IMPROVING INFORMATION TO MEDICARE BENEFICIARIES.

SEC. 4311. IMPROVING INFORMATION TO MEDICARE BENEFICIARIES. (a) Inclusion of Information Regarding Medicare Waste, Fraud, and Abuse in Annual Notice.— (1) In general.—Section 1804 (42 U.S.C. 1395b–2) is amended by adding at the end the following new subsection: “(c) The notice provided under subsection (a) shall include— “(1) a statement which indicates that because errors do occur and because medicare fraud, waste, and abuse is a significant problem, beneficiaries should carefully check any explanation of benefits or itemized statement furnished pursuant to section 1806 for accuracy and report any errors or questionable charges by calling the toll-free phone number described in paragraph (4); “(2) a statement of the beneficiary’s right to request an itemized statement for medicare items and services (as provided in section 1806(b)); “(3) a description of the program to collect information on medicare fraud and abuse established under section 203(b) of the Health Insurance Portability and Accountability Act of 1996; and “(4) a toll-free telephone number maintained by the Inspector General in the Department of Health and Human Services for the receipt of complaints and information about waste, fraud, and abuse in the provision or billing of services under this title.”. (2) Effective date.—The amendment made by this subnote-section shall apply to notices provided on or after January 1, 1998.111 STAT. 385 (b) Clarification of Requirement to Provide Explanation of Medicare Benefits.— (1) In general.—Title XVIII is amended by inserting after section 1805 (as added by section 4022) the following new section: “explanation of medicare benefits “Sec. 1806. (a) In General.—The Secretary shall furnish to each individual for whom payment has been made under this title (or would be made without regard to any deductible) a statement which— “(1) lists the item or service for which payment has been made and the amount of such payment for each item or service; and “(2) includes a notice of the individual’s right to request an itemized statement (as provided in subsection (b)). “(b) Request for Itemized Statement for Medicare Items and Services.— “(1) In general.—An individual may submit a written request to any physician, provider, supplier, or any other person (including an organization, agency, or other entity) for an itemized statement for any item or service provided to such individual by such person with respect to which payment has been made under this title. “(2) 30-day period to furnish statement.— “(A) In general.—Not later than 30 days after the date on which a request under paragraph (1) has been made, a person described in such paragraph shall furnish an itemized statement describing each item or service provided to the individual requesting the itemized statement. “(B) Penalty.—Whoever knowingly fails to furnish an itemized statement in accordance with subparagraph (A) shall be subject to a civil money penalty of not more than $100 for each such failure. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A are imposed and collected under that section. “(3) Review of itemized statement.— “(A) In general.—Not later than 90 days after the receipt of an itemized statement furnished under paragraph (1), an individual may submit a written request for a review of the itemized statement to the Secretary. “(B) Specific allegations.—A request for a review of the itemized statement shall identify— “(i) specific items or services that the individual believes were not provided as claimed, or “(ii) any other billing irregularity (including duplicate billing). “(4) Findings of secretary.—The Secretary shall, with respect to each written request submitted under paragraph (3), determine whether the itemized statement identifies specific items or services that were not provided as claimed or any other billing irregularity (including duplicate billing) that has resulted in unnecessary payments under this title. “(5) Recovery of amounts.—The Secretary shall take all appropriate measures to recover amounts unnecessarily paid 111 STAT. 386under this title with respect to a statement described in paragraph (4).”. (2) Conforming amendment.—Subsection (a) of section 203 of the Health Insurance Portability and Accountability Act of 1996 is repealed. (3) Effective dates.— (A) Statement by secretary.—Paragraph (1) of section 1806(a) of the Social Security Act, as added by paragraph (1), and the repeal made by paragraph (2) shall take effect on the date of the enactment of this Act. (B) Itemized statement.—Paragraph (2) of section 1806(a) and section 1806(b) of the Social Security Act, as so added, shall take effect not later than January 1, 1999.