S 1959 ISCommentsClose CommentsPermalink

To improve health care fraud enforcement.CommentsClose CommentsPermalink

October 28, 2009CommentsClose CommentsPermalink

Mr. KAUFMAN (for himself, Mr. LEAHY, Mr. SPECTER, Mr. KOHL, Mr. SCHUMER, and Ms. KLOBUCHAR) introduced the following bill; which was read twice and referred to the Committee on the JudiciaryCommentsClose CommentsPermalink

To improve health care fraud enforcement.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Health Care Fraud Enforcement Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. ENHANCEMENTS TO CRIMINAL LAWS RELATING TO HEALTH CARE FRAUD.

(a) Fraud Sentencing Guidelines-CommentsClose CommentsPermalink





(1) DEFINITION- In this subsection, the term ‘Federal health care offense’ has the meaning given that term in section 24 of title 18, United States Code, as amended by this Act.CommentsClose CommentsPermalink





(2) REVIEW AND AMENDMENTS- Pursuant to the authority under section 994 of title 28, United States Code, and in accordance with this subsection, the United States Sentencing Commission shall--CommentsClose CommentsPermalink





(A) review the Federal Sentencing Guidelines and policy statements applicable to persons convicted of Federal health care offenses;CommentsClose CommentsPermalink





(B) amend the Federal Sentencing Guidelines and policy statements applicable to persons convicted of Federal health care offenses involving Government health care programs to provide that the aggregate dollar amount of fraudulent bills submitted to the Government health care program shall constitute prima facie evidence of the amount of the intended loss by the defendant; andCommentsClose CommentsPermalink





(C) amend the Federal Sentencing Guidelines to provide--CommentsClose CommentsPermalink





(i) a 2-level increase in the offense level for any defendant convicted of a Federal health care offense relating to a Government health care program which involves a loss of not less than $1,000,000 and less than $7,000,000;CommentsClose CommentsPermalink





(ii) a 3-level increase in the offense level for any defendant convicted of a Federal health care offense relating to a Government health care program which involves a loss of not less than $7,000,000 and less than $20,000,000;CommentsClose CommentsPermalink





(iii) a 4-level increase in the offense level for any defendant convicted of a Federal health care offense relating to a Government health care program which involves a loss of not less than $20,000,000; andCommentsClose CommentsPermalink





(iv) if appropriate, otherwise amend the Federal Sentencing Guidelines and policy statements applicable to persons convicted of Federal health care offenses involving Government health care programs.CommentsClose CommentsPermalink





(3) REQUIREMENTS- In carrying this subsection, the United States Sentencing Commission shall--CommentsClose CommentsPermalink





(A) ensure that the Federal Sentencing Guidelines and policy statements--CommentsClose CommentsPermalink





(i) reflect the serious harms associated with health care fraud and the need for aggressive and appropriate law enforcement action to prevent such fraud; andCommentsClose CommentsPermalink





(ii) provide increased penalties for persons convicted of health care fraud offenses in appropriate circumstances;CommentsClose CommentsPermalink





(B) consult with individuals or groups representing health care fraud victims, law enforcement officials, the health care industry, and the Federal judiciary as part of the review described in paragraph (2);CommentsClose CommentsPermalink





(C) ensure reasonable consistency with other relevant directives and with other guidelines under the Federal Sentencing Guidelines;CommentsClose CommentsPermalink





(D) account for any aggravating or mitigating circumstances that might justify exceptions, including circumstances for which the Federal Sentencing Guidelines, as in effect on the date of enactment of this Act, provide sentencing enhancements;CommentsClose CommentsPermalink





(E) make any necessary conforming changes to the Federal Sentencing Guidelines; andCommentsClose CommentsPermalink





(F) ensure that the Federal Sentencing Guidelines adequately meet the purposes of sentencing.CommentsClose CommentsPermalink





(b) Intent Requirement for Health Care Fraud- Section 1347 of title 18, United States Code, is amended--CommentsClose CommentsPermalink





(1) by inserting ‘(a)’ before ‘Whoever knowingly’; andCommentsClose CommentsPermalink





(2) by adding at the end the following:CommentsClose CommentsPermalink





‘(b) With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.’.CommentsClose CommentsPermalink





(c) Kickbacks- Section 1128B of the Social Security Act (42 U.S.C. 1320a-7b) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(g) In addition to the penalties provided for in this section or section 1128A, a claim for items or services that are provided in violation of this section constitutes a false or fraudulent claim for purposes of subchapter III of chapter 37 of title 31, United States Code.’.CommentsClose CommentsPermalink





(d) Health Care Fraud Offense- Section 24(a) of title 18, United States Code, is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by striking the semicolon and inserting ‘or section 1128B of the Social Security Act (42 U.S.C. 1320a-7b); or’; andCommentsClose CommentsPermalink





(2) in paragraph (2)--CommentsClose CommentsPermalink





(A) by inserting ‘1349,’ after ‘1343,’; andCommentsClose CommentsPermalink





(B) by inserting ‘section 301 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 331), or section 411, 501, or 511 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1111, 1131, and 1141),’ after ‘title,’.CommentsClose CommentsPermalink

SEC. 3. SUBPOENA AUTHORITY RELATING TO HEALTH CARE.

