,i #aacth ,,congress #ast ,session ,h4 ,r4 #bhbh ,,in ,,the ,,house ,,of ,,representatives ,july #be1 #bjac ,mr4 ,bilirakis introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend titles ,,xi and ,,xviii of the ,social ,security ,act to prevent fraud and abuse under the ,medicare program and to require ,national ,provider ,identifiers for reimbursement of prescriptions under part ,d of the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,abuse ,prevention ,act of #bjac or the ,,map ,act of #bjac4 #b4 ,increased civil and criminal penalties 7a7 ,increased civil money penalties and criminal fines for ,federal health care program fraud and abuse 7#a7 ,increased civil money penalties ,section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 is amended-- 7,a7 in subsection 7a71 in the matter following paragraph 7#aj7-- 7i7 by striking #aj1jjj and inserting #bj1jjj each place it appears2 7ii7 by striking #ae1jjj and inserting #cj1jjj2 and 7iii7 by striking #ej1jjj and inserting #ajj1jjj each place it appears2 and 7,b7 in subsection 7b7-- 7i7 in paragraph 7#a71 in the flush text following subparagraph 7,b71 by striking #b1jjj and inserting #d1jjj2 7ii7 in paragraph 7#b71 by striking #b1jjj and inserting #d1jjj2 and 7iii7 in paragraph 7#c77;,a77i71 by striking #e1jjj and inserting #aj1jjj4 7#b7 ,increased criminal fines ,section #aabh;,b of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7 is amended-- 7,a7 in subsection 7a71 in the matter following paragraph 7#f7-- 7i7 by striking #be1jjj and inserting #ajj1jjj2 and 7ii7 by striking #aj1jjj and inserting #bj1jjj2 7,b7 in subsection 7b7-- 7i7 in paragraph 7#a71 in the flush text following subparagraph 7,b71 by striking #be1jjj and inserting #ajj1jjj2 and 7ii7 in paragraph 7#b71 in the flush text following subparagraph 7,b71 by striking #be1jjj and inserting #ajj1jjj2 7,c7 in subsection 7c71 by striking #be1jjj and inserting #ajj1jjj2 7,d7 in subsection 7d71 in the flush text following paragraph 7#b71 by striking #be1jjj and inserting #ajj1jjj2 and 7,e7 in subsection 7e71 by striking #b1jjj and inserting #d1jjj4 7b7 ,increased sentences for felonies involving ,federal health care program fraud and abuse 7#a7 ,false statements and representations ,section #aabh;,b7a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7a77 is amended1 in the matter following paragraph 7#f71 by striking not more than five years or both1 or 7ii7 and inserting not more than #aj years or both1 or 7ii74 7#b7 ,antikickback ,section #aabh;,b7b7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is amended-- 7,a7 in paragraph 7#a71 in the flush text following subparagraph 7,b71 by striking not more than five years and inserting not more than #aj years2 and 7,b7 in paragraph 7#b71 in the flush text following subparagraph 7,b71 by striking not more than five years and inserting not more than #aj years4 7#c7 ,false statement or representation with respect to conditions or operations of facilities ,section #aabh;,b7c7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7c77 is amended by striking not more than five years and inserting not more than #aj years4 7#d7 ,excess charges ,section #aabh;,b7d7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7d77 is amended1 in the flush text following paragraph 7#b71 by striking not more than five years and inserting not more than #aj years4 7c7 ,effective date ,the amendments made by this section shall apply to acts committed after the date of the enactment of this ,act4 #c4 ,annual ,medicare1 ,medicaid1 and ,,chip fraud reports 7a7 ,in general ,by not later than ,july #a1 #bjad1 and each subsequent year1 the ,secretary of ,health and ,human ,services shall submit to the ,committees on ,ways and ,means and ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report that contains the following3 7#a7 ,amount of fraud ,the amount1 as estimated by the ,secretary-- 7,a7 of total suspected fraud committed against the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act2 and 7,b7 the amount of such suspected fraud that is committed by employees of the ,department of ,health and ,human ,services who have access to data from any of the programs under subparagraph 7,a74 7#b7 ,data access implementation ,information on implementation of the data access requirement under section #aabh;,j7a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#gk7a77#b774 7b7 ,use of audits 7#a7 ,estimate based on audited claims ,the ,secretary shall base the estimate of suspected fraud under subsection 7a77#a77;,a7 on an audit of a random sample of at least #aj1jjj claims for payment made under the programs under title ,,xviii1 ,,xix1 or ,,xxi of the ,social ,security ,act4 7#b7 ,authority of the ,secretary ,for purposes of conducting the audits under paragraph 7#a71 the ,secretary may-- 7,a7 request that a health care provider or supplier submit