel and training) of the administration and operation of the health care fraud and abuse control program established under section 1128C(a), including the costs of-- ``(I) prosecuting health care matters (through criminal, civil, and administrative proceedings); ``(II) investigations; ``(III) financial and performance audits of health care programs and operations; ``(IV) inspections and other evaluations; and ``(V) provider and consumer education regarding compliance with the provisions of title XI. ``(ii) Use by state medicaid fraud control units for investigation reimbursements.--To reimburse the various State medicaid fraud control units upon request to the Secretary for the costs of the activities authorized under section 2134(b). ``(4) Annual report.--The Secretary and the Attorney General shall submit jointly an annual report to Congress on the amount of revenue which is generated and disbursed, and the justification for such disbursements, by the Account in each fiscal year.''. SEC. 7102. APPLICATION OF CERTAIN HEALTH ANTI-FRAUD AND ABUSE SANCTIONS TO FRAUD AND ABUSE AGAINST FEDERAL HEALTH PROGRAMS. (a) Crimes.-- (1) Social security act.--Section 1128B (42 U.S.C. 1320a- 7b) is amended as follows: (A) In the heading, by striking ``medicare or state health care programs'' and inserting ``federal health care programs''. (B) In subsection (a)(1), by striking ``a program under title XVIII or a State health care program (as defined in section 1128(h))'' and inserting ``a Federal health care program''. (C) In subsection (a)(5), by striking ``a program under title XVIII or a State health care program'' and inserting ``a Federal health care program''. (D) In the second sentence of subsection (a)-- (i) by striking ``a State plan approved under title XIX'' and inserting ``a Federal health care program''; and (ii) by striking ``the State may at its option (notwithstanding any other provision of that title or of such plan)'' and inserting ``the administrator of such program may at its option (notwithstanding any other provision of such program)''. (E) In subsection (b)-- (i) by striking ``and willfully'' each place it appears; (ii) by striking ``$25,000'' each place it appears and inserting ``$50,000''; (iii) by striking ``title XVIII or a State health care program'' each place it appears and inserting ``Federal health care program''; (iv) in paragraph (1) in the matter preceding subparagraph (A), by striking ``kind--'' and inserting ``kind with intent to be influenced--''; (v) in paragraph (1)(A), by striking ``in return for referring'' and inserting ``to refer''; (vi) in paragraph (1)(B), by striking ``in return for purchasing, leasing, ordering, or arranging for or recommending'' and inserting ``to purchase, lease, order, or arrange for or recommend''; (vii) in paragraph (2) in the matter proceeding subparagraph (A), by striking ``to induce such person'' and inserting ``with intent to influence such person''; (viii) by adding at the end of paragraphs (1) and (2) the following sentence: ``A violation exists under this paragraph if one or more purposes of the remuneration is unlawful under this paragraph.''; (ix) by redesignating paragraph (3) as paragraph (4); (x) in paragraph (4) (as redesignated), by striking ``Paragraphs (1) and (2)'' and inserting ``Paragraphs (1), (2), and (3)''; and (xi) by inserting after paragraph (2) the following new paragraph: ``(3)(A) The Attorney General may bring an action in the district courts to impose upon any person who carries out any activity in violation of this subsection a civil penalty of not less than $25,000 and not more than $50,000 for each such violation, plus three times the total remuneration offered, paid, solicited, or received. ``(B) A violation exists under this paragraph if one or more purposes of the remuneration is unlawful, and the damages shall be the full amount of such remuneration. ``(C) Section 3731 of title 31, United States Code, and the Federal Rules of Civil Procedure shall apply to actions brought under this paragraph. ``(D) The provisions of this paragraph do not affect the availability of other criminal and civil remedies for such violations.''. (F) In subsection (c), by inserting ``(as defined in section 1128(h))'' after ``a State health care program''. (G) By adding at the end the following new subsections: ``(f) For purposes of this section, the term `Federal health care program' means-- ``(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the United States Government; or ``(2) any State health care program, as defined in section 1128(h). ``(g)(1) The Secretary and Administrator of the departments and agencies with a Federal health care program may conduct an investigation or audit relating to violations of this section and claims within the jurisdiction of other Federal departments or agencies if the following conditions are satisfied: [[Page S15857]] ``(A) The investigation or audit involves primarily claims submitted to the Federal health care programs of the department or agency conducting the investigation or audit. ``(B) The Secretary or Administrator of the department or agency conducting the investigation or audit gives notice and an opportunity to participate in the investigation or audit to the Inspector General of the department or agency with primary jurisdiction over the Federal health care programs to which the claims were submitted. ``(2) If the conditions specified in paragraph (1) are fulfilled, the Inspector General of the department or agency conducting the investigation or audit may exercise all powers granted under the Inspector General Act of 1978 with respect to the claims submitted to the other departments or agencies to the same manner and extent as provided in that Act with respect to claims submitted to such departments or agencies.''. (2) Identification of community service opportunities.-- Section 1128B (42 U.S.C. 1320a-7b) is further amended by adding at the end the following new subsection: ``(h) The Secretary may-- ``(1) in consultation with State and local health care officials, identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of an offense under this section, and ``(2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.''. (b) Effective Date.--The amendments made by this section shall take effect on January 1, 1996. SEC. 7103. HEALTH CARE FRAUD AND ABUSE PROVIDER GUIDANCE. (a) Solicitation and Publication of Modifications to Existing Safe Harbors and New Safe Harbors.-- (1) In general.-- (A) Solicitation of proposals for safe harbors.