,i #aacth ,,congress #ast ,session ,h4 ,r4 #dah ,,in ,,the ,,house ,,of ,,representatives ,january #be1 #bjac ,ms4 ,ros-,lehtinen 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 reduce ,medicare waste1 fraud1 and abuse by providing for enhanced penalties to combat ,medicare and ,medicaid fraud1 for a ,medicare data-mining system1 for a study on applying biometric technology1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare ,fraud ,enforcement and ,prevention ,act of #bjac4 #b4 ,enhanced criminal penalties to combat ,medicare and ,medicaid fraud 7a7 ,in general ,section #aabh;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7 is amended-- 7#a7 in subsection 7a71 by striking #aj1jjj or imprisoned for not more than one year and inserting #bj1jjj or imprisoned for not more than two years2 and 7#b7 in each of subsections 7a71 7b77#a71 7b77#b71 7c71 and 7d71 by striking #be1jjj or imprisoned for not more than five years and inserting #ej1jjj or imprisoned for not more than #aj years4 7b7 ,illegal distribution of ,medicare or ,medicaid beneficiary identification or billing privileges ,section #aabh;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7 is amended by adding at the end the following new subsection3 7h7 ,whoever knowingly purchases1 sells1 or unlawfully distributes1 or arranges for the purchase1 sale1 or unlawful distribution of two or more ,medicare or ,medicaid beneficiary identification numbers or billing privileges under title ,,xviii or title ,,xix shall be imprisoned for not more than #aj years or fined under title #ah1 ,united ,states ,code 7or1 if greater1 an amount equal to the monetary loss to the ,federal and any ,state government as a result of such acts71 or both4 4 7c7 ,effective date ,the amendments made by this section shall apply to acts committed on or after the date of the enactment of this ,act4 #c4 ,enhanced civil authorities to combat ,medicare and ,medicaid fraud 7a7 ,civil monetary penalties law alignment and other changes 7#a7 ,section #aabh;,a7a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7a77 is amended-- 7,a7 in paragraph 7#a71 by striking to an officer1 employee1 or agent of the ,united ,states1 or of any department or agency thereof1 or of any ,state agency 7as defined in subsection 7i77#a7712 7,b7 by inserting after paragraph 7#aj71 as added by section #fdjb7;d77#b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 the following new paragraphs3 7#aa7 conspires to commit a violation of this section2 or 7#ab7 knowingly makes1 uses1 or causes to be made or used1 a false record or statement material to an obligation to pay or transmit money or property to a ,federal health care program1 or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to a ,federal health care program2 2 7,c7 in the first sentence-- 7i7 by striking or in cases under paragraph 7#i7 and inserting in cases under paragraph 7#i72 and 7ii7 by striking fact7 and inserting fact71 in cases under paragraph 7#aa71 #ej1jjj for any violation described in this section committed in furtherance of the conspiracy involved1 and in cases under paragraph 7#ab71 #ej1jjj for each false record or statement1 or concealment1 avoidance1 or decrease2 and 7,d7 in the second sentence1 by striking material fact74 and inserting material fact72 or in cases under paragraph 7#aa71 an assessment of not more than #c times the total amount that would otherwise apply for any violation described in this section committed in furtherance of the conspiracy involved2 or in cases under paragraph 7#ab71 an assessment of not more than #c times the total amount of the obligation to which the false record or statement was material or that was avoided or decreased44 7#b7 ,section #aabh;,a7c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7c77#a77 is amended by striking six years and inserting #aj years4 7#c7 ,section #aabh;,a7i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7i77 is amended-- 7,a7 by amending paragraph 7#b7 to read as follows3 7#b7 ,the term claim means any application1 request1 or demand1 whether under contract1 or otherwise1 for money or property for items and services under a ,federal health care program 7as defined in section #aabh;,b7f771 whether or not the ,united ,states or a ,state agency has title to the money or property1 that-- 7,a7 is presented or caused to be presented to an officer1 employee1 or agent of the ,united ,states1 or of any department or agency thereof1 or of any ,state agency 7as defined in subsection 7i77#a772 or 7,b7 is made to a contractor1 grantee1 or other recipient if the money or property is to be spent or used on the ,federal health care program's behalf or to advance a ,federal health care program interest1 and if the ,federal health care program-- 7i7 provides or has provided any portion of the money