,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bhbh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #be1 #bjac ,mr4 
,bilirakis introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,en]gy &    
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d titles ,,xi
 & ,,xviii ( ! ,social ,security ,act to
 prev5t fraud & abuse "u ! ,m$ic>e      
program & to require ,national ,provid] 
,id5tifi]s = reimbursem5t (             
prescriptions "u "p ,d ( ! ,m$ic>e      
program1 & = o!r purposes4  #a4 ,%ort   
title ,?is ,act may be cit$ z ! ,m$ic>e 
,abuse ,prev5tion ,act ( #bjac or !     
,,map ,act ( #bjac4  #b4 ,increas$ civil
 & crim9al p5alties  7a7 ,increas$ civil
 money p5alties & crim9al f9es = ,f$]al 
heal? c>e program fraud & abuse  7#a7   
,increas$ civil money p5alties ,section 
#aabh;,a ( ! ,social ,security ,act 7#db

 ,u4,s4,c4 #acbj;a-#g;a7 is am5d$--     
7,a7 9 subsection 7a71 9 ! matt] foll[+ 
p>agraph 7#aj7--  7i7 by /rik+ #aj1jjj &
 ins]t+ #bj1jjj ea* place x appe>s2     
7ii7 by /rik+ #ae1jjj & ins]t+ #cj1jjj2 
&  7iii7 by /rik+ #ej1jjj & ins]t+      
#ajj1jjj ea* place x appe>s2 &  7,b7 9  
subsection 7b7--  7i7 9 p>agraph 7#a71 9
 ! flu% text foll[+ subp>agraph 7,b71 by
 /rik+ #b1jjj & ins]t+ #d1jjj2  7ii7 9  
p>agraph 7#b71 by /rik+ #b1jjj & ins]t+ 
#d1jjj2 &  7iii7 9 p>agraph             
7#c77;,a77i71 by /rik+ #e1jjj & ins]t+  
#aj1jjj4  7#b7 ,increas$ crim9al f9es   
,section #aabh;,b ( su* ,act 7#db       
,u4,s4,c4 #acbj;a-#g;b7 is am5d$--  7,a7
 9 subsection 7a71 9 ! matt] foll[+     
p>agraph 7#f7--  7i7 by /rik+ #be1jjj & 
ins]t+ #ajj1jjj2 &  7ii7 by /rik+       
#aj1jjj & ins]t+ #bj1jjj2  7,b7 9       
subsection 7b7--  7i7 9 p>agraph 7#a71 9
 ! flu% text foll[+ subp>agraph 7,b71 by
 /rik+ #be1jjj & ins]t+ #ajj1jjj2 &     
7ii7 9 p>agraph 7#b71 9 ! flu% text     
foll[+ subp>agraph 7,b71 by /rik+       

#be1jjj & ins]t+ #ajj1jjj2  7,c7 9      
subsection 7c71 by /rik+ #be1jjj &      
ins]t+ #ajj1jjj2  7,d7 9 subsection 7d71
 9 ! flu% text foll[+ p>agraph 7#b71 by 
/rik+ #be1jjj & ins]t+ #ajj1jjj2 &  7,e7
 9 subsection 7e71 by /rik+ #b1jjj &    
ins]t+ #d1jjj4  7b7 ,increas$ s5t5ces = 
felonies involv+ ,f$]al heal? c>e       
program fraud & abuse  7#a7 ,false      
/atem5ts & repres5tations ,section      
#aabh;,b7a7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acbj;a-#g;b7a77 is      
am5d$1 9 ! matt] foll[+ p>agraph 7#f71  
by /rik+ n m ?an five ye>s or bo?1 or   
7ii7 & ins]t+ n m ?an #aj ye>s or bo?1  
or 7ii74  7#b7 ,antikickback ,section   
#aabh;,b7b7 ( su* ,act 7#db ,u4,s4,c4   
#acbj;a-#g;b7b77 is am5d$--  7,a7 9     
p>agraph 7#a71 9 ! flu% text foll[+     
subp>agraph 7,b71 by /rik+ n m ?an five 
ye>s & ins]t+ n m ?an #aj ye>s2 &  7,b7 
9 p>agraph 7#b71 9 ! flu% text foll[+   
subp>agraph 7,b71 by /rik+ n m ?an five 
ye>s & ins]t+ n m ?an #aj ye>s4  7#c7   
,false /atem5t or repres5tation )       

