< Back to H.R. 4028 (103rd Congress, 1993–1994)

Text of the Health Care Fraud and Abuse Advisory Opinion Act of 1994

This bill was introduced on March 11, 1994, in a previous session of Congress, but was not enacted. The text of the bill below is as of Mar 11, 1994 (Introduced).

Source: GPO

HR 4028 IH

103d CONGRESS

2d Session

H. R. 4028

To empower the Department of Health and Human Services to issue advisory opinions on whether certain arrangements for the delivery of health care services and supplies are in compliance with statutes and rules establishing acceptable health care billing and payment practices and with statutes and rules defining health care fraud and abuse.

IN THE HOUSE OF REPRESENTATIVES

March 11, 1994

Mr. HOAGLAND (for himself, Mr. PORTER, Mr. BREWSTER, and Mr. THOMAS of California) introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and Commerce


A BILL

To empower the Department of Health and Human Services to issue advisory opinions on whether certain arrangements for the delivery of health care services and supplies are in compliance with statutes and rules establishing acceptable health care billing and payment practices and with statutes and rules defining health care fraud and abuse.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; REFERENCES IN ACT.

    (a) SHORT TITLE- This Act may be cited as the ‘Health Care Fraud and Abuse Advisory Opinion Act of 1994’.

    (b) REFERENCES IN ACT- Except as otherwise specifically provided, whenever an amendment herein is expressed in terms of an amendment to, or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.

SEC. 2. AUTHORIZING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO ISSUE ADVISORY OPINIONS UNDER TITLE XI.

    (a) AUTHORIZATION- Title XI, section 1128 (42 U.S.C. 1320a-7) is amended by the addition of the following new paragraph:

    ‘(j) The Secretary shall issue advisory opinions as provided in this section.

      ‘(1) MATTERS SUBJECT TO ADVISORY OPINIONS- The Secretary shall issue advisory opinions as to the following matters:

        ‘(i) What constitutes prohibited remuneration within the meaning of section 1320a-7b(b) of title 42, United States Code.

        ‘(ii) Whether an arrangement or proposed arrangement satisfies the criteria set forth in section 1320a-7b(b)(3) of title 42, United States Code as amended for activities which do not result in prohibited remuneration.

        ‘(iii) Whether an arrangement or proposed arrangement satisfies the criteria which the Secretary has established, or shall establish by regulation for activities which do not result in prohibited remuneration.

        ‘(iv) What constitutes an inducement to reduce or limit services to individuals entitled to benefits under part A or part B of title XVIII or title XIX within the meaning of section 1320a-7a(b) of title 42, United States Code.

        ‘(v) Whether an arrangement, activity or proposed arrangement or proposed activity violates any other provision of the Act.

      ‘(2) MATTERS NOT SUBJECT TO ADVISORY OPINIONS- Such advisory opinions shall not address the following matters:

        ‘(i) Whether the fair market value shall be, or was paid or received for any goods, services or property.

        ‘(ii) Whether an individual is a bona fide employee within the requirements of section 3121(d)(2) of title 26, United States Code.

      ‘(3) Effect of advisory opinions-

        ‘(i) Each advisory opinion issued by the Secretary shall be binding as to the Secretary and the party or parties requesting the opinion.

        ‘(ii) The failure of a party to seek an advisory opinion may not be introduced into evidence to prove that the party intended to violate the provisions of sections 1320a-7, 1320a-7(a), or 1320a-7(b) of title 42, United States Code.

      ‘(4) REGULATIONS- The Secretary within one hundred and eighty days of the date of enactment, shall issue regulations establishing a system for the issuance of advisory opinions. Such regulations shall provide for--

        ‘(i) the procedure to be followed by a party applying for an advisory opinion;

        ‘(ii) the procedure to be followed by the Secretary in responding to a request for an advisory opinion;

        ‘(iii) the interval in which the Secretary shall respond;

        ‘(iv) the reasonable fee to be charged to the party requesting an advisory opinion; and

        ‘(v) the manner in which advisory opinions will be made available to the public.

      ‘(5) INTERVAL FOR ISSUANCE OF ADVISORY OPINIONS- Under no circumstances shall the interval in which the Secretary shall respond to a party requesting an advisory opinion exceed 30 days.’.

SEC. 3. AUTHORIZING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO ISSUE ADVISORY OPINIONS UNDER TITLE XVIII.

    (a) AUTHORIZATION- Title XVIII, section 1877 (42 U.S.C. 1395nn) is amended by the addition of the following new paragraph:

    ‘(i)(1) ADVISORY OPINIONS- The Secretary shall issue advisory opinions on whether an arrangement or proposed arrangement will result in a prohibited referral within the meaning of section 1395nn of title 42, United States Code, as amended.

    ‘(2) Effect of Advisory Opinions-

      ‘(i) Each advisory opinion issued by the Secretary shall be binding as to the Secretary and the party or parties requesting the opinion.

      ‘(ii) The failure of a party to seek an advisory opinion may not be introduced into evidence to prove that the party intended to violate the provisions of section 1395nn of title 42, United States Code.

    ‘(3) REGULATIONS- The Secretary within one hundred and eighty days of the date of enactment, shall issue regulations establishing a system for the issuance of advisory opinions. Such regulations shall provide for--

      ‘(i) the procedure to be followed by a party applying for an advisory opinion;

      ‘(ii) the procedure to be followed by the Secretary in responding to a request for an advisory opinion;

      ‘(iii) the interval in which the Secretary shall respond;

      ‘(iv) the reasonable fee to be charged to the party requesting an advisory opinion; and

      ‘(v) the manner in which advisory opinions will be made available to the public.

    ‘(4) INTERVAL FOR ISSUANCE OF ADVISORY OPINIONS- Under no circumstances shall the interval in which the Secretary shall respond to a party requesting an advisory opinion exceed thirty days.’.

SEC. 4. EFFECTIVE DATE.

    Unless otherwise specified herein, the Health Care Fraud and Abuse Advisory Opinion Act of 1994 shall be effective upon enactment.