Health Care Fraud Prevention Act of 1995

TABLE OF CONTENTS:

Title I: All-Payer Fraud and Abuse Control Program

Title II: Revisions to Current Sanctions for Fraud and Abuse

Title III: Administrative and Miscellaneous Provisions

Title IV: Civil Monetary Penalties

Title V: Amendments to Criminal Law

Title VI: Payments For State Health Care Fraud Control Units

Health Care Fraud Prevention Act of 1995 - Title I: All-Payer Fraud and Abuse Control Program - Directs the Secretary of Health and Human Services to establish: (1) an all-payer fraud and abuse control program; and (2) standards, including information standards and disclosure standards, to carry out such program. Authorizes appropriations. Establishes, to carry out such program, the Health Care Fraud and Abuse Account (the Account), which shall consist of gifts, bequests, deposits, and transfers under certain health care offenses provisions of specified Acts.

(Sec. 102) Provides for the application to any health plan of specified health anti-fraud and abuse provisions of part A (General Provisions) of title XI of the Social Security Act.

(Sec. 103) Directs the Secretary to annually solicit proposals for modification of, and modify, existing safe harbor rules. Permits any individual, at any time, to request a notice from the Inspector General (IG) which informs the public of practices which the IG considers to be suspect or of particular concern.

(Sec. 104) Directs the Secretary to establish a program through which individuals entitled to Medicare benefits may confidentially report instances of suspected fraud.

Title II: Revisions to Current Sanctions for Fraud and Abuse - Amends provisions of titles XI (General Provisions and Peer Review) and XVIII (Medicare) of the Social Security Act to: (1) provide for the mandatory exclusion of individuals with a felony fraud conviction from participation in Medicare and State health care programs; (2) establish a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from Medicare and State health care programs; (3) provide for the permissive exclusion of individuals with ownership or control interest in sanctioned activities; (4) provide for a minimum period of exclusion for practitioners and individuals failing to meet statutory obligations; and (5) intermediate sanctions for Medicare health maintenance organizations.

Title III: Administrative and Miscellaneous Provisions - Directs the Secretary to provide for the establishment of a national health care fraud and abuse data collection program for the reporting of final adverse actions against health care providers, suppliers, or practitioners.

Title IV: Civil Monetary Penalties - Provides, under part A of title XI of the Social Security Act, for: (1) the payment of the portion of amounts recovered under provisions of this Act into the Account; and (2) an increase in the civil monetary penalty. Subjects an excluded individual retaining an ownership or controlling interest in a Medicare or State health care program to such penalty. Permits the Secretary to impose a penalty on any individual (including any organization, but excluding a beneficiary) who knowingly receives any kickback or bribe in return for making a referral or purchasing equipment in a Medicare or State health care program.

Title V: Amendments to Criminal Law - Amends the Federal criminal code provisions: (1) relating to mail fraud, to impose a fine or imprisonment for up to ten years or both in the case of health care fraud; (2) to provide for the forfeiture of property in certain Federal health care offenses; (3) provide for injunctive relief as specified; (4) provides for fines or imprisonment or both in connection with Federal health care offenses; (5) establish a voluntary disclosure program in connection with Federal health care offenses; and (6) provide penalties for obstructions of criminal investigations of Federal health care offenses, theft or embezzlement in connection with health care, and the laundering of monetary instruments in connection with a Federal health care offense.

Title VI: Payments for State Health Care Fraud Control Units - Directs the Governor of each State to establish and maintain a State agency to act as a State Health Care Fraud and Abuse Control Unit. Provides for specified Federal payments to the States for such agencies.