respect to conditions or op]ations (    
facilities ,section #aabh;,b7c7 ( su*   
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7c77 is 
am5d$ by /rik+ n m ?an five ye>s &      
ins]t+ n m ?an #aj ye>s4  7#d7 ,excess  
*>ges ,section #aabh;,b7d7 ( su* ,act   
7#db ,u4,s4,c4 #acbj;a-#g;b7d77 is      
am5d$1 9 ! flu% text foll[+ p>agraph    
7#b71 by /rik+ n m ?an five ye>s &      
ins]t+ n m ?an #aj ye>s4  7c7 ,effective
 date ,! am5dm5ts made by ?is section   
%all apply to acts committ$ aft] ! date 
( ! enactm5t ( ?is ,act4  #c4 ,annual   
,m$ic>e1 ,m$icaid1 & ,,*ip fraud reports
  7a7 ,9 g5]al ,by n lat] ?an ,july #a1 
#bjad1 & ea* subsequ5t ye>1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all submit  
to ! ,committees on ,ways & ,means &    
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives & ! ,committee on       
,f9ance ( ! ,s5ate a report t conta9s ! 
foll[+3  7#a7 ,am\nt ( fraud ,! am\nt1 z
 e/imat$ by ! ,secret>y--  7,a7 ( total 
suspect$ fraud committ$ aga9/ ! ,m$ic>e 
program "u title ,,xviii ( ! ,social    

,security ,act1 ! ,m$icaid program "u   
title ,,xix ( su* ,act1 & ! ,*ildr5's   
,heal? ,insurance ,program "u title     
,,xxi ( su* ,act2 &  7,b7 ! am\nt ( su* 
suspect$ fraud t is committ$ by         
employees ( ! ,dep>tm5t ( ,heal? &      
,human ,s]vices :o h access to data f   
any ( ! programs "u subp>agraph 7,a74   
7#b7 ,data access implem5tation         
,in=mation on implem5tation ( ! data    
access requirem5t "u section            
#aabh;,j7a77#b7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;a-#gk7a77#b774
  7b7 ,use ( audits  7#a7 ,e/imate bas$ 
on audit$ claims ,! ,secret>y %all base 
! e/imate ( suspect$ fraud "u subsection
 7a77#a77;,a7 on an audit ( a r&om      
sample ( at lea/ #aj1jjj claims = paym5t
 made "u ! programs "u title ,,xviii1   
,,xix1 or ,,xxi ( ! ,social ,security   
,act4  7#b7 ,au?ority ( ! ,secret>y ,=  
purposes ( conduct+ ! audits "u p>agraph
 7#a71 ! ,secret>y may--  7,a7 reque/ t 
a heal? c>e provid] or suppli] submit   
docum5tation relat+ to ! claim be+      

audit$ & review su* docum5tation2  7,b7 
conduct unann\nc$ onsite visits2 &  7,c7
 int]view pati5ts4  7#c7 ,submission (  
in=mation ,n lat] ?an #cj days aft]     
receiv+ a reque/ = docum5tation "u      
p>agraph 7#b77;,a71 ! heal? c>e provid] 
or suppli] %all provide to ! ,secret>y  
all reque/$ docum5tation relat$ to su*  
claim4  7#d7 ,int]nal audit ,! ,secret>y
 %all base ! e/imate ( suspect$ fraud   
committ$ by employees ( ! ,dep>tm5t (   
,heal? & ,human ,s]vices "u subsection  
7a77#a77;,b7 on an int]nal audit4  7c7  
,fraud def9$ ,9 ?is section1 ! t]m fraud
 has ! mean+ giv5 su* t]m 9 section     
#dee4b ( title #db1 ,code ( ,f$]al      
,regulations4  #d4 ,protect+ pr$ictive  
analytics te*nologies f compell$        
disclosure "u ! ,fre$om ( ,in=mation    
,act ,section #dbda ( ! ,small ,bus9ess 
,jobs ,act ( #bjaj 7#db ,u4,s4,c4       
#acbj;a-#gm7 is am5d$ by add+ at ! end !
 foll[+3  7j7 ,exemption f ,,foia ,!    
algori?ms us$ 9 pr$ictive model+ & o!r  
analytics te*nologies "u ?is section are

