,i #aacth ,,congress #b;d ,session ,h4 ,r4 #egcb ,,in ,,the ,,house ,,of ,,representatives ,november #ah1 #bjad ,mr4 ,deutch 7for himself and ,mr4 ,roskam7 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 title ,,xviii of the ,social ,security ,act to crack down on fraud in the ,medicare program to protect seniors1 people with disabilities1 and taxpayers4 #a4 ,short title ,this ,act may be cited as the ,stop ,schemes and ,crimes ,against ,medicare and ,seniors 7,stop ,,scams7 ,act4 #b4 ,ensuring that new medical coding systems do not compromise fraud prevention efforts 7a7 ,in general ,section #aagc7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d-#b7;c77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,a71 by striking 2 or and inserting or1 if no code sets for such data elements have been developed1 establish code sets for the data elements22 and 7,b7 by striking subparagraph 7,b7 and adding the following new subparagraphs3 7,b7 ensure that any entity producing and transmitting valid transactions that include code sets are subject to a consistent1 industry-wide framework that supports a seamless transition to new and modified code sets2 and 7,c7 establish1 by a rule promulgated after notice and an opportunity for a hearing on the record1 an end-to-end testing procedure for new and modified code sets that shall require the participation of any entity producing and transmitting valid transactions that use such new or modified code set4 2 and 7#b7 by adding at the end the following paragraphs3 7#c7 ,adopting new and modified code sets ,the ,secretary shall not adopt a new or modified code set unless the ,secretary-- 7,a7 assesses the impact of the code set on fraud prevention and pre-payment review1 determines that anti-fraud edits work as intended1 and confirms that a plan is in place to ensure continuing effective detection of fraud following the adoption of the code set2 7,b7 ensures that the end-to-end testing procedure established by the ,secretary under paragraph 7#a7 has been completed2 and 7,c7 completes end-to-end testing with any ,federal ,government entity that produces and transmits valid transactions that include the code set with private sector tracking partners4 7#d7 ,routine updates to existing code sets ,paragraph 7#c7 shall not apply to routine1 regularly scheduled updates to existing code sets4 4 7b7 ,effective date ,the amendments made by this section shall be effective as of ,october #a1 #bjae4 #c4 ,verification of provider ownership interests 7a7 ,in general ,section #aabd7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#c7;c77 is amended-- 7#a7 by redesignating paragraph 7#e7 as paragraph 7#f72 and 7#b7 by inserting after paragraph 7#d7 the following paragraph3 7#e7 ,verification of ,information 7,a7 ,in general ,with respect to information supplied by a disclosing entity under subsections 7a7 and 7b71 the ,secretary shall-- 7i7 verify such information by comparing it to available data on the provider collected through disclosures made to the ,secretary under section #aabh;,g7a77#b71 or1 in the case of a disclosing entity to which section #aabh;,g7a77#b7 does not apply1 verify such information through comparison with at least one other public or private database which contains information as to the identity of each person with an ownership or control interest in the entity2 and 7ii7 confirm the accuracy of any social security account number or employer identification number supplied under subsection 7a7 by verifying-- 7,i7 each social security account number with the ,commissioner of ,social ,security2 and 7,,ii7 each employer identification number with the ,secretary of the ,treasury4 7,b7 ,discrepancies ,if the comparison described in subparagraph 7,a77i7 reveals a discrepancy between information supplied by a disclosing entity under subsections 7a7 and 7b7 and available data on the provider collected through disclosures made to the ,secretary under section #aabh;,g7a77#b71 the ,secretary shall independently verify the accuracy of such data collected under section #aabh;,g7a77#b7 before taking any action against a provider based on such discrepancy4 4 7b7 ,effective date ,the amendments made by this section shall be effective as of the date that is #a year after the date of enactment of this ,act4 #d4 ,supporting public and private information sharing to prevent health care fraud 7a7 ,definitions ,in this section3 7#a7 ,healthcare fraud prevention partnership2 ,partnership ,the terms ,healthcare ,fraud ,prevention ,partnership and ,partnership mean the information sharing partnership established between the ,department of ,health and ,human ,services1 the ,department of ,justice1 and other public and private stakeholders1 including private insurers1 under the authority of section #aabh;,c7a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;c7a77#b77 for the purpose of detecting and preventing health care fraud4 7#b7 ,private insurer ,the term private insurer has the meaning given the term health insurance issuer under section #bgia7;b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;,,gg-#ia7;b77#b774 7b7 ,safe harbor for the sharing of information 7#a7 ,general immunity 7,a7 ,in general ,a non-governmental entity participating in the ,partnership 7including a private insurer7 that-- 7i7 provides data or information described in clause 7i7 or 7ii7 of subparagraph 7,b7 to