(a) Subpoenas Under the Health Insurance Portability and Accountability Act of 1996- Section 1510(b) of title 18, United States Code, is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by striking ‘to the grand jury’; andCommentsClose CommentsPermalink





(2) in paragraph (2)--CommentsClose CommentsPermalink





(A) in subparagraph (A), by striking ‘grand jury subpoena’ and inserting ‘subpoena for records’; andCommentsClose CommentsPermalink





(B) in the matter following subparagraph (B), by striking ‘to the grand jury’.CommentsClose CommentsPermalink





(b) Subpoenas Under the Civil Rights of Institutionalized Persons Act- The Civil Rights of Institutionalized Persons Act (42 U.S.C. 1997 et seq.) is amended by inserting after section 3 the following:CommentsClose CommentsPermalink

‘SEC. 3A. SUBPOENA AUTHORITY.

‘(a) Authority- The Attorney General, or at the direction of the Attorney General, any officer or employee of the Department of Justice may require by subpoena access to any institution that is the subject of an investigation under this Act and to any document, record, material, file, report, memorandum, policy, procedure, investigation, video or audio recording, or quality assurance report relating to any institution that is the subject of an investigation under this Act to determine whether there are conditions which deprive persons residing in or confined to the institution of any rights, privileges, or immunities secured or protected by the Constitution or laws of the United States.CommentsClose CommentsPermalink





‘(b) Issuance and Enforcement of Subpoenas-CommentsClose CommentsPermalink





‘(1) ISSUANCE- Subpoenas issued under this section--CommentsClose CommentsPermalink





‘(A) shall bear the signature of the Attorney General or any officer or employee of the Department of Justice as designated by the Attorney General; andCommentsClose CommentsPermalink





‘(B) shall be served by any person or class of persons designated by the Attorney General or a designated officer or employee for that purpose.CommentsClose CommentsPermalink





‘(2) ENFORCEMENT- In the case of contumacy or failure to obey a subpoena issued under this section, the United States district court for the judicial district in which the institution is located may issue an order requiring compliance. Any failure to obey the order of the court may be punished by the court as a contempt that court.CommentsClose CommentsPermalink





‘(c) Protection of Subpoenaed Records and Information- Any document, record, material, file, report, memorandum, policy, procedure, investigation, video or audio recording, or quality assurance report or other information obtained under a subpoena issued under this section--CommentsClose CommentsPermalink





‘(1) may not be used for any purpose other than to protect the rights, privileges, or immunities secured or protected by the Constitution or laws of the United States of persons who reside, have resided, or will reside in an institution;CommentsClose CommentsPermalink





‘(2) may not be transmitted by or within the Department of Justice for any purpose other than to protect the rights, privileges, or immunities secured or protected by the Constitution or laws of the United States of persons who reside, have resided, or will reside in an institution; andCommentsClose CommentsPermalink





‘(3) shall be redacted, obscured, or otherwise altered if used in any publicly available manner so as to prevent the disclosure of any personally identifiable information.’.CommentsClose CommentsPermalink

SEC. 4. ADDITIONAL AUTHORIZATION OF APPROPRIATIONS TO THE DEPARTMENT OF JUSTICE FOR CRIMINAL AND CIVIL ENFORCEMENT OF HEALTH CARE FRAUD.

(a) Authorization- There is authorized to be appropriated to the Attorney General, to remain available until expended, $20,000,000 for each of fiscal years 2011 through 2016 for the purposes of investigations, prosecutions, and civil or other proceedings relating to fraud and abuse in connection with any health care benefit program, as defined in section 24(b) of title 18, United States Code.CommentsClose CommentsPermalink





(b) Allocations- With respect to each of fiscal years 2011 through 2016, the amount authorized to be appropriated under subsection (a) shall be allocated as follows:CommentsClose CommentsPermalink





(1) For the offices of the United States attorneys, $10,000,000.CommentsClose CommentsPermalink





(2) For the Criminal Division of the Department of Justice, $5,000,000.CommentsClose CommentsPermalink





(3) For the Civil Division of the Department of Justice, $5,000,000.CommentsClose CommentsPermalink