& Acwwhbiiy l Integrity l Reliability United States General Accounting Office Accounting and Information Washington, DC 20548 Management Division B-278606 December 13,1999 Congressional Committees Subject:~ Medicare: Reporting on the Health Care Fraud and Abuse Control Program for F’iscal Years 1998 and 1999 In August 1996, the Congress established the Health Care Fraud and Abuse Control (HCFAC) program with the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The HCFAC program was created to establish a national framework to coordinate federal, state, and local law enforcement efforts to detect, prevent, and successfully prosecute health care fraud and abuse in the public and private sectors. The Departments of Health and Human Services (HHS) and Justice (DOJ) together administer the HCFAC program and are required to issue a report to the Congress on January 1 of each year concerning HCFAC program activities for the preceding fiscal year. Specifically, HHS and DOJ are required to report on (1) amounts appropriated to (deposited to) the Federal Hospital Insurance Trust Fund’ pursuant to HIP& and the source of those amounts and (2) amounts appropriated from the trust fund for the HCFAC program and the justification for the expenditure of such amounts. HHS and DOJ have issued two joint reports, covering fiscal years 19972 and 1998.3 The next joint report, covering the fiscal year 1999 HCFAC program, is due on January 1,200O. HIP&$ as amended by the Balanced Budget Act of 1997: also requires that we submit reports by June 1,1998s and January 1,2000,2002, and 2004, that identify (1) the amounts deposited to the trust fund pursuant to HIPS and the sources of such ‘The Hospital Insurance Trust F’und funds the Medicare Part A program, which helps pay for hospital, home health, skilled nursing facility, and hospice care for the aged and disabled. The trust fund is funded primarily through employment taxes (taxes on payroll and self-employment). ‘Annual Report of the Departments of Health and Human Services and Justice, Health Care Fkaud and Abuse Control Program 1997 (January 23,1998). ‘Annual Report of the Depments of Health and Human Services and Justice, Health Care Fraud and Abuse Conlrol Program 1998 (February 1999:). ‘Public Law 10533. “Medicare: Health Care Fraud and Abuse Control Program F’inancial Report for F&al Year 1997 (GAO/~98-157, June 1,1998). GAO/ATMD-OO-51R Reporting on the HCFAC Program B-278606 amounts, (2) the amounts appropriated from the trust fund for the HCFAC program and the justification for the expenditures of such amounts, (3) expenditures from the trust fund for HCFAC activities not related to Medicare, and (4) any savings to the tz-ust fund, as well as other savings, resulting from expenditures from the trust fund for the HCFAC program. In addition, HIPAA also provides for us to report on other aspects of the operation of the trust fund, as we consider appropriate. The joint HHSKDOJ report covering fiscal year 1999 HCFAC program &tivity, which is not required to be issued until January 1,2000, will contain information we need to perform our review. Once we receive the joint report covering fiscal year 1999, we will need time to determine what, if any, additional information ‘we need as well as to obtain and review that information. Therefore, we will be unable to meet our reporting deadline of January 1,2000, and in all likelihood, our 2002 and 2004 commitments as well. We will keep you informed of our progress. We are sending copies of this letter to Senator Orrin G. Hatch, Chairman, and Senator Patrick J. Leahy, Ranking Minority Member, Senate Committee on the Judiciary; Representative Henry J. Hyde, Chairmen, and Representative John Conyers, Jr., Ranking Minority Member, House Committee on the Judiciary; the Honorable Donna E. Shalala, Secretary of Health and Human Services; and the Honorable Janet Reno, Attorney General. Please contact me at (202) 512-4476 or by e-mail at @firstname.lastname@example.org or Deborah A. Taylor at (202) 512-9395 or by e-r-nail at email@example.com you or your staffs have any questions. Gloria L. Jamron Director, Health, Education, and Human Services Accounting and Financial Management Page 2 GAO/AlMD-00-51R Reporting on the HCFAC Program B-278606 List of Committees The Honorable William V. Roth, Jr. Chairman The Honorable Daniel P. Moynihan Ranking Minority Member Committee on Finance United States Senate The Honorable James M. Jeffords Chairman The Honorable Edward M. Kennedy . Ranking Minority Member Committee on Health, Education, Labor, and Pensions United States Senate The Honorable Tom Bailey Chairman The Honorable John D. Dingell Ranking Minority Member Committee on Commerce House of Representatives The Honorable Bill Archer Chairman The Honorable Charles B. Range1 Ranking Minority Member Committee on Ways and Means House of Representatives (916314) Page 3 GAO/AI&ID-OO-51R Reporting on the HCFAC Program Ordering Information The first copy of each GAO report and testimony is free. Additional copies are $2 each. Orders should be sent to the following address, accompanied by a check or money order made out to the Superintendent of Documents, when necessary. VISA and Mastercard credit cards are accepted, also. Orders for 100 or more copies to be mailed to a single address are discounted 25 percent. Orders by mail: U.S. General Accounting Oftice P.O. Box 37050 Washington, DC 20013 or visit: Room 1100 700 4th St. NW (corner of 4th and G Sts. NW) U.S. General Accounting Office Washington, DC Orders may also be placed by calling (202) 512-6000 or by using fax number (202) 512-6061, or TDD (202) 512-2537. Each day, GAO issues a list of newly available reports and testimony. To receive facsimile copies of the daily list or any list from the past 30 days, please call (202) 512-6000 using a touchtone phone. A recorded menu will provide information on how to obtain these lists. For information on how to access GAO reports on the INTERNET, send an e-mail message with “info” in the body to: firstname.lastname@example.org or visit GAO’s World Wide Web Home Page at: httpz//www.gao.gov United States General Accounting Office Washington, D.C. 20548-0001 Official Business PenaJty for Private Use $300 Address Correction Requested
Medicare: Reporting on the Health Care Fraud and Abuse Control Program for Fiscal Years 1998 and 1999
Published by the Government Accountability Office on 1999-12-13.
Below is a raw (and likely hideous) rendition of the original report. (PDF)