--Not later than January 1, 1996, and not less than annually thereafter, the Secretary shall publish a notice in the Federal Register soliciting proposals, which will be accepted during a 60-day period, for-- (i) modifications to existing safe harbors issued pursuant to section 14(a) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (42 U.S.C. 1320a-7b note); (ii) additional safe harbors specifying payment practices that shall not be treated as a criminal offense under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) and shall not serve as the basis for an exclusion under section 1128(b)(7) of such Act (42 U.S.C. 1320a-7(b)(7)); (iii) interpretive rulings to be issued pursuant to subsection (b); and (iv) special fraud alerts to be issued pursuant to subsection (c). (B) Publication of proposed modifications and proposed additional safe harbors.--After considering the proposals described in clauses (i) and (ii) of subparagraph (A), the Secretary, in consultation with the Attorney General, shall publish in the Federal Register proposed modifications to existing safe harbors and proposed additional safe harbors, if appropriate, with a 60-day comment period. After considering any public comments received during this period, the Secretary shall issue final rules modifying the existing safe harbors and establishing new safe harbors, as appropriate. (C) Report.--The Inspector General of the Department of Health and Human Services (in this section referred to as the ``Inspector General'') shall, in an annual report to Congress or as part of the year-end semiannual report required by section 5 of the Inspector General Act of 1978 (5 U.S.C. App.), describe the proposals received under clauses (i) and (ii) of subparagraph (A) and explain which proposals were included in the publication described in subparagraph (B), which proposals were not included in that publication, and the reasons for the rejection of the proposals that were not included. (2) Criteria for modifying and establishing safe harbors.-- In modifying and establishing safe harbors under paragraph (1)(B), the Secretary may consider the extent to which providing a safe harbor for the specified payment practice may result in any of the following: (A) An increase or decrease in access to health care services. (B) An increase or decrease in the quality of health care services. (C) An increase or decrease in patient freedom of choice among health care providers. (D) An increase or decrease in competition among health care providers. (E) An increase or decrease in the ability of health care facilities to provide services in medically underserved areas or to medically underserved populations. (F) An increase or decrease in the cost to Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)). (G) An increase or decrease in the potential overutilization of health care services. (H) The existence or nonexistence of any potential financial benefit to a health care professional or provider which may vary based on their decisions of-- (i) whether to order a health care item or service; or (ii) whether to arrange for a referral of health care items or services to a particular practitioner or provider. (I) Any other factors the Secretary deems appropriate in the interest of preventing fraud and abuse in Federal health care programs (as so defined). (b) Interpretive Rulings.-- (1) In general.-- (A) Request for interpretive ruling.--Any person may present, at any time, a request to the Inspector General for a statement of the Inspector General's current interpretation of the meaning of a specific aspect of the application of sections 1128A and 1128B of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) (in this section referred to as an ``interpretive ruling''). (B) Issuance and effect of interpretive ruling.-- (i) In general.--If appropriate, the Inspector General shall in consultation with the Attorney General, issue an interpretive ruling not later than 120 days after receiving a request described in subparagraph (A). Interpretive rulings shall not have the force of law and shall be treated as an interpretive rule within the meaning of section 553(b) of title 5, United States Code. All interpretive rulings issued pursuant to this clause shall be published in the Federal Register or otherwise made available for public inspection. (ii) Reasons for denial.--If the Inspector General does not issue an interpretive ruling in response to a request described in subparagraph (A), the Inspector General shall notify the requesting party of such decision not later than 120 days after receiving such a request and shall identify the reasons for such decision. (2) Criteria for interpretive rulings.-- (A) In general.--In determining whether to issue an interpretive ruling under paragraph (1)(B), the Inspector General may consider-- (i) whether and to what extent the request identifies an ambiguity within the language of the statute, the existing safe harbors, or previous interpretive rulings; and (ii) whether the subject of the requested interpretive ruling can be adequately addressed by interpretation of the language of the statute, the existing safe harbor rules, or previous interpretive rulings, or whether the request would require a substantive ruling (as defined in section 552 of title 5, United States Code) not authorized under this subsection. (B) No rulings on factual issues.--The Inspector General shall not give an interpretive ruling on any factual issue, including the intent of the parties or the fair market value of particular leased space or equipment. (c) Special Fraud Alerts.-- (1) In general.-- (A) Request for special fraud alerts.--Any person may present, at any time, a request to the Inspector General for a notice which informs the public of practices which the Inspector General considers to be suspect or of particular concern under section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) (in this subsection referred to as a ``special fraud alert''). (B) Issuance and publication of special fraud alerts.--Upon receipt of a request described in subparagraph (A), the Inspector General shall investigate the subject matter of the request to determine whether a special fraud alert should be issued. If appropriate, the Inspector General shall issue a special fraud alert in response to the request. All special fraud alerts issued pursuant to this subparagraph shall be published in the Federal Register. (2) Criteria for special fraud alerts.--In determining whether to issue a special fraud alert upon a request described in para

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