United States. Congress. House Committee on Interstate
and Foreign Commerce. Sibommittee on Health and Environnie

INTERSTATE AND FOREIGN COMMERCE
HOUSE OF REPRESENTATIVES

NINETY-FOURTH CONGRESS

SECOND SESSION

ON

H.R. 15536

A BILL TO STRENGTHEN THE CAPABILITY OF THE GOVERNMENT TO
DETECT, PROSECUTE, AND PUNISH FRAUDULENT ACTIVITIES UNDER
THE MEDICARE AND MEDICAID PROGRAMS, AND FOR OTHER PURPOSES

H.R. 13347 and H.R. 14805

BILLS TO AMEND TITLE XIX OF THE SOCIAL SECURITY ACT TO
PROVIDE FOR EFFECTIVE DETECTION AND PREVENTION OF FRAUD
AND ABUSE IN CONNECTION WITH THE MEDICAL ASSISTANCE PRO-
GRAM UNDER THAT TITLE
H.R. 6483

A BILL TO AMEND THE SOCIAL SECURITY ACT TO PROVIDE FOR
THE ESTABLISHMENT OF AN INSPECTOR GENERAL FOR HEALTH

ADMINISTRATION

H.R. 6623

A BILL TO AMEND TITLE XI OF THE SOCIAL SECURITY ACT TO PRO-
VIDE FOR A SYSTEM OF REVIEWS, INSPECTIONS, AND AUDITS OF THE
MEDICARE PROGRAM UNDER TITLE XVIII OF SUCH ACT, TO BE CON-
DUCTED BY A NEWLY ESTABLISHED INSPECTOR GENERAL FOR
HEALTH ADMINISTRATION IN THE DEPARTMENT OF HEALTH,
EDUCATION, AND WELFARE

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE

HARLEY O. STAGGERS, West Virginia, Chairman

Allen, Paul M., chief deputy director, Michigan Department of

Social Services; also on behalf of the American Public Welfare

Association, National Council of State Public Welfare Admin-

istrators..

Bussman, John W., M.D., president, American Association of Pro-

fessional Standards Review Organizations -

Diamond, Mitchell, treasurer, IMFC Professional Services Corp---.

Dochter, Ivan, general counsel, IMFC Professional Services Corp---

Fullerton, William, Washington representative, American Association

of Professional Standards Review Organizations---

Goran, Michael J., M.D., Director, Bureau of Quality Assurance,

Health Services Administration, Department of Health, Education,

and Welfare.

Haislip, Gene R., Deputy Assistant Secretary for Legislation (Health),

Department of Health, Education, and Welfare..

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Hill, Dan, assistant director, department of legislation, American

Medical Association_.

106

Holden, Raymond T., M.D., chairman, board of trustees, American

Medical Association

106

Horty, John F., president, Council of Community Hospitals --

Morrill, William A., Assistant Secretary for Planning and Evaluation,

Department of Health, Education, and Welfare__

Myers, Beverlee A., lecturer, department of medical care organiza-

tion, School of Public Health, University of Michigan. --

Peterson, Harry N., director, department of legislation, American

Medical Association..

Schneider, Andy, staff attorney, National Health Law Program..

Schwartz, Victor L., attorney, former Assistant U.S. Attorney for the

Eastern District of Pennsylvania

Tierney, Thomas M., Director, Bureau of Health Insurance, Social

Security Administration, Department of Health, Education, and

Welfare...

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56

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Walsh, John, Director, Office of Investigations, Department of Health,

Education, and Welfare...

56

Weikel, Keith M., Ph. D., Commissioner, Medical Services Admin-

istration, Social Rehabilitation Service, Department of Health,

Education, and Welfare...

56

Additional material submitted for the record by-

American Association of Professional Standards Review Organiza-

tions:

Excerpt from report of first year of operation of Redwood Health

Foundations (RHF), a demonstration project----

Memorandum report-Summary of Federal review effectiveness

studies (Colorado Foundation for Medical Care) _ _.

Memorandum report-Analysis of data prepared for presentation

to the House Subcommittee on Health and the Environment-

February 18, 1976...

Additional material submitted for the record by-Continued
American Association of Professional Standards-Continued

Memorandum report-Analysis of data prepared for presentation
to the House Subcommittee on Health and the Environment-
February 18, 1976 (revised).

Memorandum re telephone conversation with Charles Fischer,
Office on Research and Statistics (ORS), SSA.......
Memorandum re telephone conversation concerning MADOC
(Medicare Analysis and Days of Care) data with the Office
of Research and Statistics (ORS), June 24, 1976–

American Dental Association, statement....
American Hospital Association, statement.
Blue Cross Association, statement..

Fountain, Hon. L. H., Chairman, Intergovernmental Relations and
Human Resources Subcommittee, Committee on Government
Operations, letter dated September 22, 1976, to Chairman Rogers
re committee approval of H.R. 15390, a bill to establish an Office
of Inspector General for the Department of HEW
National Association of Manufacturers, Brenda G. Ballard, director,
employee benefits, letter dated September 23, 1976, to Chairman
Rogers--

National Health Law Program, appendixes to Mr. Schneider's pre-
pared statement:

Appendix I-Amendment to H.R. 15536, provision to encourage
States participating in medicaid to take effective administra-
tive measures to detect and prevent fraud and abuse.......
Appendix II-Amendment to H.R. 15536, provision to assure
continuity of ambulatory care to persons eligible for medical
assistance..

Appendix III-Amendment to H.R. 15536, provision to protect
medicaid recipients from collection efforts by shared health
facilities..

Appendix IV-Amendment to H.R. 15536, provision to require
States participating in medicaid to inventory ambulatory care
providers, to identify areas where shared health facilities are
concentrated, and to notify recipients of alternative sources
of services__.

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