documentation relating to the claim being audited and review such documentation2 7,b7 conduct unannounced onsite visits2 and 7,c7 interview patients4 7#c7 ,submission of information ,not later than #cj days after receiving a request for documentation under paragraph 7#b77;,a71 the health care provider or supplier shall provide to the ,secretary all requested documentation related to such claim4 7#d7 ,internal audit ,the ,secretary shall base the estimate of suspected fraud committed by employees of the ,department of ,health and ,human ,services under subsection 7a77#a77;,b7 on an internal audit4 7c7 ,fraud defined ,in this section1 the term fraud has the meaning given such term in section #dee4b of title #db1 ,code of ,federal ,regulations4 #d4 ,protecting predictive analytics technologies from compelled disclosure under the ,freedom of ,information ,act ,section #dbda of the ,small ,business ,jobs ,act of #bjaj 7#db ,u4,s4,c4 #acbj;a-#gm7 is amended by adding at the end the following3 7j7 ,exemption from ,,foia ,the algorithms used in predictive modeling and other analytics technologies under this section are exempt from disclosure under section #eeb7;b77#c7 of title #e1 ,united ,states ,code4 7k7 ,audit and review ,the ,inspector ,general of the ,department of ,health and ,human ,services and the ,comptroller ,general of the ,united ,states shall1 beginning on ,january #a1 #bjae1 and annually thereafter1 complete an audit and review of the implementation of this section1 including the effectiveness of the algorithms used in predictive modeling and other analytics technologies under this section4 4 #e4 ,requiring valid ,national ,provider ,identifiers for prescribers on pharmacy claims and limiting access to the ,national ,provider ,identifier registry 7a7 ,requiring valid ,national ,provider ,identifiers of prescribers on pharmacy claims 7#a7 ,in general ,section #ahfj;,d-#b7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77#b77 is amended by adding at the end the following new subparagraph3 7,c7 ,drugs prescribed by nonvalid prescribers ,for plan years that begin on or after ,january #a1 #bjae1 such term does not include a drug prescribed by an individual who does not have a valid ,national ,provider ,identifier1 as determined through procedures established by the ,secretary4 4 7#b7 ,identifying and reporting invalid prescribers 7,a7 ,transfer of information to the ,inspector general ,in the case that the procedures established by the ,secretary of ,health and ,human ,services under section #ahfj;,d-#b7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77#b77 result in a ,,pdp sponsor identifying a claim for reimbursement under a prescription drug plan under part ,d of title ,,xviii of such ,act as being for a drug that was prescribed by an individual who did not have a valid ,national ,provider ,identifier1 the ,,pdp sponsor shall submit to the ,inspector ,general of the ,department of ,health and ,human ,services any information on such invalid prescribers on pharmacy claims1 including any invalid national provider identifiers being used to submit such claims and any records related to such claims4 7,b7 ,responsibility of the ,inspector ,general ,the ,inspector ,general of the ,department of ,health and ,human ,services shall provide to the appropriate law enforcement agencies information submitted under subparagraph 7,a74 7,c7 ,report to ,congress ,not later than ,january #a1 #bjaf1 the ,inspector ,general of the ,department of ,health and ,human ,services shall submit to ,congress a report on the effectiveness of the procedures established under section #ahfj;,d-#b7;e77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77#b77;,c774 7b7 ,limiting access to ,national ,provider ,identifier registry 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 in consultation with the ,attorney ,general1 the ,inspector ,general of the ,department of ,health and ,human ,services1 the ,chairman of the ,federal ,trade ,commission1 and affected parties 7including prescription drug plans under part ,d of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aja et seq471 ,,ma-,,pd plans under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq471 pharmacies1 physicians1 and pharmacy computer vendors71 shall establish procedures and rules to restrict access to the ,national ,provider ,identifier ,registry in order to deter the fraudulent use of ,national ,provider ,identifiers for purposes of making claims under titles ,,xviii and ,,xix of the ,social ,security ,act4 7#b7 ,access 7,a7 ,in general ,the procedures established under paragraph 7#a7 shall provide governmental and nongovernmental entities with appropriate 7as determined by the ,secretary7 access to the ,national ,provider ,identifier ,registry4 7,b7 ,data use agreements ,in order to receive such access1 each such governmental and nongovernmental