ADVISORY

FROM THE COMMITTEE ON WAYS AND MEANS
Subcommittee on Health

FOR IMMEDIATE RELEASE, Contact: (202) 225-3943
September 16, 1997
No. HL-16

Congressman Bill Thomas (R-CA), Chairman, Subcommittee on Health of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on waste, fraud, and abuse in the U.S. health care . The hearing will take place on Tuesday, September 30, 1997, in the main Committee hearing room, 1100 Longworth House Office Building, beginning at 10:00 a.m.

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing.

BACKGROUND:

There has been considerable attention focused during the past several years on the problem of waste, fraud, and abuse in the Medicare program and in the U.S. health care system generally. The U.S. General Accounting Office has estimated that waste, fraud, and abuse account for up to 10 percent of Medicare costs, and the Inspector General of the Department of Health and Human Services (HHS) announced at a recent Subcommittee hearing that the Medicare program made improper payments totaling $23 billion in fiscal year 1996.

In the past two years, Congress has passed significant legislation designed to address these growing concerns about waste, fraud, and abuse. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) (P.L. 104-191) established and provided funding for the Health Care Fraud and Abuse Control Program, under the direction of the Attorney General and the Secretary of HHS. The program is designed to combat fraud and abuse committed against both public and private health plans by coordinating law enforcement efforts among Federal, State, and local officials. In addition, HIPAA created new health care crimes for criminal conduct involving health care programs and significantly increased penalties for health care fraud and abuse.

The Balanced Budget Act of 1997 (BBA) (P.L. 105-33) significantly expands upon HIPPA's anti-fraud and abuse measures. Among other reforms, the BBA: (1) requires that providers convicted of three program-related offenses be excluded permanently from Medicare and other Federal health programs, (2) provides new civil monetary penalties for violations of the anti-kickback statute, (3) requires home health agencies, durable medical equipment suppliers, and other providers to post a surety bond of at least $50,000 in order to provide items and services to Medicare beneficiaries, (4) requires the Inspector General to establish a toll-free hotline for Medicare beneficiaries to report fraud and billing irregularities, (5) requires hospitals to disclose to beneficiaries requiring post-acute care any provider in which the hospital has a financial interest, and (6) provides the Secretary with new authority to reduce or increase Medicare reimbursement where the current payment amount is "grossly excessive or grossly deficient and not inherently reasonable." In addition, the BBA modernized Medicare by establishing prospective payment systems designed to minimize opportunities for fraud and abuse.

In announcing the hearing, Chairman Thomas stated: "Congress must assure Medicare beneficiaries and the taxpayers that Medicare is not frittering away precious program dollars on waste, fraud, and abuse. To meet our obligations, we passed landmark anti-fraud and abuse legis- lation in both the 104^th and 105^th Congress. Now, we must ensure that these reforms are implemented and that the Health Care Financing Administration makes combating fraud and abuse its top priority."

FOCUS OF THE HEARING:

The hearing will assess implementation of the BBA and HIPAA initiatives aimed at combating waste, fraud, and abuse in the health care system. It also will identify those areas of the Medicare program where waste, fraud, and abuse challenges still lie ahead.

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:

Any person or organization wishing to submit a written statement for the printed record of the hearing should submit at least six (6) single-space legal-size copies of their statement, along with an IBM compatible 3.5-inch diskette in ASCII DOS Text or WordPerfect 5.1 format only, with their name, address, and hearing date noted on a label, by the close of business, Tuesday, October 14, 1997, to A.L. Singleton, Chief of Staff, Committee on Ways and Means, U.S. House of Representatives, 1102 Longworth House Office Building, Washington, D.C. 20515. If those filing written statements wish to have their statements distributed to the press and interested public at the hearing, they may deliver 200 additional copies for this purpose to the Subcommittee on Health office, room 1136 Longworth House Office Building, at least one hour before the hearing begins.

FORMATTING REQUIREMENTS:

Each statement presented for printing to the Committee by a witness, any written statement or exhibit submitted for the printed record or any written comments in response to a request for written comments must conform to the guidelines listed below. Any statement or exhibit not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee.

1. All statements and any accompanying exhibits for printing must be typed in single space on legal-size paper and may not exceed a total of 10 pages including attachments. At the same time written statements are submitted to the Committee, witnesses are now requested to submit their statements on an IBM compatible 3.5-inch diskette in ASCII DOS or WordPerfect 5.1 format. Witnesses are advised that the Committee will rely on electronic submissions for printing the official hearing record.

2. Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee.

3. A witness appearing at a public hearing, or submitting a statement for the record of a public hearing, or submitting written comments in response to a published request for comments by the Committee, must include on his statement or submission a list of all clients, persons, or organizations on whose behalf the witness appears.

4. A supplemental sheet must accompany each statement listing the name, full address, a telephone number where the witness or the designated representative may be reached and a topical outline or summary of the comments and recommendations in the full statement. This supplemental sheet will not be included in the printed record.

The above restrictions and limitations apply only to material being submitted for printing. Statements and exhibits or supplementary material submitted solely for distribution to the Members, the press and the public during the course of a public hearing may be submitted in other forms.

The Committee seeks to make its facilities accessible to persons with disabilities. If you are in need of special accommodations, please call 202-225-1721 or 202-226-3411 TTD/TTY in advance of the event (four business days notice is requested). Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may be directed to the Committee as noted above.