or property requested or demanded2 or 7ii7 will reimburse such contractor1 grantee1 or other recipient for any portion of the money or property which is requested or demanded4 2 7,b7 by amending paragraph 7#c7 to read as follows3 7#c7 ,the term item or service means1 without limitation1 any medical1 social1 management1 administrative1 or other item or service used in connection with or directly or indirectly related to a ,federal health care program4 2 7,c7 in paragraph 7#g7-- 7i7 by striking term should know means and inserting terms knowing1 knowingly1 and should know mean2 7ii7 by redesignating subparagraphs 7,a7 and 7,b7 as subparagraphs 7,b7 and 7,c71 respectively2 7iii7 by inserting before subparagraph 7,b71 as redesignated by clause 7ii71 the following new subparagraph3 7,a7 has actual knowledge of the information2 2 and 7iv7 in the matter following subparagraph 7,c71 as redesignated by clause 7ii7-- 7,i7 by inserting require after and2 and 7,,ii7 by striking is required2 and 7,d7 by adding at the end the following new paragraphs3 7#h7 ,the term obligation means an established duty1 whether or not fixed1 arising from an express or implied contractual1 grantor-grantee1 or licensor licensee relationship1 from a fee-based or similar relationship1 from statute or regulation1 or from the retention of any overpayment4 7#i7 ,the term material means having a natural tendency to influence1 or be capable of influencing1 the payment or receipt of money or property4 4 7b7 ,exclusion of responsible corporate officials ,section #aabh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is amended by striking clauses 7i7 and 7ii7 of paragraph 7#ae77;,a7 and inserting the following3 7i7 who has or had a direct or indirect ownership or control interest in a sanctioned entity at the time of and who knew or should have known 7as defined in section #aabh7;i77#g77 of any of the conduct that formed a basis for the conviction or exclusion described in subparagraph 7,b72 or 7ii7 who is or was an officer or managing employee 7as defined in section #aabf7;b77 of such an entity at the time of any of the conduct that formed a basis for the conviction or exclusion so described4 4 7c7 ,payment suspensions ,subsection 7o77#a7 of section #ahfb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by striking may and inserting shall4 7d7 ,civil monetary penalties for false statements or delaying inspections ,paragraph 7#i7 of section #aabh;,a7a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7a77 is amended by inserting or to timely provide information in response to a request authorized by section #aabh;,j7b71 after regulations714 #d4 ,enhanced screening1 ,medicare data-mining system2 biometric technology study 7a7 ,enhanced screening ,section #ahff7;j77#b77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77ii77 is amended by striking may and inserting shall4 7b7 ,access to ,real ,time ,claims and ,payment ,data ,section #aabh;,j7a77#b7 of the ,social ,security ,act is amended-- 7#a7 by inserting including real time claims and payment data1 after access to claims and payment data2 and 7#b7 by adding at the end the following sentence3 ,in carrying out this section1 the ,inspector ,general of the ,department of ,health and ,human ,services1 in consultation with the ,attorney ,general1 shall implement mechanisms for the sharing of information about suspected fraud relating to the ,federal health care programs under titles ,,xviii1 ,,xix1 and ,,xxi with other appropriate law enforcement officials44 7c7 ,study on use of biometric technology 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall provide for a study that analyzes the feasibility and benefits in reducing waste1 fraud1 and abuse of carrying out a program 7in this subsection referred to as a biometric technology program7 that implements biometric technology to ensure that individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled under part ,b of such title are physically present at the time and place of receipt of certain items and services 7specified by the ,secretary7 for which payment may be made under such title4 ,such a program may provide for financial incentives to encourage voluntary participation of providers of services 7as defined in section #ahfa7u7 of such ,act7 and suppliers 7as defined in section #ahfa7;d7 of such ,act74 7#b7 ,report ,not later than #f months after the date of the enactment of this ,act1 the ,secretary shall submit to the ,congress a report on the study conducted under paragraph 7#a74 ,such report shall include an analysis of the likely effectiveness of a biometric technology program on reducing waste1 fraud1 and abuse under the ,medicare program and may include recommendations with regard to whether such a program1 on a pilot or other basis1 should be implemented4