Medicare Antifraud Act of 1997

TABLE OF CONTENTS: Title I: Protecting Program Integrity Title II: Sanctions for Fraud and Abuse Title III: Technical Clarifications and Corrections Title IV: Coordination of Benefits Medicare Antifraud Act of 1997 - Title I: Protecting Program Integrity - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) prohibit the Secretary of Health and Human Services from issuing or renewing the provider number of a durable medical equipment (DME) supplier unless the supplier provides information on ownership or control interests and a surety bond of at least $50,000; (2) require home health agencies to provide such a surety bond; and (3) authorize application of such disclosure and surety bond requirements to suppliers of ambulance services and clinics that furnish medical and other health services (other than physicians' services) under Medicare part B (Supplementary Medical Insurance). (Sec. 102) Amends SSA title XI to condition provider payment under the Medicare, Medicaid (SSA title XIX), and Maternal and Child Health Services (SSA title V) programs on the disclosure to the Secretary of certain applicable employer identification and social security numbers, including those of individuals with an ownership or control interest in the provider. Requires verification of such information, and correction if necessary, by the Social Security Administration. (Sec. 103) Requires non-physician practitioners to provide diagnostic codes for furnished items or services. Requires both physicians and non-physician practitioners to provide diagnostic information to another entity when ordering from it certain items or services if the Secretary requires such entity to provide such information in order to be paid. (Sec. 104) Replaces the reasonable charge methodology for the payment of Medicare benefits with a methodology that uses fee schedules developed by the Secretary. (Sec. 105) Requires the Secretary to describe by regulation the factors to be used in determining the cases or particular items in which application of special DME payment rules results in inherently unreasonable amounts. Applies such regulations to payment for surgical dressings. (Sec. 106) Amends SSA title XI to authorize the Secretary to exclude from the Medicare program an entity controlled by a family or household member of a sanctioned individual. (Sec. 107) Amends SSA title XVIII to make Medicare carriers, States, and fiscal intermediaries liable to the Secretary for any payment of claims submitted by excluded providers after the Secretary notifies the organization or agency of such exclusion. (Sec. 108) Amends SSA titles XVIII and XIX to authorize the Secretary or a State to refuse to enter into Medicare or Medicaid agreements with individuals or entities convicted of felonies. (Sec. 109) Amends part A (General Provisions) of SSA title XI to provide that Medicare- and Medicaid-related actions are not stayed by bankruptcy proceedings, and Medicare- and Medicaid-related debt is not dischargeable in bankruptcy. Amends SSA title XVIII to provide for the use of Medicare standards and procedures in bankruptcy proceedings. (Sec. 110) Amends the Health Care Quality Improvement Act of 1986 to: (1) authorize the availability of National Practitioner Data Bank information to the Inspectors General of the Departments of Health and Human Services (HHS), of Defense, and of Labor, of the Office of Personnel Management, and of the Railroad Retirement Board; and (2) exempt the HHS Inspector General from fees for such information. (Sec. 111) Amends SSA title XIX to extend the authority of State Medicaid Fraud Control Units to investigate and prosecute: (1) fraud in other Federal health care programs, upon the approval of the relevant Federal agency; and (2) patient abuse in non-Medicaid board and care facilities. (Sec. 112) Amends SSA title XVIII to change from biennial to annual the General Accounting Office report on the Federal Hospital Insurance Trust Fund's Health Care Fraud and Abuse Control Account. Title II: Sanctions for Fraud and Abuse - Amends SSA title XI to permit the Secretary to impose civil monetary penalties for kickback violations, and for persons that contract with individuals excluded from participation in a Federal health care program, as well as for services ordered or prescribed by an excluded individual or entity. Title III: Technical Clarifications and Corrections - Makes technical amendments to SSA title XI. Title IV: Coordination of Benefits - Amends SSA title XVIII to repeal the termination dates of, thus extending permanently, certain Medicare secondary payer provisions with respect to the working disabled, individuals with end-stage renal disease, and the IRS-SSA- HCFA data match. (Sec. 402) Makes technical changes concerning minimum sizes of group health plans. (Sec. 403) Requires group health plans to provide the Secretary, and employers and employee organizations to provide plan administrators, certain information pertaining to employers, employees, and employee family members with current or former employment status. (Sec. 404) Makes certain technical revisions to time and filing limitations, the liability of third party administrators, and requirements for reimbursement for Medicare secondary payer payments.