42 U.S.C. § 1395b–5: Beneficiary incentive…

Summary

The Secretary must set up two programs within 3 months after August 21, 1996. The first program asks people to report individuals or groups who have done things that can lead to penalties under sections 1320a–7, 1320a–7a, or 1320a–7b, or who otherwise committed Medicare fraud that is punishable by law. The program must discourage and not use reports that are frivolous, false, or not helpful. If a report leads the Secretary or the Attorney General to recover at least $100 (not including amounts paid as a penalty under section 1320a–7b), the Secretary may give part of what is collected to the person who reported it, using procedures like Internal Revenue Code section 7623. The second program asks for ideas to make Medicare more efficient. If a suggestion is adopted and saves money, the Secretary may pay the person an amount the Secretary thinks is appropriate.

Title 42, §1395b–5

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Repealed. Pub. L. 105–33, title IV, § 4311(b)(2), Aug. 5, 1997, 111 Stat. 386

(b)Program to collect information on fraud and abuse

(1)Establishment of program

Not later than 3 months after August 21, 1996, the Secretary shall establish a program under which the Secretary shall encourage individuals to report to the Secretary information on individuals and entities who are engaging in or who have engaged in acts or omissions which constitute grounds for the imposition of a sanction under section 1320a–7, 1320a–7a, or 1320a–7b of this title, or who have otherwise engaged in fraud and abuse against the Medicare program under this subchapter for which there is a sanction provided under law. The program shall discourage provision of, and not consider, information which is frivolous or otherwise not relevant or material to the imposition of such a sanction.

(2)Payment of portion of amounts collected

If an individual reports information to the Secretary under the program established under paragraph (1) which serves as the basis for the collection by the Secretary or the Attorney General of any amount of at least $100 (other than any amount paid as a penalty under section 1320a–7b of this title), the Secretary may pay a portion of the amount collected to the individual (under procedures similar to those applicable under section 7623 of the Internal Revenue Code of 1986 to payments to individuals providing information on violations of such Code).

(c)Program to collect information on program efficiency

(1)Establishment of program

Not later than 3 months after August 21, 1996, the Secretary shall establish a program under which the Secretary shall encourage individuals to submit to the Secretary suggestions on methods to improve the efficiency of the Medicare program.

(2)Payment of portion of program savings

If an individual submits a suggestion to the Secretary under the program established under paragraph (1) which is adopted by the Secretary and which results in savings to the program, the Secretary may make a payment to the individual of such amount as the Secretary considers appropriate.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (b)(2), is classified generally to Title 26, Internal Revenue Code. Codification Section was enacted as part of the Health Insurance Portability and Accountability Act of 1996, and not as part of the Social Security Act which comprises this chapter.

Amendments

1997—Subsec. (a). Pub. L. 105–33 struck out heading and text of subsec. (a). Text read as follows: “The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall provide an explanation of benefits under the Medicare program under this subchapter with respect to each item or service for which payment may be made under the program which is furnished to an individual, without regard to whether or not a deductible or coinsurance may be imposed against the individual with respect to the item or service.”

§1395b–5 Beneficiary Incentive Programs