 exempt f disclosure "u section         
#eeb7;b77#c7 ( title #e1 ,unit$ ,/ates  
,code4  7k7 ,audit & review ,!          
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices & ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all1 beg9n+ on
 ,janu>y #a1 #bjae1 & annually !reaft]1 
complete an audit & review ( !          
implem5tation ( ?is section1 includ+ !  
effectiv5ess ( ! algori?ms us$ 9        
pr$ictive model+ & o!r analytics        
te*nologies "u ?is section4  4  #e4     
,requir+ valid ,national ,provid]       
,id5tifi]s = prescrib]s on ph>macy      
claims & limit+ access to ! ,national   
,provid] ,id5tifi] regi/ry  7a7 ,requir+
 valid ,national ,provid] ,id5tifi]s (  
prescrib]s on ph>macy claims  7#a7 ,9   
g5]al ,section #ahfj;,d-#b7;e77#b7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7;e77#b77 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,c7  
,drugs prescrib$ by nonvalid prescrib]s 
,= plan ye>s t beg9 on or aft] ,janu>y  
#a1 #bjae1 su* t]m does n include a drug

 prescrib$ by an individual :o does n h 
a valid ,national ,provid] ,id5tifi]1 z 
det]m9$ ?r\gh proc$ures e/abli%$ by !   
,secret>y4  4  7#b7 ,id5tify+ & report+ 
invalid prescrib]s  7,a7 ,transf] (     
in=mation to ! ,inspector g5]al ,9 !    
case t ! proc$ures e/abli%$ by !        
,secret>y ( ,heal? & ,human ,s]vices "u 
section #ahfj;,d-#b7;e77#b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;e77#b77 result 9 a ,,pdp   
sponsor id5tify+ a claim = reimbursem5t 
"u a prescription drug plan "u "p ,d (  
title ,,xviii ( su* ,act z be+ = a drug 
t 0 prescrib$ by an individual :o did n 
h a valid ,national ,provid] ,id5tifi]1 
! ,,pdp sponsor %all submit to !        
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices any in=mation on su* 
invalid prescrib]s on ph>macy claims1   
includ+ any invalid national provid]    
id5tifi]s be+ us$ to submit su* claims &
 any records relat$ to su* claims4  7,b7
 ,responsibility ( ! ,inspector ,g5]al  
,! ,inspector ,g5]al ( ! ,dep>tm5t (    

,heal? & ,human ,s]vices %all provide to
 ! appropriate law en=cem5t ag5cies     
in=mation submitt$ "u subp>agraph 7,a74 
7,c7 ,report to ,congress ,n lat] ?an   
,janu>y #a1 #bjaf1 ! ,inspector ,g5]al (
 ! ,dep>tm5t ( ,heal? & ,human ,s]vices 
%all submit to ,congress a report on !  
effectiv5ess ( ! proc$ures e/abli%$ "u  
section #ahfj;,d-#b7;e77#b77;,c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ajb7;e77#b77;,c774  7b7 ,limit+ 
access to ,national ,provid] ,id5tifi]  
regi/ry  7#a7 ,9 g5]al ,! ,secret>y (   
,heal? & ,human ,s]vices1 9 consultation
 ) ! ,attorney ,g5]al1 ! ,inspector     
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 ! ,*airman ( ! ,f$]al ,trade  
,commission1 & affect$ p>ties 7includ+  
prescription drug plans "u "p ,d ( title
 ,,xviii ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciew-#aja et seq471        
,,ma-,,pd plans "u "p ,c ( title ,,xviii
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#ba et seq471          
ph>macies1 physicians1 & ph>macy comput]

 v5dors71 %all e/abli% proc$ures & rules
 to re/rict access to ! ,national       
,provid] ,id5tifi] ,regi/ry 9 ord] to   
det] ! fraudul5t use ( ,national        
,provid] ,id5tifi]s = purposes ( mak+   
claims "u titles ,,xviii & ,,xix ( !    
,social ,security ,act4  7#b7 ,access   
7,a7 ,9 g5]al ,! proc$ures e/abli%$ "u  
p>agraph 7#a7 %all provide gov]nm5tal & 
nongov]nm5tal entities ) appropriate 7z 
det]m9$ by ! ,secret>y7 access to !     
,national ,provid] ,id5tifi] ,regi/ry4  
7,b7 ,data use agreem5ts ,9 ord] to     
receive su* access1 ea* su* gov]nm5tal &
 nongov]nm5tal entity %all ent] into a  
data use agreem5t ) ! ,secret>y & agree 
to use ! data 9 su* regi/ry 9 accordance
 ) rules e/abli%$ by ! ,secret>y        
pursuant su* p>agraph4  #f4 ,enc\rag+ ! 
e/abli%m5t ( ,/ate prescription drug    
monitor+ programs  7a7 ,9 g5]al ,section
 #aije ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acif;d7 is am5d$ by add+ at !
 end ! foll[+3  7ee7 ,inc5tives = ,/ates
 ,to id5tify fraud ?r\gh ,/ate          

