Medicare & Medicaid Patient & Program Protection Act

The Medicare and Medicaid Patient and Program Protection Act was implemented in 1987. Congress constructed and initiated the act to provide protection against fraud and empower the Beneficiary Protection Programs. The act lists as Section 1921 within the Social Security Act.

Benefits

• The Medicare and Medicaid Patient and Program Protection Act enables state agencies to collect, analyze and retain information from entities that utilize Medicare and Medicaid funds. The act enabled pulling information regarding state sanctions against health-care organizations. The information gained through investigations of fraud conducted by representatives of the state is conveyed to the Department of Health and Human Services under the 1987 act.

Amendments

• In 1990 the Omnibus Budget Reconciliation Act amended the 1987 act to include all negative acts in the information-gathering process. In 2006 the Department of Health and Human Services initiated an amendment to include all Medicare and Medicaid organizations. According to the Department of Health and Human Services, entities such as private accreditation or peer-review organizations were included in the areas covered.

Qualitified Agencies

• The Medicare and Medicaid Patient and Program Protection Act allows for specific organizations to gather information regarding Medicare and Medicaid usage. The Department of Health and Human Services reserves the right to gather information from these organizations for any reason. Entities eligible include Medicaid fraud-control units, state licensing departments, the U.S. Attorney General, state law enforcement, the U.S. Comptroller General and quality-improvement organizations.