the ,department of ,health and ,human ,services1 the ,department of ,justice1 any other ,federal or ,state law enforcement agency1 any contractor of such ,department or agency1 or another entity participating in the ,partnership 7including a private insurer72 or 7ii7 uses such data or information as permitted by this subsection1 shall be immune from civil liability with respect to the provision or authorized use of such data or information4 7,b7 ,data or information 7i7 ,data ,the data described in this clause is aggregated claims data or other information described in clause 7ii7 that does not include individually identifiable information with respect to any health care provider1 supplier1 or beneficiary1 whether or not analysis of such information results in the identification of a health care provider1 supplier1 or other person or organization as having committed fraud or having committed acts suspected of being fraudulent4 7ii7 ,information ,the information described in this clause is information concerning fraud or suspected fraudulent acts that identifies a specific health care provider1 supplier1 or other person or organization if the provider1 supplier1 or other person or organization so identified-- 7,i7 is the subject of a bona fide fraud investigation conducted by the entity participating in the ,partnership1 including a private insurer1 that is providing the information2 7,,ii7 is the subject of a fraud-related allegation that has been filed by or received by the entity participating in the ,partnership1 including a private insurer1 that is providing the information2 or 7,,iii7 has been convicted of a fraud-related offense4 7#b7 ,limitation ,the immunity described in paragraph 7#a7 shall apply only where-- 7,a7 the data or information involved was provided in good faith and without malice2 and 7,b7 the data or information provided is true1 based on a reasonable belief1 to the knowledge of the person providing the information1 or if false1 the information is provided without knowledge of1 and without reckless disregard for1 its falsity4 7#c7 ,use of ,partnership data or information ,for purposes of this subsection1 data or information relating to a specific provider or supplier received by a private insurer solely through the ,partnership shall be used1 with respect to such provider or supplier1 only for the purpose of informing decisionmaking by the private insurer related to fraud investigations1 including whether to conduct such an investigation4 ,nothing in the preceding sentence shall prevent a private insurer or other entity participating in the ,partnership from taking other actions1 not specific to such provider or supplier1 based on such data or information4 7c7 ,report ,not later than ,october #a of each calendar year that begins after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to the ,special ,committee on ,aging1 the ,committee on ,finance1 and the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate1 and the ,committee on ,ways and ,means and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 a report that describes the activities of the ,healthcare ,fraud ,prevention ,partnership4 ,such report shall include-- 7#a7 a description of how input was obtained from private insurers regarding the appropriate usage of data shared through the ,healthcare ,fraud ,prevention ,partnership2 and 7#b7 plans for the ,partnership to be expanded to encompass a representative sample of national private insurers and to include health care provider organizations4 #e4 ,med,p,a,c study and report 7a7 ,study ,the ,medicare ,payment ,advisory ,commission shall conduct a study on administrative efforts to strengthen program integrity in the ,medicare program4 ,such study may include-- 7#a7 an evaluation of ways to detect fraudulent claims before payment is made2 7#b7 a review of the efficiency and effectiveness of post-payment recovery methods2 7#c7 analysis by the ,centers for ,medicare ,medicaid ,services and public reporting of claims and spending patterns2 and 7#d7 a review of the organizational structure and resources of the ,centers for ,medicare ,medicaid ,services as they relate to program integrity4 7b7 ,report ,not later than ,june #ae1 #bjaf1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislative and administrative action as the ,commission determines appropriate4 #f4 ,ability to measure fraud prevention efforts ,section #dbda of the ,small ,business ,jobs ,act of #bjaj 7#db ,u4,s4,c4 #acbj;a-#gm7 is amended-- 7#a7 in subsection 7b77#d71 by inserting and on civil recoveries1 administrative actions1 and criminal convictions for fraud after reimbursement2 and 7#b7 in subsection 7c71 by adding at the end the following paragraph3 7#g7 ,implementation of amendments ,the ,secretary shall implement amendments made to this subsection by the ,stop ,schemes and ,crimes ,against ,medicare and ,seniors 7,stop ,,scams7 ,act not later than #f months after the date of enactment of such ,act4 ,if the ,secretary determines that new technology or data processing systems are required to carry out such amendments1 the ,secretary shall issue a request for proposals to carry out such amendments not later than #f months after the enactment of such ,act1 and the contractors selected under such request for proposal shall implement such amendments not later than #ab months after the date of enactment of such ,act4 4