prescription drug monitor+ programs     
7#a7 ,9 g5]al ,) respect to a cal5d>    
qu>t]1 ! ,f$]al m$ical assi/ance        
p]c5tage = ! am\nts "u clauses 7i7 &    
7,,ii7 ( subp>agraph 7,c7 %all be       
decreas$ by #aj p]c5t = su* qu>t]1 if-- 
7,a7 a ,/ate is receiv+ a grant = a     
,/ate controll$ sub/ance monitor+       
program "u section #cii,o ( ! ,public   
,heal? ,s]vice ,act 7or ! ,secret>y     
det]m9es t ! ,/ate meets ! requirem5ts =
 su* a grant72  7,b7 ?r\gh su* program1 
! ,/ate id5tifies fraud1 wa/e1 or abuse 
9 connection ! provision ( prescription 
drug cov]age "u ! ,/ate plan2 &  7,c7 ! 
,/ate or a political subdivision ( !    
,/ate--  7i7 is reimburs$ an am\nt by a 
?ird p>ty 7pursuant to ! provisions ( ! 
,/ate plan 9 compliance ) section       
#aijb7;a77#be77 = exp5ditures relat$ to 
su* fraud1 wa/e1 or abuse2 or  7ii7     
recov]$ 7z su* t]m is us$ "u section    
#aijc7;d77#c77;,a77 an am\nt4  7#b7 ,use
 ( funds ,a ,/ate may use ! am\nts      
receiv$ z a result ( ! increas$ ,f$]al  

m$ical assi/ance p]c5tage "u p>agraph   
7#a7 to support ! ,/ate controll$       
sub/ance monitor+ program e/abli%$ by ! 
,/ate4  4  7b7 ,con=m+ am5dm5ts ,section
 #aije7;b7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acif;d7b77 is am5d$ by  
/rik+ ,subject to subsections 7y71 7z71 
& 7aa7 & ins]t+ ,subject to subsections 
7y71 7z71 7aa71 & 7ee74  7c7 ,effective 
date ,! am5dm5ts made by ?is subsection 
%all apply to cal5d> qu>t]s beg9n+ on or
 aft] ! end ( ! #cj-;day p]iod aft] !   
date ( ! enactm5t ( ?is ,act4  #g4      
,prohibit+ ! display ( ,social ,security
 acc\nt numb]s on newly issu$ ,m$ic>e   
id5tification c>ds & communications     
provid$ to ,m$ic>e b5efici>ies  7a7 ,9  
g5]al ,n lat] ?an #b ye>s aft] ! date ( 
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is section z ! ,secret>y71 act+ 9      
consultation ) ! ,commission] ( ,social 
,security1 %all e/abli% & implem5t      
proc$ures to elim9ate ! unnecess>y      
collection1 use1 & display ( ,social    

,security acc\nt numb]s ( ,m$ic>e       
b5efici>ies "u ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq474  7b7    
,newly issu$ m$ic>e c>ds &              
communications provid$ to b5efici>ies ,n
 lat] ?an #d ye>s aft] ! date ( !       
enactm5t ( ?is ,act1 ! ,secret>y %all d 
! foll[+3  7#a7 ,newly issu$ c>ds ,act+ 
9 consultation ) ! ,commission] (       
,social ,security1 ensure t ea* newly   
issu$ ,m$ic>e id5tification c>d does n  
display or electronically /ore1 9 an    
un5crypt$ =mat1 a ,m$ic>e b5efici>y's   
,social ,security acc\nt numb]1 except--
  7,a7 if ! heal? insurance claim numb] 
( a b5efici>y is ! ,social ,security    
numb] ( ! b5efici>y1 ! b5efici>y's      
sp\se1 or ano!r individual1 ! ,secret>y 
may use su* numb] on su* c>d2 &  7,b7 if
 ! ,secret>y det]m9es t ! risk (        
fraudul5t use ( su* numb]s is n         
unacceptably high1 ! ,secret>y may use a
 p>tial ,social ,security acc\nt numb]  
on a ,m$ic>e id5tification c>d4  7#b7   