entity shall enter into a data use agreement with the ,secretary and agree to use the data in such registry in accordance with rules established by the ,secretary pursuant such paragraph4 #f4 ,encouraging the establishment of ,state prescription drug monitoring programs 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended by adding at the end the following3 7ee7 ,incentives for ,states ,to identify fraud through ,state prescription drug monitoring programs 7#a7 ,in general ,with respect to a calendar quarter1 the ,federal medical assistance percentage for the amounts under clauses 7i7 and 7,,ii7 of subparagraph 7,c7 shall be decreased by #aj percent for such quarter1 if-- 7,a7 a ,state is receiving a grant for a ,state controlled substance monitoring program under section #cii,o of the ,public ,health ,service ,act 7or the ,secretary determines that the ,state meets the requirements for such a grant72 7,b7 through such program1 the ,state identifies fraud1 waste1 or abuse in connection the provision of prescription drug coverage under the ,state plan2 and 7,c7 the ,state or a political subdivision of the ,state-- 7i7 is reimbursed an amount by a third party 7pursuant to the provisions of the ,state plan in compliance with section #aijb7;a77#be77 for expenditures related to such fraud1 waste1 or abuse2 or 7ii7 recovered 7as such term is used under section #aijc7;d77#c77;,a77 an amount4 7#b7 ,use of funds ,a ,state may use the amounts received as a result of the increased ,federal medical assistance percentage under paragraph 7#a7 to support the ,state controlled substance monitoring program established by the ,state4 4 7b7 ,conforming amendments ,section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking ,subject to subsections 7y71 7z71 and 7aa7 and inserting ,subject to subsections 7y71 7z71 7aa71 and 7ee74 7c7 ,effective date ,the amendments made by this subsection shall apply to calendar quarters beginning on or after the end of the #cj-;day period after the date of the enactment of this ,act4 #g4 ,prohibiting the display of ,social ,security account numbers on newly issued ,medicare identification cards and communications provided to ,medicare beneficiaries 7a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting in consultation with the ,commissioner of ,social ,security1 shall establish and implement procedures to eliminate the unnecessary collection1 use1 and display of ,social ,security account numbers of ,medicare beneficiaries under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7b7 ,newly issued medicare cards and communications provided to beneficiaries ,not later than #d years after the date of the enactment of this ,act1 the ,secretary shall do the following3 7#a7 ,newly issued cards ,acting in consultation with the ,commissioner of ,social ,security1 ensure that each newly issued ,medicare identification card does not display or electronically store1 in an unencrypted format1 a ,medicare beneficiary's ,social ,security account number1 except-- 7,a7 if the health insurance claim number of a beneficiary is the ,social ,security number of the beneficiary1 the beneficiary's spouse1 or another individual1 the ,secretary may use such number on such card2 and 7,b7 if the ,secretary determines that the risk of fraudulent use of such numbers is not unacceptably high1 the ,secretary may use a partial ,social ,security account number on a ,medicare identification card4 7#b7 ,communications provided to beneficiaries ,prohibit the display of a ,medicare beneficiary's ,social ,security account number in any written or electronic communication provided to the beneficiary unless the ,secretary1 in consultation with the ,commissioner of ,social ,security1 determines that inclusion of ,social ,security account numbers in such communications is essential for the operation of the ,medicare program4 7c7 ,medicare beneficiary defined ,in this section1 the term ,medicare beneficiary means an individual who is entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled under part ,b of such title4 7d7 ,conforming amendments 7#a7 ,reference in the ,social ,security ,act ,section #bje7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c77 is amended-- 7,a7 by moving clause 7x71 as added by section #adad7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 #f ems to the left2 7,b7 by redesignating clause 7x71 as added by section #b7;a77#a7 of the ,social ,security ,number ,protection ,act of #bjaj 7#db ,u4,s4,c4 #acje note71 as clause 7xii72 and 7,c7 by adding after clause 7xii71 as redesignated by subparagraph 7,b71 the following new clause3 7xiii7 ,subject to section #g of the ,medicare ,abuse ,prevention ,act of #bjac1 social security account numbers shall not be displayed on ,medicare identification cards or on communications provided to ,medicare beneficiaries4 4 7#b7 ,access to information ,section #bje7r7 of the ,social ,security ,act 7#dje ,u4,s4,c4 #dje7r77 is amended by adding at the end the following new paragraph3 7#aj7 7,a7 ,to prevent and identify fraudulent activity-- 7i7 the ,attorney ,general or the ,secretary of ,health and ,human ,services may submit to the ,commissioner a request that the ,commissioner enter into an agreement under this paragraph2 and 7ii7 subject to the requirements of subparagraphs 7,a7 and 7,b7 of paragraph 7#c71 upon receiving a request under subparagraph 7,a71 the ,commissioner shall enter into a reimbursable agreement with the individual making such request to provide to such individual the information collected under paragraph 7#a74 7,b7 ,the agreement under subparagraph 7,a77ii7 shall contain appropriate provisions 7as determined by the ,commissioner7 to protect the confidentiality of information provided by the ,commissioner under such agreement4 4 7e7 ,pilot program 7#a7 ,establishment ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall establish a pilot program utilizing smart card technology to evaluate-- 7,a7 the applicability of smart card technology to the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7,b7 whether such cards would be effective in preventing fraud under the ,medicare program4 7#b7 ,scope and duration ,the ,secretary shall conduct the pilot program-- 7,a7 in not less than #b ,states2 and 7,b7 for a period of not less than #ahj days and not more than #b years4 7#c7 ,report ,not later than #ab months after the completion of the pilot program under this subsection1 the ,secretary shall submit to the appropriate committees of ,congress and make available to the public a report that includes the following3 7,a7 ,a summary of the pilot program and findings resulting from such program1 including-- 7i7 any costs or savings to the ,medicare program as a result of the implementation of the pilot program2 7ii7 whether the use of smart card technology resulted in improvements in the quality of care provided to ,medicare beneficiaries under the pilot program2 and 7iii7 whether such technology was useful in preventing or detecting fraud1 waste1 and abuse in the ,medicare program4 7,b7 ,recommendations regarding whether the use of smart card technology should be expanded under the ,medicare program4 7#d7 ,definitions ,in this subsection3 7,a7 ,medicare beneficiary ,the term ,medicare beneficiary means an individual entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 or enrolled for benefits under part ,b of such title 7#db ,u4,s4,c4 #acie;j et seq474 7,b7 ,medicare provider ,the term ,medicare provider means-- 7i7 a provider of services 7as defined in section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u7772 or 7ii7 a supplier 7as defined in section #ahfa7;d7 of such ,act 7#db ,u4,s4,c4 #aciex7d7774 7,c7 ,smart card ,the term smart card means an identification card used by a ,medicare beneficiary or a ,medicare provider that includes antifraud attributes4 ,such a card-- 7i7 may rely on existing commercial data transfer networks or on a network of proprietary card readers or databases2 and 7ii7 may include-- 7,i7 cards using technology adapted from the financial services industry2 7,,ii7 cards containing individual biometric identification1 provided that such identification is encrypted and not contained in any central database2 7,,iii7 cards adapting technology and processes utilized in the ,,tricare program under chapter #ee of title #aj1 ,united ,states ,code1 or by the ,veterans' ,administration2 or 7,,iv7 such other technology as the ,secretary determines appropriate4 #h4 ,improving claims processing and detection of fraud within the ,medicaid and ,,chip programs 7a7 ,medicaid ,section #aijc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77 is amended-- 7#a7 in paragraph 7#be71 by striking or at the end2 7#b7 in paragraph 7#bf71 by striking the period and inserting 2 or2 and 7#c7 by inserting after paragraph 7#bf7 the following paragraph3 7#bg7 with respect to any amount expended for an item or service unless the claim for payment for such item or service contains-- 7,a7 a valid beneficiary identification number for the individual to whom such item or service was furnished1 and the ,state has determined that such number corresponds to an individual who is enrolled under the ,state plan or an applicable waiver of a requirement of such plan2 and 7,b7 a valid provider identifier for the provider who furnished such item or service1 and the ,state has determined that such identifier corresponds to a provider that is eligible to receive payment for furnishing such item or service under the ,state plan or an applicable waiver of a requirement of such plan4 4 7b7 ,,chip ,section #bajg7;e77#a77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77;,i77 is amended by striking and 7#ag7 and inserting 7#ag71 and 7#bg74