Reimbursement Rates for Calendar Year 2006, 48552 [E6-13785]

Download as PDF 48552 Federal Register / Vol. 71, No. 161 / Monday, August 21, 2006 / Notices will be effective for services provided on/or after January 1, 2006 to the extent consistent with payment authorities including the applicable Medicaid State plan. DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2006 Indian Health Service, HHS. Notice. AGENCY: ACTION: SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public Health Service Act (42 U.S.C. 248 and 249(b)), Public Law 83–568 (42 U.S.C. 2001 (a)), and the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.), has approved the following rates for inpatient and outpatient medical care provided by IHS facilities for Calendar Year 2006 for Medicare and Medicaid beneficiaries and beneficiaries of other Federal programs. The Medicare Part A inpatient rates are excluded from the table below as they are paid based on the prospective payment system. Since the inpatient rates set forth below do not include all physician services and practitioner services, additional payment may be available to the extent that those services meet applicable requirements. Public Law 106–554, section 432, dated December 21, 2000, authorized IHS facilities to file Medicare Part B claims with the carrier for payment for physician and certain other practitioner services provided on or after July 1, 2001. Calendar year 2006 hsrobinson on PROD1PC72 with NOTICES Inpatient Hospital Per Diem Rate (Excludes Physician/Practitioner Services): Lower 48 States ...................... Alaska ..................................... Outpatient Per Visit Rate (Excluding Medicare): Lower 48 States ...................... Alaska ..................................... Outpatient Per Visit Rate (Medicare): Lower 48 States ...................... Alaska ..................................... Medicare Part B Inpatient Ancillary Per Diem Rate: Lower 48 States ...................... Alaska ..................................... $1,660 2,131 242 406 193 348 340 625 Outpatient Surgery Rate (Medicare) Established Medicare rates for freestanding Ambulatory Surgery Centers. Effective Date for Calendar Year 2006 Rates Consistent with previous annual rate revisions, the Calendar Year 2006 rates VerDate Aug<31>2005 17:53 Aug 18, 2006 Jkt 208001 Dated: June 27, 2006. Charles W. Grim, Assistant Surgeon General, Director, Indian Health Service. [FR Doc. E6–13785 Filed 8–18–06; 8:45 am] BILLING CODE 4165–16–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Inspector General Publication of OIG’s Guidelines for Evaluating State False Claims Acts Office of Inspector General (OIG), HHS. ACTION: Notice. AGENCY: SUMMARY: Under section 1909 of the Social Security Act (the Act), 42 U.S.C. 1396h, the Inspector General of the Department of Health and Human Services is required to determine, in consultation with the Attorney General, whether a State has in effect a law relating to false or fraudulent claims submitted to a State Medicaid program that meets certain enumerated requirements. If the Inspector General determines that a State law meets these requirements, the State medical assistance percentage, with respect to any amounts recovered under a State action brought under such a law, shall be increased by 10 percentage points. This notice sets forth the Inspector General’s guidelines for evaluating whether a State law meets the requirements of section 1909 of the Act. DATES: Effective Date: These guidelines are effective on August 21, 2006. FOR FURTHER INFORMATION CONTACT: Roderick T. Chen, Office of Counsel to the Inspector General, (202) 401–4134, or Joel Schaer, Office of External Affairs, (202) 619–0089. SUPPLEMENTARY INFORMATION: I. Background Section 1909 of the Act, added by section 6031 of the Deficit Reduction Act of 2005 (Pub. L. 109–171), creates a financial incentive for States to enact legislation that establishes liability to the State for individuals or entities that submit false or fraudulent claims to the State Medicaid program. This incentive takes the form of an increase in the State’s share of any amounts recovered from a State action brought under a PO 00000 Frm 00024 Fmt 4703 Sfmt 4703 qualifying law.1 In order for a State to qualify for this incentive, the State law must meet certain enumerated requirements, as determined by the Inspector General of the Department of Health and Human Services in consultation with the Attorney General. Medicaid, authorized under Title XIX of the Act, 42 U.S.C. 1396–1396v, is a joint Federal and State program that pays for medical and other related benefits provided to needy beneficiaries. States that participate in Medicaid administer their own programs within broad Federal guidelines and receive matching funds from the Federal government. The Federal share generally varies between 50 percent and 83 percent, depending on the State per capita income. False or fraudulent claims presented to State Medicaid programs by participating providers and others may give rise to civil liability under the Federal False Claims Act (FCA), 31 U.S.C. 3729–3733. Under the FCA, any person who knowingly submits a false or fraudulent claim to a State Medicaid program is liable to the Federal Government for three times the amount of the Federal Government’s damages plus penalties of $5,000 to $10,000 for each false or fraudulent claim. Any recovery of damages to the State Medicaid program will be shared with the State in the same proportion as the State’s share of the costs of the Medicaid program. For example, if a State’s Medicaid share is 40 percent, then the State would be entitled to receive 40 percent of the damages and the Federal Government would retain 60 percent of the damages. Under the qui tam provisions of the FCA, private persons (known as relators) may file lawsuits in Federal court against individuals and/or entities that defraud the Federal government by filing false or fraudulent Medicaid claims. The Department of Justice (DOJ) has an opportunity to investigate the relator’s allegations, and DOJ may intervene and take over the prosecution of the action. If DOJ chooses not to intervene, the relator has the right to conduct the action. In general, with respect to recoveries of Federal damages and penalties in cases in which DOJ has intervened, the relator is entitled to between 15 and 25 percent of the recovery of Federal damages and penalties depending upon the extent to which the relator substantially contributed to the case. In general, the relator is entitled to between 25 and 30 1 The increase results from a 10-percentage point decrease in the Federal share of any recovery from a State action brought under a qualifying law. E:\FR\FM\21AUN1.SGM 21AUN1

