“A bill to combat fraud in Federal programs, and for other purposes.”
No CRS summary available for this bill.
This section amends the Child Care and Development Block Grant Act of 1990 to prevent fraud in child care services. Specifically, it (1) revises state plan requirements to assure that lead agencies provide payments to child care providers based on recorded attendance rather than enrollment alone; (2) prohibits lead agencies from paying providers prior to the provision of services, requiring instead timely reimbursement based on services provided; and (3) requires providers receiving payments to maintain attendance and service records for seven years, available for audit by the Secretary, Attorney General, and Comptroller General. (As background, the act provides block grants to states to subsidize child care for low-income working families.)
This section directs the Secretary of Health and Human Services (HHS) to notify the HHS Inspector General within 60 days of determining that Medicare payments for an item or service in a zip code and county equivalent, or the number of providers of services or suppliers, increased by more than 100% in a single year. This section similarly requires the HHS Secretary to notify the HHS Inspector General within 60 days of a more-than-100% single-year increase in payments under qualified health plans on American Health Benefit Exchanges or in the number of such providers in a zip code and county equivalent (effective 180 days after enactment). It further requires Exchanges to collect necessary information annually from qualified health plans and submit it to the HHS Secretary. This section amends Medicaid law (SSA §1902) to require states to notify the HHS Secretary and HHS Inspector General within 60 days of a more-than-100% single-year increase in payments or providers under the state plan (or waiver) for an item or service in a zip code and county equivalent (effective 180 days after enactment, with possible delay if state legislation is required); and amends CHIP law (SSA §2107(e)(e)(1)) to incorporate the same requirements. This section further directs the HHS Inspector General to identify, based on such notifications, any Medicare program, ACA Exchange plan, Medicaid state plan, or CHIP waiver with payments or providers that increased by at least 400% over a preceding 5-year period in a zip code and county equivalent—and to audit them—not later than 5 years after enactment and annually thereafter.
This section (1) directs the Director of the Office of Management and Budget to prescribe guidance to agencies ensuring recovery of all improper payments; and (2) amends Inspector General annual reporting requirements under 31 U.S.C. 3353(a)(1) to require inclusion of the amount of improper payments recovered by the executive agency in the fiscal year covered by the report.