oversight

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)

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         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
@rznong.aimd@gao.gov or Deborah A. Taylor at (202) 512-9395 or by e-r-nail at
taylord.aimd@gao.govif 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
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