PRIA, Government Policy, Made Personal

Summary

Within 3 months after August 21, 1996, the Secretary must create two programs. One program asks people to report individuals or entities who did acts or failed to act that could lead to sanctions under sections 1320a–7, 1320a–7a, or 1320a–7b, or who committed other Medicare fraud or abuse that is sanctionable. Frivolous or irrelevant reports must be discouraged and not counted. If a report leads to at least $100 being collected (not counting penalties under 1320a–7b), the Secretary may pay part of the recovery to the reporter using procedures like section 7623 of the Internal Revenue Code. The other program asks for suggestions to make Medicare more efficient. If a suggestion is adopted and saves money, the Secretary may pay the person an amount the Secretary deems appropriate.

Title 42, §1395b–5

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

(a)

(b)(1)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)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)(1)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)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