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AMENDMENTS SUBMITTED
(Senate - October 26, 1995)
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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.
______
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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.
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``(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
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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.
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``(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:
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``(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),
Major Actions:
All articles in Senate section
AMENDMENTS SUBMITTED
(Senate - October 26, 1995)
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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.
______
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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.
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``(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:
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``(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