,i #aacth ,,congress #ast ,session ,h4 ,r4 #bifj ,,in ,,the ,,house ,,of ,,representatives ,august #a1 #bjac ,mr4 ,pallone introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means and the ,judiciary1 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 title ,,xviii of the ,social ,security ,act to require sponsors of ,medicare prescription drug plans to implement procedures to prevent fraud and abuse1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,prescription ,drug ,integrity ,act of #bjac4 #b4 ,prevention of fraud and abuse in ,medicare prescription drug plans 7a7 ,procedures for ,,pdp sponsors ,to identify fraud and abuse ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended-- 7#a7 in paragraph 7#a77;,d7-- 7,a7 by inserting 1 designed to after program2 and 7,b7 by inserting 1 that includes the procedures described in paragraph 7#d7 after waste2 and 7#b7 by adding at the end the following3 7#d7 ,procedures to prevent fraud and abuse 7,a7 ,,pdp sponsor procedures ,a ,,pdp sponsor shall have in place procedures designed to-- 7i7 identify an individual that has obtained coverage for a covered part ,d drug at a frequency or amount not medically necessary1 as determined in accordance with utilization guidelines established by the ,secretary2 7ii7 subject to procedures developed by the ,secretary1 limit coverage for some or all classes of covered part ,d drugs for an individual identified under clause 7i7 to drugs prescribed by one or more designated prescribers or dispensed by one or more designated dispensers1 or both1 for a reasonable period of time following the date the individual is notified of such identification2 7iii7 provide to the ,secretary the name1 and other information that the ,secretary may require1 of individuals identified pursuant to clause 7i72 7iv7 as directed by the ,secretary1 limit coverage for some or all classes of covered part ,d drugs for an individual identified pursuant to clause 7i7 by a ,,pdp sponsor with whom such individual was previously enrolled2 and 7v7 deny payment of a claim for a controlled substance in schedule ,,ii or ,,iii as established under ,controlled ,substances ,act unless the ,,pdp sponsor has verified at point-of-sale that the prescriber and dispenser are authorized by the ,administrator of the ,drug ,enforcement ,administration to prescribe or dispense such controlled substances4 7,b7 ,authorization for the ,secretary to share information ,the ,secretary may share information with respect to an individual provided under subparagraph 7,a77iii7 with a ,,pdp sponsor enrolling such individual4 4 7b7 ,dual eligibles ,section #ahfj;,d-#a7;b77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aja7;b77#c77;,d77 is amended by inserting 1 subject to such limits as the ,secretary may establish for individuals identified pursuant to section #ahfj;,d-#d7;c77#d77;,a77i7 after the ,secretary4 7c7 ,exclusion and denial of payment for inappropriate prescribing and dispensing 7#a7 ,exclusion for inappropriate prescribing or dispensing ,section #aabh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is amended by adding at the end the following3 7#ag7 ,inappropriate prescribing or dispensing ,any individual or entity that the ,secretary determines has prescribed or dispensed under title ,,xviii-- 7,a7 a covered part ,d drug to an individual under a prescription drug plan or a ,,ma-,,pd plan1 as such terms are defined for purposes of part ,d of such title1 that could not have been prescribed or dispensed to the individual on the date of such prescribing or dispensing2 or 7,b7 any drug under such title at a frequency or amount that-- 7i7 represents a practice or pattern of abusive prescribing or dispensing2 or 7ii7 presents a risk to enrollee health or safety4 4 7#b7 ,denial of payment for inappropriate prescribing or dispensing ,section #ahfj;,d-#b7;e77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77#c77 is amended-- 7,a7 in subparagraph 7,a71 by striking 2 or and inserting a semicolon2 7,b7 in subparagraph 7,b71 by striking the period at the end and inserting 2 or2 7,c7 by inserting after subparagraph 7,b7 the following3 7,c7 which is prescribed or dispensed by an individual or entity that the ,secretary determines1 subject to such review1 redetermination1 and appeal as the ,secretary provides1 has prescribed or dispensed to an individual under a prescription drug plan or a ,,ma-,,pd plan a covered part ,d drug-- 7i7 that could not have been prescribed or dispensed to the individual on the date of such prescribing or dispensing2 or 7ii7 at a frequency or amount that presents a risk to the health or safety of an enrollee or that represents a practice or pattern of abusive prescribing or dispensing4 2 and 7,d7 by adding at the end the following3 ,the exclusion of a prescriber or dispenser under subparagraph 7,c7 shall be for such period of time as the ,secretary shall specify4 7d7 ,registration of authorization for individuals ,to prescribe and dispense controlled substances ,section #cjc of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7 is amended by adding at the end the following3 7i7 ,unique health identifiers for members of group practices 7#a7 ,in general ,the ,attorney ,general shall-- 7,a7 compile and maintain a list of the unique health identifiers of prescribers and dispensers that are members of a group practice registered under this section and have authority to prescribe or dispense controlled substances in schedules ,,ii and ,,iii2 and 7,b7 make the list compiled under subparagraph 7,a7 available to all ,,pdp sponsors4 7#b7 ,definitions ,in this section3 7,a7 ,group practice ,the term group practice has the meaning given such term in section #ahgg7;h77#d7 of the ,social ,security ,act4 7,b7 ,unique health identifier ,the term unique health identifier has the meaning given such term in section #aagc7;b7 of the ,social ,security ,act4 7,c7 ,,pdp sponsor ,the term ,,pdp sponsor has the meaning given such term in section #ahfj;,d-#da7;a77#ac7 of the ,social ,security ,act4 4 7e7 ,use of recovery audit contractor recoveries ,to prevent fraud and waste ,section #ahic7;h77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77#a77;,c77 is amended-- 7#a7 by striking the ,secretary shall retain and inserting the ,secretary-- 7i7 shall retain 2 7#b7 in clause 7i71 as added by paragraph 7#a7-- 7,a7 by inserting 1 in addition to any other funds that may be available1 after available2 and 7,b7 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7ii7 may retain an additional portion of the amounts recovered 7not to exceed #be percent of such amounts recovered7 which shall be available1 in addition to any other funds that may be available1 to such program management account until expended for purposes of carrying out the amendments made by the ,medicare ,prescription ,drug ,integrity ,act of #bjac4 4 7f7 ,implementation ,the ,secretary of ,health and ,human ,services may implement the amendments made by subsections 7a71 7b71 and 7c77#b7 by regulations1 guidance1 or otherwise4 7g7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall take effect on the date of the enactment of this ,act4 7#b7 ,delayed effective date for certain provisions ,the amendments made by subsection 7a7 shall apply with respect to plan years beginning after the date that is #h months after the date of the enactment of this ,act1 except that subparagraph 7,a77v7 of section #ahfj;,d-#d7;c77#d7 of the ,social ,security ,act1 as added by subsection 7a77#b71 shall apply with respect to plan years beginning after the date that is #f months after the date on which the ,secretary of ,health and ,human ,services determines ,,pdp sponsors1 as defined in section #ahfj;,d-#da7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aea7;a77#ac771 have access at the point-of-sale to the information necessary to determine valid prescribing and dispensing authority4