On October 28, 2009, Senator Ted Kaufman (along with co-sponsoring Senators Patrick Leahy, Arlen Specter, Herb Kohl, Chuck Schumer, and Amy Klobuchar) introduced the Health Care Fraud Enforcement Act of 2009 (S.1959).
As drafted, S.1959 aims to strengthen the U.S. government's capacity to investigate and prosecute waste, fraud and abuse in government health care programs and private health insurance. In brief, S.1959 would (among other things):
- Amend the Federal Sentencing Guidelines to provide a two-level increase in the offense for a defendant convicted of a federal health care offense relating to a government health care program that involves a loss of $1 million or more, a three-level increase if the loss is $7 million or more, and a four-level increase if the loss is $20 million on more.
- Specify that, for purposes of the Federal Anti-Kickback Statute and health care fraud statute (18 U.S.C. 1347), "willful conduct" does not require proof that a defendant had actual knowledge of the law in question or specific intent to violate the law.
- Amend the Federal Anti-Kickback Statute to ensure that all claims resulting from illegal kickbacks are false, even if the claims are not submitted directly by the wrongdoers themselves.
- Expand the definition of a "health care fraud offense."
- Authorize the Department of Justice to issue subpoenas for access to any institution that is the subject of an investigation related to a violation of the Civil Rights for Institutionalized Persons Act (and for any documents, records, materials, files, reports, memoranda, policies, procedures, investigations, video or audio recordings, and quality assurance reports).
- Authorize the appropriation of $20 million per year from 2011 through 2016 for investigations, prosecutions and civil or other proceedings related to fraud and abuse.
According to Senator Kaufman's Press Release, "[f]raud perpetuated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system."
S.1959 has been referred to the Judiciary Committee.
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