Agencies

[Federal Register Volume 71, Number 161 (Monday, August 21, 2006)]
[Notices]
[Page 48552]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-13785]



[[Page 48552]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Reimbursement Rates for Calendar Year 2006

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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SUMMARY: Notice is given that the Director of Indian Health Service 
(IHS), under the authority of sections 321(a) and 322(b) of the Public 
Health Service Act (42 U.S.C. 248 and 249(b)), Public Law 83-568 (42 
U.S.C. 2001 (a)), and the Indian Health Care Improvement Act (25 U.S.C. 
1601 et seq.), has approved the following rates for inpatient and 
outpatient medical care provided by IHS facilities for Calendar Year 
2006 for Medicare and Medicaid beneficiaries and beneficiaries of other 
Federal programs. The Medicare Part A inpatient rates are excluded from 
the table below as they are paid based on the prospective payment 
system. Since the inpatient rates set forth below do not include all 
physician services and practitioner services, additional payment may be 
available to the extent that those services meet applicable 
requirements. Public Law 106-554, section 432, dated December 21, 2000, 
authorized IHS facilities to file Medicare Part B claims with the 
carrier for payment for physician and certain other practitioner 
services provided on or after July 1, 2001.

------------------------------------------------------------------------
                                                               Calendar
                                                               year 2006
------------------------------------------------------------------------
Inpatient Hospital Per Diem Rate (Excludes Physician/
 Practitioner Services):
  Lower 48 States...........................................      $1,660
  Alaska....................................................       2,131
Outpatient Per Visit Rate (Excluding Medicare):
  Lower 48 States...........................................         242
  Alaska....................................................         406
Outpatient Per Visit Rate (Medicare):
  Lower 48 States...........................................         193
  Alaska....................................................         348
Medicare Part B Inpatient Ancillary Per Diem Rate:
  Lower 48 States...........................................         340
  Alaska....................................................         625
------------------------------------------------------------------------

Outpatient Surgery Rate (Medicare)

    Established Medicare rates for freestanding Ambulatory Surgery 
Centers.

Effective Date for Calendar Year 2006 Rates

    Consistent with previous annual rate revisions, the Calendar Year 
2006 rates will be effective for services provided on/or after January 
1, 2006 to the extent consistent with payment authorities including the 
applicable Medicaid State plan.

    Dated: June 27, 2006.
Charles W. Grim,
Assistant Surgeon General, Director, Indian Health Service.
 [FR Doc. E6-13785 Filed 8-18-06; 8:45 am]
BILLING CODE 4165-16-P