,communications provid$ to b5efici>ies  
,prohibit ! display ( a ,m$ic>e         
b5efici>y's ,social ,security acc\nt    
numb] 9 any writt5 or electronic        
communication provid$ to ! b5efici>y    
unless ! ,secret>y1 9 consultation ) !  
,commission] ( ,social ,security1       
det]m9es t inclusion ( ,social ,security
 acc\nt numb]s 9 su* communications is  
ess5tial = ! op]ation ( ! ,m$ic>e       
program4  7c7 ,m$ic>e b5efici>y def9$ ,9
 ?is section1 ! t]m ,m$ic>e b5efici>y   
means an individual :o is entitl$ to1 or
 enroll$ =1 b5efits "u "p ,a ( title    
,,xviii ( ! ,social ,security ,act or   
enroll$ "u "p ,b ( su* title4  7d7      
,con=m+ am5dm5ts  7#a7 ,ref]5ce 9 !     
,social ,security ,act ,section         
#bje7;c77#b77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #dje7;c77#b77;,c77  
is am5d$--  7,a7 by mov+ clause 7x71 z  
add$ by section #adad7;a77#b7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh71 #f ems to 
! left2  7,b7 by r$esignat+ clause 7x71 

z add$ by section #b7;a77#a7 ( ! ,social
 ,security ,numb] ,protection ,act (    
#bjaj 7#db ,u4,s4,c4 #acje note71 z     
clause 7xii72 &  7,c7 by add+ aft]      
clause 7xii71 z r$esignat$ by           
subp>agraph 7,b71 ! foll[+ new clause3  
7xiii7 ,subject to section #g ( !       
,m$ic>e ,abuse ,prev5tion ,act ( #bjac1 
social security acc\nt numb]s %all n be 
display$ on ,m$ic>e id5tification c>ds  
or on communications provid$ to ,m$ic>e 
b5efici>ies4  4  7#b7 ,access to        
in=mation ,section #bje7r7 ( ! ,social  
,security ,act 7#dje ,u4,s4,c4 #dje7r77 
is am5d$ by add+ at ! end ! foll[+ new  
p>agraph3  7#aj7 7,a7 ,to prev5t &      
id5tify fraudul5t activity--  7i7 !     
,attorney ,g5]al or ! ,secret>y ( ,heal?
 & ,human ,s]vices may submit to !      
,commission] a reque/ t ! ,commission]  
ent] into an agreem5t "u ?is p>agraph2 &
  7ii7 subject to ! requirem5ts (       
subp>agraphs 7,a7 & 7,b7 ( p>agraph     
7#c71 ^u receiv+ a reque/ "u subp>agraph
 7,a71 ! ,commission] %all ent] into a  

reimbursable agreem5t ) ! individual    
mak+ su* reque/ to provide to su*       
individual ! in=mation collect$ "u      
p>agraph 7#a74  7,b7 ,! agreem5t "u     
subp>agraph 7,a77ii7 %all conta9        
appropriate provisions 7z det]m9$ by !  
,commission]7 to protect !              
confid5tiality ( in=mation provid$ by ! 
,commission] "u su* agreem5t4  4  7e7   
,pilot program  7#a7 ,e/abli%m5t ,n lat]
 ?an #a ye> aft] ! date ( ! enactm5t (  
?is ,act1 ! ,secret>y %all e/abli% a    
pilot program utiliz+ sm>t c>d te*nology
 to evaluate--  7,a7 ! applicability (  
sm>t c>d te*nology to ! ,m$ic>e program 
"u title ,,xviii ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq472 &   
7,b7 :e!r su* c>ds w\ld be effective 9  
prev5t+ fraud "u ! ,m$ic>e program4     
7#b7 ,scope & duration ,! ,secret>y %all
 conduct ! pilot program--  7,a7 9 n    
less ?an #b ,/ates2 &  7,b7 = a p]iod ( 
n less ?an #ahj days & n m ?an #b ye>s4 
7#c7 ,report ,n lat] ?an #ab mon?s aft] 
! completion ( ! pilot program "u ?is   

