NCJ Number
48024
Date Published
1977
Length
507 pages
Annotation
A JOINT HEARING BEFORE TWO HOUSE SUBCOMMITTEES WAS HELD IN MARCH 1977 TO CONSIDER A BILL THAT WOULD STRENGTHEN THE CAPABILITY OF GOVERNMENT TO DETECT AND PROSECUTE FRAUD IN THE MEDICARE AND MEDICAID PROGRAMS.
Abstract
THE BILL (H.R. 3) IS NOT INTENDED TO ELIMINATE EVERY FRAUDULENT OR ABUSIVE PRACTICE; RATHER, IT IS VIEWED AS AN INITIAL RESPONSE BY THE CONGRESS THAT FRAUDULENT PRACTICES SHOULD STOP. INCREASED ATTENTION IS BEING FOCUSED ON PROBLEMS OF FRAUD AND ABUSE IN ALL FEDERAL HEALTH FINANCING PROGRAMS, BUT THE MEDICARE AND MEDICAID PROGRAMS ARE EMPHASIZED. TESTIMONY PERTAINING TO SPECIFIC PROVISIONS OF THE BILL AND OTHER PROPOSALS ON ELIMINATING FRAUDULENT PRACTICES IS PRESENTED. SPECIFIC CONSIDERATION IS GIVEN TO THE FOLLOWING FACTORS: THE IMPORTANCE OF IMPROVED LEGISLATION AT ALL LEVELS OF GOVERNMENT; COST CONTAINMENT; SERVICE IMPROVEMENT; THE USE OF EXISTING AUTHORITIES OR THE CREATION OF NEW AUTHORITIES TO CURB FRAUD AND ABUSE; DHEW EXPENDITURES AND PROGRAM ACTIVITIES; THE POSSIBILITY OF IMPOSING A CRIMINAL PENALTY FOR CERTAIN PRACTICES; BILLING AND FINANCIAL MANAGEMENT PROCEDURES; AND THE ROLE OF INNOVATIVE HEALTH SYSTEM ORGANIZATIONAL ARRANGEMENTS (PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS, HEALTH MAINTENANCE ORGANIZATIONS, AND NATIONAL HEALTH INSURANCE) IN THE MEDICARE AND MEDICAID PROGRAM. PRESENTATIONS WERE MADE AT THE JOINT HEARING BY GOVERNMENT OFFICIALS, INSURANCE COMPANY REPRESENTATIVES, PROFESSIONAL ASSOCIATION REPRESENTATIVES, AND CONSUMER GROUPS. MATERIAL NOT CONTAINED IN FORMAL PRESENTATIONS WAS SUBMITTED FOR THE RECORD.