In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed and became effective on January 1, 1997. It created new criminal statutes related to health care fraud, making it illegal to defraud health care benefit programs and obtain money or property fraudulently. This new law allows federal prosecutors to charge individuals involved in fraudulent schemes related to health care, with penalties of up to 10 years in prison, or even life imprisonment for more serious cases. Section 243 creates a new law that makes it illegal to steal or misuse money or property from a health care benefit program. The maximum punishment is 10 years in prison, unless the stolen property is worth less than $100, in which case the maximum punishment is one year.
Section 244 creates a new law that makes it illegal to lie or hide important information in any matter involving a health care benefit program. The maximum punishment is five years in prison. These new laws help federal prosecutors charge and punish people who commit theft or fraud in health care programs, even if they don’t meet the requirements of existing laws. The new criminal statutes under Section 245 and Section 217 of the Act create penalties for obstructing the communication of information related to health care fraud and for knowingly disposing of assets to become eligible for Medicaid. These laws also expand existing money laundering and fraud injunction statutes to cover federal health care offenses. Section 246 expanded the types of illegal activities that can be considered money laundering to include federal health care offenses. Section 249 stated that anyone convicted of a federal health care offense has to give up property they got from the crime. Section 248 allowed the US to sue and freeze the assets of people involved in federal health care offenses.
Section 204 expanded the Anti-Kickback Act to cover more federal health care programs, not just Medicare and Medicaid. Section 216 created a new exception to the Anti-Kickback Act for managed care organizations and providers who share financial risks. The law was changed to define “remuneration” as including waivers of coinsurance and deductibles, but there are exceptions, like waivers for patients in financial need or for preventive care. The government also has to regularly ask for input on changing the rules and then publish any proposed changes for public comments before making them final. Section 205 of the Anti-Kickback Act requires the Department of Health and Human Services (HHS) to provide written advisory opinions on what counts as illegal payments and whether certain business arrangements break the law. These opinions are binding, but not seeking one doesn’t prove intent to break the law. HHS must issue regulations for this process, including a fee for the opinion and a 60-day response time. The advisory opinions will be available until August 21, 2000.
Section 248 creates a new law that allows the Department of Justice to use subpoenas to get records and testimony for investigations of federal health care crimes. But the records can’t be asked for if they’re more than 500 miles away. If someone is asked for health records as part of a legal investigation, they have to give them up. But they won’t get in trouble for doing it, and the records can only be used for the investigation. If someone at a financial institution gives out the investigation request, they can get in trouble. Also, if someone is convicted of certain crimes related to healthcare, they can be excluded from working in healthcare for at least three years. And people who own or work for a healthcare company that’s been punished can also be excluded. Section 231 of the law increased the penalties for making false claims in federal health care programs, and expanded the types of conduct that can result in penalties. It also clarified the level of knowledge required to impose penalties.
Section 232 introduced a new penalty for physicians who falsely certify their eligibility to receive home health care.
Section 201 allocated more money for investigating and prosecuting health care fraud, which will result in more resources for the Department of Justice and HHS to catch and punish fraud in the health care system. Section 201 of the Medicare program requires the Department of Health and Human Services to create a Medicare Integrity Program using funds from the Medicare Part A Trust Fund. This program will focus on reviewing medical services, identifying and preventing fraud, auditing cost reports, recovering payments made in error, and educating healthcare providers and patients. The program will start with $430-440 million in 1997 and increase to $710-720 million in 2002. Public Law 104-191 shows that the government is cracking down on health care fraud. There are more laws, penalties, and enforcement agents than ever before. Health care providers need to be careful and get legal help if they have any problems. Kevin J. Darken is a lawyer who knows a lot about health care law and can help. This column is from the Health Law Section, with Karen O. Emmanuel as the chair and Robert C. McCurdy as the editor. It talks about the principles of duty and service to the public, improving justice administration, and advancing the study of law. It’s basically about lawyers doing good work and helping people.
Source: https://www.floridabar.org/the-florida-bar-journal/understanding-the-new-federal-health-care-fraud-legislation/
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