ADVISORY

FROM THE COMMITTEE ON WAYS AND MEANS
Subcommittee on Health

FOR IMMEDIATE RELEASE, Contact: (202) 225-3943
April 29, 1997
No. HL-13

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 health care system. The hearing will take place on Tuesday, May 6, 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:

Health care fraud accounts for a significant percentage of national health care costs, by as much as 10 percent, according to GAO.

To fight fraud and abuse, the Congress included landmark reforms in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (P.L. 104-191). HIPAA establishes and provides funding for the Health Care Fraud and Abuse Control Program, under the direction of the Attorney General and the Secretary of Health and Human Services (HHS). The program combats 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 creates new health care crimes for criminal conduct involving health care programs and significantly increases penalties for health care fraud and abuse.

At the same time, HIPAA attempts to recognize significant changes in the marketplace and address some of the confusion in the application of current fraud statutes. This is done by: (1) providing an exception to the anti-kickback provisions for arrangements in which providers assume significant financial risk for their treatment decisions, (2) requiring HHS to issue binding advisory opinions regarding specific proposals, and (3) requiring HHS to develop additional broadly applicable safe harbors and modifications to existing safe harbors.

The Administration has proposed in its budget to fight fraud and abuse through a number of proposed revisions in the Medicare program. This includes instituting consolidated billing for nursing homes, eliminating periodic interim payments for home health providers, requiring that non-physician practitioners provide diagnostic information on all claims, and increasing the number of laboratory tests paid on an automated basis.

In March, President Clinton announced a supplemental package of additional waste, fraud, and abuse reforms. This proposal includes new requirements for individuals and companies that wish to participate in Medicare and Medicaid, technical modifications to HIPAA, and some increased sanctions.

In announcing the hearing, Chairman Thomas stated: "Nothing is more important to the integrity of Medicare than combating fraud. I look forward to working with the Administration and others who wish to build on the significant progress we made during the 104^th Congress in passing the landmark anti-fraud and abuse initiatives in the Health Insurance Portability and Accountability Act."

FOCUS OF THE HEARING:

The hearing will focus on the implementation of HIPAA, President Clinton's Medicare waste, fraud, and abuse proposals, and additional recommendations for combating waste, fraud, and abuse in the health care system.

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) copies of their statement and a 3.5-inch diskette in WordPerfect or ASCII format, with their address and date of hearing noted, by the close of business, Tuesday, May 20, 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 a 3.5-inch diskette in WordPerfect or ASCII format.

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.