United States. Congress

“ The Secretary may disenroll, for a period of not more than one year for each act, a physician or supplier under section 1866 (j) if such physician or supplier fails to maintain and, upon request of the Secretary, provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services, or referrals for other items or services written or ordered by such physician or supplier under this title, as specified by the Secretary. ”

“ Establishment of core elements.—The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish core elements for a compliance program under paragraph (1) . Such elements may include written policies, procedures, and standards of conduct, a designated compliance officer and a compliance committee; effective training and education pertaining to fraud, waste, and abuse for the organization’s employees and contractors ”

“ Program Integrity.—A State child health plan shall include a description of the procedures to be used by the State— `` (1) to enforce any determination made by the Secretary under subsection (a) of section 1128G (relating to a significant risk of fraudulent activity with respect to a category of provider or supplier described in such subsection through use of the appropriate procedures described in such subsection) ; and `` (2) to carry out any activities as required by the Secretary for purposes of such subsection. ”

“ Application to Other Areas Under Medicare.— The Secretary may apply the face-to-face encounter requirement described in the amendments made by subsections (a) and (b) to other items and services for which payment is provided under title XVIII of the Social Security Act based upon a finding that such an decision would reduce the risk of waste, fraud, or abuse. ”

“ The terms ‘knowing’, ‘knowingly’, and ‘should know’ mean that a person, with respect to information— `` (A) has actual knowledge of the information; `` (B) acts in deliberate ignorance of the truth or falsity of the information ”

“ Person.—The term ‘person’ means a provider of services, supplier, Medicaid managed care organization (as defined in section 1903 (m) (1) (A) ) , Medicare Advantage organization (as defined in section 1859 (a) (1) ) , or PDP sponsor (as defined in section 1860D–41 (a) (13) ) , but excluding a beneficiary. ́ ́.
Sec. 1642. Expanded Application of Hardship Waivers for OIG Exclusions to Beneficiaries of Any Federal Health Care Program. ”