subsection1 ! ,secret>y %all submit to !
 appropriate committees ( ,congress &   
make available to ! public a report t   
includes ! foll[+3  7,a7 ,a summ>y ( !  
pilot program & f9d+s result+ f su*     
program1 includ+--  7i7 any co/s or     
sav+s to ! ,m$ic>e program z a result ( 
! implem5tation ( ! pilot program2  7ii7
 :e!r ! use ( sm>t c>d te*nology result$
 9 improvem5ts 9 ! quality ( c>e provid$
 to ,m$ic>e b5efici>ies "u ! pilot      
program2 &  7iii7 :e!r su* te*nology 0  
useful 9 prev5t+ or detect+ fraud1 wa/e1
 & abuse 9 ! ,m$ic>e program4  7,b7     
,recomm5dations reg>d+ :e!r ! use ( sm>t
 c>d te*nology %\ld be exp&$ "u !       
,m$ic>e program4  7#d7 ,def9itions ,9   
?is subsection3  7,a7 ,m$ic>e b5efici>y 
,! t]m ,m$ic>e b5efici>y means an       
individual entitl$ to1 or enroll$ =1    
b5efits "u "p ,a ( title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;c et seq47 or enroll$ = b5efits "u
 "p ,b ( su* title 7#db ,u4,s4,c4       
#acie;j et seq474  7,b7 ,m$ic>e provid] 

,! t]m ,m$ic>e provid] means--  7i7 a   
provid] ( s]vices 7z def9$ 9 section    
#ahfa7u7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciex7u7772 or  7ii7 a      
suppli] 7z def9$ 9 section #ahfa7;d7 (  
su* ,act 7#db ,u4,s4,c4 #aciex7d7774    
7,c7 ,sm>t c>d ,! t]m sm>t c>d means an 
id5tification c>d us$ by a ,m$ic>e      
b5efici>y or a ,m$ic>e provid] t        
includes antifraud attributes4 ,su* a   
c>d--  7i7 may rely on exi/+ comm]cial  
data transf] networks or on a network ( 
propriet>y c>d read]s or databases2 &   
7ii7 may include--  7,i7 c>ds us+       
te*nology adapt$ f ! f9ancial s]vices   
indu/ry2  7,,ii7 c>ds conta9+ individual
 biometric id5tification1 provid$ t su* 
id5tification is encrypt$ & n conta9$ 9 
any c5tral database2  7,,iii7 c>ds      
adapt+ te*nology & processes utiliz$ 9 !
 ,,tric>e program "u *apt] #ee ( title  
#aj1 ,unit$ ,/ates ,code1 or by !       
,vet]ans' ,adm9i/ration2 or  7,,iv7 su* 
o!r te*nology z ! ,secret>y det]m9es    
appropriate4  #h4 ,improv+ claims       

process+ & detection ( fraud )9 !       
,m$icaid & ,,*ip programs  7a7 ,m$icaid 
,section #aijc7;i7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;b7i77 is     
am5d$--  7#a7 9 p>agraph 7#be71 by /rik+
 or at ! end2  7#b7 9 p>agraph 7#bf71 by
 /rik+ ! p]iod & ins]t+ 2 or2 &  7#c7 by
 ins]t+ aft] p>agraph 7#bf7 ! foll[+    
p>agraph3  7#bg7 ) respect to any am\nt 
exp5d$ = an item or s]vice unless !     
claim = paym5t = su* item or s]vice     
conta9s--  7,a7 a valid b5efici>y       
id5tification numb] = ! individual to   
:om su* item or s]vice 0 furni%$1 & !   
,/ate has det]m9$ t su* numb]           
corresponds to an individual :o is      
enroll$ "u ! ,/ate plan or an applicable
 waiv] ( a requirem5t ( su* plan2 &     
7,b7 a valid provid] id5tifi] = !       
provid] :o furni%$ su* item or s]vice1 &
 ! ,/ate has det]m9$ t su* id5tifi]     
corresponds to a provid] t is eligible  
to receive paym5t = furni%+ su* item or 
s]vice "u ! ,/ate plan or an applicable 
waiv] ( a requirem5t ( su* plan4  4  7b7

 ,,*ip ,section #bajg7;e77#a77;,i7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acig;gg7e77#a77;,i77 is am5d$ by /rik+ 
& 7#ag7 & ins]t+ 7#ag71 & 7#bg74